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*

In recent years, the prevalence of obstructive coronary artery disease has continued to rise. Despite the widespread application of strategies such as intensive pharmacotherapy, coronary artery bypass grafting, or percutaneous coronary intervention, a subset of patients still experience recurrent angina symptoms, which severely impacts their quality of life. For such cases of refractory angina (RA), researchers domestically and internationally have explored therapeutic approaches such as spinal cord stimulation, transmyocardial laser revascularization, and sympathectomy. However, existing studies are largely limited to small-scale clinical trials, and their clinical translation still faces challenges due to insufficient validation of safety and efficacy. Injectable hydrogels, as functional materials with hydrophilic three-dimensional network structures, demonstrate unique advantages in the treatment of RA. They can not only provide mechanical support but also serve as controlled-release carriers for drugs and proteins, and synergize with gene therapy and stem cell therapy to promotemyocardial tissue repair. This article systematically reviews the application prospects of injectable hydrogels in the treatment of RA, aiming to provide insights for future therapeutic strategies.

Type 2 diabetes (T2D) is an independent risk factor for cognitive impairment. The dysregulation of hypoxia inducible factor (HIF) signaling in T2D patients results in impaired adaptive responses to hypoxia, thereby accelerating the progression of complications. However, limited knowledge is available regarding its precise function in diabetes-associated cognitive impairment (DACI). Here, elevated HIF-1α levels were observed in brain endothelial cells (ECs) of db/db mice. Functionally, brain ECs-specific knockdown of H if1 a significantly ameliorated T2D-induced memory loss and neuronal damage. Glycolysis in brain ECs was inhibited in this process, as indicated by RNA-seq, leading to decreased hippocampal lactate production through reduced LDHA expression. Notably, T2D patients showed increased cerebrospinal fluid lactate levels, which were strongly associated with their cognitive dysfunction. Intrahippocampal injection of lactate accelerated cognitive dysfunction and impaired adult hippocampal neurogenesis (AHN) in db/db mice. Conversely, reducing hippocampal lactate levels through the intrahippocampal injection of oxamate delayed the onset of memory deficits. Furthermore, asiatic acid was discovered to protect db/db mice from cognitive impairment by decreasing brain endothelial HIF-1α expression and subsequently reducing hippocampal lactate-induced AHN damage. Overall, this study elucidates the inhibiting role played by endothelial HIF-1α-driven lactate in AHN and highlights a potential tactic of targeting HIF-1α in brain ECs for treating cognitive impairment.

Retinopathy of prematurity (ROP) is a vision-threatening disorder that leads to pathological growth of the retinal vasculature due to hypoxia. Here, we investigated the potential effects of alamandine, a novel heptapeptide in the renin-angiotensin system (RAS), on hypoxia-induced retinal neovascularization and its underlying mechanisms. In vivo, the C57BL/6J mice with oxygen-induced retinopathy (OIR) were injected intravitreally with alamandine (1.0 μmol/kg per eye). In vitro, human retinal microvascular endothelial cells (HRMECs) were utilized to investigate the effects of alamandine (10 μg/mL) on proliferation, apoptosis, migration, and tubular formation under vascular endothelial growth factor (VEGF) stimulation. Single-cell RNA sequencing (scRNA-seq) matrix data from the Gene Expression Omnibus (GEO) database and RAS-related genes from the Molecular Signatures Database (MSigDB) were sourced for subsequent analyses. By integrating scRNA-seq data across multiple species, we identified that RAS-associated endothelial cell populations were highly related to retinal neovascularization. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis revealed a significant decrease in alamandine levels in both the serum and retina of OIR mice compared to those in the control group. Next, alamandine ameliorated hypoxia-induced retinal pathological neovascularization and physiologic revascularization in OIR mice. In vitro, alamandine effectively mitigated VEGF-induced proliferation, scratch wound healing, and tube formation of HRMECs primarily by inhibiting the hypoxia-inducible factor-1α (HIF-1α)/VEGF pathway. Further, coincubation with D-Pro⁷ (Mas-related G protein-coupled receptor D (MrgD) antagonist) hindered the beneficial impacts of alamandine on hypoxia-induced pathological angiogenesis both in vivo and in vitro. Our findings suggested that alamandine could mitigate retinal neovascularization by targeting the MrgD-mediated HIF-1α/VEGF pathway, providing a potential therapeutic agent for OIR prevention and treatment.
Animals ; Retinal Neovascularization/prevention & control* ; Mice, Inbred C57BL ; Vascular Endothelial Growth Factor A/metabolism* ; Humans ; Mice ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism* ; Oligopeptides/therapeutic use* ; Signal Transduction/drug effects* ; Cell Proliferation/drug effects* ; Endothelial Cells/drug effects* ; Retinopathy of Prematurity/drug therapy* ; Apoptosis/drug effects* ; Cell Movement/drug effects* ; Renin-Angiotensin System/drug effects* ; Cells, Cultured

Background:Ribosomal protein L22-like 1(RPL22L1)exerts regulatory effects on various malignant tumors such as lung cancer,prostate cancer,and cervical cancer.However,its role in colorectal cancer(CRC)remains unclear.Aims:To investigate the expression of RPL22L1 in CRC and its role in patients' prognosis and glucose metabolism of tumor cells.Methods:A total of 142 newly diagnosed CRC patients admitted to the Taizhou First People's Hospital from February 2022 to June 2024 were enrolled.The expression levels of RPL22L1 mRNA and protein were detected by quantitative real-time PCR and immunohistochemistry,respectively.The correlation between RPL22L1 expression and clinicopathological characteristics was analyzed.Kaplan-Meier survival analysis was used to evaluate the impact of RPL22L1 expression on the prognosis of CRC patients.RPL22L1 siRNA was transfected into SW480 cells to establish a low-expression cell model.Cell proliferation was assessed by CCK-8 assay,cell migration by Transwell chamber assay,and apoptosis by flow cytometry.Gene set enrichment analysis(GSEA)was performed to evaluate the effect of RPL22L1 on glucose metabolism of tumor cells.Results:The expression levels of RPL22L1 mRNA and protein were significantly higher in CRC tissues than in adjacent normal tissues(all P<0.05).The expression level of RPL22L1 mRNA was correlated with the TNM stage and carcinoembryonic antigen level of CRC(all P<0.05).Kaplan-Meier analysis showed that the cumulative survival rate of high RPL22L1 mRNA expression group was significantly lower than that of low-expression group(P=0.027).The expression level of RPL22L1 mRNA was significantly higher in SW480 cells than in normal intestinal epithelial cells(P<0.001).After inhibiting RPL22L1 expression,the proliferation and migration capacities of SW480 cells were significantly decreased(all P<0.05),the apoptosis rate was significantly increased(P=0.005),and the lactate level and relative glucose uptake level were significantly reduced(all P<0.05).GSEA indicated that RPL22L1 gene was associated with glycolysis/gluconeo-genesis(P=0.02).Conclusions:RPL22L1 is highly expressed in CRC and is associated with poor prognosis of patients,suggesting its potential as a molecular target for CRC therapy.Furthermore,RPL22L1 may promote the tumorigenesis and progression of CRC by modulating glucose metabolism.

Objective:To explore the impact of age on the genetic variant spectrum and prognosis of patients with previously untreated Diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective analysis was conducted on the clinical data and follow-up information of 254 previously untreated DLBCL patients from 14 hospitals in the Jiangsu Cooperative Lymphoma Group (JCLG) enrolled from July 2018 and July 2023. Following extraction of DNA from tumor tissue samples, next-generation sequencing (NGS) technique was employed to analyze the genetic variant spectrum of the DLBCL patients, with an evaluation of the relationship between age and genetic variants as well as prognosis. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Nantong University (Ethics No.: 2023-K048-01).Results:The median age of the 254 DLBCL patients was 62 years old, with 55% of patients aged 60 years or above. Clinical evaluation showed that younger (< 60 years) patients had higher complete response (CR) (70% vs. 59%), and objective response rate (ORR) (88% vs. 79%) than older patients, though the difference between the two groups was not statistically. Survival analysis indicated that both the five-year overall survival (OS) (82.7% vs. 71.7%, P=0.006) and progression-free survival (PFS) (70.6% vs. 50.2%, P<0.05) rates were significantly higher in younger patients. NGS showed that 99.6% of the patients harbored genetic variants, with PIM1, KMT2D, TP53, MYD88, and CD79B being the most common genes. Age significantly affected the variant frequency of certain genes, with MYC variants serving an adverse prognostic factor for OS in younger patients ( P=0.001), while TP53 ( P=0.024) and BCL2 ( P=0.002) variants significantly impacted OS in older patients. Prognostic analysis identified age ≥ 60 years ( HR=3.439, 95% CI=1.318~9.874), presence of B symptoms ( HR = 2.871, 95% CI=1.133~7.307), and elevated lactate dehydrogenase ( HR=3.528, 95% CI=1.231~10.66) as independent adverse prognostic factors. Conclusion:Age, genetic variants, and clinical factors may significantly affect the prognosis of the DLBCL patients. Younger patients have better survival compared to older patients. Variants of the MYC, BCL2, and TP53 genes are closely associated with poor prognosis.

This case report describes details in treatment of a patient with a severed right upper arm and admitted to the Department of Microsurgery, Sichuan Modern Hospital in September 2024. The injury was caused by a piece of red-hot steel. In emergency surgery, the severed right upper arm was temporarily ectopically fostered in left distal leg. After 27 days of ectopic fostering, a stage-Ⅱ replantation surgery was performed to replant the ectopically fostered limb. A free anterolateral thigh perforator flap (ALTPF) was used to reconstruct the soft tissue defect on right arm after replantation. At 3 months of postoperative follow-up, the flap covering the right upper arm were soft in texture, without a sign of ulceration. Sensation was rated at S 2 on palmar side of first to third digits and as S 1 on palmar sides of fourth to fifth digits and dorsal sides of first to fifth digits. The active movement of the right wrist joint and the joints of the first to fifth fingers was not possible. The wrist joint was passively extended from 0° to 5°, passively flexed from 0° to 20°, the thumb had a passive total range of motion of 45°, the second to fourth fingers had a passive total range of motion of 70°, and the little finger had a passive total range of motion of 45°.

In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective:To evaluate the clinical efficacy of a replay propeller distal perforator flap of the lateral circumflex femoral artery in reconstruction of the donor site defect left by the harvest of a free anterolateral thigh perforator flap (ALTPF).Methods:From June 2023 to June 2024, retrospective analysis of 11 patients with foot and ankle soft tissue defects were treated in the Department of Microsurgery, Sichuan Modern Hospital. The patients were 7 males and 4 females, aged 9-57 (average 28.6) years. Causes of injury were car accident (5 patients), machine crush (5 patients) and skin necrosis following a fall (1 patient). The size of soft tissue defects was 8.0 cm ×11.0 cm - 9.0 cm×14.5 cm. A reversed perforator island flap of distal descending branch of the lateral circumflex femoral artery was prepared to reconstruct the defect left at the donor site after the harvest of a free ALTPF. The ALTPFs were 8.5 cm × 11.5 cm to 9.5 cm × 15.5 cm in size, and the sizes of the perforator flap of descending branch of lateral circumflex femoral artery designed to reconstruct the donor site defects were at 5.0 cm × 9.0 cm to 6.0 cm × 12.0 cm. After the surgery, scheduled follow-ups were carried out at outpatient clinic and via telephone and WeChat reviews. Wound healing at recipient and donor sites, flap survival and functional recovery were observed.Results:All flaps survived smoothly after surgery, and the wounds in the donor and recipient sites healed primarily. No vascular compromise, wound dehiscence or significant swelling occurred. A total of 9 patients completed the 6-18 months postoperative follow-up, with an average of 11 months. Two patients lost in the follow-up. Only linear scars left in the donor sites, without significant impact on the thigh function. The colour and appearance of the flaps were natural.Conclusion:It is effective to use a distal replay flap of the descending branch of lateral circumflex femoral artery for reconstruction of the donor site defect left by the harvest of a free ALTPF.

Objective:The performance of GeneXpert MTB/RIF (Xpert), DNA isothermal amplification fluorescence assay (DNA isothermal amplification) and RNA simultaneous amplification and testing (SAT-TB) were evaluated by detecting Mycobacterium tuberculosis in the pus samples of superficial tuberculous lymphadenitis and skeletal tuberculosis, two common extrapulmonary tuberculosis. Methods:Cross-sectional study. A total of 242 patients with suspected superficial tuberculous lymphadenitis and skeletal tuberculosis admitted to Shaanxi Provincial Tuberculosis Prevention and Control Hospital were collected from January 2022 to December 2023 and pus samples were taken from the lesions for examination. Among them, 210 patients were laboratory confirmed or clinically diagnosed with tuberculosis, 108 patients with superficial tuberculous lymphadenitis and 102 patients with skeletal tuberculosis. 32 patients without tuberculosis. Mycobacterium Tuberculosis culture, Xpert, DNA isothermal amplification, and SAT-TB detection were performed on the pus samples of all patients. The detection results were statistically analyzed using SPSS26.0 and MedCalc software. The detection effectiveness of several different detection methods for Mycobacterium tuberculosis in pus samples was compared, and P<0.05 was considered statistically significan. Results:The sensitivity of Mycobacterium Tuberculosis culture, Xpert, DNA isothermal amplification and SAT-TB in TB patients were 25.2% (53/210), 88.6% (186/210), 81.9% (172/210) and 61.0% (128/210), respectively. The area under curve (AUC) values of the four detection methods in the diagnosis of tuberculosis were 0.626, 0.943, 0.910 and 0.805, respectively. The AUC value of tuberculosis culture in the diagnosis of tuberculosis was significantly lower than that of the three molecular diagnostic techniques ( P<0.05). The AUC value of DNA isothermal amplification was significantly higher than that of SAT-TB detection method ( P<0.05). The positive tuberculosis culture was used as a reference standard where the sensitivity of Xpert, DNA isothermal amplification and SAT-TB reached 96.2%(51/53), 90.6%(48/53) and 86.8%(46/53), respectively. There was no significant difference in sensitivity among the three molecular diagnostic techniques ( P>0.05). In Xpert MTB positive patients, the positive rate of DNA isothermal amplification was 90.3% (168/186), and there was good consistency between DNA isothermal amplification and Xpert MTB detection results ( Kappa=0.765, P<0.001). Xpert detected 27 cases of rifampicin resistance, the resistance rate was 12.9% (27/210). Conclusion:GeneXpert and DNA isothermal amplification have high sensitivity and specificity in the samples of extrapulmonary tuberculosis pus, and the results of DNA isothermal amplification and GeneXpert MTB/RIF detection are highly consistent. In tuberculosis screening, DNA isothermal amplification fluorescence detection can be used for preliminary screening to reduce the detection cost.