Objective To investigate the expression profiles of microRNAs(miRNAs)in seminal plasma of the patients with hypervis-cous semen and explore their possible roles in the formation of seminal hyperviscosity.Methods Ten semen samples,including 5 with hyperviscosity(hyperviscosity group)and the other 5 without hyperviscosity(control group),were collected,and the seminal plasmas were obtained by centrifugation after completing semen analysis.The miRNAs in seminal plasma were extracted and performed sequen-cing using high-throughput sequencing technology based on the Illumina platform.The differences in miRNA expression between the two groups were compared.The differentially expressed miRNAs were validated by real-time fluorescence quantitative-PCR(qRT-PCR).The differentially expressed miRNAs were screened to predict their target genes.The Gene Ontology(GO)and KEGG Pathway were used for the enrichment analysis of functional significance.Results A total of 82 significantly differentially expressed miRNAs were found between the hyperviscosity group and the control group,of which 76 were up-regulated and 6 were down-regulated.The results of qRT-PCR validation showed that the expression trends of the differentially expressed miRNAs(miR-449a,miR-517a-3p,and miR-1257)were largely consistent with the high-throughput sequencing results.The GO functional classification annotation showed that their target genes were mainly enriched in ubiquitin-like protein ligase binding,kinase activity,and ion transmembrane transport activi-ty in molecular functions.They mainly participated in the regulation of neuronal apoptosis and ion transmembrane transport in biological processes,and the formation of cell membranes,Golgi membranes and phagocytic vesicles in cellular components.KEGG pathway en-richment analysis showed that the target genes were mainly enriched in signaling pathways,such as ErbB,neurotrophin,interaction with signaling molecules,signal transduction,and cancer-related signal pathways.Conclusion Various differentially expressed miRNAs existed in hyperviscous semen,which may provide a basis for finding a molecular marker or a group of markers in the diagno-sis and evaluation of the treatment for hyperviscous semen.

Currently,aging is a major public health topic globally.Infectious diseases exhibit high incidence and mortality among the elderly,which seriously affect the quality of life of the elderly and cause a heavy economic bur-den.The changes of immune function in the elderly are complicated.Their immune response and clinical immune regulation methods after infection need further clarification.This expert consensus summarizes the immune charac-teristics of the elderly and the inherent connection with infections,the application of glucocorticoids,the use of re-lated immune modulators,as well as diagnosis and treatment under specific conditions,providing high-quality recommendations for clinical practice.

Objective To investigate the expression profiles of microRNAs(miRNAs)in seminal plasma of the patients with hypervis-cous semen and explore their possible roles in the formation of seminal hyperviscosity.Methods Ten semen samples,including 5 with hyperviscosity(hyperviscosity group)and the other 5 without hyperviscosity(control group),were collected,and the seminal plasmas were obtained by centrifugation after completing semen analysis.The miRNAs in seminal plasma were extracted and performed sequen-cing using high-throughput sequencing technology based on the Illumina platform.The differences in miRNA expression between the two groups were compared.The differentially expressed miRNAs were validated by real-time fluorescence quantitative-PCR(qRT-PCR).The differentially expressed miRNAs were screened to predict their target genes.The Gene Ontology(GO)and KEGG Pathway were used for the enrichment analysis of functional significance.Results A total of 82 significantly differentially expressed miRNAs were found between the hyperviscosity group and the control group,of which 76 were up-regulated and 6 were down-regulated.The results of qRT-PCR validation showed that the expression trends of the differentially expressed miRNAs(miR-449a,miR-517a-3p,and miR-1257)were largely consistent with the high-throughput sequencing results.The GO functional classification annotation showed that their target genes were mainly enriched in ubiquitin-like protein ligase binding,kinase activity,and ion transmembrane transport activi-ty in molecular functions.They mainly participated in the regulation of neuronal apoptosis and ion transmembrane transport in biological processes,and the formation of cell membranes,Golgi membranes and phagocytic vesicles in cellular components.KEGG pathway en-richment analysis showed that the target genes were mainly enriched in signaling pathways,such as ErbB,neurotrophin,interaction with signaling molecules,signal transduction,and cancer-related signal pathways.Conclusion Various differentially expressed miRNAs existed in hyperviscous semen,which may provide a basis for finding a molecular marker or a group of markers in the diagno-sis and evaluation of the treatment for hyperviscous semen.

Currently,aging is a major public health topic globally.Infectious diseases exhibit high incidence and mortality among the elderly,which seriously affect the quality of life of the elderly and cause a heavy economic bur-den.The changes of immune function in the elderly are complicated.Their immune response and clinical immune regulation methods after infection need further clarification.This expert consensus summarizes the immune charac-teristics of the elderly and the inherent connection with infections,the application of glucocorticoids,the use of re-lated immune modulators,as well as diagnosis and treatment under specific conditions,providing high-quality recommendations for clinical practice.

Objective To explore the effect of the blood flow restriction(BFR)at 40%arterial oc-clusive pressure(AOP)on ergometer cycling maximal lactate steady state(MLSS).Methods A total of 11 male college students majoring in sports science(age 23±2 yrs,height 176±5 cm,weight 74.6±5.5 kg,body fat 14.5%±4.7%)were selected.The test in this study was divided into 4 parts:① an incremental ramp test to determine the maximal aerobic power(Pmax);② the MLSS test to determine the blood lactate concentration of MLSS(MLSSc),the work load of MLSS(MLSSw),and the percentage of MLSSw relative to Pmax(%MLSSw);③ the 30 min constant load BFR test(MLSS-BFR)of MLSSw based on the test ② to determine the heart rate,blood lactate and subjec-tive fatigue of MLSSw at the BFR;④ MLSS test at BFR(BFR-MLSS)to determine MLSSc and MLSSw.The BFR was performed using an adjustable pressure compression cuff applied externally to the nearest point to the thigh,at a pressure of 40%AOP.Heart rate was monitored throughout the test.When measuring the constant load in test ②③④,restrictive pressure was released for 30 s ev-ery 5 min.During the release,a blood sample was collected from the earlobe for analysis of blood lac-tate.After the constant load test,the perceived exertion was collected immediately.Results MLSSw(152.5±28.8 vs 161.3±28.1 W,P<0.05,ES=0.84)and%MLSSw(53.4%±5.7%vs 56.7%±5.5%,P<0.05,ES=0.82)of BFR-MLSS test were significantly lower than those of MLSS test.However,no significant differences were found between the BFR-MLSS and MLSS test in MLSSc(5.61±1.18 vs 5.61±0.81 mmol/L,P>0.05,ES=0.01),heart rate(152.6±14.8 vs 150.7±10.7 bpm,P>0.05,ES=0.17)and RPE(14.8±3.3 vs 14.9±2.9,P>0.05,ES=0.06).Conclusion BFR exercise achieves MLSS at a lower external load(power output),and does not reduce the internal load of MLSS.Moreover,BFR increases the internal load for the same external load,but the division of the internal load interval seems to be the same during exercise with or without BFR.

Objective To explore the effect of the blood flow restriction(BFR)at 40%arterial oc-clusive pressure(AOP)on ergometer cycling maximal lactate steady state(MLSS).Methods A total of 11 male college students majoring in sports science(age 23±2 yrs,height 176±5 cm,weight 74.6±5.5 kg,body fat 14.5%±4.7%)were selected.The test in this study was divided into 4 parts:① an incremental ramp test to determine the maximal aerobic power(Pmax);② the MLSS test to determine the blood lactate concentration of MLSS(MLSSc),the work load of MLSS(MLSSw),and the percentage of MLSSw relative to Pmax(%MLSSw);③ the 30 min constant load BFR test(MLSS-BFR)of MLSSw based on the test ② to determine the heart rate,blood lactate and subjec-tive fatigue of MLSSw at the BFR;④ MLSS test at BFR(BFR-MLSS)to determine MLSSc and MLSSw.The BFR was performed using an adjustable pressure compression cuff applied externally to the nearest point to the thigh,at a pressure of 40%AOP.Heart rate was monitored throughout the test.When measuring the constant load in test ②③④,restrictive pressure was released for 30 s ev-ery 5 min.During the release,a blood sample was collected from the earlobe for analysis of blood lac-tate.After the constant load test,the perceived exertion was collected immediately.Results MLSSw(152.5±28.8 vs 161.3±28.1 W,P<0.05,ES=0.84)and%MLSSw(53.4%±5.7%vs 56.7%±5.5%,P<0.05,ES=0.82)of BFR-MLSS test were significantly lower than those of MLSS test.However,no significant differences were found between the BFR-MLSS and MLSS test in MLSSc(5.61±1.18 vs 5.61±0.81 mmol/L,P>0.05,ES=0.01),heart rate(152.6±14.8 vs 150.7±10.7 bpm,P>0.05,ES=0.17)and RPE(14.8±3.3 vs 14.9±2.9,P>0.05,ES=0.06).Conclusion BFR exercise achieves MLSS at a lower external load(power output),and does not reduce the internal load of MLSS.Moreover,BFR increases the internal load for the same external load,but the division of the internal load interval seems to be the same during exercise with or without BFR.

Objective·To evaluate the feasibility and diagnostic performance of diffusion-relaxation correlation spectroscopic imaging(DR-CSI)in assessing the heterogeneity of benign and malignant head and neck tumors,as well as in identifying occult lymph node metastasis(OLNM).Methods·A prospective study was conducted from January to December 2024 at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,enrolling patients with suspected head and neck tumors who were scheduled for surgery and had a confirmed pathological diagnosis.All patients underwent preoperative routine head and neck plain and contrast-enhanced magnetic resonance imaging(MRI)examinations,including DR-CSI sequence.Conventional imaging parameters,including maximal diameter(MD),depth of invasion(DOI)for tumors,and MD and short diameter(SD)for lymph nodes,were obtained.Post-processing was performed to obtain apparent diffusion coefficient(ADC),T2 value,and D-T2 spectra for all lesions.The compartment segmentation strategy was optimized based on the spectral peak distribution characteristics of different diseases,and the volume fraction(Vi)of each compartment was obtained.Independent sample t-tests,Mann-Whitney U tests,chi-square tests,or Fisher's exact tests were used to compare intergroup differences in clinical data and imaging metrics.Principal component analysis(PCA)and Adonis analysis were employed to evaluate the discriminative ability of imaging metrics among different subtypes of benign tumors.Receiver operating characteristic(ROC)analysis was used to evaluate the ability of univariate and multivariable models to characterize the malignancy of head and neck squamous cell carcinoma(HNSCC)and identify OLNM.Results·A total of 97 cases were collected,including 28 benign tumors and 69 HNSCCs.Fifteen pathologically confirmed OLNMs and 20 benign lymph nodes(BLNs)were also enrolled.Among the 28 benign tumors,there were 6 cases of pleomorphic adenoma stroma-rich(PA stroma-rich),9 cases of pleomorphic adenoma stroma-poor(PA stroma-poor),9 cases of Warthin's tumor(WT),and 4 cases of basal cell adenoma(BCA).Statistically significant differences were observed in certain imaging parameters(ADC,T2,and DR-CSI Vi)among benign tumor subtypes.PCA analysis demonstrated a strong discriminative ability of imaging parameters in distinguishing pathological subtypes of benign tumors(R2=0.64,P<0.001).Among the 69 HNSCCs,47 were classified as Grade 1(well/moderately well-differentiated)and 22 as Grade 2(moderately/poorly differentiated).Compared to Grade 1,Grade 2 showed lower ADC and higher T2 values,though differences were not statistically significant.As HNSCC malignancy increased,VA4 decreased and VB4 increased significantly.OLNM showed a significant increase in SD and VA4 compared to BLNs.The combination of SD and VA4 for preoperative OLNM identification achieved a diagnostic efficiency of 0.843.Conclusion·DR-CSI can analyze diffusion and relaxation characteristics at the sub-voxel level,offering valuable insights for characterizing benign head and neck tumor subtypes,assessing HNSCC malignancy,and identifying OLNMs.Compared to traditional parameters like ADC or T2,DR-CSI provides enhanced tissue microstructure analysis.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Objective To establish an expert consensus on in-hospital transfer safety management for patients undergoing invasive mechanical ventilation,providing guidance for clinical medical teams to conduct standardized transfers,reduce transfer risks,and ensure patient safety.Methods Through systematic searching,screening,evaluation,and summary of evidence related to in-hospital transfer safety management for patients on invasive mechanical ventilation,we extracted recommendations to form a preliminary draft of the expert consensus.From July to October 2024,totally 2 rounds of expert consultations,and 2 rounds of expert reviews were conducted,and the content was refined and finalized based on expert feedback.Results The final consensus encompasses 9 aspects,including transfer assessment and decision-making,pre-transfer preparation of medical staff,pre-transfer patient preparation,pre-transfer equipment preparation,pre-transfer medication preparation,monitoring and intervention during transfer,emergency events and management,transfer handover and documentation,and post-transfer management.Conclusion This consensus demonstrates strong practicality and operability,offering professional guidance for enhancing the safety of in-hospital transfers for patients on invasive mechanical ventilation.

Objective·To evaluate the feasibility and diagnostic performance of diffusion-relaxation correlation spectroscopic imaging(DR-CSI)in assessing the heterogeneity of benign and malignant head and neck tumors,as well as in identifying occult lymph node metastasis(OLNM).Methods·A prospective study was conducted from January to December 2024 at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,enrolling patients with suspected head and neck tumors who were scheduled for surgery and had a confirmed pathological diagnosis.All patients underwent preoperative routine head and neck plain and contrast-enhanced magnetic resonance imaging(MRI)examinations,including DR-CSI sequence.Conventional imaging parameters,including maximal diameter(MD),depth of invasion(DOI)for tumors,and MD and short diameter(SD)for lymph nodes,were obtained.Post-processing was performed to obtain apparent diffusion coefficient(ADC),T2 value,and D-T2 spectra for all lesions.The compartment segmentation strategy was optimized based on the spectral peak distribution characteristics of different diseases,and the volume fraction(Vi)of each compartment was obtained.Independent sample t-tests,Mann-Whitney U tests,chi-square tests,or Fisher's exact tests were used to compare intergroup differences in clinical data and imaging metrics.Principal component analysis(PCA)and Adonis analysis were employed to evaluate the discriminative ability of imaging metrics among different subtypes of benign tumors.Receiver operating characteristic(ROC)analysis was used to evaluate the ability of univariate and multivariable models to characterize the malignancy of head and neck squamous cell carcinoma(HNSCC)and identify OLNM.Results·A total of 97 cases were collected,including 28 benign tumors and 69 HNSCCs.Fifteen pathologically confirmed OLNMs and 20 benign lymph nodes(BLNs)were also enrolled.Among the 28 benign tumors,there were 6 cases of pleomorphic adenoma stroma-rich(PA stroma-rich),9 cases of pleomorphic adenoma stroma-poor(PA stroma-poor),9 cases of Warthin's tumor(WT),and 4 cases of basal cell adenoma(BCA).Statistically significant differences were observed in certain imaging parameters(ADC,T2,and DR-CSI Vi)among benign tumor subtypes.PCA analysis demonstrated a strong discriminative ability of imaging parameters in distinguishing pathological subtypes of benign tumors(R2=0.64,P<0.001).Among the 69 HNSCCs,47 were classified as Grade 1(well/moderately well-differentiated)and 22 as Grade 2(moderately/poorly differentiated).Compared to Grade 1,Grade 2 showed lower ADC and higher T2 values,though differences were not statistically significant.As HNSCC malignancy increased,VA4 decreased and VB4 increased significantly.OLNM showed a significant increase in SD and VA4 compared to BLNs.The combination of SD and VA4 for preoperative OLNM identification achieved a diagnostic efficiency of 0.843.Conclusion·DR-CSI can analyze diffusion and relaxation characteristics at the sub-voxel level,offering valuable insights for characterizing benign head and neck tumor subtypes,assessing HNSCC malignancy,and identifying OLNMs.Compared to traditional parameters like ADC or T2,DR-CSI provides enhanced tissue microstructure analysis.