To investigate the correlation between vitamin D nutritional status and insulin resistance in pubertal adolescents.

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*

With the rapid advancement of artificial intelligence technology, chatbots have shown great potential in the healthcare sector. From personalized health advice to chronic disease management and psychological support, chatbots have demonstrated significant advantages in improving the efficiency and quality of healthcare services. As the scope of their applications expands, the relationship between technological complexity and practical application scenarios has become increasingly intertwined, necessitating a more comprehensive evaluation of both aspects. This paper, from the perspective of he althcare applications, systematically reviews the technological pathways and development of chatbots in the medical field, providing an in-depth analysis of their performance across various medical scenarios. It thoroughly examines the advantages and limitations of chatbots, aiming to offer theoretical support for future research and propose feasible recommendations for the broader adoption of chatbot technologies in healthcare.

Background and Purpose:Neoadjuvant immunotherapy currently significantly enhances treatment efficacy for locally advanced rectal cancer(LARC);However,clinical management of immune-related adverse events(irAEs)lacks robust evidence.This study aimed to investigate the characteristics,clinical management strategies,and outcomes of irAEs during neoadjuvant immunotherapy for rectal cancer,providing a basis for optimizing irAEs monitoring and intervention.Methods:We retrospectively analyzed clinical data from LARC patients who developed irAEs after receiving neoadjuvant immunotherapy at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,between July 2022 and June 2024.Types of irAEs,severity,time of onset,management strategies,and outcomes were recorded.All patients underwent regular follow-up for at least 6 months.This study has been approved by Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(ethical approval number:I-24PJ0024).Descriptive statistics were used to summarize irAEs patterns and management approaches.Results:A total of 41 irAE episodes occurred among the 30 patients.Mild irAEs(Grade 1-2)accounted for 78.0%(32/41),while severe irAEs(Grade 3-4)constituted 22.0%(9/41).Five patients(16.7%)permanently discontinued treatment due to severe toxicity.Endocrine toxicities were most frequent(36.6%,15/41),primarily characterized by progression from hyperthyroidism to hypothyroidism;75.0%required thyroid hormone replacement therapy.One case of delayed-onset adrenal insufficiency was alleviated with glucocorticoid(GC)therapy.Among hepatotoxicities(19.5%,8/41),62.5%were Grade 3 injury,and 37.5%required GC intervention;two patients experienced recurrence during adjuvant chemotherapy.Three cases of severe myositis occurred,accompanied by asymptomatic myocardial injury(evidenced by markedly elevated creatine kinase and concurrent changes in cardiac biomarkers),all requiring high-dose GC pulse therapy combined with intravenous immunoglobulin or immunosuppressants(recovery period:2-4 months).Nine dermatological reactions were managed with topical therapy.Two gastrointestinal events occurred,including one Grade 3 diarrhea treated with GCs.The overall GC usage rate was 31.7%(13/41),with 76.9%administered for Grade≥3 irAEs.Conclusion:irAEs during neoadjuvant immunotherapy for LARC are predominantly mild-to-moderate and manageable with supportive care.However,some patients develop severe(Grade 3-4)irAEs requiring multidisciplinary management.GC usage is concentrated in higher-grade irAEs,with severe myositis and cardiac involvement necessitating intensive immunosuppressive therapy despite their rarity.Recurrence of irAEs during adjuvant chemotherapy in a minority of patients underscores the necessity for early recognition,graded intervention,and comprehensive management throughout the entire treatment cycle.

Vascular cognitive impairment (VCI), caused by cerebrovascular dysfunction, severely impacts the quality of life in the elderly population, yet effective therapeutic approaches remain limited. Mitophagy, a selective mitochondrial quality-control mechanism, has emerged as a critical focus in neurological disease research. Accumulating evidence indicates that mitophagy modulates oxidative stress, neuroinflammation, and neuronal apoptosis. Key signaling pathways associated with mitophagy—including PINK1/Parkin, BNIP3/Nix, FUNDC1, PI3K/Akt/mTOR, and AMPK—have been identified as potential therapeutic targets for VCI. This review summarizes the mechanistic roles of mitophagy in VCI pathogenesis and explores emerging therapeutic strategies targeting these pathways, aiming to provide novel insights for clinical intervention and advance the development of effective treatments for VCI.

Objective:To explore the effect of Simo decoction improving the low duodenal inflammation and protecting the du-odenal mucosal barrier in rats with functional dyspepsia(FD).Methods:Sixty SD rats were randomly divided into control group(10 rats)and model group(50 rats),and the modeling rats were prepared by multivariate intervention method.After successful modeling,the modeling rats were randomly divided into model group,Simo decoction high-dose,medium-dose,low-dose group and mosapride group,with 10 rats in each group.The high-dose,medium-dose,and low-dose groups of Simo decoction were ga-vage given 5.62 g/kg,2.81 g/kg,and 1.40 g/kg,respectively,and the mosapride group was gavage given 0.305 mg/kg of mosapride,and the control group and model group were gavage given the same amount of distilled water for 14 days.The body weight of rats was observed;gastric emptying rate and small bowel propulsion rate were measured;transmission electron microscopy was used to observe the morphology of duodenal epithelial cells;ELISA detected serum levels of IL-17A and IL-22;Western blot and immunohistochemis-try were used to detect the expressions of protease-activated receptor 2(PAR-2)and tight junction protein(ZO-1,claudin-1)in the duodenum.Results:Compared with the control group,the body weight,gastric emptying rate and small intestinal propulsion rate of the model group were significantly reduced(P<0.01),transmission electron microscopy showed widening of the duodenal epithelial cell space,serum IL-17A and IL-22 levels were significantly increased(P<0.01),the expression of PAR-2 in duodenal tissue was in-creased,and the expressions of ZO-1 and claudin-1 were downregulated(P<0.01).Compared with model group,the gastric emptying rate and small intestinal propulsion rate in Simo decoction high-dose,medium-dose and mosapride group were increased(P<0.05,P<0.01),the contents of IL-17A and IL-22 in serum decreased(P<0.05,P<0.01),and the expression of PAR-2 in duodenal tissues was down-regulated,the expressions of ZO-1 and claudin-1 was significantly increased(P<0.01).The low-dose group of Simo soup could improve weight loss(P<0.01),reduce IL-17A content and PAR-2 expression,and increase ZO-1 and claudin-1 expression(P<0.05,P<0.01),while the effect on other indexes was not obvious.Conclusion:Simo decoction may reduce low-grade duodenal in-flammation to repair the mucosal barrier by down-regulating the levels of IL-17A and IL-22 and the expression of PAR-2,and up-regu-lating the expression of ZO-1 and claudin-1,so as to exert the effect of FD treatment.

Background and Aims:For patients with mid-to-low rectal cancer who achieve clinical complete response(cCR)or near-cCR after neoadjuvant chemoradiotherapy(nCRT),the key concern for both clinicians and patients is how to preserve anal function as much as possible without significantly compromising oncological outcomes.This study was performed to evaluate the safety and feasibility of local excision as an anus-preserving approach in rectal cancer patients with cCR or near-cCR.Methods:A retrospective analysis was conducted on 51 patients with mid-to-low rectal cancer who underwent local resection after achieving cCR or near-cCR following nCRT at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,between March 2014 and July 2023.The clinical characteristics,imaging and pathological findings,surgical outcomes,as well as oncological and functional results were reviewed.Results:Among the 51 patients,34 were male and 17 were female,with a mean age of 61±14 years.Pre-nCRT imaging staging showed:cT1-2N0 in 12 cases(23.5％),cT3N0 in 13 cases(25.5％),cT1-3N0-1 in 19 cases(37.4％),and cT1-3N2 in 7 cases(13.7％).The average tumor distance from the anal verge was(4.5±1.1)cm.After achieving cCR or near-cCR following nCRT,all patients underwent local resection:40 cases(78.4％)underwent transanal endoscopic microsurgery(TEM),7 cases(13.7％)underwent transanal minimally invasive surgery(TAMIS),and 4 cases(7.8％)underwent conventional transanal local excision.The postoperative complication rate was 27.5％(14/51),with 71.4％classified as Clavien-Dindo grade Ⅰ.Postoperative histopathology showed ypT0 in 26 cases(51.0％),ypT1 in 8 cases(15.7％),ypT2 in 16 cases(31.4％),and ypT3 in 1 case(2.0％).The concordance rate between pathological results and preoperative imaging was 54.9％.Over a median follow-up of 60 months(range:34-79),there were 4 cases(7.8％)of local recurrence,12 cases(23.5％)of distant metastasis,and 5 cancer-related deaths(9.8％).Six months postoperatively,both the Wexner score and the low anterior resection syndrome(LARS)score significantly improved compared to post-nCRT values[Wexner:1(0-2)vs.2(1-5);LARS:3.3±5.75 vs.4.3±6.86;both P＜0.01].Conclusion:For patients with mid-to-low rectal cancer who achieve cCR or near-cCR after nCRT,local en bloc resection of the bowel wall lesions enables accurate assessment of residual tumor status and facilitates personalized subsequent treatment,potentially sparing some patients from radical surgery.Local resection can be a viable anus-preserving option for patients who are unfit for or strongly averse to radical resection.However,local excision cannot replace radical surgery,and its precise indications warrant further investigation.

Objective:To explore the effect of Simo decoction improving the low duodenal inflammation and protecting the du-odenal mucosal barrier in rats with functional dyspepsia(FD).Methods:Sixty SD rats were randomly divided into control group(10 rats)and model group(50 rats),and the modeling rats were prepared by multivariate intervention method.After successful modeling,the modeling rats were randomly divided into model group,Simo decoction high-dose,medium-dose,low-dose group and mosapride group,with 10 rats in each group.The high-dose,medium-dose,and low-dose groups of Simo decoction were ga-vage given 5.62 g/kg,2.81 g/kg,and 1.40 g/kg,respectively,and the mosapride group was gavage given 0.305 mg/kg of mosapride,and the control group and model group were gavage given the same amount of distilled water for 14 days.The body weight of rats was observed;gastric emptying rate and small bowel propulsion rate were measured;transmission electron microscopy was used to observe the morphology of duodenal epithelial cells;ELISA detected serum levels of IL-17A and IL-22;Western blot and immunohistochemis-try were used to detect the expressions of protease-activated receptor 2(PAR-2)and tight junction protein(ZO-1,claudin-1)in the duodenum.Results:Compared with the control group,the body weight,gastric emptying rate and small intestinal propulsion rate of the model group were significantly reduced(P<0.01),transmission electron microscopy showed widening of the duodenal epithelial cell space,serum IL-17A and IL-22 levels were significantly increased(P<0.01),the expression of PAR-2 in duodenal tissue was in-creased,and the expressions of ZO-1 and claudin-1 were downregulated(P<0.01).Compared with model group,the gastric emptying rate and small intestinal propulsion rate in Simo decoction high-dose,medium-dose and mosapride group were increased(P<0.05,P<0.01),the contents of IL-17A and IL-22 in serum decreased(P<0.05,P<0.01),and the expression of PAR-2 in duodenal tissues was down-regulated,the expressions of ZO-1 and claudin-1 was significantly increased(P<0.01).The low-dose group of Simo soup could improve weight loss(P<0.01),reduce IL-17A content and PAR-2 expression,and increase ZO-1 and claudin-1 expression(P<0.05,P<0.01),while the effect on other indexes was not obvious.Conclusion:Simo decoction may reduce low-grade duodenal in-flammation to repair the mucosal barrier by down-regulating the levels of IL-17A and IL-22 and the expression of PAR-2,and up-regu-lating the expression of ZO-1 and claudin-1,so as to exert the effect of FD treatment.

The 2021 version of the Baveno Ⅶ consensus on portal hypertension and the 2023 guidelines from the European Association for the Study of the Liver define recompensated cirrhosis as the restoration and stabilization of liver function, improvement of liver fibrosis, and absence of decompensated cirrhosis for a long time following effective treatment of the underlying etiology of cirrhosis. Recompensated cirrhosis has become an important research direction in the field with the gradually increasing number of these patients. Temporary recompensation, stable recompensation, and long-term recompensation are the three stages into which patients with cirrhosis are divided, based on varying recompensation stages. Clinical characteristics and prognosis are significantly different among different stages. Patients in the temporary compensation stage have significant fluctuations in their condition and poor stability, with a high risk of recurrent complications. The prognosis of patients in the stable recompensation stage is significantly affected by the cause and the type of initial decompensation event, while the condition of patients in the long-term recompensation stage is more stable, and the long-term prognosis is close to that of compensated cirrhosis. This article aims to summarize and explore the recompensation rates at different stages of liver cirrhosis, the occurrence risk of various complications and liver cancer, and long-term management and treatment following recompensation, providing new directions for future research in this field.

Background and Purpose:Neoadjuvant immunotherapy currently significantly enhances treatment efficacy for locally advanced rectal cancer(LARC);However,clinical management of immune-related adverse events(irAEs)lacks robust evidence.This study aimed to investigate the characteristics,clinical management strategies,and outcomes of irAEs during neoadjuvant immunotherapy for rectal cancer,providing a basis for optimizing irAEs monitoring and intervention.Methods:We retrospectively analyzed clinical data from LARC patients who developed irAEs after receiving neoadjuvant immunotherapy at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,between July 2022 and June 2024.Types of irAEs,severity,time of onset,management strategies,and outcomes were recorded.All patients underwent regular follow-up for at least 6 months.This study has been approved by Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(ethical approval number:I-24PJ0024).Descriptive statistics were used to summarize irAEs patterns and management approaches.Results:A total of 41 irAE episodes occurred among the 30 patients.Mild irAEs(Grade 1-2)accounted for 78.0%(32/41),while severe irAEs(Grade 3-4)constituted 22.0%(9/41).Five patients(16.7%)permanently discontinued treatment due to severe toxicity.Endocrine toxicities were most frequent(36.6%,15/41),primarily characterized by progression from hyperthyroidism to hypothyroidism;75.0%required thyroid hormone replacement therapy.One case of delayed-onset adrenal insufficiency was alleviated with glucocorticoid(GC)therapy.Among hepatotoxicities(19.5%,8/41),62.5%were Grade 3 injury,and 37.5%required GC intervention;two patients experienced recurrence during adjuvant chemotherapy.Three cases of severe myositis occurred,accompanied by asymptomatic myocardial injury(evidenced by markedly elevated creatine kinase and concurrent changes in cardiac biomarkers),all requiring high-dose GC pulse therapy combined with intravenous immunoglobulin or immunosuppressants(recovery period:2-4 months).Nine dermatological reactions were managed with topical therapy.Two gastrointestinal events occurred,including one Grade 3 diarrhea treated with GCs.The overall GC usage rate was 31.7%(13/41),with 76.9%administered for Grade≥3 irAEs.Conclusion:irAEs during neoadjuvant immunotherapy for LARC are predominantly mild-to-moderate and manageable with supportive care.However,some patients develop severe(Grade 3-4)irAEs requiring multidisciplinary management.GC usage is concentrated in higher-grade irAEs,with severe myositis and cardiac involvement necessitating intensive immunosuppressive therapy despite their rarity.Recurrence of irAEs during adjuvant chemotherapy in a minority of patients underscores the necessity for early recognition,graded intervention,and comprehensive management throughout the entire treatment cycle.