Cirrhotic portal hypertension is a clinical syndrome caused by persistently elevated portal venous pressure due to liver cirrhosis and can lead to a series of complications， among which esophagogastric variceal bleeding has become one of the most severe complications due to sudden onset and a high mortality rate. Since the release of Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension （2019 edition）， significant advances have been achieved in this field in China and globally. In order to formulate an expert consensus aligned with the situation of China， Chinese Society of Surgery， Chinese Medical Association organized and compiled Expert Consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension （2025 edition）. This article elaborates on the key updates in the new edition and explores the major differences between the old and new editions， in order to enhance the understanding of the new edition among clinicians and provide a reference for clinicians in clinical work.

Objective To investigate the safety and efficacy of mechanical thrombectomy combined with umbilical cord blood mononuclear cell microtransplantation in the treatment of patients with acute ischemic stroke due to large vessel occlusion. Methods A prospective study was conducted among 61 patients with acute ischemic stroke due to large vessel occlusion in the anterior intracranial circulation who underwent mechanical thrombectomy in our hospital from February 2021 to February 2023， and they were randomly divided into experimental group and control group. The patients in the experimental group underwent mechanical thrombectomy combined with umbilical cord blood mononuclear cell microtransplantation， while those in the control group underwent mechanical thrombectomy alone， and there was no difference in conventional drug treatment between the two groups. The Mann-Whitney U test， chi-square test， and logistic regression analysis were used， with P<0.05 indicating statistical significance. Results There were no significant abnormalities in blood tests and imaging findings in either group at 90 days and 6 months after treatment. There was no significant difference in the degree of neurological deficit （NIHSS score） between the two groups before surgery and on days 1，3，7， and 30 after surgery （P>0.05）. The experimental group had a higher overall response rate （the proportion of patients with an mRS score of ≤2 on day 90 after surgery） than the control group [41.4% （12/29） vs 32.2% （10/31）， P>0.05]. There was no significant difference in limb motor function [Fugl-Meyer Assessment （FMA） score] between the two groups before surgery（P>0.05）， and the experimental group had a better FMA score than the control group on day 90 after surgery（P<0.05）. Conclusion Mechanical thrombectomy combined with umbilical cord blood mononuclear cell microtransplantation can effectively improve the long-term functional prognosis of patients， with a favorable safety profile.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective:To establish the model of acute kidney injury (AKI), search for more sensitive and reliable biomarkers.Methods:In April 2018, 100 male Wister rats aged 6 to 8 weeks were selected and randomly divided into experimental group (n=90) and control group (n=10). The experimental group was given Diachalefin (140 mg/kg body weight) by intragastric administration, while the control group was given saline intragastric administration. Ten rats in the experimental group were killed 0.5 h, 2 h, 6 h, 24 h, 3 d, 7 d, 14 d, 21 d and 28 d after intragastric administration, respectively. Serum creatinine (Cr), urea nitrogen (BUN) and uric acid (UA) were detected by automatic biochemical analyzer with 5 ml of blood from inferior vena cava puncture. Serum neutrophil gelatinase-associated lipid carrier protein (NGAL), kidney damage molecule-1 (KIM-1) and transforming growth factor-β1 (TGF-β1) levels were determined by enzyme-linked immunosorbent assay (ELISA). The data between groups were compared using two independent sample t tests.Results:The renal tissue structure of rats in the control group was not significantly abnormal, while the renal tissue cell damage of rats in the experimental group was obvious, which gradually increased with the extension of time in the early stage, and gradually recovered in the later stage. UA in experimental group reached its peak at 24 h after exposure and was still higher than that in control group at 14 d ( P<0.05), Cr reached its peak at 7 d, and then gradually decreased, and there was no statistical significance between experimental group and control group at 28 d ( P>0.05). BUN increased at 6 h after exposure and reached the highest value at 7~14 d ( P<0.05). Blood NGAL increased at 0.5 h after exposure, reached its peak at 24 h, continued to increase at 3, 7 and 14 days ( P<0.05), and began to decrease at 21 days. KIM-1 began to increase at 0.5 h, continued to peak at 24 h, 3 and 7 d after exposure, and began to decrease at 14 d, but it was still higher than that in control group ( P<0.05). There was no significant difference in TGF-β1 at each time point ( P>0.05). Western blot assay results: Compared with control group, there was no significant difference in the expression level of TGF-β1 in kidney tissue of experimental group ( P>0.05). NGAL increased gradually from 2 h and was higher at 7 and 14 d, with statistical significance ( P<0.05). KIM-1 increased at 2 h, decreased at 6 and 24 h, and increased again at 3 and 7 d. Conclusion:NGAL and KIM-1 can be used as early diagnostic biomarkers for diquat-induced acute kidney injury.

Objective To evaluate the impact of different methods of harvesting palatal connective tissue on patients' postoperative pain at the palatal donor site.Methods A total of 30 patients were included.The control group was de-epithelialized free gingival graft technique group,and the experimental group was the single-incision technique group.The keratinized gingival width of the recipient site,number of vertical incisions,number of teeth,donor site mucosa thickness,graft width,graft length,graft thickness,operation time and amount of anesthetic were recorded.The postoperative quality of life rating scale and visual analog scale were completed and statistical analysiswas performedon the results by SPSS 26.0.Results The postoperative quality of life score of the experimental group was significantly lower than that of the control group,and there was no significant difference in the total VAS score of the donor site.In terms of the total postoperative pain level after mucogingival surgery,the number of vertical incisions and graft thickness were positively correlated with the pain.Palate mucosal thickness was negatively correlated with postoperative pain levels.Conclusion In mucogingi-val surgery,the degree of postoperative pain in the donor palatal region of the patient is independent of the choice of de-epithelialized free gingival graft technique or single-incision technique to obtain subepithelial connective tissue.The surgeon should also give compre-hensive considerationsto the anatomical factors of the patient's donor site,surgical technical level and experience,and aesthetic require-ments when selecting the surgical method.

Objective To evaluate the impact of different methods of harvesting palatal connective tissue on patients' postoperative pain at the palatal donor site.Methods A total of 30 patients were included.The control group was de-epithelialized free gingival graft technique group,and the experimental group was the single-incision technique group.The keratinized gingival width of the recipient site,number of vertical incisions,number of teeth,donor site mucosa thickness,graft width,graft length,graft thickness,operation time and amount of anesthetic were recorded.The postoperative quality of life rating scale and visual analog scale were completed and statistical analysiswas performedon the results by SPSS 26.0.Results The postoperative quality of life score of the experimental group was significantly lower than that of the control group,and there was no significant difference in the total VAS score of the donor site.In terms of the total postoperative pain level after mucogingival surgery,the number of vertical incisions and graft thickness were positively correlated with the pain.Palate mucosal thickness was negatively correlated with postoperative pain levels.Conclusion In mucogingi-val surgery,the degree of postoperative pain in the donor palatal region of the patient is independent of the choice of de-epithelialized free gingival graft technique or single-incision technique to obtain subepithelial connective tissue.The surgeon should also give compre-hensive considerationsto the anatomical factors of the patient's donor site,surgical technical level and experience,and aesthetic require-ments when selecting the surgical method.

Objective:To establish the model of acute kidney injury (AKI), search for more sensitive and reliable biomarkers.Methods:In April 2018, 100 male Wister rats aged 6 to 8 weeks were selected and randomly divided into experimental group (n=90) and control group (n=10). The experimental group was given Diachalefin (140 mg/kg body weight) by intragastric administration, while the control group was given saline intragastric administration. Ten rats in the experimental group were killed 0.5 h, 2 h, 6 h, 24 h, 3 d, 7 d, 14 d, 21 d and 28 d after intragastric administration, respectively. Serum creatinine (Cr), urea nitrogen (BUN) and uric acid (UA) were detected by automatic biochemical analyzer with 5 ml of blood from inferior vena cava puncture. Serum neutrophil gelatinase-associated lipid carrier protein (NGAL), kidney damage molecule-1 (KIM-1) and transforming growth factor-β1 (TGF-β1) levels were determined by enzyme-linked immunosorbent assay (ELISA). The data between groups were compared using two independent sample t tests.Results:The renal tissue structure of rats in the control group was not significantly abnormal, while the renal tissue cell damage of rats in the experimental group was obvious, which gradually increased with the extension of time in the early stage, and gradually recovered in the later stage. UA in experimental group reached its peak at 24 h after exposure and was still higher than that in control group at 14 d ( P<0.05), Cr reached its peak at 7 d, and then gradually decreased, and there was no statistical significance between experimental group and control group at 28 d ( P>0.05). BUN increased at 6 h after exposure and reached the highest value at 7~14 d ( P<0.05). Blood NGAL increased at 0.5 h after exposure, reached its peak at 24 h, continued to increase at 3, 7 and 14 days ( P<0.05), and began to decrease at 21 days. KIM-1 began to increase at 0.5 h, continued to peak at 24 h, 3 and 7 d after exposure, and began to decrease at 14 d, but it was still higher than that in control group ( P<0.05). There was no significant difference in TGF-β1 at each time point ( P>0.05). Western blot assay results: Compared with control group, there was no significant difference in the expression level of TGF-β1 in kidney tissue of experimental group ( P>0.05). NGAL increased gradually from 2 h and was higher at 7 and 14 d, with statistical significance ( P<0.05). KIM-1 increased at 2 h, decreased at 6 and 24 h, and increased again at 3 and 7 d. Conclusion:NGAL and KIM-1 can be used as early diagnostic biomarkers for diquat-induced acute kidney injury.

Objective:To analyze the effects of preoperative renin-angiotensin system inhibitor (RASi) use on postoperative renal function and short-term and long-term prognosis in patients undergoing coronary artery bypass grafting (CABG).Methods:A retrospective cohort analysis was conducted. Based on the registration study data of CABG patients at Fuwai Hospital, Chinese Academy of Medical Sciences, the clinical data of adult patients who underwent CABG from January 2013 to December 2022 were analyzed. Preoperative use of RASi (PreRASi) was defined as receiving RASi treatment within 48 hours before surgery. Postoperative acute kidney injury (AKI) was defined using the diagnostic criteria of Kidney Disease: Improving Global Outcomes (KDIGO). Demographic characteristics, past medical history, comorbidities, preoperative medication, preoperative laboratory test results, specific information on surgical procedures, and postoperative treatment related data were extracted. The primary endpoint was the incidence of postoperative AKI. Secondary endpoints included in-hospital all-cause mortality and all-cause mortality within the longest follow-up period. According to whether RASi was used before surgery, the patients were divided into PreRASi group and No-PreRASi group. The baseline data of the two groups were balanced by propensity score matching (PSM). Logistic regression model and Cox proportional hazards model were used to assess the correlation between PreRASi and postoperative AKI and clinical outcomes, and analyze the subgroups of hypertension and heart failure with preserved ejection fraction (HFpEF) in the cohort.Results:A total of 33?884 patients who underwent CABG were included, with a mean follow-up duration of (3.0±2.4) years and the longest follow-up duration up to 8.5 years. There were 9?128 cases (26.94%) in the PreRASi group and 24?756 cases (73.06%) in the No-PreRASi group. The incidence of postoperative AKI in the PreRASi group was 47.61% (4?346 cases), compared to 52.37% (12?964 cases) in the No-PreRASi group. Two groups were matched with 5?094 patients each. Compared to the No-PreRASi group, both before and after PSM, PreRASi was associated with a reduction of risk of postoperative AKI [before PSM: odds ratio ( OR) = 0.834, 95% confidence interval (95% CI) was 0.793-0.877, P < 0.001; after PSM: OR = 0.875, 95% CI was 0.808-0.948, P = 0.001]. Subgroup analysis of hypertensive and HFpEF patients showed that PreRASi was associated with a decreased risk of postoperative AKI before and after PSM. The in-hospital mortality for the PreRASi and No-PreRASi groups were 0.61% (56 cases) and 0.49% (121 cases), respectively. Analysis of the overall cohort and subgroups with hypertension and HFpEF showed no correlation between PreRASi and in-hospital mortality or longest follow-up mortality. Conclusion:The perioperative use of RASi can reduce the risk of postoperative AKI in patients undergoing CABG, has a certain renal protective effect, but is not associated with short-term or long-term death risk after surgery.

Endo-periodontal lesions(EPLs)involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms,including unique anatomical and microbiological characteristics and multiple contributing factors.This etiological complexity leads to difficulties in determining patient prognosis,posing great challenges in clinical practice.Furthermore,EPL-affected teeth require multidisciplinary therapy,including periodontal therapy,endodontic therapy and others,but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy.By compiling the most recent findings on the etiology,pathogenesis,clinical characteristics,diagnosis,therapy,and prognosis of EPL-affected teeth,this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

Objective·To observe the effects of gingipain extract on the biological characteristics of oral squamous cell carcinoma cell HN6.Methods·The HN6 cell line was selected,cultivated,and divided into different groups based on the protein concentration of gingipain extract from Porphyromonas gingivalis:control group,3.125 μg/mL group,6.25 μg/mL group,12.5 μg/mL group,25 μg/mL group,50 μg/mL group,and 100 μg/mL group.After 24 and 48 h of cultivation,CCK-8 assay was used to detect the effects of gingipain extract on HN6 cell proliferation activity.Subsequent experiments were divided into control group,25 μg/mL group and 50 μg/mL group.Flow cytometry was used to examine the effects of gingipain extract on cell cycle.Scratch assay and Transwell assay were performed to evaluate cell migration and invasion ability.Real-time PCR(RT-PCR)and Western blotting were used to measure the expression of E-cadherin and N-cadherin proteins and genes in cells.Results·Stimulated with gingipain extract for 24 h,the HN6 cells showed significantly increased proliferation activity in the 25 μg/mL(P=0.025),50 μg/mL(P=0.000),and 100 μg/mL(P=0.049)groups compared to the control group.After 48 h,proliferation activity was significantly higher in the 6.25 μg/mL(P=0.024),12.5 μg/mL(P=0.006),25 μg/mL(P=0.000),50 μg/mL(P=0.000),and 100 μg/mL(P=0.000)groups compared to the control group.Cell cycle analysis revealed that,after 24 h of gingipain stimulation,the proportion of HN6 cells in the G1 phase decreased,while the proportion in the S+G2 phase significantly increased compared to the control group(25 μg/mL group:P=0.024;50 μg/mL group:P=0.001).Compared to the control group,the scratch assay demonstrated a significant increase in the percentage of scratch closure as the concentration of gingipain extract increased(P=0.001).Compared to the control group,the Transwell invasion assay showed a significant increase in the number of cells passing through the bottom of the chamber as the concentration of gingipain extract increased.RT-PCR and Western blotting results indicated that as the concentration of gingipain extract increased,the expression levels of N-cadherin mRNA and protein in HN6 cells significantly increased,while the expression levels of E-cadherin mRNA and protein significantly decreased compared to the control group.Conclusion·Gingipain extract could promote proliferation,migration,and invasion of oral squamous cell carcinoma HN6 cells.