ObjectiveTo investigate the impact of a cold environment on the pathophysiological changes in dogs after abdominal gastrointestinal blast injury. MethodsEight healthy common-grade adult male Beagles were selected and randomly divided into a cold group and a normal temperature group, with 4 dogs in each group. Prior to surgery, Beagles dogs were fasted and deprived of water for 12 hours; after establishing a vein at the edge of the ear, propofol （2 mg·kg^-1·min^-1） was continuously infused using a microinfusion pump to maintain anesthesia. Tracheal intubation was performed while preserving spontaneous breathing, and the electroencephalogram bifrequency index was maintained at 40-60 to ensure stable anesthesia. A model of abdominal gastrointestinal blast injury in Beagle dogs was established using a multifunctional combat trauma modeling platform. After blast injury, the cold group was exposed to a cold chamber at -20 ℃ combined with 10% body surface area ice water immersion for 40 min, while the normal temperature group was kept in an environment at (25±2) ℃ for 40 min after blast injury. Vital signs such as heart rate, blood pressure, and blood oxygen saturation were monitored in both groups before blast injury, immediately after blast injury, and 40 min after blast injury. And arterial blood gas parameters, including pH, partial pressure of oxygen in arterial blood (PaO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂), actual bicarbonate radical (HCO₃^-), lactic acid (Lac), and blood base excess (BEb), were measured. After the experiment, gastrointestinal tissues (gastric antrum and upper jejunum 5 cm distal to the suspensory ligament of the duodenum) were harvested for pathological analysis via hematoxylin-eosin (HE) staining combined with semi-quantitative scoring. ResultsPhysiological indicators showed that the body temperature of the cold group was significantly lower than that of the normal temperature group (P<0.01), and the heart rate and systolic blood pressure of the cold group were significantly higher than those of the normal temperature group (P<0.000 1). PaCO₂ was markedly elevated and BEb was markedly decreased in the cold group relative to the normal temperature group (P<0.000 1), suggesting aggravated respiratory acidosis and metabolic acidosis. Pathological analysis showed that gastro-intestinal tissue damage was more severe in the cold group: the gastric mucosal epithelial shedding rate was > 60% (vs. <25% in the normal temperature group), the necrosis rate of the epithelial cells at the tips of intestinal villi reached more than 70% (vs. < 30% in the normal temperature group), and inflammatory cell infiltration involved the submucosa (vs. limited to the superficial mucosa in the normal temperature group). The semi-quantitative scoring results were consistent with the pathological analysis results, further confirming that the cold environment exacerbated gastrointestinal tissue damage caused by abdominal gastrointestinal blast injury. ConclusionA cold environment can exacerbate circulatory dysfunction and gastrointestinal tissue damage in Beagle dogs after blast injury, providing experimental evidence for early rewarming intervention for combat trauma in cold regions.

Objective To elucidate the application scope and delineate the criteria of dobutamine stress echocardiography (DSE) in assessing surgical risk associated with valvular heart diseases in patients presenting with reduced left ventricular ejection fraction (LVEF). Methods This retrospective analysis encompassed data from patients with reduced LVEF (LVEF<40%) who underwent DSE prior to valvular heart surgery at the Valvular Surgery Center of Beijing Anzhen Hospital between May 2016 and September 2024. Patients were stratified based on the terminal dose of dobutamine into two cohorts: a limited dose group [receiving a maximum dobutamine dose of <5 µg/(kg·min) due to concomitant conditions such as suspected atrial thrombus, aortic dilation, or previous myocardial infarction] and a non-limited dose group (where dosage was adjusted to either achieve the maximum positive standard or the maximal dose tolerable by the patient). Within the non-limited dose group, patients were further classified into positive and negative response groups. The positive response post DSE was defined based on the following criteria: LVEF≥55% (the maximum positive standard), LVEF<55% but with a 5% improvement (the minimum positive standard) from resting situation, aortic maximum velocity (AVmax)≥400 cm/s, or mean pressure gradient (meanPG)≥40 mm Hg, latter two applicable only to patients with aortic stenosis. Clinical indicators were compared in the three groups. Results A total of 99 patients were enrolled, aged 35 to 87 years, with an average age of (61.7±10.1) years. The number of males was significantly higher than that of females (3:1). There were 61 (61.6%) patients undergoing aortic valve surgery, 25 (25.3%) undergoing mitral valve surgery, and 13 (13.1%) undergoing combined aortic and mitral valve surgery. Nineteen (19.2%) patients experienced adverse symptoms such as palpitations, head and face numbness, dizziness, chest tightness post DSE. Additionally, new-onset or aggravated ventricular premature ventricular contractions were in 40 (40.4%) patients. All above symptoms and signs resolved minutes after cessation of the test. No severe adverse events necessitating oxygen therapy or emergency intervention occurred. Among the 93 patients in the non-limited dose group, 86 were classified in the positive response group and 7 in the negative response group. The left ventricular end diastolic diameter, left ventricular end systolic diameter, and LVEF in the positive group all showed significant improvement compared to preoperative values, and were also significantly better than those in the negative group (P<0.05). All 7 patients with negative DSE results underwent interventional surgery, which was significantly different from the positive group (36 patients, 41.9%). In the limited dose group (n=6), 4 patients with a positive result or a positive trend on DSE underwent median sternotomy, 2 received interventional treatment due to a negative response. No significant differences in mortality were observed among the groups (P>0.05). Conclusion Dobutamine stress echocardiography significantly contributes to risk stratification in surgical interventions for patients with valvular heart disease complicated by reduced LVEF. It aids in determining optimal timing and methods for surgery. With comprehensive patient evaluation and controlled dobutamine dosing, the application of DSE can be safely expanded.

Objective:To evaluate the alveolar ridge preservation effect of immediate implantation at extraction site with the im-proved CBCT measuring method.Methods:Eighty patients with extraction site were divided into test group A,B,C and control group.The patients were treated by means of immediate implant placement combined with large flap surgery,guided bone regener-ation(GBR)using mass Bio-Oss bone particles in the group A(the thickness of facial bone wall＜1 mm);The patients were trea-ted by means of immediate implant placement combined without flap surgery and bone graft in the group B(the thickness of facial bone wall ≥1 mm and＜2 mm)and C(the thickness of facial bone wall ≥2 mm),the CGF was implanted in the jumping space only when the thickness of jumping space was＞2 mm.In the control group,the alveolar sockets healed naturally without any in-tervention or treatment.CBCT was taken before surgery,immediately after surgery,and 6 months after surgery to evaluate the height and width of alveolar bone,the thickness of facial bone wall and jumping space.Results:The reduction of alveolar ridge height in group A,B,C and control group was(0.41±0.13,0.94±0.18,0.59±0.12,1.31±0.19)mm,The reduction of alveolar ridge width in group A,B,C and control group was(0.93±0.10,1.48±0.21,1.12±0.17,1.66±0.16)mum.The re-sults of four groups were statistically different(F=177.0,P＜0.001;F=125.3,P＜0.001).The alveolar ridge thickness of facial bone wall in group A,B,C and con-trol group was(0.98±0.25,2.39±0.28)mm,(1.43±0.52,2.10±0.33)mm,(2.17±0.41,2.79±0.27)mm before surgery and six months after immediate implantation.The results of each group were statistically different between before surgery and six months after immediate implantation(t=16.45,P＜0.001;t=7.357,P＜0.001;t=5.488,P＜0.001).Patients in three test groups had the thickness of jumping space＞2 mm and ≤2 mm,and the reduction of alveolar ridge width was(0.78±0.18,0.88±0.17)mm.The results were statistically different(t=17.18,P=0.018).Conclusion:The alveolar ridge preservation was obtained by means of immediate implant placement combined with large flap surgery,guided bone regeneration(GBR)using mass Bio-Oss bone particles at extraction site with the thickness of facial bone wall＜1 mm;The alveolar ridge preservation was obtained without flap surgery and GBR at extraction site with the thickness of facial bone wall≥1 mm.The preservation of soft and hard tissue was better in the axial palatal side of immediate implantation with the thickness of jumping space＞2 mm than that with the thickness of jumping space≤2 mm.

Objective:To analyze the current status of global clinical trial for botulinum toxin (BTX) drugs, and to provide a reference for BTX drug research priorities and trends.Methods:All registered BTX drug-related clinical trials from the inception of the platforms until December 2024 were retrieved from the International Clinical Trials Registry Platform (ICTRP) and the Center for Drug Evaluation (CDE) Clinical Trial Registration and Information Disclosure Platform of the National Medical Products Administration of China (referred to as the CDE Platform). The data were statistically analyzed using Excel 2021. The analysis was conducted from aspects such as registration volume and annual trend, distribution of conducting countries, drug type, study type and recruitment situation, and indications.Results:A total of 2 053 clinical trials related to BTX were included. The total number of registered trials showed an increasing trend year by year. The country with the largest number of clinical trials was the United States, with 571 trials, while China ranked third with 190 trials. Among the drug formulations, the injection form accounted for the highest proportion (99.02%, 2 033/2 053). A few new formulations included topical ointments, nasal sprays, and eye drops. In terms of drug serotypes and sources, the wild-type BTX-A projects accounted for a relatively high proportion (97.86%, 2 009/2 053), and also included a few wild-type BTX-B, wild-type BTX-E, recombinant BTX-AB, and recombinant BTX-A projects. In terms of research types, 90.4% (1 856/2 053) were intervention studies, 87.5% (1 796/2 053) of the clinical trials did not restrict gender, 90.7% (1 862/2 053) of the clinical trials recruited subjects covering adults, and 9.3% (191/2 053) of the clinical trials only recruited minors. The research indications covered various disciplines, such as skin beauty, neurology, urology, orthopedics, and ophthalmology. In recent years, the types of diseases registered for clinical trials had expanded significantly on the basis of the originally approved indications.Conclusion:Innovative directions in BTX drug research, including BTX drugs of different serotypes, recombinant BTX based on recombinant gene technology, BTX formulations for non-injectable delivery, and innovative areas of clinical application, are driving its continued clinical research.

Objective To characterize the clinical features of the group of gout patients to facilitate earlier identifi-cation,and optimize the diagnosis and treatment of the condition.Methods The retrospective study analyzed 24 gout patients with shoulder joint(s)involved and consulted by physicians of Peking Union Medical College Hospital from March 2021 to April 2025,while 70 outpatient gout patients matched by clinical course duration and sex were enrolled as control group.Clinical data including medical history,laboratory tests,therapeutic interventions.Prog-nosis was systematically collected to delineate the distinctive clinical manifestations of the patients.Results All 24 gout patients with shoulder joints involved were male,aged(43.16±13.13)years and had an average BMI of 27.70±4.63.The duration of gout was 8(5,12)years while of those patients had an early onset before 30 years old.The maximal serum uric acid concentration was(754.15±175.79)μmol/L.It was shown by case review that 16.67％of the patients were asymptomatic,and 79.17％suffered from shoulder pain.A quarter of the patients developed subcutaneous tophi.All the patients affected(P＜0.05).The affected joints ascended from lower extremities to the upper averagely took 4.72±2.80 years and had heavier burden of hyperuricemia(P＜0.05),while no significant difference was found in renal function and inflammation level.Conclusions Gout patients with shoulder joints involvement are older and have atypical manifestation.The diagnosis needs support of imaging or ar-throcentesis.

This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

Objective:To analyze the current status of global clinical trial for botulinum toxin (BTX) drugs, and to provide a reference for BTX drug research priorities and trends.Methods:All registered BTX drug-related clinical trials from the inception of the platforms until December 2024 were retrieved from the International Clinical Trials Registry Platform (ICTRP) and the Center for Drug Evaluation (CDE) Clinical Trial Registration and Information Disclosure Platform of the National Medical Products Administration of China (referred to as the CDE Platform). The data were statistically analyzed using Excel 2021. The analysis was conducted from aspects such as registration volume and annual trend, distribution of conducting countries, drug type, study type and recruitment situation, and indications.Results:A total of 2 053 clinical trials related to BTX were included. The total number of registered trials showed an increasing trend year by year. The country with the largest number of clinical trials was the United States, with 571 trials, while China ranked third with 190 trials. Among the drug formulations, the injection form accounted for the highest proportion (99.02%, 2 033/2 053). A few new formulations included topical ointments, nasal sprays, and eye drops. In terms of drug serotypes and sources, the wild-type BTX-A projects accounted for a relatively high proportion (97.86%, 2 009/2 053), and also included a few wild-type BTX-B, wild-type BTX-E, recombinant BTX-AB, and recombinant BTX-A projects. In terms of research types, 90.4% (1 856/2 053) were intervention studies, 87.5% (1 796/2 053) of the clinical trials did not restrict gender, 90.7% (1 862/2 053) of the clinical trials recruited subjects covering adults, and 9.3% (191/2 053) of the clinical trials only recruited minors. The research indications covered various disciplines, such as skin beauty, neurology, urology, orthopedics, and ophthalmology. In recent years, the types of diseases registered for clinical trials had expanded significantly on the basis of the originally approved indications.Conclusion:Innovative directions in BTX drug research, including BTX drugs of different serotypes, recombinant BTX based on recombinant gene technology, BTX formulations for non-injectable delivery, and innovative areas of clinical application, are driving its continued clinical research.

Objective:To evaluate the alveolar ridge preservation effect of immediate implantation at extraction site with the im-proved CBCT measuring method.Methods:Eighty patients with extraction site were divided into test group A,B,C and control group.The patients were treated by means of immediate implant placement combined with large flap surgery,guided bone regener-ation(GBR)using mass Bio-Oss bone particles in the group A(the thickness of facial bone wall＜1 mm);The patients were trea-ted by means of immediate implant placement combined without flap surgery and bone graft in the group B(the thickness of facial bone wall ≥1 mm and＜2 mm)and C(the thickness of facial bone wall ≥2 mm),the CGF was implanted in the jumping space only when the thickness of jumping space was＞2 mm.In the control group,the alveolar sockets healed naturally without any in-tervention or treatment.CBCT was taken before surgery,immediately after surgery,and 6 months after surgery to evaluate the height and width of alveolar bone,the thickness of facial bone wall and jumping space.Results:The reduction of alveolar ridge height in group A,B,C and control group was(0.41±0.13,0.94±0.18,0.59±0.12,1.31±0.19)mm,The reduction of alveolar ridge width in group A,B,C and control group was(0.93±0.10,1.48±0.21,1.12±0.17,1.66±0.16)mum.The re-sults of four groups were statistically different(F=177.0,P＜0.001;F=125.3,P＜0.001).The alveolar ridge thickness of facial bone wall in group A,B,C and con-trol group was(0.98±0.25,2.39±0.28)mm,(1.43±0.52,2.10±0.33)mm,(2.17±0.41,2.79±0.27)mm before surgery and six months after immediate implantation.The results of each group were statistically different between before surgery and six months after immediate implantation(t=16.45,P＜0.001;t=7.357,P＜0.001;t=5.488,P＜0.001).Patients in three test groups had the thickness of jumping space＞2 mm and ≤2 mm,and the reduction of alveolar ridge width was(0.78±0.18,0.88±0.17)mm.The results were statistically different(t=17.18,P=0.018).Conclusion:The alveolar ridge preservation was obtained by means of immediate implant placement combined with large flap surgery,guided bone regeneration(GBR)using mass Bio-Oss bone particles at extraction site with the thickness of facial bone wall＜1 mm;The alveolar ridge preservation was obtained without flap surgery and GBR at extraction site with the thickness of facial bone wall≥1 mm.The preservation of soft and hard tissue was better in the axial palatal side of immediate implantation with the thickness of jumping space＞2 mm than that with the thickness of jumping space≤2 mm.

Based on the principle of selective photothermodynamics, specific laser can be selectively absorbed by melanin particles in the hair follicles, resulting in a photothermal effect, through which hairball and hair follicle stem cells are completely destroyed, rendering permanent hair removal. Laser and light technology have the characteristics of convenience, efficiency, safety and permanent effect. Since its application in the reconstruction of the outer ear, it has helped solve the problem of residual hair and improve the shape of the auricle and the satisfaction of patients. The authors reviewed the laser types, treatment parameters, timing and interval, as well as related complications and corresponding treatment measures.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.