ObjectiveTo construct a group-based trajectory model (GBTM) for early medication adherence check-in, and to analyze the relationship between different trajectories and treatment outcomes in tuberculosis patients using data that were generated from smart tools for monitoring their medication adherence and check-in. MethodsFrom October 1, 2022 to September 30, 2023, a total of 163 pulmonary tuberculosis patients diagnosed in Fengxian District were selected as the study subjects. The GBTM was utilized to analyze the weekly active check-in trajectories of the subjects during the first 4 weeks and establish different trajectory groups. The χ² tests were employed to compare the differences between groups and logistic regression analysis was conducted to explore the relationship between different trajectory groups and treatment outcomes. ResultsA total of four groups were generated by GBTM analyses, of which a low level of punch card was maintained in group A, 6% of the drug users increased rapidly from a low level in group B, 17% of drug users increased gradually from a low level in group C, and 18% of drug users maintained a high level of punch card in group D. The trajectory group was divided into two groups according to homogeneity, namely the low level medication punch card group (group A) and the high level medication punch card group (group B, group C, and group D). The results of multivariate logistic regression analyses revealed that low-level medication check-in (OR=3.250, 95%CI: 1.089‒9.696), increasing age (OR=1.030, 95%CI: 1.004‒1.056), and not undergoing sputum examination at the end of the fifth month (OR=2.746, 95%CI: 1.090‒7.009) were significantly associated with poor treatment outcomes. ConclusionThe medication check-in trajectory of pulmonary tuberculosis patients within the first 4 weeks is correlated with adverse outcomes, or namely consistent low-level medication adherence check-ins are associated with poor treatment outcomes, while high-level medication adherence check-ins are associated with a lower incidence of adverse outcomes.

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Objective To compare and analyze the biological effects of two types of helmets,which have different masses and centroids,on the neck of pilots under rapid braking condition,and provide new ideas for improving the ergonomic design of helmets for pilots.Methods A finite element model of the head,neck,helmet,and restraint system was established using Hyper Mesh 14.0 software.Finite element simulation was used to study the neck biological effects of pilots wearing different helmets for rapid braking.Results After wearing Type Ⅰ and Type Ⅱ helmets,the trend,occurrence time,and location of the maximum stress borne by each vertebra and intervertebral disc are basically consistent.The maximum stress on the vertebrae above C3 is smaller when wearing a Type Ⅰ helmet,while the maximum stress on the vertebrae below C3 is smaller when wearing a Type Ⅱ helmet.The maximum stress on the C2～C3 intervertebral disc is relatively small when wearing a TypeⅠhelmet,while the intervertebral discs below it are relatively small when wearing a Type Ⅱ helmet.The ligament elongation rate and maximum neck injury index Nij of wearing Type Ⅰ helmets are both relatively high.Conclusion Type Ⅰ helmet has a significant biological impact on the neck of pilots during rapid braking.

Objective To measure the range of cervical spine mobility in flight trainees and analyze its correlation with flight task performance.Methods A total of 55 participants were enrolled(30 in the experimental group,25 in the control group).An independently developed AI-based digital cervical spine function assessment system was used to measure rotational ranges in yaw,pitch,and roll directions,with comparative analysis performed against contralateral rotation.A subjective scoring scale was designed,and flight instructors of the experimental group were invited to provide performance ratings to explore the relationship between cervical mobility and flight task performance.Results Significant differences were observed between the experimental and control groups in left rotation(P<0.01),right rotation(P<0.05),and flexion(P<0.05).Within the experimental group,significant differences were found between left and right rotation(P<0.01)and between flexion and extension(P<0.01).Correlation analysis between flight performance scores and cervical mobility revealed a significant association between situational awareness and yaw range(r=-0.415,P<0.05).Conclusion The experimental group exhibited significant differences in certain cervical mobility parameters compared to the control group,suggesting that occupational characteristics may influence cervical mobility.The correlation between yaw range and situational awareness implies a potential link between head-neck yaw capability and vestibular-visual system functions,though further validation is required.

Skin flaps are frequently employed in plastic and reconstructive surgery to address tissue defects.However,their low survival rates remain a challenge,attributed to vascular crisis and necrosis.Despite numerous studies investigating drugs to alleviate flap necrosis,a comprehensive analysis of the research trend in this critical area is lacking.To gain a deeper understanding of the current status,research focal points,and future trends in drugs aimed at enhancing flap survival,a thorough retrospective analysis is imperative.This study aims to employ bibliometric methods to scrutinize the evolution,mechanisms,and forthcoming trends of drugs targeting flap survival improvement.Using VOSviewer software,we quantitatively and visually depict 1)annual temporal trends in the number of documents and citations;2)national/regional publications and their collaborations;3)institutional and authors'contribution;4)journal contribution and relevance;and 5)analysis of research hotspots and directions derived from keywords.Ultimately,we discussed the prospects and challenges of future advances and clinical trans-lation of drugs designed to enhance skin flap survival.In conclusion,the field of pharmacology dedicated to improving skin flap survival is expanding,and this study aims to offer a fresh perspective to promote the advancement and clinical application of such drugs.

With the continuous advancement of manned deep space exploration technology,the duration of astronauts'missions will significantly lengthen,posing new challenges for astronauts'health protection.Putting astronauts into a state of low metabolism through various means may be a feasible response.This article qualitatively explores the advantages,disadvantages,external opportunities,and threats of astronauts'low metabolic flights in deep space exploration missions through SWOT analysis,and puts forward relevant suggestions and strategies,thus providing important basis and reference for the research on astronauts'low metabolic flights in deep space exploration missions.

Objective To explore the specific mechanism by which circ_0084043/miR-31-5p regulates high mobility group AT-hook 1(HMGA1)and thus participates in atherosclerosis(AS).Methods Carotid plaque tissues,diseased vascular tissue,and corresponding normal tissue from areas adjacent to the plaques were collected from 49 AS patients between September 2020 and September 2023.Quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to determine circ_0084043 expression.The proliferation,migration,and invasion of vascular smooth muscle cells(VSMCs)induced by oxidized low-density lipoprotein(ox-LDL)were determined by CCK-8,clone formation,scratch,and Transwell assays.The targeted regulatory relationship among circ_0084043,miR-31-5p,and HMGA1 was verified by bioinformatics and dual luciferase reporter gene assay.An AS mouse model was established,and the pathological lesions in the aorta of AS model mice were observed by oil red O and HE stainings.Biochemical testing was performed to assess blood lipids in venous blood.qRT-PCR was used to determine the expression of miR-31-5p and HMGA1.Immunohistochemistry was performed to assess the expression of HMGA1 and α-smooth muscle actin(α-SMA)in the aorta of the AS model mice.Results In AS patients,the expression levels of circ_0084043 and HMGA1 in carotid plaque tissues and diseased vascular tissues were elevated(P＜0.05),while the expression level of miR-31-5p was decreased(P＜0.05).The expression of circ_0084043 was negatively correlated with the expression of miR-31-5p(r=-0.385 5,P=0.0062).HMGA1 expression was positively correlated with circ_0084043 expression(r=0.3317,P=0.0199),and negatively correlated with miR-31-5p(r=-0.3351,P=0.0186).MiR-31-5p had target binding sites for both circ_0084043 and HMGA1.Compared with the control group,the proliferation,clone formation,migration,and invasion abilities of the sh-NC group,the scramble group,the circ_0084043+miR-31-5p mimics group,the miR-31-5p inhibitor+sh-HMGA 1 group,and the circ_0084043+sh-HMGA1 group increased(P＜0.05).In contrast,the proliferation,clone formation,migration,and invasion abilities of the sh-0084043 group significant decreased compared to those of the sh-NC group(P＜0.05).The proliferation,clone formation,migration,and invasion abilities of the miR-31-5p mimics group and the sh-HMGA1 group decreased compared with those of the scramble group(P＜0.05).Compared with the sh-NC group,sh-0084043 group had decreased aortic lipid plaque and necrotic core areas(P＜0.05).Total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),and the expression levels of HMGA1 mRNA and protein and α-SMA decreased(P＜0.05),while high-density lipoprotein cholesterol(HDL-C)and miR-31-5p expression levels increased(P＜0.05).Conclusion circ_0084043 promotes the proliferation and migration of VSMCs and promotes the progress of AS by inhibiting miR-31-5p and increasing the expression of HMGA1.

Objective:To investigate cases of delayed lactation initiation in women with transvaginal delivery and the influencing factors, in order to provide a basis for effective control of delayed lactation initiation and promotion of breastfeeding.Methods:Inpatients who were admitted to the obstetric ward of Affiliated Hospital of Jining Medical College from November 6, 2020 to January 16, 2021 were selected for the study using convenience sampling method and investigated by general information questionnaire and Chindbirth Experience Questionnaire (CEQ). Binary Logistic regression analysis was used to determine the factors influencing delayed lactation initiation.Results:The incidence of delayed lactation initiation in 622 women with transvaginal delivery was 38.75% (241/622). Binary Logistic regression analysis showed that age 20-35 years, full-term delivery, labor and delivery, use of labor analgesia, and good experience of transvaginal delivery were protective factors for delayed lactation initiation ( OR values were 0.012 to 0.868, all P<0.05); age >35 years, excessive weight gain during pregnancy, presence of pregnancy complications, use of induction of labor during delivery, long labor process, and damage to perineal skin after delivery were risk factors for delayed lactation initiation ( OR values were 1.097 to 13.235, all P<0.05). Conclusions:The high incidence of delayed lactation initiation in women with transvaginal delivery is influenced by a number of factors, which reminds the clinic that lactation in women after transvaginal delivery also needs to be taken into account, with priority assessment and prevention for those who are elderly (age≥35 years), primiparous, have other diseases during pregnancy, have gained too much weight during pregnancy, have preterm delivery, have a long duration of labor, have not received labor analgesia, have had a single or combined induction of labor, have had an episiotomy or perineal laceration during labor, and have a poor transvaginal delivery experience.

Objective:To evaluate the clinical efficacy of kidney-invigorating and asthma-relieving granules in treating kidney deficiency type of bronchial asthma patients in persistent.Methods:A total of 100 patients with bronchial asthma admitted to Shanghai Municipal Hospital of TCM from March 2020 to August 2020 were selected as the research subjects. The patients were divided into control group and treatment group by random and double blind method, 50 in each group. Both groups were treated by routine basic treatment. The control group was treated with Kidney-invigorating and asthma-relieving Placebo, while the observation group was treated with kidney-invigorating and asthma-relieving granules. All the treatment lasted for 6 weeks. The TCM syndromes scores, Asthma Control Test (ACT) scores, Peak expiratory flow/predicted value (PEF%) and eosinophil in peripheral blood before and after treatment were observed.Results:A total of 91 patients completed the clinical study. There were 45 patients in the control group and 46 in the treatment group. The total effective rate in the treatment group was 93.5% (43/46), while that in the control group was 77.8% (35/45), and the difference was statistically significant ( χ2=4.579, P=0.032). After the treatment, the scores of integral efficacy on syndromes in Chinese medicine, ACT and PEF% in the treatment group were significantly higher than those in the control group ( t values were 2.802, 3.420 and 8.938, respectively, all Ps<0.01). The eosinophil in peripheral blood of patients in the treatment group was significantly lower than that of the control group ( t=3.481, P=0.001). Conclusion:On the basis of conventional treatment of western medicine, kidney-invigorating and asthma-relieving granules can relieve the clinical symptoms of asthma, improve the control level of asthma, enhance the level of PEF, reduce airway inflammation.