Objective: To explore the association between maternal lipid levels during pregnancy and the risk of overweight and obesity in offspring at 3 years of age, providing scientific evidences for the prevention and control of childhood obesity. Methods: A total of 2 432 mother-child pairs with maternal lipid tests during pregnancy and offspring s physical growth data at 3 years of age were included from the Borin in Guangzhou Cohort Study up to September 2021. Lipid indicators, including high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol(LDL-C), triglycerides (TG), and total cholesterol (TC), were measured at 13-19 +6 weeks (mid pregnancy) and 32-39 +6 weeks (late pregnancy). Children s body mass index (BMI) Z score were calculated according to the World Health Organization s growth standards for children under 5 years old. The lipid Z score were divided into four quartiles: Q 1, Q 2, Q 3 and Q 4. Linear regression was used to analyze the relationship between maternal lipid levels during pregnancy and offspring’s BMI Z score at 3 years of age. Poisson regression with a robust error variance was employed to evaluate the association between maternal lipid levels during pregnancy and the at risk of overweight and obesity in offspring at 3 years of age, after adjusting for maternal age at conception, education level, parity, pre pregnancy BMI and gestational diabetes mellitus. Results: There was a statistically significnt difference in the detection rate of overweight and obesity risk among children with different mothers s pre pregnancy BMI ( χ 2=22.85, P <0.05). Linear regression analysis showed that TG levels in late pregnancy were positively related to BMI Z score ( β=0.10, 95%CI=0.02-0.18, P <0.05). Poisson regression with a robust error variance indicated that, compared with the Q 1 group of TC, the Q 4 group of TC in mid pregnancy was associated with an increased risk of overweight and obesity in offspring at 3 years of age ( RR=1.59, 95%CI =1.04-2.44); compared with the Q 1 group of TG, the Q 4 group of TG during late pregnancy increased the risk of overweight and obesity in offspring at 3 years of age ( RR=1.79, 95%CI =1.02-3.12) (both P <0.05). Conclusions Maternal serum TC level during mid pregnancy can increase the risk of overweight and obesity in offspring at 3 years of age. Maternal serum TG levels during late pregnancy is positively correlated with BMI and the risk of overweight and obesity in offspring at 3 years of age.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.

Objective:To describe the current status and efficacy of additional acarbose combined with insulin therapy in adult patients with type 1 diabetes mellitus (T1DM) .Methods:Adult T1DM patients with acarbose combined with insulin (acarbose group) or insulin alone (insulin group), age≥18 years and disease course≥1 year, who were registered in the T1DM Translational Medicine Research Project of Guangdong Province from June 2011 to December 2014 were enrolled in the study. The hemoglobin A1c (HbA 1c), body weight, body mass index (BMI), waist-to-hip ratio (WHR), insulin dosage and hypoglycemia of acarbose group and insulin group after 1 year were compared. Results:A total of 717 adult patients with T1DM were included (62 cases in acarbose group and 655 cases in insulin group). At the time of enrollment, the onset age of acarbose group was higher than that of insulin group [(31.1±12.3)years vs (27.4±12.4)years, P=0.019]; There were no significant differences in gender, age, course of disease, body weight, BMI, WHR, proportion of carbohydrate heat ≥50%, proportion of exercise time ≥150 min per week, HbA 1c, dosage of insulin, occurence of hypoglycemia and proportion of patients with dyslipidemia between the 2 groups (all P>0.05). After 1 year of follow-up, the HbA 1c in acarbose and insulin group decreased from baseline ( P=0.014, P<0.001), the body weight and BMI increased from baseline (all P<0.05), but WHR, insulin dosage and hypoglycemia occurrence were not statistically significant between the two groups (all P>0.05). After 1 year of follow-up, there were no significant difference in changes of HbA 1c, body weight, BMI, WHR, insulin dosage and hypoglycemia occurrence in acarbose group compared with insulin group from baseline (all P>0.05). Conclusions:In the clinical practice of T1DM treatment, acarbose is used more frequently in patients with a slightly older age of onset. Treatment of T1DM with insulin combined with acarbose did not increase the incidence of hypoglycemia, and no benefit was observed in improving HbA 1c, maintaining body weight, and reducing insulin use.

Objective:To evaluate the effect of nimodipine on postoperative cognitive function in elderly patients undergoing carotid endarterectomy.Methods:Eighty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-80 yr, scheduled for elective carotid endarterectomy under general anesthesia, were divided into 2 groups ( n=41 each) using a random number table method: control group (group C) and nimodipine group (group N). Nimodipine 7.5 μg·kg -1·h -1 was intravenously infused starting from the beginning of surgery until the end of surgery in group N, while the equal volume of normal saline was given in group C. Before infusing nimodipine (T 1), before placing the the shunt (T 2), at 10 min after placing the the shunt (T 3) and at 10 min after releasing carotid artery (T 4), blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Jugular venous blood oxygen content, arterio-jugular difference of oxygen content, and cerebral oxygen extraction ratio were calculated.The concentrations of S100β protein in serum of the jugular bulb were measured by enzyme-linked immunosorbent assay.Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) Scale (Chinese version) at 1 day before surgery and 1, 3 and 7 days after surgery, and the occurrence of cognitive dysfunction (MoCA score<26) was recorded within 7 days after operation. Results:Compared with group C, MoCA scores were significantly increased at each time point after surgery, and the incidence of cognitive dysfunction was decreased (27% vs.17%), and the jugular venous blood oxygen content was increased, and arterio-jugular difference of oxygen content, cerebral oxygen extraction ratio, and concentrations of serum S100β protein were decreased at T 2-4 in group N ( P<0.05). Conclusions:Nimodipine can improve the cognitive function after carotid endarterectomy, which may be related to the improvement in intraoperative cerebral oxygen metabolism and reduction of brain injury in elderly patients.

Objective:To evaluate the effect of low-dose esketamine on postoperative delirium (POD) in elderly frail patients undergoing laparoscopic radical resection of the gastrointestinal tumor.Methods:Ninety-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ frail patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2 and preoperative Fried frailty phenotype scale score≥3, scheduled for elective laparoscopic radical resection of the gastrointestinal tumor under general anesthesia, were divided into 2 groups ( n=47 each) using a random number table method: control group (group C) and low-dose esketamine group (group K). In group K, esketamine 0.5 mg/kg was given during induction of anesthesia, and esketamine 0.25 mg·kg -1·h -1 was continuously infused during operation until the end of operation.In group C, the equal volume of normal saline was given at the corresponding time point.After induction of anesthesia and before skin incision (T 1), at 1 day after operation (T 2) and at 3 days after operation (T 3), blood samples from the internal jugular vein were collected for determination of the concentrations of S100β protein and neuron-specific enolase (NSE) in serum by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded.POD was evaluated by Confusion Assessment Method within 3 days after operation. Results:Compared with the baseline at T 1, the concentrations of serum S100β and NSE were significantly increased at T 2, 3 in both groups ( P<0.05). Compared with group C, the incidence of POD was significantly decreased (30% vs.13%), the intraoperative consumption of propofol and remifentanil was decreased, and concentrations of serum S100β protein and NSE were decreased at T 2, 3 in group K ( P<0.05). Conclusions:Low-dose esketamine can decrease the occurrence of POD in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor.

OBJECTIVE: To analyze the clinical features and variants of ABCD1 gene in a Chinese pedigree affected with X-linked adrenoleukodystrophy. METHODS: Clinical data of the proband were collected and analyzed. Potential variant of the ABCD1 gene were analyzed by PCR and Sanger sequencing of the proband, his parents and 100 unrelated healthy individuals. RESULTS: The prominent features of the proband included cerebellar and brainstem lesions, along with increased serum level of very-long chain fatty acids. He was found to harbor a hemizygous c.1509delG (p.L504Sfs*54) variant of the ABCD1 gene, for which his mother was heterozygous. The same variant was not detected in his father and 100 healthy controls. CONCLUSION X-linked adrenoleukodystrophy has a variety of clinical manifestations. Discovery of the c.1509delG (p.L504Sfs*54), as a novel pathogenic variant of the ABCD1 gene, has enabled diagnosis and genetic counseling for this pedigree.
Adrenoleukodystrophy/genetics* ; Asians/genetics* ; China ; Female ; Genetic Testing ; Humans ; Male ; Mutation ; Pedigree

Objective:To investigate the effects of fluoride exposure on proliferation, apoptosis and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in mice.Methods:BMSCs were isolated and cultured from femur bone marrow of C57BL/6 mice (6 - 8 weeks). The cells in passage 3 were used to detect the surface markers of stem cells by flow cytometry. The cells were cultured in media with a final fluoride concentration of 0.0, 0.1, 1.0, 5.0, 10.0, 15.0, 20.0 and 40.0 mg/L, respectively. The effects of different fluoride concentrations on BMSCs cell proliferation (CCK8 method), apoptosis (flow cytometry analysis), osteogenic differentiation ability [alizarin red and alkaline phosphatase (ALP) staining] were detected. Western blot was applied to detect the levels of apoptosis-related proteins [poly ADP-ribose polymerase (PARP)], mitogen-activated protein kinase (MAPK) pathway member proteins [extracellular regulated protein kinase 1/2 (ERK1/2), c-Jun amino-terminal kinase (JNK), p38 and phosphorylated ERK, JNK, p38 (p-ERK, p-JNK, p-p38)], osteogenic differentiation-related protein [Runt-related transcription factor 2 (Runx2), ALP] and Wnt/β-catenin pathway member proteins [glycogen synthase kinase-3β (GSK3β), phosphorylated GSK3β (p-GSK3β) and β-catenin]. Immunocytofluorescense staining was applied to evaluate the expression levels of p-GSK3β and β-catenin. The two pathways (MAPK and Wnt/β-catenin) were blocked by SP600125 and DKK-1, respectively, to testify their involvement in mechanisms of apoptosis and osteogenic differentiation.Results:The mouse BMSCs were successfully isolated and cultured. Flow cytometry analysis showed that the mesenchymal stem cell surface biomarkers (CD73, CD90 and CD105) were positively expressed. The comparison of cell proliferation at three time points (24, 48 and 72 h) in each concentration group was statistically significant ( F = 65.36, 160.04 and 365.32, P < 0.001), and the comparison of early apoptosis (24 h) in each concentration group was statistically significant ( F = 214.04, P < 0.001); compared with the 0.0 mg/L group, the cell proliferation in 15.0, 20.0 and 40.0 mg/L groups decreased, and the early apoptosis rate in 10.0, 15.0 and 20.0 mg/L groups increased ( P < 0.05). When cells were treated with 15.0 mg/L fluoride for 0 - 24 h, the p-JNK/JNK ratio was higher at 2, 4, 8, 12, 18 and 24 h compared with that at 0 min ( P < 0.05); compared with the fluoride group (15.0 mg/L), the early apoptosis rate of cells after SP600125 block decreased ( P < 0.05), and the protein expression levels of PARP and p-JNK decreased ( P < 0.05). After osteogenic induction, compared with the 0.0 mg/L group, in 0.1 and 1.0 mg/L groups ALP staining was enhanced and the number of calcified nodules increased, and the protein expression levels of Runx2 and ALP in the 0.1 and 1.0 mg/L groups were higher ( P < 0.05). After osteogenic induction, compared with the 0.0 mg/L group, the p-GSK3β/GSK3β ratio and β-catenin protein level were significantly higher in the 0.1 and 1.0 mg/L groups ( P < 0.05); and compared with the fluoride group (1.0 mg/L), addition of DKK-1 significantly decreased the protein expression levels of p-GSK3β and β-catenin and reduced the nuclear entry of β-catenin, and ALP staining decreased and the number of calcified nodules decreased. Conclusions:High concentration of fluoride (> 10.0 mg/L) inhibits the proliferation and promotes apoptosis of BMSCs, while low concentration of fluoride (0.1, 1.0 mg/L) promotes osteogenic differentiation. The MAPK/JNK pathway and the classical Wnt pathway are involved in the above cellular processes, respectively.

Background: Granular cell tumor (GCT) is an uncommon tumor, and gastrointestinal tract GCT is even more rare. Aims: To investigate the clinicopathological characteristics, treatment and prognosis of gastrointestinal tract GCT. Methods: Nine cases of gastrointestinal tract GCT from January 2017 to June 2021 at the 903rd Hospital of Joint Logistics Support Force, PLA and Jinhua Municipal Central Hospital Medical Group were retrieved. The clinical data, histopathological characteristics, treatment, and prognosis were retrospectively analyzed. Results: In the 9 patients with gastrointestinal tract GCT, ratio of male to female was 2:1, age at diagnosis was 19-60 years, with a median age of 52 years. Six GCT were found in esophagus, 2 in colorectum and 1 in anus. Endoscopic results showed submucosal protrusion or sessile polyps ranging in size from 2-12 mm with a median of 5 mm. Histology results showed that tumors were located in mucosa and/or submucosa, arranged in solid sheets or nests, with an infiltrative margin and inflammatory infiltrates. Tumor cells were mainly plump and polygonal with abundant cytoplasm and eosinophilic granules. Nuclei were small, the nuclear-cytoplasmic ratio was very low. Mitotic figure was rare. Immunohistochemistry results showed that S100 and CD68 proteins were positive in all patients, SOX10, CD56, Calretinin and Syn were positive in some patients, and CKp, Desmin, SMA, CD117, CD34, Dog1, and α-inhibin were negative in all patients. Esophageal and colorectal GCT patients received endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The anal GCT patient underwent local resection. Recurrence or metastasis were not observed during 9-53 months of follow-up. Conclusions: Gastrointestinal tract GCT is rare with non-specific clinical symptoms and submucosal protrusion or sessile polyps under endoscopy. Gastrointestinal tract GCT has special pathomorphology and immunophenotype. EMR or ESD is recommended for small and superficial lesions. Long-term follow-up should be performed.

OBJECTIVETo compare clinical efficacy of repositioning with precise-surgical-opening intramedullary nail insertion and traditional repositioning in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty.

METHODSClinical data of 58 patients with unstable femoral intertrochanteric fractures after closed-reposition difficulty (AO 31A2.2-3.3) were retrospective analyzed. Among them, 32 patients were treated with first open intramedullary nail and then reduction operation(modified reductuon group) including 9 males and 23 females with an average age of (80.9±11.1) years old ranging from 46 to 99 years old; and 26 patients were treated by traditional reduction(traditional reduction group) including 7 males and 19 females with an average of(78.1±13.9) years old ranging from 41 to 89 years old. The time of operation, the amount of bleeding, the length of hospital stay, the first weight-bearing time and the time of fracture healing, postoperative complications and Harris hip score were evaluated and compared between the two groups.

RESULTSAll patients were followed up for 12 to 24 months with an average of 17.3 months. The operative time(3.612, 0.008 2) nd the blood loss(3.389, 0.007 5) in the modified reduction group were lower than those in the traditional reduction group. There were no significant differences in hospitalization time(0.851, 0.392), fracture healing time(0.640, 0.531), and the first loading time(0.845, 0.411) between two groups. There was no significant difference in the Harris score between two groups(χ²=0.66, 0.831>0.05).

CONCLUSIONSTraditional repositioning requires a repositioning of the fracture bone and a correct opening reaming before the insertion and fixture of the intramedullary nail, which is a complicated operation in unstable femoral intertrochanteric fractures after closed-reposition difficulty. On the other hand, the new method implements the insertion of the intramedullary nail before the repositioning of the fracture bone, greatly simplifying the operation procedure, shortening the total operation time and reducing the amount of intraoperative blood loss.