With the rapid development of computer science, the application of artificial intelligence (AI) in the field of medical imaging has become increasingly extensive. The temporomandibular joint (TMJ) is structurally complex, with a high incidence of related disorders and diverse clinical manifestations. This review analyzes the current state of research on AI in TMJ imaging diagnosis. Deep learning models based on U-Net and its derivatives have demonstrated outstanding performance in segmentation of condyle and articular disc. Various object detection and feature extraction algorithms have shown excellent diagnostic efficacy for common conditions, such as osteoarthrosis and disc displacement, with some models even achieving expert-level performance on test datasets. Meanwhile, explainable AI provides intuitive justification for model decisions through techniques such as heatmap visualization. Notably, current studies still face critical challenges, including coverage of disease spectra, integration of multimodal data, and model generalizability. Future studies should focus on developing integrated systems that combine diagnosis, segmentation, generation, and interpretation functions. Through multicenter data validation and algorithmic optimization, these efforts will enhance the clinical applicability and decision transparency of models, ultimately laying the foundation for precise imaging diagnosis and intelligent management of TMJ disorders.

OBJECTIVE: To explore the construction of a canine model of vascularized allogeneic spinal cord transplantation (vASCT) and preliminarily evaluate its therapeutic efficacy for spinal cord injury (SCI). METHODS: Sixteen female Beagle dogs aged 8-12 months were randomly selected, with 8 dogs serving as donors for the harvesting of spinal cord tissue with a vascular pedicle [dorsal intercostal artery (DIA) at the T₁₀ level and accompanying vein]. The remaining 8 dogs underwent a 1.5-cm-length spinal cord defect at the T₁₀ level, followed by transplantation of the donor spinal cord tissue for repair. Polyethylene glycol (PEG) was applied to both ends to spinal cord graft; then, using a random number table method, the dogs were divided into an experimental group (n=4) and a control group (n=4). The experimental group received immunosuppressive intervention with oral tacrolimus [0.1 mg/(kg∙d)] postoperatively, while the control group received no treatment. The operation time and ischemia-reperfusion time of two groups were recorded. The recovery of hind limb function was estimated by Olby score within 2 months after operation; the motor evoked potentials (MEP) was measured through neuroelectrophysiological examination, and the spinal cord integrity was observed through MRI. RESULTS: There was no significant difference in the operation time and ischemia-reperfusion time between the two groups (P>0.05). All dogs survived until the completion of the experiment. Within 2 months after operation, all dogs in the control group failed to regain the movement function of hind limbs, and Olby scores were all 0. In the experimental group, the movement and weight-bearing, as well as walking abilities of the hind limbs gradually recovered, and the Olby scores also showed a gradually increasing trend. There was a significant difference between the two groups from 3 to 8 weeks after operation (P<0.05). Neuroelectrophysiological examination indicated that the electrical signals of the experimental group passed through the transplanted area, and the latency was shortened compared to that at 1 month after operation (P<0.05), showing continuous improvement, but the amplitude did not show significant improvement (P>0.05). The control group was unable to detect any MEP changes after operation. MRI examination showed that the transplanted spinal cord in the experimental group survived and had good continuity with normal spinal cord tissue, while no relevant change was observed in the control group. CONCLUSION The vASCT model of dogs was successfully constructed. This surgical procedure can restore the continuity of the spinal cord. The combination of tacrolimus anti-immunity is a key factor for the success of transplantation.
Animals ; Dogs ; Female ; Spinal Cord/blood supply* ; Spinal Cord Injuries/surgery* ; Transplantation, Homologous ; Disease Models, Animal ; Recovery of Function ; Plastic Surgery Procedures/methods* ; Tacrolimus ; Immunosuppressive Agents

[Objective]To investigates the pathogenesis and clinical management of airway remodeling in chronic obstructive pulmonary disease(COPD)through the lens of mitochondrial functionality,based on the theoretical framework of"Xuanfu".[Methods]Through review of modern literature and classical Chinese medical ancient books it explores the link between mitochondrial dysfunction and COPD airway remodeling,examines how the"Xuanfu"theory relates to mitochondrial function in both physiological and pathological contexts,discusses the traditional Chinese medical(TCM)pathogenesis of COPD airway remodeling,summarizes treatment principles,and highlights contemporary studies supporting the role of TCM in modulating mitochondrial function.[Results]Mitochondrial dysfunction is crucial in COPD airway remodeling,with mechanisms and clinical manifestations aligning with"Xuanfu obstruction"and"lung collateral damage"in TCM.Based on the"Xuanfu"theory,the core pathogenesis can be described as"Xuanfu obstruction,lung collateral damage".The treatment should focus on utilizing pungent agents to disperse and ventilate,regulating Qi to open Xuanfu portals,expelling phlegm and resolving static blood,alleviating depression to free collateral vessels,reinforcing healthy Qi while eliminating pathogenic factors,strategically harmonizing unblocking with tonifying interventions.Contemporary studies indicate that intervention with traditional Chinese herbal formulas may repair pulmonary tissue damage and inhibit airway remodeling.These effects are mediated through mechanisms including the enhancement of mitochondrial energy metabolism and the promotion of mitophagy and mitochondrial biogenesis.These findings provide a modern scientific basis for the traditional pathogenesis of"Xuanfu obstruction,lung collateral damage"and its corresponding therapeutic principles in TCM.[Conclusion]The thesis propose mitochondrial dysfunction as the key pathophysiological link between the TCM mechanism of"Xuanfu obstruction,lung collateral damage"and airway remodeling in COPD.This framework establishes mitochondrial homeostasis as a core therapeutic target for TCM interventions,offering a novel basis for integrating traditional theory with modern cellular mechanisms in COPD diagnosis and treatment.

Objective:To analyze the protective effect of a respiratory syncytial virus (RSV) vaccine based on bacterial outer membrane vesicle (OMV) in mice.Methods:The pre-fusion protein (preF) of RSV was linked to the surface of OMV through the transmembrane protein cytolysin A (ClyA) to form the nanovaccine OMV-preF. The morphological characteristics of OMV and OMV-preF were observed under a transmission electron microscope. OMV-preF was intramuscularly injected into BALB/c mice and the elicited humoral and cellular immune responses were evaluated. The protective effect of OMV-preF was assessed by challenging the immunized mice with RSV Long strain. One-way analysis of variance and Tukey test were used for statistical analysis.Results:The results showed that preF was stably expressed in OMV, and both OMV-preF and OMV exhibited a double-layer vesicle structures under the microscope. OMV-preF could significantly activate the cellular and humoral immune responses in mice, causing a significant increase in CD8 + T cells and CD19 + B cells as well as a significant increase in the serum level of specific IgG. The neutralizing antibodies produced in the immunized mice could significantly inhibit the replication of RSV Long strain in vivo. Conclusions:The nanovaccine OMV-preF can induce high-level humoral and cellular immune responses, and the antibodies produced following immunization can effectively inhibit viral replication. This study provides a new strategy for RSV subunit vaccines.

Objective:To explore the efficacy and safety of mitotane in adrenal cortical carcinoma (ACC) at high risk of recurrence.Methods:A prospective observational study was designed from September 2022 to November 2023. ACC patients undergoing surgery with high recurrence risk (positive margin or Ki-67 index >10% or capsule rupture or large size or high-grade ACC) in Peking Union Medical College Hospital were enrolled in this study. All patients started mitotane treatment within 3 months after surgery, with a dose of 1.5 g/d, increased by 0.5 g per week. Once the dose reached 3 g/day, adjustments were made based on blood concentration levels. All patients received mitotane therapy for at least 1 year, and CT was performed every 12 weeks to evaluate the efficacy. The primary endpoint was 1-year progression-free survival (PFS) and safety. The efficacy was analyzed by Kaplan-Meier method for survival, and the occurrence of treatment-related adverse events was summarized.Results:A total of 12 ACC patients at high risk of recurrence were screened, comprising 6 males and 6 females. Tumors were located on the left side in 8 patients, on the right in 3, and bilaterally in 1. Five patients were classified as ENSAT stageⅡ, while 7 were classified as ENSAT stage Ⅲ. The maximum diameter of tumor was (9.07 ± 2.86) cm; the median age at diagnosis was 48 (35, 51) years, and the median Ki-67 index was (28.9 ± 16.1)%. The median time from surgery to initiation of mitotane therapy was 31 (23.0, 43.2) days, and 9 patients had blood drug concentrations of 14-20 mg/L. The median follow-up time was 16.7 (12.4, 25.2) months. At 1 year after mitotane therapy, 10 (83.8%) patients were still in disease-free survival state, with a median mitotane PFS of 27.6 months (95% CI 16.4-not reached). All ACC patients experienced 1-2 grade adverse events after taking mitotane. One patient (8.3%) experienced grade 3 adverse event, including the increasing of alanine aminotransferase and aspartate aminotransferase, as well as anorexia. No grade 4-5 adverse events occurred. The most common adverse events were gastrointestinal symptoms (10 cases), including nausea, vomiting, anorexia, and diarrhea, followed by liver function damage(9 cases) and neurotoxicity(4 cases). Conclusions:Mitotane has shown the prospect of improving the prognosis of ACC patients at high risk of recurrence after surgery. Because of its serious toxic and side effects, it is necessary to monitor its blood concentration to adjust the dosage, and take measures for adverse reactions to ensure the safety of patients.

Objective:To explore the clinical characteristics of bilateral nodular adrenal cortical disease（BmacAD）and primary pigmentary nodular adrenal cortical disease（PPNAD）.Methods:A retrospective analysis was conducted on the clinical records of 58 patients with BmacAD and 26 patients with PPNAD who were treated at Peking Union Medical College Hospital from January 2005 to December 2024. The clinical manifestations，endocrine examination，and surgical results between BmacAD patients and PPNAD patients were compared. Endocrine related examinations were reexamined 1 to 7 days and 15 to 30 days after the operation，and the recovery of cortisol within 30 days after the operation was recorded.Results:The male to female ratios of BmacAD patients and PPNAD patients were 31/27 and 11/15，with no statistically significant difference（ P > 0.05）. The age of BmacAD patients and PPNAD patients were 53.5（45.0，61.0）years and 19.0（15.8，24.0）years，respectively，with a statistically significant difference（ P < 0.001）. In terms of clinical manifestations，the proportion of BmacAD patients and PPNAD patients with Cushing syndrome appearance were 50.00%（29/58）and 96.15%（25/26），respectively，with a statistically significant difference（ P < 0.001）. There were no statistically significant differences between BmacAD and PPNAD patients in hypertension［87.93%（51/58）and 80.77%（21/26）］，abnormal glucose tolerance/diabetes［39.66%（23/58）and 34.62%（9/26）］and hypokalemia［18.97%（11/58）and 15.38%（4/26）］（ P > 0.05）. The difference in the proportion of osteopenia/osteoporosis /fracture between the two group was statistically significant［13.79%（8/58）and 53.85%（14/26）， P < 0.001］. In terms of hormone secretion，the median levels of 24-hour urinary free cortisol in BmacAD and PPNAD patients before surgery were 174.00（85.35，531.43）μg/24 h and 408.35（334.28，800.78）μg/24h（ P < 0.001），respectively. The proportion of preoperative plasma adrenocorticotropic hormone（ACTH）levels less than 5 pg/ml were 60.34%（35/58）and 84.62%（22/26）（ P < 0.05），respectively. Among the BmacAD patients 32 underwent unilateral total adrenalectomy，23 underwent unilateral partial adrenalectomy，and 3 underwent unilateral total adrenalectomy+contralateral partial adrenalectomy；the proportion of patients with increased preoperative cortisol secretion who recovered to normal within 30 days after surgery was 79.17%（38/48）. All 26 PPNAD patients underwent unilateral adrenalectomy. Within 30 days after surgery，68.00%（17/25）of the PPNAD patients had normal 24-hour urinary free cortisol levels. Conclusions:The cortisol secretion level in PPNAD patients is significantly higher than that in BmacAD patients，and the proportion of abnormal bone metabolism is higher. The short-term therapeutic efficacy of unilateral adrenalectomy or unilateral partial adrenalectomy is significant for both BmacAD and PPNAD.

Objective To explore the feasibility and precautions of small incision bile duct stone removal in primary hospitals in extremely high-altitude areas.Methods The experience of small incision biliary exploration and cholecystectomy under general anesthesia at primary hospitals during the author's medical aid to Xizang in the high-altitude areas of northern Xizang was summarized(from June 2022 to December 2022).Results A total of 11 cases of small incision common bile duct stone removal were completed.Abdominal drainage was performed in all patients,including 6 cases with T-shaped tubes and 5 cases with primary closure of the common bile duct.The patients recovered well after surgery and was discharged.Conclusion In extreme high-altitude areas,under the guidance of medical aid doctors,it is completely feasible for primary hospitals to carry out small incision bile duct stone removal by selecting appropriate cases,training surgical skills,and performing detailed preoperative preparation.

Clinically,the incidence of portal vein thrombosis(PVT)in patients with cirrhosis can be up to 10％-23％.When PVT is not treated promptly,it may develop to cavernous transformation of the portal vein(CTPV).CTPV can aggravate portal hypertension,accelerate the progression of esophagogastric varices bleeding,refractory ascites,refractory peritonitis,biliary tract diseases,and hepatic insufficiency.At present,noninvasive imaging techniques such as portal vein reconstruction,enhanced CT and ultrasound are mostly used to make the diagnosis and evaluation of CTPV.It is rather difficult to perform portosystemic shunt surgery in patients with CTPV complicated by portal hypertension,which was once regarded as a contraindication for interventional portosystemic shunt procedures.With the improvement of related technologies and surgical instruments,the transjugular intrahepatic portosystemic shunt(TIPS)has become an important treatment for CTPV.This paper aims to make a comprehensive review about the relevant researches concerning the portosystemic shunt surgery in patients with CTPV so as to clarify the importance of TIPS in the treatment of CTPV.

Objective This study preliminarily investigated the potential mechanisms of the Huoxue Tongluo prescription(HXTLP)in treating spinal cord injury(SCI)through a combination of network pharmacology,molecular docking technology,and in vivo experimental verification.Methods The traditional Chinese medicine systems pharmacology database and analysis platform(TCMSP)were utilized to select the active ingredients,targets of action were obtained from Swiss target prediction database,and an"active ingredients-targets"network was constructed.SCI-related targets were obtained by accessing online mendelian inheritance in man(OMIM)and human gene database(GeneCards),and a protein interaction network of the common targets of HXTLP and SCI was established based on the search tool for the retrieval of interacting genes/protein(STRING)database.The Metascape database was used in KEGG pathway enrichment and GO analyses of the common targets.Molecular docking of active ingredients and key targets was performed through Autodock 1.5.7 software,and the results were visualized with Pymol 2.4.0 software.Finally,the effect of HXTLP on SCI was verified by animal experiments.Results A total of 184 intersection targets were obtained,and the key targets were serine/threonine kinase(AKT1),signal transducer and activator of transcription 3(STAT3),heat shock protein 90 kDa alpha,class A member 1(HSP90AA1),phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha(PIK3CA),phosphoinositide-3-kinase regulatory subunit 1(PIK3R1),harvey ras(HRAS),estrogen receptor 1(ESR1),mitogen-activated protein kinase 1(MAPK1),and epidermal growth factor receptor(EGFR).Molecular docking result showed strong binding abilities between the core active components and key targets.In the animal experiments,the behavioral scores of mice in the HXTLP group increased(P＜0.05),the motor function of hind limbs was improved,and the histological morphology of the injured area was more complete compared with those of the model group.Western Blot result revealed that HXTLP effectively inhibited the key target protein(HSP90AA1)and the expression of phospho-STAT3(P-STAT3)and promoted the expression of phospho-phosphatidylinositol-3-kinase(P-PI3K)and phospho-AKT1(P-AKT1).Conclusions This study verified that HXTLP has multi-component,multi-target,and multi-pathway synergistic effects in the treatment of SCI and has provided experimental and theoretical bases for further clinical medication research for SCI.

Objective:To provide theoretical support and practice model for improving the clinical medical education supervision system of university-affiliated hospitals.Methods:This study focused on the group of reserve teaching supervision experts. Through literature research, questionnaire survey, and expert interview, the Competency Evaluation Criteria for Reserve Teaching Supervision Experts was constructed, which was implemented according to the training framework of "theory, practice, summary, and feedback". The paired t-test was performed using SPSS 24.0. Results:The research team formulated the Competency Evaluation Criteria for Reserve Teaching Supervision Experts through expert interviews. Six basic competencies and three advanced competencies for reserve teaching supervision experts were identified and their weights were assigned. A supervision team was established with supervision experts (including reserve teaching supervision experts) and teaching staff at a ratio of 1∶6.9, achieving an increase in the coverage of supervised specialties. A toolkit for enhancing the supervision capabilities of reserve experts was developed, and its effectiveness was analyzed. Statistical analysis showed that the overall score gap between reserve teaching supervision experts and senior supervision experts gradually narrowed. In terms of teaching demeanor and teaching effectiveness, there were no significant differences between the two types of experts. However, in terms of teaching content scores, there was a significant difference between reserve teaching supervision experts and senior supervision experts ( P<0.05). Conclusions:The training mechanism of reserve teaching supervision experts can effectively bridge the structural defects of the traditional supervision team. However, further emphasis is needed on the standardization and professionalization of teaching content supervision.