Abstract Modern western medicine typically focuses on treating specific symptoms or diseases, and traditional Chinese medicine (TCM) emphasizes the interconnections of the body’s various systems under external environment and takes a holistic approach to preventing and treating diseases. Phenomics was initially introduced to the field of TCM in 2008 as a new discipline that studies the laws of integrated and dynamic changes of human clinical phenomes under the scope of the theories and practices of TCM based on phenomics. While TCM Phenomics 1.0 has initially established a clinical phenomic system centered on Zhenghou (a TCM definition of clinical phenome), bottlenecks remain in data standardization, mechanistic interpretation, and precision intervention. Here, we systematically elaborates on the theoretical foundations, technical pathways, and future challenges of integrating digital medicine with TCM phenomics under the framework of “TCM phenomics 2.0”, which is supported by digital medicine technologies such as artificial intelligence, wearable devices, medical digital twins, and multi-omics integration. This framework aims to construct a closed-loop system of “Zhenghou–Phenome–Mechanism–Intervention” and to enable the digitization, standardization, and precision of disease diagnosis and treatment. The integration of digital medicine and TCM phenomics not only promotes the modernization and scientific transformation of TCM theory and practice but also offers new paradigms for precision medicine. In practice, digital tools facilitate multi-source clinical data acquisition and standardization, while AI and big data algorithms help reveal the correlations between clinical Zhenghou phenomes and molecular mechanisms, thereby improving scientific rigor in diagnosis, efficacy evaluation, and personalized intervention. Nevertheless, challenges persist, including data quality and standardization issues, shortage of interdisciplinary talents, and insufficiency of ethical and legal regulations. Future development requires establishing national data-sharing platforms, strengthening international collaboration, fostering interdisciplinary professionals, and improving ethical and legal frameworks. Ultimately, this approach seeks to build a new disease identification and classification system centered on phenomes and to achieve the inheritance, innovation, and modernization of TCM diagnostic and therapeutic patterns.

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

ObjectiveTo investigate the effects of Linggui Zhugantang （LGZGT）-containing serum on primary astrocytes （AS） induced by β amyloid 1-42 （Aβ_1-42） in a rat model of Alzheimer's disease （AD） and explore the phagocytic and degradative effects of LGZGT on Aβ. MethodAn AD model was established by inducing AS with Aβ_1-42. The cells were divided into normal group， model group， LGZGT low-， medium-， and high-dose （LGZGT-L， LGZGT-M， and LGZGT-H） groups， and donepezil hydrochloride group. The model group was treated with Aβ_1-42 at a final concentration of 10 μmol∙L^-1. The LGZGT-L， LGZGT-M， and LGZGT-H groups were treated with 10% serum containing LGZGT on the basis of the model group. Cell viability was assessed using a cell counting kit-8 （CCK-8）， lactate dehydrogenase （LDH） activity was measured using an LDH assay kit， and cell morphology was observed using an inverted microscope. The expression of Aβ-related degradation enzymes insulin-degrading enzyme （IDE） and cathepsin D （CTSD） was detected using Western blot， and the fluorescence intensity of cathepsin B （CTSB） was measured using immunofluorescence. The content of Aβ_1-42 in cells was determined using an enzyme-linked immunosorbent assay （ELISA）. ResultCompared with the normal group， the viability of AS in all groups decreased， and Aβ_1-42 at different concentrations had inhibitory effects on AS proliferation. After administration， compared with the normal group， the cell survival rate of the model group decreased significantly （P<0.05）. Compared with the model group， the cell survival rates of the LGZGT-H group and donepezil hydrochloride group increased significantly （P<0.05）. The LDH activity of cells in the model group was significantly increased compared with that in the normal group （P<0.05）， and cell bodies were swollen and enlarged with increased protrusions and elongation， suggesting more obvious cell damage. Compared with the model group， the LDH activity of cells in the donepezil hydrochloride， LGZGT-L， LGZGT-M， and LGZGT-H groups decreased significantly （P<0.05）. After administration， the cell swelling in the LGZGT-M， LGZGT-H， and donepezil hydrochloride groups improved， cell protrusions shortened， and cell clustering decreased. Compared with the normal group， the expression of IDE and CTSD in the model group decreased significantly （P<0.05）. Compared with the model group， the expression of IDE increased significantly in the LGZGT-M and LGZGT-H groups （P<0.05）. Compared with the model group， the expression of CTSD increased significantly in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups （P<0.05）. The average fluorescence intensity of CTSB in the model group was significantly lower than that in the normal group （P<0.05）. Compared with the model group， the average fluorescence intensity of CTSD in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups increased significantly （P<0.05）. The intracellular content of Aβ_1-42 in cells in the model group was significantly higher than that in the normal group （P<0.05）. After administration， compared with the model group， the intracellular content of Aβ_1-42 in cells in the LGZGT-L， LGZGT-M， LGZGT-H， and donepezil hydrochloride groups decreased significantly （P<0.05）， and LGZGT-containing serum reduced Aβ_1-42 in a dose-dependent manner （P<0.05）. ConclusionLGZGT has a protective effect on Aβ_1-42-induced AS and can promote the degradation of Aβ. Its mechanism may be related to reducing Aβ toxicity， enhancing cell viability， promoting the expression of IDE， CTSD， and CTSB， and restoring lysosomal function.

Objective:To investigate the effect of total saponins of Panax japonicus(TSPJ) on ferroptosis of myocardial cells in diabetic cardiomyopathy(DCM) rats and underlying mechanism.Methods:Experiment 1: SD rats were divided into control group, DCM group, low-dose TSPJ group, high-dose TSPJ group, and metformin(Met) group, with 10 rats in each group. Experiment 2: SD rats were divided into control group, DCM group, TSPJ group, adenosine monophosphate-activated protein kinase(AMPK) inhibitor Compound C group, and TSPJ+ AMPK agonist AICAR group, with 10 rats in each group. Except for the control group, all rats were intraperitoneally injected with streptozotocin to construct a DCM model. After 8 weeks of corresponding drug intervention, the body weight as well as glucose and lipid metabolism of rats in each experimental group were assessed, and the cardiac function indicators were detected with echocardiography. The levels of serum lactate dehydrogenase(LDH), cardiac troponin I(cTnI) and creatine kinase isoenzyme MB(CK-MB) were detected by ELISA technique. The pathological changes of myocardial tissue were observed using hematoxylin-eosin(HE) staining. The levels of dismutase(SOD), glutathione(GSH), malondialdehyde(MDA), reactive oxygen species(ROS) and Fe 2+ in myocardial tissue were detected. Western blot was used to detect ferroptosis, ferritinophagy, and the AMPK/mammalian target of rapamycin/UNC-51-like kinase 1(mTOR/ULK1) signaling pathway related proteins expression in myocardial tissue. Results:Compared with control group, left ventricular ejection fraction(EF), left ventricular short axis shortening rate(FS), peak blood velocity ratio(E/A) between early and late diastolic periods were significantly decreased in DCM group, left ventricular inner diameter(LVEDd) was increased, and the serum LDH, cTnI, CK-MB were increased, the levels of SOD, GSH were decreased, MDA, ROS, Fe 2+ were increased in myocardial tissue, the expressions of TFR1, NCOA4 LC3-II/LC3-I, Beclin-1, phosphorylated AMPK and phosphorylated ULK1 were increased, the expressions of GPX4, SLC7A11 and phosphorylated mTOR were decreased. Compared with DCM group, the above indicators of rats were significantly improved in each treatment group. Compared with the TSPJ group, the AMPK agonist AICAR reversed the effects of TSPJ on ferroptosis and ferritinophagy mediated by the AMPK/mTOR/ULK1 pathway in DCM rat cardiomyocytes. Conclusion:TSPJ can inhibit ferroptosis in DCM rat cardiomyocytes and improve myocardial injury by regulating AMPK/mTOR/ULK1 mediated ferritinophagy.

The debate over the governor of spirit is an age-old yet ever-renewing topic in Traditional Chinese Medicine(TCM).The theory primarily revolves around three viewpoints:the heart governs the spirit,the brain governs the spirit,and the heart and brain have a joint role governing the spirit.This article,proceeding from the debate on the dominance of the divine spirit,aims to establish a novel perspective that integrates second-generation cognitive science with the TCM theory of the divine spirit based on their shared concerns regarding cognitive issues.Consciousness is the holistic living organism,and according to the cognitive concepts of second-generation cognitive science,consciousness is an interactive process between the body and the environment.Incorporating the embodied characteristics of the second-generation cognitive science,which emphasizes a return to the human body,behavior,and environment,and its holistic research paradigm into the exploration of the TCM theory of the divine spirit can provide a novel interpretive perspective for the debate on the dominance of the divine spirit.Additionally,conducting an in-depth analysis of the commonalities and differences between second-generation cognitive science and the TCM theory of the divine spirit offers theoretical principles and new research pathways for further developing the TCM theory of the divine spirit.This study has remarkable value in promoting the modernization of the TCM theory of the divine spirit.

Objective:To evaluate preliminary application effects of a provincial-county-township-village four-level network framework which aims at promoting oral health of the elderly, and to conduct preliminary evaluations of the application of this model in the prevention and treatment of oral diseases among the elderly in economically accelerated areas.Methods:Based on the population survey in June 2022, the study focuses on the elderly (≥85 years old) veterans who fought in the Korean War and currently resided in Wuyi County, an old revolutionary base area in Zhejiang Province with accelerated economic development. A four-level network medical service model matrix was constructed, spanning from the provincial level to the county, township, and village. Digital oral health records were established, and in-home dental treatment was provided for elderly individuals who met the inclusion and exclusion criteria. Pre-treatment and 3-months follow-up visits were conducted, and the impact of oral health was recorded using a scale, along with a survey of denture satisfaction.Results:A total of 54 elderly individuals received the geriatric oral healthcare services. After a 3-months follow-up, the mean total score of the oral health impact profile-14 questionnaires was (3.27±3.00), which was significantly lower than the score (32.82±7.15) in pre-treatment ones ( Z=-2.94, P=0.003). Scores in dimensions such as physical pain, functional limitations, psychological discomfort, psychological disorders, and physical disorders were all significantly lower than the pre-treatment scores ( P<0.05). The visual analogue score for denture satisfaction was 48.64±1.21, indicating a satisfaction rate of 100% (11/11). Conclusions:These findings confirm the favorable preliminary application effects of the four-level network framework in improving the prevention and treatment of oral diseases among the elderly in economically accelerated areas.

Objective:To study the life characteristics and related risk factors of patients with depression in Shandong Province.Methods:Based on the 2015 mental epidemiological survey database in Shandong Province,a total of 832 patients with depression,807 high-risk individuals with depression,and 819 low-risk individuals were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)and the Structured Clinical Interview for DSM-Ⅳ-TR Axis I Disorders,Research Version(SCID-I/P).In 2020,SCID-I/P was used for re diagnosis,and the General Health Questionnaire(GHQ-12),Simple Quality of Life question-naire,Pittsburgh sleep quality index(PSQI),Childhood Trauma Questionnaire(CTQ),Social Support Rating Scale(SSRS),Global Pain Scale(GPS),Montreal Cognitive Assessment(MoCA),Simplified Coping Style Question-naire(SCSQ)were used for evaluation.Compare changes in the quality of life of depression patients and construct a risk factor model.Results:Patients with depression had lower scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those in the high-and low-risk groups,those in remission of depression had higher scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those in non-re-mission,and those with new-onset disorder in the high-and low-risk groups had lower scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those with no-onset disorder(Ps＜0.001).Depres-sion diagnosis and PSQI scale scores at baseline negatively predicted at retest after 5 years(β=-0.06,-0.15),while coping style tendencies at baseline positively predicted(β=0.06).The simple quality of life questionnaire at baseline negatively predicted depression diagnosis at retest after 5 years,GHQ-12 scores at retest after 5 years,and PSQI scale scores at retest after 5 years(β=-0.11,-0.17,-0.09),while the simple quality of life question-naire at baseline positively predicted coping style tendencies at retest after 5 years(β=0.13).Depression diagnosis at retest after 5 years,GHQ-12 scores at retest after 5 years,PSQI scale scores at retest after 5 years,coping style tendencies at retest after 5 years,SSRS scale scores,CTQ scale scores,GPS scale scores,and the simple quality of life questionnaire at baseline all influenced the simple quality of life questionnaire at retest after 5 years through ei-ther direct or indirect pathways.Conclusion:It suggest that the quality of life is lower in patients with depression than in the general population.Depression diagnosis,sleep,mental health,pain,social support,childhood trauma and coping are direct and indirect risk factors affecting life.

Objective:To evaluate the intervention effectiveness of acceptance and commitment therapy(ACT)for patients with depressive disorders.Methods:A computer search of the Web of Science Core Collection,Pubmed,EMBASE,Cochrane Library,PsycINFO,CNKI,WanFang and WeiPu full-text databases(until October 23,2023)was used to collect randomized controlled studies that used acceptance and commitment therapy for trea-ting patients with depressive disorders.Using Stata 17 software,meta-analysis was performed on the literature data that met the inclusion criteria.Results:After screening,11 studies remained for data extraction.The results of a ran-dom effects model indicated that ACT could significantly reduce depression levels in patients with depressive disor-ders(SMD=-1.22,95％CI:-2.05--0.40,P＜0.01),and had a certain maintenance effect(SMD=3.59,95％CI:1.57-5.62,P＜0.01).Conclusion:Acceptance and commitment therapymay could improve the level of depression in patients.

Objective To discuss the clinical value of echocardiographic indicators in assessing the short-term efficacy of transcatheter aortic valve replacement(TAVR)and surgical aortic valve replacement(SAVR)in treating patients with severe aortic valve stenosis(AS).Methods The clinical data of 70 patients with severe AS,who received treatment at the Daping Hospital of Army Military Medical University of China between June 2019 and September 2022 were retrospectively analyzed.The patients were divided into SAVR group(n=40)and TAVR group(n=30).The preoperative one-week and postoperative one-month echocardiographic indicators were compared between the two groups.Results In both groups,the postoperative one-month peak aortic valve velocity(Vmax),aortic valve mean transvalvular pressure gradient(mPG),relative thickness of chamber wall(RWT),and left ventricular mass index(LVMI)were decreased when compared with preoperative values(all P＜0.05);in TAVR group the left ventricular ejection fraction(LVEF),LVMI and incidence of perivalvular leakage were remarkably higher than those in SAVR group,while the Vmax and mPG were obviously lower than those in SAVR group(all P＜0.05).In TAVR group,the mitral regurgitation decreased from preoperative 12 patients(40％)to postoperative 2 patients(6.7％)and the over-moderate tricuspid regurgitation decreased from preoperative 7 patients(23.3％)to postoperative one patient(3.3％)(all P＜0.05).In SAVR group,the mitral regurgitation decreased from preoperative 15 patients(37.5％)to postoperative 2 patients(5.0％)and the over-moderate tricuspid regurgitation decreased from preoperative 9 patients(22.5％)to postoperative one patient(2.5％)(all P＜0.05).The pulmonary artery hypertension in TAVR group decreased from preoperative 17 patients(56.7％)to postoperative 4 patients(13.3％),which in SAVR group decreased from preoperative 22 patients(55.0％)to postoperative 5 patients(12.5％)(P＜0.05),but the differences in the above indexes between the two groups were not statistically significant(all P＞0.05).Conclusion TAVR and SAVR have similar efficacy in improving secondary valve regurgitation and pulmonary artery hypertension caused by severe AS.TAVR is superior to SAVR in improving postoperative ventricular reverse remodeling and hemodynamics,although the incidence of paravalvular leakage in TAVR is higher than that in SAVR.(J Intervent Radiol,2024,33:479-482)

Objective:To establish an early prediction model based on triglyceride glucose index (TyG) and procalcitonin (PCT) for patients of acute pancreatitis (AP) complicated with acute kidney injury (AKI), and evaluate the diagnostic value of prediction model.Methods:This study was a single center prospective study. AP patients were recruited from the Emergency Department at Peking University People’s Hospital from January to December 2022. The observation endpoint was 14 days after the diagnosis of acute pancreatitis, patients were divided into AKI and control (no AKI) groups according to the observation endpoint. The general characteristics, clinical laboratory examinations, complications, and clinical scores were compared. The risk for AKI development was determined using logistic analyses to establish a risk prediction model. The receiver operating characteristic curve was drawn and the area under the curve (AUC) was calculated. The diagnostic sensitivity and specificity of the model were calculated, and the diagnostic value of the model was compared with that of Ranson score, APACHEⅡ score and BISAP score.Results:A total of 258 patients were selected for this study, including 79 in the AKI group and 179 in the control group. There was no significant difference in serum creatinine and blood urea nitrogen levels between the two groups. Compared with the control group, the AKI group had a higher proportion of males, older age, and had a higher proportion of hypertension. The ratio of neutrophil/lymphocyte ratio, PCT, and TyG were significantly increased. The Ranson score, APACHE Ⅱ score, and BISAP score were higher, and more patients had ARDS and serous fluid accumulation in the later period. Multivariate logistic regression showed that age ( OR=1.071, 95% CI: 1.020-1.125, P=0.006), increased TyG index ( OR=2.632, 95% CI: 1.423-4.866, P=0.002), and elevated PCT ( OR=1.275, 95% CI: 1.067-1.524, P=0.008) were risk factors for AKI in AP patients. According to the risk factors, forecast the AP patients complicated with AKI risk assessment model is established: Logistic (AKI/AP) = -16.697+0.069×age+ 0.968×TyG+0.243×PCT. The sensitivity and specificity of the model for predicting AKI in AP were 79.75% and 96.65%, respectively, and the AUC was 0.856 (95% CI: 0.790-0.922). The predictive ability was better than that of Ranson score, BISAP score and APACHE Ⅱ score (AUC: 0.856 vs. 0.691 vs. 0.745 vs. 0.705, P=0.041). Conclusion:The prediction model based on age, TyG and PCT was valuable for the prediction of AP concurrent AKI in early stage.