Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

Ischemic stroke (IS) is a globally life-threatening disease. Presently, few therapeutic medicines are available for treating IS, and rt-PA is the only drug approved by the US Food and Drug Administration (FDA) in the US. In fact, many agents showing excellent neuroprotection but no blood flow-improving activity in animals have not achieved ideal clinical efficacy, while thrombolytic drugs only improving blood flow without neuroprotection have limited their wider application. To address these challenges and meet the huge unmet clinical need, we have designed and identified a novel compound AAPB with dual effects of neuroprotection and cerebral blood flow improvement. AAPB significantly reduced cerebral infarction and neural function deficit in tMCAO rats, pMCAO rats, and IS rhesus monkeys, as well as displayed exceptional safety profiles and excellent pharmacokinetic properties in rats and dogs. AAPB has now entered phase I of clinical trials fighting IS in China.

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Objective To evaluate the safety and effectiveness of different doses of epidural oxycodone injection for traction reaction during cesarean sections to determine the optimal dose.Methods Totally 119 cases of parturients who underwent cesarean sections from October 2023 to May 2024 were selected and randomly divided into groups A,B,C and D.All four groups of lying-in women received epidural injection after the umbilical cord was cut.Groups A,B and C were given oxycodone 3 mg,5 mg and 7 mg respectively,and group D was given an equal amount of normal saline.The primary outcomes were documentation of maternal vital signs and traction reaction during the surgery.Secondary outcomes included patient-controlled intravenous analgesia(PCIA)times within 48 hours and documentation of any postoperative adverse events within 24 hours.Results The comparison of in-tra?operative vital signs among the four groups of patients revealed no statistically significant differences.In groups A,B and C the incidence of traction reactions was significantly lower at 20％,17.2％and 3.3％,respectively,compared to group D at 53.3％,showing statistically significant differences(P<0.05).Additionally,the inci?dence of traction reaction in group C was significantly lower than in group A(P<0.05).Groups A,B and C pro?duced significantly better results than group D in terms of the duration of anesthesia.PCIA presses were substan?tially less in groups A and C than in group D(P<0.05),and group C had a significantly higher total incidence of adverse events than group A and group D(P<0.05).Conclusions Epidural injection of 3 mg,5 mg and 7 mg oxycodone has been proved to significantly reduce traction reaction during cesarean sections while minimally im?pacting intraoperative vital signs.This intervention has the potential to extend the duration of anesthesia,decrease the frequency of PCIA presses.Among these,7 mg is the most effective but has the highest incidence of adverse effects,requiring carefully post?operative monitoring.

Objective To explore the relationships of vitamin D and oxidized low-density lipoprotein(ox-LDL)with infertility in patients with polycystic ovary syndrome(PCOS)based on restricted cubic spline models.Methods A total of 150 PCOS patients were selected as the study subjects and followed up for at least 1 year.They were divided into infertile group and non-infertile group according to whether they were infertile.A Logistic regression model was used to analyze the influencing factors of infertility in PCOS patients.Furthermore,the relationships of 1,25-dihydroxyvitamin D3[1,25-(OH)2D3]and ox-LDL with infertility in PCOS patients,as well as their interactive effects on infertility in PCOS patients were analyzed.A restricted cubic spline model was used to analyze the non-linear relationships between 1,25-(OH)2D3,ox-LDL,and infertility in PCOS patients.Results Among 150 PCOS patients,78 were not pregnant,resulting in an infertility rate of 52.00％(78/150).Multivariate Logistic regression analysis showed that the severity of PCOS,body mass index,age,1,25-(OH)2D3,and ox-LDL were all independent influencing factors for infertility in PCOS patients(P＜0.05).After adjusting for confounding factors,1,25-(OH)2D3 and ox-LDL were still associated with the risk of in-fertility in PCOS patients(P＜0.05).Restricted cubic spline model analysis revealed non-linear rela-tionships between 1,25-(OH)2D3,ox-LDL,and the risk of infertility in PCOS patients(P＜0.05).When the serum 1,25-(OH)2D3 level was＜35.70 nmol/L,it was negatively correlated with the risk of infertility in PCOS patients(P＜0.05).When the serum ox-LDL level was ≥381.00 μg/L,it was positively correlated with the risk of infertility in PCOS patients(P＜0.05).Interactive effect analysis showed that 1,25-(OH)2D3 and ox-LDL had antagonistic effects on infertility in PCOS pa-tients(P＜0.05).Conclusion Decreased serum 1,25-(OH)2D3 levels and increased ox-LDL levels in PCOS patients can significantly increase the risk of infertility.Moreover,there is a non-lin-ear dose-response relationship and an antagonistic interactive effect between them,suggesting that regulating vitamin D and oxidative stress levels may be an important strategy for improving the fertili-ty outcomes of PCOS patients.

This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31 +1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V 2 to V 6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34 +3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.

The "Clinical Practice Guidelines for Hypertension in China", released in 2022, has lowered the diagnostic criteria for hypertension. However, no adjustments were made to the diagnostic criteria for hypertension during pregnancy. The impact of adult hypertension diagnostic criteria on the diagnosis of gestational hypertension and pregnancy outcomes remains unclear. Borderline hypertension includes elevated blood pressure and stage 1 hypertension. Compared to pregnant women with normal blood pressure, women with borderline hypertension have an increased risk of adverse pregnancy outcomes. Still, there are no associated guidelines for pregnancy management for now. This article explores the influence of borderline hypertension on pregnancy outcomes and the optimal level for blood pressure control during pregnancy, aiming to improve maternal and fetal outcomes and optimize the management of borderline hypertension during pregnancy.

Tumor metastasis is closely related to high mortality rate of cancer.It is well known that glutamine plays an important role in the malignant progression of cancer.Notably,as an important carbon and nitrogen donor,glutamine has been found to be closely related to tumor metastasis in recent years.Glutamine is not only involved in regulating the proliferation of tumor cells,but is also closely related to the migration and invasion of tumor cells.Furthermore,various enzymes along with transporters in the metabolism of glutamine are involved in the process of tumor metastasis through different signaling pathways.This review provided a summary of the role of glutamine in tumor metastasis in recent years and proposed therapeutic targets to provide new strategies for the clinical treatment of tumor metastases.

Vulnerable research participants participating in clinical trials pose certain ethical challenges,and they require special attention from researchers,ethics committees,and management departments.Taking a deaf-mute and illiterate research participants participating in a clinical trial of breast cancer as an example,this paper discussed the ethical considerations regarding the research participants's insufficient capacity for informed consent,as well as the measures taken to ensure their compliance in the clinical trial,further provided ideas for dealing with this type of ethical issues.During the implementation of clinical trials,researchers should assess the level of informed consent ability of research participants,implement the research participants'rights to know and choose,and perform informed consent in a standardized manner.For research participants whose vulnerable factors make it difficult for them to give informed consent,they should not be excessively excluded from the research.Instead,targeted safeguards should be taken to promote the efficient implementation of clinical trials on the premise of complying with various ethical principles.