OBJECTIVE To construct three-class （insufficient， normal， excessive） and two-class （insufficient， normal） models for predicting plasma concentration of valproic acid （VPA）， and compare the performance of these two models， with the aim of providing a reference for formulating clinical medication strategies. METHODS The clinical data of 480 patients who received VPA treatment and underwent blood concentration test at the Xi’an International Medical Center Hospital were collected from November 2022 to September 2024 （a total of 695 sets of data）. In this study， predictive models were constructed for target variables of three-class and two-class models. Feature ranking and selection were carried out using XGBoost scores. Twelve different machine learning algorithms were used for training and validation， and the performance of the models was evaluated using three indexes: accuracy， F1 score， and the area under the working characteristic curve of the subject （AUC）. RESULTS XGBoost feature importance scores revealed that in the three-class model， the importance ranking of kidney disease and electrolyte disorders was higher. However， in the two-class model， the importance ranking of these features significantly decreased， suggesting a close association with the excessive blood concentration of VPA. In the three-class model， Random Forest method performed best， with F1 score of 0.704 0 and AUC of 0.519 3 on the test set； while in the two-class model， CatBoost method performed optimally， with F1 score of 0.785 7 and AUC of 0.819 5 on the test set. CONCLUSIONS The constructed three-class model has the ability to predict excessive VPA blood concentration， but its prediction and model generalization abilities are poor； the constructed two-class model can only perform classification prediction for insufficient and normal blood concentration cases， but its model performance is stronger.

Enterobacterales are important pathogens responsible for hospital-acquired infections and can cause various severe infectious diseases. Since their first report, extended-spectrum β-lactamase-producing Enterobacterales(ESBL-E) have become widely prevalent worldwide. These strains often exhibit multidrug resistance, significantly increasing the risk of treatment failure and patient mortality. In China, the prevention and control of ESBL-E face numerous challenges, including high prevalence rates, significant regional distribution disparities, uneven laboratory testing capabilities, and variations in antimicrobial stewardship and prescribing practices. To address these issues, Professors Zhuo Chao, Xu Yingchun and Yu Yunsong initiated the developmentof the Expert Consensus on Clinical Management Strategies for Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacterales (2025), in collaboration with multidisciplinary experts. This consensus systematically reviews the global and domestic epidemiological characteristics of ESBL-E, clinical laboratory detection techniques, treatment principles and key therapeutic agents, as well as infection prevention and control measures. Furthermore, it elaborates on the microbiological features and stratified treatment strategies for different infection sources (including bloodstream infections, intracranial infections, respiratory and mediastinal infections, intra-abdominal infections, and urinary tract infections) and special populations (such as neutropenic patients with fever, emergency patients, and pediatric patients). The consensus aims to enhance the detection capacity of clinical laboratories for ESBL-E, standardize diagnosis and treatment strategies in healthcare settings, and provide scientific guidance to curb the spread of ESBL-E in China, thereby reducing associated morbidity and mortality.

Adolescence is defined as a population ranging from ten to nineteen years old. Permanent teeth in adolescents are of critical significance as they are actively involved in mastication, contribute to aesthetic appearance, play a role in pronunciation, and are integral to the growth and development of the stomatognathic system. Specifically, permanent teeth in adolescents comprise those with incomplete root development and those with complete root development but unstable gingival margin positions. However, the prevalence of permanent tooth defects among adolescents remains high, primarily due to their insufficient awareness of oral health care and poor compliance with preventive measures. Therefore, it is very important to emphasize the necessity for timely and appropriate restoration of permanent tooth defects in adolescents. Given the distinct physiological characteristics of adolescent permanent teeth compared with mature permanent teeth, interim restoration approaches are required. The field of adolescent permanent tooth restoration is an interdisciplinary area, involving both prosthodontics and pediatric dentistry. Currently, a comprehensive and standardized principle for the selection of restoration indications is lacking, which poses challenges for clinicians in making optimal treatment decisions. Therefore, this article aims to comprehensively summarize the clinical dilemmas associated with the restoration of adolescent permanent teeth, and propose a set of principles for the selection of restoration methods and materials, aiming to offer practical clinical guidelines for dentists when dealing with permanent tooth defects in adolescent patients. In particular, because of the different restoration dilemmas of anterior and posterior permanent teeth, a variety of interim restoration methods, their applicable conditions, advantages, and disadvantages are introduced respectively. Additionally, it provides an in-depth discussion of different interim restoration materials, including direct restoration materials like light-cured composite resin and dual-cured temporary crown resin, as well as indirect restoration materials such as polymeric porcelain and CAD/CAM resin-matrix ceramics. The goal of this research is to provide a foundation for the development of evidence-based restoration plans in clinical practice and to contribute to the establishment of future standards in the field of adolescent permanent tooth restoration. This will enhance the quality of dental care for adolescents and promote better oral health outcomes in this population.
Humans ; Adolescent ; Dentition, Permanent ; Dental Restoration, Permanent/methods* ; Child

OBJECTIVE: To compare the registration accuracy of cone beam computed tomography (CBCT) images while registering to virtual craniodentofacial patients based on soft tissue and the dentition registration method. METHODS: Virtual dentofacial patients out of 13 selected participants who needed CBCT scanning were established by impression with a registered-block impression (RBI) based on digital dental images, three-dimensional (3D) facial images and maxillofacial CBCT images. CBCT images were processed in the Mimics software program, establishing the craniofacial virtual patients based on CBCT images (CCTs). Registration between virtual patients from RBI and CCT, using the soft tissue in lower half face (STE) and dentition (DTN) as the reference area, respectively, forming two kinds of virtual craniofacial patients based on digital dental images, 3D facial images and skeletal images of CBCT (hiding the soft tissue and dental casts from CBCT). Three-dimensional deviation analysis was performed in the upper half face and lower half face of facial images from CBCT between two kinds of virtual craniodentofacial patients and compared with 3D facial images from RBI and recorded as root mean square error (RMSE). Paired-t test was used to compare the deviations of RMSEs between the upper and lower half of the face and the upper half of the face of facial images from CCT, respectively, between the two kinds of virtual craniodentofacial patients based on STE and DTN methods. RESULTS: Paired-t tests showed that there was no statistically significant difference between the upper and lower half faces of facial images from CCT between STE and DTN (P>0.05), but the deviation of RMSEs of the upper half face of facial images from CCT in STE was smaller than those in DTN [(1.696±0.420) mm vs. (1.752±0.424) mm, P < 0.01]. CONCLUSION The registration accuracy of CBCT registered in virtual craniodentofacial patients using soft tissue as the reference area was higher.
Humans ; Cone-Beam Computed Tomography/methods* ; Imaging, Three-Dimensional/methods* ; Male ; Face/anatomy & histology* ; Female ; Adult ; Image Processing, Computer-Assisted/methods* ; Young Adult ; User-Computer Interface

The close relationship between gastric cancer (GC) and type 2 diabetes mellitus (T2DM) has garnered significant attention. On one hand, T2DM may play a role in the development and progression of GC, correlating with poor patient outcomes. On the other hand, after radical surgery for GC, T2DM can be effectively managed, potentially improving tumor prognosis. In recent years, bariatric and metabolic surgery (BMS) has revolutionized T2DM treatment for obese and overweight patients. Comparative analyses reveal similarities between surgical approaches for gastric cancer and BMS, leading to the emergence of the onco-metabolic surgery (OMS) concept, which suggests that radical tumor resection and T2DM remission in GC patients can be potentially achieved through a single procedure. However, there are notable differences between OMS and BMS, including target populations, surgical details, and perioperative management. Therefore, optimizing the application of the OMS concept in GC patients holds significant clinical importance. This article provides a review to facilitate the better implementation of this concept in practice.

Objective:To evaluate the efficacy and safety of immunotherapy with or without radiotherapy in the treatment of recurrent or metastatic esophageal squamous cell carcinoma (R/M ESCC).Methods:A retrospective analysis was conducted on the data of 75 patients with R/M ESCC treated with sintilimab at Anyang Tumor Hospital from January 2020 to October 2021. The patients were divided into the radiotherapy (RT) group ( n=37) and non-radiotherapy (NRT) group ( n=38) based on whether they received radiotherapy. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse effects were compared between two groups. Count data were expressed as composition ratios and analyzed using Chi-square test or Fisher's exact test. Survival analysis was performed using Kaplan-Meier method and log-rank test. Results:There was no statistically significant difference in ORR and DCR between the RT and NRT groups (70% vs. 61%, P=0.375; 95% vs. 89%, P=0.414). However, the complete response (CR) rate in the RT group was higher compared to that in the NRT group (19% vs. 3%, P=0.022). The median follow-up duration was 25.4 months. There was no statistically significant difference in the median PFS and OS between the RT and NRT groups (13.8 months vs. 9.9 months, P=0.221; 20.2 months vs. 18.9 months, P=0.214). Subgroup analysis demonstrated that among patients with recurrence or metastasis confined to local and / or ≤3 distant lymph nodes, there was no statistically significant difference in the median PFS between the RT and NRT groups (15.1 months vs. 8.4 months, P=0.115), but the median OS in the RT group was better than that in the NRT group (not reached vs. 12.3 months, P=0.036). Compared to the NRT group, besides an increase in grade 1-2 pneumonitis (41% vs. 18%, P=0.035), no significant increase in treatment-related toxicity was observed in the RT group. Conclusion:Immunotherapy combined with radiotherapy is safe in patients with R/M ESCC, and shows survival benefit in patients with recurrence or metastasis confined to local and / or ≤3 distant lymph nodes.

Objective:To explore the biomarkers of radiochemotherapy sensitivity and potential mechanisms in esophageal squamous cell carcinoma (ESCC), and validate the screened biomarkers at human tissue, animal and cellular levels.Methods:Based on bioinformatics system, clinical and transcriptome data of ESCC were obtained from The Cancer Genome Atlas (TCGA) and GEO databases. HUB genes related to chemoradiotherapy sensitivity were identified by weighted correlation network analysis (WGCNA) and cytoscape software and survival differences were analyzed. CellMiner database was used to predict and screen drugs with strong correlation with HUB genes. The expression levels of HUB genes in clinical tissues was detected by real-time reverse transcription PCR (qRT-PCR). Then, oe-AKR1C1 mouse model, cisplatin-resistant cells and radiation-resistant cells were constructed, and the effects of HUB genes on tumor size and mass, and cell proliferation ability were analyzed.Results:A total of 5 HUB genes were identified, among which NAD(P)H quinone dehydrogenase 1 (NQO1), AKR1C1 and NADH: ubiquinone oxidoreductase core subunit S2 (NDUFS2) were significantly correlated with ESCC survival (all P<0.05). Dacarbazine, alectinib and obatoclax were the anti-tumor drugs predicted to have a strong correlation with HUB genes in this study. Human tissue test results showed that the expression levels of NQO1, AKR1C1 and NDUFS2 were up-regulated in patients with chemoradiotherapy resistance, and AKR1C1 and NDUFS2 had statistical significance (both P<0.05). The results of mouse tumor bearing experiment showed that the tumor volume and mass of oe-AKR1C1 mice after radiotherapy and chemotherapy were significantly higher than those in the control group (both P<0.05). The cell experiment results showed that the expression levels of AKR1C1 and NDUFS2 in radiation-resistant cells and cisplatin-resistant cells were significantly higher than those in control cells ( P<0.05), while there was no statistically significant difference in the relative expression level of NQO1. Conclusion:NQO1, AKR1C1 and NDUFS2 are HUB genes significantly related to the survival of ESCC, which can be used as important therapeutic tumor targets for ESCC.

Neoadjuvant chemoradiotherapy combined with surgery is the standard treatment for patients with locally advanced esophageal cancer. However, there is significant variability in how patients respond to neoadjuvant chemoradiotherapy. The value of existing conventional diagnostic methods in predicting the effectiveness of neoadjuvant chemoradiotherapy is limited. Image-based artificial intelligence (AI), particularly radiomics and deep learning technologies, have shown great potential in predicting the efficacy of neoadjuvant chemoradiotherapy by automatically quantifying and analyzing a vast amount of information in medical images. This review summarizes AI research based on CT, positron emission computed tomography (PET-CT), and other imaging modalities, highlighting the current limitations and future directions of the research.

Objective:To evaluate the survival rate, success rate, soft tissue conditions and marginal bone level changes of implants following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis, compared to natural healing.Methods:From March 2015 to January 2017, patients scheduled for molar extraction as a consequence of severe periodontitis and planned implant-retained prostheses from Department of Periodontology Peking University School and Hospital of Stomatology were selected. A total of 40 molar extraction sockets from 40 patients received implant placement following micro crestal flap-alveolar ridge preservation or natural healing. The front consecutive 20 teeth were assigned to the natural healing group, and the back ones were assigned to the micro crestal flap-alveolar ridge preservation (MCF-ARP) group. The superstructures were placed 6 months later. Within 2 weeks (baseline) and 1, 2 and 3 years after implant crown restoration, modified plaque index, probing depth, modified bleeding index and keratinized tissue width were recorded every six months. Parallel periapical radiographs were taken to evaluate the peri-implant marginal bone level and to calculate marginal bone loss. Independent sample t test or Mann-Whitney U test were used to compare the differences in the above clinical and imaging indicators between the two groups. Results:The implant survival rate and success rate of the two groups were both 100% (20/20). There were no significant differences in the modified plaque index, probing depth, modified bleeding index, buccal keratinized tissue width and marginal bone loss between two groups at 1, 2 and 3 years after implant crown restoration (all P>0.05). Marginal bone loss was 0.22 (0.14, 0.34) mm in the natural healing group and 0.21 (0.12, 0.30) mm in the MCF-ARP group at a 3-year post-loading evaluation. Conclusions:Within the limitations of the present study, implants placed at ridge preserved and naturally healed molar extraction sockets with severe periodontitis demonstrate comparable clinical outcomes at a 3-year post-loading evaluation.

Objective This study aimed to explore the influencing factors of dynamic changes in tradi-tional Chinese medicine(TCM)constitution based on general statistics,Apriori-DEMATEL algorithm,and DoWhy causal inference framework methods. Methods Dynamic collection of TCM constitution identification data was conducted from the population aged 18-60,containing collection time and constitution type,and 11 constitu-tion influencing factors including dietary habit,sleeping habit,sleeping duration,exercise habit,emotion state,stress level,living environment,work/life calamity,family atmosphere,business trip frequency,and overtime situation.General statistical analysis was used to ana-lyze the relative percentage of corresponding influencing factors of different types of constitu-tion changes,the Apriori-DEMATEL algorithm was used to analyze the correlation between 11 constitution influencing factors such as dietary habit and constitution changes,and the DoWhy causal inference framework was used to analyze the causality between dietary habit,sleeping habit,sleeping duration,exercise habit,emotion state,and stress level,explore the frequency of constitution type transformation-change factors,and determine the key influ-encing factors causing dynamic changes in constitution type. Results After preprocessing,13 536 valid data points were obtained.Based on the Apriori-DEMATEL algorithm,the factors were divided into six original factors including dietary habit,sleeping habit,sleeping duration,exercise habit,emotion state,and stress level,and five re-sult factors including living environment,work/life calamity,family atmosphere,business trip frequency,and overtime situation.Combining with general statistics,we found that among the original factors,changes in dietary habit,sleeping habit,sleeping duration,and stress lev-el had a greater impact on other factors.In the process of constitution conditioning,attention should be paid to these four factors to maintain constitution balance.Among the five result factors,the absolute values of work/life calamity and family atmosphere were relatively large,indicating that these two factors were easily influenced by other factors.The dietary habit,sleeping habit,sleeping duration,exercise habit,emotion state,and stress level have higher centrality in changes,indicating that these six factors had important in constitution changes.According to the statistical frequency of constitution changes corresponding to each factor,we found that the changes of these six factors accounted for a large proportion of the constitu-tion transformation frequency among Qi deficiency constitution,balanced constitution,and allergic constitution,indicating that the changes of these six factors played an important role in the changes of the three constitution types.Combined with the results of the Apriori-DEMATEL algorithm,and DoWhy causal inference framework analysis,it was inferred that dietary habit and sleeping duration indirectly lead to constitution changes by affecting the changes of other factors. Conclusion This study explored the influencing factors of dynamic changes in TCM constitu-tion from the perspective of dynamic data and multiple analysis methods,and the results showed that the changes of dietary habit,sleeping habit,sleeping duration,exercise habit,emotion state,and stress level had a great impact on the changes of Qi deficiency constitu-tion,balanced constitution and allergic constitution.Attention should be paid to the changes of these six factors in daily life,and corresponding improvement plans should be formulated to reduce the probability of transforming into biased constitution.Our study also provided data support and objective analysis reference for the analysis of influencing factors of dynam-ic changes in TCM constitution types.