There are practical and cost-effective opportunities for the prevention and early intervention of periodontal disease, a common oral condition. Depression and anxiety represent major global mental health challenges, and they are characterized by high prevalence rates and an elevated suicide risk. Their clinical management is complicated by extended treatment timelines and substantial healthcare costs. Accumulating evidence demonstrates a statistically significant bidirectional association between periodontal disease and depression/anxiety disorders. However, established clinical pathways integrating these conditions remain lacking. This review presents a comprehensive analysis of current research examining the relationship between periodontal disease and mood disorders, specifically depression and anxiety. This study explored the bidirectional mechanisms within the microbiota-oral-brain axis, which includes both periodontal disease inducing neuroinflammation through pro-inflammatory factors, such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) activating the TLR-4/NF-κB signaling pathway, and depression and anxiety leading to “glucocorticoid resistance” through hypothalamic-pituitary-adrenal (HPA) axis dysregulation, thus causing dual immune dysfunction that exacerbates periodontal tissue destruction, as well as the mechanisms by which biological, psychological, and social factors contribute to the bidirectional association between periodontal disease and depression/anxiety. We propose implementing bidirectional referral protocols between dental and psychiatric services in clinical practice, incorporating mental health screening tools, such as Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7(GAD-7), for patients with moderate-to-severe periodontal disease, and incorporating periodontal examination into routine assessment during psychiatric services. This multidisciplinary approach aims to break the vicious circle between these conditions and provide clinicians with pragmatic intervention strategies.

Objective To explore the predictive value of peripheral blood cells in the efficacy of neoadjuvant immunotherapy combined with chemotherapy for esophageal squamous cell carcinoma. Methods A retrospective study was conducted on patients with esophageal squamous cell carcinoma (clinical stages Ⅱ-Ⅳa) who underwent neoadjuvant immunotherapy combined with chemotherapy at the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from April 2020 to November 2023. According to whether the pathology was completely relieved after treatment, patients were divided into a pathological complete remission group and a pathological incomplete remission group. The College of American Pathologists criteria were used to evaluate the tumor pathological regression grade (TRG) after neoadjuvant therapy (TRG=0, 1 defined as a good efficacy group, TRG=2, 3 defined as a poor efficacy group). Results A total of 92 patients with esophageal squamous cell carcinoma were collected, including 72 males and 20 females. The average age was (65.86±7.66) years. The complete remission of pathology was closely related to the number of lymphocytes in the blood before treatment (P=0.019). The area under the curve (AUC) for predicting complete remission of esophageal squamous cell carcinoma after neoadjuvant immunotherapy combined with chemotherapy was 0.678, the maximum Youden index was 0.328, and the optimal cutoff value was 1.845. The incidence of postoperative pulmonary infection in the pathological incomplete remission group was higher than that in the pathological complete remission group (25.0% vs. 5.6%, P=0.030). Using the optimal cutoff value, there were statistically significant differences in pathological N stage and pathological TNM stage between patients with lymphocyte counts <1.845×109/L and ≥1.845×109/L (P<0.05). Treatment response (by TRG) was significantly associated with the pretreatment red blood cell count (P=0.009). The AUC for predicting a good TRG response was 0.669, with a maximum Youden index of 0.385 and an optimal cutoff value of 4.235. Between the good and poor response groups, there were statistically significant differences in postoperative pathological T stage (P<0.001), N stage (P=0.041), and TNM stage (P＜0.001). When stratified by the optimal cutoff value, there were statistically significant differences in age (P＜0.001) and the prevalence of hypertension (P=0.022) between patients with red blood cell counts <4.235×1012/L and ≥4.235×1012/L. Conclusion A pretreatment absolute lymphocyte count ≥1.845×109/L and a red blood cell count <4.235×1012/L are good predictors for pathological complete response and a good pathological response, respectively, following neoadjuvant immunotherapy combined with chemotherapy in patients with esophageal squamous cell carcinoma.

Objective:To explore the learning curve of primary urologists mastering Holmium laser enucleation of the prostate for the treatment of large volume benign prostatic hyperplasia (BPH).Methods:The clinical data of 92 patients with larger volume BPH who received HoLEP performed by a urologist in Beijing Friendship Hospital Pinggu Campus, Capital Medical University were retrospectively reviewed. 92 patients were divided into group A (1-23 cases, n=23), group B (24-46 cases, n=23), group C (47-69 cases, n=23), and group D (70-92 cases, n=23) based on the sequence of surgery. The clinical characteristics, including prostate volume, operation time, enucleation efficiency, indwelling catheter time, decrease value of hemoglobin, intraoperative blood transfusion, perioperative complications, and international prostate symptom score (IPSS), quality of life (QOL) score, Qmax, and postvoid residual urine (PVR) at 3 months postoperatively were compared between the four groups. Measurement data were expressed as mean ± standard deviation ( ± s), one-way analysis of variance was used for comparisons among multiple groups, and t-test was used for comparisons between two groups. Count data were expressed as the cases and percentage, and the Chi-square test was used for comparison between groups. Results:There were significant differences among the four groups in terms of operation time [(94.43±8.26) min, (86.39±5.89) min, (70.70±5.64) min, (64.70±4.23) min, P=0.001], enucleation efficiency [(0.90±0.08) mL/min, (1.01±0.07) mL/min, (1.23±0.12) mL/min, (1.34±0.12) mL/min, P=0.001], decrease value of hemoglobin [(25.98±1.39) g/L, (23.27±1.49) g/L, (20.03±1.07) g/L, (18.49±0.96) g/L, P=0.001] and indwelling catheter time [(5.91±1.54) d, (5.35±1.27) d, (3.39±0.72) d, (3.04±0.64) d, P=0.001]. Compared with group C and group D, the operation time was longer, the enucleation efficiency was lower, the decrease value of hemoglobin before and after the operation was higher, and the indwelling catheter time was longer, the above differences were all statistically significant ( P<0.05). However, there was no statistically significant difference between group A and group B, or group C and group D ( P>0.05). Among the 92 patients, only 3 patients received blood transfusion during operation, including 2 patients in group A and 1 patient in group B. 2 patients underwent surgical complications during the perioperative period. Among them, 1 patient suffered bladder wall injury due to improper operation of the tissue pulverizer in group A, and 1 patient developed prostatic capsule perforation in group B. Furthermore, after 56 cases of operation, a primary urologist can perform HoLEP surgery quickly and safely. Conclusion:The learning curve of a primary urologist mastering HoLEP for larger volume (≥ 80 mL) BPH was 56 procedures, and the operation efficiency and safety were significantly improved.

Objective:To investigate the prognostic value of the combined use of central venous-arterial carbon dioxide partial pressure difference/arterial-central venous oxygen content difference ratio (Pv-aCO 2/Ca-vO 2) combined with peripheral perfusion index (PI) for prognosis in middle-aged and elderly patients with acute heart failure (AHF) complicated by hypoperfusion. Methods:A case-control study was conducted, enrolling middle-aged and elderly AHF patients with tissue hypoperfusion admitted to the Emergency Intensive Care Unit of Nanjing First Hospital from May 2022 to May 2024. The primary endpoint was 28-day all-cause mortality. Patients were divided into survival and death groups based on prognosis. Baseline characteristics and clinical data were compared between groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of risk factors. Stratified analysis based on optimal cutoff values was performed, and Kaplan-Meier survival curves were used to compare prognostic differences between subgroups.Results:A total of 70 patients with AHF and hypoperfusion were enrolled, with 36 deaths (28-day mortality rate: 51.43%). No significant differences were observed in baseline characteristics, N-terminal B-type natriuretic peptide precursor, creatine kinase, creatine kinase-myocardial band, cardiac troponin I,central venous pressure, or left ventricular ejection fraction between groups(all P>0.05). Compared with the survival group, the death group exhibited significantly higher APACHEⅡ scores, lactate levels, and Pv-aCO 2/Ca-vO 2 ratios, along with lower PI values (all P<0.05). The area under the ROC curve (AUCs) for PI, Pv-aCO 2/Ca-vO 2, and their combination in predicting 28-day mortality were 0.804 (95% CI: 0.701-0.908), 0.848 (95% CI: 0.758-0.938), and 0.922 (95% CI: 0.859-0.985), respectively. The optimal cutoff value for PI was 1.17 (sensitivity 83.3% and specificity 67.6%), and for Pv-aCO 2/Ca-vO 2 was 1.59 (sensitivity 77.8% and specificity 79.4%). Stratified analysis revealed that the PI≤1.17 group had a significantly higher 28-day mortality rate than the PI>1.17 group ( P<0.01), and the Pv-aCO 2/Ca-vO 2>1.59 group had a markedly higher mortality rate than the Pv-aCO 2/Ca-vO 2≤1.59 group ( P<0.01) ,consistent with Kaplan-Meier survival analysis. Conclusion:Early assessment of Pv-aCO 2/Ca-vO 2 combined with PI demonstrates superior predictive performance for prognosis in AHF patients with hypoperfusion.

Resectable non-small cell lung cancer (NSCLC) is prone to recurrence and metastasis after simple surgery. Although patients can benefit from preoperative neoadjuvant chemotherapy and postoperative adjuvant chemotherapy, the 5-year survival rate is not significantly improved. In recent years, with the rise of immunotherapy, NSCLC immunotherapy has gradually received attention. Many explorations have been made on resectable NSCLC immunotherapy, and satisfactory results have been obtained. With the release of multiple phase 3 research results, a new chapter in resectable NSCLC immunotherapy has officially opened. However, there are still many problems in the immunotherapy of resectable NSCLC. This article reviews the current relevant research and provides reference for clinical application.

Objective:To investigate the use of targeted next generation sequencing (tNGS) for the detection of drug resistance in mycoplasma pneumoniae pneumonia (MPP) and analyze the clinical characteristics of MPP.Methods:The clinical data of patients with MPP who underwent bronchoalveolar lavage fluid tNGS at the Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Hubei Province, Jianghan University from February 2022 to February 2024 were collected. According to inclusion and exclusion criteria, 80 patients with MPP were included in this study. The clinical data of the patients were retrospectively analyzed. tNGS of bronchoalveolar lavage fluid was performed to assess drug resistance in MPP. These patients were divided into a drug resistance group ( n = 55) and a non-drug resistance group ( n = 25) based on the presence or absence of the 23SrRNA:A2063G drug resistance mutation. Patient's clinical characteristics were compared between the two groups. The significant indicators from the univariate analysis were introduced into a binary logistic regression model to analyze the independent predictors of drug resistance and their predictive values. Results:The median age of patients with MPP was 38 years, with 53.75% (43/80) being female. Among the patients, 62.50% (50/80) had no underlying diseases, and 68.75% (55/80) exhibited drug resistance, while 42.50% (34/80) had mixed infections. The three most common clinical symptoms were cough (92.50%, 74/80), fever (62.50%, 50/80), and dyspnea (31.25%, 25/80). The most common imaging findings in MPP included patchy shadows (48.75%, 39/80) and consolidation shadows (42.50%, 34/80). Nodular shadows (7.50%, 6/80), tree-in-bud signs (5.00%, 4/80), ground-glass opacities (11.25%, 9/80), bronchial wall thickening (3.75%, 3/80), and pleural effusions (5.00%, 4/80) were not common. Bilateral lesions were present in 40.00% (32/80) of cases. In laboratory examinations, the median levels of inflammatory markers C-reactive protein (39.45 mg/L), procalcitonin (0.08 g/L), and serum amyloid A (168.31 mg/L) were increased. The median or mean levels of other indicators were within the normal range. There were no significant differences between the drug resistance and non-drug resistance groups in terms of gender, age, underlying diseases, clinical symptoms, length of hospital stay, mixed infection rate, mycoplasma pneumoniae (MP)-IgG positivity, MP-IgM level > 300 AU/mL, MP-DNA positivity, percentage of lymphocytes, platelet count, number of lymphocytes, and procalcitonin, D-dimer, prealbumin, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, and albumin levels as well as imaging findings (all P > 0.05). In the drug resistance group, the number of fever days, sequence number, white blood cell count, percentage of neutrophils, C-reactive protein level, and serum amyloid A level were as follows: 4 (0, 7), 24464.00 (2754.00, 43457.00), 7.35 (6.09, 9.84), 73.70 (67.20, 73.70), 39.82 (20.82, 70.40), and 205.40 (81.08, 338.30), respectively. These values were significantly higher than those in the non-drug resistance group [2 (0, 4.50), 658.00 (323.00, 7593.00), 6.12 (5.04, 7.20), 64.45 (58.58, 76.33), 35.63 (4.94, 57.36), 81.30 (12.51, 243.76), Z = -2.43, -4.67, -2.72, -2.36, -2.04, -2.37]. The albumin level in the drug resistance group was 41.50 (38.10, 44.30), which was significantly lower than that in the non-drug resistance group [43.55 (40.03, 46.05), Z = -2.07, P < 0.05]. In the binary logistic regression analysis, the sequence number was identified as an independent predictor of drug resistance. When the sequence number exceeded 1001, the area under the curve value was 0.827, with a sensitivity of 94.5% and specificity of 68.0%. Conclusions:The clinical manifestations of MPP are similar in both the macrolide-resistant and the non-resistant groups. However, the drug-resistant group exhibits a greater number of fever days, higher sequence numbers, and more severe inflammatory responses. The sequence number of MPP can be used to predict drug resistance. When the sequence number exceeds 1001, its predictive value for drug resistance is significantly higher.

Objective To investigate the differences in cortical activation and functional connectivity during speech under different cognitive loads in young individuals.Methods Twenty-one participants(mean age 21.9±1.33 years)were instructed to read short sentences embedded with color words under both congruent(where the color words matched the font color)and incongruent(where the color words did not match the font color)condi-tions.The color words required reading the font color instead of the word itself.Functional near-infrared spectros-copy(fNIRS)was utilized to analyze differences in cortical activation(changes in HbO concentration)and functional connectivity(Pearson correlation of HbO between brain regions)in the dorsolateral prefrontal cortex(DLPFC)and supplementary motor area(SMA)bilaterally.Results The fNIRS results revealed significant increase in HbO con-centration changes in the RDLPFC(t=3.4,P=0.003),LDLPFC(t=2.58,P=0.019),RSMA(t=3.59,P=0.002),and LSMA(t=4.06,P=0.001)under the incongruent condition compared to the congruent condition.Additionally,there was a significant enhancement in the correlation between RDLPFC and LDLPFC(t=2.44,P=0.025).However,the differences in correlation between left and right SMA,as well as between SMA and DLPFC,were not statistically significant(P＞0.05).Conclusion These findings suggest that during speech under incongru-ent conditions,increased cognitive load leads to elevated cortical activation in the DLPFC and SMA,along with in-creased functional connectivity between the left and right DLPFC.

Objective:To investigate the clinicopathological and molecular genetic characteristics of diffuse gliomas with the features of polymorphous low-grade neuroepithelial tumor of the young (PLNTY) and their prognostic values.Methods:A retrospective analysis was performed on 14 cases of diffuse gliomas with PLNTY features diagnosed at the First Affiliated Hospital of Fujian Medical University, Fuzhou, China from June 2020 to August 2024. Their clinicopathological characteristics were examined, and their molecular genetic and epigenetic features were assessed using next-generation sequencing (NGS) and methylation analysis. Factors influencing prognosis were also analyzed.Results:Among the 14 patients, there were 8 males and 6 females, aged 3-62 years, median 29 (9, 50) years. All cases were initially diagnosed as low-grade diffuse gliomas histologically but exhibited the histological and immunohistochemical features of PLNTY. At the molecular level, all cases showed molecular abnormalities involving the mitogen-activated protein kinase pathway, including 5 cases with FGFR3-TACC3 (F3T3) fusion, 3 cases with FGFR2 fusion, 5 cases with BRAF V600E mutation, and 1 case with FGFR1 mutation. Among them, TERT promoter mutations were frequently observed in tumors with F3T3 fusion (5/5), while NCOR2 in-frame insertion mutations were prominent in tumors with non-F3T3 fusions. Clinical follow-up showed recurrence in 3 cases, all of which had F3T3 fusion and concurrent TERT promoter mutations. Prognostic analysis confirmed that F3T3 fusion with concurrent TERT promoter mutation was associated with poor prognosis.Conclusions:Diffuse gliomas with PLNTY features exhibit heterogeneity in clinicopathology and molecular genetics, with FGFR3/FGFR2 fusions and BRAF/FGFR1 mutations as the most common molecular alteration. They often have concurrent F3T3 fusion and TERT promoter mutations, which are related to poor prognosis. The possibility of molecular glioblastoma should be considered for these tumors. It is thus recommended to perform genetic testing on diffuse gliomas with PLNTY features in order to facilitate integrated diagnosis and provide molecular evidence for accurate evaluation of prognoses.

Objective:The 5th edition of the WHO classification of central nervous system (CNS) tumors in 2021 made significant revisions to the nomenclature and grading system of solitary fibrous tumors (SFT). This study aimed to explore the changes in the grading of CNS SFT and its relationship with clinical pathological features and prognosis.Methods:This study retrospectively reviewed the clinical and pathological data of 82 patients with CNS SFT diagnosed at the First Affiliated Hospital of Fujian Medical University from March 2006 to June 2021, reassessed their grading according to the WHO 5th edition CNS tumor classification, and conducted a comprehensive analysis of their histological morphology, immunohistochemical characteristics, and clinical imaging data.Results:The age of the patients ranged from 21 to 83 years, with a median age of 48 years. Follow-up was completed for 82 patients, during which 10 patients died, 24 recurred, and 5 metastasized. MRI imaging showed that SFT exhibited isointense signals on T1-weighted imaging (T1WI) and complex signals on T2-weighted imaging (T2WI), with signal intensity decreasing as the content of collagen fibers increased. According to the 2021 grading criteria, there was a significant change in the grading of SFT, with the number of grade 1 SFT increasing from 10 cases under the 2016 standard to 39 cases, while the number of grade 2 and 3 SFT decreased accordingly. The 2016 grading system was significantly correlated with the overall survival (OS) of patients ( P=0.009), while the 2021 grading system did not reach statistical significance. Both grading systems were correlated with histological phenotype, Ki-67 index, mitotic figures, and necrosis ( P＜0.05). All cases expressed STAT6, and showed varying degrees of expression of vimentin, CD99, BCL-2, and CD34. The staining intensity of type Ⅳ collagen fibers, as analyzed semi-quantitatively, was correlated with the OS of the patients ( P=0.017). Conclusions:The new grading system for CNS SFT has undergone significant changes, and its association with OS requires further validation. In-depth study of the content and fine structure of collagen fibers in SFT may have important clinical significance for the prognosis assessment and the formulation of treatment plans for patients. Moreover, quantitative analysis of T2WI signal intensity may provide a new method for preoperative preliminary assessment of the collagen fiber content in SFT.

Hepatitis B virus (HBV)-specific CD8⁺ T cells play a central role in controlling HBV infection; however, their function is impaired during chronic HBV infection, manifesting as a state of dysfunction. Recent studies have revealed that CD8⁺ T cell dysfunction in chronic HBV infection differs from the classical exhaustion observed in other viral infections or tumors. In 2024, several pivotal studies further elucidated novel mechanisms underlying CD8⁺ T cell dysfunction in chronic HBV infection and identified new therapeutic targets, including 4-1BB and transforming growth factor-beta (TGF-β). This review, while elucidating the dysfunction of CD8⁺ T cells in chronic HBV infection and its underlying mechanisms, focuses on summarizing the key findings from these latest studies and explores their translational value and clinical significance.
Humans ; Hepatitis B, Chronic/virology* ; CD8-Positive T-Lymphocytes/immunology* ; Hepatitis B virus/physiology* ; Animals ; Transforming Growth Factor beta/immunology*