Objective:To investigate the efficacy of iRoot BP Plus pulpotomy versus root canal therapy for the management of cariously exposed pulp in deciduous molars. Methods:A total of 62 teeth from eligible patients who received treatment at Hefei Stomatological Clinical College (Hefei Stomatological Hospital), Anhui Medical University between September 2021 and March 2022 were selected for the study. These teeth were randomly treated either with iRoot BP Plus pulpotomy (pulpotomy group, n = 31) or root canal therapy (root canal therapy group, n = 31). Follow-up examinations were conducted at 6, 12, and 18 months post-treatment to compare the success rates of treatment between the two groups. Results:The success rates of treatment at 6, 12, and 18 months post-treatment in the pulpotomy group were 100.0% (31/31), 100.0% (31/31), and 96.8% (30/31), respectively, while in the root canal therapy group, they were 100.0% (31/31), 93.5% (29/31), and 80.6% (25/31). The success rates in the pulpotomy group were significantly higher than those in the root canal therapy group at both 12 and 18 months post-treatment, with a statistically significant difference observed at 18 months (χ2 = 4.02, P < 0.05). Conclusion:The iRoot BP Plus pulpotomy procedure yields a more favorable and stable outcome compared with root canal therapy for managing cariously exposed pulp in deciduous molars.

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.

Hypertension heightens the risk of cardiovascular and renal complications in individuals with type 2 diabetes mellitus. Optimal blood pressure (BP) management is crucial for preventing these complications. This review consolidates evidence from clinical trials and major BP management guidelines to shed light on key aspects of hypertension management in diabetes. It addresses BP thresholds to initiate antihypertensive treatment, optimal BP control targets, recommended first-line antihypertensive edications, and BP monitoring plan for the prevention of chronic complications in type 2 diabetes.

Objective:To explore the methods and clinical effects of reconstructing facial and cervical scars with expanded flaps based on the "MLT" principle.Methods:The study was a retrospective observational study. From January 2019 to May 2022, 74 patients with facial and cervical scars after burn or trauma injuries who met the inclusion criteria were admitted to Xiangya Hospital of Central South University, including 38 males and 36 females, aged from 5 to 58 years, including 24 patients with simple facial involvement, 24 patients with simple cervical involvement, and 26 patients with both facial and cervical involvement, with scar area ranging from 12 to 145 cm2. By following the "MLT" principle (color and texture similar to the face; flap area large enough to reconstruct the entire defect; skin tissue thin enough to transmit the expression, so as to facilitate the shape of the face and five features); in the stage Ⅰ surgery, the skin and soft tissue expanders (hereinafter referred to as the expanders) were implanted, and in the stage Ⅱ surgery, the expander removal+scar resection+flap transplantation to repair the secondary wound was performed, and the wound in the donor area of flap was directly sutured. After operation, silicone gel preparation and laser therapy were used to prevent scar hyperplasia. The expansion ratio and time period of expanders, the occurrence of complications of skin and soft tissue expansion surgery, the type of flap used, and the survival of flap after the stage Ⅱ surgery were observed and recorded. The long-term effect of facial and cervical reconstruction and the recovery of donor area and recipient area of flap were evaluated during the postoperative follow-up after surgery.Results:The expansion ratio of 135 expanders ranged from 1.36 to 3.00 times, and the expansion time period ranged from 6 to 14 months. During skin and soft tissue expansion surgery, 8 patients had poor healing of incisions after expander placement, 7 patients had expander rupture, 5 patients had infection in incisions after expander placement, 3 patients had expander exposure, 2 patients had difficult filling the injection pot, and 1 patient had water leakage from the injection pot. Dorsal shoulder expanded flaps with double blood supply of transverse cervical artery and circumflex scapular artery were used in 8 patients, the expanded flaps of anterior transverse carotid artery perforator were used in 11 patients, the expanded flaps of internal thoracic artery perforator were used in 12 patients, tandem expanded flaps of upper chest and neck were used in 16 patients, dorsal thoracic artery perforator expanded flaps were used in 5 patients, and adjacent rotary propulsive expanded flaps were used in 22 patients. After the stage Ⅱ surgery, the flaps of 71 patients were completely survived. One patient had blood circulation disorder in the flap, and the flap survived after hyperbaric oxygen treatment. Necrosis occurred at the end of the flaps in 2 patients, which healed after dressing change. After the surgery, 42 patients were followed up for 3 to 24 months. The color, texture, and thickness of flaps were good and similar to the surrounding normal skin tissue in the recipient area, the appearance and function of the face and neck were significantly improved, and the wound location in the donor and recipient areas of flaps was concealed with slight scar formation.Conclusions:In the reconstruction of facial and neck scars, by following the "MLT" principle, the expanded flap was carefully designed before surgery, the local aesthetic features within the subunit are reconstructed during the stage Ⅱ surgery, and standard anti-scar treatment measures are actively adopted after surgery. After reconstruction, the color, texture, and thickness of flaps were close to the normal skin in face and neck, and the appearance and function of face and neck are significantly improved, with less linear scars left. It is beneficial to improve the therapeutic effect.

Objective:To understand the epidemiological characteristics of human parainfluenza viruses（HPIVs）infections in patients with acute lower respiratory tract infection（ALRTI）in Changsha，Hunan from 2013 to 2023.Methods:The respiratory virus detection results,demographic characteristics and clinical data of children hospitalized with ALRTI in Children's Medical Center of Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2013 to December 2023 were retrospectively collected.The epidemic characteristics and clinical symptoms of HPIVs infection were analyzed.Results:During the study,59 725 children with ALRTI were included,the detection rate of HPIVs was 6.66% (3 978/59 725),among which,HPIV1,HPIV2,HPIV3 were detected in 753(1.26%) cases,217(0.36%) cases and 3 055(5.12%) cases,respectively.Among 3 978 cases infected with HPIVs,the overall detection rate in males was higher than that in females(6.99% vs. 6.14%),and the detection rate of HPIVs in 6-11 months old was higher than those in other age groups,with statistically significant differences( P<0.001).Among cases infected with HPIVs,the main clinical diagnosis were mild pneumonia (77.28%) and acute bronchiolitis (14.40%).The detection rate of HPIV3 was the highest (84.62%) in 208 HPIVs-positive children with severe pneumonia,and the difference was statistically significant ( P<0.001).The detection rate of HPIVs varied across different years,reaching its peak in 2020 with a detection rate of 13.99% ( P<0.001).The overall epidemic peak of HPIVs was in spring and summer.The seasonal epidemic characteristics in different types of HPIVs were not completely consistent.The detection rates of HPIV1(2.07%) and HPIV2(0.60%) were the highest in autumn,while that of HPIV3 (7.11%) was the highest in spring ( P<0.001).The seasonal epidemic characteristics of HPIVs have changed in different years:From 2013 to 2019,HPIVs was mainly prevalent in spring and summer,then shifted to summer and autumn in 2020,and autumn as well as winter in 2021 to 2022,then resumed in spring and summer in 2023. Conclusion:From 2013 to 2023,HPIVs in Changsha,Hunan Province had unique epidemiological characteristics.HPIV3 is the dominant type of HPIVs infection in the hospitalized children with ALRTI in Changsha，Hunan.The epidemic peak of HPIVs was postponed in 2020 to 2022.Paying attention to the continuous monitoring of HPIVs infection is helpful to guide clinicians' diagnosis and treatment.

Neurocutaneous syndrome is a multi-system disease involving the nervous system and skin,with onset in various forms and typically in infancy,which are difficult to cure with a poor prognosis.The etiology of neurocutaneous syn-drome is complex,mostly caused by gene mutations,including heritable mutations and occasionally non-hereditary postzy-gotic somatic mutations.Cases of different types of neurocutaneous syndrome have been reported,such as Sturge-Weber syndrome,tuberous sclerosis,and neurofibromatosis.Specific medications are lacking among current therapeutic ap-proaches including symptomatic treatment,drug therapy,chemoradiotherapy,surgery,and physical therapy.With the in-creasing understanding of the pathogenesis and progress in drug research and development,new drugs could be on the hori-zon.Remarkable evidence in the field of genetic diseases suggests that gene therapy may hold promise as a treatment for neurocutaneous syndrome through fixing the pathogenic gene defects.Considering the lack of systematic review on the rare and diverse conditions,we summarize relevant studies to provide a reference for clinical workers in the diagnosis and treat-ment of neurocutaneous syndrome.

Objective To investigate the protective effects of 2-methoxyestradiol(2ME)against hypoxic pulmonary hypertension(HPH)in neonatal rats.Methods Ninety-six Wistar neonatal rats were randomly divided into a normoxia group,a hypoxia group,and a hypoxia+2ME group,with each group further subdivided into 3-day,7-day,14-day,and 21-day subgroups,containing eight rats each.The hypoxia and hypoxia+2ME groups received daily subcutaneous injections of saline and 2ME(240 μg/kg),respectively,while the normoxia group was raised in a normoxic environment with daily saline injections.Right ventricular systolic pressure(RVSP)was measured using the direct pressure method.Pulmonary vascular morphology was assessed using hematoxylin and eosin staining,with metrics including the percentage of medial thickness of small pulmonary arteries relative to the external diameter(MT%)and the cross-sectional area of the media of small pulmonary arteries relative to the total cross-sectional area(MA%).Immunohistochemistry was used to detect the expression levels of hypoxia-inducible factor-1α(HIF-1α)and proliferating cell nuclear antigen(PCNA)proteins,while real-time quantitative PCR was used to to assess HIF-1α and PCNA mRNA levels.Results Compared to the normoxia group,the hypoxia and hypoxia+2ME groups showed increased RVSP and upregulated HIF-1α and PCNA protein and mRNA expression levels at 3,7,14,and 21 days after hypoxia(P<0.05).Furthermore,at 7,14,and 21 days after hypoxia,the hypoxia group showed increased MT%and MA%(P<0.05).In comparison to the hypoxia group,the hypoxia+2ME group exhibited reduced RVSP and downregulated HIF-1α and PCNA protein and mRNA expression levels,along with decreased MT%and MA%at 7,14,and 21 days after hypoxia(P<0.05).Conclusions 2ME may protect against HPH in neonatal rats by inhibiting the expression of HIF-1α and PCNA and reducing pulmonary vascular remodeling.

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.

In addition to providing energy for cells, mitochondria also participate in calcium homeostasis, cell information transfer, cell apoptosis, cell growth and differentiation. Therefore, maintaining mitochondrial homeostasis is very crucial for the body to carry out normal life activities. Ubiquitination, a post-translational modification of proteins, is involved in various physiological and pathological processes of cells by regulating mitochondrial homeostasis. However, the mechanism by which ubiquitination regulates mitochondrial homeostasis has not been summarized, especially the effect of Parkin protein on cardiovascular diseases. In this paper, the specific mechanism of mitochondrial homeostasis regulated by ubiquitination of Parkin protein is discussed, and the influence of mitochondrial homeostasis imbalance on cardiovascular diseases is reviewed, with a view to providing potential therapeutic strategies for the clinical treatment of cardiovascular diseases.

Background Improper settings of outdoor smoking points in public places may increase the risk of secondhand smoke exposure among the population. Conducting research on air pollution in and around smoking spots and related influencing factors can provide valuable insights for optimizing the setting of outdoor smoking points. Objective To investigate the influence of the number of smokers at outdoor smoking points and the distance on the diffusion characteristics of surrounding air pollutants, in order to optimize the setting of outdoor smoking points. Methods Surrounding the exhibition halls in the China International Import Expo (CIIE), two outdoor smoking points were randomly selected, one on the first floor (ground level) and the other on the second floor (16 m above ground), respectively. At 0, 3, 6, and 9 m from the smoking points in the same direction, validated portable air pollutant monitors were used to measure the real-time fine particulate matter (PM_2.5) and carbon dioxide (CO₂) concentrations for consecutive 5 d during the exhibition, as well as the environmental meteorological factors at 0 m with weather meters including wind speed, wind direction, and air pressure. An open outdoor atmospheric background sampling point was selected on each of the two floors to carry out parallel sampling. Simultaneously, the number of smokers at each smoking point were double recorded per minute. The relationships between the number of smokers, distance from the smoking points, and ambient PM_2.5 and CO₂ concentrations were evaluated by generalized additive regression models for time-series data after adjustment of confounders such as temperature, relative humidity, and wind speed. Results The median numbers of smokers at smoking points on the first and second floors were 6 [interquartile range (IQR): 3, 9] and 9 (IQR: 6, 13), respectively. Windless (wind speed <0.6 m·s⁻¹) occupied most of the time (85.9%) at both locations. The average concentration of ambient PM_2.5 at the smoking points (0 m) [mean ± standard deviation, (106±114) μg·m⁻³] was 4.2 times higher than that of the atmospheric background [(25±7) μg·m⁻³], the PM_2.5 concentration showed a gradient decline with the increase of distance from the smoking points, and the average PM_2.5 concentration at 9 m points [(35±22) μg·m⁻³] was close to the background level (1.4 times higher). The maximum concentration of CO₂ [(628±23) μmol·mol⁻¹] was observed at 0 m, and its average value was 1.3 times higher than that of the atmospheric background [(481±40) μmol·mol⁻¹], and there was no gradient decrease in CO₂ concentration with increasing distance at 0, 3, 6, and 9 m points. The regression analyses showed that, taking smoking point as the reference, every 3 m increase in distance was associated with a decrease of ambient PM_2.5 by 24.6 [95% confidence interval (95%CI): 23.5, 25.8] μg·m⁻³ (23.2%) and CO₂ by 54.1 (95%CI: 53.1, 55.1) μmol·mol⁻¹ (8.6%). Every one extra smoker at the smoking point was associated with an average increase of PM_2.5 and CO₂ by 2.0 (95%CI: 1.7, 2.8) μg·m⁻³ and 1.0 (95%CI: 0.7，1.2) μmol·mol⁻¹, respectively. The sensitivity analysis indicated that, under windless conditions, the concentrations of PM_2.5 and CO₂ at the smoking points were even higher but the decreasing and dispersion characteristics remained consistent. Conclusion Outdoor smoking points could significantly increase the PM_2.5 concentrations in the surrounding air and the risks of secondhand smoke exposure, despite of the noticeable decreasing trend with increasing distance. Considering the inevitable poor dispersion conditions such as windless and light wind, outdoor smoking points are recommended to be set at least 9 m or farther away from non-smoking areas.