ObjectiveTo investigate the optimal termination time for acupuncture in treating patients with acute peripheral facial paralysis and its cost-effectiveness. MethodsA total of 120 eligible patients with acute-stage peri-pheral facial paralysis were randomly assigned to either the mild dysfunction termination group and the complete recovery termination group， with 60 patients in each group. Both groups received the standard acupuncture treatment protocol. Treatment in the mild dysfunction termination group was terminated when the Sunnybrook facial grade scale （SFGS） score first reached or exceeded 83 points， while that in the complete recovery termination group was terminated when the SFGS score first reached or exceeded 95 points. Assessments were conducted before treatment， 6 and 12 months after onset. SFGS， facial disability index （FDI） including physical function （FDIp） and social function （FDIs）， self-rating anxiety scale （SAS）， and self-rating depression scale （SDS） scores were assessed before treatment， and 6 and 12 months after onset. Any acupuncture-related adverse events during treatment were recorded for safety evaluation. Treatment sessions and medical costs including direct costs， indirect costs， insurance coverage， total societal costs， and patient out-of-pocket expenses were also recorded， and an economic evaluation was conducted including cost-effectiveness ratio （CER） and incremental cost-effectiveness ratio （ICER）. ResultsUltimately， 56 patients in the mild dysfunction termination group and 55 in the complete recovery termination group completed the follow-up. At 6 and 12 months after onset， SFGS and FDIp scores in both groups improved significantly while FDIs， SAS and SDS scores decreased （P＜0.05）. Comparison of scores between groups 6 months and 12 months after onset showed no statistically significant differences （P＞0.05）. During the trial， the incidence of adverse events was 13.3% （8/60） in the mild dysfunction termination group and 18.3% （11/60） in the complete recovery termination group， with no statistically significant difference （P＞0.05）. The number of treatment sessions， total social costs， and out-of-pocket expenses in the mild dysfunction termination group were significantly lower than those in the complete recovery termination group （P＜0.05）. The CER of the mild dysfunction termination group in SFGS， FDIp， FDIs， SAS， and SDS scores was lower than that of the complete recovery termination group. The ICER analysis showed that continuing treatment until full recovery incurred an additional cost of 573.30 CNY/point in SFGS improvement， whereas 1-point improvement in FDIp， FDIs， SAS， and SDS required 21,355.25 CNY， 1779.60 CNY， 3713.96 CNY， and 2755.52 CNY， respectively. ConclusionFor acupuncture in treating acute peripheral facial palsy， terminating treatment when mild dysfunction is achieved yields long-term efficacy comparable to that of continuing treatment until complete recovery， while significantly reducing medical costs and socioeconomic burden.

Alzheimer's disease (AD) is characterized by cognitive and functional deterioration, with pathological features such as amyloid-beta (Aβ) aggregates in the extracellular spaces of parenchymal neurons and intracellular neurofibrillary tangles formed by the hyperphosphorylation of tau protein. Despite a thorough investigation, current treatments targeting the reduction of Aβ production, promotion of its clearance, and inhibition of tau protein phosphorylation and aggregation have not met clinical expectations, posing a substantial obstacle in the development of drugs for AD. Recently, artificial intelligence (AI), computational biology (CB), and systems biology (SB) have emerged as promising methodologies in AD research. Their capacity to analyze extensive and varied datasets facilitates the identification of intricate patterns, thereby enriching our comprehension of AD pathology. This paper provides a comprehensive examination of the utilization of AI, CB, and SB in the diagnosis of AD, including the use of imaging omics for early detection, drug discovery methods such as lecanemab, and complementary therapies like phototherapy. This review offers novel perspectives and potential avenues for further research in the realm of translational AD studies.

Peri-implant keratinized mucosa (PIKM) augmentation refers to surgical procedures aimed at increasing the width of PIKM. Consensus reports emphasize the necessity of maintaining a minimum width of PIKM to ensure long-term peri-implant health. Currently, several surgical techniques have been validated for their effectiveness in increasing PIKM. However, the selection and application of PIKM augmentation methods may present challenges for dental practitioners due to heterogeneity in surgical techniques, variations in clinical scenarios, and anatomical differences. Therefore, clear guidelines and considerations for PIKM augmentation are needed. This expert consensus focuses on the commonly employed surgical techniques for PIKM augmentation and the factors influencing their selection at second-stage surgery. It aims to establish a standardized framework for assessing, planning, and executing PIKM augmentation procedures, with the goal of offering evidence-based guidance to enhance the predictability and success of PIKM augmentation.
Humans ; Consensus ; Dental Implants ; Mouth Mucosa/surgery* ; Keratins

Objective To explore the value of ovarian-adnexal reporting and data system(O-RADS)MRI score combined with tumor markers(CA125+HE4)in ovarian tumors.Methods Data from 223 patients with ovarian tumors confirmed by pathology were analyzed retrospectively,including 260 lesions.The Kappa test was used to assess the consistency of O-RADS MRI score between low and high seniority physician groups.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic effi-cacy of O-RADS MRI score combined with tumor markers(CA125+HE4)in ovarian tumors.Results The Kappa value of the O-RADS MRI score between low and high seniority physician groups was 0.803[95%confidence interval(CI)0.746-0.860].The sensitivity based on O-RADS MRI score for distinguishing benign and malignant ovarian tumors was 0.957 and 0.989,the specificity was 0.784 and 0.820,the accuracy was 0.846 and 0.881,the positive predictive value was 0.712 and 0.754,and the negative pre-dictive value was 0.970 and 0.993,and the area under the curve(AUC)was 0.871 and 0.905,respectively in the low and high senior-ity physician groups.Combined with tumor markers(CA125+HE4),the sensitivity and negative predictive value of both low and high seniority physician groups were 1.000.Conclusion The O-RADS MRI score has high diagnostic efficacy and good repeatability in ovarian tumors.Combined with tumor markers CA125 and HE4,the O-RADS MRI score can further improve the diagnostic sen-sitivity.

Animal models of cardiac arrhythmia are important tools for analyses of antiarrhythmic drug mechanisms and medical laboratory teaching.In this study,two major models,namely,barium chloride-induced arrhythmia in rabbits and ouabain-induced arrhythmia in guinea pigs,were systematically compared in terms of technical principles,modeling method,and indexes.By optimizing electrocardiographic parameters,standardizing arrhythmia grading criteria,and introducing quantitative analysis method,we revealed differences between the two models in terms of ion channel mechanisms,drug targets,and applicability to teaching.The barium chloride model was characterized by rapidly induced ventricular arrhythmia,which is suitable for the observation of acute drug efficacy.The ouabain model simulated the development of progressive arrhythmia,which is suitable for the study of the preventive effects of anti-arrhythmic drugs.This study provides a technical reference for the selection of arrhythmia models,optimization process,and mechanistic analyses in medical experimental teaching and is of great significance for improving the electrophysiology experimental skills of medical students.

ObjectiveTo identify key factors influencing cognitive function in the elderly, including traditional Chinese medicine (TCM) constitutional classification, and to rank their relative importance.MethodsWe used cross-sectional data from seven geographical regions across mainland China. The Changsha version of the Montreal Cognitive Assessment was used to assess cognitive function. A “least absolute shrinkage and selection operator” (LASSO) model, multivariate linear regression analysis, and random forest (RF) model were used. Subgroup analyses were performed to examine the correlation between key TCM constitution types and cognitive function in different population subgroups.ResultsA total of 24 803 individuals aged 60 and above were included in the study. We selected 18 influential factors using the LASSO model. Higher education, being married, and having insurance were positively correlated with cognitive function in the elderly (all P .05). In contrast, poor sleep, vision impairment, hearing impairment, basic activities of daily living disability, instrumental activities of daily living disability, depression, hypertension, coronary heart disease, diabetes, stroke, yang-deficiency constitution (YADC), yin-deficiency constitution (YIDC), qi deficiency constitution (QDC), and blood stasis constitution (BSC) were negatively correlated with cognitive function (all P .05). YIDC and BSC affected all dimensions of cognitive function (all P .05). YADC mainly affected attention, language, abstraction (verbal analogies), memory, and orientation to time and place dimensions (P .001). QDC mainly affected language and abstraction (verbal analogies) dimensions (P .05). The negative correlations between BSC, YADC, YIDC, and QDC scores and cognitive function revealed statistically significant differences across most subgroups. The RF model identified education, BSC, and poor sleep quality as the three most influential factors in our study.ConclusionBSC, YADC, YIDC, and QDC were associated with cognitive decline in the elderly. Our findings provide new perspectives and significant references for interventions for early-stage cognitive disorders.

Objective To explore the value of ovarian-adnexal reporting and data system(O-RADS)MRI score combined with tumor markers(CA125+HE4)in ovarian tumors.Methods Data from 223 patients with ovarian tumors confirmed by pathology were analyzed retrospectively,including 260 lesions.The Kappa test was used to assess the consistency of O-RADS MRI score between low and high seniority physician groups.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic effi-cacy of O-RADS MRI score combined with tumor markers(CA125+HE4)in ovarian tumors.Results The Kappa value of the O-RADS MRI score between low and high seniority physician groups was 0.803[95%confidence interval(CI)0.746-0.860].The sensitivity based on O-RADS MRI score for distinguishing benign and malignant ovarian tumors was 0.957 and 0.989,the specificity was 0.784 and 0.820,the accuracy was 0.846 and 0.881,the positive predictive value was 0.712 and 0.754,and the negative pre-dictive value was 0.970 and 0.993,and the area under the curve(AUC)was 0.871 and 0.905,respectively in the low and high senior-ity physician groups.Combined with tumor markers(CA125+HE4),the sensitivity and negative predictive value of both low and high seniority physician groups were 1.000.Conclusion The O-RADS MRI score has high diagnostic efficacy and good repeatability in ovarian tumors.Combined with tumor markers CA125 and HE4,the O-RADS MRI score can further improve the diagnostic sen-sitivity.

Animal models of cardiac arrhythmia are important tools for analyses of antiarrhythmic drug mechanisms and medical laboratory teaching.In this study,two major models,namely,barium chloride-induced arrhythmia in rabbits and ouabain-induced arrhythmia in guinea pigs,were systematically compared in terms of technical principles,modeling method,and indexes.By optimizing electrocardiographic parameters,standardizing arrhythmia grading criteria,and introducing quantitative analysis method,we revealed differences between the two models in terms of ion channel mechanisms,drug targets,and applicability to teaching.The barium chloride model was characterized by rapidly induced ventricular arrhythmia,which is suitable for the observation of acute drug efficacy.The ouabain model simulated the development of progressive arrhythmia,which is suitable for the study of the preventive effects of anti-arrhythmic drugs.This study provides a technical reference for the selection of arrhythmia models,optimization process,and mechanistic analyses in medical experimental teaching and is of great significance for improving the electrophysiology experimental skills of medical students.

Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.

Tuberculosis (TB) is an ancient infectious disease. Before the availability of effective drug therapy, it had high morbidity and mortality. In the past 100 years, the discovery of revolutionary anti-TB drugs such as streptomycin, isoniazid, pyrazinamide, ethambutol and rifampicin, along with drug combination treatment, has greatly improved TB control globally. As anti-TB drugs were widely used, multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis emerged due to acquired genetic mutations, and this now presents a major problem for effective treatment. Genes associated with drug resistance have been identified, including katG mutations in isoniazid resistance, rpoB mutations in rifampin resistance, pncA mutations in pyrazinamide resistance, and gyrA mutations in quinolone resistance. The major mechanisms of drug resistance include loss of enzyme activity in prodrug activation, drug target alteration, overexpression of drug target, and overexpression of the efflux pump. During the disease process, Mycobacterium tuberculosis may reside in different microenvironments where it is expose to acidic pH, low oxygen, reactive oxygen species and anti-TB drugs, which can facilitate the development of non-replicating persisters and promote bacterial survival. The mechanisms of persister formation may include toxin-antitoxin (TA) modules, DNA protection and repair, protein degradation such as trans-translation, efflux, and altered metabolism. In recent years, the use of new anti-TB drugs, repurposed drugs, and their drug combinations has greatly improved treatment outcomes in patients with both drug-susceptible TB and MDR/XDR-TB. The importance of developing more effective drugs targeting persisters of Mycobacterium tuberculosis is emphasized. In addition, host-directed therapeutics using both conventional drugs and herbal medicines for more effective TB treatment should also be explored. In this article, we review historical aspects of the research on anti-TB drugs and discuss the current understanding and treatments of drug resistant and persistent tuberculosis to inform future therapeutic development.
Humans ; Pyrazinamide/therapeutic use* ; Isoniazid/therapeutic use* ; Antitubercular Agents/therapeutic use* ; Tuberculosis, Multidrug-Resistant/microbiology* ; Mycobacterium tuberculosis/genetics* ; Tuberculosis/drug therapy* ; Rifampin/therapeutic use* ; Mutation ; Drug Resistance, Multiple, Bacterial/genetics*