Objective To comprehensively investigate the levels of exposure and distribution characteristics of trihalomethanes (THMs) in drinking water in Guangzhou City, and evaluate the health risks of different groups of children, adolescents and adults, and to provide data and evidence for protecting human health and promoting risk control of drinking water. Methods According to the technical requirements of the ^"Standards for Drinking Water Quality Testing Methods^" (GB/T 5750-2023), the concentration of THMs, including trichloromethane (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and tribromomethane (TBM) in drinking water in Guangzhou City from 2023-2024 were detected. The health risk model recommended by USEPA was used for risk assessment．Results TCM, BDCM and DBCM were detected in the factory water and terminal water, with TCM contributing the most. There was a statistically significant difference (P<0.05) between the wet and dry seasons, and the concentration of TCM in the wet season was higher than that in the dry season. Among the multiple exposure factors, the amount of exposure through drinking water intake was much greater than that through skin absorption. The carcinogenic risk index of THMs for children, adolescents, and adults was 22.0×10^-6, 12.2×10^-6, and 11.4×10^-6, respectively, while the non-carcinogenic risk was less than 1. Conclusion The exposure risks of THMs in children, adolescents, and adults is within an acceptable range, but monitoring needs to be strengthened, with a particular focus on children.

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.

ObjectiveTo investigate the mechanisms by which the combination of berberine （BBR） and baicalin （BAI） ameliorates type 2 diabetes mellitus （T2DM） due to internal accumulation of dampness-heat from the perspectives of gut microbiota and metabolomics. MethodsAntibiotics were used to induce pseudo-sterile mice. Thirty pseudo-sterile mice were randomized into a normal fecal microbiota transplantation group （n=10） and a T2DM （syndrome of internal accumulation of dampness-heat） fecal microbiota transplantation group （n=20）. The mice were then administrated with suspensions of fecal microbiota from healthy volunteers and a patient with T2DM due to internal accumulation of dampness-heat by gavage， respectively. Each mouse received 200 µL suspension every other day for a total of 15 times to reshape the gut microbiota. The T2DM model mice were then assigned into a model group （n=8） and a BBR-BAI group （n=11）. BBR was administrated at a dose of 200 mg·kg^-1， and BAI was administrated in a ratio of BBR-BAI 10∶1 based on preliminary research findings. The administration lasted for 8 consecutive weeks. Fasting blood glucose （FBG）， glycated hemoglobin （HbA1c）， insulin （INS）， triglycerides （TG）， total cholesterol （CHOL）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， aspartate aminotransferase （AST）， and alanine aminotransferase （ALT） levels were measured to evaluate the effects of the BBR-BAI combination on glucose and lipid metabolism and liver function in T2DM mice. Hematoxylin-eosin staining was employed to observe pathological changes in the colon tissue. The expression of claudin-1， zonula occludens-1 （ZO-1）， and occludin in the colon tissue was determined by Western blot. Real-time quantitative polymerase chain reaction（Real-time PCR） was employed to assess the levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6） in the colon tissue. The fecal microbiota composition and differential metabolites were analyzed by 16S rRNA sequencing and ultra-high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry （UPLC-Q-TOF-MS）， respectively. ResultsThe BBR-BAI combination lowered the FBG， HbA1c， and INS levels （P<0.05， P<0.01） and alleviated insulin resistance （P<0.01） in T2DM mice. Additionally， BBR-BAI elevated the levels of ZO-1， occludin， and claudin-1 （P<0.05， P<0.01） and down-regulated the expression levels of TNF-α， IL-1β， and IL-6 in the colon （P<0.05， P<0.01）. The results of 16S rRNA sequencing showed that BBR-BAI increased the relative abundance of Ligilactobacillus， Phascolarctobacterium， and Akkermansia （P<0.05）， while significantly decreasing the relative abundance of Alistipes， Odoribacter， and Colidextribacter （P<0.05）. UPLC-Q-TOF-MS identified 28 differential metabolites， which were primarily involved in arachidonic acid metabolism and α-linolenic acid metabolism. ConclusionBBR-BAI can ameliorate T2DM due to internal accumulation of dampness-heat by modulating the relative abundance of various bacterial genera in the gut microbiota and the expression of fecal metabolites.

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.

Traditional Chinese Medicine(TCM)emphasizes syndrome differentiation and treatment,characterized by"maintaining the prescription if effective"and"changing the prescription if ineffective".Traditional randomized controlled trials(RCTs)are inadequate for evaluating the efficacy of dynamic treatment adjustments.The Sequential Multiple Assignment Randomized Trial(SMART)is an emerging adaptive research design that incorporates randomization at multiple stages,allowing for adjustments in subsequent interventions based on treatment responses.This approach is suitable for evaluating dynamic treatment regimens while retaining the low bias risk of traditional RCTs,making it highly promising for clinical research in TCM.This paper summarizes recent methodological advancements in SMART design,including different sample size estimation and statistical analysis methods for primary effect objectives,embedded adaptive intervention objectives,and optimization objectives,along with providing corresponding operational software.Additionally,it offers considerations for applying SMART design in TCM research,such as the selection of disease types,interventions,decision points,tailoring variables,sample size calculation,statistical methods,the importance of pilot trials,ethical considerations,and limitations.The aim is to promote the exploration and practice of this method in the field of TCM,thereby contributing to the generation of high-quality evidence-based evidence for TCM.

Objective To analyze the correlation between SLC7A5 expression and clinicopathological features in breast cancer by bioinformatics,and to provide reference for the treatment and prognosis evaluation of breast cancer.Methods The expression of SLC7A5 in breast cancer was analyzed by bioinformatics in Timer2.0,The cancer genome atlas(TCGA),UALAN in gene expression profiling in-teractive analysis 2(GEPIA2)and human protein atlas(HPA).Human protein atlas(HPA)and other databases to obtain the expression characteristics of SLC7A5 in breast cancer.Western blot was used to detect the expression of SLC7A5gene in normal breast cells MCF-10A and breast cancer cell line MCF-7.the prognostic value of SLC7A5 in breast cancer was analyzed by using R software,and double-validated in Kaplan-Meier plotter and gene expression omnibus(GEO)databases.validation,as well as analyzing the correla-tion between its expression and different pathological features of breast cancer patients.The correlation between SLC7A5 and tumor muta-tion burden(TMB)and immunodetection point-related genes was analyzed using R language,and gene set enrichment analysis(GSEA)was performed,and the results were further visualized.Results The expression of SLC7A5 was significantly elevated in a variety of solid malignant tumors,including breast cancer,and the overall survival of breast cancer patients with high expression of SLC7 A5 was signifi-cantly shortened.The expression level of SLC7A5 in breast cancer was significantly correlated with estrogen receptor(ER),progesterone receptor(PR),lymph node metastasis,and molecular typing of breast cancer.The results showed that the expression of SLC7A5 in breast cancer was positively correlated with TMB(r=0.33,P＜0.001).The results of the immune checkpoint analysis showed that the expres-sion of SLC7 A5 was significantly correlated with the expression of programmed death-1(PD-1),cytotoxic T lymphocyte-associated protein 4(cytotoxic T lymphocyte-associated protein 4(cytotoxic T lymphocyte-associated protein 4),and the expression of SLC7A5 was significantly correlated with the expression of ER,PR,lymph node metastasis and molecular typing.cytotoxic T lymphocyte-associ-ated antigen 4(CTLA4)and B and T lymphocyte attenuator(BTLA).GSEA enrichment analysis showed that SLC7 A5 was mainly associ-ated with the interferon γ response(IFN-γ)related pathway.Conclusion SLC7A5 is up-regulated in breast cancer,and its expres-sion level correlates with poor prognosis,which may affect the progression of breast cancer by participating in the IFN-γ-related path-way to promote the expression of immune checkpoints,and it may be used as a biomarker for prognostic assessment and guidance of treat-ment for breast cancer patients.

Objective To explore the clinical application value of CT radiomics in predicting the grade of liver cancer and the prognosis after hepatectomy.Methods A retrospective selection was conducted on 385 liver cancer patients who underwent preoperative CT scans,and they were divided into training group(265 cases)and testing group(120 cases).The CT radiomics features were extracted and logistic regression was used to construct radiomics markers.A retrospective analysis was performed on 60 patients with liver cancer who underwent hepatectomy and regular follow-up.Results The area under the curve(AUC)of the radiomics signature in the train-ing group was 0.889.The AUC in the testing group was 0.941.For predicting prognosis after hepatectomy,the radiomics features with filter parameter of Filter 1.0 achieved optimal performance,with Dif.Scale1.2 being a good independent predictor of overall survival(OS).Conclusion CT radiomics has certain application value in predicting the grade of liver cancer and the prognosis after hepatectomy.

Objective:To investigate the correlation between the timing of minimally invasive puncture drainage and the outcome of patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region.Methods:Patients with HICH in the basal ganglia region underwent minimally invasive puncture and drainage at Hanchuan People's Hospital from January 2019 to September 2023 were selected. According to the timing of surgery, the patients were divided into onset to surgery time ≤12-hour group and >12-hour group. According to the modified Rankin Scale score at 90 days after onset, they were divided into a good outcome group (0-2) and a poor outcome group (>2). Multivariate logistic regression analysis was used to evaluate the independent influencing factors of functional outcome. Results:A total of 150 patients were included, with 78 males (52.00%), aged 53.15±4.35 years (range, 40-75 years). Eighty-six patients (57.33%) underwent surgery within 12 hours after onset, while 64 (42.67%) underwent surgery after 12 hours; 97 patients (64.67%) had good outcome, while 53 (35.33%) had poor outcome. Univariate analysis showed that compared with the onset to surgery time ≤12-hour group, the onset to surgery time >12-hour group had a longer time from onset to admission, a larger postoperative hematoma volume, longer hospitalization time, lower postoperative hematoma clearance rate, and a higher proportion of patients with poor outcome and deaths within 90 days (all P<0.05). Compared with the good outcome group, the poor outcome group had a longer time from onset to admission, higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, larger baseline and postoperative hematoma volumes, and a higher proportion of patients with onset to surgery time >12 hours. However, the postoperative hematoma clearance rate, baseline Glasgow Coma Scale (GCS) score, and the proportion of patients with baseline GCS score >8 was lower in the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio [ OR] 1.847, 95% confidence interval [ CI] 1.362-2.503; P=0.001) and the time from onset to surgery >12 hours (compared with ≤12 hours: OR 1.347, 95% CI 1.058-1.715; P=0.016) were the independent risk factors for poor outcome, while higher baseline GCS scores ( OR 0.723, 95% CI 0.558-0.937; P=0.006) and higher postoperative hematoma clearance rates ( OR 0.615, 95% CI 0.462-0.819; P=0.004) were the independent protective factors for good outcome. Conclusion:In patients with HICH in basal ganglia, it is ideal to perform minimally invasive puncture and drainage within 12 h after onset, and the postoperative recovery is relatively better.

Background and aims:Despite growing evidence linking pretransplant exposure to immune checkpoint inhibitors(ICIs)to increased allograft rejection risk after liver transplantation(LT),a lack of comparative studies to definitively establish the correlation between ICI exposure and adverse short-term outcomes after LT exists.This study aimed to analyze the impact of preoperative ICI exposure on short-term post-LT prognosis and allograft rejection risk.Methods:This retrospective cohort study included 121 recipients who underwent LT for hepatocellular carcinoma(HCC)between June 2019 and March 2023.The recipients were categorized into ICI(n=35)and non-ICI(n=86)exposure groups based on pretransplant ICI exposure.Demographics,clinical characteristics,and short-term outcomes were compared between the cohorts.Kaplan-Meier analysis evaluated the impact of ICI exposure on graft survival.Univariate and multivariate logistic regression models assessed the impact of patient characteristics on allograft rejection.Results:Recipients with or without ICI exposure exhibited comparable demographic baseline charac-teristics.The incidences of early allograft dysfunction and biliary and vascular complications were similar between both groups.Post-transplant infection incidence was 37.1％and 20.9％in the ICI and non-ICI groups,respectively(P=0.064).Allograft rejection rates were significantly higher in the ICI group than in the non-ICI group(22.9％vs.5.8％,P=0.015).The ICI group exhibited a higher 90-day post-transplant mortality rate than that of the non-ICI group(14.3％vs.2.3％,P=0.034).Logistic regression analyses demonstrated that allograft rejection independently correlated with 90-day post-transplant mortality,with ICI exposure being an independent risk factor for allograft rejection.In recipients with ICI exposure,a shorter interval between ICIs and LT(washout period)was significantly associated with a higher allograft rejection risk,with the optimal washout period identified as 21 days for predicting 90-day rejection-free survival(P=0.0001).Moreover,in recipients with allograft rejection,the peripheral CD4+/CD8+T cell ratio was much lower in the ICI group than in the non-ICI group.Conclusions:Pretransplant ICI exposure was an independent risk factor for allograft rejection and was significantly associated with 90-day post-transplant mortality after LT for HCC.A ≤21-day washout period was significantly associated with allograft rejection.Future multicenter studies with larger cohorts and prospective designs are essential to validate these findings,confirm causality,and establish standardized clinical guidelines for ICI use before transplantation.Trail registration:ClinicalTrials.gov NCT05913583.

Objective To evaluate the value of Bushen Qianggu Formula(BSQGF)applying in the treatment of patients with postmenopausal osteoporotic lumbar vertebral compression fracture(PM-OLVCF)of kidney deficiency and blood stasis type,and to observe its effects on lumbar function and sex hormone profiles.Methods A total of 162 patients with PM-OLVCF of kidney deficiency and blood stasis type treated at Haikou Traditional Chinese Medicine Hospital from February 2023 to June 2024 were collected.The patients were equally randomized into a control group and an observation group by using a table of random numbers,with 81 cases in each group.Both groups received percutaneous kyphoplasty and conventional western treatment with analgesics and antibiotics after the operation.Moreover,the control group received oral use of Alfacalcidol+Calcium Carbonate D3 Tablets postoperatively,while the observation group received additional BSQGF decoction orally for 12 weeks.Primary outcomes included Cobb angle,Oswestry Disability Index(ODI),traditional Chinese medicine(TCM)syndrome scores,bone mineral density(BMD),and serum levels of preadipocyte factor 1(Pref-1),thromboxane B2(TXB2),cyclooxygenase 2(COX-2),interleukin 6(IL-6),prostaglandin E2(PGE2),bone morphogenetic protein 2(BMP-2),and relative sex hormones.After treatment,therapeutic effects of patients in both groups were evaluated.Results(1)After 12 weeks of treatment,the total effective rate in the observation group was 93.83%(76/81)and that in the control group was 83.95%(68/81),and the observation group showed significantly better therapeutic efficacy than the control group(χ2=8.134,P＜0.05).(2)After 12 weeks of treatment,both groups showed reductions in Cobb angle,ODI scores,and total TCM syndrome scores compared to those before treatment(P＜0.05),and the observation group demonstrated significantly greater reductions than the control group(P＜0.05).(3)After 6 and 12 weeks of treatment,BMD values were increased in both groups compared to those before treatment(P＜0.05),and the observation group showed significantly greater increase of BMD at both 6 and 12 weeks than the control group(P＜0.05).(4)After 2 weeks of treatment,serum TXB2,COX-2,Pref-1,PGE2,and IL-6 levels were decreased while serum BMP-2 level was increased in both groups compared to those before treatment(P＜0.05),and the observation group showed significantly greater reductions in TXB2,COX-2,Pref-1,PGE2,and IL-6 levels and greater increase of BMP-2 level than the control group(P＜0.05).(5)After 12 weeks of treatment,the control group showed no significant changes in serum levels of luteinizing hormone(LH),estradiol(E2),or follicle-stimulating hormone(FSH)(P＞0.05),while the observation group showed decreased serum LH and FSH levels(P＜0.05)and increased serum E2 level(P＜0.05)compared to those before treatment.The intergroup comparison showed that the observation group had more improvements in all these sex hormone indicators than the control group(P＜0.05).Conclusion BSQGF combined with conventional western medicine therapy is effective on inhibiting the secretion of inflammatory factors,promoting fracture healing,and improving lumbar function in patients with PM-OLVCF of kidney deficiency and blood stasis type,and enhances the therapeutic efficacy compared to western medicine treatment alone.