ObjectiveTo investigate the effect and mechanism of cordycepin in inhibiting fat infiltration after rotator cuff injuries in rats by regulating the Wnt/β-catenin signaling pathway， providing a theoretical basis for clinical treatment of rotator cuff injuries. MethodsFifty SPF-grade female SD rats were used in this study， with 10 randomly selected as the blank group. A rotator cuff injury repair model was established by supraspinatus tendon and suprascapular nerve compression. The successfully modeled rats were randomized into model and low-dose （20 mg·kg^-1）， medium-dose （40 mg·kg^-1）， and high-dose （80 mg·kg^-1） cordycepin groups. After 6 weeks of treatment， the gait analysis was performed to assess the limb function in rats. Oil red O staining and Masson staining were employed to observe pathological changes in the muscle tissue. Enzyme-linked immunosorbent assay （ELISA） was used to measure the levels of interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in the serum. Immunohistochemistry （IHC） was employed to detect the expression of peroxisome proliferator-activated receptor γ （PPARγ） and CCAAT/enhancer-binding protein α （C/EBPα）， which are markers of adipogenesis. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were employed to determine the mRNA and protein levels， respectively， of Wnt3a， Wnt10b， and β-catenin. ResultsCompared with the blank group， the model group showed decreases in stride length and paw print area （P<0.01）， an increase in ratio of wet muscle mass reduction and a decrease in muscle fiber cross-sectional area （P<0.05）， and decreased ratios of fat infiltration area and collagen fiber area （P<0.01）. Additionally， the model group showed elevated levels of IL-1β， IL-6， and TNF-α （P<0.05）， up-regulated protein levels of PPARγ and C/EBPα （P<0.01）， and down-regulated mRNA and protein levels of Wnt3a， Wnt10b， and β-catenin （P<0.05， P<0.01）. Compared with the model group， the low-， medium-， and high-dose cordycepin groups showed increases in stride length and paw print area （P<0.01）， a decrease in ratio of wet muscle mass reduction and an increase in muscle fiber cross-sectional area （P<0.05）， and increases in ratios of fat infiltration area and collagen fiber area （P<0.05， P<0.01）. In addition， cordycepin lowered the serum levels of IL-1β， IL-6， and TNF-α （P<0.05， P<0.01）， down-regulated the protein levels of PPARγ and C/EBPα （P<0.01）， and up-regulated the mRNA and protein levels of Wnt3a， Wnt10b， and β-catenin （P<0.05， P<0.01）. ConclusionCordycepin can improve the limb function， alleviate rotator cuff muscle atrophy， fat infiltration， and fibrosis， and inhibit inflammation in rats by regulating the Wnt/β-catenin signaling pathway.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Objective:To investigate the safety and efficacy of four-hook needle combined with holographic image in robot-assisted partial nephrectomy for completely intrarenal tumors.Methods:The clinical data of 8 patients with completely intrarenal tumors treated by robot-assisted partial nephrectomy with four-hook needle combined with holographic image admitted to General Hospital of Central Theater Command from October 2023 to December 2023 were retrospectively analyzed. There were 6 males and 2 females, with average age of (44.5±12.0) years old. Tumors of 6 cases were in the left side and 2 cases in the right side. The maximum diameter of the tumor was (23.2±8.1) mm. The R. E.N.A.L. score was (9.0±1.4). The preoperative serum creatinine (Scr) was (73.1±14.7) μmol/L. CT-guided four-hook needle was used to locate the edge of completely intrarenal tumor before surgery. During the operation, the tumor was precisely resected under the guidance of hologram and four-hook needle. Perioperative data of patients were collected and analyzed.Results:All the tumor were successfully resected under the guidance of four-hook needle and hologram without conversion to radical nephrectomy or open surgery. The mean operative time was (117.0±14.5) min, the mean hot ischemia time was (20.2±5.1) min, the mean intraoperative blood loss was (75.0±17.3) ml, and the average hospitalization time was (9.5±1.3) days.The one week postoperative Scr was (73.2±14.8) μmol/L, which had no significant difference with that of before operation ( P=0.952). None of them received blood transfusion. The pathology results of 8 patients were clear cell renal cell carcinoma, and the surgical margins were negative. Conclusions:For completely intrarenal tumors, the four-hook needle combined with the hologram can guide the surgeon to quickly locate the tumor, accurately resect the tumor, reduce perioperative complications, and is safe and effective.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the self-healing of congenital auricular deformity (CAD) and the efficacy of the auricle corrector in infants.Methods:The infants with CAD who were born in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January to December 2020 were collected. The patients who disagreed with the use of auricle corrector were included in the observation group. The patients were followed up on the day of one month and one year after birth by phone or WeChat, and the self-healing rate (the proportion of the number of ears found to be healed in the total number of affected ears after follow-up) of auricle was calculated. The patients treated with auricle corrector were included in the non-invasive correction group, which was treated with domestic auricle corrector. And according to the initial correction age, the patients were divided into ≤7 d, 8-28 d and >28 d three subgroups. The patients were followed up on the day of one month and one year after treatment by phone or WeChat, and the effective rate(the proportion of healed ears to the total number of affected ears after treatment) was calculated. And statistical analysis was used in the three subgroups of initial correction age ≤7 d, 8-28 d, >28 d. Variance analysis was used for general comparison between three groups, and LSD- t test for the comparison between two groups. P<0.05 was considered statistically significant. Results:A total of 43 children (71 ears, 34 left ears and 37 right ears) were included in the observation group, including 21 males and 22 females, (2.1±0.3) days after birth. In the non-invasive correction group, 24 children (41 ears, 20 left ears and 21 right ears) were included, including 8 males and 16 females, (29.1±23.8) days after birth. There were 6 cases (10 ears) in the initial correction age group ≤7 days, 6 cases (9 ears) in the 8-28 days group, and 12 cases (22 ears) in the >28 days group. In the observation group (71 ears), the rates of self-healing on the day of one month and one year after birth were 29/71 and 30/71, respectively, including 23/31 and 24/31 for lop ear, 3/6 for Stahl’s ear, 3/3 for complex deformity, and 0 for other ear deformities. The effective rates were 41/41 and 35/41 one month and one year after treatment in the 24 children (41 ears) in the non-invasive correction group, respectively. Among them, the helical rim deformity was 12/12, lop ear 3/3, cup ear 7/7 and 5/7, Stahl’s ear 4/4, contracted ear 6/6, 5/6, prominent ear 2/2 and 0, the complex deformity 6/6 and 5/6, and microtia(Ⅰ) 1/1. The auricular deformities reoccurred in a total of 4 children (6 ears) 1 year after the end of treatment. According to the initial correction age into three groups, the treatment duration of the auricle corrector was (31.8±11.2) days, (31.3±10.1) days and (41.8±13.8) days, and the difference among the three groups was statistically significant ( F=3.42, P=0.043). There was no statistical significance between the groups ≤7 days and 8-28 days ( P=0.936), but there was statistical significance in the treatment duration between the groups ≤7 days and >28 days ( P=0.043), and between the groups 8-28 days and > 28 days ( P=0.041). Conclusion:CAD can self-heal to some extent. Self-healing rate is higher in lop ear and Stahl’s ears. The domestic auricle corrector has a good effect on CAD. The older the age of initial correction is, the longer the time of correction is. The type of CAD has a certain influence on the correction effect.

Objective:To investigate the self-healing of congenital auricular deformity (CAD) and the efficacy of the auricle corrector in infants.Methods:The infants with CAD who were born in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January to December 2020 were collected. The patients who disagreed with the use of auricle corrector were included in the observation group. The patients were followed up on the day of one month and one year after birth by phone or WeChat, and the self-healing rate (the proportion of the number of ears found to be healed in the total number of affected ears after follow-up) of auricle was calculated. The patients treated with auricle corrector were included in the non-invasive correction group, which was treated with domestic auricle corrector. And according to the initial correction age, the patients were divided into ≤7 d, 8-28 d and >28 d three subgroups. The patients were followed up on the day of one month and one year after treatment by phone or WeChat, and the effective rate(the proportion of healed ears to the total number of affected ears after treatment) was calculated. And statistical analysis was used in the three subgroups of initial correction age ≤7 d, 8-28 d, >28 d. Variance analysis was used for general comparison between three groups, and LSD- t test for the comparison between two groups. P<0.05 was considered statistically significant. Results:A total of 43 children (71 ears, 34 left ears and 37 right ears) were included in the observation group, including 21 males and 22 females, (2.1±0.3) days after birth. In the non-invasive correction group, 24 children (41 ears, 20 left ears and 21 right ears) were included, including 8 males and 16 females, (29.1±23.8) days after birth. There were 6 cases (10 ears) in the initial correction age group ≤7 days, 6 cases (9 ears) in the 8-28 days group, and 12 cases (22 ears) in the >28 days group. In the observation group (71 ears), the rates of self-healing on the day of one month and one year after birth were 29/71 and 30/71, respectively, including 23/31 and 24/31 for lop ear, 3/6 for Stahl’s ear, 3/3 for complex deformity, and 0 for other ear deformities. The effective rates were 41/41 and 35/41 one month and one year after treatment in the 24 children (41 ears) in the non-invasive correction group, respectively. Among them, the helical rim deformity was 12/12, lop ear 3/3, cup ear 7/7 and 5/7, Stahl’s ear 4/4, contracted ear 6/6, 5/6, prominent ear 2/2 and 0, the complex deformity 6/6 and 5/6, and microtia(Ⅰ) 1/1. The auricular deformities reoccurred in a total of 4 children (6 ears) 1 year after the end of treatment. According to the initial correction age into three groups, the treatment duration of the auricle corrector was (31.8±11.2) days, (31.3±10.1) days and (41.8±13.8) days, and the difference among the three groups was statistically significant ( F=3.42, P=0.043). There was no statistical significance between the groups ≤7 days and 8-28 days ( P=0.936), but there was statistical significance in the treatment duration between the groups ≤7 days and >28 days ( P=0.043), and between the groups 8-28 days and > 28 days ( P=0.041). Conclusion:CAD can self-heal to some extent. Self-healing rate is higher in lop ear and Stahl’s ears. The domestic auricle corrector has a good effect on CAD. The older the age of initial correction is, the longer the time of correction is. The type of CAD has a certain influence on the correction effect.

Humans ; Asthma/drug therapy* ; Biological Therapy

【Objective】 To explore the expressions of PBRM1 and PD-L1 in renal cell carcinoma (RCC), and the molecular mechanism of PBRM1 regulating PD-L1, in order to provide experimental results for clinical immunotherapy. 【Methods】 The protein expressions of PBRM1 and PD-L1 were detected with immunohistochemistry, and their mRNA expressions were determined by analyzing TCGA database. Meanwhile, the relationship between overall survival and mRNA expressions of PBRM1 and PD-L1 were analyzed in TCGA database. The exosomes were extracted with exoEasy Maxi Kit. Expressions of exosomal biomarkers CD63 and CD9 were detected with Western blotting, and their morphology was observed with transmission electron microscope. PD-L1 expression after IFN-γ, IL-6 and TNF-α treatment was detected with Western blotting. 【Results】 The expression of PBRM1 was significantly lower in canver tissue than in paracancerous tissue (P<0.001). The loss rate of PBRM1 was up to 76.4%. PBRM1 expression was not correlated with PD-L1 expression. PBRM1 deletion activated TNF-α/exosome signaling pathway, leading to increase of PD-L1 secretion in exosomes, which was then transported to the outside of cells. 【Conclusion】 There is no relationship between PBRM1 and PD-L1 protein expressions in RCC. However, PBRM1 mutation can lead to inflammatory signaling pathway activation, inducing PD-L1 secretion, which is encapsulated in exosomes and transported to the outside of cells, and affects the response of immunotherapy.