Acute Gelsemium poisoning is a systemic disease primarily affecting the central nervous system and respiratory symptoms caused by the ingestion of a substantial amount of Gelsemium within a short period. It manifests as sudden onset and rapid progression, primarily caused by accidental ingestion due to misidentification, and posing significant health risks. The compilation of the Technical Plan for Emergency Health Response to Acute Gelsemium Poisoning describes in detail the specialized practice and technical requirements in the process of handling acute Gelsemium poisoning, including accident investigation and management, laboratory testing and identification, in-hospital treatment, and health monitoring. The guidelines clarify key procedures and requirements such as personal protection, investigation elements, etiology determination, medical rescue, and health education. The key to acute Gelsemium poisoning investigation lies in promptly identifying the toxin through exposure history, clinical manifestations, and sample testing. Because there is no specific antidote for Gelsemium poisoning, immediate removal from exposure, rapid elimination of the toxin, and respiratory monitoring are critical on-site rescue measures. Visual identification of food or herbal materials, followed by laboratory testing to determine Gelsemium alkaloids in samples is a rapid effective screening method. These guidelines offer a scientific, objective, and practical framework to support effective emergency responses to acute Gelsemium poisoning incidences.

ObjectiveTo investigate the clinicopathological features， diagnosis and treatment methods， and prognosis of gallbladder sarcomatoid carcinoma （GBSC）. MethodsA retrospective analysis was performed for the clinical data of 16 patients with GBSC who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2015 to April 2023， including general information， clinical manifestations， imaging features， pathological features， and treatment modality， and follow-up was performed for all patients. The Kaplan-Meier method was used to perform the survival analysis and plot the survival curve， and the Log-rank test was used for comparison between groups. ResultsAmong the 16 patients， there were 6 male patients and 10 female patients， with a mean age of 62.9±8.4 years. The main clinical manifestations were right upper abdominal pain in 13 patients （81.3%）， nausea in 5 patients （31.3%）， abdominal distension in 4 patients （25.0%）， poor appetite in 3 patients （18.8%）， weakness in 2 patients （12.5%）， fever in 2 patients （12.5%）， and jaundice in 1 patient （6.3%）， and 3 patients were asymptomatic and were found to have this disease by physical examination. Of all patients， 81.3% （13/16） were in the advanced stage （stage Ⅲ/Ⅳ） at the time of initial diagnosis. Histopathological examination showed that some cancer cells were spindle-shaped under the microscope， with marked nuclear division and noticeable heteromorphism. Immunohistochemistry showed a positive expression rate of 100% （16/16） for Vimentin， AE1/AE3， and CK8/18， and Ki-67 proliferation index was highly expressed in 81.3% （13/16） of the patients （≥50%）， with a median of 70% （range 20%‍ ‍—‍ ‍90%）. All 16 patients underwent surgical treatment， with radical surgery in 11 patients and palliative surgery in 5 patients， among whom 9 received R0 resection， 2 received R1 resection， and 5 received R2 resection， and 7 patients received adjuvant therapy after surgery. Effective follow-up was achieved for all 16 patients， with a follow-up time of 0.5‍ ‍—‍ ‍26.0 months and a median follow-up time of 11.0 months. By the end of follow-up， 2 patients survived and 14 patients died due to tumor recurrence or metastasis， with a median survival time of 10.0 months， and the 1- and 2-year cumulative survival rates after surgery were 31.3% and 8.3%， respectively. The prognostic analysis showed that TNM stage （χ²=6.727， P=0.009）， surgical approach （χ²=7.508， P=0.006）， margin condition （χ²=7.934， P=0.005）， and adjuvant therapy （χ²=4.608， P=0.032） were associated with the prognosis of patients. ConclusionThe clinical manifestations of GBSC lack specificity， and a confirmed diagnosis relies on immunohistochemical analysis. Most patients are in the advanced disease at the time of initial diagnosis and tend to have a poor prognosis. There are currently no targeted therapies for this disease， and radical surgery with negative margins and adjuvant therapy can improve the survival rate of patients.

Objective:To evaluate the effectiveness of Z-plasty combined with auricular cartilage grafting in the correction of cryptotia.Methods:A retrospective analysis was conducted on the clinical data of cryptotia patients who underwent Z-plasty combined with auricular cartilage grafting at the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from January 2020 to December 2023. The surgery consisted of five steps: design of the Z-plasty flap, harvesting of auricular cartilage from the conchal cavity, dissection and reshaping of the auricular cartilage, transplantation of auricular cartilage, and skin coverage with flap transfer. Early and late complications were recorded according to postoperative follow-up, and the external ear morphology was evaluated by both plastic surgeons and the patients’ guardians using a Likert 4-point scale (the higher the score, the better the auricular morphology). Normally distributed data were presented as Mean±SD.Results:A total of 32 patients were included in the study, comprising 23 males and 9 females, aged 5 to 14 years, with an average age of 7.3 years. Two children were lost to follow-up, and 30 completed long-term follow-up, with follow-up periods ranging from 6 to 24 months, averaging 9.3 months. Early complications included hematoma in 2 cases [6.3%(2/32)] and flap vascular compromise in 1 case[3.1%(1/32)]. Late complications primarily involved hypertrophic scars in 2 cases[6.7%(2/30)], with no recurrence of deformity. After the operation, the cranioauricular sulcus on the upper pole of the auricle were significantly deepened, and the patients could wear masks and glasses. The average score for the external ear morphology was 3.5±0.5 by plastic surgeons and 3.5±0.5 by patients.Conclusion:Z-plasty combined with auricular cartilage grafting provides satisfactory result in the correction of cryptotia, with few postoperative complications and high patient satisfaction, making it suitable for the treatment of cryptotia.

Ferroptosis is a new type of regulatory cell death and is mainly caused by changes in intracellular iron homeostasis due to various inducers,which promotes the occurrence of iron ion-dependent lipid peroxidation,thereby leading to the accumulation of toxic lipid peroxides and finally resulting in cell death.Hepatic ischemia-reperfusion injury is a common and serious complication after liver surgery,with the main mechanisms of anaerobic respiration,mitochondrial injury,oxidative stress response,inflammatory response,calcium overload,and microcirculation dysfunction.This article introduces the concepts and mechanisms of ferroptosis and hepatic ischemia-reperfusion injury and summarizes some related treatment strategies,so as to provide a reference for exploring new treatment methods for hepatic ischemia-reperfusion injury.

Objective:To investigate the characteristics of extracellular matrix vesicle mimetics prepared by mechanical extrusion and their effects on the cell viability and osteogenic differentiation potential of human periodontal ligament stem cells (PDLSC).Methods:PDLSC derived extracellular matrix vesicles were prepared by collagenase digestion, while the cell derived vesicle mimetics were simulated by mechanical extrusion. The obtained extracellular matrix vesicles and parental cell derived vesicle mimetics were divided into 4 groups: matrix vesicles derived from PDLSC cultured in basic medium for 7 days (PDLSC matrix vesicles, MVs), vesicle mimetics derived from PDLSC cultured in basic medium for 7 days (PDLSC vesicle mimetics, CVMs), matrix vesicles derived from PDLSC cultured in osteogenic inducing medium for 7 days (osteogenic-induced PDLSC matrix vesicles, O-MVs) and vesicle mimetics derived from PDLSC cultured in osteogenic inducing medium for 7 days (osteogenic-induced PDLSC vesicle mimetics, O-CVMs). Vesicles morphologies and sizes were observed by transmission electron microscopy and nanoparticle tracking analysis. Vesicles uptake was detected by immunofluorescence. With PDLSC as the control group, the effects of vesicles on the viability of PDLSC were detected by cell activity assay (cell counting kit-8), and the effects of vesicles on the osteogenic differentiation potential of PDLSC were detected by alizarin red staining and Western blotting.Results:Vesicles in MVs, O-MVs, CVMs and O-CVMs were all observed with a round structure (size 50-250 nm), and could be taken up by PDLSC without affecting the cell viability. Under osteogenic inducing conditions, PDLSC incubated with O-MVs or O-CVMs could produce more mineralized nodules than those in the control group (PDLSC). MVs, O-MVs, CVMs and O-CVMs could promote the expression of osteogenic-related proteins in PDLSC. PDLSC in group O-CVMs showed significant higher expressions of osteogenic-related proteins, including alkaline phosphatase (ALP) (1.571±0.348), osteopontin (OPN) (1.827±0.627) and osteocalcin (OCN) (1.798±0.537) compared to MVs (ALP: 1.156±0.170, OPN: 1.260±0.293, OCN: 1.286±0.302) ( P<0.05). Compared to CMVs-incubated PDLSC, O-CVMs-incubated PDLSC expressed more Runt-related transcription factor 2 (1.632±0.455 vs 1.176±0.128) and OPN (1.827±0.627 vs 1.428±0.427) ( P<0.05). Moreover, there was no significant difference in the expression levels of osteoblast-related proteins in PDLSC cultured with MVs, O-MVs and CVMs ( P>0.05). Conclusions:The vesicle mimetics prepared by mechanical extrusion method are similar in shape and size to the extracellular matrix vesicles. MVs, O-MVs, CVMs and O-CVMs do not affect the cell viability of PDLSC, and can promote the osteogenic differentiation potential of PDLSC to a certain extent.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Objective:To evaluate the effectiveness of Z-plasty combined with auricular cartilage grafting in the correction of cryptotia.Methods:A retrospective analysis was conducted on the clinical data of cryptotia patients who underwent Z-plasty combined with auricular cartilage grafting at the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from January 2020 to December 2023. The surgery consisted of five steps: design of the Z-plasty flap, harvesting of auricular cartilage from the conchal cavity, dissection and reshaping of the auricular cartilage, transplantation of auricular cartilage, and skin coverage with flap transfer. Early and late complications were recorded according to postoperative follow-up, and the external ear morphology was evaluated by both plastic surgeons and the patients’ guardians using a Likert 4-point scale (the higher the score, the better the auricular morphology). Normally distributed data were presented as Mean±SD.Results:A total of 32 patients were included in the study, comprising 23 males and 9 females, aged 5 to 14 years, with an average age of 7.3 years. Two children were lost to follow-up, and 30 completed long-term follow-up, with follow-up periods ranging from 6 to 24 months, averaging 9.3 months. Early complications included hematoma in 2 cases [6.3%(2/32)] and flap vascular compromise in 1 case[3.1%(1/32)]. Late complications primarily involved hypertrophic scars in 2 cases[6.7%(2/30)], with no recurrence of deformity. After the operation, the cranioauricular sulcus on the upper pole of the auricle were significantly deepened, and the patients could wear masks and glasses. The average score for the external ear morphology was 3.5±0.5 by plastic surgeons and 3.5±0.5 by patients.Conclusion:Z-plasty combined with auricular cartilage grafting provides satisfactory result in the correction of cryptotia, with few postoperative complications and high patient satisfaction, making it suitable for the treatment of cryptotia.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

The clinical demand for occlusal reconstruction increases rapidly with increasing number of patients who have lost their normal occlusion because of tooth wear and dentition defects.Occlusal reconstruction is a special type of restoration defined as a comprehensive restoration of the function of the stomatognathic system by reestablishing a uni-form and stable occlusal relationship between the upper and lower dentitions.Occlusal function analysis is an important part of occlusal reconstruction to achieve accurate restora-tion design and adjustment.Digital occlusal function analysis was conducted to monitor the movement of the mandible and obtain related data for the parameter design of occlusal reconstruction.Preoperative design,intraoper-ative adjustment,and postoperative verification were achieved,thereby improving the efficiency and accuracy of occlusal reconstruction.

Objective:To analyze the prognosis,clinicopathological characteristics,and genetic mutation features of patients with very low-and low-risk gastrointestinal stromal tumors(GISTs).Methods:A retrospective data collection of 433 patients with very low-and low-risk GISTs,diagnosed by pathology after surgical or endoscopic resection at Tianjin Medical University Cancer Institute&Hospital,was conduc-ted to analyze clinical pathology and prognosis.Results:Compared with low-risk GIST,a higher proportion of patients with very low-risk GIST had gastric GISTs,a Ki-67 index≤3%,and 0-1 mitotic indexes/5 mm2,whereas the proportion of patients with small intestinal GIST was low(all P<0.05).Genetic testing was performed in 118 patients,and there was no significant difference in the mutation types and KITmutation types between low-risk and very low-risk GISTs(all P>0.05).Patient follow-up was conducted on 87 very low-risk and 210 low-risk GIST pa-tients without other concurrent diseases,with a median follow-up of 86(27-158)months.None of the patients with very low-risk GISTs showed progression;three cases of low-risk GIST had recurrence or metastasis,with progression-free survival(PFS)ranging from 27 to 84 months.The mitotic indices of the primary tumors in these three patients were all 4/5 mm2,which is close to the critical value between the low-and intermediate-risk GIST mitotic indices,and all had KIT exon11 mutations.After the first progression,these three patients were treated with imatinib,and all survived until the end of follow-up,with overall survival ranging from 116 to 155 months.Conclusions:Among patients with low-risk GISTs,a very small number with high mitotic indices may have the potential for recurrence or metastasis,but after re-currence or metastasis,they can still maintain long-term,high-quality survival through targeted therapy,surgery,and other treatment meth-ods.The possibility of postoperative progression in very low-risk patients with GIST is extremely low,and the follow-up interval can be ap-propriately extended to reduce medical costs and alleviate the psychological burden on the patients and their families.