OBJECTIVES: Managing patients with refractory head and neck cancer pain is one of the more challenging issues in clinical practice, and traditional intrathecal drug delivery also fails to provide adequate analgesia. There are currently no comprehensive and effective treatment methods. This study aims to observe the efficacy and safety of treating intractable head and neck cancer pain with morphine pump via lumbar approach to the prepontine cistern. METHODS: A total of 18 patients with intractable head and neck cancer pain treated with prepontine cistern morphine pumps were selected from the Department of Pain Management, Second Xiangya Hospital, Central South University between September 2019 and July 2023. Statistical analysis was performed on patients' preoperative and postoperative (1 week, 1 month, and 2 months after surgery), Numerical Rating Scale (NRS) scores, Self-Rating Depression Scale (SDS) scores, daily oral morphine consumption, the number of daily breakthrough pain episodes, and postoperative daily intrathecal morphine dosage. RESULTS: The NRS scores, SDS scores, daily oral morphine consumption, and the number of daily breakthrough pain episodes of patients at each time point after surgery were significantly lower than before surgery (all P<0.05). With the gradual increase in the dosage of intrathecal morphine, the daily oral morphine consumption of patients at each postoperative time point was significantly reduced compared to preoperative levels (all P<0.05). The complications related to the operation were mild, including nausea in 5 cases (31.3%), headache in 2 cases (12.5%); hypotension, urine retention, hypersomnia and constipation in 1 case (6.3% each), and no serious adverse events occurred. All improved and were discharged after symptomatic treatment. CONCLUSIONS The implantation of prepontine cistern morphine pump effectively controls intractable head and neck cancer pain, demonstrating characteristics of minimal invasiveness, mild side effects, and low medication dosage under the premise of standardized procedures.
Humans ; Morphine/administration & dosage* ; Male ; Female ; Middle Aged ; Head and Neck Neoplasms/surgery* ; Analgesics, Opioid/administration & dosage* ; Cancer Pain/drug therapy* ; Pain, Intractable/etiology* ; Aged ; Adult ; Infusion Pumps, Implantable ; Pain Management/methods*

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.

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
Humans ; Consensus ; Orthodontics, Corrective/standards* ; Periodontal Diseases/complications* ; Tooth Movement Techniques/methods* ; Practice Guidelines as Topic

Objective:To explore the longitudinal predictive relationship between self-neglect and frailty among older adults.Methods:Data were drawn from the Chinese Longitudinal Healthy Longevity Survey conducted in 2011 (T1), 2014 (T2), and 2018 (T3). A total of 1 495 older adults aged≥65 years at T1 who participated in three consecutive surveys and had no missing key variables were included. General demographic information, self-neglect scores, and frailty status were extracted. Spearman correlation analysis was used to examine the association between self-neglect and frailty. Cross-lagged analysis was employed to investigate the potential causal relationship between the two variables.Results:The self-neglect scores for 1 495 older adults at T1, T2, and T3 were (2.84±1.39), (2.47±1.30), and (2.41±1.20), respectively, showing a declining trend. The frailty scores at T1, T2, and T3 were 0 (0, 1.00), 0 (0, 2.00), and 1.00 (0, 2.00), respectively, indicating an increasing trend. Cross-lagged analysis revealed that self-neglect at T1 positively predicted frailty at T2 (β=0.076, P=0.004). Frailty at both T1 and T2 positively predicted self-neglect at T2 (β=0.057, P=0.044) and T3 (β=0.058, P=0.029), respectively. Conclusions:Frailty among older adults positively predicts self-neglect, and self-neglect also has a certain predictive effect on frailty. Medical staff should strengthen early screening and intervention for frailty in older adults to delay the occurrence and progression of self-neglect.

Objective:To explore the longitudinal predictive relationship between self-neglect and frailty among older adults.Methods:Data were drawn from the Chinese Longitudinal Healthy Longevity Survey conducted in 2011 (T1), 2014 (T2), and 2018 (T3). A total of 1 495 older adults aged≥65 years at T1 who participated in three consecutive surveys and had no missing key variables were included. General demographic information, self-neglect scores, and frailty status were extracted. Spearman correlation analysis was used to examine the association between self-neglect and frailty. Cross-lagged analysis was employed to investigate the potential causal relationship between the two variables.Results:The self-neglect scores for 1 495 older adults at T1, T2, and T3 were (2.84±1.39), (2.47±1.30), and (2.41±1.20), respectively, showing a declining trend. The frailty scores at T1, T2, and T3 were 0 (0, 1.00), 0 (0, 2.00), and 1.00 (0, 2.00), respectively, indicating an increasing trend. Cross-lagged analysis revealed that self-neglect at T1 positively predicted frailty at T2 (β=0.076, P=0.004). Frailty at both T1 and T2 positively predicted self-neglect at T2 (β=0.057, P=0.044) and T3 (β=0.058, P=0.029), respectively. Conclusions:Frailty among older adults positively predicts self-neglect, and self-neglect also has a certain predictive effect on frailty. Medical staff should strengthen early screening and intervention for frailty in older adults to delay the occurrence and progression of self-neglect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective Explore a comprehensive and multi-level set of passive defensive medical governance strate-gies.Methods Literature related to passive defensive medical governance was retrieved,and the Ucinet social net-work analysis software was utilized to calculate indicators such as the frequency and centrality of passive defensive medical governance strategies,thereby understanding the importance of these strategies.Results The formed set of negative defensive medical governance strategies covers three levels social cogniton,institutional mechanisms and doctor-patient relationship.Among them,there are 5 governance strategies at the social cognition level,24 governance strategies at the institutional mechanism level,and 12 governance strategies at the doctor-patient rela-tionship level,totaling 41 governance strategies.Conclusion The constructed set of passive defensive medical governance strategies is scientific,practical,and comprehensive in content,providing a reference framework for medical institutions to govern passive defensive medical behaviors.

Objective To explore the effect of bionic electrical stimulation(BES)combined with resistance tightening leg training on postpartum pelvic floor dysfunction(PFD).Methods A total of 205 patients with PFD were divided into the BES group(n=102)and the combined group(n=103)by random number table method.All subjects received routine pelvic floor muscle training.In addition,the BES group was treated with BES intervention,and the combined group was treated with BES combined with resistance tightening leg training,with 8 weeks of treatment.The classification of pelvic floor muscle strength,electrophysiological indexes of pelvic floor function,urodynamics and stress urinary incontinence(SUI)classification/pelvic organ prolapse(POP)degree were compared between the two groups before and after treatment.Results After treatment,the pelvic floor muscle strength classification,SUI classification and POP degree in the combined group were significantly better than those in the BES group(P<0.05).After treatment,ClassⅠ/ClassⅡmuscle fiber fatigue,vaginal dynamic pressure and maximal electromyography(EMG)value of fast muscle in the combined group were(-1.20±0.35)%,(-0.90±0.30)%,(76.30±5.51)cmH2 O,(43.00±5.82)μV,respectively,which were all significantly higher than those in the BES group(P<0.05).After treatment,the indexes of urodynamics in both groups were significantly improved,and the combined group was better than the BES group(P<0.05).Conclusions BES combined with resistance tightening leg training can significantly improve pelvic floor muscle strength,muscle fiber fatigue and urodynamics in patients with PFD,thus alleviating SUI/POP symptoms.

Objective To explore the effect of bionic electrical stimulation(BES)combined with resistance tightening leg training on postpartum pelvic floor dysfunction(PFD).Methods A total of 205 patients with PFD were divided into the BES group(n=102)and the combined group(n=103)by random number table method.All subjects received routine pelvic floor muscle training.In addition,the BES group was treated with BES intervention,and the combined group was treated with BES combined with resistance tightening leg training,with 8 weeks of treatment.The classification of pelvic floor muscle strength,electrophysiological indexes of pelvic floor function,urodynamics and stress urinary incontinence(SUI)classification/pelvic organ prolapse(POP)degree were compared between the two groups before and after treatment.Results After treatment,the pelvic floor muscle strength classification,SUI classification and POP degree in the combined group were significantly better than those in the BES group(P<0.05).After treatment,ClassⅠ/ClassⅡmuscle fiber fatigue,vaginal dynamic pressure and maximal electromyography(EMG)value of fast muscle in the combined group were(-1.20±0.35)%,(-0.90±0.30)%,(76.30±5.51)cmH2 O,(43.00±5.82)μV,respectively,which were all significantly higher than those in the BES group(P<0.05).After treatment,the indexes of urodynamics in both groups were significantly improved,and the combined group was better than the BES group(P<0.05).Conclusions BES combined with resistance tightening leg training can significantly improve pelvic floor muscle strength,muscle fiber fatigue and urodynamics in patients with PFD,thus alleviating SUI/POP symptoms.

Objective Explore a comprehensive and multi-level set of passive defensive medical governance strate-gies.Methods Literature related to passive defensive medical governance was retrieved,and the Ucinet social net-work analysis software was utilized to calculate indicators such as the frequency and centrality of passive defensive medical governance strategies,thereby understanding the importance of these strategies.Results The formed set of negative defensive medical governance strategies covers three levels social cogniton,institutional mechanisms and doctor-patient relationship.Among them,there are 5 governance strategies at the social cognition level,24 governance strategies at the institutional mechanism level,and 12 governance strategies at the doctor-patient rela-tionship level,totaling 41 governance strategies.Conclusion The constructed set of passive defensive medical governance strategies is scientific,practical,and comprehensive in content,providing a reference framework for medical institutions to govern passive defensive medical behaviors.