arcopenia is a systemic skeletal muscle disorder characterized by a decrease in skeletal muscle mass and progressive decline in function， with multiple signaling pathways involved in its occurrence and development. Among them， the AMP-activated protein kinase （AMPK） signaling pathway， as a key pathway regulating cellular energy homeostasis， plays an important role in the regulation of skeletal muscle metabolism and functional maintenance by improving abnormalities in glucose and lipid metabolism， balancing skeletal muscle protein synthesis and degradation， improving mitochondrial function， promoting autophagy， and inhibiting inflammatory responses and oxidative stress. This article reviews the research progress on how various traditional Chinese medicine （TCM） monomers， including polyphenols， flavonoids， and terpenoids； various traditional Chinese medicine extracts， such as those from Lycium barbarum ， Asini Corii Colla， and Panax quinquefolium ， and TCM compounds， such as Guiqi zhuangjin decoction， Jianpi qiangji granules， and Qigu capsules， intervene in sarcopenia by regulating the AMPK signaling pathway to promote muscle protein synthesis， inhibit protein degradation， improve mitochondrial function， and alleviate inflammation and oxidative stress. Additionally， their molecular mechanisms are explored. The aim is to deeply elucidate the basis of TCM in the prevention and treatment of sarcopenia and to provide theoretical support for the development of related innovative drugs.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Mitochondrial diseases are a group of hereditary disorders characterized by impaired oxidative phosphorylation in the mitochondrial respiratory chain caused by defects in either mitochondrial DNA or nuclear DNA， and such diseases have complex and diverse clinical manifestations and often involve multiple organs and systems， with the main manifestation of lesions in the nervous system and muscles due to their high energy demands. At present， there is still a lack of effective therapies for most mitochondrial diseases， and therefore， multidisciplinary management is essential in clinical practice， integrating various therapeutic approaches to provide personalized treatment regimens for patients with mitochondrial diseases. The primary treatment principle involves the timely correction of pathological and physiological abnormalities through pharmacological interventions， dietary modifications， and exercise management， along with the prompt treatment of system-specific impairments and the prevention of potential complications.
Diagnosis

Background: Psoralea corylifolia L. (Buguzhi, BGZ), known for its efficacy in supporting pregnancy and preventing miscarriage, has been used in China for over 1000 years. Recently, BGZ has been identified as a potential cause of drug-induced liver injury. However, its safety during pregnancy remains unclear, which significantly hinders its routine clinical application. Objective: To investigate the effects of BGZ administration during pregnancy on the liver of mouse mothers and their weaned 21-day-old offspring. Methods: Mice were orally administered BGZ at doses of 2.5 and 10 g/kg during pregnancy, with BGZ withdrawal during the lactation period. Liver histopathology (hematoxylin-eosin staining), biochemical analysis, and evaluation of liver bile acid metabolism were performed after the lactation period. Results: BGZ administration at doses of 2.5 and 10 g/kg during pregnancy, followed by withdrawal during the lactation period, caused mild liver damage in both mothers and their 21-day-old offspring. Serum total bile acid (TBA) levels were elevated compared with those in the control group. Additionally, changes were observed in the levels and proportions of various bile acids (BAs) in the liver, suggesting mild effects on BA metabolism. Conclusion: BGZ administration during pregnancy caused mild liver damage and increased serum TBA levels in both mouse mothers and their 21-day-old offspring. This phenomenon may be associated with imbalanced BA metabolism in the liver. Based on the present study and the limited toxicological research on BGZ, pregnant women should avoid prolonged use of BGZ. If BGZ is administered during pregnancy, serum TBA levels should be monitored, and if elevated, BGZ should be discontinued.

Objective To analyze the correlations between platelet-related parameters and the incidence of anxiety and depression in the patients undergoing peritoneal dialysis(PD),and evaluate the efficacy of the pa-rameters in the diagnosis of anxiety and depression in PD patients.Methods A total of 245 patients undergoing PD in the First Affiliated Hospital of Hebei North University from September 2022 to February 2023 were enrolled.The gener-alized anxiety scale(GAD-7)and the patient health questionnaire(PHQ-9)were used to evaluate the anxiety and depression of the patients,respectively.The personal information and biochemical indicators of the patients were col-lected,and the platelet count(PLT),mean platelet volume(MPV),and platelet distribution width(PDW)were measured.Logistic regression was adopted to analyze the relationships of platelet-related parameters with anxiety and depression in PD patients.Results Among the 245 patients undergoing PD,the incidences of anxiety and depression were 15.9% and 38.0% ,respectively.There were differences in the dialysis period(Z=-2.358,P =0.018;Z =-3.079,P=0.002),MPV(Z=-4.953,P<0.001;Z=-7.878,P<0.001),and PDW(Z =-4.587,P<0.001;Z=-7.367,P<0.001)between the anxiety group and the non-anxiety group as well as between the de-pression group and the non-depression group.The correlation analysis showed that MPV(r =0.358,P<0.001;r =0.489,P<0.001)and PDW(r =0.340,P<0.001;r =0.447,P<0.001)were positively correlated with anxiety and depression in the patients undergoing PD.The Logistic regression model showed that MPV(P =0.022,P =0.011),PDW(P =0.041,P =0.018),and dialysis period(P =0.011,P =0.030)were independent risk factors for the anxiety and depressive state in PD patients.The areas under the receiver operating characteristic curve of MPV in the diagnosis of anxiety and depression in PD patients were 0.750 and 0.800,respectively,and those of PDW were 0.732 and 0.780,respectively.Conclusion MPV and PDW have high efficacy in the diagnosis of anxiety and depression associated with PD and can be used as objective indicators to evaluate the anxiety and depression in the patients undergoing PD.

Objective:To explore the effect of clomiphene citrate (CC) with different dosages on the endometrial factor, number of oocytes retrieved, pregnancy outcomes and other factors in diminished ovarian reserve (DOR) patients with minimal stimulation/natural protocol.Methods:This was a retrospective cohort study. The patients who underwent minimal stimulation protocol of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were divided into 4 groups. Group A: the patients had CC 50 mg/d from the third day of menstruation to the trigger day (1 457 cycles); group B: the patients had 50 mg/d from the third day of menstruation for 3 d (1 533 cycles); group C: the patients had CC 25 mg/d from the third day of menstruation to the trigger day (345 cycles); group D: the patients had CC 25 mg/d for 3 d (319 cycles). The general data, clinical results, pregnancy and delivery outcomes were compared between group A and group B, as well as group C and group D. Results:In the treatment of IVF/ICSI, the dosage of gonadotropin (Gn) used, number of dominant follicles, estradiol level, luteinizing hormone level, progesterone level, number of oocytes retrieved, rate of oocytes retrieved, number of fertilizations, number of transplantable embryos and whole embryo freezing rate in patients of group A were significantly higher than those in group B (all P<0.05). The endometrial thickness [7.10 (5.40,8.65) mm] and the ratio of endometrial type (A/A-B) on trigger day [70.70% (888/1 256)] of group B were significantly better than those of group A [6.00 (4.70,8.00) mm, P<0.001; 63.62% (649/1 020), P<0.001], and the fresh embryo transfer rate of group B was significantly higher than that of group A [20.00% (259/1 295) vs. 42.94% (584/1 360), P<0.001]. There were no statistical differences in the number of high-quality embryos and the rate of no embryo transfer between the two groups (both P>0.05). In group C and group D, the Gn used dosage, the number of dominant follicles, the estradiol level on trigger day, number of oocytes retrieved, embryos/cycles were significantly increased (all P<0.05), the endometrial thickness on trigger day of group D [7.00 (5.40, 8.60) mm] was significantly higher than that of group C [6.10 (5.00,7.93) mm, P<0.001], but there was no statistical difference of the ratio of endometrial type (A/A-B) between the two groups ( P=0.739). In addition, the luteinizing hormone and progesterone values on the trigger day in group C were significantly higher than those in group D ( P=0.014, P=0.005), but there were no significant differences in pre-ovulation rate and all embryos frozen rate between the two groups (all P<0.05), and the rate of fresh embryo transfer in group C [26.04% (75/288)] was significantly lower than that in group D [38.80% (97/250), P<0.001]. Finally, there were no significant differences in cumulative clinical pregnancy rate and fresh/frozen embryo transfer outcome between group A and group B as well as group C and group D (all P>0.05). Conclusion:The use of low-dose and short-time CC in minimal stimulation protocol does not change the final pregnancy outcome, while saving patients' economic and time costs, so it could be an appropriate project for DOR patients.

Objective:To evaluate the effects of recombinant luteinizing hormone (rLH) and human menopausal gonadotropins (hMG) supplementation on pregnancy outcomes for suboptimal ovarian responders undergoing follicular phase long protocol.Methods:The data of infertile patients who underwent in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) for the first time with follicular phase long protocol from January 2017 to January 2020 in Reproductive Medicine Center of the First Affiliated Hospital of Nanjing Medical University Hospital were retrospectively cohort analyzed. Totally 2 336 patients with normal ovarian reserve were included in the study with suboptimal ovarian response to ovarian stimulation. According to the different exogenous LH supplementation, they were divided into hMG group ( n=1 558) and rLH group ( n=778). The clinical features and effects of ovulation induction were compared between the two groups and reproductive outcomes were compared in both fresh embryo transfer cycles and subsequent frozen-thawed embryo transfer (FET) cycles. Logistic regression analysis were performed to explore the relationship between different LH activity drugs supplementation and the cumulative live birth rate of suboptimal ovarian responders. Results:The basic characteristics such as age, infertility type and diagnosis, body mass index and biomarkers of ovarian reserve were comparable between the two groups (all P>0.05). Total dosage [(2 088.98±628.24) U] and duration [(12.22±2.29) d] of FSH used in the hMG group were significantly higher than those in the rLH group [(1 866.90±602.65) U, P<0.001; (11.89±2.37) d, P=0.001]. Total dosage [(537.30±484.49) U] and duration [(7.40±3.52) d] of LH used in the hMG group were significantly higher than those in the rLH group [(498.10±472.04) U, (5.67±3.78) d, P<0.001]. The serum LH levels on the first day [(0.78±0.77) U/L] and the sixth day [(0.81±0.49) U/L] of gonadotropin stimulation in the hMG group were higher than those in the rLH group [(0.67±0.32) U/L, P<0.001; (0.71±0.33) U/L, P=0.002]. However, the serum LH level was comparable on the trigger day between the two groups without significant difference ( P=0.303). The levels of serum estrodiol [(8 377.14±7 000.63) pmol/L] and progesterone [(3.84±2.18) nmol/L] on the trigger day were significantly higher in the hMG group than in the rLH group [(7 644.91±5 145.64) pmol/L, P=0.009; (3.14±1.80) ng/L, P<0.001]. The pregnancy outcomes including clinical pregnancy rates, abortion rates and live birth rates were comparable between the two groups in fresh embryo transfer cycles and the subsequent FET cycles (all P>0.05). The cumulative pregnancy rate (CPR) [89.46% (696/778)] and the cumulative live birth rate (CLBR) [78.02% (607/778)] in the rLH group were significantly higher than those in the hMG group [84.60% (1 318/1 558), P=0.001; 72.98% (1 137/1 558), P=0.008]. Multivariate logistic regression analysis showed that age was a risk factor for CLBR ( OR=0.930, 95% CI: 0.906-0.955, P<0.001) and antral follicle count ( OR=1.029, 95% CI: 1.005-1.054, P=0.018), total number of oocytes retrieved ( OR=1.064, 95% CI: 1.029-1.100, P<0.001), the number of embryos transferred ( OR=1.714, 95% CI: 1.293-2.272, P<0.001), the stage of embryos transferred ( OR=1.567, 95% CI: 1.243-1.975, P<0.001), endometrial thickness on transfer day ( OR=1.122, 95% CI: 1.077-1.170, P<0.001) and rLH supplementation ( OR=1.348, 95% CI:1.101-1.651, P=0.004) were protective factors for CLBR of suboptimal responders. Conclusion:For suboptimal ovarian responders with normal ovarian reserve, rLH supplementation may achieve a higher CLBR than hMG supplementation in follicular phase long protocol.

ObjectiveBased on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E） technique， we identified qualitatively the metabolites of aristolochic acid（AAs） in rat in order to analyze the metabolic differences between water extract of Aristolochiae fructus（AFE） and Aristolochic acid Ⅰ（AAⅠ）. MethodSD rats were selected and administered AFE（110 g·kg^-1·d^-1） or AAⅠ（5 mg·kg^-1·d^-1） by oral for 5 days， respectively. Serum， urine and feces were collected after administration. Through sample pretreatment， ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） was used with the mobile phase of 0.01% formic acid methanol（A）-0.01% formic acid water（B， containing 5 mmol·L^-1 ammonium acetate） for gradient elution（0-1 min， 10%B； 1-7 min， 10%-75%B； 7-7.2 min， 75%-95%B； 7.2-10.2 min， 95%B； 10.2-10.3 min， 95%-10%B； 10.3-12 min， 10%B） at a flow rate of 0.3 mL·min^-1. Positive ion mode of electrospray ionization（ESI⁺） was performed in the scanning range of m/z 100-1 200. In combination with UNIFI 1.9.4.053 system， the Pathway-MS^E was used to qualitatively analyze and identify the AAs prototype and related metabolites in biological samples（serum， urine and feces）， and to compare the similarities and differences of metabolites in rats in the subacute toxicity test between AFE group and AAⅠ group. ResultCompared with AAⅠ group， 6， 10， 13 common metabolites and 14， 20， 30 unique metabolites were identified in biological samples（serum， urine and feces） of AFE group， respectively. Moreover， the main AAs components always followed the metabolic processes of demethylation， nitrate reduction and conjugation. Compared with common metabolites in AAⅠ group， prototype components of AAⅠ in serum and most metabolic derivatives of AAⅠ［AAⅠa， aristolochic lactam Ⅰ（ALⅠ）a， 7-OHALⅠ and its conjugated derivatives］ in biological samples were significantly increased in AFE group（P<0.05， P<0.01）， except that the metabolic amount of ALⅠ in feces of AFE group was remarkably lowed than that of AAⅠ group（P<0.01）. In addition， a variety of special ALⅠ efflux derivatives were also identified in the urine and feces of the AFE group. ConclusionAlthough major AAs components in AFE all show similar metabolic rules as AAⅠ components in vivo， the coexistence of multiple AAs components in Aristolochiae Fructus may affect the metabolism of AAⅠ， and achieve the attenuating effect by increasing the metabolic effection of AAⅠ and ALⅠ.

Objective:To elucidate the phenomenon that epileptic seizure occurs in patients with epilepsy without definite diagnosis when driving a motor vehicle and its hazards.Methods:From January 2020 to June 2022, 7 epileptic patients who experienced traffic accidents caused by seizures were selected from the First Affiliated Hospital of Soochow University, and their demographic data, traffic accident related data and epilepsy diagnosis and treatment data were summarized and analyzed.Results:A total of 7 adult patients with epilepsy were collected, including 6 males, 4 of whom had been driving for more than 10 years. Among them, 1 patient drove a bus, and the other 6 patients drove private cars. Totally 5/7 of the accidents resulted in personal injury, and 3/7 of the accidents resulted in personal death. In 5 patients, video electroencephalogram showed interictal epileptiform discharges. In 2 patients, the imaging findings suggested the presence of cerebral cortical lesions that may lead to seizures. In terms of the form of seizure, 3 patients′ seizure type was focal to bilateral tonic-clonic, and the other 4 patients were very probable to be focal impaired awareness seizure.Conclusions:Undiagnosed epileptic seizures lead to traffic accidents, endanger patients and public safety, which need to attract attention from both doctors and patients, as well as the whole society.