Objective:To explore the effects of Yiqi Yangyin Tongluo Decoction combined with TCM syndrome differentiation diet on renal function, inflammatory factors, and nutritional status of DN patients with qi-yin deficiency and blood stasis syndrome based on propensity score matching method.Methods:Retrospective clinical studies were carried out. A total of 152 DN patients with qi-yin deficiency and blood stasis syndrome in Dongfang Hospital, Beijing University of Chinese Medicine from January 2022 to January 2024 were selected and divided into an observation group of 83 cases and a control group of 69 cases according to the treatment method. Propensity score matching (PSM) was further adopted to balance the confounding factors before treatment at a ratio of 1:1. Finally, 46 patients in each group were successfully matched. The control group received conventional Western medicine therapy intervention, while the observation group received a combination of Yiqi Yangyin Tongluo Decoction and TCM syndrome differentiation diet treatment on the basis of the control group. Both groups were treated for 3 months. TCM syndrome scores were performed before and after treatment, and t-test was used to detect the levels of SCr, BUN, and β2-MG. ELISA was used to detect the levels of IL-1β, TGF-β1, and TNF-α. Body composition analyzer was used to measure the triceps circumference (AMC) and triceps skinfold thickness (TSF) of the upper arm; the Mini Nutritional Assessment (MNA) was used to assess the risk or status of malnutrition. Adverse reactions were recorded and clinical efficacy was evaluated.Results:The total effective rate of the observation group was 91.3% (42/46), while that of the control group was 69.7% (32/46). There was a statistical significance in the total effective rate between the two groups ( χ2=4.84, P=0.028). After treatment, the observation group had lower scores of soreness and weakness in the waist and knees, fatigue and weakness, restlessness and heat in the five hearts, and a decrease in the depth of the tongue and dark veins compared to the control group ( t values of 4.23, 3.86, 3.68, 4.62, respectively, P<0.001); serum SCr [(221.53±23.40) mmol/L vs. (261.92±25.48) mmol/L, t=7.92], BUN [(21.74 ± 4.13) mmol/L vs. (25.12 ± 4.50) mmol/L, t=3.75], β2-MG [(2.88 ± 0.71) mg/L vs. (4.54 ± 0.93) mg/L, t=9.62] levels, as well as IL-1β [(47.21 ± 5.48) μg/L vs. (51.92 ± 5.63) μg/L, t=4.07], TGF-β [(67.84 ± 8.03) μg/L vs. (73.29 ± 8.88) μg/L, t=4.75], TNF-α [(29.74 ± 4.13) μg/L vs. (33.12 ± 4.98) μg/L, t=3.54] were lower than those in the control group ( P<0.001); the MNA score (24.89 ± 4.48 vs. 21.02 ± 4.16, t=4.29), AMC [(24.34±2.83) mm vs. (22.19 ± 2.88) mm, t=3.61], TSF [(8.34 ± 2.13) mm vs. (7.12 ± 1.98) mm, t=2.85] were higher than those in the control group ( P<0.001 or P<0.05). During the treatment period, the incidence of adverse reactions in the observation group was 13.0% (6/46), while in the control group it was 8.7% (4/46). There was no statistical significance between the two groups ( χ2=0.45, P=0.503). Conclusion:The combination of Yiqi Yangyin Tongluo Decoction and TCM syndrome differentiation diet can effectively alleviate the clinical symptoms of DN patients, improve their kidney function, enhance their nutritional and health status, and inhibit inflammatory response levels, with good treatment safety.

Objective: To study the effect of metformin sensitizing pancreatic cancer cells with radiotherapy, with a focus on elucidating the underlying mechanisms of radiotherapy resistance. In particular, the role of the PERK/P-eIF2/ATF4 signaling pathway in mediating these effects was preliminarily explored. Methods : Pancreatic cancer cell lines(PANC-1 and PANC-2) were categorized into control, radiotherapy, and drug treatment groups. Following the respective treatments, cell proliferation inhibition was assessed using the CCK-8 assay, colony formation assays, and cell death staining. Senescence was quantified by β-galactosidase(SA-β-Gal) staining. The expression of cell cycle regulators(P21, P16, γ-H2AX), apoptosis markers(Bax, Bcl-2, Cleaved caspase-3), and pathway-related proteins(PERK, P-eIF2, ATF4) was evaluated by Western blot and immunofluorescence. To further investigate the role of the PERK/P-eIF2/ATF4 axis in metformin-mediated modulation of pancreatic cancer cell senescence and radiosensitization, selective inhibitors(GSK2606414) and agonists(MK-28) of PERK were employed. Results : Radiotherapy markedly upregulated senescence-associated markers(P21, P16, γ-H2AX, and β-galactosidase activity) in pancreatic cancer cells. Senescent cells exhibited enhanced proliferative activity and increased tumor volume both in vitro and in vivo. Metformin mitigated radiotherapy-induced senescence by reducing the expression of senescence markers and significantly suppressing the clonogenic and proliferative capacity of treated cells. Mechanistically, radiotherapy activated the PERK signaling pathway, leading to increased expression of PERK, P-eIF2, and ATF4, thereby driving cellular senescence. Pharmacological inhibition of PERK reduced β-galactosidase activity, while PERK activation further promoted the expression of senescence-associated proteins—an effect that was reversed by metformin. Conclusion Metformin inhibits the activation of the PERK/P-eIF2/ATF4 signaling pathway in pancreatic cancer cells following radiotherapy, thereby delaying cellular senescence and reducing the associated radiotherapy resistance of senescent cells. This modulation contributes to the sensitization of pancreatic cancer cells to radiotherapy.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Ameloblastoma is a benign tumor characterized by locally invasive phenotypes,leading to facial bone destruction and a high recurrence rate.However,the mechanisms governing tumor initiation and recurrence are poorly understood.Here,we uncovered cellular landscapes and mechanisms that underlie tumor recurrence in ameloblastoma at single-cell resolution.Our results revealed that ameloblastoma exhibits five tumor subpopulations varying with respect to immune response(IR),bone remodeling(BR),tooth development(TD),epithelial development(ED),and cell cycle(CC)signatures.Of note,we found that CC ameloblastoma cells were endowed with stemness and contributed to tumor recurrence,which was dominated by the EZH2-mediated program.Targeting EZH2 effectively eliminated CC ameloblastoma cells and inhibited tumor growth in ameloblastoma patient-derived organoids.These data described the tumor subpopulation and clarified the identity,function,and regulatory mechanism of CC ameloblastoma cells,providing a potential therapeutic target for ameloblastoma.

Ectopic eruption of the second permanent molar is a tooth replacement disorder during adolescence.If not treated in time,it can cause hard tissue of the adjacent first molar resorption,early tooth loss,decreased chewing efficien-cy,and other serious malocclusions.Timely detection and treatment of ectopic eruption of the second permanent molar are of great significance in preventing malocclusions in adolescents and establishing normal occlusion relationships.However,current case reports on the ectopic eruption of the mandibular second molar are relatively rare and are mostly concentrated on surgical and orthodontic treatments,and long-term follow-up is lacking.This paper reports a case in which brass wire ligation was used to treat ectopic eruption of the mandibular second permanent molar,allowing the per-manent teeth to erupt smoothly and establish a normal occlusion.The patient was observed for five years after the opera-tion.The occlusion was stable,and the tooth root development,pulp vitality,and periodontal conditions were normal.This paper provides a clinical approach that is short in treatment duration,simple,and minimally invasive for young man-dibular second permanent molars with moderate mesial inclination and partial eruption.This method is of impor-tance in helping children establish physiological occlu-sion.

Facial paralysis causes both physical pain and psychological distress to patients. It is difficult for a patient with facial paralysis to engage with a normal social life and at work. Progresses have been made in recent years in the treatment of facial paralysis. More attentions have been caught by masseteric to facial nerve transposition, which has advantages of adjacency in location, abundancy in nerve supply and reliability in the outcome and now has deemed an important option of facial reanimation. It has not been long since the application of the technique of masseteric to facial nerve transposition in China, therefore it still lacks a universal guidance on practice. In order to achieve the aim of better quality control and popularisation of the technique, hereby a consensus with suggestions on facial reanimation with masseteric to facial nerve transposition is proposed as the reference for surgeons specialised in facial reanimation. This consensus is proposed, discussed and drafted by experts from plastic and reconstructive surgery, oral and maxillofacial surgery, head and neck surgery and neurosurgery.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Background: Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation. Methods: Thirteen consecutive patients with a median age of 55 years (range, 21–70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed. Results: All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10–51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5°C and 25% at 25°C). Conclusions Finer sensation could be partially restored. However, thermal sensation remained poor.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To evaluated the clinical efficacy of transurethral en bloc resection of bladder tumor with 2 μm laser in the high-risk elderly patients with bladder cancer under local anesthesia. Methods All of 64 high-risk elderly patients having underwent surgical treatment from April 2015 to October 2016 were divided into 2 groups,2 μm laser group(30 patients)and transurethral resection of bladder tumor(TURBT)group(34 group)according to surgical methods.The area and degree of pain was observed and recorded using visual analogue scales(VAS)during the 2 μm laser operation. The operation time,bladder irrigation time,catheter indwelling time,hospital stay,complications and 1-year cumulative recurrence rate were compared between 2 groups. Results The ASA grade in 2 μm laser group was higher than that in TURBT group and there was significant difference(P<0.05).During the 2 μm laser operation,the urethra pain was 53.33%(16/30),bladder pain was 20.00%(6/30), both urethra and bladder pain was 26.67%(8/30).The VAS scores were(2.50 ± 1.38)points,all the patients tolerated the pain in the 2 μm laser group.There was no significant difference in operation time between 2 groups(P>0.05).The bladder irrigation time,catheter indwelling time and hospital stay were shorter in 2 μm laser group than those in TURBT group:(40.00 ± 19.06)h vs.(56.47 ± 14.55)h,(4.33 ± 1.40)d vs. (5.65 ± 0.93) d,(4.13 ± 1.51) d vs. (6.24 ± 0.75) d,P<0.05 or<0.01. The overall incidence of complications was lower in 2 μm laser group than that in TURBT group:13.33%(4/30) vs. 64.71% (22/34),χ2=8.719,P=0.003.Compared with that of pre-treatment,the quality of life was higher after treatment in two groups,but there were no significant differences between the two groups.There were no significant differences in 1-year cumulative recurrence rate between the two groups after treatment (χ2= 0.496,P = 0.481). Conclusions Transurethral 2 μm laser treatment in bladder cancer under urethral surface anesthesia is safe and reliable for the high-risk elderly patients and complications are fewer than TURBT.The recent curative effect is satisfied.