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 epidemiological characteristics and influencing factors of Femoral Artery Compression-Related Skin Complications Around the Puncture Site(FACR-SCAPS)in patients with primary hepatocellular carcinoma(HCC)undergoing transarterial chemoembolization(TACE).Methods A multicenter cross-sectional study was conducted using convenience sampling.A total of 1 573 HCC patients who underwent TACE between April 2023 and October 2024 were recruited from interventional radiology departments,oncology units,and specialized centers across 10 hospitals in Beijing,Tianjin,Shandong,Hebei,Qinghai,and Inner Mongolia.Descriptive statistics,univariate analysis,and multivariate logistic regression were used to explore the epidemiological characteristics and influencing factors of FACR-SCAPS in this population.Results Among the 1 573 primary HCC patients undergoing TACE interventional therapy,FACR-SCAPS occurred in 28.99％(456/1 573),with a total of 476 complication instances recorded(30.26 per 100 patients).Patients with a single complication accounted for 96.93％,whereas those with multiple complications constituted 3.07％.The most prevalent types of complications were skin erythema,skin ecchymosis,and hard lumps formation,collectively accounting for 96.49％of all complications.Hematoma,blisters,and rupture complications collectively accounted for only 4.61％.Logistic regression analysis revealed that peak diastolic blood pressure during compression(OR=1.024,95％CI:1.013-1.035,P＜0.001),use of rotary compression hemostasis devices(OR=3.220,95％CI:2.120-4.891,P＜0.001),elevated PT-INR(OR=19.630,95％CI:6.039-63.810,P＜0.001),and anticoagulant use within the last three months(OR=1.909,95％CI:1.064-3.427,P=0.030)were significant influencing factors associated with FACR-SCAPS post-TACE.Conclusion FACR-SCAPS is commonly seen among primary HCC patients after TACE,its risk factors include peak diastolic blood pressure during compression,use of rotary compression devices,elevated PT-INR,and recent anticoagulant use.

Objective To investigate the effects of microgravity environment on hibernating myoblasts.Methods Hibernating myoblasts were cultured under real and simulated microgravity conditions for 10 days.RNA-seq analysis and immunofluorescence are used to analysis the impact of microgravity environment on cell growth and gene expression of myoblasts.Results Under the microgravity conditions,genes associated with proliferation were upregulated.Under simulated microgravity,there were more and higher proportion of Ki67 positive cells compared to normal gravity conditions.Conclusion The microgravity environment promotes the proliferation of hibernating myoblasts.

Objective:To compare the clinical outcomes of a double purse-string and bridging technique versus duct-to-mucosal pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods:The clinical data of patients who underwent laparoscopic pancreaticoduodenectomy using the double purse-string and bridging pancreaticojejunostomy technique versus those who underwent duct-to-mucosa pancreaticojejunostomy at the Affiliated Jinhua Hospital of Zhejiang University School of Medicine from January 2016 to August 2021 were retrospectively analyzed. Of the 93 patients who underwent laparoscopic pancreaticoduodenectomy, there were 48 males and 45 females, with age of (62±10) years old. These patients were divided into two groups: patients who underwent double purse-string and bridging pancreaticojejunostomy (the double purse-string group, n=51), and patients who underwent duct-to-mucosa pancreaticojejunostomy (the duct-to-mucosa group, n=42). The clinical data of the two groups were compared. Results:All the 93 patients underwent laparoscopic pancreaticoduodenectomy successfully, and there were no deaths within 3 months of operation. Compared with the duct-to-mucosa group, the double purse-string group had significantly shorter time of pancreaticojejunal anastomosis [(32.41±8.75) vs. (47.62±8.90) min] and time of operation [(365.75±43.74) vs. (389.07±45.31) min] (all P<0.05). The postoperative pancreatic fistula rates were 9.8% (5/51) in the double purse-string group and 7.1% (3/42) in the duct-to-mucosa group. There was no significant difference between the two groups ( P>0.05). In the double purse-string group, there were 18 patients with a pancreatic duct diameter >3 mm, and 3 of these patients developed grade B pancreatic fistula, giving a grade B pancreatic fistula rate of 16.6% (3/18). In the duct-to-mucosa group, there were 11 patients with a pancreatic duct diameter >3 mm, and no patients developed grade B pancreatic fistula, giving a pancreatic fistula rate of 0(0/11). Conclusion:Compared with the duct-to-mucosa anastomosis, the double purse string and bridging pancreaticojejunostomy was technically simpler. It shortened the time of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, especially for patients with a non-dilated pancreatic duct.

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
Consensus ; Humans ; Oral Ulcer/therapy*

Objective:To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation.Methods:A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups ( t=1.327, 0.157, 0.542; P>0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results:Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant ( t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P<0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant ( t=3.424, 4.516; P<0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region ( r=0.314, P<0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region ( r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P<0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions ( r=-0.138, -0.016, -0.221; P>0.05); CBP and IMH staging in other regions were significantly negatively correlated ( r=-0.560, -0.390,-0.819, -0.692, -0.329, -0.587; P<0.05). Conclusions:The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.

Objective To systematically summarize the effect of flipped classroom (FC) in physiotherapy teaching.Methods The following electronic bibliographic databases were searched from inception to June, 2021: CENTRAL, Medline, EMBASE, CINAHL plus, Academic Search Premier, Teacher Reference Center, ERIC, and Education Research. Original researches about FC for physiotherapy teaching were searched. The researches were screened, selected, extracted and assessed independently by two researchers, and, systematically reviewed.Results and Conclusion A total of 1 307 literatures were retrieved, and seven studies involving at least 770 student participants were finally included, which published mainly from 2013 to 2019. The subjects were students majored in physiotherapy, and the primary outcome index was exam results. FC teaching model generally can improve students' written test scores and enhance their high-level thinking ability. Students and teachers generally hold a positive attitude towards the FC teaching model.

Objective:To evaluate the effectiveness and safety of intravitreal injection of different doses of aflibercept for polypoidal choroidal vasculopathy (PCV) with serous pigment epithelial detachment (PED) resistant to ranibizumab.Methods:A non-randomized controlled clinical study was conducted.Seventy-three eyes of 73 patients with PCV and serous PED resistant to ranibizumab were enrolled at the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2020.All patients were treated by intravitreal injection of 2 mg or 4 mg aflibercept according to patients' willingness.2 mg aflibercept or 4 mg aflibercept was intravitreally injected monthly for three consecutive months following pro re nata (PRN) regimen in 2 mg aflibercept group (38 eyes) and 4 mg aflibercept group (35 eyes), respectively.PED height and central macular thickness (CMT) were measured by optical coherence tomography, and the best corrected visual acuity (BCVA) was examined with a visual acuity chart and converted to logarithm of the minimum angle of resolution (LogMAR) unit before injection and 1 month, 2, 3, 6 months from the first injection.Intraocular pressure and treatment-related adverse events were recorded.This study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2021-KY-1252).Written informed consent was obtained from each patient prior to entering study cohort.Results:Thirty-three patients (86.84%) in 2 mg aflibercept group and 30 patients (85.71%) in 4 mg aflibercept group finished the treatment and follow-up, respectively. The PED, BCVA and CMT before treatment and at the end of follow-up were (379.24±95.50) and (280.09±120.50)μm, 0.68±0.27 and 0.51±0.19, (393.96±100.81) and (291.70±44.09)μm in 2 mg aflibercept group, respectively, showing statistically significant differences (all at P<0.05).The PED, BCVA and CMT before treatment and at the end of follow-up were (393.07±93.76) and (278.63±145.07)μm, 0.66±0.31 and 0.48±0.22, (377.43±79.61) and (284.67±84.88)μm in 4 mg aflibercept group, respectively, with statistically significant differences (all at P<0.05).The CMT value in 4 mg aflibercept group was significantly lower than that in the 2 mg aflibercept group in one month after injection ( P<0.05).No severe ocular and systemic adverse events were found during the follow-up, such as retinal detachment, endophthalmitis, cataract, and persistent high intraocular pressure. Conclusions:Both 2 mg and 4 mg aflibercept can effectively treat ranibizumab-resistant PCV with serous PED, and improve the anatomical structure of retina and BCVA.4 mg aflibercept can accelerate the recovery of PED and CMT.

Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.