Liver cirrhosis is the end-stage of various chronic liver diseases， and hepatic fibrosis caused by persistent inflammation is the core mechanism of the development and progression of liver cirrhosis. With the evolution of disease spectrum and a deeper understanding of the reversal of hepatic fibrosis， dual antiviral-antifibrotic therapy initially applied in the treatment of hepatitis B cirrhosis has gradually evolved into a broad-sense dual therapy for liver cirrhosis， which integrates etiological treatment with antifibrotic and/or anti-inflammatory interventions. This article systematically reviews the conceptual evolution of dual therapy for liver cirrhosis and related research advances.

Pancreatic portal hypertension （PPH） is a type of regional portal hypertension secondary to pancreatic diseases and their complications. Unlike portal hypertension caused by liver cirrhosis， PPH is confined to the splenic venous system， and most patients tend to have normal liver function. Splenic vein obstruction and impaired blood return are the core mechanisms underlying the development of PPH， and isolated gastric fundal varices represent a characteristic manifestation of PPH. For patients with pancreatic diseases， it is necessary to establish early warning and risk stratification strategies， and high-quality studies are needed to further confirm the safety and efficacy of anticoagulation， surgical approaches， and interventional therapies in patients with PPH. This article systematically reviews the pathogenesis， etiological classification， clinical features， and key diagnostic points of PPH and discusses the current status of PPH treatment and existing challenges.

Objective:To explore the application value of selective transurethral plasma kinetic resection of the prostate (PKRP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of diabetes benign prostatic hyperplasia (BPH).Methods:A total of 114 patients with diabetes BPH diagnosed and treated in Lanxi People′s Hospital from September 2020 to September 2023 were retrospectively selected and divided into resection group and enunciation group according to the operation method, with 57 cases in each group. The resection group received selective PKRP and the enucleation group received HoLEP. Preoperative and postoperative stress response indexes were compared between the two groups, as well as urodynamics indexes and complications before and 3 months after surgery.Results:The quality of prostatectomy in the enucleation group was higher than that in the resection group : (39.68 ± 3.02) g vs. (30.25 ± 2.84) g; the operation time, intraoperative blood loss, bladder irrigation time and hospital stay in the enucleation group were lower than those in the resection group: (63.84 ± 5.44) min vs. (72.58 ± 11.33) min, (62.38 ± 15.84) ml vs. (89.54 ± 17.91) ml, (1.84 ± 0.71) d vs. (2.35 ± 0.80) d, (4.98 ± 1.16) d vs.(5.64 ± 1.05) d, there were statistical differences ( P<0.05). The levels of serum cortisol (COR) and norepinephrine (NE) in the enucleation group at 1, 3 d after surgery were lower than those in the excision group [1 d after surgery: (279.76 ± 17.82) ng/L vs. (289.51 ± 18.37) ng/L, (287.44 ± 26.51) ng/L vs. (300.47 ± 28.35) ng/L; 3 d after surgery: (236.58 ± 15.98) ng/L vs. (247.46 ± 16.47) ng/L, (269.13 ± 23.51) ng/L vs. (278.76 ± 25.62) ng/L, there were statistical differences ( P<0.05). Three months after surgery, the maximum urine flow rate in the enucleation group was higher than that in the excision group : (21.51 ± 3.82) ml/s vs. (18.74 ± 4.17) ml/s, and the residual urine volume (RUV) was lower than that in the excision group : (8.47 ± 3.06) ml vs. (10.25 ± 2.43) ml, there were statistical differences ( P<0.05). There was no significant difference in the incidence of urethral stricture and urinary incontinence between the two groups ( P>0.05). Conclusions:HoLEP for the treatment of diabetes BPH can reduce stress response, promote disease recovery, improve urodynamics, and has a safety comparable to that of selective PKRP.

Objective To study the effects from varying stenosis degrees of the mesencephalic aqueduct on intracranial cerebrospinal fluid(CSF)flow field.Methods Based on the clinical magnetic resonance image sequences of a male volunteer,a complete normal CSF circulation model was reconstructed by using semi-automated image segmentation technique.Subsequently,eight ideal models representing different stenosis degrees of the mesencephalic aqueduct were manually created.Computational fluid dynamics(CFD)was then performed to simulate the CSF flow field in the nine models.Results The stenosis degree of the mesencephalic aqueduct was positively correlated with the maximum pressure difference between the aqueduct upstream and downstream and the maximum velocity of CSF within the stenosed aqueduct.In the normal model,the maximum pressure difference was 0.84 Pa and the maximum velocity was 11.4 mm/s.While in the maximum stenosed model,the maximum pressure difference and velocity were 21.36 Pa and 60.3 mm/s,respectively.Compared to the normal model,the maximum pressure difference and velocity were approximately increased by 25 times and 5 times,respectively.Moreover,the maximum pressure difference was inversely proportional to the stenosis area square of the aqueduct,and there was a linear relationship between the pressure difference and the quadratic of the maximun CSF velocity.Conclusions The pressure difference and velocity of the stenosed mesencephalic aqueduct was not apparently increased with mild stenosis with respect to the normal aqueduct,while the great aqueductal stenosis increased the risk of hydrocephalus.This study provides a theoretical framework which contributes to understanding the development of obstructive hydrocephalus and intracranial hypertension.

Objective:To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies.Methods:This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed.Results:Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7–13).Conclusion:Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.

Objective:To explore the application value of selective transurethral plasma kinetic resection of the prostate (PKRP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of diabetes benign prostatic hyperplasia (BPH).Methods:A total of 114 patients with diabetes BPH diagnosed and treated in Lanxi People′s Hospital from September 2020 to September 2023 were retrospectively selected and divided into resection group and enunciation group according to the operation method, with 57 cases in each group. The resection group received selective PKRP and the enucleation group received HoLEP. Preoperative and postoperative stress response indexes were compared between the two groups, as well as urodynamics indexes and complications before and 3 months after surgery.Results:The quality of prostatectomy in the enucleation group was higher than that in the resection group : (39.68 ± 3.02) g vs. (30.25 ± 2.84) g; the operation time, intraoperative blood loss, bladder irrigation time and hospital stay in the enucleation group were lower than those in the resection group: (63.84 ± 5.44) min vs. (72.58 ± 11.33) min, (62.38 ± 15.84) ml vs. (89.54 ± 17.91) ml, (1.84 ± 0.71) d vs. (2.35 ± 0.80) d, (4.98 ± 1.16) d vs.(5.64 ± 1.05) d, there were statistical differences ( P<0.05). The levels of serum cortisol (COR) and norepinephrine (NE) in the enucleation group at 1, 3 d after surgery were lower than those in the excision group [1 d after surgery: (279.76 ± 17.82) ng/L vs. (289.51 ± 18.37) ng/L, (287.44 ± 26.51) ng/L vs. (300.47 ± 28.35) ng/L; 3 d after surgery: (236.58 ± 15.98) ng/L vs. (247.46 ± 16.47) ng/L, (269.13 ± 23.51) ng/L vs. (278.76 ± 25.62) ng/L, there were statistical differences ( P<0.05). Three months after surgery, the maximum urine flow rate in the enucleation group was higher than that in the excision group : (21.51 ± 3.82) ml/s vs. (18.74 ± 4.17) ml/s, and the residual urine volume (RUV) was lower than that in the excision group : (8.47 ± 3.06) ml vs. (10.25 ± 2.43) ml, there were statistical differences ( P<0.05). There was no significant difference in the incidence of urethral stricture and urinary incontinence between the two groups ( P>0.05). Conclusions:HoLEP for the treatment of diabetes BPH can reduce stress response, promote disease recovery, improve urodynamics, and has a safety comparable to that of selective PKRP.

Objective To evaluate the recognition capability of AI-enabled Cellsee CS-BM1 automatic cell morphology analyzer for pe-ripheral blood smears and its roles in assisting manual classification,and explore the application value of AI system in the diagnosis network of tiered primary medical units.Methods The blood samples which triggered the re-examination rules were collected from six primary medical units,including the Laboratory Department of Shanghai Jiahui International Hospital,and so on,from March to No-vember 2023.The smears of peripheral blood were prepared and AI analyzer was used for pre-classification to evaluate its recognition performance in identifying the samples with abnormal WBC and RBC.The sensitivity,specificity,and accuracy of WBC classification by six junior and intermediate technicians,both with and without AI assistance,were analyzed.Additionally,the roles of the AI system in tiered diagnosis of primary medical units were also evaluated.Results The sensitivity,specificity,and accuracy of AI system in recognizing malignant primitive cells were 92.86％,95.16％,and 95.10％,respectively.The sensitivities of AI system in recognizing immature granulocytes,reactive lymphocytes,and nucleated RBCs were all greater than 90％.The sensitivity of AI system in identif-ying abnormal morphology of RBCs reached 99.59％,along with rapid quantitative analysis for various anomalous types of RBCs.In AI-assisted mode,the sensitivity of recognition for all cell types was improved to varying degrees by junior and intermediate technicians,and the sensitivity for recognizing malignant primitive cells,reactive lymphocytes,and immature granulocytes increased to 58.24％,53.39％,and 62.37％for junior technicians,and to 92.06％,83.24％,and 83.12％for intermediate technicians,respectively.The improvements for junior technicians were particularly significant,with increases of 12.46％,10.61％,and 3.71％for each cell type,respectively.Both groups achieved higher specificity and accuracy.Through AI pre-classification and manual review,a variety of pe-ripheral blood cell-related diseases were accurately diagnosed in the tiered healthcare practice of primary medical units,including 339 cases(11.13％)of red blood cell diseases,5 cases(0.16％)of platelet diseases,2 343 cases(76.90％)of infection-related disea-ses,and 28 cases(0.92％)of malignant hematological diseases.In addition,332 cases(10.90％)which lacked an obvious related cause or required further examinations were identified as well.Conclusion AI pre-classification has demonstrated strong cell recogni-tion capabilities and may assist technicians in improving the sensitivity,specificity,and accuracy of blood cell classification.AI could en-hance the disease-screening capabilities in the tiered diagnosis network of primary medical units,presenting a broad application prospect.

Objective To evaluate the recognition capability of AI-enabled Cellsee CS-BM1 automatic cell morphology analyzer for pe-ripheral blood smears and its roles in assisting manual classification,and explore the application value of AI system in the diagnosis network of tiered primary medical units.Methods The blood samples which triggered the re-examination rules were collected from six primary medical units,including the Laboratory Department of Shanghai Jiahui International Hospital,and so on,from March to No-vember 2023.The smears of peripheral blood were prepared and AI analyzer was used for pre-classification to evaluate its recognition performance in identifying the samples with abnormal WBC and RBC.The sensitivity,specificity,and accuracy of WBC classification by six junior and intermediate technicians,both with and without AI assistance,were analyzed.Additionally,the roles of the AI system in tiered diagnosis of primary medical units were also evaluated.Results The sensitivity,specificity,and accuracy of AI system in recognizing malignant primitive cells were 92.86％,95.16％,and 95.10％,respectively.The sensitivities of AI system in recognizing immature granulocytes,reactive lymphocytes,and nucleated RBCs were all greater than 90％.The sensitivity of AI system in identif-ying abnormal morphology of RBCs reached 99.59％,along with rapid quantitative analysis for various anomalous types of RBCs.In AI-assisted mode,the sensitivity of recognition for all cell types was improved to varying degrees by junior and intermediate technicians,and the sensitivity for recognizing malignant primitive cells,reactive lymphocytes,and immature granulocytes increased to 58.24％,53.39％,and 62.37％for junior technicians,and to 92.06％,83.24％,and 83.12％for intermediate technicians,respectively.The improvements for junior technicians were particularly significant,with increases of 12.46％,10.61％,and 3.71％for each cell type,respectively.Both groups achieved higher specificity and accuracy.Through AI pre-classification and manual review,a variety of pe-ripheral blood cell-related diseases were accurately diagnosed in the tiered healthcare practice of primary medical units,including 339 cases(11.13％)of red blood cell diseases,5 cases(0.16％)of platelet diseases,2 343 cases(76.90％)of infection-related disea-ses,and 28 cases(0.92％)of malignant hematological diseases.In addition,332 cases(10.90％)which lacked an obvious related cause or required further examinations were identified as well.Conclusion AI pre-classification has demonstrated strong cell recogni-tion capabilities and may assist technicians in improving the sensitivity,specificity,and accuracy of blood cell classification.AI could en-hance the disease-screening capabilities in the tiered diagnosis network of primary medical units,presenting a broad application prospect.

Objective:To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies.Methods:This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed.Results:Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7–13).Conclusion:Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*