Chronic heart failure （CHF） is an end-stage cardiac syndrome driven by multiple factors. Its pathological process involves interactions of multiple pathways such as energy metabolism dysfunction， neuroendocrine dysregulation， and myocardial fibrosis. Although current clinical medicine can alleviate symptoms through single-target approaches， significant limitations in reversing cardiac remodeling and disease progression remain. Puerarin， a major bioactive isoflavone constituent derived from Pueraria lobata， exhibits multidimensional pharmacological effects， such as vasodilatory effects， regulation of neuroendocrine balance， enhancement of metabolic homeostasis， and suppression of myocardial apoptosis. This review systematically integrated puerarin's multi-target regulatory network， elucidating its mechanisms such as improving energy metabolism by AMP-activated protein kinase/mechanistic target of rapamycin （AMPK/mTOR） pathway， inhibiting fibrosis mediated by transforming growth factor-β （TGF-β）/Smad signals， and attenuating oxidative-inflammatory cascades by regulating nuclear factor erythroid 2 （E₂）-related factor 2/nuclear transcription factor-κB（Nrf2/NF-κB） axis. Clinical research data was used to validate its efficacy in improving the left ventricular ejection function and reducing the therapeutic potential of cardiovascular events' risks. The study proposed that puerarin's "systemic regulation" characteristic breaks through the limitations of traditional single-target drugs and prospected its clinical translation pathway based on metabolomics and nano-delivery technology， offering an integrative perspective from molecular mechanisms to precise therapy for the research on modernization of traditional Chinese medicine.

Chronic heart failure （CHF） is an end-stage cardiac syndrome driven by multiple factors. Its pathological process involves interactions of multiple pathways such as energy metabolism dysfunction， neuroendocrine dysregulation， and myocardial fibrosis. Although current clinical medicine can alleviate symptoms through single-target approaches， significant limitations in reversing cardiac remodeling and disease progression remain. Puerarin， a major bioactive isoflavone constituent derived from Pueraria lobata， exhibits multidimensional pharmacological effects， such as vasodilatory effects， regulation of neuroendocrine balance， enhancement of metabolic homeostasis， and suppression of myocardial apoptosis. This review systematically integrated puerarin's multi-target regulatory network， elucidating its mechanisms such as improving energy metabolism by AMP-activated protein kinase/mechanistic target of rapamycin （AMPK/mTOR） pathway， inhibiting fibrosis mediated by transforming growth factor-β （TGF-β）/Smad signals， and attenuating oxidative-inflammatory cascades by regulating nuclear factor erythroid 2 （E₂）-related factor 2/nuclear transcription factor-κB（Nrf2/NF-κB） axis. Clinical research data was used to validate its efficacy in improving the left ventricular ejection function and reducing the therapeutic potential of cardiovascular events' risks. The study proposed that puerarin's "systemic regulation" characteristic breaks through the limitations of traditional single-target drugs and prospected its clinical translation pathway based on metabolomics and nano-delivery technology， offering an integrative perspective from molecular mechanisms to precise therapy for the research on modernization of traditional Chinese medicine.

Background Lead is a typical persistent environmental pollutant that can accumulate in bones for decades. During pregnancy, alterations in calcium metabolism promote the mobilization of bone lead, resulting in secondary exposure; however, the mechanisms by which pregnancy-associated bone lead mobilization affects maternal renal function remain unclear. Objective To investigate the role of mitochondrial dysfunction in pregnancy-related bone lead mobilization-induced renal injury. Methods Newly weaned female Wistar rats were randomly assigned to a control or a lead-exposed group administered either 0.05% sodium acetate or 0.05% lead acetate in drinking water. Following a 4-week lead exposure and a 4-week washout period, the females were co-housed with healthy age-matched males for mating. Rats were sacrificed at early (gestational day 3) and late (gestational day 17) pregnancystages, respectively. Renal histopathology was assessed using hematoxylin and eosin staining staining. Mitochondria-related indicators, including oxidative stress, inflammatory responses, and energy metabolism, were measured. Differential metabolites were identified using serum metabolomics. Results Renal injury in the lead-exposed pregnant rats progressed in a time-dependent manner, characterized by degeneration of proximal tubular epithelial cells, glomerular hyaline changes, and interstitial inflammatory cell infiltration. Repeated measures ANOVA indicated a significant interaction between the treatment factor (lead exposure) and the temporal factor (gestational stage) on renal injury (P<0.001). Further analysis of mitochondrial function-related indicators in late-pregnancy renal tissue revealed that the lead exposure group exhibited significantly increased levels of malondialdehyde (MDA) and reactive oxygen species (ROS) (P<0.05), accompanied by a reduction in superoxide dismutase (SOD) and reduced glutathione (GSH) activities (P<0.05); regarding inflammatory markers, levels of interleukin-18 (IL-18) and interleukin-1β (IL-1β) were elevated (P<0.01), whereas interleukin-33 (IL-33) was decreased in the lead-exposed group (P<0.05); energy metabolism-related indicators, including adenosine triphosphate (ATP) level, Na⁺-K⁺-ATPase and Ca²⁺-Mg²⁺-ATPase activities, and mitochondrial respiratory chain complexes I, III, and V activities, were significantly reduced (P<0.05) in the lead-exposed gorup. The typical differential metabolite N-methylisoleucine, identified through serum metabolomics analysis, was negatively correlated with blood lead levels, kidney injury scores, and IL-1β, while positively correlated with catalase (CAT) activity and Ca²⁺-Mg²⁺-ATPase. Conclusions Mitochondrial dysfunction may play a critical role in renal injury induced by bone lead mobilization during late gestation.

Objective: To investigate the status of heat illness, knowledge awareness and adaptive behaviors of heat wave knowledge among food delivery riders, so as to provide a basis for optimizing heat wave response measures for food delivery riders. Methods: In November 2022, food delivery riders from a large food delivery platform in Ningbo City, Zhejiang Province were selected as survey subjects using a cluster sampling method. A self-designed electronic questionnaire was used to select demographic information, work status, lifestyle behaviors and disease history, heat illness status, knowledge awareness and adaptive behaviors of heatwave. Results: A total of 911 questionnaires were distributed, and 830 valid questionnaires were recovered, resulting in a valid response rate of 91.11%. Among the respondents, 796 (95.90%) were male, and 818 (98.55%) worked full-time. The mean age was (27.75±8.00) years. A total of 470 respondents (56.63%) had a work tenure of less than 1 year. The primary working hours were 8-<12 hours, with 504 people accounting for 60.72%. There were 108 cases of heatstroke, with an occurrence rate of 13.01%. And 286 people reported heat-related symptoms, with an occurrence rate of 34.46%. The overall awareness rate of heat wave knowledge was 73.22%, while the awareness rate of heat warning signal classification was relatively low at 9.04%. The heat wave cognition score was (5.86±1.31) points. There were statistically significant differences in heat wave cognition scores among food delivery riders of different ages, educational levels, family annual income, work tenures, and work durations (all P<0.05). Regarding positive adaptive behaviors, the number of riders paying attention to weather forecasts and actively learning about preventive measures was higher (734 people each, accounting for 88.43%). Regarding negative adaptive behaviors, the number of riders who often drank ice-cold beverages was higher (509 people, accounting for 61.33%). The heat wave adaptive behavior score was (6.88±1.77) points. There were statistically significant differences in adaptive behavior scores among riders with different educational levels, family annual income, work tenures, and smoking frequency (all P<0.05). Conclusions The occurrence rates of heatstroke and heat-related symptoms among food delivery riders are relatively high. The knowledge awareness and adaptive behaviors regarding heat wave are at a moderate level. It is suggested to strengthen health education, reinforce risk cognition of heat wave, and promote positive adaptive behaviors among food delivery riders.

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 investigate the neurorestorative effect of basic fibroblast growth factor (bFGF) on neurological function recovery in rats with spinal cord injury and its potential mechanisms.Methods:Ninety adult SD rats were selected and randomly divided into 6 groups using a random number table: sham-operated group ( n=24), spinal cord injury group ( n=24), bFGF group ( n=24), bFGF autophagy pathway validation group ( n=6), bFGF+rapamycin group ( n=6), and bFGF+MHY1485 group ( n=6). A spinal cord injury model was established by impacting the T 10 spinal cord segment using a self-made Allen′s weight-drop impactor. The sham-operated group underwent a 3 cm midline dorsal incision without spinal cord injury; the bFGF group received immediate intrathecal injection of 100 μl bFGF solution (20 μg/L) after injury; the sham surgery group and spinal cord injury group received an equal volume of saline after injury; the bFGF autophagy pathway validation group received the identical treatment as the bFGF group; the bFGF+rapamycin group received the same treatment as the bFGF group with additional intraperitoneal injection of rapamycin (4 mg·kg -1·d -1); the bFGF+MHY1485 group received the identical bFGF treatment plus intraperitoneal injection of MHY1485 (10 mg·kg -1·d -1). At 28 days after injury, the rats were sacrificed and the spinal cord tissue was collected at 5 mm from the injury epicenter for HE staining and pathological observation. At 7, 14, 21, and 28 days after injury, BBB scoring was used to assess hindlimb motor function; P wave latency and P1-N1 wave amplitude were recorded to evaluate neuroelectrophysiological changes; Western blot analysis was performed to detect the expression levels of phosphorylated mammalian target of rapamycin (p-mTOR)/mammalian target of rapamycin (mTOR) and microtubule-associated protein light chain 3-II (LC3-II) and evaluate changes in mTOR signaling pathway and autophagy activity. At 28 days after injury, behavioral alterations, neuroelectrophysiological changes, and auctophagy-related protein expression levels were assessed in the bFGF autophagy pathyway validation group, bFGF+rapamycin group and bFGF+MHY1485 group. Results:At 28 days after injury, the sham-operated group exhibited regular nuclear morphology, while the spinal cord injury group showed disordered cell structures and the bFGF group displayed relatively normal nuclear morphology. At 7, 14, 21, and 28 days after injury, the BBB scores in both the spinal cord injury group and bFGF group were lower than those in the sham-operated group ( P<0.01), with higher scores in the bFGF group than those in the spinal cord injury group ( P<0.01). At 7, 14, 21, and 28 days after injury, P-wave latency was longer and P1-N1 wave amplitude was lower in both the spinal cord injury group and bFGF group compared to those in the sham-operated group ( P<0.01), with shorter P-wave latency and higher P1-N1 wave amplitude in the bFGF group compared to those in the spinal cord injury group ( P<0.01). Western blot results indicated that at 7, 14, 21, and 28 days after injury, in the spinal cord injury group, p-mTOR/mTOR levels were lower than those in both the sham-operated group and bFGF group ( P<0.01), while LC3-II expression levels were higher ( P<0.01); in the bFGF group, p-mTOR/mTOR levels were higher than those in the spinal cord injury group but lower than those in the sham-operated group ( P<0.01), and LC3-II expression levels were lower than those in the spinal cord injury group but higher than those in the sham-operated group ( P<0.01). At 28 days after injury, the BBB scores were higher in both the bFGF autophagy pathway validation group and bFGF+MHY1485 group than those in the bFGF+rapamycin group ( P<0.01), with higher scores in the bFGF+MHY1485 group than those in the bFGF autophagy pathway validation group ( P<0.01). P-wave latency was shorter in both the bFGF autophagy pathway validation group and bFGF+MHY1485 group than those in the bFGF+rapamycin group ( P<0.01), with shorter P-wave latency in the bFGF+MHY1485 group than that in the bFGF autophagy pathway validation group ( P<0.01). P1-N1 wave amplitude was lower in both the bFGF autophagy pathway validation group and bFGF+MHY1485 group than that in the bFGF+rapamycin group ( P<0.01), with lower P1-N1 wave amplitude in the bFGF+MHY1485 group than that in the bFGF autophagy pathway validation group ( P<0.01). The p-mTOR/mTOR levels were higher in both the bFGF autophagy pathway validation group and bFGF+MHY1485 group than those in the bFGF+rapamycin group ( P<0.01), with higher p-mTOR/mTOR levels in the bFGF+MHY1485 group than those in the bFGF autophagy pathway validation group ( P<0.01). The LC3-II expression levels were higher in both the bFGF autophagy pathway validation group and bFGF+MHY1485 group than those in the bFGF+rapamycin group ( P<0.01), with higher LC3-II expression levels in the bFGF+MHY1485 group than those in the bFGF autophagy pathway validation group ( P<0.01). Conclusion:bFGF can improve the pathological state, motor behavior, and neuroelectrophysiological function in rats with spinal cord injury, for which the mechanism of action may involve downregulating cellular autophagy function by activating the mTOR pathway, thereby inhibiting excessive autophagy to promote neuronal regeneration and repair.

Objective:To investigate the clinicopathological characteristics of patients with early gastric carcinoma with lymphoid stroma(EGCLS).Methods:A retrospective analysis was conducted on 27 consecutive patients with EGCLS who underwent radical surgery at The Second People's Hospital of Changzhou between January 2007 and December 2023.Sixty-nine cases of conventional early gastric carcinoma with matched T stages were randomly selected as controls.Immunohistochemical staining was performed to detect the expression of P53,mismatch repair(MMR)proteins,programmed death-ligand 1(PD-L1),E-cadherin,and human epidermal growth factor receptor 2(HER2)in the study cohort.FISH analysis was conducted on HER2 2+cases,and in situ hybridization was used to detect Epstein-Barr virus(EBV).Res-ults:No significant differences were observed between the two groups in terms of patient sex,age,tumor location,size,ulceration,lymph-ovascular or perineural invasion,tumor budding grade,P53 expression,or MMR protein deficiency.The EGCLS group showed significantly higher proportions of SM2 invasion(88.9%),poor tumor differentiation(70.4%),pushing tumor border(48.1%),PD-L1 positivity(59.3%),Epstein-Barr virus-encoded small RNA(EBER)positivity(55.6%),and abnormal E-cadherin expression(48.1%)compared to the control group(59.4%,46.4%,18.8%,24.6%,1.4%,and 23.2%,respectively;P<0.05).The frequency of lymph node metastasis(7.4%)and the pro-portion of elevated macroscopic type(14.8%)in the EGCLS group were significantly lower than in the control group(30.4%and 40.6%,re-spectively;P<0.05).Lymphovascular invasion,tumor budding grade,and non-EGCLS status were identified as risk factors for lymph node metastasis,with lymphovascular invasion being the only independent risk factor.Conclusions:EGCLS is a rare subtype of early gastric car-cinoma characterized by a low frequency of lymph node metastasis and a high proportion of EBER positivity or MMR protein deficiency.En-doscopic resection or immunotherapy may be preferred treatment options for patients who are not suitable candidates for surgery.

Objective To analyze the technical movement characteristics of female table tennis play-ers with shoulder impingement syndrome when hitting a forehand topspin loop ball,in order to explore the reasons for shoulder impingement syndrome.Methods Thirteen female table tennis athletes with shoulder impingement syndrome were recruited for the shoulder impingement group(age 20.31±2.56 years,height 165.69±4.00 cm,weight 56.62±6.00 kg)and 13 healthy female table tennis athletes(age 21.54±2.78 years,height 165.54±4.45 cm,weight 60.08±8.02 kg)were selected for the healthy group.Kinematic and electromyographic data of the upper limbs were collected during six tri-als of forehand topspin strokes using a three-dimensional motion capture system and a wireless surface electromyographic system.The data were then averaged and compared between the groups.Results The shoulder impingement group had a greater shoulder flexion angular velocity at the end of the forward swing compared to the healthy group(t=-3.689,P=0.001).In addition,the shoulder impingement group showed significantly smaller trunk torsion angular amplitude(t=2.614,P=0.015)and average an-gular velocity of trunk torsion(t=3.958,P=0.001).Furthermore,the peak activation level of the anteri-or serratus muscle was smaller in the shoulder impingement group compared to the healthy group(t=2.363,P=0.027).Finally,the deactivation duration of both the triceps brachii and brachioradialis mus-cles was shorter in the shoulder impingement group compared to the latter(t=3.705,P=0.002;t=3.29,P=0.004).Conclusion Female table tennis players with shoulder impingement syndrome exhibit the fol-lowing characteristics in their forehand topspin:1)insufficient trunk rotation and premature deactiva-tion of the brachioradialis muscle,which lead to excessive loading on the shoulder during flexion;2)inadequate activation of the serratus anterior muscle,resulting in compromised scapular stability;3)premature deactivation of the triceps brachii muscle,which negatively affects the control of eccentric contraction velocity at the shoulder joint.

Blonanserin,a second-generation atypical antipsychotic agent,acts as an antagonist for dopamine D2,D3,and serotonin 5-HT2A receptors.Clinical studies have demonstrated that blonanserin is non-inferior to other antipsychotics,such as haloperidol and risperidone,in alleviating the symptoms of schizophrenia.Moreover,it exhib-its beneficial effects on cognitive symptoms and social functioning,with a favorable safety profile,making it one of the key treatment options for schizophrenia.With extensive clinical experience accumulated in China,this expert consensus aims to provide psychiatrists with updated and localized guidance on the optimal use of blonan-serin.Based on a systematic review of the latest evidence-particularly studies in Chinese population,this paper pres-ents the updated Chinese expert recommendations for the clinical use of blonanserin in 2024.