Background: We investigated osteoporosis management strategies and clinical outcomes following the occurrence of medicationrelated osteonecrosis of the jaw (MRONJ). Methods: We retrospectively studied individuals diagnosed with MRONJ during osteoporosis treatment who were managed in the Osteoporosis Center or the Oral Maxillofacial Surgery & Dental Unit at Queen Mary Hospital in Hong Kong between 2010 and 2022. We examined subsequent osteoporosis management plans, fracture events, and bone mineral density (BMD). Results: Thirty-six individuals were included (mean age, 78.5 years; 94.4% women). The estimated prevalence of MRONJ was 0.26%. All patients had been exposed to bisphosphonates, and seven had also received denosumab before MRONJ. Following MRONJ, only 14 individuals continued anti-osteoporosis treatment, a decision influenced by a higher fracture probability at MRONJ onset. The most common regimen was a teriparatide-raloxifene sequence (n=8): three patients achieved stable BMD, four achieved improving BMD, and one exhibited a mixed response. The patient with a mixed BMD response had also been treated with denosumab. Six patients sustained incident fractures after MRONJ, and these patients had lower BMD T-scores than their counterparts. Two patients experienced MRONJ recurrence, which was associated with the resumption of bisphosphonate or denosumab therapy after MRONJ. These patients had higher BMD T-scores than those who did not experience MRONJ recurrence. Conclusion MRONJ is challenging because high fracture risk necessitates discontinuation of antiresorptive agents. Teriparatide followed by raloxifene may be a reasonable regimen. Individualised decisions in osteoporosis management after MRONJ are required to balance fracture risk reduction with minimising MRONJ recurrence.

Objective This study aims to identify hotspots in this field and predict future research directions by understanding the development trends and hotspots.Methods we analyzed 4102 papers on artesunate from 2001 to 2022 by using two visualization software,CiteSpace and VOSviewer.Results Our findings indicate that the number of artesunate-related articles published has steadily increased in recent years.The United Kingdom participated in the largest number of studies.Mahidron University is the institution with the largest number of publications.Malaria artemisinin,efficacy and cancer are research hotspots in the field of artesunate.Severe malaria,drug resistance,apoptosis and ferroptosis may be the focus of future artesunate-related research.Conclusion Artesunate research focuses on malaria and artemisinin.As a result of bibliometric analysis,new ideas are provided to improve the clinical application of artesunate.

Purpose: This study aims to examine predisposing anatomic factors and subsequent post-decompression functional outcomes among high-intensity athletes with thoracic outlet syndrome (TOS). Materials and Methods: A single-institution retrospective review was performed on a prospective database of patients with TOS from 2018 to 2023 who had undergone operative decompression for TOS. Demographics, TOS characteristics, predisposing anatomy, operative details, and postoperative outcomes were examined.The primary outcome was postoperative return to sport. Secondary outcomes included vascular patency. Results: A total of 13 patients who were engaged in high-demand athletic activity at the time of their diagnosis were included. Diagnoses included 8 (62%) patients with venous TOS, 4 (31%) patients with neurogenic TOS, and 1 (8%) patient with arterial TOS. Mixed vascular and neurogenic TOS was observed in 3 (23%) patients. The mean age of the cohort was 30 years. Abnormal scalene structure was observed in 12 (92%) patients, and abnormal bone structures were noted in 4 (27%) patients; 2 (15%) with cervical ribs and 3 (23%) patients with clavicular abnormalities. Prior ipsilateral upper extremity trauma was reported in 4 (27%) patients. Significant joint hypermobility was observed in 8 (62%) patients with a median Beighton score of 6. Supraclavicular cervical and/or first rib resection with scalenectomy was performed in all patients. One case of postoperative pneumothorax was treated non-operatively. Ten (77%) patients returned to sport. Duplex ultrasonography showed subclavian vein patency in all 8 patients with venous TOS and wide patency with no drop in perfusion indices in the patient with arterial TOS. Conclusion Athletes with TOS who required operative intervention had a high incidence of musculoskeletal aberrations and joint hypermobility. Supraclavicular decompression was associated with a high success rate, with overall good functional outcomes and good likelihood of patients returning to preoperative high-intensity athletics.

Purpose: Clomiphene citrate (CC) is prescribed off-label in men to improve testosterone and sperm parameters, but the duration of treatment needed to reach maximal benefit remains unclear. Our objective was to examine temporal effects of CC on total testosterone (TT) and semen analysis (SA) using longitudinal follow-up data in treated men.   Materials and Methods: We analyzed an IRB-approved database of men treated with CC (25 mg q.d. or 50 mg q.o.d.) from January 2016 through May 2021. We identified patients with 3, 6, 9, and 12 month follow-up data for TT and 3, 6, and 9 month follow-up SA. Mean absolute changes in TT and sperm concentration compared to baseline were calculated, along with 95% confidence intervals. Men with prior genitourinary procedures or hormone therapy were excluded. Paired t-tests were used to compare TT and sperm concentration at each time point to baseline (alpha=0.05).  Results: One hundered thirty-four men received CC, mean age 37.7 years (SD 6.7, range 24–52). TT at all follow-ups (3, 6, 9, and 12 months) were available for 25 men, and SA at 3, 6, and 9 months for 26 men. Baseline TT was 358±145 ng/dL and sperm concentration was 13±17.2 M/mL. Significant improvement in TT was identified at 3 months (62.7 ng/dL, 95% CI: 0.49–125.0, p=0.048), additional benefit at 6 months (181.8 ng/dL, 95% CI: 114.1–249.5, p<0.01), and plateau at 9 and 12 months. Improvement in sperm concentration was first observed at 9 months (20.7 M/mL, 95% CI: 10.2–31.2, p<0.01). Semen volume and sperm motility did not change.   Conclusions Duration of treatment with clomiphene may impact testosterone and sperm concentration, and the historical 3 month milestone may be insufficient for clinical and research evaluation. Men taking CC may experience plateau in TT at 6 months and first benefit in sperm concentration at 9 months.

The mammalian central nervous system (CNS) is considered an immune privileged system as it is separated from the periphery by the blood brain barrier (BBB). Yet, immune functions have been postulated to heavily influence the functional state of the CNS, especially after injury or during neurodegeneration. There is controversy regarding whether adaptive immune responses are beneficial or detrimental to CNS injury repair. In this study, we utilized immunocompromised SCID mice and subjected them to spinal cord injury (SCI). We analyzed motor function, electrophysiology, histochemistry, and performed unbiased RNA-sequencing. SCID mice displayed improved CNS functional recovery compared to WT mice after SCI. Weighted gene-coexpression network analysis (WGCNA) of spinal cord transcriptomes revealed that SCID mice had reduced expression of immune function-related genes and heightened expression of neural transmission-related genes after SCI, which was confirmed by immunohistochemical analysis and was consistent with better functional recovery. Transcriptomic analyses also indicated heightened expression of neurotransmission-related genes before injury in SCID mice, suggesting that a steady state of immune-deficiency potentially led to CNS hyper-connectivity. Consequently, SCID mice without injury demonstrated worse performance in Morris water maze test. Taken together, not only reduced inflammation after injury but also dampened steady-state immune function without injury heightened the neurotransmission program, resulting in better or worse behavioral outcomes respectively. This study revealed the intricate relationship between immune and nervous systems, raising the possibility for therapeutic manipulation of neural function via immune modulation.

Asthma ; therapy ; Humans ; Patient Education as Topic ; Physician-Patient Relations ; Self Care

OBJECTIVE: This research developed a practical, multi-dimensional attention deficit hyperactivity disorder (ADHD) rating scale (i.e., the Symptoms and Functional Impairment Rating Scale, SFIRS) for Chinese children, aged 6–12 years, with ADHD. METHODS: The structural validity, criterion validity, internal consistency, and test-retest reliability of the scale were evaluated. Item screening was conducted with 412 ADHD patients and 322 developmentally typical controls. RESULTS: The scale includes 44 items, divided among Hyperactivity-Impulsivity, Self-Control, Inattention, Self-Management, Academic Performance, and Social Interaction. The six-factor model showed good data fit, with each factor significantly correlated with its corresponding criterion (r=0.690–0.841). The Cronbach's α of the full scale was 0.976. Total score test-retest reliability was r=0.816 (p < 0.01). CONCLUSION: The SFIRS thus demonstrated good reliability and validity and may be used to assess ADHD among children aged 6–12 years in China.
Asian Continental Ancestry Group ; Attention Deficit Disorder with Hyperactivity ; Behavior Rating Scale ; Child ; China ; Executive Function ; Humans ; Interpersonal Relations ; Mass Screening ; Reproducibility of Results ; Self Care ; Self-Control

PURPOSEEarly intramedullary nailing (IMN) within the first 24 h for multiply injured patients with femoral fracture and concomitant thoracic trauma is controversial. Previously published studies have been limited in size and their outcomes have been inconclusive. A meta-analysis was conducted to evaluate the available data in order to guide care and help improve the outcomes for these patients.

METHODSWe searched the literature up to December 2011 in the main medical search engines and identified 6 retrospective cohort studies that explored the safety of early IMN in patients with both femoral fracture and chest injury. Our primary outcome was the rates of pulmonary complication (pneumonia, adult respiratory distress syndrome, fat embolism syndrome), multiple organ failure (MOF) and mortality.

RESULTSWe found no statistically significant difference in the rate of pulmonary complications, MOF or mortality in the patients treated with early IMN.

CONCLUSIONEarly IMN for femoral fractures does not increase the mortality and morbidity in chest- injured patients in the studies analyzed.

Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; mortality ; Humans ; Multiple Organ Failure ; epidemiology ; Pneumonia ; epidemiology ; Respiratory Distress Syndrome, Adult ; epidemiology ; Thoracic Injuries ; surgery

Objective:To identify the healing effect of electrospun silk fibroin-BMP-2 as a biologic pulp capping agent to inflammatory pulp in rat caused by lipopolysaccharide ( LPS) .Methods:A total of 30 healthy adult male Wistar rats were randomly divided into five groups:(1) normal control group without operation;(2) blank control group without capping agents;(3) calcium hydroxide capping group;(4) electrospun silk fibroin capping group;(5) electrospun silk fibroin-BMP-2 capping group .Bilateral up-per first molars of each rat in group 2-5 were drilled to expose the pulp to LPS which was used to estab-lish a model of inflammatory pulp .The exposed pulp was capped with different capping agents or without capping agents.Then the hole was sealed.The animals were sacrificed on days 3, 7, and 14 post-opera-tion and histological analysis was carried out , including HE stain and CD 14 immunohistochemical stain . Results:On day 7 and 14 , the lowest inflammatory reaction score in HE stain among pulp capping groups was that of silk fibroin-BMP-2 group .The next were calcium hydroxide group and silk fibroin group .That of blank control group was the highest .The ranking of reparative dentine scores of those groups was just reversed.The D values of immunohistochemical stain of CD 14 were not significantly different in groups applied pulp capping agents but significantly lower than blank control group on days 3 and 7.However, the D value of silk fibroin-BMP-2 group ( 0 .145 ±0 .011 ) was significantly lower than blank control group (0.287 ±0.019), calcium hydroxide group (0.170 ±0.017) and silk fibroin group (0.175 ± 0 .018 ) on day 14 .Conclusion:Electrospun silk fibroin compounded with BMP-2 promoted wound hea-ling of exposed pulp and had better potential to stimulate formation of reparative dentine to establish a suitable environment for pulp recovery .

OBJECTIVEThis study examined the gender differences in drug-related problems and predictors of recidivism among a sample of 1444 offenders with co-morbid drug abuse and mental disorders participating in California's Proposition 36 Program.

METHODSBackground characteristics and problem severity in multiple key life areas were assessed at intake by using Addiction Severity Index, and drug treatment participation, mental health diagnoses and arrests were based on official records.

RESULTSWomen demonstrated greater problem severity than men in family relationships, health, psychological health, and sexual and physical abuse history. Men on the other hand had greater criminal history, high rates of attention disorder, and psychotic disorder. More men than women were rearrested during the year after treatment admission. Logistic regression analyses showed that for the combined sample, male, young age, cocaine use (relative to methamphetamine), drug abuse severity, methadone treatment, arrest history and fewer prior treatment history were associated with higher recidivism at 12-month follow-up; lower education, cocaine use, and arrest history were related to women's recidivism, while young age, outpatient treatment, and arrest history were predictors of men's recidivism.

CONCLUSIONAlthough the specific type of mental disorder did not seem to be predictive of recidivism, the high rates of mental health disorder and arrest of this population is problematic. Intervention strategies taking into consideration gender-specific problems and needs can improve outcomes for both.

Adolescent ; Adult ; Crime ; Female ; Humans ; Male ; Mental Disorders ; complications ; Middle Aged ; Recurrence ; Sex Factors ; Substance Abuse Treatment Centers ; Substance-Related Disorders ; complications ; Treatment Outcome ; Young Adult