Flap transplantation is a critical surgical strategy for the reconstruction of tissue defects caused by trauma, tumor resection, and congenital malformations, and its survival rate directly determines surgical efficacy and patient prognosis. Following transplantation, flaps inevitably undergo ischemia-reperfusion (I/R) injury, during which oxidative stress, inflammatory responses, and metabolic disturbances are intricately intertwined, ultimately leading to cellular injury and tissue necrosis. Recent studies have demonstrated that multiple forms of programmed cell death—including apoptosis, pyroptosis, ferroptosis, necroptosis, and PANoptosis—play central roles in flap I/R injury. The extensive crosstalk and molecular interactions among these pathways form a highly complex cell death network. Specifically, apoptosis is mediated by the imbalance of Bcl-2 family proteins and the activation of cysteine-dependent aspartate-specific protease (caspase) cascades; pyroptosis is driven by the NLRP3-caspase-1-GSDMD axis, resulting in membrane pore formation and the release of pro-inflammatory cytokines; ferroptosis is characterized by iron-dependent lipid peroxidation and dysfunction of glutathione peroxidase 4 (GPX4); necroptosis is triggered by the receptor-interacting serine/threonine-protein kinase 1 (RIPK1)-RIPK3-MLKL signaling complex, leading to membrane rupture; and PANoptosis represents an integrated form of inflammatory cell death that coordinates multiple death pathways. Importantly, these forms of programmed cell death are not independent but are interconnected through extensive signaling crosstalk. Key regulatory molecules, including caspase-8, reactive oxygen species (ROS), nuclear factor-κB (NF-κB), and nuclear factor erythroid 2-related factor 2 (Nrf2), collectively modulate the dynamic balance among these pathways. Therefore, the multidimensional interplay and spatiotemporal dynamics of programmed cell death constitute a fundamental pathological basis of flap I/R injury. This review systematically summarizes the latest advances in the mechanisms and interactions of various programmed cell death pathways in flap I/R injury, aiming to elucidate the underlying regulatory network. These insights may provide novel theoretical foundations for optimizing flap protection strategies, improving flap survival, and promoting tissue repair.

Objective To investigate the prognostic differences among pure urothelial carcinoma,squamous-differentiated urothelial carcinoma,and pure squamous cell carcinoma,so as to provide reference for postoperative risk stratification.Methods The clinical data of bladder cancer patients who visited the Department of Urology,Peking University First Hospital and underwent radical cystectomy during Jan.2005 and Jun.2024 were retrospectively analyzed.Patients were categorized into the pure urothelial carcinoma group(n=725),squamous-differentiated urothelial carcinoma group(n=189),and pure squamous cell carcinoma group(n=36).General characteristics,surgical approaches,pathological staging,muscle invasion status,and lymph node positivity were compared among the three groups.Kaplan-Meier survival curves were plotted,and prognostic differences among the groups were compared after 1∶1 propensity score matching between each pair.Independent risk factors of prognosis were identified with Cox multivariable regression.Results The pure squamous cell carcinoma group had a higher proportion of female patients(50.00％vs.25.24％vs.22.75％,P=0.002 4).Compared with the pure urothelial carcinoma group,the other two groups demonstrated higher proportions of stage Ⅲ+Ⅳ,higher rates of muscle invasion,and higher lymph node positivity,with the pure squamous cell carcinoma group showing the highest overall staging(69.45％vs.58.20％vs.29.38％,P＜0.000 1).Kaplan-Meier analysis showed that squamous-differentiated urothelial carcinoma group and pure squamous cell carcinoma group had significantly worse survival than the pure urothelial carcinoma group(P＜0.05),while the former two groups exhibited similar outcomes(P=0.85).After propensity score matching,postoperative survival curves among the three groups were not significantly different(all P＞0.05).In multivariable Cox proportional hazards models adjusting for confounders,prognosis was primarily associated with age,muscle invasion,and lymph-node positivity(P＜0.05);pathological subtype was not an independent predictor of postoperative survival.Conclusion In a cohort of non-metastatic patients undergoing radical cystectomy,pure squamous cell carcinoma and squamous-differentiated urothelial carcinoma presented with higher clinical and pathological staging and poorer unadjusted prognosis compared with pure urothelial carcinoma.However,postoperative survival did not differ significantly among the three groups in the same clinicopathological conditions.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.

Objective To observe impact factors of average glandular dose(AGD)of full field digital mammography(FFDM)and digital breast tomosynthesis(DBT)under breast Combo mode.Methods Totally 169 subjects who received FFDM and DBT under Combo mode were collected retrospectively.The breast compression thickness,tube voltage,tube current and AGD of FFDM and DBT exposure at cranio-caudal(CC)and mediolateral oblique(MLO)positions of bilateral breast were recorded.FFDM or DBT exposure conditions and AGD among different breast compression thickness and breast types were compared,and their correlations were analyzed.The impacts of breast compression thickness and breast density on AGD of FFDM or DBT were observed.Results There were significant differences in tube voltage,tube current and AGD of FFDM or DBT among different breast compression thicknesses(all P＜0.001).With the increase of breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT all increased(all P＜0.001).There were statistical differences in breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT among different types breast(all P＜0.001).Hierarchical analysis showed that,when breast compression thickness was＜50 mm,50-59 mm and＞59 mm respectively,statistical differences in AGDFFDM and AGDDBT among different breast types at CC or MLO positions were found(all P＜0.001).Under the same breast compression thickness,tube current,AGDFFDM and AGDDBT of FFDM or DBT all increased with the increase of breast density(all P＜0.001),while tube voltage of FFDM or DBT had no obvious change(all P＞0.05).Breast compression thickness and breast density were both independent factors of AGD of FFDM or DBT(all P＜0.001).Conclusion Under breast Combo mode,breast compression thickness and gland density both had impacts on AGD of FFDM or DBT,and the former had more significant impact on AGD.

Objective To observe impact factors of average glandular dose(AGD)of full field digital mammography(FFDM)and digital breast tomosynthesis(DBT)under breast Combo mode.Methods Totally 169 subjects who received FFDM and DBT under Combo mode were collected retrospectively.The breast compression thickness,tube voltage,tube current and AGD of FFDM and DBT exposure at cranio-caudal(CC)and mediolateral oblique(MLO)positions of bilateral breast were recorded.FFDM or DBT exposure conditions and AGD among different breast compression thickness and breast types were compared,and their correlations were analyzed.The impacts of breast compression thickness and breast density on AGD of FFDM or DBT were observed.Results There were significant differences in tube voltage,tube current and AGD of FFDM or DBT among different breast compression thicknesses(all P＜0.001).With the increase of breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT all increased(all P＜0.001).There were statistical differences in breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT among different types breast(all P＜0.001).Hierarchical analysis showed that,when breast compression thickness was＜50 mm,50-59 mm and＞59 mm respectively,statistical differences in AGDFFDM and AGDDBT among different breast types at CC or MLO positions were found(all P＜0.001).Under the same breast compression thickness,tube current,AGDFFDM and AGDDBT of FFDM or DBT all increased with the increase of breast density(all P＜0.001),while tube voltage of FFDM or DBT had no obvious change(all P＞0.05).Breast compression thickness and breast density were both independent factors of AGD of FFDM or DBT(all P＜0.001).Conclusion Under breast Combo mode,breast compression thickness and gland density both had impacts on AGD of FFDM or DBT,and the former had more significant impact on AGD.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Background and purpose:Colorectal cancer(CRC),ranking as the third most common malignant tumor globally,continues to pose a significant public health challenge due to its high incidence and mortality rates.Chemotherapy remains a cornerstone treatment for advanced CRC.However,its efficacy is often severely limited by the emergence of multidrug resistance(MDR).The drug efflux mediated by ABCB1 is a key mechanism underlying chemotherapeutic failure.Although the non-steroidal anti-inflammatory drug tepoxalin exhibits potential antitumor activity,it remains unclear whether it influences CRC progression and chemoresistance by targeting ABCB1.This study aimed to elucidate the mechanism by which tepoxalin suppresses CRC cell growth and reverses chemoresistance through the regulation of ABCB1.Methods:This study employed a multifaceted research strategy:Bioinformatics analysis was conducted using the DepMap,The Cancer Genome Atlas(TCGA),Genotype-Tissue Expression(GTEx)and Human Protein Atlas(HPA)databases to analyze ABCB1 expression profiles and drug sensitivity.In vitro,the cell counting kit-8(CCK-8)assay was used to assess cell proliferation and chemosensitivity,and IC50 values were calculated.A subcutaneous xenograft model in nude mice was established to evaluate the antitumor efficacy in vivo.The drug affinity responsive target stability(DARTS)assay was performed to validate the direct binding between tepoxalin and ABCB1 protein.Transcriptome sequencing and gene set enrichment analysis(GSEA)were utilized to identify downstream signaling pathways.Western blot and immunohistochemistry were applied to detect the expression changes of key proteins.The PI3K-Akt pathway inhibitor copanlisib was used for reverse validation.Statistical analysis was performed using SPSS 20.0 software,and graphs were generated using GraphPad Prism 8.0.1.A value of P＜0.05 was considered statistically significant.Results:ABCB1 was significantly overexpressed in CRC tissues and cell lines(P＜0.05).Cells with high ABCB1 expression exhibited increased sensitivity to tepoxalin(R=-0.323,P＜0.001).Tepoxalin directly bound to the ABCB1 protein and promoted its proteasomal degradation.In vivo,tepoxalin significantly inhibited the growth of xenograft tumors(P＜0.01)and downregulated the expression of ABCB1 and Ki-67 proliferation index in tumor tissues.Transcriptomic analysis revealed that tepoxalin suppressed the PI3K-Akt signaling pathway[GSEA,false discovery rate(FDR)＜0.05],leading to reduced transcriptional expression of ABCB1.This effect was replicated using the PI3K-Akt pathway inhibitor copanlisib.Ultimately,tepoxalin synergistically enhanced the efficacy of 5-fluorouracil(5-FU)through the aforementioned actions.Conclusion:Tepoxalin targets ABCB1 through a dual-track mechanism:it directly binds to and destabilizes the ABCB1 protein while simultaneously downregulating its transcriptional expression via inhibition of the PI3K-Akt pathway.This coordinated action can synergistically inhibit CRC cell growth and effectively reverse chemoresistance,offering a novel potential therapeutic strategy for overcoming drug resistance in CRC.

In recent decades,the incidence of human papillomavirus(HPV)-associated oropharyngeal squamous cell carcinoma(OPSCC)has shown a marked increase.Significant changes have also occurred in the OPSCC diagnosis and treatment paradigm.Deter-mining HPV status prior to treatment is now essential,and radiotherapy/chemotherapy,immunotherapy,and minimally invasive surgical techniques have progressively emerged as key modalities for managing OPSCC.However,alongside these paradigm shifts,a comprehen-sive technical consensus guiding the entire diagnostic and therapeutic process for OPSCC patients is currently lacking.Given China's large population base and the rising incidence of OPSCC,an expert panel convened to develop a clinical technical consensus on OPSCC diagno-sis and management tailored to China's specific context.This consensus aims to further enhance and standardize understanding of OPSCC management techniques among relevant healthcare professionals.

Nanchang University and Queen Mary University of London have integrated their educational and teaching advantageous resources to establish a Sino-foreign cooperative clinical medicine program in China. The program awards the degrees of Bachelor of Science in Biomedical Sciences and Bachelor of Clinical Medicine, aiming to cultivate well-rounded medical talents with both clinical and scientific research capabilities and an international perspective. By introducing biomedical courses and integrating them with basic medical courses, the program emphasizes basic knowledge, practical training, active learning, and the cultivation of scientific research skills and critical thinking ability. The evaluation parameters include academic output, innovation competitions, and the number of students pursuing graduate education. The results showed substantial increases in the number of SCI academic articles published by students in this program, the number of awards in innovation competitions, and the number of students pursuing graduate education. This program is a new attempt in the reform of medical education in China.

Objective This study aimed to investigate the prognostic impact of different subtypes of metastatic renal cell carcinoma(mRCC)and establish corresponding predictive models using the Surveillance,Epidemiology,and End Results(SEER)database.Methods Clinical data of 2595 patients diagnosed with mRCC from 2010 to 2015 were extracted from the SEER database,including age,gender,race,tumor size,and metastatic sites.Patients were divided into clear cell renal cell carcinoma(ccRCC)group and non-clear cell renal cell carcinoma(non-ccRCC)group.Firstly,Kaplan-Meier survival analysis was performed for both groups,followed by uni-variate and multivariate COX regression analysis.Based on the results of univariate analysis,common factors affecting prognosis were de-termined.Combining the results of multivariate analysis,prognostic nomograms were established for ccRCC group and non-ccRCC group respectively,and the performance of the models was evaluated.Results The median overall survival(OS)of ccRCC group and non-ccRCC group were 18months and 11 months respectively.Univariate analysis indicated that age,T stage,bone metastasis,liver metasta-sis,and log odds of positive lymph nodes(LODDS)were common prognostic factors for different subtypes of mRCC patients.In addition,gender,tumor differentiation degree,whether receiving radiotherapy or chemotherapy,marital status,tumor size,N stage,lung metastasis and brain metastasis were also found to be associated with prognosis in ccRCC group.The OS nomogram model for ccRCC group had good predictive performance while the model for non-ccRCC group had poor performance,which might be related to the small sample size in this group.Conclusion Prognostic factors for different subtypes of mRCC are both homogeneous and heterogeneous.The prognostic pre-diction model established in this study can provide individualized treatment decision support for clinicians,thereby potentially improving patient prognosis.