Objective: To examine the relationship between self-management behaviors and time perspective among patients with comorbid diabetes, so as to provide the evidence for improving self-management behaviors among patients with comorbid diabetes. Methods: The patients with comorbid diabetes who were registered in the chronic disease health management system of Minhang District, Shanghai Municipality in 2021, followed up regularly, and lived in Meilong Town were recruited. Demographic information and family history of diabetes were collected through questionnaire surveys. Time perspective and self-management behaviors were assessed using the Zimbardo Time Perspective Inventory and Diabetes Self-Management Behavior Scale, respectively. The relationship between self-management behaviors and time perspective was analyzed using a multivariable ordinal logistic regression model. Results: A total of 907 patients with comorbid diabetes were enrolled, including 472 males (52.04%) and 435 females (47.96%). There were 652 cases aged 65 years and above, accounting for 71.89%. In terms of the types of time perspective, 280 patients were future-oriented (30.87%), 236 were balanced (26.02%), 162 were sensation-seeking (17.86%), 123 were fatalistic (13.56%), and 106 were negative (11.69%). In terms of the self-management behaviors, 46 patients were good (5.07%), 643 were moderate (70.89%), and 218 were poor (24.04%). Multivariable ordinal logistic regression analysis showed that after adjusting for age, gender, educational level, marital status, occupation status, monthly income, and family history of diabetes, the patients with comorbid diabetes who had a future-oriented time perspective had better self-management behaviors (OR=1.874, 95%CI: 1.204-2.915). Conclusion The self-management behaviors among patients with comorbid diabetes are moderate to poor, and patients with a future-oriented time perspective can better engage in self-management behaviors.

Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disease characterized by structural or functional abnormalities of motile cilia. It often presents clinically with recurrent respiratory infections, situs inversus, hydrocephalus, and infertility. Currently, there is no clinical treatment to directly restore ciliary motility in PCD patients.In recent years, researchers have explored gene therapy methods such as gene replacement, gene editing, and RNA replacement in vitro and in mouse models, offering potential new strategies for PCD treatment. This paper comprehensively reviews the current status of PCD gene therapy research, evaluates the potential of different gene therapies, and provides an outlook on the future treatment directions for this disease.

Objective: To investigate the trajectories of fasting blood glucose fluctuations and their influencing factors among patients with comorbidity of type 2 diabetes mellitus (T2DM), so as to provide the basis for strengthening blood glucose management in this population. Methods: In October 2023, data of patients diagnosed with comorbid T2DM from January to October 2021, including demographic information, lifestyle, health status and fasting blood glucose were collected through the chronic disease health management system of Minhang District, Shanghai Municipality. Fasting blood glucose fluctuation trajectories were analyzed by group-based trajectory model established based on fasting blood glucose values from January 2021 to October 2023. Influencing factors of fasting blood glucose fluctuation trajectories among patients with comorbidity of T2DM were analyzed using a multinomial logistic regression model. Results: A total of 907 patients with comorbidity of T2DM were enrolled, including 472 males (52.04%) and 435 females (47.96%). There were 652 cases aged ≥65 years, accounting for 71.89%. The group-based trajectory model analysis identified three trajectory groups: a low-level stable group (492 cases, 54.24%), a medium-level stable group (287 cases, 31.64%), and a high-level decreasing group (128 cases, 14.11%). Multinomial logistic regression analysis showed that, compared with the low-level stable group, patients with comorbidity of T2DM who had an education level of junior high school or below (OR=1.420, 95%CI: 1.011-1.995) or college degree or above (OR=2.109, 95%CI: 1.249-3.560), as well as those who engaged in regular exercise (OR=1.387, 95%CI: 1.017-1.893), were more likely to be in the medium-level stable group. Patients with comorbidity of T2DM who were overweight or obese (OR=1.675, 95%CI: 1.116-2.513) or had dyslipidemia (OR=3.195, 95%CI: 1.642-6.216) were more likely to be in the high-level decreasing group. Conclusions From January 2021 to October 2023, the fasting blood glucose levels of patients with comorbidity of T2DM exhibited three fluctuating trajectories: low-level stability, medium-level stability, and high-level decline. Compared with the low-level stable group, the medium-level stable group was mainly influenced by educational level and regular exercise. The high-level decline group was primarily affected by overweight/obesity and dyslipidemia.

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
Humans ; Consensus ; Orthodontics, Corrective/standards* ; Periodontal Diseases/complications* ; Tooth Movement Techniques/methods* ; Practice Guidelines as Topic

Liver diseases have become a major challenge threating the global health, posing a heavy burden on both social and personal well-being. In recent years, the development of the gut-liver axis theory has provided new research perspectives and intervention strategies for the prevention and treatment of liver diseases. Natural products, recognized as biological molecules with diverse sources, rich activities, and minimal side effects, demonstrate great potential in regulating intestinal flora and improving liver health. Studies have shown that natural products such as saponins, polyphenols, polysaccharides, and alkaloids can regulate the composition and metabolites of intestinal flora, thereby intervening in liver diseases. In this paper, we systematically review the role of natural products in the regulation of the intestinal flora-gut-liver axis and summarize recent research progress in the prevention and treatment of liver diseases. Furthermore, we outline the challenges and limitations currently facing the study in this field. Finally, this paper makes an outlook on the clinical application of natural products in treating liver diseases and discusses future research directions, aiming to give new insights into the mechanisms by which natural products regulate the intestinal flora-gut-liver axis and the applications of these products in the prevention and treatment of liver diseases.
Humans ; Gastrointestinal Microbiome/drug effects* ; Liver Diseases/prevention & control* ; Biological Products/pharmacology* ; Polyphenols/pharmacology* ; Saponins/pharmacology* ; Intestines/microbiology* ; Alkaloids/pharmacology* ; Polysaccharides/pharmacology* ; Liver

Objective:The distribution characteristics of intrathecal drugs and the limitation of current catheterization techniques make traditional intrathecal analgesic treatment nearly useless for refractory craniofacial pain,such as trigemina neuralgia.This technical guideline aims to promote the widespread and standardize the application of intra-prepontine cisternal drug delivery via spinal puncture and catheterization. Methods:A modified Delphi approach was used to work for this guideline.On the issues related to the intra-prepontine cisternal targeted drug delivery technique,the working group consulted 10 experts from the field with 3 rounds of email feedback and 3 rounds of conference discussion. Results:For the efficacy and safety of the intra-prepontine cisternal targeted drug delivery technique,a consensus was formed on 7 topics(with an agreement rate of more than 80%),including the principles of the technique,indications and contraindications,patient preparation,surgical specifications for intra-prepontine cisternal catheter placement,analgesic dosage coordination,analgesic management,and prevention and treatment of complications. Conclusion:Utilizing the intra-prepontine cisternal drug infusion system to manage refractory craniofacial pain could provide advantages in terms of minimally invasive,secure,and effective treatment.This application can not only alleviate the suffering of individuals experiencing the prolonged pain but also support the maintenance of quality of life and dignity in their final moments,justifiing its widespread dissemination and standardized adoption in domestic and international professional fields.

ObjectiveTo observe the effects of Agrimoniae Herba and Coptidis Rhizoma（XHC-HL） on the proliferation， migration， invasion， apoptosis， and autophagy of colorectal tumor cells and explore the mechanism of Agrimoniae Herba and Coptidis Rhizoma in inhibiting colorectal cancer by regulating chaperone-mediated autophagy（CMA）. MethodXHC-HL-containing serum was prepared， and human colorectal cancer cell lines HT29 and LOVO were cultivated and divided into blank group （20% blank serum）， low XHC-HL groups （5%， 10%， 20% drug-containing serum）， and a positive control group using 5-fluorouracil （5-FU）. Cell viability was measured using the cell counting kit-8 （CCK-8） method. Cell proliferation ability was assessed through 5-ethynyl-2′-deoxyuridine （EdU） staining. Scratch assays and Transwell migration tests were conducted to evaluate cell migration ability， and Transwell invasion assays were used to assess cell invasion ability. Apoptosis rates were determined by flow cytometry， and the impact of XHC-HL on yeast Atg6 homologous 1 （Beclin-1）， microtubule-associated protein1 light chain3 Ⅱ （LC3 Ⅱ）， and p62 was analyzed via Western blot. The influence of XHC-HL on CMA-related proteins and mRNA was examined using Western blot and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared to that in the blank group， the vitality of colorectal cancer cells HT-29 and LOVO was significantly inhibited in XHC-HL groups and the 5-FU group （P<0.01）. Compared to that in the blank group， the proliferation of colorectal cancer cells HT-29 and LOVO was significantly inhibited in XHC-HL groups and the 5-FU group （P<0.05， P<0.01）. Compared to the blank group， there was a significant reduction in cell migration rates （P<0.01）， the number of cells migrating to the lower chamber （P<0.01）， and the number of invasive cells （P<0.01）， as well as and an increase in cell apoptosis （P<0.01） in XHC-HL groups and the 5-FU group （P<0.01）. Western blot results indicated that compared to that in the blank group， the expression levels of Beclin-1 and LC3 Ⅱ were increased（P<0.05，P<0.01）in XHC-HL groups and the 5-FU group， while the p62 levels were decreased（P<0.05，P<0.01）. Furthermore， the protein expression levels of lysosomal associated protein 2A （LAMP2A）， heat shock cognate protein 70 （HSC70）， and heat-shock protein 90 （HSP90） in XHC-HL groups and the 5-FU group were decreased to varying extents， whereas the expression levels of glyceraldehyde-3-phosphate dehydrogenase （GAPDH） were elevated （P<0.01）. The Real-time PCR results showed that compared to those in the blank group， the mRNA levels of LAMP2A， HSC70， and HSP90 were downregulated in XHC-HL groups and the 5-FU group， and the mRNA expression level of GAPDH was upregulated （P<0.01）. ConclusionXHC-HL can inhibit the proliferation， migration， and invasion of colorectal cancer cells by suppressing CMA activity， thus inducing autophagy and promoting apoptosis.

Objective·To explore the effects of hypertension and dyslipidemia on cognitive function in the elderly.Methods·A dynamic population cohort was established by using prospective cohort study methods.In 2019,a complete cohort was selected from residents aged 65 and above who voluntarily participated in a free physical examination program in a community in Shanghai,serving as the baseline cohort.In 2022,512 community-dwelling elderly aged 67 to 93 were randomly selected from the same community as the follow-up cohort for the study.The collected date included residents' health records,various physical examination measurements,and Mini-mental State Examination(MMSE)scale scores.Results·Of the 512 cases that were followed up,the valid sample size was reduced to 495 after data cleaning.According to the baseline and follow-up cognitive assessments and changes,the cases were categorized into three cognitive groups:the improvement group,the normal group,and the decline group.The prevalence of hypertension in the decline group was 43.14%higher than that in the improvement group and 24.39%higher than that in the normal group(66.67%in the decline group vs 23.53%in the improvement group,P=0.011;66.67%in the decline group vs 42.28%in the normal group,P=0.040).Total cholesterol(TC)in the improvement group was lower than that in the normal group[improvement group(4.38±1.04)mmol/L vs normal group(5.11±1.12)mmol/L,P=0.009].Additionally,TC in the decline group in 2022 was higher than that in 2019[paired difference(0.46±0.87)mmol/L,95%CI 0.08?0.84,P=0.021].LDL-Ch in the improvement group was lower than that in the normal group[improved group(2.51±0.92)mmol/L vs normal group(3.07±1.00)mmol/L,P=0.024],and their HDL-Ch in 2022 was higher than that in 2019[paired difference(0.16±0.20)mmol/L,95%CI 0.06?0.26,P=0.005].The results of multinomial Logistic regression showed:TC in the improved group was lower than that in the normal group[β=4.12,OR=61.64,95%CI 1.52?2494.07,P=0.029]and the decline group[β=5.88,OR=357.35,95%CI 4.54?28149.75,P=0.008];the TAG[β=1.85,OR=6.34,95%CI 1.05?38.43,P=0.045],LDL-Ch[β=5.61,OR=274.06,95%CI 3.65?20567.57,P=0.011],and hypertension[β=1.90,OR=6.69,95%CI 1.53?29.16,P=0.011]in the decline group were higher than those in the improvement group;the age of the decline group was greater than that of the normal group[β=0.08,OR=1.08,95%CI 1.00?1.16,P=0.041],and the education level was lower than that of the normal group[β=1.22,OR=3.39,95%CI 1.28?8.94,P=0.014].Conclusion·Low TC and LDL-Ch and high HDL-Ch are beneficial to cognitive improvement.Conversely,hypertension,high TC,high TAG,high LDL-Ch,low education level,and advanced ages are risk factors for cognitive decline.

Objective:To investigate the effects of Apelin-13 regulatory peptide on neuronal cell pyroptosis in mice modeled with cerebral ischemia-reperfusion(I/R).Methods:We prepared a mouse cerebral I/R model using middle cerebral artery embolization and Reperfusion(MCAO/R).The HT22 cell injury model was prepared by the oxygen glu-cose deprivation/reoxygenation(OGD/R),and Apelin-13 treatment was also given.Neurological function was assessed by neurological deficit score;hematoxylin-eosin(HE)staining and Nissl staining were used to observe the morphologic changes of the infarcted area of the mice;and 2,3,5triphenyltetrazolium chloride(TTC)staining was used to observe the volume of cerebral infarcts;The expression of NOD-like receptor thermoprotein structural domain-related protein 3(NLRP3),gasdermin D(GSDMD),caspase-1,apoptosis-associated speck-like protein(ASC),interleukin 1β(IL-1β),and interleukin 18(IL-18)in brain tissues from infarcted areas or HT22 cells was detected by Western Blot,and IL-1β and IL-18 were detected by enzyme-linked immunosorbent assay(ELISA)in serum of mice and culture supema-tants;The cell viability and cell damage of HT22 were detected by CCK-8 kit and lactate dehydrogenase(LDH)assay kit,respectively;caspase-1 activity was measured by caspase-1 activity kit in HT22 cells;and the expression of caspase-1 and GSDMD was observed by immunofluorescence staining in HT22 cells.Results:Apelin-13 significantly improved neurological function and cerebral infarct volume in I/R mice,and attenuated pathological damage in the in-farcted area.It also reduced the serum levels of IL-1β and IL-18.In addition,Apelin-13 reduced the expression of mol-ecules such as NLRP3,GSDMD,caspase-1,IL-1β,and IL-18 in the cerebral infarct area of mice.In vitro experiments showed that Apelin-13 significantly increased the viability of OGD/R-treated HT22 cells,decreased caspase-1 activity,and reduced the LDH content,as well as decreased the expression of molecules such as NLRP3,GSDMD,caspase-1,IL-1β,IL-18,and so on,in OGD/R-treated HT22 cells.Conclusion:Apelin-13 inhibits pyroptosis through the NL-RP3/caspase-1/GSDMD pathway in cerebral ischemia/reperfusion mice and thus exerts neuroprotective effects.

Primary ciliary dyskinesia(PCD)is a rare monogenic disorder primarily associated with structural and functional abnormalities of motile cilia.It is typically inherited in an autosomal recessive pattern.The disease affects multiple organs,and the variability in clinical phenotypes,along with genetic heterogeneity significantly complicates its diagnosis.Although the application of clinical exome sequencing has significantly improved the diagnostic rate of PCD,more than 30％of patients are still unable to obtain a definitive diagno-sis.This article reviews and discusses the pathogenesis,diagnostic methods,and expanding genetic diag-nostic approaches for patients with PCD that are negative for exome sequencing.The aim of this article is to assist clinicians in selecting more advanced emerging genetic testing technologies,with the hope of increasing the positive diagnostic rate of PCD,deepening the understanding of its genetic pathogenesis,and laying a foundation for the practice of gene therapy in the future.