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 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.

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 effects of Wnt5a on the vasculogenic mimicry(VM)and cancer stem cell(CSC)properties of prostate cancer(PCa)cells by upregulating the expression of miR-141-3p.Methods:Human prostate epithelial cell line RWPE-1 and PCa cell lines PC-3,LNCaP,and DU145 were cultured.qPCR was employed to detect miR-141-3p expression,and Western blotting(WB)was used to measure Wnt5a protein levels.Stable Wnt5a-knockdown or miR-141-3p-knockdown LNCaP and DU145 cell lines were established respectively via plasmid transfection.VM formation ability was assessed by three-dimensional culture assay.Cell proliferation ability and drug sensitivity were measured by CCK-8 assay.Cell migration and invasion abilities were detected using wound healing and Transwell assays,respectively.The expressions of VM-related molecules and CSC markers were detected by qPCR and WB.Colony formation ability was determined by clonogenic assay.The proportion of CD133+cells was sorted and calculated by flow cytometry.The expressions of miR-141-3p and Wnt5a in CD133+and CD133-cells were detected by qPCR and WB.Stable Wnt5a-overexpressing PCa cell lines were constructed via plasmid transfection.The effects of Wnt5a and different Wnt pathway downstream inhibitors on miR-141-3p expression and promoter activity were detected by qPCR and dual-luciferase reporter assays.Expression of c-Jun was knocked down in Wnt5a-overexpressing cells using si-c-Jun transfection.The target binding relationship between c-Jun and the miR-141-3p promoter was verified by qPCR,dual-luciferase reporter assay,and chromatin immunoprecipitation assay.Results:The expressions of miR-141-3p and Wnt5a were significantly higher in PCa cells compared with those in RWPE-1 cells,with the highest relative expression in DU145 cells and the lowest in LNCaP cells(P<0.001).Downregulation of Wnt5a or miR-141-3p significantly inhibited VM formation ability and stemness of PCa cells,and significantly suppressed the proliferation,migration,invasion abilities,and enhanced the sensitivity to bicalutamide of PCa cells(P<0.05 or P<0.01 or P<0.001).Downregulation of Wnt5a significantly inhibited miR-141-3p expression and promoter transcriptional activity(P<0.01 or P<0.05),whereas upregulation of Wnt5a significantly promoted miR-141-3p expression and promoter transcriptional activity(P<0.01 or P<0.001).The promoting effect of Wnt5a on miR-141-3p expression and promoter transcriptional activity could be inhibited by a JNK/c-Jun pathway inhibitor(P>0.05).Downregulation of c-Jun significantly inhibited the promoting effect of Wnt5a on miR-141-3p expression and promoter transcriptional activity(P>0.05).c-Jun could bind to the-348 to-295 sequence of the miR-141-3p promoter.In absence of this fragment Wnt5a wouldn't promote miR-141-3p expression(P>0.05).Conclusion:The Wnt5a/JNK/c-Jun signaling pathway can upregulate miR-141-3p expression,and thereby promote VM formation in PCa cells,possibly by activating CSC properties.

Objective To develop an evaluation management information system for new nurses(EMISNN),and to explore the effectiveness of its application in the training of new nurses.Methods A research and development team was set up to design and build the EMISNN.EMISNN is a system which comprises 3 main modules,namely data integration module,query statistics module and strategy generation module.From August 2021 to April 2023,the new nurses of Qinhuangdao city,a tertiary A hospital who joined in 2022 were selected as an experimental group,and the new nurses joined in 2021 were selected as a control group by the convenience sampling method.The experimental group adopted the data analysis and strategies provided by the EMISNN to guide the training of the theory and practice of surgery,while the control group adopted the routine training plan,and then the performance of the 2 groups nurses in the theory test of surgical nursing and their satisfaction with the training were compared.Results After training,the experimental group was(73.51±8.51)points,while the control group was(69.14±8.01)points,and the difference between the 2 groups was statistically significant(t=3.112,P=0.002).The training satisfaction of the experimental group was(34.53±2.80)points,while the control group was(32.42±2.70)points,and the difference between the 2 groups was statistically significant(t=4.486,P＜0.001).Conclusion The application of the EMISNN conduces to the precision and intelligence of new nurses trainings,and it is also conducive to enhancing the satisfaction of new nurses with the training and improves the training quality.

Objective To investigate the correlation of Wnt5a expression and vasculogenic mimicry (VM) in prostate cancer tissues, and analyze their relationships with cancer stem cells (CSCs) characteristics and epithelial–mesenchymal transition (EMT). Methods Immunohistochemistry was conducted to detect the expression of Wnt5a in 50 prostate cancer tissues and 50 benign prostatic hyperplasia tissues. The expression levels of CD133, vimentin, and E-cadherin were detected in the prostate cancer tissues, and CD34/PAS double staining was used to detect VM structures. We analyzed the difference in Wnt5a level between prostate cancer and benign prostatic hyperplasia tissues, the clinical significance of Wnt5a and VM, the relationship of Wnt5a expression and VM, and the relationships of Wnt5a expression and VM with CD133, Vimentin, E-cadherin. Results The expression of Wnt5a was significantly higher in prostate cancer tissues than in benign prostatic hyperplasia (P < 0.05). A positive correlation was observed between Wnt5a expression and VM (P < 0.05). The expression levels of Wnt5a and VM were positively correlated with those of CD133 and vimentin (P < 0.05). Wnt5a expression and VM were positively correlated with Gleason score, vas deferens invasion and lymphatic metastasis (P < 0.05) of prostate cancer, and VM was also positively correlated with T stage of prostate cancer (P < 0.05). Conclusion The expression level of Wnt5a in prostate cancer tissues is elevated and positively related with VM formation. Wnt5a expression and VM are correlated with cancer stem cells characteristics and the expression of epithelial–mesenchymal transition marker proteins.

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 understand school physician in primary and secondary schools in Yichang City, Hubei Province from 2019 to 2020, and to provide a reference for strengthening the school physician team in primary and secondary schools. Methods: 149 and 102 primary and secondary schools from 6 municipal districts in Yichang City, Hubei Province, were randomly selected in November 2019 and November 2020, respectively, and were administered by questionnaire survey. Results: The proportion of school physicians increased from 39.6% in 2019 to 65.7% in 2020. In the past two years, the equipment rate of school physician in both central and fringe urban areas increased, especially the fringe urban areas, number of school physician increased from 38 to 96. A total of 93 and 141 school physicians were selected to pariticipate in questionaire survey in 2019 and 2020 respectively. The survey showed that more than 90% of school physicians in primary and secondary schools in Yichang received training, and 74.5% had college education level. However, most of them lack professional qualification and medical background. Conclusion School physician of primary and secondary of Yichang is well development over the past two years, and the proportion substantially increased. However, there is still room for improvement in the quantity and quality of school physicians, and professional qualification needs to be improved. More attention should be paid to the marginal urban areas to achieve a balance between quantity and quality.