Background and Aims:Chronic skin ulcers are a significant disease affecting patients'daily lives and psychological well-being.Abnormalities in the cells and extracellular matrix within the tissue may disrupt the balance of the microenvironment,hindering the normal skin repair process and leading to delayed healing of the ulcer.There is currently a lack of research on the mechanisms underlying the development of chronic ulcers and their diagnostic biomarkers.Single-cell sequencing,a newly developed high-throughput sequencing method in recent years,uses gene sequencing at the single-cell resolution to precisely reveal disease mechanisms and has been applied in various diseases.This study used single-cell transcriptome sequencing(scRNA-Seq)to investigate the cellular heterogeneity in chronic skin ulcer tissue to elucidate the potential molecular mechanisms behind delayed healing and provide new insights for clinical treatment.Methods:The scRNA-Seq technology was used to compare the differences in cell subpopulations and gene expression between chronic ulcer tissue and normal skin tissue.Single cells were sorted using a microfluidic platform,and cDNA libraries were constructed for subsequent differential gene analysis and functional enrichment analysis.Results:scRNA-Seq analysis revealed significant immune-metabolic remodeling features in chronic ulcer tissue:the number of B cells,monocytes,and macrophages in ulcer tissue increased by 2.1 to 3.5 times compared to the normal tissue control.This was accompanied by widespread activation of collagen synthesis genes(COL1A1/COL3A1)and synergistic suppression of immune regulators(e.g.,granzyme family GZMA/GZMB/H).Cross-cell subpopulation functional network analysis showed that hypoxia response mediated by the HIF-1 signaling pathway and PI3K/Akt pathway abnormalities formed a positive feedback loop,exacerbating the imbalance in the secretion of inflammatory factors(CXCL3/8,TGFBI)and compensatory upregulation of mitochondrial oxidative phosphorylation.Conclusion:Chronic skin ulcers exhibit significant differences in cellular heterogeneity and gene expression,suggesting that chronic ulcers are not simply tissue defects but a complex pathological process dominated by chronic inflammation and immune dysregulation.The coordinated dysregulation of multiple cell subpopulations in the ulcer microenvironment,along with persistent inflammatory responses and metabolic abnormalities,is interconnected through the HIF-1/TNF/MAPK pathway network.Downregulation of granzyme gene family members and abnormal histone modifications may contribute to immune clearance defects,providing a theoretical basis for developing novel therapies targeting epigenetic regulation or mitochondrial function.

OBJECTIVES: Whether vortioxetine has a utility as an adjuvant drug in the treatment of bipolar depression remains controversial. This study aimed to validate the efficacy and safety of vortioxetine in bipolar depression. METHODS: Patients with bipolar Ⅱ depression were enrolled in this prospective, two-center, randomized, 12-week pilot trial. The main indicator for assessing treatment effectiveness was a Montgomery-Asberg Depression Rating Scale (MADRS) of ≥50%. All eligible patients initially received four weeks of lurasidone monotherapy. Patients who responded well continued to receive this kind of monotherapy. However, no-response patients were randomly assigned to either valproate or vortioxetine treatment for eight weeks. By comprehensively comparing the results of MADRS over a period of 4‍‒‍12 weeks, a systematic analysis was conducted to determine whether vortioxetine could be used as an adjuvant drug for treating bipolar depression. RESULTS: Thirty-seven patients responded to lurasidone monotherapy, and 60 patients were randomly assigned to the valproate or vortioxetine group for eight weeks. After two weeks of combined valproate or vortioxetine treatment, the MADRS score in the vortioxetine group was significantly lower than that in the valproate group. There was no difference in the MADRS scores between the two groups at 8 and 12 weeks. The incidence of side effects did not significantly differ between the valproate and vortioxetine groups. Importantly, three patients in the vortioxetine group appeared to switch to mania or hypomania. CONCLUSIONS This study suggested that lurasidone combination with vortioxetine might have potential benefits to bipolar II depression in the early stage, while disease progression should be monitored closely for the risk of switching to mania.
Humans ; Bipolar Disorder/drug therapy* ; Vortioxetine/therapeutic use* ; Male ; Female ; Middle Aged ; Adult ; Valproic Acid/administration & dosage* ; Lurasidone Hydrochloride/administration & dosage* ; Prospective Studies ; Treatment Outcome ; Pilot Projects ; Drug Therapy, Combination ; Sulfides/therapeutic use* ; Antidepressive Agents/therapeutic use*

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
Humans ; Consensus ; Orthodontics, Corrective/standards* ; Periodontal Diseases/complications* ; Tooth Movement Techniques/methods* ; Practice Guidelines as Topic

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

With the growing emphasis on maternal and child oral health, the significance of managing oral health across preconception, pregnancy, and infancy stages has become increasingly apparent. Oral health challenges extend beyond affecting maternal well-being, exerting profound influences on fetal and neonatal oral development as well as immune system maturation. This expert consensus paper, developed using a modified Delphi method, reviews current research and provides recommendations on maternal and child oral health management. It underscores the critical role of comprehensive oral assessments prior to conception, diligent oral health management throughout pregnancy, and meticulous oral hygiene practices during infancy. Effective strategies should be seamlessly integrated across the life course, encompassing preconception oral assessments, systematic dental care during pregnancy, and routine infant oral hygiene. Collaborative efforts among pediatric dentists, maternal and child health workers, and obstetricians are crucial to improving outcomes and fostering clinical research, contributing to evidence-based health management strategies.
Humans ; Pregnancy ; Female ; Infant ; Consensus ; Mouth Diseases/therapy* ; Pregnancy Complications/therapy* ; Oral Health ; Infant, Newborn ; Delphi Technique ; Oral Hygiene

[Objective]To study the clinical features of viral encephalitis with isolated dizziness,and to analyze the diagnostic efficacy of vestibular function examination and cerebrospinal fluid cytology in these patients.[Methods]Totally 37 cases of viral encephalitis with isolated dizziness and 10 healthy volunteers were included.Clinical data[dizziness handicap inventory(DHI)score,head imaging,electroencephalogram,vestibular function test,cerebrospinal fluid routine,biochemistry,cell morphology,etiology second-generation sequencing,misdiagnosis]were collected.The area under the ROC curve(AUC)of diagnostic value of each type of test was analyzed.The changes of each examination before and after treatment were compared.[Results]We found 89.19%(33/37)of the patients were misdiagnosed.Vestibular function smooth follow-up test indicated vestibular central lesion(AUC value:0.82)in 64.86%(24/37)of the patients.The number of CSF transformed lymphocytes increased in 86.49%(32/37)of the patients(AUC value:0.93),the CSF large lymphocytes increased in 97.30%(36/37)of the patients(AUC value:0.99),and the mononucleosis was activated in 94.59%(35/37)of the patients(AUC value:0.97).Furthermore,18.92%(7/37)of the patients had increased EEG slow wave(AUC value:0.60),while 13.51%(5/37)of the patients showed cortical swelling on head MR(AUC:0.60).After antiviral treatment,dizziness grade decreased(Z=-4.899,P<0.001),smooth tracking abnormalities decreased(Z=-4.583,P<0.001),the proportion of CSF transformed lymphocytes decreased(t=4.281,P<0.001),and the proportion of large lymphocytes decreased(t=6.905,P<0.001).[Conclusion]The misdiagnosis rate of viral encephalitis with isolated dizziness is high.Incorporating into diagnosis the increased large lymphocytes,transformed lymphocytes,activated monocytes in CSF cytology with smooth follow-up test may improve diagnostic efficiency.

Prostate cancer is one of the common malignant tumors in men.With the aging of the population and the progress of diagnostic technology,its incidence continues to rise.Radical prostatectomy is an effective treatment for localized prostate cancer.However,the incidence of inguinal hernia after surgery is high,which seriously affects patients' postoperative recovery and quality of life.This article provides a systematic review for the pathogenesis of inguinal hernia after prostate cancer surgery,including changes in anatomical structure,scar formation in the retroperitoneal space,no closure of sheath process,and increased intra-abdominal pressure after surgery.It also summarizes the relevant influencing factors,such as surgical methods,patients' own conditions,and postoperative recovery status.On this basis,surgical prevention and treatment strategies are explored,such as intraoperative preventive repair,re-fined surgical procedures,and postoperative targeted treatment.At the same time,future research directions are proposed,focusing on the in-depth exploration of molecular biological mechanisms,research and development of new materials,and application of artificial intelligence technology,aiming to reduce the incidence of inguinal hernia after prostate cancer surgery and improving patients' postop-erative quality of life.

BACKGROUND:The sports medicine community has widely called for the use of machine learning technology to efficiently process the huge and complicated sports data resources,and construct intelligent sports injury prediction models,enabling accurate early warning of sports injuries.It is of great significance to comprehensively summarize and review such research results so as to grasp the direction of early warning model improvement and to guide the construction of sports injury prediction models in China. OBJECTIVE:To systematically review and analyze relevant research on sports injury prediction models based on machine learning technology,thereby providing references for the development of sports injury prediction models in China. METHODS:Literature search was conducted on CNKI,Web of Science and EBSCO databases,which mainly searched for literature related to machine learning techniques and sports injuries.Finally,61 articles related to sports injury prediction models were included for analysis. RESULTS AND CONCLUSION:(1)In terms of external risk feature indicators,there is a lack of competition scenario indicators,and the inclusion of related feature indicators needs to be further improved to further enrich the dimensions of the dataset for model training.In addition,the inclusion feature weighting methods of the sports injury prediction model are mainly based on filtering methods and the use of embedding and wrapping weighting methods needs to be strengthened in order to enhance the analysis of the interaction effects of multiple risk factors.(2)In terms of model body training,supervised learning algorithms become the mainstream choice.Such algorithms have higher requirements for the completeness of sample labeling information,and the application scenarios are easily limited.Therefore,the application of unsupervised and semi-supervised algorithms can be increased in the later stage.(3)In terms of model performance evaluation and optimization,the current studies mainly adopt two verification methods:HoldOut crossover and k-crossover.The range of AUC values is(0.76±0.12),the range of sensitivity is(75.92±11.03)%,the range of specificity is(0.03±4.54)%,the range of F1 score is(80.60±10.63)%,the range of accuracy is(69.96±13.10)%,and the range of precision is(70±14.71)%.Data augmentation and feature optimization are the most common model optimization operations.The accuracy and precision of the current sports injury prediction model are about 70%,and the early warning effect is good.However,the model optimization operation is relatively single,and data augmentation methods are often used to improve model performance.Further adjustments to the model algorithm and hyperparameters are needed to further improve model performance.(4)In terms of model feature extraction,most of the internal risk profile indicators included are mainly based on anthropometrics,training load,years of training,and injury history,but there is a lack of sports recovery and physical function indicators.

Background and Aims:Chronic skin ulcers are a significant disease affecting patients'daily lives and psychological well-being.Abnormalities in the cells and extracellular matrix within the tissue may disrupt the balance of the microenvironment,hindering the normal skin repair process and leading to delayed healing of the ulcer.There is currently a lack of research on the mechanisms underlying the development of chronic ulcers and their diagnostic biomarkers.Single-cell sequencing,a newly developed high-throughput sequencing method in recent years,uses gene sequencing at the single-cell resolution to precisely reveal disease mechanisms and has been applied in various diseases.This study used single-cell transcriptome sequencing(scRNA-Seq)to investigate the cellular heterogeneity in chronic skin ulcer tissue to elucidate the potential molecular mechanisms behind delayed healing and provide new insights for clinical treatment.Methods:The scRNA-Seq technology was used to compare the differences in cell subpopulations and gene expression between chronic ulcer tissue and normal skin tissue.Single cells were sorted using a microfluidic platform,and cDNA libraries were constructed for subsequent differential gene analysis and functional enrichment analysis.Results:scRNA-Seq analysis revealed significant immune-metabolic remodeling features in chronic ulcer tissue:the number of B cells,monocytes,and macrophages in ulcer tissue increased by 2.1 to 3.5 times compared to the normal tissue control.This was accompanied by widespread activation of collagen synthesis genes(COL1A1/COL3A1)and synergistic suppression of immune regulators(e.g.,granzyme family GZMA/GZMB/H).Cross-cell subpopulation functional network analysis showed that hypoxia response mediated by the HIF-1 signaling pathway and PI3K/Akt pathway abnormalities formed a positive feedback loop,exacerbating the imbalance in the secretion of inflammatory factors(CXCL3/8,TGFBI)and compensatory upregulation of mitochondrial oxidative phosphorylation.Conclusion:Chronic skin ulcers exhibit significant differences in cellular heterogeneity and gene expression,suggesting that chronic ulcers are not simply tissue defects but a complex pathological process dominated by chronic inflammation and immune dysregulation.The coordinated dysregulation of multiple cell subpopulations in the ulcer microenvironment,along with persistent inflammatory responses and metabolic abnormalities,is interconnected through the HIF-1/TNF/MAPK pathway network.Downregulation of granzyme gene family members and abnormal histone modifications may contribute to immune clearance defects,providing a theoretical basis for developing novel therapies targeting epigenetic regulation or mitochondrial function.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.