Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

OBJECTIVE To study the mechanism of Wenshen Tongdu Recipe in promoting the recovery of motor function in rats with spinal cord injury.METHODS A total of 144 SD rats were randomly divided into sham operation group,model group,predni-sone group,low-dose Wenshen Tongdu Recipe group,medium-dose Wenshen Tongdu Recipe group,high-dose Wenshen Tongdu Recipe group,3BDO group,and 3BDO+Wenshen Tongdu Recipe group(medium dose).The rat spinal cord injury model was estab-lished by modified Allen's method.Intervention began 1 day after modeling,and the drug was administered continuously for 14 days.During the drug administration period,the motor function of the rats in each group was evaluated by Basso-Beattie-Bresnahan(BBB)score and inclined plane test.On the 3rd,7th and 14th days after modeling,the pathological changes of the spinal cord tissues of the rats in each group were observed by HE staining;the expression levels of inflammatory factors IL-1β,IL-6,IL-4 and IL-10 in the serum of the rats in each group were detected by ELISA;the expression of Beclin 1,LC3B and p62 proteins was detected by immu-nohistochemistry;the expression of CD16 and CD206 proteins was detected by immunofluorescence staining;the expression of autoph-agy-related molecules(Beclin 1,LC3B)and Akt/mTOR pathway-related proteins in the spinal cord tissues was detected by Western blot.RESULTS Compared with the model group,the BBB score and angle of the inclined board test of rats in the medium-dose Wenshen Tongdu Recipe group were increased,and the disordered arrangement of spinal cord tissue,spinal cord vacuoles and inflam-matory infiltration were significantly improved,especially on the 14th day.Compared with the sham operation group,the expression levels of serum IL-1β and IL-6 in the model group increased(P<0.01),and the expression levels of IL-4 and IL-10 decreased(P<0.05,P<0.01);compared with the model group,the levels of IL-1β and IL-6 in the Wenshen Tongdu Recipe group were signifi-cantly decreased(P<0.01),and the levels of IL-4 and IL-10 were significantly increased(P<0.05,P<0.01);compared with the Wenshen Tongdu Recipe group,the serum IL-1β and IL-6 concentrations of mice in the 3BDO group increased(P<0.01),and the level of IL-10 decreased(P<0.05).Compared with the sham operation group,the M1/M2 ratio,P62 protein expression,p-Akt/Akt and p-mTOR/mTOR ratios in the spinal cord tissue of the rats in the model group were significantly increased(P<0.05,P<0.01),and the relative protein expression of Beclin1 was decreased(P<0.01);compared with the model group,the M1/M2 ratio,p-Akt/Akt and p-p70S6K/p70S6K ratios in the Wenshen Tongdu Recipe group were significantly decreased(P<0.01).Compared with the model group,the Beclin1 protein level in the 3BDO group was decreased,and the p-Akt/Akt and p-mTOR/mTOR ratios were increased(P<0.05,P<0.01).Compared with the Wenshen Tongdu Recipe group,the M1/M2 ratio in the 3BDO group and the 3BDO+Wen-shen Tongdu Recipe group increased(P<0.01),the positive rates of Beclin1 and LC3B proteins in the 3BDO group decreased signifi-cantly(P<0.01),and the p-p70S6K/p70S6K ratio in the 3BDO+Wenshen Tongdu Recipe group increased significantly(P<0.01).CONCLUSION Wenshen Tongdu Recipe may regulate microglial polarization through Akt/mTOR signaling pathway to acti-vate autophagy,promote the secretion of anti-inflammatory factors,reduce the release of pro-inflammatory factors,alleviate neuroin-flammatory response,and thus promote spinal cord injury repair.

Objective:To investigate the genetic characteristics of fetuses carrying a small supernumerary marker chromosome (sSMC) derived from chromosome 15.Methods:This was a retrospective study involving three fetuses who were diagnosed with microdeletions or microduplications by non-invasive prenatal testing (NIPT) and confirmed to carry sSMC derived from chromosome 15 through prenatal diagnosis at the Center of Prenatal Diagnosis, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University from June to October 2023. Clinical data, including NIPT results and ultrasound findings, were collected. Genetic tests for the fetuses and their parents were performed using genetic karyotype analysis, fluorescence in situ hybridization (FISH), and single nucleotide polymorphisms array (SNP-array). All data were analyzed using descriptive statistics. Results:(1) The mothers of the three fetuses were aged 36, 37, and 41 years, and all of them were multiparous with no family history of genetic disorders. The fetuses exhibited duplications of 8.80, 8.17, and 8.80 Mb in the 15q11.2q13.3 region, respectively. Amniotic fluid karyotyping revealed a 47,XN,+mar karyotype in all three cases. The abnormal sSMC contained two centromeres. One of them was pycnotic, deeply stained, but remained active, while the other was enlarged and formed a band, losing its activity. Both were pseudo-dicentric structures. (2) FISH was not performed on Fetus 1. FISH results for both Fetus 2 and Fetus 3 were ish idic(15)( D15Z1++, SNRPN++, PML-), indicating the presence of two copies of the D15Z1 and SNRPN probes on the sSMC, with no PML probe signal. The D15Z1 probe was located at both ends of the sSMC, while the SNRPN probe was near the center. (3) SNP-array results were arr[GRCh37] 15q11.2q13.2(22 770 422-31 098 691)×4 for Fetus 1, covering 29 OMIM genes including UBE3A and 38 protein-coding genes; arr[GRCh37] 15q11.2q13.3(22 770 422-32 915 723)×4 for Fetus 2, covering 36 OMIM genes including UBE3A and 50 protein-coding genes; and arr[GRCh37] 15q11.2q13.1 (22 770 422-28 560 664)×4 and arr[GRCh37] 15q13.1q13.3(29 009 041-32 444 043)×3 for Fetus 3, covering 24 OMIM genes including UBE3A and 20 protein-coding genes. Additionally, Fetus 3 had a 3.435 Mb duplication in 15q13.1q13.3, covering 11 OMIM genes including CHRNA7 and 20 protein-coding genes. (4) No significant abnormalities were found in the peripheral blood karyotyping for the parents of Fetus 1 or in the SNP-array analysis for the parents of Fetus 3. (5) All three families opted for pregnancy termination. There were no obvious abnormalities in the appearance of Fetus 1 and Fetus 3 after induction, while details of Fetus 2 were unavailable. Conclusion:The three fetuses carried a psu idic(15)(q13)-derived sSMC, leading to increased copy numbers in the 15q11q13 region.

OBJECTIVE To study the mechanism of Wenshen Tongdu Recipe in promoting the recovery of motor function in rats with spinal cord injury.METHODS A total of 144 SD rats were randomly divided into sham operation group,model group,predni-sone group,low-dose Wenshen Tongdu Recipe group,medium-dose Wenshen Tongdu Recipe group,high-dose Wenshen Tongdu Recipe group,3BDO group,and 3BDO+Wenshen Tongdu Recipe group(medium dose).The rat spinal cord injury model was estab-lished by modified Allen's method.Intervention began 1 day after modeling,and the drug was administered continuously for 14 days.During the drug administration period,the motor function of the rats in each group was evaluated by Basso-Beattie-Bresnahan(BBB)score and inclined plane test.On the 3rd,7th and 14th days after modeling,the pathological changes of the spinal cord tissues of the rats in each group were observed by HE staining;the expression levels of inflammatory factors IL-1β,IL-6,IL-4 and IL-10 in the serum of the rats in each group were detected by ELISA;the expression of Beclin 1,LC3B and p62 proteins was detected by immu-nohistochemistry;the expression of CD16 and CD206 proteins was detected by immunofluorescence staining;the expression of autoph-agy-related molecules(Beclin 1,LC3B)and Akt/mTOR pathway-related proteins in the spinal cord tissues was detected by Western blot.RESULTS Compared with the model group,the BBB score and angle of the inclined board test of rats in the medium-dose Wenshen Tongdu Recipe group were increased,and the disordered arrangement of spinal cord tissue,spinal cord vacuoles and inflam-matory infiltration were significantly improved,especially on the 14th day.Compared with the sham operation group,the expression levels of serum IL-1β and IL-6 in the model group increased(P<0.01),and the expression levels of IL-4 and IL-10 decreased(P<0.05,P<0.01);compared with the model group,the levels of IL-1β and IL-6 in the Wenshen Tongdu Recipe group were signifi-cantly decreased(P<0.01),and the levels of IL-4 and IL-10 were significantly increased(P<0.05,P<0.01);compared with the Wenshen Tongdu Recipe group,the serum IL-1β and IL-6 concentrations of mice in the 3BDO group increased(P<0.01),and the level of IL-10 decreased(P<0.05).Compared with the sham operation group,the M1/M2 ratio,P62 protein expression,p-Akt/Akt and p-mTOR/mTOR ratios in the spinal cord tissue of the rats in the model group were significantly increased(P<0.05,P<0.01),and the relative protein expression of Beclin1 was decreased(P<0.01);compared with the model group,the M1/M2 ratio,p-Akt/Akt and p-p70S6K/p70S6K ratios in the Wenshen Tongdu Recipe group were significantly decreased(P<0.01).Compared with the model group,the Beclin1 protein level in the 3BDO group was decreased,and the p-Akt/Akt and p-mTOR/mTOR ratios were increased(P<0.05,P<0.01).Compared with the Wenshen Tongdu Recipe group,the M1/M2 ratio in the 3BDO group and the 3BDO+Wen-shen Tongdu Recipe group increased(P<0.01),the positive rates of Beclin1 and LC3B proteins in the 3BDO group decreased signifi-cantly(P<0.01),and the p-p70S6K/p70S6K ratio in the 3BDO+Wenshen Tongdu Recipe group increased significantly(P<0.01).CONCLUSION Wenshen Tongdu Recipe may regulate microglial polarization through Akt/mTOR signaling pathway to acti-vate autophagy,promote the secretion of anti-inflammatory factors,reduce the release of pro-inflammatory factors,alleviate neuroin-flammatory response,and thus promote spinal cord injury repair.

Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

Objective:To investigate the genetic characteristics of fetuses carrying a small supernumerary marker chromosome (sSMC) derived from chromosome 15.Methods:This was a retrospective study involving three fetuses who were diagnosed with microdeletions or microduplications by non-invasive prenatal testing (NIPT) and confirmed to carry sSMC derived from chromosome 15 through prenatal diagnosis at the Center of Prenatal Diagnosis, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University from June to October 2023. Clinical data, including NIPT results and ultrasound findings, were collected. Genetic tests for the fetuses and their parents were performed using genetic karyotype analysis, fluorescence in situ hybridization (FISH), and single nucleotide polymorphisms array (SNP-array). All data were analyzed using descriptive statistics. Results:(1) The mothers of the three fetuses were aged 36, 37, and 41 years, and all of them were multiparous with no family history of genetic disorders. The fetuses exhibited duplications of 8.80, 8.17, and 8.80 Mb in the 15q11.2q13.3 region, respectively. Amniotic fluid karyotyping revealed a 47,XN,+mar karyotype in all three cases. The abnormal sSMC contained two centromeres. One of them was pycnotic, deeply stained, but remained active, while the other was enlarged and formed a band, losing its activity. Both were pseudo-dicentric structures. (2) FISH was not performed on Fetus 1. FISH results for both Fetus 2 and Fetus 3 were ish idic(15)( D15Z1++, SNRPN++, PML-), indicating the presence of two copies of the D15Z1 and SNRPN probes on the sSMC, with no PML probe signal. The D15Z1 probe was located at both ends of the sSMC, while the SNRPN probe was near the center. (3) SNP-array results were arr[GRCh37] 15q11.2q13.2(22 770 422-31 098 691)×4 for Fetus 1, covering 29 OMIM genes including UBE3A and 38 protein-coding genes; arr[GRCh37] 15q11.2q13.3(22 770 422-32 915 723)×4 for Fetus 2, covering 36 OMIM genes including UBE3A and 50 protein-coding genes; and arr[GRCh37] 15q11.2q13.1 (22 770 422-28 560 664)×4 and arr[GRCh37] 15q13.1q13.3(29 009 041-32 444 043)×3 for Fetus 3, covering 24 OMIM genes including UBE3A and 20 protein-coding genes. Additionally, Fetus 3 had a 3.435 Mb duplication in 15q13.1q13.3, covering 11 OMIM genes including CHRNA7 and 20 protein-coding genes. (4) No significant abnormalities were found in the peripheral blood karyotyping for the parents of Fetus 1 or in the SNP-array analysis for the parents of Fetus 3. (5) All three families opted for pregnancy termination. There were no obvious abnormalities in the appearance of Fetus 1 and Fetus 3 after induction, while details of Fetus 2 were unavailable. Conclusion:The three fetuses carried a psu idic(15)(q13)-derived sSMC, leading to increased copy numbers in the 15q11q13 region.

Patients with diabetic retinopathy often experience diabetes distress when facing the challenges of the disease, which has adverse effects on their health outcomes. This paper summarizes the current situation of diabetes distress in patients with diabetic retinopathy, and the assessment tools, influencing factors, and intervention measures, aiming to provide a reference for healthcare professionals to conduct intervention studies.

Objective This study proposes a chairside digital design and manufacturing method for band and loop space maintainers and preliminarily validates its clinical feasibility.Methods Clinical cases of 10 children requiring space maintenance caused by premature loss of primary teeth were collected.Intraoral scan data of the affected children were also collected to establish digital models of the missing teeth.Using a pediatric band and loop space maintainer de-sign software developed by our research team,a rapid personalized design of band and loop structures was achieved,and a digital model of an integrated band and loop space maintainer was ultimately generated.A chairside space maintainer was manufactured through metal computer numerical control machining for the experimental group,whereas metal 3D printing in the dental laboratory was used for the control group.A model fitting assessment was conducted for the space maintainers of both groups,and senior pediatric dental experts were invited to evaluate the clinical feasibility of the space maintainers with regard to fit and stability using the visual analogue scale scoring system.Statistical analysis was also performed.Results The time spent in designing and manufacturing the 10 space maintainers of the experimental group was all less than 1 h.Statistical analysis of expert ratings showed that the experimental group outperformed the control group with regard to fit and stability.Both types of space maintainers met clinical requirements.Conclusion The chairside digital design and manufacturing method for pediatric band and loop space maintainers proposed in this study can achieve same-day fitting of space maintainers at the first appointment,demonstrating good clinical feasibility and significant potential for clinical application.

Pediatric dentistry treats patients aged 0-18 years, encompassing the characteristics of general dentistry. The clinical techniques are closely related to restorative dentistry, endodontics, orthodontics, and maxillofacial surgery, while also possessing unique aspects. It particularly focuses on the growth and development patterns of children′s dentition and maxillofacial structures. Currently, digital technology has deeply integrated with various clinical disciplines of dentistry, and pediatric dentistry has made significant progress with pediatric-specific digital applications. On one hand, the introduction of mature digital technologies is enabling the digital transformation of pediatric dental treatment models; on the other hand, there is innovative development of new digital technologies tailored to the specific needs of pediatric dental care, filling gaps in the field. Based on years of research in digital technology for pediatric dentistry, our team details the current innovative applications and scientific explorations in this area from these two perspectives. Additionally, we anticipate the potential expansion of digital technologies not yet applied in pediatric dentistry, providing a reference for clinical scholars in the field to conduct exploratory research.

Objective:To analyze the incidence and risk factors of non-acute symptomatic portal vein thrombosis (PVT) after endoscopic gastric variceal injection (GVI) in the treatment of liver cirrhosis with gastric variceal bleeding (GVB).Methods:66 patients with GVB who were treated with GVI for the first time from July 2017 to October 2019 in Minhang Hospital Affiliated to Fudan University were retrospectively analyzed. The data of gender, age, preoperative Child-Pugh grade, preoperative platelet count, preoperative plasma D-dimer concentration, preoperative splenic length, preoperative portal vein velocity, preoperative splenic vein velocity, preoperative portal vein diameter, preoperative splenic vein diameter, treatment times, total number of injection points, total dose of sclerosing agent and tissue adhesive agent were collected. The patients were divided into PVT group and non-PVT group according to the occurrence of non-acute symptomatic PVT within one year after GVI. Univariate analysis was performed first, and then the factors with P<0.2 were included in the binary logistic regression model to screen the risk factors of PVT after GVI. Results:There were 25 cases (37.88%) in PVT group and 41 cases (62.12%) in non-PVT group. There were significant differences in D-dimer concentration, spleen length, Child-Pugh grade and total dose of sclerosing agent between the two groups ( P<0.05). The D-dimer concentration ( OR=2.319, 95% CI:1.359-3.956), spleen length ( OR=1.044, 95% CI:1.007-1.081) and total dose of sclerosing agent ( OR=1.075, 95% CI:1.004-1.152) were independent risk factors for PVT ( P<0.05). Conclusions:Preoperative D-dimer concentration, spleen length and total dose of sclerosing agent can predict the risk of PVT after GVI. In order to reduce the risk of PVT after GVI, the dose of sclerosing agent should be reduced as much as possible.