Objective:To develop a Protection Motivation Questionnaire(PMQ)for frailty management in the elderly based on the Protection Motivation Theory(PMT), and test its reliability and validity.Methods:Guided by PMT, the initial questionnaire items were formulated through literature review, semi-structured interviews, and Delphi expert consultation.A total of 551 elderly patients with frailty from a tertiary hospital in Changsha were investigated.Item screening was conducted via critical ratio method, Cronbach's α coefficient, correlation analysis, and factor analysis.The reliability was assessed through internal consistency and test-retest reliability, while validity was evaluated via content validity and structural validity.Results:The final PMQ comprised 25 items across five dimensions: severity, susceptibility, response efficacy, response cost, and self-efficacy.The overall Cronbach's α coefficient was 0.818, with subscale coefficients ranging from 0.701 to 0.821.The split-half reliability was 0.811, test-retest reliability was 0.929, and content validity indexwas 0.86.Exploratory factor analysis extracted five factors, accounting for 52.0% of the cumulative variance.Confirmatory factor analysis demonstrated good model fit( χ2/df=1.626, RMSEA=0.05, CFI =0.914). Conclusions:The developed questionnaire exhibits strong reliability and validity, serving as an effective tool to assess protection motivation for frailty management in the elderly.

Objective To investigate the renal function recovery and perioperative risk factors for chronic kidney disease in patients after acute Stanford type A aortic dissection (ATAAD) repair. Methods A retrospective study was conducted on patients who underwent ATAAD repair at the Xiamen Cardiovascular Hospital, Xiamen University from 2020 to 2021, and their clinical data were analyzed. Results A total of 255 patients were included, with 200 males and 55 females, and an average age of (52.80±12.46) years. The incidence of acute kidney injury (AKI) after ATAAD repair was 43.9%. Dissection involving the renal artery [OR=2.144, 95%CI (1.234, 3.765), P=0.007], intraoperative urine output [OR=0.761, 95%CI (0.625, 0.911), P=0.004], and intraoperative red blood cell transfusion [OR=1.288, 95%CI (1.088, 1.543), P=0.004] were significantly associated with early AKI after ATAAD repair. Long-term renal function follow-up data were available for 232 patients, among whom 40 (17.2%) patients developed chronic kidney disease (CKD). Independent predictors for CKD included lower body mass index [OR=0.827, 95%CI (0.723, 0.931), P=0.003], preoperative cardiac tamponade [OR=5.344, 95%CI (1.65, 17.958), P=0.005], preoperative renal hypoperfusion syndrome [OR=12.629, 95%CI (5.003, 35.373), P<0.001], postoperative peak serum creatinine time>3 d [OR=7.566, 95%CI (2.799, 22.731), P<0.001], and AKI grade [grade 1: OR=4.418, 95%CI (1.339, 15.361), P=0.016; grade 2: OR=8.345, 95%CI (1.762, 40.499), P=0.007; grade 3: OR=9.463, 95%CI (2.602, 37.693), P<0.001]. Conclusion AKI related to ATAAD repair can recover in the early postoperative period, but both the duration and severity of AKI will affect long-term renal function. In addition, patients' nutritional status, preoperative cardiac tamponade, and renal hypoperfusion syndrome are also independent risk factors for long-term renal dysfunction.

Objective:To develop a Protection Motivation Questionnaire(PMQ)for frailty management in the elderly based on the Protection Motivation Theory(PMT), and test its reliability and validity.Methods:Guided by PMT, the initial questionnaire items were formulated through literature review, semi-structured interviews, and Delphi expert consultation.A total of 551 elderly patients with frailty from a tertiary hospital in Changsha were investigated.Item screening was conducted via critical ratio method, Cronbach's α coefficient, correlation analysis, and factor analysis.The reliability was assessed through internal consistency and test-retest reliability, while validity was evaluated via content validity and structural validity.Results:The final PMQ comprised 25 items across five dimensions: severity, susceptibility, response efficacy, response cost, and self-efficacy.The overall Cronbach's α coefficient was 0.818, with subscale coefficients ranging from 0.701 to 0.821.The split-half reliability was 0.811, test-retest reliability was 0.929, and content validity indexwas 0.86.Exploratory factor analysis extracted five factors, accounting for 52.0% of the cumulative variance.Confirmatory factor analysis demonstrated good model fit( χ2/df=1.626, RMSEA=0.05, CFI =0.914). Conclusions:The developed questionnaire exhibits strong reliability and validity, serving as an effective tool to assess protection motivation for frailty management in the elderly.

Background and Aims:Accurate early pathogen diagnosis is a breakthrough for improving the prognosis of infectious pancreatic necrosis(IPN)patients.However,there is currently a lack of efficient methods for early identification of IPN in clinical settings.This study was performed to assess the application value of next-generation sequencing technology based on metagenomic capture(MetaCAP)in the pathogen diagnosis of IPN. Methods:A prospective study was conducted on 29 patients suspected of having acute necrotizing pancreatitis at Xiangya Hospital of Central South University between January and July 2024.Blood samples were tested using MetaCAP and conventional pathogen culture.The results of peritoneal fluid pathogen culture were used as the gold standard to compare the diagnostic efficacy of the two methods. Results:Due to three cases lacking peritoneal fluid culture results,a total of 26 cases were included in the final analysis.The overall mortality rate was 23.1％(6/26).During hospitalization,9 cases(34.6％)were diagnosed with IPN.The sensitivity and negative predictive value of MetaCAP for diagnosing IPN were significantly higher than those of conventional pathogen culture(77.8％vs.11.1％,P=0.031;86.7％vs.65.2％,P=0.032),while the differences in specificity(76.5％vs.88.2％,P=0.689)and positive predictive value(63.6％vs.33.3％,P=0.347)between the two methods were not statistically significant.The average detection time for MetaCAP was 33(20-49)h,while microbial culture took 125(45-142)h,with a significant difference(P＜0.001).The average cost for blood MetaCAP testing was 2 500 yuan per case,but it accounted for only 1.19％of the average hospitalization cost. Conclusion:MetaCAP has significant value in the early pathogen diagnosis of IPN,with a shorter detection time,good testing efficacy,and health-economic value,demonstrating a promising clinical application prospect.

For most patients undergoing clear aligner treatment, it could be necessary to bond multiple attachments on their tooth surfaces. The clear aligner attachment is designed to enhance aligner retention, transmit orthodontic forces, and make the programmed tooth movement more predictable. Materials such as restorative resin, orthodontic bonding adhesive, flowable resin, and resin-modified glass ionomer cement are currently used for attachment bonding. But there is currently no conclusion as to which material suits most. The objective of this review is to look into the studies published in recent years, in order to explore the optimal material option for making clear aligner attachments.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Background: TAM receptors (Tyro3, Axl and Mertk), as subfamily of receptor tyrosine kinases, are intracellular negative feedback regulators and play a crucial role in regulating inflammation and immune response. Aims: To study the expressions and clinical value of TAM receptors in serum and intestinal mucosa of patients with ulcerative colitis (UC). Methods: Forty⁃five patients who were initially diagnosed as active UC from June, 2020 to May, 2021 at the First Affiliated Hospital of Kunming Medical University were enrolled prospectively. Fifteen healthy subjects were served as the control group. Eight cases each in moderate UC group and healthy control group were selected randomly for detection of TAM receptors in serum and intestinal mucosa by ELISA, real⁃time PCR and Western blotting. The correlations of serum Tyro3 with routine clinical indicators of UC were analyzed by Pearson correlation coefficient. Furthermore, immunohistochemistry was used to detect the expression level of TAM receptors in intestinal mucosa in all UC patients and the healthy controls. Results: Expressions of Axl and Mertk were not fully consistent in serum and intestinal mucosa in UC patients. While the serum Tyro3 level, as well as the intestinal Tyro3 mRNA and protein expressions were consistently increased in moderate UC patients than in controls (all P<0.05). Serum level of Tyro3 was positively correlated with platelet count and C⁃reactive protein, and negatively correlated with albumin in moderate UC patients (r=0.97, r=0.96, r=-0.86, all P<0.05). Positivity rate of Tyro3 in intestinal mucosa of UC patients was positively correlated with the disease severity (all P<0.05). Conclusions: Tyro3 is closely related to UC and positively correlated with the disease severity. It might be a promising novel molecular marker and therapeutic target of UC.

In orthodontic and orthognathic practice, cephalometric analysis is an integral tool throughout the clinical process. However, as landmark identification is still unautomated, both the conventional and semiautomated approaches are open to considerable subjectivity and could be time-consuming for inexperienced clinicians. Deep learning (DL), a state-of-the-art artificial intelligence (AI) technique, is highly effective in image recognition. In recent years, many studies have focused on the application of DL in cephalometric analysis, including automated landmark detection, automated diagnosis, cervical vertebral maturation stage determination, adenoid hypertrophy analysis and upper airway identification. Studies show that DL can effectively improve the efficiency of cephalometric analysis. In most studies, the accuracy of DL can reach more than 80%, and its difference from the gold standard is clinically acceptable, demonstrating good potential for future applications. However, most studies are limited to landmark detection, and the broadness and richness of the training dataset are limited. Future studies should broaden the research scope, improve the algorithm, elevate the richness of the datasets, and combine DL with other AI algorithms to improve its accuracy, stability and generalizability.

Enamel demineralization is one of the most common adverse reactions to orthodontic treatment. The existence of orthodontic appliances affects oral hygiene maintenance, which easily leads to plaque accumulation and oral flora dysbiosis, and cariogenic bacteria produce acid to cause enamel demineralization. It not only affects aesthetics but may develop into caries and endanger oral health. Therefore, enamel demineralization has become an urgent problem. Nanoparticles generally refer to solid particles with diameters of 1 to 100 nm and have unique physicochemical properties that provide a new strategy for preventing enamel demineralization during orthodontics. Reviewing the relevant literature, nanoparticles used for the prevention of enamel demineralization in orthodontics may be classified into antibacterial, remineralization and carrier-type nanoparticles according to their functions. Most research was performed on the application of nanoparticles to modify orthodontic adhesives for enhancement of antibacterial or remineralization properties, but some studies also focused on the modification of orthodontic appliances with nanoparticles for surface coating or overall doping to provide antimicrobial properties. The advantage of these two approaches is that they are not dependent on patient compliance. Nanoparticle-modified fluoride varnishes and nanocarriers loaded with antimicrobial or remineralization agents may be used to promote oral health care in orthodontic patients, which have a sustained preventive effect but depend on the cooperation of the patient. It was indicated that the small size effect of nanoparticles provides better performance, but there may be certain safety issues, and there is still some influence on the physicochemical properties of the modified materials themselves. These issues must be further explored. Although there are some limitations in the current studies, nanoparticles are expected to play an important role in the prevention of enamel demineralization during orthodontics in the future.

With the deepening of research in oral microbiomics, an important relationship between changes in the oral microbiome and orthodontic treatment has been found. Orthodontic treatment will have an impact on the oral and systemic microbiome. The presence of oral appliances can change the quantity and quality of the oral microbiometo and increase the risk of oral and even systemic diseases in patients undergoing orthodontic treatment. Compared with fixed orthodontic treatment, clear aligners will not have a harmful impact on the structure of the oral microbiome, which is more conducive to maintain oral health during the orthodontic treatment process. In addition, different bracket types and materials can lead to different changes in the oral microbiome, and the occurrence and development of orthodontic-related diseases, such as white spot lesions, dental caries, gingivitis and periodontitis, are also related to changes in the oral microbiome. At present, the role of the oral microbiome in the process of orthodontic treatment needs to be further studied. Whether a change in the oral microbiome caused by orthodontic treatment can be restored after orthodontic treatment is still uncertain and needs more research. This paper reviews the research progress on the application of microbiomics in orthodontics, including the impact of fixed appliances and clear aligners on the microbiome and the relationship between orthodontic-related diseases and the oral microbiome.