Psychotropic medication plays a crucial role in the field of mental illness,and the issues of drug efficacy and safety due to individual differences cannot be ignored.Genetic factors,especially the genetic poly-morphisms related to drug-metabolizing enzymes,drug action targets,and risk,have a significant impact on drug responses.Pharmacogenomics,by detecting genetic polymorphisms,can reveal a patient's inherited tend-encies towards drug efficacy,pharmacokinetic characteristics,and potential toxicity,thereby predicting the therapeutic effects and adverse reactions of drug treatment,and providing guidance for personalized therapy.Therefore,individualized medication based on pharmacogenomics helps to improve cure rates,reduce relapse rates,and decrease medical costs,which is of great significance to clinical medication in mental illness.

Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

BACKGROUND: The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined. METHODS: All CTO vessels treated with successful anatomical PCI in patients from PANDA III trial were retrospectively measured for post-PCI QFR. The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs, composite of target vessel-related cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization). Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs, and all vessels were stratified by this optimal cutoff value. Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI. RESULTS: Among 428 CTO vessels treated with PCI, 353 vessels (82.5%) were analyzable for post-PCI QFR. 31 VOCEs (8.7%) occurred at 2 years. Mean value of post-PCI QFR was 0.92 ± 0.13. Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91. The incidence of 2-year VOCEs in the vessel with post-PCI QFR < 0.91 (n = 91) was significantly higher compared with the vessels with post-PCI QFR ≥ 0.91 (n = 262) (22.0% vs. 4.2%, HR = 4.98, 95% CI: 2.32-10.70). CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO. Achieving functionally optimal PCI results (post-PCI QFR value ≥ 0.91) tends to get better prognosis for patients with CTO lesions.

Musculoskeletal disorders (MSDs) are characterized by extensive pathological involvement and high prevalence and cause a significant disease burden. Long-term drug administration often causes by adverse effects with poor therapeutic efficacy. Low-intensity pulsed ultrasound (LIPUS), as a specialized therapeutic modality, delivers acoustic energy at a low intensity in a pulsed wave mode, thus ensuring stable energy transmission to the target tissues while minimizing thermal effects. This non-invasive approach has demonstrated significant potential for MSD treatment by delivering effective physical stimulations. Extensive animal and clinical studies have demonstrated the efficacy of LIPUS for accelerating the healing process of fresh fractures and nonunions, promoting soft tissue regeneration and suppressing inflammatory responses. Emerging evidence suggests promising applications of LIPUS in skeletal muscle injury treatment and promoting tissue regeneration and repair. This review outlines the recent advancements and mechanistic studies of LIPUS for treatment of common MSDs including fractures, nonunions, muscle injuries, and osteoarthritis, addressing also the technical parameters of commercially available LIPUS devices, current therapeutic approaches, the existing challenges, and future research directions.
Humans ; Ultrasonic Therapy/methods* ; Musculoskeletal Diseases/therapy* ; Ultrasonic Waves ; Osteoarthritis/therapy* ; Muscle, Skeletal/injuries*

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: Pneumoconiosis, a lung disease caused by irreversible fibrosis, represents a significant public health burden. This study investigates the causal relationships between gut microbiota, gene methylation, gene expression, protein levels, and pneumoconiosis using a multi-omics approach and Mendelian randomization (MR). METHODS: We analyzed gut microbiota data from MiBioGen and Esteban et al. to assess their potential causal effects on pneumoconiosis subtypes (asbestosis, silicosis, and inorganic pneumoconiosis) using conventional and summary-data-based MR (SMR). Gene methylation and expression data from Genotype-Tissue Expression and eQTLGen, along with protein level data from deCODE and UK Biobank Pharma Proteomics Project, were examined in relation to pneumoconiosis data from FinnGen. To validate our findings, we assessed self-measured gut flora from a pneumoconiosis cohort and performed fine mapping, drug prediction, molecular docking, and Phenome-Wide Association Studies to explore relevant phenotypes of key genes. RESULTS: Three core gut microorganisms were identified: Romboutsia ( OR = 0.249) as a protective factor against silicosis, Pasteurellaceae ( OR = 3.207) and Haemophilus parainfluenzae ( OR = 2.343) as risk factors for inorganic pneumoconiosis. Additionally, mapping and quantitative trait loci analyses revealed that the genes VIM, STX8, and MIF were significantly associated with pneumoconiosis risk. CONCLUSIONS This multi-omics study highlights the associations between gut microbiota and key genes ( VIM, STX8, MIF) with pneumoconiosis, offering insights into potential therapeutic targets and personalized treatment strategies.
Humans ; Male ; East Asian People/genetics* ; Europe ; Gastrointestinal Microbiome ; Lung ; Macrophage Migration-Inhibitory Factors/metabolism* ; Mendelian Randomization Analysis ; Multiomics ; Pneumoconiosis/microbiology* ; Intramolecular Oxidoreductases

Objective To explore the impact of an intelligent puncture navigation used by different physicians with varying years of experience to perform the lung puncture biopsy surgery.Methods A retrospective selection was conducted of 182 patients who completed lung puncture biopsy surgery.The primary parameters were recorded included puncture time,the number of needle adjust-ments,dose length product(DLP),and complications.The physicians were categorized into high-experience and low-experience groups based on their years of clinical practice.The differences of navigation guidance and manual puncture were compared between the two groups.Results The use of navigation guidance significantly reduced the procedure time for both groups of physicians(P<0.05).Additionally,for the low-experience group,navigation guidance notably decreased the number of needle adjustments(P<0.05)and reduced the radiation dose received by patients(P<0.05).Conclusion The application of intelligent puncture navigation can shorten the procedure time,reduce the number of needle adjustments,and lower the radiation dose received by patients in lung puncture biopsy procedures.It also bridges the operational performance gap between low-experience and high-experience physicians,making it a val-uable imaging-guided tool for widespread adoption.

Objective:To evaluate the efficacy of remimazolam-based anesthesia in daytime laparoscopic cholecystectomy.Methods:In this multicenter, non-inferiority, randomized controlled trial, 300 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-60 yr, with body mass index of 18-28 kg/m 2, who underwent daytime laparoscopic cholecystectomy under general anesthesia with tracheal intubation at Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou First People′s Hospital Affiliated to Westlake University School of Medicine, Ningbo No. 2 Hospital, and the Second Affiliated Hospital of Nanchang University from August 2021 to August 2023, were selected and divided into 2 groups ( n=150 each) using a random number table method: remimazolam group (R group) and propofol group (P group). Anesthesia was induced as follows: Sufentanil was intravenously injected at a rate of 0.5 μg/kg, remimazolam was intravenously injected at a rate of 0.3 mg/kg in group R, propofol was intravenously injected at a rate of 2.0-2.5 mg/kg in group P, and cisatracurium besilate was intravenously injected at a rate of 0.2 mg/kg after loss of consciousness in two groups. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained as follows: Remimazolam was intravenously injected at a rate of 0.5-1.0 mg·kg -1·h -1 in group R, propofol was intravenously injected at a rate of 4-10 mg·kg -1·h -1 in group P, and remifentanil was intravenously infused at a rate of 0.25-2.00 μg·kg -1·min -1, maintaining intraoperative bispectral index value of 40-60. The success rate of sedation was recorded, and non-inferiority tests were conducted. The time to loss of consciousness, emergence time, extubation time, recovery time of orientation, time of stay in post-anesthesia care unit and occurrence of delayed emergence were recorded. Liver function and renal function were measured before operation and within 24 h after operation. The occurrence of abnormal alanine transaminase, abnormal aspartate transaminase, abnormal creatinine and abnormal urea was recorded. The occurrence of adverse reactions during and after operation was recorded. Results:The success rates of sedation were 98.6% and 99.3% in group R and group P, respectively, there was no statistically significant difference in the success rate of sedation between the two groups ( P>0.05), and the difference in the success rates of sedation between the two groups was -0.007 (95% confidence interval-0.0301-0.0161), which met the pre-set non-inferiority criteria(95% confidence interval >-0.055). Compared with group P, the time to loss of consciousness and recovery time of orientation were significantly prolonged, and the incidence of delayed emergence was increased ( P<0.05), and no statistically significant changes were found in the emergence time, extubation time, time of stay in post-anesthesia care unit and severity of postoperative nausea and vomiting in group R ( P>0.05). There was no statistically significant difference in the abnormal rates of alanine transaminase, aspartate transaminase, creatinine and urea before and after operation between the two groups ( P>0.05). Conclusions:The efficacy of remimazolam-based anesthesia in daytime laparoscopic cholecystectomy is not inferior to that of propofol-based anesthesia.

Objective To investigate the effect of rapid maxillary expansion(RME)on sagittal soft and hard maxillofacial tissue in growing children.Methods In this retrospective study,children aged 6-12 years treated in Shanghai Stomatology Hospital from Jan 2018 to Dec 2020 were employed as subjects.Of the subjects,40 patients treated with RME were as the experimental group,27 patients presenting individualized malocclusion were as the control group.Lateral cephalogram was taken before(T0)and 2 years after treatment(T1).The images were imported into Dolphin Imaging's cephalometric measurement software,and the results were statistically analyzed using SPSS 22.0 software.Results Statistically significant differences were observed in all measurements before and after treatment in both two groups.A comparative analysis revealed that SNB value increased and ANB value decreased in the experimental group after treatment,while the changes in the control group were significantly smaller than those in the experimental group(P<0.05),indicating that RME is beneficial to the growth and development of mandibular in sagittal direction.Among the dentoalveolar measurements,statistically significant differences(P<0.01)were observed in U1-SN(upper incisor to sella-nasion angle),U1-NA(upper incisor to nasion-A point angle),U1-APog(upper incisor to A point-pogonion line distance),and overjet between the two groups.These findings indicate that RME significantly reduces the inclination of the maxillary central incisors,while having no significant effect on the mandibular central incisors.Compared with the control group,RME significantly reduced upper lip prominence,lip space and upper central incisor exposure(P<0.05),but had no effect on nose,chin and their correlation.Conclusion RME not only improved the prominence of the upper teeth and upper lip,but also facilitate the sagittal growth of mandibular in growing children.

BACKGROUND:Previous studies have demonstrated that moxibustion can alleviate osteoarthritis-induced cartilage lesions and delay the progression of knee osteoarthritis. In a previous study conducted by our research group,it was found that regulating the circPan3/miR-667-5p/Ghrelin signaling pathway can enhance the level of autophagy in chondrocytes,thereby exerting a cartilage protective role in knee osteoarthritis. OBJECTIVE:To explore the effect of moxibustion on knee osteoarthritis cartilage in rats based on the circPan3/miR-667-5p/Ghrelin signaling pathway. METHODS:Sprague-Dawley rats were randomly divided into three groups (n=10 per group):sham operation,model,and moxibustion groups. A rat model of knee osteoarthritis was established in the latter two groups by anterior cruciate ligament transection and medial meniscus resection. Rats in the sham operation group underwent arthrotomy only. At 6 weeks after modeling,moxibustion intervention at Zusanli and Shenyu acupoints was applied in the moxibustion group,20 minutes daily for 4 weeks,while the other two groups did not receive any special treatment. After 4 weeks,histopathological staining was performed to observe the degree of synovial lesions and cartilage damage in the knee joint. Additionally,changes in the serum levels of inflammatory cytokines,interleukin-6 and tumor necrosis factor-α,were detected by enzyme-linked immunosorbent assay. Furthermore,chondrocytes isolated from the above three groups of rats were divided into three groups:a normal control group,a model group,and a moxibustion group. The expression levels of cartilage matrix anabolic molecules (type Ⅱ collagen and Sox9),matrix degradation molecules (matrix metalloproteinase 13 and ADAMTS5),autophagy markers (ATG5,Beclin-1,microtubule-associated protein 1 light chain 3),Ghrelin,CircPan3,and miR-667-5P were determined by western blot and qRT-PCR in each group. RESULTS AND CONCLUSION:After 4 weeks of treatment,the model group exhibited significant thickening of the synovium,infiltration of inflammatory cells,narrowing of the joint space,rough and uneven cartilage surfaces,thinning,reduction in the number of chondrocytes,a significant increase in synovitis and Osteoarthritis Research Society International scores,and a significant up-regulation of interleukin-6 and tumor necrosis factor-α levels (P<0.0001). In comparison,the sham operation group showed no significant changes. Compared with the model group,the moxibustion group exhibited a reduction in synovial thickening,a decrease in inflammatory cell infiltration,an increase in joint space,a reduction in cartilage roughness and loss of integrity,an increase in the number of chondrocytes,a reduction in synovitis and Osteoarthritis Research Society International scores,and a significant reduction in the levels of interleukin-6 and tumor necrosis factor-α (P<0.0001). The results of in vitro experiments demonstrated that the expression of matrix metalloproteinase 13,ADAMTS5,and miR-667-5P was elevated,while the expression of type Ⅱ collagen,Sox9,autophagy markers,Ghrelin,and Circpan3 was reduced in the model group compared with the normal control group (P<0.01). Moxibustion was found to reverse these changes in the moxibustion group compared with the model group (P<0.01). To conclude,moxibustion may enhance chondrocyte autophagy by modulating the circPan3/miR-667-5p/Ghrelin signaling pathway,which may inhibit knee osteoarthritis inflammation and cartilage destruction,exerting a protective effect on cartilage.