Objective To evaluate the predictive value of different machine learning models constructed in a multicenter environment for potential organ donors and verify their clinical application feasibility. Methods The study included 2 000 inpatients admitted to five domestic tertiary hospitals from January 2020 to December 2023, who met the criteria for potential organ donation assessment. They were randomly divided into a training set and an internal validation set (7∶3). Another 300 similar patients admitted to the First Affiliated Hospital of Harbin Medical University from January 2024 to April 2025 were included as an external validation set. The area under the curve (AUC), sensitivity, specificity, accuracy and F1-score of three models were compared, and the consistency of the potential organ donor determination process was tested. Multivariate logistic regression analysis was used to identify predictive factors of potential organ donors. Decision curve analysis (DCA) was employed to verify the resource efficiency of each model, and the threshold interval and intervention balance point were assessed. Results Apart from age, there were no significant differences in other basic characteristics among the centers (all P>0.05). The consistency of the potential organ donor determination process among researchers in each center was good [all 95% confidence interval (CI) lower limits >0]. In the internal validation set, the XGBoost model had the best predictive performance (AUC=0.92, 95% CI 0.89-0.94) and the best calibration (P=0.441, Brier score 0.099). In the external validation set, the XGBoost model also had the best predictive performance (AUC=0.91, 95% CI 0.88-0.94), outperforming logistic regression and random forest models. Multivariate logistic regression showed that mechanical ventilation had the greatest impact (odds ratio=2.06, 95% CI 1.54-2.76, P<0.001). DCA indicated that the XGBoost model had the highest net benefit in the threshold interval of 0.2-0.6. The “treat all” strategy only had a slight advantage at extremely low thresholds. The recommended threshold interval, which balances intervention costs and clinical benefits, considers ≥50% positive predictive value (PPV) and ≤50 referrals per 100 high-risk patients. Conclusions The XGBoost model established in a multicenter environment is accurate and well-calibrated in predicting potential organ donors. Combined with DCA, it may effectively guide the timing of clinical interventions and resource allocation, providing new ideas for the assessment and management of organ donation after brain death.

OBJECTIVE To investigate the protective effects and potential mechanism of alisol B 23-acetate on acute alcoholic liver injury in mice. METHODS Fifty male Kunming mice were divided into the blank group， model group， and alisol B 23-acetate low-， medium- and high-dose groups （10， 20， 40 mg/kg）， with 10 mice in each group. Each group was given relevant drug solution or normal saline intragastrically， once a day， for 2 consecutive weeks. On the 15th day， mice in the blank group were given normal saline intragastrically， while the other four groups were given 12 mL/kg white wine intragastrically， twice at six-hour intervals， to establish an acute alcoholic liver injury model. On the 16th day of the experiment， the liver indexes of mice in each group were calculated； the serum levels of alanine transaminase （ALT）， aspartate transaminase （AST）， total cholesterol （TC）， triglycerides （TG）， malondialdehyde （MDA） and glutathione （GSH） were also determined. The histopathological morphology of their liver tissues was observed and scored. The protein expressions of cytochrome P450 2E1 （CYP2E1）， Kelch-like ECH-associated protein 1 （Keap1）， nuclear factor erythroid 2-related factor 2 （Nrf2） and NAD（P）H： quinone oxidoreductase 1 （NQO1） were measured in liver tissue. RESULTS Compared with model group， mice in each dosage group of alisol B 23-acetate showed varying degrees of recovery in body weight， along with improvements in pathological changes in liver tissues such as inflammatory cell infiltration and fatty vacu oles. Their liver indexes， histopathological scores of liver tissue， serum levels of ALT， AST， TC， TG and MDA， as well as the protein expressions of CYP2E1 and Keap1 in liver tissue， were all significantly decreased （ P ＜0.05 or P ＜0.01）. The serum GSH levels and the protein expressions of Nrf2 （except for the alisol B 23-acetate low-dose group） and NQO1 in liver tissue were significantly increased （ P ＜0.05 or P ＜0.01）， and the changes in the above quantitative indicators showed a dose-dependent pattern. CONCLUSIONS Alisol B 23-acetate can ameliorate acute alcoholic liver injury in mice， and its mechanism may be related to improving antioxidant capacity by regulating the Keap1/Nrf2/NQO1 signaling pathway while simultaneously improving liver lipid metabolism-related indexes.

BACKGROUND:Skeletal muscle aging is associated with various chronic diseases.Exercise is considered an important means to delay this process,but the multimechanism regulation of exercise intervention strategies still requires in-depth exploration.OBJECTIVE:To systematically outline the main physiological changes in skeletal muscle aging and explore the multiple mechanisms by which exercise regulates these changes,thereby providing a theoretical basis for basic research and clinical applications.METHODS:By searching databases such as Web of Science,PubMed,Embase,CNKI,WanFang,and VIP,relevant literature from database inception to October 2024 was retrieved by the first author,including original research articles and reviews.The search terms were"skeletal muscle aging,sarcopenia,exercise regulation,physical activity,chronic inflammation,inflammaging,mitochondrial dysfunction,extracellular matrix fibrosis,lipid mediators,satellite cells"in English and Chinese.Literature was screened based on inclusion and exclusion criteria,and the included 95 articles underwent quality assessment and data extraction.RESULTS AND CONCLUSION:(1)The core manifestations of skeletal muscle aging are the decline in muscle mass,strength,and function,closely related to various physiological changes.The decreased protein synthesis capacity and accelerated degradation rate in muscles lead to muscle atrophy and functional decline.Additionally,dysfunction of satellite cells is considered a key factor in the reduced regenerative capacity of muscles.Mitochondrial dysfunction is another important factor leading to muscle fatigue and energy metabolism disorders,directly affecting the metabolic activity and endurance of skeletal muscles.Chronic inflammatory responses and extracellular matrix fibrosis further exacerbate muscle aging.These factors interact synergistically,collectively resulting in skeletal muscle degeneration.(2)Exercise is widely recognized as an important means to delay skeletal muscle aging.Exercise alleviates chronic low-grade inflammatory responses in skeletal muscle by regulating the immune system,increasing the secretion of anti-inflammatory factors,and inhibiting the expression of pro-inflammatory factors,thereby mitigating the damage of inflammation to muscles.Exercise also enhances mitochondrial biogenesis and function,improves the muscle's energy metabolism capacity,and consequently increases endurance and strength.Furthermore,exercise regulates lipid metabolism and the synthesis of lipid mediators,reduces fat accumulation and alleviates fat-induced inflammatory responses,thereby further protecting skeletal muscles.The mechanical stimulation from exercise promotes the remodeling of the extracellular matrix,reduces fibrosis occurrence,and improves muscle structure and function.Additionally,exercise activates satellite cells,enhancing the regenerative capacity of skeletal muscles,especially notable with strength training and high-intensity interval training.(3)Future research should include large-scale,multicenter clinical trials to evaluate the comprehensive effects of long-term exercise interventions on skeletal muscle aging.By analyzing data from genomics,metabolomics,and other fields,exploring individual differences in responses to exercise interventions can provide more precise theoretical bases for personalized exercise strategies.Besides exercise,the impacts of other interventions such as nutritional supplementation and pharmacological treatments on skeletal muscle aging should not be overlooked.Future studies can explore the combined use of exercise with these interventions to achieve more significant effects.

BACKGROUND:Skeletal muscle aging is associated with various chronic diseases.Exercise is considered an important means to delay this process,but the multimechanism regulation of exercise intervention strategies still requires in-depth exploration.OBJECTIVE:To systematically outline the main physiological changes in skeletal muscle aging and explore the multiple mechanisms by which exercise regulates these changes,thereby providing a theoretical basis for basic research and clinical applications.METHODS:By searching databases such as Web of Science,PubMed,Embase,CNKI,WanFang,and VIP,relevant literature from database inception to October 2024 was retrieved by the first author,including original research articles and reviews.The search terms were"skeletal muscle aging,sarcopenia,exercise regulation,physical activity,chronic inflammation,inflammaging,mitochondrial dysfunction,extracellular matrix fibrosis,lipid mediators,satellite cells"in English and Chinese.Literature was screened based on inclusion and exclusion criteria,and the included 95 articles underwent quality assessment and data extraction.RESULTS AND CONCLUSION:(1)The core manifestations of skeletal muscle aging are the decline in muscle mass,strength,and function,closely related to various physiological changes.The decreased protein synthesis capacity and accelerated degradation rate in muscles lead to muscle atrophy and functional decline.Additionally,dysfunction of satellite cells is considered a key factor in the reduced regenerative capacity of muscles.Mitochondrial dysfunction is another important factor leading to muscle fatigue and energy metabolism disorders,directly affecting the metabolic activity and endurance of skeletal muscles.Chronic inflammatory responses and extracellular matrix fibrosis further exacerbate muscle aging.These factors interact synergistically,collectively resulting in skeletal muscle degeneration.(2)Exercise is widely recognized as an important means to delay skeletal muscle aging.Exercise alleviates chronic low-grade inflammatory responses in skeletal muscle by regulating the immune system,increasing the secretion of anti-inflammatory factors,and inhibiting the expression of pro-inflammatory factors,thereby mitigating the damage of inflammation to muscles.Exercise also enhances mitochondrial biogenesis and function,improves the muscle's energy metabolism capacity,and consequently increases endurance and strength.Furthermore,exercise regulates lipid metabolism and the synthesis of lipid mediators,reduces fat accumulation and alleviates fat-induced inflammatory responses,thereby further protecting skeletal muscles.The mechanical stimulation from exercise promotes the remodeling of the extracellular matrix,reduces fibrosis occurrence,and improves muscle structure and function.Additionally,exercise activates satellite cells,enhancing the regenerative capacity of skeletal muscles,especially notable with strength training and high-intensity interval training.(3)Future research should include large-scale,multicenter clinical trials to evaluate the comprehensive effects of long-term exercise interventions on skeletal muscle aging.By analyzing data from genomics,metabolomics,and other fields,exploring individual differences in responses to exercise interventions can provide more precise theoretical bases for personalized exercise strategies.Besides exercise,the impacts of other interventions such as nutritional supplementation and pharmacological treatments on skeletal muscle aging should not be overlooked.Future studies can explore the combined use of exercise with these interventions to achieve more significant effects.

Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

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*

Objective:Comparative study on the application value of bronchial ultrasound combined with different biopsy methods under thin-layer CT navigation in the diagnosis of malignant peripheral lung lesions.Methods:A retrospective analysis of patients with suspected malignant peripheral lung lesions identified by chest CT from January 2019 to September 2024 at the Cancer Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, and Xianyang Central Hospital, who underwent routine bronchoscopy with negative results (209 cases). These patients were diagnosed using bronchial ultrasound under thin-layer CT navigation. The cases were divided into a cryobiopsy group (127 cases) and a conventional forceps biopsy group based on the biopsy method (82 cases). The diagnostic rates of the two groups were statistically analyzed, along with factors influencing the diagnostic rates. The tissue size obtained from both groups was compared, and the occurrence of complications was summarized.Results:This study included 209 cases with 216 peripheral lung lesions. A total of 209 cases with 210 lesions were successfully located through thin-slice CT guidance, resulting in a guiding success rate of 97.2% (210/216). Among the 130 lesions in the cryobiopsy group, 78 lesions were diagnosed as lung malignancies, with a diagnostic rate of 82.1% (64/78) for cryobiopsy in lung malignant lesions. In the forceps biopsy group, 46 of the 86 lesions were diagnosed as lung malignancies, with a diagnostic rate of 87.0% (40/46) for forceps biopsy in lung malignant lesions. There was no statistically significant difference between the two diagnostic rates ( P=0.473). The average longest diameter of tissue obtained by cryobiopsy was (6.11±0.23) mm, while the average longest diameter of tissue obtained by forceps biopsy was (1.58±0.43) mm. There was a statistically significant difference in tissue longest diameter between the two groups ( P＜0.001). When the distance from the bronchoscopic tip to the lesion was ≥3 cm and the most distal bronchus visible under bronchoscopy was ≤5th generation, the diagnostic rate of forceps biopsy was higher [83.3%(25/30) and 94.1%(32/34)] than that of cryobiopsy [79.3%(23/29) and 78.0%(46/59)], and the difference was statistically significant ( P＜0.05). Regarding complications, one case (1.3%, 1/78) of clinically significant complications occurred in the cryobiopsy group, while no complications occurred in the forceps biopsy group. Conclusions:Under thin-layer CT navigation, bronchial ultrasound combined with different biopsy methods demonstrates a high diagnostic rate for malignant peripheral lung lesions and is safe to operate. Cryobiopsy allows for the collection of larger tissue specimens.

Objective:To investigate the effect of mast cell-derived chemokine C-C motif ligand 5 (CCL5) on the migration of CD8 + T cells from vitiligo patients under oxidative stress conditions. Methods:From January 2017 to January 2023, 10 patients with progressive segmental vitiligo, 10 patients with non-segmental vitiligo, and 10 healthy individuals were collected from the Department of Dermatology, Xijing Hospital. Skin tissue samples were obtained from the lesions of vitiligo patients and from the normal skin of healthy individuals, with sampling sites including the face, neck, and upper extremities, and toluidine blue staining was performed to analyze the characteristics of mast cells infiltrating the skin lesions. The effect of H 2O 2 treatment on mast cells was investigated in Transwell chambers. Peripheral blood mononuclear cells (PBMCs) from vitiligo patients were added to the upper chamber, while the human mast cell line LAD2 was added to the lower chamber and divided into 4 groups to receive different treatments: untreated group receiving no special treatment, H 2O 2 group pretreated with H 2O 2, H 2O 2 + neutralization antibody group pretreated with H 2O 2 followed by the treatment with CCL5/RANTES-neutralizing antibodies, and H 2O 2 + PF group pretreated with H 2O 2 followed by the treatment with a Janus kinase 3/non-receptor protein tyrosine kinase selective inhibitor PF-06651600. After 6 hours of co-incubation, cell suspensions were collected from the lower chamber. The number of CD8 + T cells was counted using flow cytometry, and the CCL5 level in the cell culture supernatant was detected using enzyme-linked immunosorbent assay. One-way analysis of variance was used to analyze differences among groups, and least significant difference- t test was used for multiple comparisons. Pearson correlation analysis was performed for correlation analysis. Results:In the 200 × magnification field, the numbers of infiltrating mast cells significantly differed among segmental vitiligo lesions, non-segmental vitiligo lesions, and normal skin tissues (15.7 ± 3.3, 20.9 ± 3.9, 7.2 ± 2.9, respectively; F = 8.07, P = 0.002) ; additionally, the number of infiltrating mast cells was significantly higher in the segmental or non-segmental vitiligo lesions than in the normal skin tissues (LSD- t = 3.50, 5.70, P = 0.047, 0.001, respectively), but there was no significant difference between the segmental and non-segmental vitiligo lesions (LSD- t = 2.20, P = 0.293). A significant positive correlation was observed between the number of infiltrating mast cells and that of CD8 + T cells in the vitiligo lesions ( r = 0.82, P = 0.004). The numbers of CD8 + T cells and CCL5 levels significantly differed among the untreated group, H 2O 2 group, H 2O 2 + neutralization antibody group, and H 2O 2 + PF group (CD8 + T cells: 197.0 ± 45.9, 580.4 ± 62.6, 296.0 ± 43.2, 398.6 ± 62.8, respectively; CCL5: 2.2 ± 0.6 pg/ml, 9.9 ± 1.3 pg/ml, 3.4 ± 0.4 pg/ml, 6.33 ± 0.7 pg/ml, respectively; F = 11.03, 17.77, respectively, both P < 0.001) ; additionally, the H 2O 2 group showed significantly increased numbers of CD8 + T cells and CCL5 levels compared with the untreated group, H 2O 2 + neutralization antibody group, and H 2O 2 + PF group (all P < 0.05) . Conclusion:Mast cells may be involved in the pathogenesis of vitiligo under oxidative stress, and mast cell-derived CCL5 appears to contribute to the occurrence and development of vitiligo by affecting CD8 + T cell migration.

Objective:To investigate the relationship between preoperative serum CA19-9 levels and pathological grades in pseudomyxoma peritonei(PMP)and evaluate its impact on overall survival.Methods:A retrospective analysis was conducted on clinical data from 321 pa-tients with PMP who underwent initial cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy(CRS+HIPEC)by our team between October 2004 and October 2024.Receiver operating characteristic curve analysis was used to assess the discriminative value of CA19-9 for the pathological grade.Kaplan-Meier analysis was conducted to evaluate the impact of preoperative CA19-9 on overall survival.Results:Among the 321 patients included in this study,148(46.1%)had increased preoperative CA19-9 levels,which were associated with pathological grades.When preoperative CA19-9>693.3 U/mL,the pathological grade was more likely to be high-grade peritoneal mucinous carcinoma with signet ring cells(area under the curve:0.67,95%confidence interval:0.54-0.80,P=0.021).Elevated preoperative CA19-9 was an independent risk factor for overall survival in patients with PMP(mOS was 53.62 m vs.not reached in the elevated group vs.normal group,respectively,P<0.001).Conclusions:Preoperative serum CA19-9 levels were associated with pathological grades in patients with PMP undergoing initial CRS+HIPEC,with an independent negative impact on overall survival.