Healthy dental pulp is essential for preserving teeth and maintaining their normal function. Vital pulp therapy (VPT) is widely used in clinical applications because it aims to preserve vital pulp and enhance the long-term survival of teeth. An accurate diagnosis of pulp vitality is a prerequisite for successful VPT. However, accurately assessing pulp viability remains challenging in clinical practice. Pulp viability is influenced by various factors, including the type of pulp exposure, caries status, periodontitis, trauma, treatment factors, patient age, and individual differences. Assessing pulp viability requires a comprehensive consideration of medical history and clinical manifestations, along with a combination of various auxiliary methods, such as pulp sensibility tests, pulp blood flow tests, imaging techniques and molecular diagnostics. In the future, the technology for assessing pulp vitality should evolve toward chairside, visualization, and precision techniques, to achieve consistency between clinical and histological diagnoses, thereby providing patients with the most effective treatment.

Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder worldwide, causing dementia and affecting millions of individuals. One prominent characteristic in the brains of AD patients is glucose hypometabolism. In the context of galactose metabolism, intracellular glucose levels are heightened. Galactose mutarotase (GALM) plays a crucial role in maintaining normal galactose metabolism by catalyzing the conversion of β-D-galactose into α-D-galactose (α-D-G). The latter is then converted into glucose-6-phosphate, improving glucose metabolism levels. However, the involvement of GALM in AD progression is still unclear. In the present study, we found that the expression of GALM was significantly increased in AD patients and model mice. Genetic knockdown of GALM using adeno-associated virus did not change the expression of amyloid precursor protein (APP) and APP-cleaving enzymes including a disintegrin and metalloprotease 10 (ADAM10), β-site APP-cleaving enzyme 1 (BACE1), and presenilin-1 (PS1). Interestingly, genetic overexpression of GALM reduced APP and Aβ deposition by increasing the maturation of ADAM10, although it did not alter the expression of BACE1 and PS1. Further electrophysiological and behavioral experiments showed that GALM overexpression significantly ameliorated the deficits in hippocampal CA1 long-term potentiation (LTP) and spatial learning and memory in AD model mice. Importantly, direct α-D-G (20 mg/kg, i.p.) also inhibited Aβ deposition by increasing the maturation of ADAM10, thereby improving hippocampal CA1 LTP and spatial learning and memory in AD model mice. Taken together, our results indicate that GALM shifts APP processing towards α-cleavage, preventing Aβ generation by increasing the level of mature ADAM10. These findings indicate that GALM may be a potential therapeutic target for AD, and α-D-G has the potential to be used as a dietary supplement for the prevention and treatment of AD.
Animals ; ADAM10 Protein/metabolism* ; Alzheimer Disease/pathology* ; Amyloid Precursor Protein Secretases/metabolism* ; Disease Models, Animal ; Humans ; Mice ; Amyloid beta-Peptides/metabolism* ; Male ; Mice, Transgenic ; Membrane Proteins/metabolism* ; Cognitive Dysfunction/pathology* ; Mice, Inbred C57BL ; Amyloid beta-Protein Precursor/metabolism* ; Female ; Hippocampus/metabolism* ; Long-Term Potentiation/physiology*

OBJECTIVE: To construct machine learning prediction model for sepsis-associated encephalopathy (SAE), and analyze the application value of the model on early identification of SAE risk in elderly septic patients. METHODS: Patients aged over 60 years with a primary diagnosis of sepsis admitted to intensive care unit (ICU) from 2008 to 2023 were selected from Medical Information Mart for Intensive Care-IV 2.2 (MIMIC-IV 2.2). Demographic variables, disease severity scores, comorbidities, interventions, laboratory indicators, and hospitalization details were collected. Key factors associated with SAE were identified using univariate Logistic regression analysis. The data were randomly divided into training and validation sets in a 7 : 3 ratio. Multivariable Logistic regression analysis was conducted in the training set and visualized using a nomogram model for prediction of SAE. The discrimination of the model was evaluated in the validation set using the receiver operator characteristic curve (ROC curve), and its calibration was assessed using calibration curve. Furthermore, multiple machine learning algorithms, including multi-layer perceptron (MLP), support vector machine (SVM), naive bayes (NB), gradient boosting machine (GBM), random forest (RF), and extreme gradient boosting (XGB), were constructed in the training set. Their predictive performance was subsequently evaluated on the validation set. Taking the XGB model as an example, the interpretability of the model through the SHapley Additive exPlanations (SHAP) algorithm was enhanced to identify the key predictive factors and their contributions. RESULTS: A total of 2 204 septic patients were finally enrolled, of whom 840 developed SAE (38.1%). A total of 21 variables associated with SAE were screened through univariate Logistic regression analysis. Multivariable Logistic regression analysis showed that endotracheal intubation [odds ratio (OR) = 0.40, 95% confidence interval (95%CI) was 0.19-0.88, P < 0.001], oxygen therapy (OR = 0.76, 95%CI was 0.53-0.95, P = 0.023), tracheotomy (OR = 0.20, 95%CI was 0.07-0.53, P < 0.001), continuous renal replacement therapy (CRRT; OR = 0.32, 95%CI was 0.15-0.70, P < 0.001), cerebrovascular disease (OR = 0.31, 95%CI was 0.16-0.60, P < 0.001), rheumatic disease (OR = 0.44, 95%CI was 0.19-0.99, P < 0.001), male (OR = 0.68, 95%CI was 0.54-0.86, P = 0.001), and maximum anion gap (AG; OR = 0.95, 95%CI was 0.93-0.97, P < 0.001) were associated with an decreased probability of SAE, and age (OR = 1.05, 95%CI was 1.03-1.06, P < 0.001), acute physiology score III (APSIII; OR = 1.02, 95%CI was 1.01-1.02, P < 0.001), Oxford acute severity of illness score (OASIS; OR = 1.04, 95%CI was 1.03-1.06, P < 0.001), and length of hospital stay (OR = 1.01, 95%CI was 1.01-1.02, P < 0.001) were associated with an increased probability of SAE. A nomogram model was constructed based on these variables. In the validation set, ROC curve analysis showed that the model achieved an area under the ROC curve (AUC) of 0.723, and the calibration curve showed good consistency between the predicted probability of the model and the observed probability. Among the machine learning algorithms, including MLP, SVM, NB, GBM, RF, and XGB, the SVM model and RF model demonstrated relatively good predictive performance, with AUC of 0.748 and 0.739, respectively, and the sensitivity was both exceeding 85%. The predictive performance of the XGB model was explained through SHAP analysis, and the results indicated that APSIII score (SHAP value was 0.871), age (SHAP value was 0.521), and OASIS score (SHAP value was 0.443) were important factors affecting the predictive performance of the model. CONCLUSIONS The machine learning-based SAE prediction model exhibits good predictive capability and holds significant application value for the early identification of SAE risk in elderly septic patients.
Humans ; Machine Learning ; Aged ; Sepsis-Associated Encephalopathy ; Sepsis/complications* ; Intensive Care Units ; Logistic Models ; Middle Aged ; Male ; ROC Curve ; Female ; Bayes Theorem ; Nomograms ; Support Vector Machine ; Algorithms

Objective:To evaluate the efficacy and safety of a Chinese herbal mask in the treatment of melanized-type melasma by stereological measurements.Methods:A randomized, controlled, evaluator- and statistician-blind clinical study was conducted. A total of 116 patients with melasma who met the inclusion and exclusion criteria were selected and equally divided into two groups by using a random number table method, with 58 patients in each group. The treatment group received topical treatment with a Chinese herbal mask once a night, while the control group received topical hydroquinone cream in the morning and evening twice daily. The course of treatment lasted 12 weeks, with follow-ups every 4 weeks, and an additional follow-up was performed 12 weeks after discontinuation of treatment. A facial image analyzer and a reflectance confocal microscopy (RCM) were used to collect images before and after treatment. Melasma area and severity index (MASI) scores and RCM scores served as outcome measures, and stereological measurement methods were employed to compare scores before and after treatment; response rates and recurrence rates were calculated, and adverse reactions were observed and recorded. Statistical analyses were performed using the chi-square test and t test. Results:A total of 54 patients in the treatment group and 47 patients in the control group completed the study. After 4- and 8-week treatment, there were no significant differences in MASI scores or RCM scores between the two groups (all P > 0.05) ; after 12-week treatment, the MASI scores and RCM scores were significantly lower in the treatment group (2.91 ± 1.16, 5.48 ± 1.60, respectively) than in the control group (3.99 ± 2.03, 6.66 ± 1.88, t = -3.32, -3.37, respectively, both P < 0.01). After the end of treatment, there was no significant difference in the response rate between the treatment group (44/54, 81.5%) and the control group (34/47, 72.3%; χ2 = 0.12, P > 0.05). Twelve weeks after discontinuation of treatment, 2 patients (3.7%) relapsed in the treatment group, while 15 (31.9%) relapsed in the control group, showing a significant difference in recurrence rates between the two groups ( χ2 = 12.34, P < 0.01). Adverse reactions occurred in 2 patients (3.7%) in the treatment group and 6 (11.5%) in the control group, and there was no significant difference in the incidence of adverse reactions between the two groups ( χ2 = 1.34, P > 0.05) . Conclusions:The Chinese herbal mask was safe and effective in the treatment of melanized-type melasma. The application of the facial image analyzer and RCM technology in combination with stereological measurement methods has certain value in reducing the subjectivity in efficacy evaluation for melasma.

Objective To formulate an expert consensus on the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound(hereinafter referred to as the consensus).To standardize the clinical practice of ultrasound-guided puncture of difficult autologous arteriovenous fistula.Methods We conducted a comprehensive literature review of domestic and international publications,integrated clinical nursing experts' practical experience,and followed evidence-based nursing principles to identify the best available evidence.Through expert panel discussions and 3 rounds of Delphi expert consultation,we systematically revised,refined and improved the initial draft of the consensus,ultimately developing the finalized version.Results The response rates of the 3 rounds of Delphi expert correspondence inquiries were all 100％;the authority coefficient of expert correspondence inquiries was 0.97;the mean importance assignment of the 3 rounds of correspondence inquiries was more than 3.50.The Kendall coordination coefficients of the 3 rounds of expert consultation were 0.127,0.120,and 0.201,respectively(P＜0.05),and the degree of coordination of expert opinions was good and the expert opinions were consistent.The consensus summarized 5 aspects,including relevant terms and definitions,indications for real-time ultrasound-guided arteriovenous fistula puncture,personnel qualifications and training,difficult arteriovenous fistula puncture procedures under real-time ultrasound-guided,and nursing quality control.Conclusion The consensus is scientific,which can provide a basis for hemodialysis practitioners to practice the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound.

OBJECTIVES: This study aimed to investigate the incidence, imaging characteristics, and clinical manifestations of the eruption failure of deciduous molars using panoramic radiographs to provide a foundation for diagnosis and treatment in this population. METHODS: This study retrospectively reviewed panoramic radiographs of children aged 4-8 years obtained from Stomatology Hospital, Zhejiang University School of Medicine between January 2021 and December 2023. A total of 31 331 subjects were included for the radiographic assessment of the tooth eruption failure of deciduous molars. Incidence, radiographic characteristics, and associated complications were documented. Statistical analysis was performed using SPSS 26.0. RESULTS: The incidence of the eruption failure of deciduous molars among children aged 4-8 years was 0.94% (296/31 331). The rate was 1.55 times higher in females than in males, demonstrating a significant gender difference (P<0.001). Among the affected deciduous molars, mandibular first deciduous molars accounted for 76.4%, followed by the mandibular second deciduous molars (13.8%), and the maxillary deciduous molars collectively comprised 9.8%. The severity of eruption disorders was significantly associated with the mesial and distal tilting of adjacent teeth and elongation of the antagonist (P<0.001). CONCLUSIONS The incidence of the eruption failure of deciduous molars in children aged 4-8 years was 0.94%, with a high prevalence in females and a predilection for the mandible, particularly the mandibular first deciduous molar. For deciduous molars with severe eruption failure, early intervention is crucial to mitigate complications such as malocclusion and space loss.
Humans ; Child ; Child, Preschool ; Tooth, Deciduous/diagnostic imaging* ; Female ; Molar/physiopathology* ; Male ; Retrospective Studies ; Tooth Eruption ; Radiography, Panoramic ; Incidence

Objective:To evaluate the efficacy and safety of a Chinese herbal mask in the treatment of melanized-type melasma by stereological measurements.Methods:A randomized, controlled, evaluator- and statistician-blind clinical study was conducted. A total of 116 patients with melasma who met the inclusion and exclusion criteria were selected and equally divided into two groups by using a random number table method, with 58 patients in each group. The treatment group received topical treatment with a Chinese herbal mask once a night, while the control group received topical hydroquinone cream in the morning and evening twice daily. The course of treatment lasted 12 weeks, with follow-ups every 4 weeks, and an additional follow-up was performed 12 weeks after discontinuation of treatment. A facial image analyzer and a reflectance confocal microscopy (RCM) were used to collect images before and after treatment. Melasma area and severity index (MASI) scores and RCM scores served as outcome measures, and stereological measurement methods were employed to compare scores before and after treatment; response rates and recurrence rates were calculated, and adverse reactions were observed and recorded. Statistical analyses were performed using the chi-square test and t test. Results:A total of 54 patients in the treatment group and 47 patients in the control group completed the study. After 4- and 8-week treatment, there were no significant differences in MASI scores or RCM scores between the two groups (all P > 0.05) ; after 12-week treatment, the MASI scores and RCM scores were significantly lower in the treatment group (2.91 ± 1.16, 5.48 ± 1.60, respectively) than in the control group (3.99 ± 2.03, 6.66 ± 1.88, t = -3.32, -3.37, respectively, both P < 0.01). After the end of treatment, there was no significant difference in the response rate between the treatment group (44/54, 81.5%) and the control group (34/47, 72.3%; χ2 = 0.12, P > 0.05). Twelve weeks after discontinuation of treatment, 2 patients (3.7%) relapsed in the treatment group, while 15 (31.9%) relapsed in the control group, showing a significant difference in recurrence rates between the two groups ( χ2 = 12.34, P < 0.01). Adverse reactions occurred in 2 patients (3.7%) in the treatment group and 6 (11.5%) in the control group, and there was no significant difference in the incidence of adverse reactions between the two groups ( χ2 = 1.34, P > 0.05) . Conclusions:The Chinese herbal mask was safe and effective in the treatment of melanized-type melasma. The application of the facial image analyzer and RCM technology in combination with stereological measurement methods has certain value in reducing the subjectivity in efficacy evaluation for melasma.

Objective To formulate an expert consensus on the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound(hereinafter referred to as the consensus).To standardize the clinical practice of ultrasound-guided puncture of difficult autologous arteriovenous fistula.Methods We conducted a comprehensive literature review of domestic and international publications,integrated clinical nursing experts' practical experience,and followed evidence-based nursing principles to identify the best available evidence.Through expert panel discussions and 3 rounds of Delphi expert consultation,we systematically revised,refined and improved the initial draft of the consensus,ultimately developing the finalized version.Results The response rates of the 3 rounds of Delphi expert correspondence inquiries were all 100％;the authority coefficient of expert correspondence inquiries was 0.97;the mean importance assignment of the 3 rounds of correspondence inquiries was more than 3.50.The Kendall coordination coefficients of the 3 rounds of expert consultation were 0.127,0.120,and 0.201,respectively(P＜0.05),and the degree of coordination of expert opinions was good and the expert opinions were consistent.The consensus summarized 5 aspects,including relevant terms and definitions,indications for real-time ultrasound-guided arteriovenous fistula puncture,personnel qualifications and training,difficult arteriovenous fistula puncture procedures under real-time ultrasound-guided,and nursing quality control.Conclusion The consensus is scientific,which can provide a basis for hemodialysis practitioners to practice the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound.

Iron metabolism plays a regulatory role in various metabolic diseases, and excessive iron accumulation can increase the risk of metabolic diseases, especially type 2 diabetes mellitus (T2DM). Pathological processes such as iron deposition, iron overload, and ferroptosis can activate oxidative stress, lipid peroxidation, autophagy, and other processes, promote the amplification of inflammatory reactions and the reduction of antioxidant capacity, gradually decline the function of pancreatic islet β-cells, thereby promoting the occurrence and development of T2DM. Glucagon-like peptide-1 (GLP-1) is a physiological hormone secreted by intestinal L cells. GLP-1 analogs or GLP-1 receptor agonists can regulate the body's iron metabolism process, inhibit iron deposition, iron overload, and ferroptosis-related inflammatory reactions, promote the proliferation and differentiation of pancreatic islet β-cells, thereby reducing insulin resistance, inhibiting endothelial cell damage, and playing an important role in the prevention and treatmentof T2DM and its complications.

Objective To investigate the changes and clinical significance of serum monocyte chemoattractant protein-1 (MCP-1) and prostaglandin E₂ (PGE₂) levels in children with functional dyspepsia (FD). Methods A retrospective study was conducted to enroll 89 FD children admitted from October 2022 to October 2023 as FD group, and 91 healthy children in the same period were selected as control group. The FD group was further divided into mild group (n=36), moderate group (n=33), and severe group (n=20) based on the severity of the disease. The serum levels of MCP-1 and PGE₂ were detected by enzyme-linked immunosorbent assay (ELISA). The severity of the disease was assessed by the Global Overall Symptom Score (GOSS), and gastric emptying was evaluated in all the children. Pearson and Spearman correlation analyses were performed to explore the correlations of serum MCP-1 and PGE₂ levels with gastric half-emptying time and FD symptom scores. Results The serum MCP-1 level in the FD group was significantly higher than that in the control group, while the PGE₂level was significantly lower (P < 0.05). In the severe group, the serum MCP-1 level was significantly higher while the PGE₂ level was significantly lower than that in the moderate and mild groups, and similar differences were significantly observed between the moderate and mild groups (P < 0.05). The gastric half-emptying time and postprandial 2-hour residual rate were significantly higher in the FD group than the control group (P < 0.05). Serum MCP-1 in FD children was positively correlated with gastric half-emptying time and postprandial 2-hour residual rate (P < 0.05), while serum PGE₂ was negatively correlated with these parameters (P < 0.05). Serum MCP-1 in FD children was significantly positively correlated with upper abdominal burning sensation, early satiety, belching, upper abdominal pain, and the total GOSS score (r=0.611, 0.509, 0.504, 0.491, 0.513; P < 0.05), while PGE2 was significantly negatively correlated with upper abdominal burning sensation, early satiety, belching, upper abdominal pain, acid reflux, and GOSS total score (r=-0.516, -0.561, -0.493, -0.533, -0.497, -0.482; P < 0.05). Conclusion Elevated serum MCP-1 and decreased PGE₂ levels in children with FD are closely related to the severity of the disease, gastric emptying, and some FD symptoms.