Development and Validation of Clinical-Radiomics Nomogram for Preoperative Prediction of Central Lymph Node Metastasis in Papillary Thyroid Carcinoma.

BACKGROUND: This investigation sought to create and verify a nomogram utilizing ultrasound radiomics and crucial clinical features to preoperatively identify central lymph node metastasis (CLNM) in patients diagnosed with papillary thyroid carcinoma (PTC). METHODS: We enrolled 1069 patients with PTC between January 2022 and January 2023. All patients were randomly divided into a training cohort (n = 748) and a validation cohort (n = 321). We extracted 129 radiomics features from the original gray-scale ultrasound image. Then minimum Redundancy-Maximum Relevance and Least Absolute Shrinkage and Selection Operator regression were used to select the CLNM-related features and calculate the radiomic signature. Incorporating the radiomic signature and clinical risk factors, a clinical-radiomics nomogram was constructed using multivariable logistic regression. The predictive performance of clinical-radiomics nomogram was evaluated by calibration, discrimination, and clinical utility in the training and validation cohorts. RESULTS: The clinical-radiomics nomogram which consisted of five predictors (age, tumor size, margin, lateral lymph node metastasis, and radiomics signature), showed good calibration and discrimination in both the training (AUC 0.960; 95% CI, 0.947-0.972) and the validation (AUC 0.925; 95% CI, 0.895-0.955) cohorts. Discrimination of the clinical-radiomics nomogram showed better discriminative ability than the clinical signature, radiomics signature, and conventional ultrasound model in both the training and validation cohorts. Decision curve analysis showed satisfactory clinical utility of the nomogram. CONCLUSION: The clinical-radiomics nomogram incorporating radiomic signature and key clinical features was efficacious in predicting CLNM in PTC patients.

A self-assembling peptide inhibits the growth and function of fungi via a wrapping strategy.

Fungal infections contribute substantially to human morbidity and mortality. A particular concern is the high rate of mortality associated with invasive fungal infections, which often exceeds 50.0% despite the availability of several antifungal drugs. Herein, we show a self-assembling antifungal peptide (AFP), which is able to bind to chitin on the fungal cell wall and in situ form AFP nanofibers, wrapping fungi. As a result, AFP limits the proliferation of fungi, slows down the morphological transformation of biphasic fungi, and inhibits the adhesion of fungi to host cells and the formation of biofilms. Compared to the broad-spectrum antifungal fluconazole, AFP achieved a comparable inhibitory effect (MIC50 = 3.5 µM) on fungal proliferation. In addition, AFP significantly inhibited the formation of fungal biofilms with the inhibition rate of 69.6% at 1 µM, better than fluconazole (17.2% at 1 µM). In a skin infection model of mice, it was demonstrated that AFP showed significantly superior efficacy to fluconazole. In the systemic candidiasis mouse model, AFP showed similar efficacy to first-line antifungal amphotericin B (AmpB) and anidulafungin (AFG). This study provides a promising wrapping strategy for anti-fungal infection.

Construction of a nomogram for central lymph node metastasis in papillary thyroid cancer based on gender grouping.

BACKGROUND: The status of central lymph nodes is crucial for determining the surgical approach to papillary thyroid carcinoma (PTC). Because of the differences between genders in central lymph node metastasis (CLNM), we aimed to construct separate predictive models for CLNM according to gender. METHODS: In our study, a total of 1258 PTC patients who underwent thyroid cancer surgery from September 2021 to March 2023 were analyzed retrospectively. The data were analysed univariately and multivariately using SPSS software grouped according to gender and nomograms of CLNM were plotted using R software. The variables included in this study were sex, Age, body mass index, Diabetes, chronic lymphocytic thyroiditis (CLT), Suspicious central lymph node (SCLN), A/T, Margin, Microcalcification (MC), BRAF, Number, Location, CLNM. RESULTS: The preoperative nomogram in male patients included four clinical variables: CLT, Margin, Number, Size. The preoperative nomogram of female patients included six clinical variables: Age, SCLN, Margin, MC, Number, Size. The calibration curves showed great agreement in both the training group and the validation group. The decision curve analysis showed the feasibility of nomogram in predicting CLNM in both man and woman. CONCLUSION: Based on the successful establishment of nomogram, we can analyze the variability of CLNM between male and female, which may provide clinicians with personalized clinical schemes in the treatment of PTC.

Association between sleep problems and psychological behavioral in disabled children in Beijing / 中国儿童保健杂志

【Objective】 To examine the association between psychological behavioral problems and sleep problems in disabled children in Beijing, in order to provide reference for reducing the sleep problems of disabled children. 【Methods】 From September 2017 to February 2018, children with disabilities aged 6 to 17 years were selected by random sampling, and were investigated by a self-designed questionnaire to get their demographic characteristics.Pediatric Symptom Checklist-17 (PSC-17) was used to assess psychological and behavioral problems.The relationship between psychological behavior and sleep problems was analyzed by binary Logistic regression. 【Result】 Totally 650 children with disabilities were included in the study.The detection rates of sleep problems was significantly different in children with different genders, different school styles, different types of disabilities and different grades of disabilities (χ2=3.984, 4.437, 12.925, 18.104, P<0.001). There was statistically significant difference in the detection rate of sleep problems between children with and without psychological and behavioral problems (χ2=30.722, P<0.001).Psychological and behavioral problems were the main risk factors for sleep problems of disabled children (OR=2.540, 95%CI:1.740 - 3.709).The risk of sleep problems in day students with disabilities was 1.577 times as high as that of boarders with disabilities. 【Conclusions】 Psychological and behavioral problems of disabled children are related to sleep problems.Improving psychological and behavioral status can effectively prevent their sleep problems.

Discussion on Features of Acupuncture and Moxibustion Treatment for Migraine Based on Ancient Books and Documents / 中医杂志

This paper systematically analyzed the ancient monographs of acupuncture and moxibustion and comprehensive medical books from pre-Qin to 1911， and extracted the data according to the etiology and pathogenesis， treatment principles and methods， acupoint selection， needling and moxibustion， and taboos of needling and moxibustion. The pathogenesis of migraine in ancient books and documents is summarized as "the causes are diverse， and phlegm-dampness is the majority". For treatment， the features include "needling has a sequence， and the root and the branch should be treated separately" and "focusing on tonifying deficiency and drain excess". It is also obtained of the rich ideas of acupoints selection， extensive application records of moxibustion， unique application of bloodletting therapy and clear explanation of acupuncture and moxibustion taboos. All mentioned above is expected to enrich the ideas and methods of modern migraine treatment and improve the clinical effects.

Effects of berberine hydrochloride tablets combined with compound glutamine on intestinal mucosal barrier function in patients with ulcerative colitis / 天津医药

Objective To investigate the effect of berberine hydrochloride tablets combined with compound glutamine in treating ulcerative colitis(UC).Methods One hundred and two patients with UC admitted to our hospital were collected and grouped into two groups according to the random number table.Fifty-one patients in the control group were given conventional treatment+compound glutamine,and 51 patients in the experimental group were given berberine hydrochloride tablets based on the control group.Both groups were treated for 8 weeks.The efficacy,modified Mayo score,intestinal mucosal barrier function,soluble late glycation end product receptor(sRAGE),interleukin-17(IL-17),IL-6 and incidence of untoward reactions were compared between the two groups.Results The total effective rate of the experimental group was higher than that of the control group(92.2%vs.76.5%,P＜0.05).After treatment,scores of defecation frequency,blood in stool,endoscopic findings,physician's overall evaluation,diamine oxidase(DAO),D-lactic acid,endotoxin,sRAGE,IL-17 and IL-6 were lower in both groups than those before treatment(P＜0.05),and the research group was lower than the control group(P＜0.05).There was no significant difference in the total incidence of untoward reactions between the experimental group and the control group(P＞0.05).Conclusion Berberine hydrochloride tablets combined with compound glutamine are effective in treating UC,which can reduce the activity of UC,improve the intestinal mucosal barrier function,regulate serum sRAGE,IL-17 and IL-6 levels,without increasing adverse reactions.

Cellular and cytokine immune responses during varicella zoster virus reactivation of herpes zoster infection / 西安交通大学学报(医学版)

Objective To study changes in immune cells and cytokines during the reactivation stage of varicella-zoster virus(VZV)in patients with herpes zoster.Methods A total of 50 patients with herpes zoster and 30 healthy individuals were selected from Xi'an Ninth Hospital between May 2022 and October 2022.Flow cytometry was used to detect the proportion of peripheral blood CD3+cells,CD4+cells,CD8+T cells,B cells and NK cells,as well as levels of cytokines IL-2,IFN-γ,IL-10 and IL-6.We analyzed the immune mechanism of VZV reactivation stage in herpes zoster patients.Results Compared with the healthy control group,the proportion of CD3+cells and CD4+T cells in herpes zoster patients decreased significantly;the proportion of NK cells significantly increased;the levels of IFN-γ,IL-10 and IL-6 significantly increased;the proportion of CD8+T cells,B cells and IL-2 content showed an increasing trend,but there was no significant difference.In addition,the severity of neurological involvement in herpes zoster patients might affect changes in cytokine levels.Conclusion During the reactivation period of VZV,changes in the proportion of immune cells and cytokine expression levels are closely related to the occurrence and development of herpes zoster.

Binding-induced fibrillogenesis peptide inhibits RANKL-mediated osteoclast activation against osteoporosis.

Osteoporosis is primarily driven by an imbalance between bone resorption and formation, stemming from enhanced osteoclast activity during bone remodeling. At the crux of this mechanism lies the pivotal RANK-RANKL-OPG axis. In our study, we designed two binding-induced fibrillogenesis (BIF) peptides, namely BIFP and BIFY, targeting RANK and RANKL, respectively. These BIF peptides, with distinct hydrophilic and hydrophobic characteristics, assemble into nanoparticles (NPs) in aqueous solution. Through specific ligand-receptor interactions, these NPs efficiently target and bind to specific proteins, resulting in the formation of fibrous networks that effectively inhibit the RANK-RANKL associations. Experiments have confirmed the potent inhibitory effects of peptides on both osteoclast differentiation and function. Compared with the +RANKL controls, BIFP and BIFY demonstrated a more remarkable reduction in tartrate resistant acid phosphatase (TRAP)-positive cells, achieving an impressive decline of 82.8% and 70.7%, respectively. Remarkably, the administration of BIFP led to a substantial reduction in bone resorption pit area by 17.4%, compared to a significant increase of 92.4% in the +RANKL groups. In vivo experiments on an ovariectomized mouse model demonstrated that the BIFP treated group exhibited an impressive 2.6-fold elevation in bone mineral density and an astounding 4.0-fold enhancement in bone volume/total volume as against those of the PBS-treated group. Overall, BIF peptides demonstrate remarkable abilities to impede osteoclast differentiation, presenting promising prospects for the treatment of osteoporosis.

Phthalate exposure in the neonatal intensive care unit is associated with development of bronchopulmonary dysplasia.

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is a serious yet common morbidity of preterm birth. Although prior work suggests a possible role for phthalate exposure in the development of BPD, no study has rigorously evaluated this. Our objective was to determine whether hospital-based phthalate exposure is associated with the development of BPD and to identify developmental windows sensitive to exposure. STUDY DESIGN: This is a prospective multicenter cohort study of 360 preterm infants born at 23-33 weeks gestation participating in the Developmental Impact of NICU Exposures (DINE) cohort. 939 urine specimens collected during the NICU stay were analyzed for biomarkers of phthalate exposure by liquid chromatography with tandem mass spectrometry. The modified Shennan definition was used to diagnose bronchopulmonary dysplasia. Reverse distributed-lag modeling identified developmental windows sensitive to specific phthalate exposure, controlling for relevant covariates including sex and respiratory support. RESULTS: Thirty-five percent of participants were diagnosed with BPD. Exposure to specific phthalate mixtures at susceptible points in preterm infant development are associated with later diagnosis of BPD in models adjusted for use of respiratory support. The weighted influence of specific phthalate metabolites in the mixtures varied by sex. Metabolites of di(2-ethylhexyl) phthalate, a phthalate previously linked to neonatal respiratory support equipment, drove this association, particularly among female infants, at 26- to 30-weeks post-menstrual age. CONCLUSIONS: This is the largest and only multi-site study of NICU-based phthalate exposure and clinical impact yet reported. In well-constructed models accounting for infant sex and respiratory support, we found a significant positive association between ultimate diagnosis of BPD and prior exposure to phthalate mixtures with DEHP predominance at 26- to 30-weeks PMA or 34-36-weeks PMA. This information is critically important as it identifies a previously unrecognized and modifiable contributing factor to BPD.

Prediction model of lymph node metastasis posterior to the right recurrent laryngeal nerve.

BACKGROUND: At present, it is still controversial whether lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC) patients should be dissected. Failure to dissect metastatic lymph nodes results in continued metastasis from the positive lymph nodes to other regions. Our study aimed to establish a predictive model and predict the probability of metastasis of the lymph nodes posterior to the right recurrent laryngeal nerve (LNM-prRLN) in patients. METHODS: A total of 309 patients underwent surgery for thyroid cancer between May 2019 and September 2022. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic (ROC) curve to verify the accuracy of the prediction model. RESULTS: Multivariate analysis showed that irregular tumor margins (OR: 3.549, 95% CI 1.294-9.733, P = 0.014), extrathyroidal extension (OR: 4.507, 95% CI 1.694-11.993, P = 0.003), maximum tumor diameter > 1 cm (OR: 5.729, 95% CI 2.617-12.542, P < 0.001), overweight status (OR: 2.296, 95% CI 1.057-4.987, P = 0.036), high total cholesterol level (OR: 5.238, 95% CI 2.304-11.909, P < 0.001), and multifocality (OR: 11.954, 95% CI 5.233-27.305, P < 0.001) were independent risk factors for LNM-prRLN. The area under the ROC curve was 0.927. The calibration curve showed good agreement between the predicted and observed rates of LNM-prRLN. CONCLUSION: The probability of LNM-prRLN could be predicted by a nomogram based on the statistically significant risk factors identified in the multivariate analysis. This nomogram can guide clinicians when preoperatively evaluating the status of the LN-prRLN with regard to LNM-prRLN in PTC patients. For patients at high risk for LNM-prRLN, the preventive dissection of LN-prRLNs can be considered.

Nomograms for Prediction of High-Volume Lymph Node Metastasis in Papillary Thyroid Carcinoma Patients.

OBJECTIVE: The coexistence rate between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC) is quite high. Whether CLT influences metastatic lymph nodes remains uncertain. High-volume lymph node metastasis is recommended as an unfavorable pathological feature. We aimed to investigate risk factors for high-volume central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in PTC patients. STUDY DESIGN: Retrospective cohort study. SETTING: Changzhou First People's Hospital. METHODS: Clinicopathological characteristics of 1094 PTC patients who underwent surgery in our center from January 2019 to November 2021 were analyzed. RESULTS: The number of metastatic lymph nodes in the central compartment and lateral compartment were lower in the CLT group. We demonstrated that age, BRAF V600E, shape, and the number of foci were risk factors for high-volume CLNM in patients with CLT. For patients without CLT, sex, age, tumor size, number of foci, and margin were risk factors for high-volume CLNM. Tumor size, number of foci, location, and CLNM were all risk factors for high-volume LLNM in patients with or without CLT. Body mass index was only associated with high-volume LLNM in CLT patients. All the above factors were incorporated into nomograms, which showed perfect discriminative ability. CONCLUSION: Separate predictive systems should be used for CLT and non-CLT patients for a more accurate clinical assessment of lymph node status. Our nomograms of predicting high-volume CLNM and LLNM could facilitate risk-stratified management of PTC recurrence and treatment decisions.

Construction of prediction models for determining the risk of lateral lymph node metastasis in patients with thyroid papillary carcinoma based on gender stratification.

BACKGROUND: Lateral lymph node metastasis (LLNM) is associated with poor prognosis in patients with papillary thyroid cancer (PTC). The purpose of this study was to determine the risk factors for LLNM and establish prediction models that could individually assessed the risk of LLNM. METHODS: A total of 619 PTC patients were retrospectively analyzed in our study. Univariate and multivariate analysis were performed for male and female patients, respectively, to assess relationships between clinicopathological features and LLNM. By integrating independent predictors selected by binary logistic regression modeling, preoperative and postoperative nomograms were developed to estimate the risk of LLNM. RESULTS: LLNM was detected in 80 of 216 male patients. Of 403 female patients, 114 had LLNM. The preoperative nomogram of male patients included three clinical variables: the number of foci, tuner size, and echogenic foci. In addition to the above three variables, the postoperative nomogram of male patients included extrathyroidal extension (ETE) detected in surgery, central lymph node metastasis (CLNM) and high-volume CLNM. The preoperative nomogram of female patients included the following variables: age, chronic lymphocytic thyroiditis (CLT), BRAF V600E, the number of foci, tumor size and echogenic foci. Variables such as CLT, BRAF V600E, the number of foci, tumor size, ETE detected in surgery, CLNM, high-volume CLNM and central lymph node ratio were included in the postoperative nomogram. Above Nomograms show good discrimination. CONCLUSIONS: Considering the difference in the incidence rate of LLNM between men and women, a separate prediction system should be established for patients of different genders. These nomograms are helpful in promoting the risk stratification of PTC treatment decision-making and postoperative management.

High-frequency ultrasonography-assisted evaluation of treatment outcomes of erysipelas: a prospective controlled study / 中华皮肤科杂志

Objective:To measure the skin thickness in patients with erysipelas by high-frequency ultrasonography (HF-USG), and to compare the clinical efficacy of systemic antibiotics alone versus their combination with glucocorticoids in the treatment of erysipelas.Methods:Hospitalized patients with erysipelas were enrolled from Zhongda Hospital, Southeast University from January to December in 2021, and randomly divided into the study group and control group according to the order of visits. The study group was treated with systemic cefathiamidine for 7 days followed by oral methylprednisolone at a dose of 0.4 mg·kg -1·d -1, while the control group was treated with cefathiamidine alone. Before and after the treatment for 10 days, the thicknesses of the epidermis-dermis layers and subcutaneous tissues were measured by HF-USG at the sites of the most severe skin lesions on the affected limbs and at the corresponding sites on the healthy limbs, and white blood cell (WBC) counts, neutrophil (NEU) counts, as well as C-reaction protein (CRP) levels were determined. The t test and non-parametric test were used to compare the efficacy between two groups. Results:A total of 23 patients with erysipelas were enrolled. Among the 12 patients in the study group, 8 were males and 4 were females, and their age was 71.4 ± 11.4 years. Among the 11 patients in the control group, 7 were males and 4 were females, and their age was 67.4 ± 11.1 years. Before treatment, the thicknesses of the epidermis-dermis layers (0.33 ± 0.12 cm) and subcutaneous tissues (1.08 ± 0.49 cm) in the study group were not significantly different from those in the control group (0.25 ± 0.09 cm, 0.98 ± 0.46 cm; t = -1.83, -0.49, P = 0.081, 0.626, respectively). After the 10-day treatment, the thicknesses of the epidermis-dermis layers and subcutaneous tissues of the skin lesions on the affected limbs significantly decreased in both groups compared with those before treatment (both P < 0.05), and the decrease in the thicknesses of subcutaneous tissues was significantly stronger in the study group (0.32 ± 0.33 cm) than in the control group (0.10 ± 0.07 cm; t = 2.20, P = 0.039). Before treatment, the WBC counts ([11.16 ± 4.42] × 10 9/L), NEU counts ([8.26 ± 4.16] × 10 9/L) and CRP levels (median [ Q1, Q3]: 72.20 [19.28, 140.50] mg/L) in the study group were not significantly different from those in the control group ([10.10 ± 4.53] × 10 9/L, [7.21 ± 3.00] × 10 9/L, 34.40 [8.00, 74.20] mg/L, respectively; t or Z = 0.60, 0.71, -0.85, P = 0.578, 0.496, 0.196, respectively). After the 10-day treatment, the WBC counts, NEU counts, and CRP levels significantly decreased in both groups compared with those before treatment (all P < 0.05) . Conclusion:The combined treatment with systemic antibiotics and glucocorticoids could effectively alleviate skin inflammation, and more rapidly reduce the thicknesses of inflamed subcutaneous tissues in patients with erysipelas compared with systemic antibiotics alone.

Effect of pancreatic extracorporeal shock wave lithotripsy on chronic pancreatitis stones / 中华外科杂志

Objective: To analyze the therapeutic effect and safety of pancreatic extracorporeal shock wave lithotripsy(P-ESWL) for patients with chronic pancreatitis complicated by stones of the pancreatic duct and to investigate the influencing factors. Methods: A retrospective analysis was performed on clinical data from 81 patients with chronic pancreatitis complicated by pancreatic duct calculus treated with P-ESWL in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi 'an Jiaotong University from July 2019 to May 2022. There were 55 males(67.9%) and 26 females(32.1%). The age was (47±15)years (range: 17 to 77 years). The maximum diameter(M(IQR)) of the stone was 11.64(7.60) mm, and the CT value of the stone was 869 (571) HU. There were 32 patients (39.5%) with a single pancreatic duct stone and 49 patients(60.5%) with multiple pancreatic duct stones. The effectiveness, remission rate of abdominal pain, and complications of P-ESWL were evaluated. Student's t test, Mann Whitney U test, χ2 test, or Fisher's exact test was used to compare the characteristics between the effective and ineffective groups of lithotripsy. The factors influencing the effect of lithotripsy were analyzed by univariate and multivariate logistic regression analysis. Results: Eighty-one patients with chronic pancreatitis were treated with P-ESWL 144 times, with an average of 1.78 (95%CI:1.60 to 1.96) times per person. Among them, 38 patients(46.9%) were treated with endoscopy. There were 64 cases(79.0%) with effective removal of pancreatic duct calculi and 17 cases(21.0%) with ineffective removal. Of the 61 patients with chronic pancreatitis accompanied by abdominal pain, 52 cases(85.2%) had pain relief after lithotripsy. After lithotripsy treatment, 45 patients(55.6%) developed skin ecchymosis, 23 patients(28.4%) had sinus bradycardia, 3 patients(3.7%) had acute pancreatitis, 1 patient(1.2%) had a stone lesion, and 1 patient(1.2%) had a hepatic hematoma. Univariate and multivariate logistic regression analysis showed that the factors affecting the efficacy of lithotripsy included the age of patient(OR=0.92, 95%CI: 0.86 to 0.97), the maximum diameter of the stone(OR=1.12,95%CI:1.02 to 1.24) and the CT value of the stone(OR=1.44, 95%CI: 1.17 to 1.86). Conclusions: P-ESWL is effective in the treatment of patients with chronic pancreatitis complicated by calculi of the main pancreatic duct.Factors affecting the efficacy of lithotripsy include patient's age, maximum stone diameter, and CT value of calculi.

Epidemiologic characteristics and a prognostic nomogram for patients with vulvar cancer: results from the Surveillance, Epidemiology, and End Results (SEER) program in the United States, 1975 to 2016 / 부인종양

Objective@#To elucidate clinical characteristics and build a prognostic nomogram for patients with vulvar cancer. @*Methods@#The study population was drawn from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly assigned to training and validation sets. Cox proportional hazards model and competing risk model were used to identify the prognostic parameters of overall survival (OS) and cancer-specific survival (CSS) to construct a nomogram. The nomogram was assessed by concordance index (C-index), area under the curve (AUC), calibration plot, and decision curve analysis (DCA). @*Results@#A total of 20,716 patients were included in epidemiological analysis, of whom 7,025 patients were selected in survival analysis, including 4,215 and 2,810 in training and validation sets, respectively. The multivariate Cox model showed that the predictors for OS were age, marital status, histopathology, differentiation and tumor node metastasis (TNM) stages, whether to undergo surgery and chemotherapy. However, the predictors for CSS were age, race, differentiation and TNM stages, whether to undergo surgery and radiation. The C-index for OS and CSS in the training set were 0.76 and 0.80. The AUC in the training set for 1-, 3- and 5-year OS and CSS were 0.84, 0.81, 0.80 and 0.88, 0.85, 0.83, respectively, which was similar in the validation set. The calibration curves showed good agreement between prediction and actual observations. DCA revealed that the nomogram had a better discrimination than TNM stages. @*Conclusions@#The nomogram showed accurate prognostic prediction in OS and CSS for vulvar cancer, which could provide guidance to clinical practice.

Application of clinical value assessment of treatment protocols in guideline development: taking the WFAS Clinical Practice Guideline of Acupuncture and Moxibustion for Migraine as an example / 中国针灸

To enhance the clinical applicability of guidelines and provide more effective guidance for clinical practice, a clinical value assessment was conducted during the development of the World Federation of Acupuncture-Moxibustion Societies (WFAS) Clinical Practice Guideline of Acupuncture and Moxibustion for Migraine, which involved the evaluation of 59 acupuncture and moxibustion treatment protocols from randomized controlled trials (RCTs). This article introduced the methodology, content and results of the clinical value assessment of RCT-based acupuncture and moxibustion treatment protocols, which involved the integration of historical and contemporary medical evidence and expert consensus. It served as a methodological reference for the future development of acupuncture and moxibustion clinical practice guidelines.

Progress on mRNA vaccine for the prevention of major infectious diseases in humans and animals / 生理学报

A large number of studies have demonstrated that mRNA vaccine has been characterized as a technique with good safety, strong immunogenicity and high developmental potential, which makes it have broad prospects in immunotherapy. In recent years, the stability and in vivo delivery efficiency of mRNA vaccines have been largely addressed by the progresses in mRNA engineering and delivery innovation. And some mRNA vaccines are now clinical approved or in preclinical trials. Here, we summarize current knowledge on the research advances, technology, and application in major infectious diseases in humans and animals of mRNA vaccines, with the aim to provide a reference for improving the development of novel mRNA vaccines.

Textbook outcome in gallbladder carcinoma after curative-intent resection: a 10-year retrospective single-center study / 中华医学杂志(英文版)

BACKGROUND@#Textbook outcome (TO) can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement. We explored the factors associated with achieving a TO for gallbladder carcinoma (GBC) after curative-intent resection and analyzed the effect of adjuvant chemotherapy (ACT) on TO and non-TO patients.@*METHODS@#A total of 540 patients who underwent curative-intent resection for GBC at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed. Multivariable logistic regression was used to investigate the factors associated with TO.@*RESULTS@#Among 540 patients with GBC who underwent curative-intent resection, 223 patients (41.3%) achieved a TO. The incidence of TO ranged from 19.0% to 51.0% across the study period, with a slightly increasing trend over the study period. The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection ( P = 0.003). Age ≤60 years ( P = 0.016), total bilirubin (TBIL) level ≤34.1 μmol/L ( P <0.001), well-differentiated tumor ( P = 0.008), no liver involvement ( P <0.001), and T1-2 stage disease ( P = 0.006) were independently associated with achieving a TO for GBC after resection. Before and after propensity score matching (PSM), the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant; ACT improved the prognosis of patients in the non-TO group ( P <0.05).@*CONCLUSION@#Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection, and ACT can improve the prognosis of those with non-TO.

Cognition about emergency management of avulsed incisor in children among dentists in Guangdong province / 华西口腔医学杂志

OBJECTIVES@#This study aimed to evaluate and analyze the current situation of dentists in Guangdong pro-vince regarding the management of avulsed incisors, thereby providing a reference for making treatment strategies for avulsed incisors in the future.@*METHODS@#A total of 712 dentists with different educational backgrounds and working conditions in Guangdong province were randomly selected to conduct an online questionnaire survey on the cognition of children with avulsed incisors from April 2022 to May 2022. The data were recorded by Excel software and statistics were analyzed on Stata/SE 15.1.@*RESULTS@#A total of 712 dentists were investigated and 701 questionnaires were collected (98.46%). In addition, 65.9% of investigators came from the Department of Stomatology in a First-class Hospital or Stomatological Hospital. The results showed that the average number of avulsed teeth consulted by dentists was less than 20 per year. Although 99.7% of respondents considered normal saline as a suitable storage medium, 3.1% and 23.8% of them had a misunderstanding that the tap/alcohol could be used for root cleaning. Moreover, 93.4% was the correct selection rate of the treatment plan for processing on root surfaces before replanting by investigators. The correct selection rate of the duration using elastic fixation was only 10.7%. Meanwhile, 42.9% of investigators refused to inoculate tetanus immunoglobulin after teeth replanting. Emergency management of dental avulsion (EM) and clinical management of dental avulsion (CM) answered correctly with average scores of 14.60±11.85 and 14.48±2.67, respectively. Multivariate linear regression analysis revealed that working years were negatively correlated with EM and CM scores (P<0.05). There was a positive correlation between CM and EM scores with the number of avulsion cases treated by physicians each year (P<0.05). In terms of the EM score of dentists' learning attitude, investigators who had received enough knowledge were higher than those who had not and insufficient knowledge reserved, and the difference was statistically significant (P<0.05). The scores of investigators who thought they had a certain degree of knowledge about dental trauma were higher than those who thought they "did not understand", and the difference was statistically significant (P<0.05). In terms of CM scores, investigators who thought the knowledge of dental trauma was "very helpful" had higher scores than those who thought it was "not helpful", and the difference was statistically significant (P<0.05). The scores of the investigators who thought they had "relatively sufficient knowledge" of dental trauma were higher than those who thought they had "no knowledge" or "insufficient know-ledge", and the difference was statistically significant (P<0.05).@*CONCLUSIONS@#The overall accuracy of the management of avulsed incisors among dentists was low in Guangdong province. Dentists were more likely to have a higher rate of accuracy choice in treatment options for luxation injury and avulsion to enhance the prognosis of replanted teeth.