Objective To compare the reflux characteristics between reflux esophagitis (RE) patients with Los Angeles (LA) classification grade A and grades B/C based on esophageal pH-impedance monitoring results. Methods A total of 74 RE patients at Zhongshan Hospital (Xiamen Branch), Fudan University from June 2021 to June 2024 were enrolled, and were divided into the LA-A group (n＝46) and the LA-B/C group (n＝28) based on the endoscopic diagnosis results. The general clinical data, symptom questionnaire score, and esophageal 24-hour pH-impedance monitoring results were compared between the two groups. Results There were no statistically significant differences in demographic data and the response rate of acid suppression therapy between the two groups. 24-hour esophageal pH-impedance monitoring results showed that there were no statistically significant differences in upright, supine, and total reflux indices, including reflux episodes, acid exposure time (AET), AET percentage (AET%), long acid reflux episodes, longest reflux duration, and total DeMeester score between the two groups. There were no statistically significant differences in distal reflux episodes, proximal reflux episodes, and high reflux (acid, weak acid, and non-acidic reflux) episodes, mean nocturnal baseline impedance (MNBI) between the two groups. The rates of pathological reflux (AET%≥6%) in LA-A group and LA-B/C group were 67.4% and 71.4%, respectively; there were no statistically significant differences in the ratio of AET% composition and the count of impedance reflux exceeding 80 during 24 h between the two groups. Conclusions LA-A grade RE based on the endoscopic diagnosis facilitates the identification of gastroesophageal reflux disease in the Chinese population

BACKGROUND:The research of dental stem cells in the fields of regenerative medicine and tissue engineering has been deepening,bringing hope for the repair of tooth-related tissues and the treatment of systemic diseases.However,there is a lack of systematic research and analysis on the biological characteristics of dental stem cells in different age groups. OBJECTIVE:To explore the biological characteristics of the human deciduous tooth and permanent tooth pulp stem cells cultured in umbilical cord blood platelet lysate to provide a reliable basis for human platelet lysates to replace fetal bovine serum. METHODS:The pulp tissues of deciduous teeth,juvenile permanent teeth and adult permanent teeth were taken out and cultured in DMEM/F-12 medium supplemented with 10%fetal bovine serum or different concentrations(5%,10%and 15%)of human platelet lysates.Cell proliferation in the four groups was detected by cytometry.The optimal concentration of human platelet lysates was selected for subsequent experiments.Under the optimal concentration of human platelet lysates,human deciduous tooth and juvenile and adult permanent tooth pulp stem cells were cultured in vitro.The cell growth status was observed under the microscope.The specific antigen on the cell surface was detected by flow cytometry.The cell proliferation ability was tested by the cell counting method and CCK-8 assay.The cell differentiation ability in vitro was observed by a three-line differentiation assay. RESULTS AND CONCLUSION:(1)The cell proliferation rate of the 10%human platelet lysate group was the highest.(2)In all three groups,fusiform fibrous cells grew and expanded from around the tissue block.There was no significant difference between deciduous teeth and juvenile permanent tooth cells,but the adult permanent tooth cells were larger than the deciduous and juvenile permanent tooth cells of the same generation.(3)The results of flow cytometry showed that deciduous teeth,juvenile permanent teeth and adult permanent teeth conformed to the phenotypic characteristics of mesenchymal stem cells.(4)The proliferative capacity of adult permanent dental pulp stem cells was significantly lower than those of deciduous teeth and juvenile permanent dental pulp stem cells(P<0.01).(5)mRNA expressions of osteoblast-related genes alkaline phosphatase and bone morphogenetic protein 2,lipoprotein lipase and peroxisome proliferator-activated receptor γ2,mRNA expressions of chondroblast related gene type II collagen α1 and cartilage oligomeric matrix protein in adult pulp stem cells of permanent teeth were significantly lower than those of deciduous teeth and juvenile permanent teeth pulp stem cells(P<0.01).(6)Compared with adult dental pulp stem cells,human deciduous teeth and juvenile permanent teeth dental pulp stem cells have the stronger proliferative capacity and multidirectional differentiation potential,and are more suitable for clinical research and disease treatment.

BACKGROUND:Due to the very limited ability of articular cartilage to repair itself,articular cartilage defects caused by natural degeneration or trauma often cannot be repaired on their own,which triggers or aggravates osteoarthritis and even leads to severe disability.Therefore,the repair treatment after articular cartilage injury has become an urgent clinical problem. OBJECTIVE:To summarize the hot research topics and development trends in the field of articular cartilage repair using bibliometric analysis. METHODS:Literature related to articular cartilage repair was searched from the Web of Science Core Collection from 2000 to 2023,and bibliometric and visualization analyses were carried out using VOSviewer,Citespeace and Bibliometrix R-package. RESULTS AND CONCLUSION:The annual publication volume in the field of articular cartilage repair shows an overall increasing trend,with the United States,China,and Germany being the top three countries in terms of publication volume,and the research institutions focus on universities and hospitals,with Harvard University,New York Hospital for Special Surgery,and Shanghai Jiao Tong University being the top three institutions in terms of publication volume.AMERICAN JOURNAL OF SPORTS MEDICINE is the journal that publishes the most research literature in the field,and BIOMATERIALS is the journal with the highest number of citations in the field."Injectable hydrogels for cartilage and bone tissue engineering"is the most cited document published in the last decade,and the author with the most publications is Madry Henning,an active author in the field.The active authors in this field have formed a number of stable research teams with each other,and the cooperation between different teams needs to be further strengthened.Intra-articular injections,high tibial osteotomies,hydrogels,drug delivery,inflammation,cartilage regeneration,and scaffolds are the current hot topics of research in this field,and the application of 3D printing technology,bio-inks,silk proteins,injectable hydrogels,and exosomes in articular cartilage repair may be the frontier of research in this field.Integrating various innovative technologies and methods for more effective,durable and functional cartilage tissue regeneration and repair,and facilitating the clinical translation of the relevant technologies and methods by conducting more high-quality clinical studies may be the future research trend in this field.

Aristolochic acid (AA), extracted from Aristolochiaceae plants, plays an essential role in traditional herbal medicines and is used for different diseases. However, AA has been found to be nephrotoxic and is known to cause aristolochic acid nephropathy (AAN).AA-induced acute kidney injury (AKI) is a syndrome in AAN with a high morbidity that manifests mitochondrial damage as a key part of its pathological progression. Melatonin primarily serves as a mitochondria-targeted antioxidant. However, its mitochondrial protective role in AA-induced AKI is barely reported. In this study, mice were administrated 2.5 mg/kg AA to induce AKI. Melatonin reduced the increase in Upro and Scr and attenuated the necrosis and atrophy of renal proximal tubules in mice exposed to AA. Melatonin suppressed ROS generation, MDA levels and iNOS expression and increased SOD activities in vivo and in vitro. Intriguingly, the in vivo study revealed that melatonin decreased mitochondrial fragmentation in renal proximal tubular cells and increased ATP levels in kidney tissues in response to AA. In vitro, melatonin restored the mitochondrial membrane potential (MMP) in NRK-52E and HK-2 cells and led to an elevation in ATP levels. Confocal immunofluorescence data showed that puncta containing Mito-tracker and GFP-LC3A/B were reduced, thereby impeding the mitophagy of tubular epithelial cells. Furthermore, melatonin decreased LC3A/B-II expression and increased p62 expression. The apoptosis of tubular epithelial cells induced by AA was decreased. Therefore, our findings revealed that melatonin could prevent AA-induced AKI by attenuating mitochondrial damage, which may provide a potential therapeutic method for renal AA toxicity.

Objective:To evaluate the diagnostic value of neck imaging reporting and data systems (NI-RADS) based on MRI in extracavity local recurrent nasopharyngeal carcinoma (ELRNPC) and posttreatment changes (PTC).Methods:From April 2015 to September 2020, 33 cases of ELRNPC and 37 cases of PTC confirmed by pathology or follow-up were retrospectively enrolled at Zhongshan City People′s Hospital. Two radiologists independently evaluated the conventional MRI findings using NI-RADS criteria in the first step, then evaluated with conventional MRI and diffusion weighted imaging (DWI) sequences in the second step. All images were re-evaluated by one senior radiologist in the same steps after three months. Inter- and intra-reader agreements were assessed with Cohen′s Kappa test. Receiver operating characteristic curves were generated to assess the diagnostic values of NI-RADS categories between ELRNPC and PTC. The area under the curve (AUC) was compared by Delong test.Results:Inter- and intra-reader agreements of Kappa value were 0.742 and 0.909 for conventional MRI and 0.807 and 0.934 for conventional MRI with DWI. In the differential diagnosis of ELRNPC and PTC, the AUC, sensitivity, and specificity of NI-RADS categories based on conventional MRI were 0.932 (95%CI 0.846-0.978), 87.9% (95%CI 71.8%-96.6%), 94.6% (95%CI 81.8%-99.3%), and of NI-RADS based on conventional MRI with DWI were 0.991 (95%CI 0.933-1.000), 93.9% (95%CI 79.8%-99.3%), 97.3% (95%CI 85.8%-99.9%), respectively. There was a statistical difference between the AUCs of the two categories ( Z=2.20, P=0.028). Conclusions:For both the NI-RADS based on MRI with or without DWI, the differential diagnostic value of ELRNPC and PTC is excellent, while the consistency and diagnostic performance are more substantial when combined with DWI.

Objective:To investigate the pathogenesis, selection of endovascular treatment (EVT) strategies, and efficacies of acute vertebrobasilar artery occlusion (AVBAO) of different lesion sites.Methods:One hundred and five patients with AVBAO, admitted to and accepted EVT in our hospital from February 2017 to September 2019, were chosen in our study. The data of disease onset, imaging findings, EVT status, perioperative complications, and prognoses of these patients were collected. According to DSA results, the involved lesions were divided into 4 sites: the upper segment of basilar artery (BA), the middle segment of BA, the lower segment of BA, and the intracranial segment of vertebral artery (V4 segment), and patients with tandem lesions would be recorded as distal lesions. The risk factors, EVT strategies, and prognoses 90 d after follow-up (modified Rankin scale [mRS] scores≤3: good prognosis) were compared in patients with 4 different lesion sites.Results:There were significant differences in etiological classifications and percentage of patients combined with atrial fibrillation among patients with 4 different lesion sites ( P<0.05). There was significant difference in proportion of patients accepted emergency stent implantation among patients with 4 different lesion sites ( P<0.05): those with lesions at the V4 segment had the highest proportion of patients accepted emergency stent implantation (79.55%), followed by those with lesions at the lower segment of BA (50.00%). There was significant difference in EVT time (the time from arterial puncture to successful recanalization of occluded vessels) among patients with 4 different lesion sites ( P<0.05): the EVT time in patients with lesions at the middle segment of BA was the shortest (87.5 [58.5, 130.8] min), and the EVT time in patients with lesions at the lower segment of BA was the longest (115.0 [81.0, 163.0] min). There was no statistical difference among patients with different lesion sites in good prognosis rate 90 d after follow-up ( P>0.05). Conclusion:The pathogenesis of patients with different AVBAO lesion sites is different, so different EVT strategies should be adopted.

Objective:To assess the role of arterial spin labeling (ASL) in detecting the blood-brain barrier (BBB) permeability of cerebral infarction lesions in patients with anterior circulation subacute ischemic stroke (SIS), and to evaluate the value of ASL in predicting hemorrhagic transformation (HT) of SIS patients after endovascular recanalization.Methods:A prospective analysis was performed. Patients with anterior circulation SIS who received endovascular treatment (EVT) in our hospital from January 2021 to September 2021 were enrolled. At 24 h before EVT and immediately after EVT, MRI scans of ASL sequences and dynamic contrast-enhanced magnetic resonance (DCE) sequence were completed, and Xper CT was performed; accordingly, imaging typing was performed. Head CT scan was performed 24-48 h after EVT to observe HT; according to the presence or absence of HT, these patients were divided into HT group and non-HT group; the relative cerebral blood flow (rCBF) values of ASL sequence parameters, volume transfer constant (K trans) of DCE sequence parameters and the differences of ASL, DCE and Xper CT imaging types between the two groups were compared. The weighted Kappa coefficient was used to test the consistency among ASL, DCE and Xper CT imaging types. Results:Among 22 eligible patients, 5 patients occurred HT (5/22, 22.72%). As compared with those in the non-HT group (1.14±0.04; 0.032[0.024, 0.039]/min), patients in the HT group had significantly higher rCBF value (1.57±0.18) and K trans (0.072[0.0455, 0.117]/min, P<0.05). There were significant differences in the distribution of ASL, DCE and Xper CT imaging types between the two groups ( P<0.05); among them, 4 out of 6 patients with ASL imaging type III, 4 out of 6 patients with DCE imaging type III, and 4 out of 5 patients with Xper CT imaging type III had HT. ASL sequence and DCE sequence had a high consistency in the imaging types (Kappa coefficient=0.941, 95%CI: 0.862-1.020, P<0.001). Conclusion:ASL can effectively evaluate the BBB permeability of cerebral infarction lesions in patients with anterior circulation SIS; patients with ASL imaging type III have a relatively high risk of HT.

Objective:To assess the role of arterial spin labeling (ASL) in detecting the blood-brain barrier (BBB) permeability of cerebral infarction lesions in patients with anterior circulation subacute ischemic stroke (SIS), and to evaluate the value of ASL in predicting hemorrhagic transformation (HT) of SIS patients after endovascular recanalization.Methods:A prospective analysis was performed. Patients with anterior circulation SIS who received endovascular treatment (EVT) in our hospital from January 2021 to September 2021 were enrolled. At 24 h before EVT and immediately after EVT, MRI scans of ASL sequences and dynamic contrast-enhanced magnetic resonance (DCE) sequence were completed, and Xper CT was performed; accordingly, imaging typing was performed. Head CT scan was performed 24-48 h after EVT to observe HT; according to the presence or absence of HT, these patients were divided into HT group and non-HT group; the relative cerebral blood flow (rCBF) values of ASL sequence parameters, volume transfer constant (K trans) of DCE sequence parameters and the differences of ASL, DCE and Xper CT imaging types between the two groups were compared. The weighted Kappa coefficient was used to test the consistency among ASL, DCE and Xper CT imaging types. Results:Among 22 eligible patients, 5 patients occurred HT (5/22, 22.72%). As compared with those in the non-HT group (1.14±0.04; 0.032[0.024, 0.039]/min), patients in the HT group had significantly higher rCBF value (1.57±0.18) and K trans (0.072[0.0455, 0.117]/min, P<0.05). There were significant differences in the distribution of ASL, DCE and Xper CT imaging types between the two groups ( P<0.05); among them, 4 out of 6 patients with ASL imaging type III, 4 out of 6 patients with DCE imaging type III, and 4 out of 5 patients with Xper CT imaging type III had HT. ASL sequence and DCE sequence had a high consistency in the imaging types (Kappa coefficient=0.941, 95%CI: 0.862-1.020, P<0.001). Conclusion:ASL can effectively evaluate the BBB permeability of cerebral infarction lesions in patients with anterior circulation SIS; patients with ASL imaging type III have a relatively high risk of HT.

Objective:To investigate the efficacy and safety of endovascular recanalization treatment for acute vertebral basilar artery occlusion (AVBAO) underlying intracranial atherosclerotic disease (ICAD) using a balloon-mounted stent.Methods:A total of 16 cases of consecutive AVBAO patients who underwent endovascular treatment with the balloon-mounted stent within 24 h after onset were retrospectively enrolled in Henan Provincial People′s Hospital from February 2017 to August 2019. And the recanalization rate, operation-related complications, symptomatic intracranial hemorrhage, the improvement of 1 week National Institutes of Health Stroke Scale (NIHSS) score and 3 months modified Rankin Scale (mRS) after treatment were recorded.Results:In all of the 16 patients, 4 patients underwent direct stenting angioplasty, 12 patients received salvage stenting. Stent placement was successful in all 16 patients. Balloon-mounted stent were implanted in basilar artery of 4 cases, in intracranial segment of vertebral artery of 8 cases, and in origination segment of vertebral artery of 4 cases. Recanalization was successful (thrombolysis in cerebral infarction grade 2b and 3) in 15 patients. The time between arterial puncture and recanalization was 79.0 (72.3, 109.3) min. One patient experienced distal thrombosis during surgery. Two patients suffered symptomatic intracranial hemorrhage within 48 h after surgery. The scores of the NIHSS were improved more than 4 points at 1 week after operation in 8 patients. At 3 months follow-up, 9 patients had a good outcome (mRS 0-3 points) and 4 patients died.Conclusion:Selective stenting angioplasty treatment with a balloon-mounted stent seems to be feasible and safe for AVBAO patients underlying ICAD.

Objective:To explore the characteristics of high-density sign of flat-panel CT (FDCT) after endovascular treatment in patients with acute ischemic stroke (AIS) in the anterior circulation of large vessels and their relation with hemorrhagic transformation.Methods:Seventy-eight patients with AIS in the anterior circulation of large vessels accepted endovascular treatment in our hospital from March 2018 to June 2019 were chosen in our study. All patients underwent FDCT, and they were grouped according to the presence of local high-density sign and occurrence of hemorrhagic transformation. The baseline and clinical data of patients from high-density sign group and non-high-density sign group, and from hemorrhagic transformation group and non-hemorrhagic transformation group were compared and analyzed. The correlation between high-density sign and hemorrhagic transformation was analyzed. The morphological characteristics and distribution of FDCT high-density sign in patients from high-density sign group were analyzed, and univariate and multivariate Logistic regression analyses were used to screen the influencing factors for post-operative hemorrhagic transformation in patients from the high-density sign group.Results:(1) The incidence of high-density sign in these patients after endovascular treatment was 41.0% (32/78); as compared with patients in the non-high-density sign group, patients in the high-density sign group had significantly higher rate of hemorrhagic transformation (6.5% vs. 53.1%, P<0.05) and significantly higher 3-month modified Rankin scale (mRS) scores (2.0 [1.0, 3.0] vs. 3.9 [3.0, 5.3], P<0.05). (2) The incidence of hemorrhagic transformation after endovascular treatment was 25.6% (20/78); as compared with those in the non-hemorrhagic transformation group, patients in the hemorrhage transformation group had statistically higher incidence of high-density sign in FDCT (31% vs. 70%, P<0.05); multivariate Logistic regression analysis showed that FDCT high density sign was an independent risk factor for hemorrhage transformation after endovascular treatment ( OR=1.823, 95%CI: 1.125-2.358, P=0.000). (3) In the 32 patients with FDCT high-density sign, 4 (12.5%), 13 (40.6%) and 7 (21.9%) had high-density sign in the cortex and subcortex, basal ganglia, and subarachnoid space, whose hemorrhagic transformation incidences were 75% (3/4), 53.8% (7/13), and 57.1% (4/7), respectively, and mean 3-month mRS scores were 4.5, 3.0 and 4.0, respectively; another 8 patients (25%) had endovascular FDCT high-density sign, whose hemorrhagic transformation incidence was 87.5% (7/8), and 3-month mRS scores were ≥4. (4) Multivariate Logistic regression analysis showed that the vascular opening time ≤6 h was a protective factor for hemorrhage transformation in patients with FDCT high-density sign ( OR=0.687, 95%CI: 0.193-0.936, P=0.044). Conclusions:In patients with AIS in the anterior circulation of large vessels accepted endovascular treatment, FDCT high-density sign indicates high risk of hemorrhage transformation and poor prognosis, especially in patients having high-density sign in the cerebral cortex, subcortical area and intravascular area. Minimizing the vascular opening time may reduce the risk of hemorrhagic transformation in patients with FDCT high-density sign.