Oral submucous fibrosis (OSF), characterized by excessive deposition of extracellular matrix (ECM) that causes oral mucosal tissue sclerosis, and even cancer transformation, is a chronic, progressive fibrosis disease. However, despite some advancements in recent years, no targeted antifibrotic strategies for OSF have been approved; likely because the complicated mechanisms that initiate and drive fibrosis remain to be determined. In this review, we briefly introduce the epidemiology and etiology of OSF. Then, we highlight how cell-intrinsic changes in significant structural cells can drive fibrotic response by regulating biological behaviors, secretion function, and activation of ECM-producing myofibroblasts. In addition, we also discuss the role of innate and adaptive immune cells and how they contribute to the pathogenesis of OSF. Finally, we summarize strategies to interrupt key mechanisms that cause OSF, including modulation of the ECM, inhibition of inflammation, improvement of vascular disturbance. This review will provide potential routes for developing novel anti-OSF therapeutics.
Humans ; Oral Submucous Fibrosis/immunology* ; Extracellular Matrix/metabolism* ; Myofibroblasts

Objective To observe the efficacy of modified endoscopic sinus surgery(ESS)in treatment of chronic rhinosinusitis with nasal polyps(CRSwNP)complicated by allergic rhinitis(AR).Methods Forty patients with CRSwNP and perennial AR who were scheduled for ESS were divided into study group and control group,with 20 cases in each group.The control group was treated with conventional ESS,while the study group underwent resection of a large part of the middle turbi-nate on the basis of ESS to enhance middle meatal drainage.The postoperative mucosal outcomes,complications,as well as the Visual Analog Scale(VAS),sino-nasal outcome test-20(SNOT-20),and nasal endoscopic Lund-Kennedy scores before surgery,at 3 months after surgery,and at 1 year af-ter surgery were compared between the two groups.Results In the control group,there were 3 cases of local adhesion between the displaced middle turbinate and the lateral nasal wall at 3 months after surgery,and 10 cases of middle turbinate edema at 1 year after surgery,including 4 cases with local polypoid changes in the middle turbinate and polypoid hyperplasia in the ethmoid sinus and frontal re-cess regions.No complications were observed in the study group,and the epithelialization of the surgical area was good.Moreover,the nasal congestion score,olfactory score,and Lund-Kennedy score at 1 year after surgery in the study group were lower than those in the control group,with statistically significant differences(P＜0.05).Conclusion Modified ESS can significantly improve nasal con-gestion and olfactory symptoms in patients with CRSwNP complicated by perennial AR and effective-ly enhance their quality of life.

Objective To develop and validate a risk prediction model for infiltration/extravasation in peripheral intravenous catheter therapy.Methods This retrospective study analyzed 942 patients who completed the Infiltration/Extravasation Risk Assessment Form between January and June 2023 at the First Affiliated Hospital of Army Medical University(including Departments of Neurology,Endocrinology,Gastroenterology and Hepatobiliary Surgery).Patients were allocated to a derivation cohort(n=628)and validation cohort(n=314)in a 2∶1 ratio based on catheterization chronology.The derivation cohort served for model development and internal validation,while the validation cohort underwent external validation.Logistic scoring method constructed the risk model,with Hosmer-Lemeshow(HL)test assessing goodness-of-fit and ROC curve evaluating predictive performance.Twenty-one potential risk factors were assessed,including age,gender,chronic diseases,clinician experience,treatment compliance,and total infusion volume.Results Infiltration/extravasation occurred in 48 cases(5.10%incidence:31 derivation/17 validation).Among 21 factors,15 showed significant association(P<0.05),with 6 independent predictors:junior high school education or below(OR=5.2),chronic disease history(OR=3.1),poor compliance(OR=2.8),lower extremity venipuncture(OR=4.1),total infusion≥1 000 mL(OR=3.5),and hyperosmotic/corrosive medications(OR=6.7).The final prediction model was:Y=2×(low education)+1×(chronic disease)+1×(poor compliance)+1×(lower extremity puncture)+1×(volume≥1 000 mL)+2×(corrosive agents).For the derivation cohort,AUC was 0.967(95%CI:0.936～0.998),specificity 0.911,sensitivity 0.935,with good calibration(χ2=4.135,P=0.845).Validation cohort showed AUC 0.939(0.853～1.000),specificity 0.919,sensitivity 0.941,and acceptable calibration(χ2=8.998,P=0.085).Conclusion This model demonstrates excellent discriminative ability and calibration,providing an effective tool for identifying high-risk patients and guiding targeted preventive strategies.

Objective:To establish a risk scoring system for moderate to severe spermatogenic dysfunction based on scrotal ultrasound parameters and machine learning, and to explore its value.Methods:A retrospective cohort analysis was conducted on 112 patients diagnosed with azoospermia, moderate to severe oligospermia, and asthenospermia in the Department of Reproductive Medicine at Binzhou Medical University Affiliated Hospital from June 2021 to December 2022. Scrotal ultrasound parameters of these patients were compared with those of 116 normal male patients who visited the same hospital during the same period for reproductive assistance. Models were constructed using Random Forest, Support Vector Machine, logistic Regression, K-nearest neighbor algorithm, and XGBoost. A risk scoring system was established based on the average SHapley Additive exPlanation values of each model. The predictive performance of the model was evaluated using the receiver operating characteristic curve, and the clinical application value of the model was evaluated using the decision curve analysis.Results:The scoring system included bilateral testicular total volume, whether the testicular echo was uniform, the inner diameter of the right spermatic vein, and the reflux time of varicocele. The area under the curve (AUC) of the risk scoring system for the training set was 0.757, and the AUC for the test set was 0.718. The decision curve showed that this scoring system had a high clinical value.Conclusion:A risk scoring system based on scrotal ultrasound parameters and machine learning can effectively predict moderate to severe spermatogenic dysfunction, which is of positive significance for early detection of such patients.

Objective:To explore the optimum opportunity for lumbodorsal muscles exercises of patients undergoing posterior lumbar decompression and instrumentation, and investigate its effect on the rehabilitation outcomes and kinesiophobia.Methods:A randomized controlled trial was used. By convenient sampling method, a total of 120 lumbar disc herniation patients were prospectively selected from Affiliated Nantong Hospital of Shanghai(Nantong Sixth People′s Hospital) from February 2020 to December 2021. The paitients were assigned to early group, middle group and late group, with 40 cases in each group. All patients were given routine postoperative care and lumbodorsal muscles exercises. The early group started to exercise 10th day after operation, the middle group started to exercise 3 weeks after operation, and the late group started to exercise 6 weeks after operation. The intervention effect was respectively evaluated by Japanese Orthopaedics Association (JOA) and Tampa Scale for Kinesiophobia (TSK).Results:There were 3, 1 and 1 missing cases in the early, middle and late group respectively, the age in the 3 groups were (56.05 ± 11.77), (57.33 ± 14.64) and (54.23 ± 15.73) years old in turn. Three months after exercising, the total score of JOA in the early, middle and late group were (25.32 ± 2.45), (24.44 ± 2.19) and (22.13 ± 1.58) in turn, the difference was significant ( F=23.64, P<0.05); the score of TSK in the early, middle and late group were (37.95 ± 6.81), (34.18 ± 6.39) and (33.33 ± 7.36) in turn, the difference was significant ( F=4.82, P<0.05). Conclusions:Lumbodorsal muscles exercises start at 3 weeks after operation can significantly improve the rehabilitation outcome of lumbar disc herniation patients undergoing posterior lumbar decompression and instrumentation, and will not increase the level of kinesiophobia, its can be consider as optimum opportunity for lumbodorsal muscles exercises.

OBJECTIVE To retrospectively summarize the CT and enhanced MRI imaging characteristics of common unilateral benign nasal and sinus lesions and to outline key points for differentiation from malignant lesions.METHODS A total of 134 cases of unilateral benign nasal and sinus lesions were included in this study,with preoperative sinus CT and enhanced MRI examinations performed.The imaging characteristics of CT and MRI,the extent of the lesions,and the involvement and destruction of surrounding bone and structures were recorded and summarized for each type of lesion.RESULTS Unilateral lesions on CT appeared as generally homogeneous soft tissue density shadows.The affected sinus bones showed internal calcification,localized bone hyperplasia of the sinus wall,extensive uniform centripetal bone hyperplasia and thickening of the sinus wall,expansive destruction of the sinus wall bone,and worm-eaten destruction of the sinus wall bone in 33,13,29,9,and 5 cases,respectively.On MRI T1WI,the lesions appeared as generally homogeneous isointense shadows.Enhanced T1 images showed mild,moderate,and significant enhancement in 3,10,and 108 cases,respectively,with 55 cases presenting as mixed signals.CONCLUSION The imaging manifestations of unilateral benign lesions vary.CT can clearly present high-density shadows such as calcifications within unilateral lesions and changes in surrounding bone.Enhanced MRI of the sinuses provides richer information about the different components within the lesions.Careful differentiation of unilateral lesions should be performed by combining the imaging characteristics of sinus CT and enhanced MRI.

Objective:To establish a risk scoring system for moderate to severe spermatogenic dysfunction based on scrotal ultrasound parameters and machine learning, and to explore its value.Methods:A retrospective cohort analysis was conducted on 112 patients diagnosed with azoospermia, moderate to severe oligospermia, and asthenospermia in the Department of Reproductive Medicine at Binzhou Medical University Affiliated Hospital from June 2021 to December 2022. Scrotal ultrasound parameters of these patients were compared with those of 116 normal male patients who visited the same hospital during the same period for reproductive assistance. Models were constructed using Random Forest, Support Vector Machine, logistic Regression, K-nearest neighbor algorithm, and XGBoost. A risk scoring system was established based on the average SHapley Additive exPlanation values of each model. The predictive performance of the model was evaluated using the receiver operating characteristic curve, and the clinical application value of the model was evaluated using the decision curve analysis.Results:The scoring system included bilateral testicular total volume, whether the testicular echo was uniform, the inner diameter of the right spermatic vein, and the reflux time of varicocele. The area under the curve (AUC) of the risk scoring system for the training set was 0.757, and the AUC for the test set was 0.718. The decision curve showed that this scoring system had a high clinical value.Conclusion:A risk scoring system based on scrotal ultrasound parameters and machine learning can effectively predict moderate to severe spermatogenic dysfunction, which is of positive significance for early detection of such patients.

Myocardial ischemia (MI) causes somatic referred pain and sympathetic hyperactivity, and the role of sensory inputs from referred areas in cardiac function and sympathetic hyperactivity remain unclear. Here, in a rat model, we showed that MI not only led to referred mechanical hypersensitivity on the forelimbs and upper back, but also elicited sympathetic sprouting in the skin of the referred area and C8-T6 dorsal root ganglia, and increased cardiac sympathetic tone, indicating sympathetic-sensory coupling. Moreover, intensifying referred hyperalgesic inputs with noxious mechanical, thermal, and electro-stimulation (ES) of the forearm augmented sympathetic hyperactivity and regulated cardiac function, whereas deafferentation of the left brachial plexus diminished sympathoexcitation. Intradermal injection of the α₂ adrenoceptor (α₂AR) antagonist yohimbine and agonist dexmedetomidine in the forearm attenuated the cardiac adjustment by ES. Overall, these findings suggest that sensory inputs from the referred pain area contribute to cardiac functional adjustment via peripheral α₂AR-mediated sympathetic-sensory coupling.
Animals ; Ganglia, Spinal ; Hyperalgesia/etiology* ; Myocardial Ischemia/complications* ; Pain, Referred/complications* ; Rats ; Sympathetic Nervous System

Cardiomyopathy, Dilated/metabolism* ; Humans ; Microfilament Proteins/metabolism* ; Models, Cardiovascular ; Mutation ; Myocytes, Cardiac ; Pluripotent Stem Cells/metabolism* ; Transcription Factors/metabolism* ; Troponin T/metabolism*