Objective To evaluate and summarise the best evidence on non-pharmacological preventive measures for lower limb lymphedema in patients with gynecologic malignancy so as to provide an evidence-based guidance for prevention of lower limb lymphedema.Methods Systematic searches were conducted from inception to 31th January,2024 on databases of UpToDate,BMJ Best Practice,the National Institute for Health and Care Excellence(NICE),the Oncology Nursing Society(ONS),Guidelines International Network(GIN),China Guideline Clearinghouse,Medlive,National Comprehensive Cancer Network(NCCN),Registered Nurses Association of Ontario(RNAO),American Society of Clinical Oncology(ASCO),European Society for Medical Oncology(ESMO),Cancer Australia(CA),National Lymphedema Network(NLN),Scottish Intercollegiate Guidelines Network(SIGN),Lymphedema Support Network(LSN),International Society of Lymphology(ISL),International Society of Nurses in Cancer Care,Lymphedema Association of Ontario,Lymphoedema United,Cochrane Library,Web of Science,PubMed,Scopus,OVID,Embase,CINAHL,VIP,Wangfang Data,CNKI and SinoMed for the relevant evidence in non-pharmacological preventive measures for lower limb lymphedema in patients with gynecological malignancy.Two researchers evaluated the quality of clinical decisions,expert consensus,systematic reviews and randomised controlled trials,while four investigators assessed the quality of the guidelines.Another two researchers performed data extraction and evidence summary.Results A total of 17 articles were included,comprising two clinical decisions,two guidelines,two systematic reviews,seven expert consensuses,one evidence summary,three randomised controlled trials.A total of 32 pieces of evidence were summarised across eight dimensions:prevention timing,evaluation element,general self-care,skin care,manual lymphatic drainage,compression therapy,exercise and health education.Conclusion This study provides an evidence-based guidance for prevention of lower limb lymphedema in patients with gynecological malignancy.Healthcare professionals should apply the best evidences based on the conditions,preferences,resource allocation,and other factors of the patients,to reduce limb lymphedema and improve the quality of life of the patients.

BACKGROUND:Polycystic ovary syndrome is a common reproductive endocrine disease leading to infertility in women of reproductive age.Currently,there is no effective treatment.Human umbilical cord mesenchymal stem cells may help to repair ovarian function,but few studies have reported their role in the treatment of polycystic ovary syndrome.OBJECTIVE:To explore the effect and mechanism of human umbilical cord mesenchymal stem cells in the treatment of polycystic ovary syndrome.METHODS:3-week-old female ICR mice were divided into three groups(n=15).Normal control group was not treated.Model group was given letrozole for 21 days to induce polycystic ovary syndrome.Treatment group was given letrozole via intragastric administration for 21 consecutive days,and human umbilical cord mesenchymal stem cell suspension was injected through the tail vein.The body weight of mice was monitored before treatment,7 and 14 days after treatment.The estrous cycle of mice was detected by continuous vaginal smears for 10 consecutive days after treatment.Fourteen days after treatment,peripheral blood sex hormone levels of mice were detected by ELISA.Hematoxylin-eosin staining was used to observe ovarian morphological changes.Immunofluorescence and immunohistochemistry were used to detect the expression of Rab27A protein in ovarian tissues.RESULTS AND CONCLUSION:(1)Compared with the normal control group,the estrous cycle of mice in the model group was disturbed;body weight was significantly increased;follicle stimulating hormone was decreased;luteinizing hormone and testesterone were both increased;more follicles were found in the ovaries,and the relative expression level of Rab27A protein was decreased.(2)Compared with the model group,the treatment group had diminished body weight,increased follicle stimulating hormone,decreased luteinizing hormone and testesterone,decreased follicles with polycystic dilatation,and increased Rab27A protein relative expression level.(3)These findings suggest that human umbilical cord mesenchymal stem cells improve serum sex hormone levels and ovarian function in polycystic ovary syndrome mice by upregulating the expression of Rab27A.

Objective The purpose of this study was to provide a more effective method for researching the prevention and treatment of Graves'disease by comparing the effects of two plasmid vectors expressing the human thyrotropin receptor(TSHR)A subunit gene in inducing an animal model of Graves'disease via electroporation.Methods Plasmids pcDNA3.1-THSR A,and pTriEx1.1-THSR A expressing the TSHR A subunit were constructed and used to induce Graves'disease by intramuscular injection with immediate electroporation once every 3 weeks for a total of 4 times.Mice in the control group were injected with PBS.One week after the second electroporation,blood was collected to measure serum thyrotropin receptor antibody(TRAb).Three weeks following the last electroporation,echocardiography was performed on the mice.Mice were sacrificed 4 weeks after the last electroporation;blood,thyroid,and orbital tissues were collected;serum total thyroxine(TT4)was measured;and histological examination was performed.Results The average concentrations of serum TRAb in the pcDNA3.1-TSHR A group(n=15)and the pTriEx1.1-TSHR A group(n=13)were(6.9±2.0)U/L and(7.5±2.2)U/L,respectively.The latter was significantly higher than that in the control group(4.9±0.5)U/L(P=0.033).The average concentrations of serum TT4 in the pcDNA3.1-TSHR A group and pTriEx1.1-TSHR A group were(41.4±23.8)ng/mL and(63.2±53.7)ng/mL,respectively,both higher than that in the control group:(20.2±4.0)ng/mL(P＜0.01).Thyroid pathology showed thyroid follicular epithelial hyperplasia with T-cell infiltration in the model group.Echocardiography showed that the left ventricle mass in the pTriEx1.1-TSHR A group was higher than those in the control group(P=0.007)and pcDNA3.1-TSHR A group(P=0.012).Orbital pathology showed fibrotic changes in the extraocular muscles of mice in the model groups.Conclusions Both pcDNA3.1 and pTriEx1.1 expressing the TSHR A subunit were able to induce Graves'disease in mice by electroporation,and the efficiency of the two plasmids in inducing hyperthyroidism and Graves'ophthalmopathy was similar.The efficiency of pTriEx 1.1-TSHR A in inducing thyrotoxic heart disease was better than that of pcDNA3.1-TSHR A.

Objective To explore the roles of the mechanoreceptor Yes-associated protein 1(YAP1)and piezo type mechanosensitive ion channel component 2(PIEZO2)in mechanotransduction in mouse bladder urothelial cells.Methods Mouse bladder urothelial cells were subjected to mechanical stretching using the FX-6000T cell stretching system and treated with the YAP1-specific inhibitor verteporfin(VP).The expressions of PIEZO2,YAP1 and connective tissue growth factor(CTGF)at the mRNA and protein levels,as well as changes in cellular adenosine triphosphatase(ATP)concentration,were detected using reverse transcription quantitative PCR(RT-qPCR)and Western blotting(WB).Results After stretching stimulation,under the fluorescence microscope,it was observed that the diameter length of the stretched cells were longer than that before stretching,and the difference was statistically significant(P＜0.05).The expressions of YAP1,PIEZO2 and CTGF at the mRNA and protein levels were increased in the stretched group compared to those of the non-stretched group(P＜0.05).VP effectively reduced the expressions of YAP1,PIEZO2 and CTGF at the mRNA and protein levels after stretching stimulation(P＜0.05).Stretching stimulation significantly increased the intracellular ATP concentration,while VP was able to inhibit the increase in ATP concentration,with a statistically significant difference(P＜0.000 1).Conclusion Stretching stimulation increased the expressions of YAP1 and PIEZO2 in bladder urothelial cells and promoted the release of ATP;verteporfin inhibited the increase in YAP1 activity and the overexpression of PIEZO2 caused by stretching,thereby reducing the release of ATP.It is suggested that mouse bladder urothelial cells may primarily sense mechanical signals through the YAP1-PIEZO2-ATP pathway.

Objective To observe the value of MR T2WI intratumoral and peritumoral CT radiomics for predicting von Hippel-Lindau(VHL)gene mutation in renal carcinoma.Method Totally 150 patients with renal carcinoma were retrospectively enrolled and divided into training set(n=105)and validation set(n=45)at the ratio of 7∶3,and furtherly assigned into mutation subgroup and wild subgroup according to with VHL gene mutation or not.Multivariate logistic regression analysis was performed to screen the independent risk factors of VHL gene mutation in renal carcinoma,then a clinical model was constructed.The optimal radiomics features were extracted and screened based on intratumoral+peritumoral 2 mm regions shown on MR T2WI.Logistic regression algorithm was used to construct radiomics model,and finally a combined model was established based on radiomics model and clinical model.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each model for predicting VHL gene mutation in renal carcinoma.Result Patients'age,smoking history,hypertension history,other family histories and β2-microglobulin were all independent clinical risk factors for VHL gene mutation in renal carcinoma(all P＜0.05).The efficacy of clinical model,radiomics model and combined model for predicting VHL gene mutation in renal carcinoma increased successively(all P＜0.05),with AUC of 0.758,0.831 and 0.952 in training set,0.729,0.803 and 0.896 in validation set,respectively.Conclusion MR T2WI intratumoral and peritumoral CT radiomics had good efficacy for predicting VHL gene mutation in renal carcinoma.Combining with clinical features could further improve predicting efficacy of model.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

BACKGROUND:Polycystic ovary syndrome is a common reproductive endocrine disease leading to infertility in women of reproductive age.Currently,there is no effective treatment.Human umbilical cord mesenchymal stem cells may help to repair ovarian function,but few studies have reported their role in the treatment of polycystic ovary syndrome.OBJECTIVE:To explore the effect and mechanism of human umbilical cord mesenchymal stem cells in the treatment of polycystic ovary syndrome.METHODS:3-week-old female ICR mice were divided into three groups(n=15).Normal control group was not treated.Model group was given letrozole for 21 days to induce polycystic ovary syndrome.Treatment group was given letrozole via intragastric administration for 21 consecutive days,and human umbilical cord mesenchymal stem cell suspension was injected through the tail vein.The body weight of mice was monitored before treatment,7 and 14 days after treatment.The estrous cycle of mice was detected by continuous vaginal smears for 10 consecutive days after treatment.Fourteen days after treatment,peripheral blood sex hormone levels of mice were detected by ELISA.Hematoxylin-eosin staining was used to observe ovarian morphological changes.Immunofluorescence and immunohistochemistry were used to detect the expression of Rab27A protein in ovarian tissues.RESULTS AND CONCLUSION:(1)Compared with the normal control group,the estrous cycle of mice in the model group was disturbed;body weight was significantly increased;follicle stimulating hormone was decreased;luteinizing hormone and testesterone were both increased;more follicles were found in the ovaries,and the relative expression level of Rab27A protein was decreased.(2)Compared with the model group,the treatment group had diminished body weight,increased follicle stimulating hormone,decreased luteinizing hormone and testesterone,decreased follicles with polycystic dilatation,and increased Rab27A protein relative expression level.(3)These findings suggest that human umbilical cord mesenchymal stem cells improve serum sex hormone levels and ovarian function in polycystic ovary syndrome mice by upregulating the expression of Rab27A.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective:To identify and summarize the best evidence for pelvic floor muscle exercises (PFME) in preventing pelvic floor dysfunction (PFD) during pregnancy.Methods:A systematic search was conducted in databases including UpToData, Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, Wanfang Data, SinoMed, Yiigle, and Joanna Briggs Institute Evidence Based Healthcare Center Database and so on. The search spanned from January 1, 2018, to March 16, 2023. Two researchers independently evaluated the quality of clinical decision-making articles, expert consensus, and systematic reviews, while four researchers appraised the quality of guidelines. Evidence extraction and grading were performed independently by two researchers.Results:A total of nine documents were included: three guidelines, two clinical decision-making articles, one expert consensus, and three systematic reviews. A total of 20 evidence-based recommendations were summarized in six categories: indications and contraindications, assessment, implementation plans, supervision and follow-up, management, and outcome evaluation.Conclusions:PFME during pregnancy is effective in preventing PFD. Healthcare providers should integrate best evidence into clinical practice to develop tailored PFME plans for pregnant women, aiming to prevent PFD.