Objective: To deeply explore the systemic management dilemmas affecting patients with chronic periodontitis in underdeveloped regions, providing practical pathways for achieving oral health equity. Methods: This study has been reviewed and approved by the Medical Ethics Committee, and written informed consent was obtained from the participants. Based on a comprehensive design integrating literature review and theory, an interview guide was developed. Using purposive sampling, semi-structured interviews were conducted with 20 patients diagnosed with chronic periodontitis who were from underdeveloped regions and attended the Stomatological Hospital of Southern Medical University between November 2025 and February 2026. The sample size was determined by data saturation. Data analysis employed Colaizzi’s seven-step method. Results: Through interview with 20 participants, three core themes were extracted, encompassing eight sub-themes: individual cognitive-behavioral dilemmas (cognitive limitations and passive coping, inefficient and superficial self-management, and economic and psychological barriers to seeking care); systemic and environmental structural obstacles (distrust in primary healthcare capabilities, and the limited buffering effect and constraints of medical insurance); and the need for health empowerment and support systems (authoritative knowledge and management skill guidance, aspirations for access to high-quality specialized medical resources, and sustained and reminder-based remote support). Conclusion Patients with chronic periodontitis in underdeveloped regions face a multidimensional dilemma composed of limited health literacy, poor adherence to health behaviors, weak primary care service capacity, uneven medical insurance coverage, and insufficient high-quality specialized medical resources. Patients’ health literacy should be advanced through innovative health education, primary care capacity should be strengthened for periodontal disease prevention and treatment, and it is recommended to prioritize the inclusion of initial periodontal therapy in outpatient coordination or chronic disease management, and a remote medical support system based on digital technology should be established.

Both cold stress and ischemia-reperfusion injury significantly contribute to poor prognosis after liver transplantation(LT).However,limited animal models incorporating both stimuli hinder the advance-ment of transplant-related research.Here,a simplified and reproducible isolated perfused liver model is established to simulate the stresses experienced by livers maximally during transplantation.We provide a detailed protocol for a straightforward technique that requires 20-30 min for harvesting,24-48 h for static cold storage(SCS),and 2 h for normothermic machine perfusion(NMP)to induce LT-like stresses in the liver.Hepatic injury from SCS and NMP(LT-like stresses)is evaluated using three types of parameters.The pH values and hepatic enzyme levels of cold preservation solutions and perfusate serve as dynamic indicators of hepatic injury.Bile production and portal venous resistance directly reflect liver function,whereas pathological analysis visually illustrates the location and extent of injury.This animal model eliminates the influence of hemodynamic and immune factors,yielding highly reproducible results,and is strongly recommended as a standardized animal model for inducing LT-like stresses.

Objective To assess the accuracy and consistency of point-of-care testing(POCT)technology in detecting D-dimer(DDI),Procalcitonin(PCT),and N-terminal pro B-type natriuretic peptide(NT-proBNP)in whole blood samples,as well as to validate its feasibility for rapid clinical diagnosis.Methods From July 8 to August 22,2022,a total of 104 paired DDI whole blood and plasma samples,496 paired PCT whole blood and serum samples,and 77 paired NT-proBNP whole blood and serum samples were collected.The consistency and accuracy of test results between whole blood and plasma/serum samples were assessed using the Mann-Whitney U test,regression analysis,relative sensitivity,relative specificity,Youden's index,and Kappa value.Results The test results of DDI,PCT,and NT-proBNP in whole blood and plasma/serum samples demonstrated excellent consistency,with correlation coefficients of r2=0.951 2,r2=0.942 8,and r2=0.991 6,respectively,and all P-values exceeding 0.05.At the medical decision levels,for DDI(0.55 μg/mL),the relative sensitivity,rela-tive specificity,Youden index,and Kappa value were 94.3%,94.1%,0.88,and 0.87,respectively.For PCT(0.5 ng/mL and 2.0 ng/mL),the relative sensitivities were 97.4%and 89.0%,the relative specificities were 95.8%and 98.3%,the Youden indices were 0.93 and 0.87,and the Kappa values were 0.93 and 0.89,respectively.For NT-proBNP(125 pg/mL),the relative sensitivity was 94.1%,the relative specificity was 100%,the Youden index was 0.94,and the Kappa value was 0.87.These findings confirm the high accuracy of whole blood sample testing and the strong concordance between the two methods.Conclusions This study confirmed the efficacy of POCT technology for detecting DDI,PCT,and NT-proBNP in whole blood samples.The results showed a high level of consistency compared to traditional plasma/serum methods,thereby reinforcing the clinical applicability of POCT for rapid diagnosis.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

OBJECTIVE To summarize the follow-up,survival time and treatment of a patients who received heart transplantation from a hepatitis B virus(HBV)-positive donor so as to raise the perception and awareness of pre-vention of hepatitis B after receiving the heart transplantation from a HBV-positive donor and extend the survival time of the patient.METHODS A patient who had new onset of hepatitis B after receiving heart transplantation from a HBV-positive donor and was treated in infectious diseases department of Zhongnan Hospital of Wuhan Uni-versity in Mar.2021 was enrolled in the study.The clinical data,including the main clinical symptoms,medication and treatment history,individual history,major positive signs and treatment outcomes,were retrospectively ana-lyzed.The process of diagnosis and treatment was analyzed and was further discussed in combination with litera-ture search.RESULTS The patient was treated with immunosuppression and anti-HBV therapy for 11 months after the heart transplantation,and the patient had anorexia,fatigue,diarrhea,and skin icteric sclera in the current month of withdrawal of drug therapy.The patient was admitted to the hospital and was finally diagnosed with a-cute hepatic failure,acute hepatitis B,acute renal failure,septic shock,heart transplantation and gastrointestinal hemorrhage.The patient died due to ineffective treatment.CONCLUSIONS The patient with new onset of HBV in-fection who receives organ transplantation and takes a long-term use of immunosuppressors may have severe con-sequences such as new onset of hepatitis B and acute hepatic failure.It is necessary to attach great importance to and take comprehensive measures for the prevention of new onset HBV infection in the donor after the organ transplantation,stick to the long-term reexamination of HBV infection-related indexes and maintain the antiviral therapy as long as possible(at least 1 year),which may facilitate the protection of the patient from HBV infec-tion-related adverse events and help to extend the survival time of the patient after the organ transplantation.

Objective:To detect the serum levels of 25(OH)D,miR-125b-5p,hypoxia-inducible factor-1α(HIF-1α)and vascular endothelial growth factor A(VEGFA)in patients with multiple myeloma(MM),and explore the role of miR-125b-5p/HIF-1α pathway in the involvement of vitamin D deficiency in the pathogenesis of MM.Methods:Fifty three newly diagnosed/relapsed MM patients admitted to the department of hematology of our hospital from October 2021 to December 2023 were included.Meanwhile,25 healthy individuals matched in gender and age from our hospital's Health Management Center were selected as controls.The serum level of 25(OH)D was monitored by mass spectrometry,the serum level of miR-125b-5p was detected by real-time fluorescence quantitative PCR,and serum levels of HIF-1α and VEGFA were measured by enzyme-linked immunosorbent assay.The levels of 25(OH)D,miR-125b-5p,HIF-1α,and VEGFA were compared between the two groups.According to the level of 25(OH)D,the MM patients were divided into vitamin D deficiency group(＜20 ng/ml)and vitamin D non-deficiency group(≥ 20 ng/ml),and the levels of miR-125b-5p,HIF-1α,and VEGFA were compared between the two groups.The correlations between 25(OH)D,miR-125b-5p,HIF-1α and VEGFA were analyzed.The receiver operating characteristic(ROC)curve analysis was used to determine the diagnostic value of25(OH)D combined with miR-125b-5p for newly diagnosed MM.Results:The level of 25(OH)D in MM patients was significantly lower than that in control group(P＜0.01).There was no significant difference in 25(OH)D level between newly diagnosed and relapsed MM patients(P＞0.05).Compared with the control group,the level of miR-125b-5p was significantly reduced in MM patients(P＜0.01),while the levels of HIF-1α and VEGFA were significantly increased(both P＜0.001).In MM patients,the miR-125b-5p level in the vitamin D deficiency group was significantly decreased than that in the non-deficiency group(P＜0.01),while the levels of HIF-1 α and VEGFA were significantly increased(both P＜0.05).In MM patients,25(OH)D was positively correlated with miR-125b-5p,while negatively correlated with HIF-1α and VEGFA(both P＜0.05).Moreover,miR-125b-5p was negatively correlated with HIF-1α and VEGFA(both P＜0.05).The area under the curve(AUC)for diagnosing MM with 25(OH)D,miR-125b-5p,and their combination were 0.699,0.751,and 0.791,respectively.Conclusion:The incidence of vitamin D deficiency is high in MM patients.Vitamin D deficiency may promote angiogenesis and participate in the occurrence and development of MM by downregulating miR-125b-5p and upregulating HIF-1α and VEGFA expression.

Objective·To prepare self-assembled drug-loaded nanoprobes with activatable chemical exchange saturation transfer(CEST)imaging capability,and evaluate their imaging performance and therapeutic potential for photodynamic-sensitized pyroptosis in breast cancer in vivo and in vitro.Methods·GC nanoprobes co-loaded with gemcitabine(Gem)and chlorin e6(Ce6)were constructed by using a self-assembly strategy.The physicochemical properties of the GC nanoprobes were characterized by scanning electron microscopy(SEM)and dynamic light scattering(DLS).The pH-/time-dependent CEST activation and drug release profiles were investigated.The 2',7'-dichlorodihydrofluorescein diacetate(DCFH-DA)probe was used to detect the generation of reactive oxygen species(ROS),and enzyme-linked immunosorbent assay(ELISA)was used to detect the release of inflammatory factors such as interleukin-1β(IL-1β)and IL-18 in mouse breast cancer 4T1 cells after treatment with GC nanoprobes with synergistic laser irradiation.Immunofluorescence was performed to detect immunogenic cell death(ICD)markers,including calreticulin(CRT)and high mobility group box 1 protein(HMGB1).The 4T1 breast cancer mouse models were established to validate tumor-specific CEST activation and evaluate anti-tumor efficacy by measuring tumor volume and detecting inflammatory factors and ICD markers.Results·SEM and DLS confirmed the uniform spherical morphology of the GC nanoprobes.The CEST imaging results showed that the nanoprobes had excellent pH-concentration and time-dependent activation imaging effects both in the simulated acidic microenvironment and at the cellular level in vitro.The drug release from this drug-loaded nanoprobe was 80％at pH 5.0,which was significantly higher than at pH 7.4(P=0.003).DCFH-DA fluorescence staining demonstrated that GC-mediated photodynamic therapy induced a significant generation of ROS.Analysis of pyroptosis-related factors revealed a marked increase in the release levels of IL-1β and IL-18(both P＜0.05),along with elevated fluorescence expression of CRT and HMGB1.The in vivo CEST imaging results showed that the CEST signal at the tumor site was significantly enhanced,peaking at 4 h with tail vein injection of GC.The GC nanoprobes with synergistic laser irradiation group showed markedly elevated inflammatory factors(IL-1β,IL-18),changed ICD biomarkers(HMGB1 and CRT),and significant tumor suppression,compared to the PBS control group(all P＜0.05).Conclusion·The GC nanoprobes enables specific CEST imaging-guided photodynamic therapy,effectively inducing pyroptosis and precise ablation of breast cancer.

Objective This study aimed to investigate the efficacy of modified endoscopic autologous cartilage eustachian tube pharyngeal orifice tuboplasty(MEACETT)in patients with patulous eustachian tube(PET).Meth-ods A retrospective analysis was conducted on the clinical data of 27 patients(30 ears)diagnosed with PET who underwent MEACETT.Autologous cartilage was used through the incision at the posterior end of the inferior turbi-nate and filled into the lateral wall of the pharyngeal orifice of the eustachian tube.Without affecting the movement function of the eustachian tube during swallowing,the collapse of the pharyngeal orifice was fully filled.Before and after the surgery,the visual analogue scale(VAS),the eustachian tube dysfunction questionnaire-7(ETDQ-7)and hospital anxiety and depression scale(HADS)was used for assessment to evaluate the surgical efficacy.Results There was no significant difference in depression scores before and after surgery(P＞0.05).However,postopera-tive anxiety scores,ETDQ-7 scores,and VAS scores were significantly lower than preoperative scores(P＜0.05).Among the 27 patients,9 showed significant symptom relief,13 exhibited partial relief,and 5 had no significant change compared to preoperative symptoms.The overall response rate of the treatment(significant relief and partial relief)was 81.48％(22/27).All surgeries were successfully performed.Except for secretory otitis media occurring in 2 cases,no major complications were observed.Conclusion MEACETT demonstrates significant symptom relief in PET patients,with high surgical safety and low complication rates,making it worthy of clinical promotion.

Objective To evaluate the diagnostic efficacy of the R value in tubomanometry(TMM)for the di-agnosis of patulous eustachian tube(PET).Methods The clinical data of 58 patients with PET and 65 controls were retrospectively analyzed.TMM was performed on both groups under nasopharyngeal pressures of 30,40,and 50 mbar respectively.The diagnostic efficacy of the R value for PET was evaluated through receiver operating char-acteristic(ROC)curves.Results In the control group,the average R values under nasopharyngeal pressures of 30,40,and 50 mbar were 0.86±0.50,0.76±0.41,and 0.68±0.34 respectively.In contrast,the corresponding R values in the PET group were significantly lower,which were 0.56±0.38,0.50±0.36,and 0.46±0.38 respec-tively.According to the ROC curve analysis,the areas under the curve(AUC)at these pressures were 0.62,0.74,and 0.74 respectively.The specificity and sensitivity of the R value under nasopharyngeal pressures of 30,40,and 50 mbar were 76.90％and 54.30％,74.60％and 68.10％,86.90％and 54.30％,respectively.Under pressures of 30,40,and 50 mbar,the incidence rates of R＞1 in the control group and the PET group were 29.23％(38/130)and 12.77％(12/94)(x2=8.69,P=0.003),20.00％(26/130)and 6.38％(6/94)(x2=7.20,P=0.007),10.00％(13/130)and 3.19％(3/94)(x2=2.87,P=0.09)respectively.Conclusion Although the low R value in TMM reflects the presence of PET to some extent,it does not provide adequate sensitivity and specificity to serve as an independent diagnostic criterion for PET.