Traditional Chinese medicine （TCM）， through its multi-target and systematic regulatory effects， has demonstrated unique advantages in the treatment of gastric precancerous lesions （GPL）. At present， TCM theoretical research on GPL is mainly reflected in three aspects， the integration of macroscopic syndrome differentiation， the inflammation-carcinoma transformation mechanism， as well as the systematization and scientization of theoretical inheritance from famous TCM practitioners. High-quality evidence-based research findings serve as the foundation for clinical practice guidelines on GPL， and TCM has gained international academic recognition in the field of GPL prevention and treatment. Research on TCM mechanisms has yielded a series of important outcomes in the aspects of signaling pathways， gene expression regulation， cellular epigenetics， histone modification， and intestinal microecology. It is proposed that future research on GPL should focus on four key directions， establishing multi-omics data， exploring targeted intervention strategies on key regulatory nodes， advancing the standardization process of integrated traditional Chinese and western medicine prevention and treatment technologies， and constructing stratified screening and intervention platforms. The in-depth integration of TCM microcosmic mechanism of action with its macroscopic syndrome differentiation and treatment system， coupled with interdisciplinary research， will provide valuable references for the clinical treatment and scientific research of GPL.

OBJECTIVE To assess the safety profile of sintilimab in combination with chemotherapy for the treatment of cholangiocarcinoma. METHODS The data of patients with cholangiocarcinoma from January 1st， 2021 to December 31st， 2022 were collected and divided into control group （29 cases） and observation group （18 cases） based on different medication regimens. Patients in the control group were treated with Gemcitabine hydrochloride for injection+Cisplatin for injection or Oxaliplatin for injection， the observation group was treated with Sintilimab injection based on the control group. Patients in each group underwent blood routine， liver and kidney function， biochemical and other examinations before and after each treatment cycle to observe the occurrence of adverse drug reactions. The correlation of adverse drug reactions with drugs was evaluated with Naranjo’s scale. RESULTS The correlation between blood toxicity and drug use was deemed “probable” in both groups； however， the observation group exhibited a significantly higher score， indicating a stronger correlation. In the control group， hepatotoxic reactions were classified as “suspicious” whereas in the observation group， they were categorized as “probable”. The correlation of gastrointestinal symptoms between the two groups was considered “possible”. Systemic symptoms， skin toxicity， musculoskeletal toxicity， endocrine toxicity and renal toxicity were all classified as having a “suspicious” correlation with drug use. The total incidence of blood toxicity in the observation group was significantly higher than control group （P＝0.014）. There was no statistically significant difference in the total incidences of hepatotoxic， gastrointestinal symptoms， systemic symptoms， skin toxicity， musculoskeletal toxicity， endocrine toxicity， renal toxicity， or the incidence of grade 3 or higher blood toxicity， hepatotoxic between the two groups （P＞0.05）. For the patients experiencing adverse drug reactions， the symptoms were alleviated following drug discontinuation or symptomatic supportive treatment. No fatalities occurred during the treatment period. CONCLUSIONS Sintilimab combined with chemotherapy may significantly increase the risk of blood toxicity in patients with cholangiocarcinoma， especially thrombocytopenia， but the adverse reactions are within a controllable range， and the overall safety is good.

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

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Limited-stage small cell lung cancer(SCLC)is a highly malignant and rapidly progressing neuroendocrine tumor,while uremia is a complication of the end-stage of chronic renal failure.The patients with SCLC complicated with uremia have poor treatment tolerance,limited options for anti-tumor treatment regimens,and great difficulty in diagnosis and treatment.This study analyzed one case of a 69-year-old male patient with limited-stage SCLC complicated with uremia(with a history of regular hemodialysis,3 times per week),to discuss his first-line treatment regimen,efficacy,and the impact of hemodialysis on the plasma concentrations of the anti-tumor drugs,and reviewed the relevant literature to provide a reference for the treatment of similar patients.The patient was admitted to the hospital due to"cough and hemoptysis for half a month"and was diagnosed with limited-stage SCLC stage ⅢA(T2aN2M0)by computed tomography(CT)and lung puncture biopsy.After discussion by the multi-disciplinary treatment(MDT)team,the patient received 6 cycles of Etoposide(VP-16)+carboplatin chemotherapy combined with adebrelimab immunotherapy,followed by sequential adebrelimab maintenance therapy.The efficacy was evaluated as partial response(PR)and the response is ongoing.During the treatment,level 4 hemoglobin decrease,level 3 neutropenia,and level 2 leukopenia occurred,which were alleviated after symptomatic treatment.The blood concentration monitoring results showed that the plasma concentrations of etoposide and carboplatin increased rapidly during drug infusion,and gradually decreased after the end of infusion.Hemodialysis could rapidly reduce the plasma concentration of carboplatin,but had no significant effect on the plasma concentration of etoposide.Therefore,the immunotherapy combined with reduced-dose chemotherapy regimen is safe and effective for this type of patient.Plasma drug concentration monitoring can be used to observe drug metabolism,but the optimal monitoring time points and clinical value need further study and validation.

Objective To investigate the quality of life status in patients with type 2 diabetes mellitus and its influencing factors,understand their demands for continuous nursing services,analyze the correlation,and provide a reference for formulating and implementing continuous nursing plans for diabetes in the later stage.Methods From May to December 2024,a cross-sectional survey was conducted among 294 patients with type 2 diabetes mellitus in this hospital by using the Self-Rating Anxiety Scale(SAS),the Diabetes Pa-tient-Specific Quality of Life Scale(DSQL),and the Questionnaire on the Need for Continuous Care.Results The SAS score of patients with type 2 diabetes was 45.76±7.45,DSQL score was 54.68±10.99,and the score of continuous care needs was 32.98±5.79.The quality of life of patients with type 2 diabetes mellitus is mainly influenced by factors such as age,family type,educational level,average monthly family in-come,duration of diabetes,blood glucose control,dietary compliance,intensity of physical exercise,and diabet-ic complications.The quality of life of patients with type 2 diabetes mellitus was positively correlated with need for continuous care(P<0.05).Conclusion The quality of life of patients with type 2 diabetes mellitus is influenced by multiple factors and is related to the need for continuous care.Professional continuous care plans can be formulated and implemented based on the needs of patients with type 2 diabetes mellitus.

Objective:To investigate the anti-inflammatory effects of Duhuo Jisheng Decoction on type Ⅱ collagen emulsion induced arthritis (CIA) model rats from the perspective of M1/M2 macrophage balance mediated development of rheumatoid arthritis.Methods:SD rats were divided into a normal group of 8 and a model group of 32. The CIA model was established using collagen antibody induction method for modeling. The successfully modeled rats were randomly divided into model group, methotrexate group, and Duhuo Jisheng Decoction medium- and high-dosage groups using a random number table method, with 8 rats in each group. Duhuo Jisheng Decoction medium- and high-dosage groups were orally administered with Duhuo Jisheng Decoction at dosages of 13.5 and 27.0 g/kg, once a day; methotrexate group received oral administration of 2.0 mg/kg methotrexate twice a week; normal group and model group were given equal volumes of physiological saline by gavage once a day for 28 consecutive days. The general condition of each group of rats was observed, the degree of swelling in the right knee joint was measured, and the arthritis index was scored; HE was used to observe pathological changes in synovial tissue; immunofluorescence was used to detect the expressions of markers CD86 and CD206 in synovial macrophages; Real time PCR was used to detect the mRNA levels of IL-6, TNF-α, IL-10, and TGF-β in synovial tissue.Results:Duhuo Jisheng Decoction could significantly improve the mental state of the rats and reduced the swelling of the knee joints and the arthritis index ( P<0.01). Compared with the model group, the cartilage structure in the knees of rats in the Duhuo Jisheng Decoction group was more intact and clearer. The expression level of the M1 macrophage marker CD86 significantly decreased, and the expression level of the M2 macrophage marker CD206 significantly increased; the mRNA expressions of IL-6 and TNF-α in the knee joint synovial tissue were significantly reduced ( P<0.05), while IL-10 and TGF-β levels significantly increased ( P<0.05). Conclusion:Duhuo Jisheng Decoction may promote macrophage polarization towards M2 type, thereby achieving M1/M2 macrophage balance, alleviating inflammatory response in rheumatoid arthritis rats, and exerting therapeutic effects on rheumatoid arthritis.

BACKGROUND:Ankylosing spondylitis is a chronic inflammatory disease with chronic rheumatic immunity.Soft tissue ossification and fusion and spinal stiffness can cause biomechanical changes. OBJECTIVE:To reconstruct the lumbar-sacral intervertebral disc in ankylosing spondylitis patients with lumbar kyphosis by finite element analysis,and to study the range of motion of each segment of T11-S1 and the biomechanical characteristics of annulus fibrosus and nucleus pulposus. METHODS:The imaging data were obtained from an ankylosing spondylitis patient with lumbar kyphosis.The original CT image data of continuously scanned spine were imported into Mimics 21.0 in DICOM format,and T11-S1 was reconstructed respectively.The established model was imported into 3-Matic software in the format of"Stl"to reconstruct the intervertebral disc,and the fibrous intervertebral disc model was obtained.The improved model was further imported into Hypermesh software,and the vertebra,nucleus pulposus,annulus fibrosus and ligament were mesh-divided.After the material properties were given,the model was imported into ABAQUS software to observe the range of motion of each vertebral body in seven different working conditions of T11-S1,and analyze the biomechanical characteristics of each segment of annulus fibrosus and nucleus pulposus. RESULTS AND CONCLUSION:(1)The range of motion of L1 vertebrae was higher than that of other vertebrae under six different working conditions:extension,forward flexion,rotation(left and right),and lateral flexion(left and right).The maximum range of motion was 2.18° during L1 vertebral flexion,and the minimum range of motion was 0.12° during L5 vertebral extension.(2)The annular fiber flexion at L2-L3 segments was greater than the extension(P<0.05),and the annular fiber flexion at L3-L4 and L4-L5 segments was less than the extension(P<0.05).The left rotation of L1-L2 annular fibers was greater than the right rotation(P<0.05).The left flexion of the annulus was greater than the right flexion in L1-L2,L2-L3,L3-L4,L4-L5 and L5-S1 segments(P<0.05).(3)The nucleus pulposus stresses of T11-L12,L1-L2,L2-L3,L3-L4 and L4-L5 segments in forward flexion were greater than in extension(P<0.05).The left rotation of T12-L1 and L3-L4 segments was smaller than the right rotation(P<0.05),and that of T11-T12,L1-L2,and L2-L3 segments was larger than the right rotation(P<0.05).The left flexion was larger than the right flexion in the T11-S1 segment.(4)It is concluded that in ankylosing spondylitis patients with lumbar kyphosis,the minimum range of motion of the vertebral body is located at the L5 vertebral body in extension.To prevent fractures,it is recommended to avoid exercise in the extension position.During the onset of lumbar kyphosis in patients with ankylosing spondylitis,the maximum stress of the annulus fibrosus and nucleus pulposus is located in the L1-L2 segment,which is fixed and will not alter with the change of body position.The late surgical treatment and correction of deformity should focus on releasing the pressure of the annulus fibrosus and nucleus pulposus in this segment to avoid the rupture of the annulus fibrosus and the injury of the nucleus pulposus.

To achieve early warning of dengue fever from multiple sources and improve the ability to detect and identify dengue fever outbreaks timely, we took Hangzhou as an example and proposed the possibility of early warning of dengue fever. This study divided early warning of dengue fever into three stages: early warning of epidemic source, epidemic symptom, and epidemic. The early warning of epidemic source and epidemic symptom were emphasized to provide reference for other similar studies. Our findings showed that the staged warning of dengue fever was meaningful. Combining the source early warning with the symptom early warning could improve the sensitivity of the warning. Monthly warning can be used as a supplement to weekly warning.