Objective:To analyze the relevant studies on fertility concerns intervention programs for breast cancer survivors of childbearing age, and identify the specific content, outcome indicators and intervention effects of intervention, in order to provide reference for clinical staff to implement relevant intervention.Methods:According to the research method of scope review, the studies on the fertility concerns with breast cancer patients of childbearing age in China National Knowledge Infrastructure, WanFang, VIP, China Biomedical Literature Database, CINAHL, PubMed, Cochrane Library, Web of Science etc. were searched. The search period was from database establishment to May 9, 2024. The included literature was classified and analyzed.Results:A total of 12 articles were included, 9 were randomized controlled trials, 2 were self-controlled before and after studies, and 1 was a prospective cohort study. Fertility concerns intervention programs included group fertility counseling centered on couples, fertility support based on a multidisciplinary team collaboration model, and fertility management based on "Internet + reproductive health". The duration of intervention was usually 4 or 24 weeks. The intervention had different effects on the level of fertility concerns, psychological state and marital status.Conclusions:At present, the intervention programs for fertility concerns of breast cancer survivors of childbearing age reflect the importance, professionalism, immediacy and interactivity, but China is in the initial stage, and there are still shortcomings in multidisciplinary teams, fertility referral system, and Internet platform construction. Future research should build a breast cancer fertility intervention program suitable for our country, and promote its application through the Internet.

Objective To explore the effect on the expression of ERα/PGC1α/PPARα pathway,the therapeutic effect of Danhe Liuwei Dihuang Decoction on ovariectomized NAFLD rats was observed.Methods 60 female non-pregnant SPF SD rats were randomly divided into sham operation group(Sham),model group(Model),estrogen group(E2),traditional Chinese medicine high,medium and low dose group(DHR-H/M/L).Sham group was given normal diet after sham operation,and the other groups were given high-fat,high-fructose and high-cholesterol diet(HF/HF/HC)after bilateral ovariectomy to prepare postmenopausal NAFLD model.The Sham group and the Model group were given normal saline by gavage,and the other groups were given corresponding doses of drugs by gavage.The intervention time was 12 weeks,and the experimental period was 14 weeks.The general condition and body weight of rats in each group were recorded.HE staining of uterus was used to observe the morphology of uterus,HE staining of liver and oil red O staining were used to observe steatosis.Serum liver function(ALT,AST)and lipid metabolism indexes(TG,TC)were measured by automatic biochemical analyzer.The levels of serum E2 and free fatty acid(FFA)and the expression of FFA and TG in liver tissue were detected by ELISA.The mRNA and protein expressions of ERα,PGC1α and PPARα in liver tissues were detected by RT-PCR and Western blot.Results Compared with the Model group,by Danhe Liuwei Dihuang Decoction,the body weight and liver weight of ovariectomized NAFLD rats significantly decreased,liver fat deposition significantly decreased,E2 level increased,ALT,AST,TG,TC,FFA and liver tissue homogenate FFA,TG content significantly decreased,liver ERα,PGC1α,PPARα mRNA and protein expression up-regulated(P<0.05 or P<0.01).Conclusion Danhe Liuwei Dihuang Decoction can improve liver steatosis in postmenopausal NAFLD model rats.The mechanism may be related to up-regulating the expression of ERα/PGC1α/PPARα signaling pathway to promote liver FFA oxidation and reduce liver TG deposition.

Objective To explore the effect on the expression of ERα/PGC1α/PPARα pathway,the therapeutic effect of Danhe Liuwei Dihuang Decoction on ovariectomized NAFLD rats was observed.Methods 60 female non-pregnant SPF SD rats were randomly divided into sham operation group(Sham),model group(Model),estrogen group(E2),traditional Chinese medicine high,medium and low dose group(DHR-H/M/L).Sham group was given normal diet after sham operation,and the other groups were given high-fat,high-fructose and high-cholesterol diet(HF/HF/HC)after bilateral ovariectomy to prepare postmenopausal NAFLD model.The Sham group and the Model group were given normal saline by gavage,and the other groups were given corresponding doses of drugs by gavage.The intervention time was 12 weeks,and the experimental period was 14 weeks.The general condition and body weight of rats in each group were recorded.HE staining of uterus was used to observe the morphology of uterus,HE staining of liver and oil red O staining were used to observe steatosis.Serum liver function(ALT,AST)and lipid metabolism indexes(TG,TC)were measured by automatic biochemical analyzer.The levels of serum E2 and free fatty acid(FFA)and the expression of FFA and TG in liver tissue were detected by ELISA.The mRNA and protein expressions of ERα,PGC1α and PPARα in liver tissues were detected by RT-PCR and Western blot.Results Compared with the Model group,by Danhe Liuwei Dihuang Decoction,the body weight and liver weight of ovariectomized NAFLD rats significantly decreased,liver fat deposition significantly decreased,E2 level increased,ALT,AST,TG,TC,FFA and liver tissue homogenate FFA,TG content significantly decreased,liver ERα,PGC1α,PPARα mRNA and protein expression up-regulated(P<0.05 or P<0.01).Conclusion Danhe Liuwei Dihuang Decoction can improve liver steatosis in postmenopausal NAFLD model rats.The mechanism may be related to up-regulating the expression of ERα/PGC1α/PPARα signaling pathway to promote liver FFA oxidation and reduce liver TG deposition.

ObjectiveTo investigate the association of menopausal time and menopausal age with the risk of nonalcoholic fatty liver disease （NAFLD）， and to provide a basis for the early prevention and treatment of NAFLD in clinical practice. MethodsRelated data were collected from 373 postmenopausal women who attended the outpatient service of Department of Spleen， Stomach， Liver and Gallbladder Diseases， The First Affiliated Hospital of Henan University of Chinese Medicine， from January 2017 to December 2021， including general information， menopausal age， menopausal time， and presence or absence of NAFLD. The chi-square test was used for comparison of categorical data； the independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups. A Logistic regression analysis was used to calculate the association intensity and 95% confidence interval （95%CI） of menopausal time and menopausal age for the risk of NAFLD， and the restricted cubic spline （RCS） method was used to investigate the dose-response relationship between menopausal time/age and the risk of NAFLD. ResultsCompared with the women with normal menopause or late menopause， the women with early menopause had a higher prevalence rate of NAFLD and a higher degree of steatosis and fibrosis （all P<0.05）. After adjustment for the confounding factors such as age and age of menarche， the risk of NAFLD in women with a menopausal time of >3 years was 4.80 （95%CI： 1.93‍ ‍—‍‍ ‍11.95， P=0.001） times that in women with a menopausal time of ≤3 years， and the risk of NAFLD in women with early or late menopause was 8.14 times （95%CI： ‍1.77 ‍— ‍37.58， P=0.007） and 0.09 times （95%CI： 0.03 ‍— ‍0.32， P<0.001）， respectively， that in those with a normal menopausal age. There is a dose-response relationship between menopausal time/age and the risk of NAFLD. Menopausal time is positively correlated with the association intensity of NAFLD， while menopausal age is negatively correlated with the association intensity of NAFLD. ConclusionThe longer the menopause time and the earlier the menopause age， the ligher the risk of NAFLD.

ObjectiveTo observe the clinical effect of Xiaozhi Hugan capsules in treating patients with non-alcoholic steatohepatitis （NASH） combined with phlegm-dampness and blood stasis syndrome and its effects on serum interleukin-6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1）. MethodsA total of 124 patients with NASH combined with phlegm-dampness and blood stasis syndrome who were admitted to the Department of Spleen， Stomach， and Hepatobiliary Diseases， the First Affiliated Hospital of Henan University of Chinese Medicine from July 2020 to December 2022 were selected. According to the random number table method， patients were randomly divided into an observation group （62 cases） and a control group （62 cases）. The treatment duration was 6 months. The observation group received Xiaozhi Hugan capsules orally， while the control group received polyene phosphatidylcholine capsules. The efficacy indicators included alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， controlled attenuation parameter （CAP）， liver stiffness measurement （LSM）， traditional Chinese medicine （TCM） syndrome scores （discomfort/dull pain/distending pain in liver region， fatigue， etc.）， body mass index （BMI）， waist-to-height ratio （WHtR）， high-density lipoprotein cholesterol （HDL-C）， total cholesterol （TC）， triglycerides （TG）， homeostatic model assessment for insulin resistance （HOMA-IR） ［including fasting blood glucose （FBG） and fasting insulin level （INS）］， free fatty acids （FFA）， IL-6， and MCP-1. Adverse drug reactions were recorded. ResultsAfter treatment， the total effective rate in the observation group was 92.3% （48/52）， while that in the control group was 75.5% （39/49）. The total effective rate in the observation group was higher than that in the control group （χ²=5.339， P<0.05）. After treatment， the TCM syndrome scores in both groups were significantly reduced （P<0.05）， and the post-treatment scores in the observation group were better than those in the control group （P<0.05）. After treatment， the levels of ALT， AST， TC， FFA， fasting insulin （FINS）， HOMA-IR， MCP-1， IL-6， CAP， LSM， BMI， and WHtR were decreased （P<0.05） significantly in both groups， and the observation group showed superior improvement in the above indicators compared to the control group （P<0.05）. The observation group exhibited significant reductions in TG and FBG （P<0.05） and an increase in HDL-C （P<0.05）， while no significant changes were observed in the control group. The observation group was superior to the control group after treatment （P<0.05）. No severe adverse reactions occurred in either group during the treatment. ConclusionXiaozhi Hugan capsules have significant clinical efficacy in treating patients with NASH combined with phlegm-dampness and blood stasis syndrome. It reduces hepatic steatosis， lowers liver stiffness， inhibits the expression of serum inflammatory factors， and alleviates liver inflammation. No obvious adverse reactions occur， suggesting it is suitable for clinical application.

ObjectiveTo observe the clinical effect of Xiaozhi Hugan capsules in treating patients with non-alcoholic steatohepatitis （NASH） combined with phlegm-dampness and blood stasis syndrome and its effects on serum interleukin-6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1）. MethodsA total of 124 patients with NASH combined with phlegm-dampness and blood stasis syndrome who were admitted to the Department of Spleen， Stomach， and Hepatobiliary Diseases， the First Affiliated Hospital of Henan University of Chinese Medicine from July 2020 to December 2022 were selected. According to the random number table method， patients were randomly divided into an observation group （62 cases） and a control group （62 cases）. The treatment duration was 6 months. The observation group received Xiaozhi Hugan capsules orally， while the control group received polyene phosphatidylcholine capsules. The efficacy indicators included alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， controlled attenuation parameter （CAP）， liver stiffness measurement （LSM）， traditional Chinese medicine （TCM） syndrome scores （discomfort/dull pain/distending pain in liver region， fatigue， etc.）， body mass index （BMI）， waist-to-height ratio （WHtR）， high-density lipoprotein cholesterol （HDL-C）， total cholesterol （TC）， triglycerides （TG）， homeostatic model assessment for insulin resistance （HOMA-IR） ［including fasting blood glucose （FBG） and fasting insulin level （INS）］， free fatty acids （FFA）， IL-6， and MCP-1. Adverse drug reactions were recorded. ResultsAfter treatment， the total effective rate in the observation group was 92.3% （48/52）， while that in the control group was 75.5% （39/49）. The total effective rate in the observation group was higher than that in the control group （χ²=5.339， P<0.05）. After treatment， the TCM syndrome scores in both groups were significantly reduced （P<0.05）， and the post-treatment scores in the observation group were better than those in the control group （P<0.05）. After treatment， the levels of ALT， AST， TC， FFA， fasting insulin （FINS）， HOMA-IR， MCP-1， IL-6， CAP， LSM， BMI， and WHtR were decreased （P<0.05） significantly in both groups， and the observation group showed superior improvement in the above indicators compared to the control group （P<0.05）. The observation group exhibited significant reductions in TG and FBG （P<0.05） and an increase in HDL-C （P<0.05）， while no significant changes were observed in the control group. The observation group was superior to the control group after treatment （P<0.05）. No severe adverse reactions occurred in either group during the treatment. ConclusionXiaozhi Hugan capsules have significant clinical efficacy in treating patients with NASH combined with phlegm-dampness and blood stasis syndrome. It reduces hepatic steatosis， lowers liver stiffness， inhibits the expression of serum inflammatory factors， and alleviates liver inflammation. No obvious adverse reactions occur， suggesting it is suitable for clinical application.

Objective:To investigate the clinical features and prognostic factors of pediatric patients with acute hyperleukocytic leukemia (AHL).Methods:A retrospective case series study was conducted. The clinical data of 99 pediatric patients diagnosed with AHL who admitted to the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University between May 2015 and November 2020 were retrospectively analyzed. The enrolled children were grouped based on the following factors including gender, age, initial white blood cell count (WBC), initial lactate dehydrogenase (LDH), whether tumor lysis syndrome (TLS) occurred, immunophenotype, fusion gene, whether complete remission (CR) was achieved on the 19th day (D19) after transplantation, and whether CR was achieved on the 46th day (D46) after transplantation. All the patients were treated with the chemotherapy regimen of Shanghai Children's Medical Center - Acute Lymphoblastic Leukemia - 2015 (SCMC-ALL-2015). Flow cytometry was used to monitor the minimal residual disease (MRD); fluorescence in situ hybridization (FISH) was used to screen out the mutant genes. The median follow-up time was 47 months. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for intergroup comparisons. Multivariate Cox proportional hazard regression model was used to screen out the the prognostic factors.Results:Among 99 AHL patients, there were 65 males and 35 females; the median age was 7.71 (3.32, 11.20) years. At the initial diagnosis, 48 cases had WBC≤100×10 9/L, and 51 cases had WBC>100×10 9/L; 36 cases had LDH ≤ 2 000 U/L, and 63 cases had LDH > 2 000 U/L; 3 cases had TLS, 5 cases had MLL::AF4 positive, 7 cases had BCR::ABL positive, 7 cases had E2APBX1 positive, and 10 cases had TEL::AML1 positive; 28 cases were acute T-cell lymphoblastic leukemia (T-ALL), and 71 cases were acute B-cell lymphoblastic leukemia (B-ALL). At D19, 74 cases achieved bone marrow CR; at D46, 82 cases achieved bone marrow CR; 3-year and 5-year OS rates were 74.5% and 71.3%, respectively. During the follow-up, 14 cases relapsed and 15 died, including 12 dying of relapse, 2 dying of infection and 1 case dying of pulmonary graft-versus-host disease (GVHD). There were statistically significant differences in the 3-year OS rate in patients with different age, initial WBC, initial LDH, immunophenotyping, whether bone marrow CR at D19 was achieved, whether MRD at D19 occurred, whether bone marrow CR at D46 was achieved, whether MRD at D46 occurred, the presence of TLS, MLL::AF4 positive and TEL::AML1 positive (all P < 0.05). Furthermore, multivariate Cox regression analysis showed that LDH(>2 000 U/L), MLL::AF4 positive, T immunophenotyping, relapse, not achieving bone marrow CR at D19, not achieving bone marrow CR at D46, and MRD positive at D46 were independent risk factors influencing 3-year OS rate (all P < 0.05). Conclusions:Pediatric patients with AHL have high tumor burden at early stage, and TLS may cause death. Patients treated with the SCMC-ALL-2015 protocol can achieve favorable therapeutic effects and prognosis. LDH, MLL::AF4, immunophenotyping and relapse are prognostic factors.

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*