Objective:To search, evaluate, and summarize the best evidence of built-in fecal incontinence management device, to inform the management of incontinence dermatitis by clinical healthcare professionals.Methods:BMJ Best Practice, UpToDate, Guideline International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses′Association of Ontario, The Cochrane Library, Medline, Embase, SinoMed, CINAHL, PubMed, Web of Science, OVID, China National Knowledge Infrastructure, Wanfang Database were systematically searched for all evidence regarding the application of fecal collection devices. It included clinical practice, guidelines, systematic reviews, expert consensuses, evidence summaries, and randomized controlled trial. Two researchers independently evaluated the literature quality and extracted the literature that met the standards.Results:A total of 12 pieces of the literature were involved, including 2 best practice, 5 guidelines, 3 expert consensuses, and 2 systematic reviews. This study summarized 26 pieces of best evidence in relation to the following 5 themes: indications and contraindications, device insertion, device maintenance, device removal and effectiveness evaluation.Conclusions:This study scientifically and systematically summarized the best evidence regarding the insertion and maintenance of built-in fecal incontinence management device. We recommend that clinical practitioners integrate this evidence into their practice, while considering individual patient preferences and medical contexts. Adhering to individualization for evidence translation improves standardization and benefits patients in the clinical use of fecal collection devices.

Objective To explore the effect of esketamine combined with butorphanol on hemodynamics in painless gastroenteroscopy for elderly patients with obesity and the anesthetic efficacy and safety of this combined anesthesia regimen.Methods The subjects of this study,124 elderly patients with obesity who received painless gastroenteroscopy from January 2022 to March 2024,were randomly divided into two groups,each with 62 cases.Both groups were administrated with propofol 1.50 mg/kg for anesthesia induction.The observation group was given esketamine 0.20 mg/kg combined with butorphanol 10 μg/kg intravenously prior to propofol injection,while the control group was given saline of the same volume as esketamine combined with butorphanol 10 μg/kg intravenously before propofol injection.Vital signs indicators[mean arterial pressure(MAP),heart rate(HR),and percutaneous arterial oxygen saturation(SpO2)]were compared between the two groups at the time of entry(T0),immediately after anesthesia induction(T1),immediately after gastroscopy placement(T2),immediately upon completion of gastroscopy(T3),immediately after colonoscopy insertion(T4),and immediately upon completion of colonoscopy examination(T5).The anesthesia effect was evaluated for the two groups during painless gastroenteroscopy examination.The duration of gastroenteroscopy and propofol dosage were compared between the two groups as well.Visual analogue scale(VAS)score was used to evaluate the postoperative pain level for patients from the two groups 1,2,3,and 4 h after surgery.Intraoperative and postoperative adverse reactions in two groups were recorded.Results The MAP at T3,T4,and T5 time points in observation group were lower than that at T0 time point,the HR at T4 and T5 time point in observation group was lower than that at T0 time point,the differences were statistically significant(P＜0.05),there was no significant difference in SpO2 at each time point in observation group(P＞0.05).While the MAP,HR,and SpO2 at T1,T2,T3,T4,and T5 time points in control group were significantly lower than those at T0 time points,the differences were statistically significant(P＜0.05).The MAP,HR,and SpO2 at T1,T2,T3,T4,and T5 time points in control group were lower than those in observation group,the differences were statistically significant(P＜0.05).The excellent and good rate of anesthesia in observation group was better than that in control group,the difference was statistically significant(P＜0.05).The propofol dosage in observation group was less than that in control group,the recovery time in observation group was shorter than that in control group,the differences were statistically significant(P＜0.05).There were no significant differences in duration of gastroenteroscopy examination,postanesthesia care unit(PACU)stay and leave hospital time between the two groups(P＞0.05).1,2,3,and 4 h postoperative pain VAS scores in observation group were less than those in control group,the differences were statistically significant(P＜0.05).The incidence of respiratory depression was 3.23％,which was significantly lower than 19.35％in control group,the incidence of hypotension was 4.84％,which was significantly lower than 25.81％in control group,the incidence of bradycardia was 0.00％,which was significantly lower than 17.74％in control group,the incidence of nausea and vomiting was 1.61％,which was significantly lower than 12.90％in control group,the differences were statistically significant(P＜0.05).There were no significant differences in the incidence of tachycardia,coughing,body movement,and dizziness between the two groups(P＞0.05).Conclusion Application of esketamine combined with butorphanol in painless gastroenteroscopy for elderly patients with obesity can effectively improve sedative and analgesic effects,stabilize hemodynamics,and reduce adverse reactions.It is worthy clinical application.

Objective:To analyze the differences in clinicopathological features between non-elderly and elderly patients with melanoma, and to identify risk factors for prognosis in elderly patients with melanoma.Methods:A retrospective analysis was conducted on clinical and pathological data collected from non-elderly (aged < 60 years) and elderly (aged ≥ 60 years) patients with melanoma, who were confirmedly diagnosed according to clinical manifestations and histopathological findings at the People's Hospital of Xinjiang Uygur Autonomous Region from January 2008 to December 2023. The differences in clinical and pathological characteristics between the two groups were analyzed using the chi-square test and Wilcoxon rank-sum test. Survival curves were estimated using the Kaplan-Meier method and log-rank test. The relationship between clinicopathological variables and overall survival was analyzed using a Cox regression model.Results:A total of 233 patients with cutaneous melanoma were included, with the age being 60.3 ± 14.7 years, and the number of patients was highest in the age group of 60 - 69 years. There were 102 cases (43.8%) in the < 60 years old group and 131 cases (56.2%) in the ≥ 60 years old group. Compared with the < 60 years old group, the ≥ 60 years old group showed a significant increase in the proportion of patients with active tumor-infiltrating lymphocytes ( P = 0.040), proportion of those with Ki-67 index ≥ 30% ( P = 0.010), and Charlson comorbidity index ( P = 0.002), but a significant decrease in the proportion of patients with BRAF/KIT/NRAS mutations ( P = 0.003), proportion of those receiving surgical treatment ( P = 0.034), and proportion of those receiving adjuvant therapy ( P = 0.042). There was a significant difference in the overall survival between the two groups (log-rank test, χ2 = 6.10, P = 0.014). The gender, metastasis status, presence or absence of ulceration, distant metastasis status, American Joint Committee on Cancer staging, Charlson comorbidity index, and Breslow thickness were important prognostic indicators affecting the overall survival in the elderly patients with melanoma. Multivariate Cox regression analysis showed that males ( P = 0.015, HR = 4.622, 95% CI: 1.352 - 15.798), presence of distant metastasis ( P = 0.013, HR = 9.844, 95% CI: 4.621 - 59.763), and Charlson comorbidity index ≥ 3 ( P = 0.038, HR = 3.149, 95% CI: 1.067 - 9.294) were independent risk factors affecting the overall survival in the elderly patients with melanoma. Conclusions:Compared with the non-elderly patients with melanoma, a higher Ki-67 index, a higher Charlson comorbidity index, less surgical treatment, and less adjuvant therapy were more common in the elderly patients with melanoma. Males, the presence of distant metastasis, and Charlson comorbidity index ≥ 3 appeared to be independent risk factors affecting the overall survival in the elderly patients with melanoma.

Objective:To investigate the effect of 308-nm light-emitting diode (LED) phototherapy at escalating doses after autologous melanocyte transplantation on the repigmentation in patients with refractory stable vitiligo.Methods:A prospective, randomized, self-controlled trial was conducted. Twelve patients with refractory stable vitiligo (a total of 17 skin lesions) were collected from the Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region from November 2023 to September 2024. Autologous cultured melanocyte transplantation was performed. One week after the inner layer of petrolatum gauze had fallen off, each white patch was bisected by the midline and randomly divided into a test group and a control group; both groups received 308-nm LED light irradiation at an initial dose of 50 mJ/cm 2; then, the test group received a slow (5%) dose escalation, while the control group received a quick (10%) dose escalation. The repigmentation outcomes, clinical efficacy and safety were observed at 1, 3, and 6 months after the start of phototherapy. Results:A total of 12 patients with refractory stable vitiligo were collected, including 3 males and 9 females, aged 5 to 59 (29.4 ± 19.6) years. At 1 month after phototherapy, there was no significant difference in the vitiligo repigmentation area score between the test group and the control group ( P = 0.666) ; at 3 months after phototherapy, the vitiligo repigmentation area score was significantly higher in the test group (54.45 [5.17, 85.50] points) than in the control group (39.75 [4.52, 65.05] points, Z = -2.51, P = 0.012) ; at 6 months after phototherapy, no significant difference in the vitiligo repigmentation area score was observed between the two groups ( P = 0.11). In the test group, the marked response rate increased from 41.18% (7/17) at 1 month to 58.82% (10/17) and 58.82% (10/17) at 3 and 6 months after treatment, respectively; in the control group, it increased from 29.41% (5/17) at 1 month to 35.29% (6/17) and 47.06% (8/17) at 3 and 6 months after treatment, respectively. At 1 month after treatment, the response rate was 58.82% (10/17) in the test group, and 64.71% (11/17) in the control group, which both increased to 70.59% (12/17) at 3 and 6 months after treatment. There were no significant differences in the marked response rates or response rates between the two groups at different time points after treatment (all P > 0.05). The maximum dose of 308-nm LED light was 106.0 (87.0, 152.5) mJ/cm 2 in the test group, and 219.0 (200.5, 268.5) mJ/cm 2 in the control group; the total accumulated dose of 308-nm LED light was 2 101.0 (1 865.0, 2 270.5) mJ/cm 2 in the test group, and 3 411.0 (2 683.5, 4 016.5) mJ/cm 2 in the control group. Blisters occurred in 3 lesions (17.6%) in the control group, while no adverse reactions were observed in the test group. Seven patients (58.3%) preferred the low-dose escalation irradiation protocol in the test group. Conclusion:Autologous melanocyte transplantation combined with 308-nm LED phototherapy initiated at a minimum dose and followed by a 5% dose-escalation irradiation protocol exhibited comparable efficacy but superior safety profiles compared with a conventional 10% dose-escalation irradiation protocol in the treatment of refractory stable vitiligo.

OBJECTIVES: To investigate the association between methylation levels of tumor suppressing subtransferable candidate 1 (TSSC1) and melanophilin (MLPH) genes in peripheral blood and coronary heart disease (CHD) in Chinese population. METHODS: This case-control study was conducted in 86 CHD patients and 95 healthy individuals, whose methylation levels of TSSC1 and MLPH genes in peripheral blood were determined using mass spectrometry. Mann-Whitney U test was used to compare the methylation levels in different subgroups. The correlation of TSSC1 and MLPH gene methylation levels with age and gender were evaluated using Spearman correlation coefficient and contingency coefficient, respectively. RESULTS: Compared with the healthy individuals, the CHD patients showed a significant correlation between MLPH hypermethylation and myocardial infarction (MI) (MLPH_CpG_2.7: P=0.045; MLPH_CpG_3/cg06639874: P=0.049; MLPH_CpG_5: P=0.019), and this correlation was even stronger in individuals below 65 years of age (MLPH_CpG_2.7: P=0.014; MLPH_CpG_4: P=0.001) and in male subjects (MLPH_CpG_2.7: P=0.004; MLPH_CpG_3/cg06639874: P=0.044). The methylation level of TSSC1 gene in peripheral blood was not found to correlate with CHD or its subtypes. CONCLUSIONS Our findings suggest a correlation of MLPH hypermethylation in peripheral blood with CHD and MI in Chinese population, especially in individuals below 65 years and in male individuals.
Humans ; DNA Methylation ; Male ; Female ; Middle Aged ; Case-Control Studies ; Aged ; Coronary Disease/blood* ; Adult ; CpG Islands

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*

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Objective:To investigate the effectiveness of the 5A (Ask, Assess, Advise, Assist, Arrange follow-up) management model based on personalized health education records in community patients with type 2 diabetes mellitus.Methods:A convenience sampling method was used to select patients with type 2 diabetes mellitus who were enrolled with family doctors in Yuxin Community, Haidian District, Beijing, from January 2022 to May 2023. Using a random number table method, the patients were divided into an observation group ( n=68) and a control group ( n=68). The control group received routine community management, while the observation group received management based on the 5A model and personalized health education records. Differences in metabolic indicators, including glycated hemoglobin (HbA1c), fasting blood glucose, 2-hour postprandial blood glucose, body mass index (BMI), and waist circumference, as well as self-management behaviors were compared between the two groups at 3, 6, and 12 months of intervention. Results:During the entire intervention period, four cases were lost in the observation group and eight cases were lost in the control group. Finally, data from 124 patients were included in the analysis, including 64 cases in the observation group and 60 cases in the control group. Repeated measures analysis of variance showed interaction effects between time points and groups for HbA1c, BMI, waist circumference, and self-management behavior scores among patients with diabetes, with statistically significant differences ( P<0.05) . Conclusions:The 5A management model based on personalized health education records has a positive impact on improving metabolic indicators and self-management behaviors in community patients with type 2 diabetes mellitus.

Tuberculosis is a zoonotic disease posing a substantial public health threat.Immunological diagnosis and vaccine im-munization are both necessary to control tuberculosis prevalence.However,the identical antigenic components in diagnostic reagents and vaccines hinder the use of animal vaccines and limit the specificity of clinical diagnosis in humans.Differentiating infected from vaccinated animals can overcome these problems.This article reviews the progress in differential diagnosis research from three as-pects:the diagnostic effects of antigens,methods for discovering new antigens,and screening of new host immune markers,to provide a theoretical basis for future research.