Objective: To enhance the recognition of necrotizing sialometaplasia (NS) by elucidating its clinical, pathological characteristics and key diagnostic points, providing a basis for the diagnosis and treatment of the disease. Methods: This study has been reviewed and approved by the Medical Ethics Committee, and informed consent has been obtained from patients. Review the data of a patient with NS occurring at the junction of the right soft and hard palate, and comprehensively analyze its diagnostic process based on its clinical manifestations, imaging, and histopathological examination results. And review the relevant literature on the disease. Results: This study describes a 24-year-old male patient with a documented betel nut habit (2 pieces/day for >6 months), who presented with a bone-deep, irregular crateriform ulcer (3 mm × 6 mm × 5 mm) localized to the right hard-soft palate junction. Spiral CT showed a local soft tissue defect with no apparent underlying bone destruction. Histopathology demonstrated chronic inflammation of the mucosal and minor salivary gland tissues, with no evidence of malignancy. A final diagnosis of NS was established. The ulcer healed completely three weeks after initiation of local anti-inflammatory therapy. A literature review indicates that NS is a rare, benign salivary gland disorder, typically occurring at the hard-soft palate junction in middle-aged men (40-60 years). Its etiology remains unclear, but it is widely attributed to salivary lobe infarction following mechanical trauma-induced ischemia. Due to its clinical resemblance to malignancy, it is often misdiagnosed. Treatment entails local anti-inflammatory measures and meticulous wound care aimed at promoting mucosal healing. Conclusion NS is a self-limiting, benign condition that poses a significant diagnostic challenge due to its close clinical simulation of malignancy. Thus, accurate diagnosis requires a combined assessment of clinical presentation, radiological features, and pathological findings. Treatment is predicated based on a conservative strategy with an emphasis on symptomatic management.

Objective:To study the current situation and influencing factors of the ability of grassroots personnel involved in prevention and control of drinking water-borne endemic fluorosis based on a feasible ability theory.Methods:A self-developed evaluation tool was used to assess the ability of grassroots personnel involved in prevention and control of drinking water-borne endemic fluorosis. A questionnaire survey was conducted in 2024 via the Wenjuanxing platform to evaluate the current status of their ability and scores. A multivariate logistic regression model was employed to analyze the factors affecting the ability of these personnel.Results:A total of 2 879 questionnaires were collected, of which 2 751 were valid, with a validity rate of 95.55%. Among the valid questionnaires, 917 (33.33%) were filled out by personnel from the endemic areas. The overall ability score of grassroots personnel was (14.74 ± 2.56) points, with welfare scoring (3.45 ± 0.62) points, autonomy scoring (3.57 ± 0.89) points, subjectivity scoring (3.81 ± 0.69) points, and achievement scoring (3.79 ± 0.69) points. Multivariate logistic regression analysis showed that income and employment type were associated with the ability scores of grassroots personnel ( OR = 0.61, 1.31, 95% CI: 0.45 - 0.94, 0.89 - 1.94, P < 0.05). Conclusions:The ability of grassroots personnel involved in prevention and control of drinking water-borne endemic fluorosis is at a moderate level, and there is still room for improvement. Income and employment type are the main factors affecting their ability scores. Efforts should be made to improve salary and welfare benefits, refine professional title promotion mechanism, attract high-level talent, and enhance personnel stability, thus more effectively enhance the ability of grassroots personnel in prevention and control of drinking water-borne endemic fluorosis.

Objective To develop a system for retrieving information from clinical records of Traditional Chinese Medicine(TCM)based on generative large language models(LLMs).Methods Applicational needs of the system were analyzed,and entity types to be retrieved were identified.The functions,workflows,and architecture of the system were designed by combining the automatic retrieval capabilities of LLMs with human-in-the-loop(HITL).The software was developed using such frameworks as vLLM and Node.js.Interaction of multiple commercial/open source LLMs was implemented using OpenAI-compatible interfaces.The quality of information retrieved from LLMs was enhanced by prompt engineering.Results This system supported task allocation,automatic retrieval of structured information,and manual review.To evaluate its performance,the moonshot-v1-8k model was used to retrieve clinical records of TCM before manual edition was performed.Combining large language model pre-annotation with meticulous annotator edits improved accuracy by 26.6％compared to the BERT-BiLSTM-CRF model,and enhanced extraction efficiency by 1.6-fold relative to purely manual methods.Conclusion General generative LLMs can retrieve a wide range of entity information from TCM records with high accuracy and scalability.The design and implementation of this system approach may provide a useful reference for developing other biomedical information retrieval systems.

OBJECTIVE: To analyze the effectiveness of single three-dimensional (3D)-printed microporous titanium prostheses and flap combined prostheses implantation in the treatment of large segmental infectious bone defects in limbs. METHODS: A retrospective analysis was conducted on the clinical data of 76 patients with large segmental infectious bone defects in limbs who were treated between January 2019 and February 2024 and met the selection criteria. Among them, 51 were male and 25 were female, with an age of (47.7±9.4) years. Of the 76 patients, 51 had no soft tissue defects (single prostheses group), while 25 had associated soft tissue defects (flap combined group). The single prostheses group included 28 cases of tibial bone defects, 11 cases of femoral defects, 5 cases of humeral defects, 4 cases of radial bone defects, and 3 cases of metacarpal, or carpal bone defects, with bone defect length ranging from 3.5 to 28.0 cm. The flap combined group included 3 cases of extensive dorsum of foot soft tissue defects combined with large segmental metatarsal bone defects, 19 cases of lower leg soft tissue defects combined with large segmental tibial bone defects, and 3 cases of hand and forearm soft tissue defects combined with metacarpal, carpal, or radial bone defects, with bone defect length ranging from 3.8 to 32.0 cm and soft tissue defect areas ranging from 8 cm×5 cm to 33 cm×10 cm. In the first stage, vancomycin-loaded bone cement was used to control infection, and flap repair was performed in the flap combined group. In the second stage, 3D-printed microporous titanium prostheses were implanted. Postoperative assessments were performed to evaluate infection control and bone integration, and pain release was evaluated using the visual analogue scale (VAS) score. RESULTS: All patients were followed up postoperatively, with an average follow-up time of (35.2±13.4) months. In the 61 lower limb injury patients, the time of standing, walk with crutches, and fully bear weight were (2.2±0.6), (3.9±1.1), and (5.4±1.1) months, respectively. The VAS score at 1 year postoperatively was significantly lower than preoperative one ( t=-10.678, P<0.001). At 1 year postoperatively, 69 patients (90.8%) showed no complication such as infection, fracture, prosthesis displacement, or breakage, and X-ray films indicated good integration at the prosthesis-bone interface. According to the Paley scoring system for the healing of infectious bone defects, the results were excellent in 37 cases, good in 29 cases, fair in 3 cases, and poor in 7 cases. In the single prostheses group, during the follow-up, there was 1 case each of femoral prostheses fracture, femoral infection, and tibial infection, with a treatment success rate of 94.1% (48/51). In lower limb injury patients, the time of fully bear weight was (5.0±1.0) months. In the flap combined group, during the follow-up, 1 case of tibial fixation prostheses screw fracture occurred, along with 2 cases of recurrent foot infection in diabetic patients and 1 case of tibial infection. The treatment success rate was 84.0% (21/25). The time of fully bear weight in lower limb injury patients was (5.8±1.2) months. The overall infection eradication rate for all patients was 93.4% (71/76). CONCLUSION The use of 3D-printed microporous titanium prostheses, either alone or in combination with flaps, for the treatment of large segmental infectious bone defects in the limbs results in good effectiveness with a low incidence of complications. It is a feasible strategy for the reconstruction of infectious bone defects.
Humans ; Male ; Female ; Middle Aged ; Printing, Three-Dimensional ; Titanium ; Retrospective Studies ; Surgical Flaps ; Adult ; Prosthesis Implantation/methods* ; Plastic Surgery Procedures/methods* ; Treatment Outcome ; Prostheses and Implants ; Bone Diseases, Infectious/surgery* ; Extremities/surgery* ; Prosthesis Design

Objective:To explore the differences in bacterial communities within tissues during the process of oral mucosal carcinogenesis, and analyze the relationship between the high-abundance species Prevotella intermedia (Pi) and the occurrence and development of oral mucosal carcinogenesis. Methods:Fresh tissue samples were collected from patients diagnosed with oral leukoplakia (OLK), oral squamous cell carcinoma (OSCC), and healthy controls (HC) at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, from January 2022 to November 2024, following strict inclusion criteria. Bacterial DNA was extracted from these specimens, and the 2bRAD sequencing for microbiome (2bRAD-M) was employed to analyze and compare the α and β diversity, as well as the community composition of bacteria within tissues, aiming to identify specifically expressed bacteria. Subsequently, paraffin-embedded clinical specimens were collected: 15 cases in the OLK group (including 4 cases of simple hyperplasia, 6 cases of mild dysplasia, and 5 cases of moderate to severe dysplasia), 12 cases in the OSCC group, and 5 cases in the HC group. A 4-nitroquinoline N-oxide (4NQO)-induced OLK progression mouse model was also constructed. Mice were randomly divided into three groups using a random number table, with six in each group. The negative control group was given distilled water to drink; Group 1 was given distilled water containing 4NQO to drink until week 12, while Group 2 was given distilled water containing 4NQO to drink until week 22. After the mice were sacrificed, their tongue tissue were collected and fixed. Fluorescence in situ hybridization (FISH) with specific probes was used to validate the presence of Pi in human and mouse tissue sections, analyzing the correlation between histopathological grading and the invasion depth of Pi.Results:The 2bRAD-M microbial analysis revealed that the relative abundance of Pi in OSCC tissues (10.80%) was significantly higher than in the HC group (0.50%) ( P=0.001) and OLK group (0.70%) ( P=0.002). FISH probe detection showed that the fluorescence intensity of Pi in human OSCC tissues [123.50 (101.00, 142.30)] was higher than in the HC group [0.00 (0.00, 28.50)], simple hyperplasia OLK [0.00 (0.00, 35.25)], and mild dysplasia OLK [24.50 (0.00, 55.50)] groups, with statistically significant differences respectively ( P=0.002, P=0.003, P=0.005). However, there was no significant difference compared to moderate to severe dysplasia OLK [56.00 (28.00, 62.50)] ( P=0.210). The fluorescence area of Pi in human OSCC tissues [8 615.00 (7 439.00, 11 084.00)] was significantly larger than in the HC group [0.00 (0. 00, 45.00)], simple hyperplasia OLK group [0.00 (0.00, 81.00)], mild dysplasia [49.00 (0.00, 151.00)], and moderate to severe dysplasia groups [1 450.00 (454.00, 2 892.00)], with highly significant differences ( P<0.001). There was a significant correlation between the invasive depth of Pi and the degree of histopathological grading ( P<0.001). In mice, the fluorescence intensity of Pi in OSCC tissues [120.00 (110.00, 127.00)] was significantly higher than in the HC group [0.00 (0.00, 12.25)] ( P<0.01), but showed no significant difference compared with the OLK group [50.00 (0.00, 58.00)] ( P>0.05). The fluorescence area of Pi in mice OSCC tissues [11 020.00 (6 790.00, 12 102.00)] was significantly larger than in the HC group [0.00 (0.00, 56.75)] and the OLK group [0.00 (0.00, 751.50)] ( P=0.006, P=0.043). There is a significant correlation between the depth of invasion of Pi and the degree of histopathological grading ( P<0.01). Conclusions:This study suggests that Pi in oral mucosal tissue may be a potential biomarker for early detection of OSCC and play an important role in the carcinogenesis process of oral mucosa.

Objective:Based on the characteristics of grassroots disease prevention and control centers, medical institutions, and personnel involved in the prevention and control of drinking water-borne endemic fluorosis in China, the aim of this study is to develop a competency evaluation tool for grassroots personnel involved in the prevention and treatment of the disease.Methods:Through literature review and expert consultation, a competency evaluation tool was designed and developed. The tool was distributed nationwide via the Wenjuanxing platform. Valid data were collected and analyzed for item discrimination, validity, and reliability to assess its measurement effectiveness.Results:A total of 150 valid questionnaires were collected, covering 13 provinces across China (67 males, 83 females). The evaluation tool demonstrated significant differences in scores between high and low groups for all items ( P < 0.001). The correlation coefficients between each item and its corresponding factor ranged from 0.77 to 0.87, with factor loadings ranged from 0.68 to 0.97. In the validity analysis, root mean square error of approximation ( RMSEA) was 0.07, and standardized root mean square residual ( SRMR) was 0.03. The goodness-of-fit indices were as follows: goodness-of-fit index (GFI) = 0.94, normed fit index (NFI) = 0.96, incremental fit index (IFI) = 0.95, tucker-lewis index(TLI) = 0.96, and comparative fit index (CFI) = 0.96. In the reliability analysis, the overall Cronbach's α coefficient was 0.91, and the split-half coefficient was 0.88. Conclusions:The competency evaluation tool for grassroots personnel in the prevention and treatment of drinking water-borne endemic fluorosis exhibits high item discrimination, as well as good overall reliability and validity. It can be used to evaluate the competency of prevention and treatment personnel and to study influencing factors.

Objective:To explore the differences in bacterial communities within tissues during the process of oral mucosal carcinogenesis, and analyze the relationship between the high-abundance species Prevotella intermedia (Pi) and the occurrence and development of oral mucosal carcinogenesis. Methods:Fresh tissue samples were collected from patients diagnosed with oral leukoplakia (OLK), oral squamous cell carcinoma (OSCC), and healthy controls (HC) at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, from January 2022 to November 2024, following strict inclusion criteria. Bacterial DNA was extracted from these specimens, and the 2bRAD sequencing for microbiome (2bRAD-M) was employed to analyze and compare the α and β diversity, as well as the community composition of bacteria within tissues, aiming to identify specifically expressed bacteria. Subsequently, paraffin-embedded clinical specimens were collected: 15 cases in the OLK group (including 4 cases of simple hyperplasia, 6 cases of mild dysplasia, and 5 cases of moderate to severe dysplasia), 12 cases in the OSCC group, and 5 cases in the HC group. A 4-nitroquinoline N-oxide (4NQO)-induced OLK progression mouse model was also constructed. Mice were randomly divided into three groups using a random number table, with six in each group. The negative control group was given distilled water to drink; Group 1 was given distilled water containing 4NQO to drink until week 12, while Group 2 was given distilled water containing 4NQO to drink until week 22. After the mice were sacrificed, their tongue tissue were collected and fixed. Fluorescence in situ hybridization (FISH) with specific probes was used to validate the presence of Pi in human and mouse tissue sections, analyzing the correlation between histopathological grading and the invasion depth of Pi.Results:The 2bRAD-M microbial analysis revealed that the relative abundance of Pi in OSCC tissues (10.80%) was significantly higher than in the HC group (0.50%) ( P=0.001) and OLK group (0.70%) ( P=0.002). FISH probe detection showed that the fluorescence intensity of Pi in human OSCC tissues [123.50 (101.00, 142.30)] was higher than in the HC group [0.00 (0.00, 28.50)], simple hyperplasia OLK [0.00 (0.00, 35.25)], and mild dysplasia OLK [24.50 (0.00, 55.50)] groups, with statistically significant differences respectively ( P=0.002, P=0.003, P=0.005). However, there was no significant difference compared to moderate to severe dysplasia OLK [56.00 (28.00, 62.50)] ( P=0.210). The fluorescence area of Pi in human OSCC tissues [8 615.00 (7 439.00, 11 084.00)] was significantly larger than in the HC group [0.00 (0. 00, 45.00)], simple hyperplasia OLK group [0.00 (0.00, 81.00)], mild dysplasia [49.00 (0.00, 151.00)], and moderate to severe dysplasia groups [1 450.00 (454.00, 2 892.00)], with highly significant differences ( P<0.001). There was a significant correlation between the invasive depth of Pi and the degree of histopathological grading ( P<0.001). In mice, the fluorescence intensity of Pi in OSCC tissues [120.00 (110.00, 127.00)] was significantly higher than in the HC group [0.00 (0.00, 12.25)] ( P<0.01), but showed no significant difference compared with the OLK group [50.00 (0.00, 58.00)] ( P>0.05). The fluorescence area of Pi in mice OSCC tissues [11 020.00 (6 790.00, 12 102.00)] was significantly larger than in the HC group [0.00 (0.00, 56.75)] and the OLK group [0.00 (0.00, 751.50)] ( P=0.006, P=0.043). There is a significant correlation between the depth of invasion of Pi and the degree of histopathological grading ( P<0.01). Conclusions:This study suggests that Pi in oral mucosal tissue may be a potential biomarker for early detection of OSCC and play an important role in the carcinogenesis process of oral mucosa.

Objective:To study the current situation and influencing factors of the ability of grassroots personnel involved in prevention and control of drinking water-borne endemic fluorosis based on a feasible ability theory.Methods:A self-developed evaluation tool was used to assess the ability of grassroots personnel involved in prevention and control of drinking water-borne endemic fluorosis. A questionnaire survey was conducted in 2024 via the Wenjuanxing platform to evaluate the current status of their ability and scores. A multivariate logistic regression model was employed to analyze the factors affecting the ability of these personnel.Results:A total of 2 879 questionnaires were collected, of which 2 751 were valid, with a validity rate of 95.55%. Among the valid questionnaires, 917 (33.33%) were filled out by personnel from the endemic areas. The overall ability score of grassroots personnel was (14.74 ± 2.56) points, with welfare scoring (3.45 ± 0.62) points, autonomy scoring (3.57 ± 0.89) points, subjectivity scoring (3.81 ± 0.69) points, and achievement scoring (3.79 ± 0.69) points. Multivariate logistic regression analysis showed that income and employment type were associated with the ability scores of grassroots personnel ( OR = 0.61, 1.31, 95% CI: 0.45 - 0.94, 0.89 - 1.94, P < 0.05). Conclusions:The ability of grassroots personnel involved in prevention and control of drinking water-borne endemic fluorosis is at a moderate level, and there is still room for improvement. Income and employment type are the main factors affecting their ability scores. Efforts should be made to improve salary and welfare benefits, refine professional title promotion mechanism, attract high-level talent, and enhance personnel stability, thus more effectively enhance the ability of grassroots personnel in prevention and control of drinking water-borne endemic fluorosis.

Objective:Based on the characteristics of grassroots disease prevention and control centers, medical institutions, and personnel involved in the prevention and control of drinking water-borne endemic fluorosis in China, the aim of this study is to develop a competency evaluation tool for grassroots personnel involved in the prevention and treatment of the disease.Methods:Through literature review and expert consultation, a competency evaluation tool was designed and developed. The tool was distributed nationwide via the Wenjuanxing platform. Valid data were collected and analyzed for item discrimination, validity, and reliability to assess its measurement effectiveness.Results:A total of 150 valid questionnaires were collected, covering 13 provinces across China (67 males, 83 females). The evaluation tool demonstrated significant differences in scores between high and low groups for all items ( P < 0.001). The correlation coefficients between each item and its corresponding factor ranged from 0.77 to 0.87, with factor loadings ranged from 0.68 to 0.97. In the validity analysis, root mean square error of approximation ( RMSEA) was 0.07, and standardized root mean square residual ( SRMR) was 0.03. The goodness-of-fit indices were as follows: goodness-of-fit index (GFI) = 0.94, normed fit index (NFI) = 0.96, incremental fit index (IFI) = 0.95, tucker-lewis index(TLI) = 0.96, and comparative fit index (CFI) = 0.96. In the reliability analysis, the overall Cronbach's α coefficient was 0.91, and the split-half coefficient was 0.88. Conclusions:The competency evaluation tool for grassroots personnel in the prevention and treatment of drinking water-borne endemic fluorosis exhibits high item discrimination, as well as good overall reliability and validity. It can be used to evaluate the competency of prevention and treatment personnel and to study influencing factors.

Objective:To identify characteristic genes of bipolar disorder using the random forest method and to construct a discriminative model for bipolar disorder using neural network approaches.Methods:The study utilized gene expression data from individuals with bipolar disorder ( n=20) and healthy controls ( n=15) from the GSE23848 dataset. Background correction was performed using negative control probes, and normalization was done with both negative and positive control probes. Differentially expressed genes were identified through linear model analysis and empirical Bayesian statistical methods. A random forest model was built for feature extraction of differentially expressed genes, and a neural network model was constructed using the characteristic genes identified by the random forest model. The discriminative efficiency of the model was validated on an independent external dataset GSE39653, which included bipolar disorder patients ( n=8) and healthy controls ( n=24). Biological functions of the characteristic genes were explored through gene ontology (GO) and protein-protein interaction networks (PPI). Results:A total of 1 330 differentially expressed genes related to bipolar disorder and 35 characteristic genes were selected for model construction. The final model was a feedforward neural network with four hidden layers and four dropout layers, possessing 50 433 trainable parameters. Bootstrap methods with 1 000 resampling were used to calculate the confidence intervals for sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and accuracy, all of which were 1. In the GSE39653 external validation set, the model′s AUC was 0.72. Enrichment analysis of the characteristic genes suggested that the functions of the genes in the model are related to mitochondrial structure and energy metabolism.Conclusion:The random forest method can identify characteristic genes of bipolar disorder, and a diagnostic model established through the combination of random forests and feedforward neural networks shows good classification performance in bipolar disorder.