Objective: To identify early clinical predictors associated with dysphagia and delayed swallowing recovery in patients with traumatic brain injury (TBI). Methods: In this retrospective study, we enrolled adult TBI patients admitted to the rehabilitation unit of a tertiary medical center between June 2019 and June 2023. Data on baseline characteristics, neurological status, imaging findings, and rehabilitation-related variables were collected. Swallowing function was assessed using two indicators: (1) nasogastric (NG) tube retention and (2) the Functional Oral Intake Scale (FOIS) scores at 1, 4, and 12 weeks post-injury. Regression analyses were conducted to identify predictors associated with dysphagia and swallowing recovery. Results: A total of 160 patients were included. At 1 week post-injury, longer intensive care unit (ICU) stay, poor initial sitting balance and use of sedative medication in ICU were associated with NG tube retention. At 4 weeks, lower initial Rancho Los Amigos Scale (RLAS) scores, immobility-related complications, longer hospitalization, and temporal lobe hematomas were associated with persistent NG tube dependence. By 12 weeks, older age, delayed ability to follow commands, and poor initial sitting balance remained associated with NG tube retention. FOIS outcomes were also associated with older age, delayed time to follow commands, impaired initial sitting balance, prolonged ICU stay, temporal lobe hematomas, lower initial RLAS scores, immobility-related complications, prolonged endotracheal tube placement and extended hospital stays. Conclusion Impaired cognitive status, poor physical function, immobility-related complications, and temporal lobe hematomas were key factors associated with dysphagia and delayed oral intake in individuals with TBI.

Background: Cerebral hypoxia-ischemia impairs brain development in extremely preterm infants and is associated with poor neurological outcomes. Near-infrared spectroscopy (NIRS) is a noninvasive continuous monitoring method for regional cerebral oxygen saturation (rcSO2).Purpose: This study evaluated the clinical feasibility and neurological impact of a neurocritical care bundle that incorporates prolonged multidisciplinary hemodynamic monitoring and a stepwise management algorithm. Methods: Preterm infants with a gestational age (GA) ≤28 weeks or birth weight (BW) ≤1,000 g were prospectively enrolled in a bundle group subjected to NIRS for rcSO2, electrical cardiometry for cardiac output, and daily brain and cardiac echography during the first 72 hours of life. Monitoring was repeated weekly in the first month and then monthly until discharge or the term-equivalent age (TEA) was reached. We implemented a stepwise management algorithm for treating cerebral hypoxia. The primary outcome was a composite of mortality and adverse neurological events (structural abnormalities or electroencephalogram-confirmed seizures) before discharge. The secondary outcomes were the physiological pattern of rcSO2 within the initial 72 hours and up to discharge or TEA. Results: Thirty preterm infants (GA, 27.1±2.0 weeks; BW, 830±225 g) were enrolled in the bundle group. The mean time-averaged rcSO2 (66.8%±10.3%) was not associated with GA or BW. However, postnatal age appeared to influence physiological rcSO2 changes, given that rcSO2 values were higher during the initial 72 hours than at subsequent intervals. Seven infants (23.3%) had poor outcomes and significantly lower time-averaged rcSO2 (51.1% [50.0%–65.2%] vs. 71.8% [67.1%–73.1%], P=0.002). Multivariate regression indicated that a lower rcSO2 was an independent risk factor, and a 65% threshold showed an optimal predictive value for poor outcomes. Conclusion The neurocritical care bundle helped identify preterm infants at risk of cerebral hypoxia, and lower rcSO2 was an independent risk factor for composite mortality and adverse neurological outcomes.

It is considered that "latent wind in stomach collaterals" is the core pathogenesis underlying the inflammation-caner transformation of helicobacter pylori-associated gastritis （HpAG）. The concept of "latent wind in stomach collaterals" integrates stomach wind theory， latent pathogen theory， and collateral disease theory， referring to wind pathogen deeply hidden in the stomach collaterals， characterized by both external and internal wind pathogen as well as latent pathogen that remain concealed and may be triggered under certain conditions. Accordingly， the Correa cascade is reclassified into four stages including the prodromal stage， progressive stage， transitional stage and carcinogenic stage. In the prodromal stage， the fundamental pathogenesis is described as "wind toxin invading externally with collateral deficiency and stirring of wind". In the progressive stage， wind is accompanied by qi constraint， fire pathogen， and dryness pathogen， manifesting as "wind pathogen complicated by constraint" "wind-fire agitation" and "wind-dryness interaction". In the transitional stage， "wind transforming into phlegm-drool and stomach collaterals being obstructed by stasis" is identified as a critical window for disease reversal. In the carcinogenesis stage， "wind-qi hyperactivity leading to pathological transformation， and collateral damage resulting in abdominal masses" drives tumor progression and metastasis. This paper proposes the treatment principle of "wind-dispelling throughout the entire process and stage-based treatment"， according to the pathological evolution of "collateral deficiency-collateral stagnation-collateral accumulation". In the prodromal stage， it is suggested to dispel wind and resolve toxin， fortify spleen and tonify collaterals； in the progressive and transitional stage， the method of dispelling wind pathogen， clearing phlegm and eliminating stasis should be used； in the carcinogenesis stage， it is suggested to expel wind and remove pathogens from collaterals， disperse concretions and eliminate tumors.

Objective To conduct Monte Carlo simulations on the microselectro-HDR¹⁹²Ir radiation source, investigate dose distributions under various conditions, and provide assistance in optimizing radiotherapy plans. Methods A microselectro-HDR¹⁹²Ir radiation source model was established based on the MCNP5 software. Theoretical calculation formulas were used to validate the simulation results. The dose distributions under different activities and positions were obtained through simulations using the MCNP5 transport program. By fitting the simulation data, the relationship between the safe distance for at-risk organs and treatment time was analyzed. Results As the distance from the origin increased in the X-direction, the distance required for the absorbed dose rate to decrease to half its original value increased, and the isodose lines became sparser. The shapes of the dose distribution diagrams under different activities were consistent, presenting concentric polygons and concentric circles at different distances. Under the condition of the same lethal dose, the difference in the safe distance between two organs increased with time; under different lethal dose conditions, the differences were not significant whether between similar organs or between different organs. Conclusion The Monte Carlo method can accurately describe the radiation field generated by the microselectro-HDR¹⁹²Ir radioactive source during high-dose-rate brachytherapy. Quantitative analysis of the radiation field will help optimize the radiotherapy plan.

Objective To conduct Monte Carlo simulations on the microselectro-HDR¹⁹²Ir radiation source, investigate dose distributions under various conditions, and provide assistance in optimizing radiotherapy plans. Methods A microselectro-HDR¹⁹²Ir radiation source model was established based on the MCNP5 software. Theoretical calculation formulas were used to validate the simulation results. The dose distributions under different activities and positions were obtained through simulations using the MCNP5 transport program. By fitting the simulation data, the relationship between the safe distance for at-risk organs and treatment time was analyzed. Results As the distance from the origin increased in the X-direction, the distance required for the absorbed dose rate to decrease to half its original value increased, and the isodose lines became sparser. The shapes of the dose distribution diagrams under different activities were consistent, presenting concentric polygons and concentric circles at different distances. Under the condition of the same lethal dose, the difference in the safe distance between two organs increased with time; under different lethal dose conditions, the differences were not significant whether between similar organs or between different organs. Conclusion The Monte Carlo method can accurately describe the radiation field generated by the microselectro-HDR¹⁹²Ir radioactive source during high-dose-rate brachytherapy. Quantitative analysis of the radiation field will help optimize the radiotherapy plan.

Objective To conduct Monte Carlo simulations on the microselectro-HDR¹⁹²Ir radiation source, investigate dose distributions under various conditions, and provide assistance in optimizing radiotherapy plans. Methods A microselectro-HDR¹⁹²Ir radiation source model was established based on the MCNP5 software. Theoretical calculation formulas were used to validate the simulation results. The dose distributions under different activities and positions were obtained through simulations using the MCNP5 transport program. By fitting the simulation data, the relationship between the safe distance for at-risk organs and treatment time was analyzed. Results As the distance from the origin increased in the X-direction, the distance required for the absorbed dose rate to decrease to half its original value increased, and the isodose lines became sparser. The shapes of the dose distribution diagrams under different activities were consistent, presenting concentric polygons and concentric circles at different distances. Under the condition of the same lethal dose, the difference in the safe distance between two organs increased with time; under different lethal dose conditions, the differences were not significant whether between similar organs or between different organs. Conclusion The Monte Carlo method can accurately describe the radiation field generated by the microselectro-HDR¹⁹²Ir radioactive source during high-dose-rate brachytherapy. Quantitative analysis of the radiation field will help optimize the radiotherapy plan.

Objective: Whether elevation in plasma levels of amyloid and tau protein biomarkers are better indicators of cognitive decline than higher baseline levels in patients with amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) remains understudied. Methods: We included 67 participants with twice testing for AD-related plasma biomarkers via immunomagnetic reduction (IMR) assays (amyloid beta [Aβ]1-40, Aβ1-42, total tau [t-Tau], phosphorylated tau [p-Tau] 181, and alpha-synuclein [α-Syn]) and the Mini-Mental State Examination (MMSE) over a 1-year interval. We examined the correlation between biomarker levels (baseline vs. longitudinal change) and annual changes in the MMSE scores. Receiver operating characteristic curve analysis was conducted to compare the biomarkers. Results: After adjustment, faster cognitive decline was correlated with lower baseline levels of t-Tau (β=0.332, p=0.030) and p-Tau 181 (β=0.369, p=0.015) and rapid elevation of t-Tau (β=-0.330, p=0.030) and p-Tau 181 levels (β=-0.431, p=0.004). However, the levels (baseline and longitudinal changes) of Aβ1-40, Aβ1-42, and α-Syn were not correlated with cognitive decline. aMCI converters had lower baseline levels of p-Tau 181 (p=0.002) but larger annual changes (p=0.001) than aMCI non-converters. The change in p-Tau 181 levels showed better discriminatory capacity than the change in t-Tau levels in terms of identifying AD conversion in patients with aMCI, with an area under curve of 86.7% versus 72.2%. Conclusion We found changes in p-Tau 181 levels may be a suitable biomarker for identifying AD conversion.

Cancer immunotherapy has emerged as a promising strategy. However, low response rates and immune-related side effects have plagued immunotherapy. Metallic nanoparticles, utilizing metals as their framework, are gaining prominence in cancer immunotherapy. Metal ions have shown the ability to modulate immune status by activating the cGAS-STING pathway and inducing immunogenic cell death (ICD), thereby enabling multidimensional activation of immunotherapy. Metallic nanoparticles offer significant advantages in cancer immunotherapy, leading to their increasing use in enhancing therapeutic outcomes. In view of the ever-increasing research on metallic nanoparticles, this review presents the construction, characterization, and enhanced cancer immunotherapeutic effects of different types of metal nanosystems from the perspective of the immunoregulatory mechanisms of metal ions. We delve into the current limitations and future directions of metallic nanoparticles in this rapidly evolving field. To the best of our knowledge, this review offers the most up-to-date and systematic analysis of metallic nanoparticles in immunotherapeutic applications. It is anticipated that this review of metallic nanoparticles will inspire a more refined and intelligent design of metallic nanoparticles for future research, paving the way for advancing their clinical applications.

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*