BACKGROUND:Exercise interventions,recognized for their economic and non-pharmaceutical efficacy,have demonstrated the potential to upregulate brain-derived neurotrophic factor levels,thereby offering a therapeutic approach to the prevention and management of Parkinson's disease.However,the specific mechanisms by which exercise targeting brain-derived neurotrophic factor expression to delay Parkinson's disease onset and progression are not clear.OBJECTIVE:To explore the interplay between brain-derived neurotrophic factor and Parkinson's disease,to analyze the specific regulatory effect and mechanism of exercise on the expression of brain-derived neurotrophic factor in the pathological state of Parkinson's disease,to review the improvement effect of different exercise methods mediated by brain-derived neurotrophic factor on Parkinson's disease,to clarify the potential mechanism of exercise therapy targeting brain-derived neurotrophic factor in the prevention and treatment of Parkinson's disease,in order to provide a new theoretical basis for exercise prevention and treatment of Parkinson's disease.METHODS:A systematic literature review was conducted using"Parkinson's disease,brain-derived neurotrophic factor,neuroprotection,dopamine,neuronal apoptosis,neuroinflammation,and synaptic plasticity"as Chinese keywords,and"Parkinson's disease,BDNF,neuroprotection,neuroinflammation,and synaptic plasticity"as English keywords.Databases including CNKI,WanFang Data,PubMed,and Web of Science were searched for relevant articles published up to February 2024.Totally 98 core articles were selected based on inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Within the pathophysiological framework of Parkinson's disease,exercise has been shown to stimulate the release of the myokine Irisin and to specifically enhance brain-derived neurotrophic factor expression,counteracting kynurenine pathway metabolic dysregulation.(2)Aerobic activities,notably specialized forms such as Running on a Wheel with Electrical Stimulation(rotarod walking exercise)in animals and Nordic Walking in humans,along with multimodal exercise regimens,have been demonstrated to significantly enhance brain-derived neurotrophic factor expression.This upregulation is instrumental in ameliorating the motor symptoms associated with Parkinson's disease.Furthermore,brain-derived neurotrophic factor is implicated in the beneficial modulation of non-motor symptoms,including cognitive and sleep disturbances,through the practice of mind-body interventions like Tai Chi.(3)Exercise-induced high expression of brain-derived neurotrophic factor exerts a neuroprotective effect through several mechanisms:By upregulating the expression of anti-inflammatory cytokines such as interleukin-10,nerve growth factor-beta,and transforming growth factor-beta,and concurrently downregulating the expression of pro-inflammatory cytokines such as tumor necrosis factor-alpha and interleukin-1 beta,thereby suppressing the activation of microglia via the inhibition of the nuclear factor-kappa B signaling pathway,leading to a reduction in neuroinflammatory responses;by augmenting the activity of tyrosine hydroxylase,which facilitates the synthesis and release of dopamine.This is complemented by the inhibition of matrix metalloproteinase-3 and glycogen synthase kinase-3 beta,preventing the hyperphosphorylation of alpha-synuclein at serine 129,thus counteracting abnormal neuronal apoptosis.By inducing long-term potentiation and promoting the robust expression of post-synaptic density protein 95 and synaptophysin,thereby enhancing synaptic plasticity and exerting a neuroprotective influence that may delay the onset and progression of Parkinson's disease.(4)Considering the pivotal role of brain-derived neurotrophic factor in Parkinson's disease progression and treatment,targeted exercise therapies could advance"Exercise+Medicine"precision medicine for Parkinson's disease.However,current research is limited by a narrow focus on motor symptoms and a lack of diverse exercise protocols.There is a need for more comprehensive,longitudinal studies using varied exercise modalities to better understand and address non-motor symptoms in Parkinson's disease patients to improve the lack of research in the field of Parkinson's disease exercise prevention and treatment.

Objective To investigate the clinical characteristics in an elderly patient with sellar multiple myeloma.Methods Clinical features,laboratory data and radiologic profile of an elderly patient with sellar multiple myeloma were collected.Results The patient was an 85-year-old male.The main clinical manifestations were fatigue,poor appetite and polyuria.Laboratory examinations showed a significant decrease in blood sodium,several anterior pitu-itary hormones and an increase in total protein,mass of pituitary lesion and concentration of prolactin.During etio-logical screening,it was found that the blood immunoglobulin G(IgG)level was significantly increased,the blood M protein was positive and the bone marrow smear showed myeloma cells accompanied by multiple osteolytic lesions in the bones of the whole body.Considering the diagnosis of multiple myeloma,the pituitary lesion was likely to be the extra-medullary involvement.Conclusions The intrasellar plasmacytoma is not common.The disease onset is insidious with clinical features and imaging findings lacking specificity.Therefore,diagnosis relies on biopsy which poses risks for elderly patients and increases diagnostic challenges leading to misdiagnosis.

BACKGROUND:Exercise interventions,recognized for their economic and non-pharmaceutical efficacy,have demonstrated the potential to upregulate brain-derived neurotrophic factor levels,thereby offering a therapeutic approach to the prevention and management of Parkinson's disease.However,the specific mechanisms by which exercise targeting brain-derived neurotrophic factor expression to delay Parkinson's disease onset and progression are not clear.OBJECTIVE:To explore the interplay between brain-derived neurotrophic factor and Parkinson's disease,to analyze the specific regulatory effect and mechanism of exercise on the expression of brain-derived neurotrophic factor in the pathological state of Parkinson's disease,to review the improvement effect of different exercise methods mediated by brain-derived neurotrophic factor on Parkinson's disease,to clarify the potential mechanism of exercise therapy targeting brain-derived neurotrophic factor in the prevention and treatment of Parkinson's disease,in order to provide a new theoretical basis for exercise prevention and treatment of Parkinson's disease.METHODS:A systematic literature review was conducted using"Parkinson's disease,brain-derived neurotrophic factor,neuroprotection,dopamine,neuronal apoptosis,neuroinflammation,and synaptic plasticity"as Chinese keywords,and"Parkinson's disease,BDNF,neuroprotection,neuroinflammation,and synaptic plasticity"as English keywords.Databases including CNKI,WanFang Data,PubMed,and Web of Science were searched for relevant articles published up to February 2024.Totally 98 core articles were selected based on inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Within the pathophysiological framework of Parkinson's disease,exercise has been shown to stimulate the release of the myokine Irisin and to specifically enhance brain-derived neurotrophic factor expression,counteracting kynurenine pathway metabolic dysregulation.(2)Aerobic activities,notably specialized forms such as Running on a Wheel with Electrical Stimulation(rotarod walking exercise)in animals and Nordic Walking in humans,along with multimodal exercise regimens,have been demonstrated to significantly enhance brain-derived neurotrophic factor expression.This upregulation is instrumental in ameliorating the motor symptoms associated with Parkinson's disease.Furthermore,brain-derived neurotrophic factor is implicated in the beneficial modulation of non-motor symptoms,including cognitive and sleep disturbances,through the practice of mind-body interventions like Tai Chi.(3)Exercise-induced high expression of brain-derived neurotrophic factor exerts a neuroprotective effect through several mechanisms:By upregulating the expression of anti-inflammatory cytokines such as interleukin-10,nerve growth factor-beta,and transforming growth factor-beta,and concurrently downregulating the expression of pro-inflammatory cytokines such as tumor necrosis factor-alpha and interleukin-1 beta,thereby suppressing the activation of microglia via the inhibition of the nuclear factor-kappa B signaling pathway,leading to a reduction in neuroinflammatory responses;by augmenting the activity of tyrosine hydroxylase,which facilitates the synthesis and release of dopamine.This is complemented by the inhibition of matrix metalloproteinase-3 and glycogen synthase kinase-3 beta,preventing the hyperphosphorylation of alpha-synuclein at serine 129,thus counteracting abnormal neuronal apoptosis.By inducing long-term potentiation and promoting the robust expression of post-synaptic density protein 95 and synaptophysin,thereby enhancing synaptic plasticity and exerting a neuroprotective influence that may delay the onset and progression of Parkinson's disease.(4)Considering the pivotal role of brain-derived neurotrophic factor in Parkinson's disease progression and treatment,targeted exercise therapies could advance"Exercise+Medicine"precision medicine for Parkinson's disease.However,current research is limited by a narrow focus on motor symptoms and a lack of diverse exercise protocols.There is a need for more comprehensive,longitudinal studies using varied exercise modalities to better understand and address non-motor symptoms in Parkinson's disease patients to improve the lack of research in the field of Parkinson's disease exercise prevention and treatment.

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Objective:To evaluate the effects of different intervention measures on duration of mechanical ventilation and the length of intensive care unit (ICU) stay in critically ill patients using network Meta-analysis.Methods:Randomized controlled trial (RCT) on the effects of different intervention measures on duration of mechanical ventilation and the length of ICU stay in critically ill patients were systematically searched in PubMed, Embase, China Biomedical Literature Database, CNKI, and other databases. The search time limit was from the establishment of the database to November 2023. Literature screening, quality assessment, and data extraction were independently conducted by two researchers. Network Meta-analysis was employed to assess the effects of each intervention on duration of mechanical ventilation and the length of ICU stay, and funnel plots were generated.Results:A total of 37 RCTs were included, involving 3?977 severe patients, 2?041 in the intervention group and 1?936 in the control group. Thirteen types of interventions were analyzed, including usual care (UC), early activity (EA), early comprehensive rehabilitation (ECR), early pulmonary rehabilitation (EPR), cluster intervention strategy (CS), sedation, analgesia and cluster nursing (SACN), music therapy (MT), neuromuscular electrical stimulation (NMES), modified education and visitation (MV), virtual reality (VR), auricular point sticking (APS), acupoint acupuncture (AA), and concerted intervention (COR). Network Meta-analysis showed that MV significantly better than COR [standardized mean difference ( SMD) = -2.35, 95% confidence interval (95% CI) was -4.30 to -0.39], EPR ( SMD = -2.59, 95% CI was -4.81 to -0.37), and UC ( SMD = -4.10, 95% CI was -5.71 to -2.49) in improving duration of mechanical ventilation in critically ill patients. COR was significantly better than UC in shortened length of ICU stay ( SMD = -5.72, 95% CI was -10.07 to -1.37). The efficacy ranking results showed that for duration of mechanical ventilation, the surface under the cumulative ranking curve (SUCRA) was highest for MV (85.4%) and EA (85.4%), followed by AA (74.9%), NMES (63.1%), ECR (51.7%), CS (48.8%), SACN (34.3%), COR (29.4%), EPR (26.1%), and UC (0.7%). For the length of ICU stay, COR had the highest SUCRA (82.3%), followed by APS (79.7%), MV (77.7%), EPR (68.0%), NMES (57.6%), CS (54.4%), ECR (51.1%), SACN (41.9%), MT (39.8%), EA (39.3%), AA (33.0%), VR (15.4%), and UC (9.8%). The funnel plot results of ICU stay showed that the publication bias between studies were relatively small. Conclusions:MV and COR appear to be effective interventions for reducing mechanical ventilation time and ICU stay in critically ill patients. However, due to the number and quality of included studies, these findings require confirmation through additional high-quality research.

Objective:To explore the application of the semi-flipped classroom combined with knowledge point auction learning method in the theoretical teaching among stomatological students and its effectiveness.Methods:Undergraduates from four classes at Guanghua School of Stomatology, Sun Yat-Sen University were taken as research subjects. Students from two classes ( n=198) were taught using the semi-flipped classroom combined with the knowledge point auction learning method, while students from the other two classes ( n=172) were taught with the regular classroom teaching method as controls. Classroom quizzes were used to compare the two classes' mastery of important and difficult points, and a questionnaire was used to investigate students' feedback on the class outcomes. SPSS 22.0 was used for the independent samples t-test. Results:The mean test score of the experimental class was higher than that of the control class (88.51±11.02 vs. 80.40±8.53). The results of the questionnaire showed that students' interest in the course, comprehension and absorption of knowledge points, degree of satisfaction with the class, and mastery of the contents in sections in the experimental class were significantly higher than those in the control class (7.28±1.51 vs. 9.10±0.73, 6.92±1.44 vs. 8.69±1.62, 6.09±1.87 vs. 7.61±1.46, 6.40±1.04 vs. 7.70±0.86 ).Conclusions:The semi-flipped classroom combined with the knowledge point auction learning method is innovative and achieves good teaching outcomes. It holds promise for wider use in the theoretical teaching of various clinical subjects. To explore the application of the semi-flipped classroom combined with knowledge point auction learning method in the theoretical teaching among stomatological students and its effectiveness.

Objective:To explore the value of octreotide suppression test(OST) in predicting the efficacy of somatostatin receptor ligands(SRLs) in the treatment of active acromegaly.Methods:The clinical data of 76 patients with active acromegaly from 2011 to 2020 was retrospectively analyzed. OST was carried out as follows: After an overnight fasting and baseline sampling of growth hormone(GH), 100 μg octreotide was subcutaneously injected, and sampling for GH was obtained every 2 hours for 8 hours. All patients were treated with SRLs for at least 3 months. A good GH response is defined as a post-treatment random GH<1 μg/L or >80% fall compared with the baseline GH. A good insulin-like growth factor Ⅰ(IGF-Ⅰ) response is defined as IGF-Ⅰ<1.3 upper limit of normal(ULN) or >50% reduction compared with the baseline. If both GH and IGF-Ⅰ fulfill the criteria of a good response, it is defined as a good GH and IGF-Ⅰ response.Results:The baseline level of GH during OST was 15.00(6.38, 34.20) μg/L, the median time to reach the nadir GH was(3.65±1.65) hours, and the nadir GH level was 1.47(0.50, 4.19) μg/L. The median GH suppression rate was 89.12%(72.71%, 95.09%). When the cutoff value of GH suppression rate in predicting a good GH response was 89.32%, the area under the curve(AUC) was 0.74, with a sensitivity of 81.80% and specificity of 66.00%. When the cutoff value of GH suppression rate in predicting a good IGF-Ⅰ response was 93.14%, the AUC was 0.64, with a sensitivity of 50.00% and specificity of 75.60%. When the GH suppression rate was 90.71%, the AUC was 0.78, with the sensitivity of 83.30% and specificity of 70.00% in predicting a good GH and IGF-Ⅰ response. Compared with GH/IGF-Ⅰ non-responders, GH/IGF-Ⅰ responders displayed lower nadir GH during OST, higher GH suppression rate and IGF-Ⅰ reduction rate, and lower ratio of IGF-1 to ULN( P<0.05). Conclusion:GH suppression rate during the OST is a valuable predictor to evaluate the efficacy of SRLs in patients with acromegaly, with the highest sensitivity and specificity when the cutoff value is 90.71%.

Objective:To explore the application effect of case reporting model in newly recruited nurses.Methods:A total of 149 newly recruited nurses in First Hospital of Qinhuangdao from August 2016 to August 2018 were selected as the observation group. A total of 79 newly recruited nurses from August 2014 to August 2015 were selected as the control group. The newly recruited nurses in the observation group were trained in accordance with the requirements of the routine Syllabus for Newly Recruited Nurses and reported cases for 6 months, once a month. The control group was trained in accordance with the requirements of the Syllabus for Newly Recruited Nurses. The head nurses evaluated and compared the professional theoretical ability, active communication ability, problem solving ability, work cooperation ability, emergency capability, expression and communication ability and PPT production ability of the two groups of newly recruited nurses.Results:In the evaluation of newly recruited nurses by head nurses, the excellent rates and the good rates of professional theoretical ability, active communication ability, problem solving ability, work coordination ability, emergency capability, PPT production ability, expression and communication ability of newly recruited nurses in the observation group were all better than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The implementation of the case report model in standardized training of newly recruited nurses can promote active learning of newly recruited nurses, enhance the ability of newly recruited nurses to analyze the disease, and improve their job competence.

Artemisinin and its derivatives (ARTs) were reported to display heme-dependent antitumor activity. On the other hand, histone deacetylase inhibitors (HDACi) were known to be able to promote heme synthesis in erythroid cells. Nevertheless, the effect of HDACi on heme homeostasis in non-erythrocytes remains unknown. We envisioned that the combination of HDACi and artesunate (ARS) might have synergistic antitumor activity through modulating heme synthesis. studies revealed that combination of ARS and HDACi exerted synergistic tumor inhibition by inducing cell death. Moreover, this combination exhibited more effective antitumor activity than either ARS or HDACi monotherapy in xenograft models without apparent toxicity. Importantly, mechanistic studies revealed that HDACi coordinated with ARS to increase 5-aminolevulinate synthase (ALAS1) expression, and subsequent heme production, leading to enhanced cytotoxicity of ARS. Notably, knocking down significantly blunted the synergistic effect of ARS and HDACi on tumor inhibition, indicating a critical role of ALAS1 upregulation in mediating ARS cytotoxicity. Collectively, our study revealed the mechanism of synergistic antitumor action of ARS and HDACi. This finding indicates that modulation of heme synthesis pathway by the combination based on ARTs and other heme synthesis modulators represents a promising therapeutic approach to solid tumors.

Objective: To explore the feasibility and advantage of the drones in a county emergency medical service system. Methods: The study was conducted in Changxing County, Zhejiang Province from January to September 2018. The Changxing County People's Hospital and the health centers within its radius of 25 km were included in the study. Three types of indicators were obtained by using commercial drones to transfer simulated first-aid medical supplies from health centers to county people's hospitals: (1)The flight time of the drone; (2) The road traffic time measured by Baidu map and Tencent map software of the above-mentioned route at midnight; (3) The road traffic time measured by Amap software of these routes at 0: 00, 8: 00, 10:00, 12:00, 14:00, 16:00, 18:00, 20:00. The road traffic time at different time points measured by map softwares and drones flight time were compared. Wilcoxon symbolic rank test was used for statistical analysis, and P value of < 0.05 was considered statistically significant. Results: (1) A total of 10 health centers were involved in this study, the air straight-line distance between them and the county people's hospital was (10.97±3.59) km, and the road traffic distance was (13.61±4.95) km. (2) The flight time of drone was (16.35±5.15) min, less than road traffic time measured by Amap, Baidu and Tencent map software, which were (21.40±5.15) min, (22.50±6.11) min, (22.00±5.23) min, respectively (P< 0.01). (3)The road traffic time measured by Amap software was longer than that of drones from 0:00 to 20:00 (P< 0.01), with the maximum time of (27.80±6.12) min at 18:00, and the minimum time of (21.40±5.15) min at midnight. Drones could save up 14.07 min at most and 2.8 min at least, with an average save of (7.98±1.32) min. Conclusions Drone might be used to transfer first aid medical supplies between health centers in a county area, which is faster than road transportation. It has a better application prospect and is worth to further study.