The operating room is the core settings of various surgical treatments, and exhibits distinct attributes and systemic complexities. Medical staff who work long term in operating rooms face multiple exposures to potential health hazards. Especially with the progress of electrosurgical technology and the frequent use of electrosurgical equipment, the possible health effects of the resulting electrosurgical smoke to those working in operating rooms have gradually attracted attention. This paper reviewed the composition, hazard, exposure risk monitoring, and protective measures of electrosurgical smoke, aiming to deepen the understandings of potential health risks of electrosurgical smoke, improve the self-protection awareness of medical staff, strengthen attention to electrosurgical smoke protection in all hospitals, and ensure the occupational safety of medical staff.

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 study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective To investigate the value of triglyceride glucose-body mass index(TyG-BMI)index in predicting the severity of hyperlipidemic acute pancreatitis(HLAP).Methods A retrospective analysis was performed for the clinical data of 185 patients with HLAP who were admitted to Tianyou Hospital Affiliated to Wuhan University of Science and Technology from January 2021 to December 2023,and according to the revised Atlanta classification criteria for acute pancreatitis,they were divided into mild group with 95 patients and moderate or severe group with 90 patients.Clinical features were compared between the two groups to analyze the correlation between TyG-BMI and the severity of HLAP,and the efficacy of TyG-BMI in predicting the severity of HLAP was analyzed.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for the severity of HLAP.A Spearman correlation analysis was used to investigate the correlation between TyG-BMI and the severity of HLAP,and the receiver operating characteristic(ROC)curve was used to analyze the efficacy of TyG-BMI in predicting the severity of HLAP.Results There were significant differences between the mild group and the moderate or severe group in creatinine,blood glucose(GLU),triglyceride,TyG-BMI,and Bedside Index for Severity in Acute Pancreatitis(BISAP)score(Z=-2.059,-7.217,-7.799,-9.566 and-11.386,all P<0.05).The multivariate Logistic regression analysis showed that BISAP score(odds ratio[OR]=4.221,95%confidence interval[CI]:1.421-12.538,P=0.001),TyG-BMI(OR=1.262,95%CI:1.140-1.396,P=0.010),and GLU(OR=1.316,95%CI:1.040-1.666,P=0.022)were independent risk factors for the severity of HLAP and were positively correlated with the severity of HLAP(r=0.839,0.705,and 0.532,all P<0.05).In the comparison of the efficacy of these indicators in predicting the severity of HLAP,TyG-BMI had a slightly lower efficacy than BISAP score(Z=-4.368,P<0.001)and a significantly better efficacy than GLU(Z=2.155,P<0.001),with an area under the ROC curve of 0.891,a sensitivity of 91.10%,and a specificity of 96.80%.Conclusion TyG-BMI index has a certain value in predicting the severity of HLAP and can be used in clinical comprehensive assessment of HLAP.

Objective: To evaluate the characteristics and related factors of physical activities both inside and outside the kindergarten among preschool children, so as to provide a reference for promoting targeted physical activities among different types of children in the future. Methods: From April 2016 to December 2022, 706 preschool children aged 3 to 6 years from the Shanghai parent child cohort followed up. Accelerometers were used to measure their physical activities during kindergarten hours, and a parent questionnaire was employed to assess their physical activities and screen time outside the kindergarten. Restrictive cubic spline analysis was used to examine the relationship between moderate to vigorous physical activities (MVPA) inside and outside the kindergarten. Cluster analysis was performed to identify physical activity patterns among children, and multinomial Logistic regression analysis was conducted to explore the influencing factors of these physical activity patterns. Results: On weekdays, preschooler accumulated an average of (40.83±15.71) minutes of MVPA inside the kindergarten and 30(15, 53) minutes outside daily. Restricted cubic spline analysis revealed an inverted U shaped relationship between MVPA inside and outside the kindergarten. Cluster analysis identified four groups: low daily MVPA but active inside (196, 27.8%), moderate daily MVPA but high screen time outside (97, 13.7%), adequate daily MVPA and relatively active outside (96, 13.6%), and low daily MVPA and relatively inactive both inside and outside (317, 44.9%). Compared to the reference group of adequate daily MVPA and relatively active outside, children with screen time exceeding 60 minutes at 2 years old were more likely to belong to the group with adequate daily MVPA but more screen time outside ( OR =3.84, 95% CI =1.16-12.74, P <0.05). Boys had a lower likelihood of being in the group with low daily MVPA and relatively inactive both inside and outside ( OR =0.33, 95% CI =0.16-0.70, P <0.05). Children from neighborhoods with insufficient sport facilities were more likely to be in the low daily MVPA and relatively inactive group ( OR =2.20, 95% CI = 1.05 -4.63, P <0.05). Conclusions Behavior patterns of physical activity and screen time for both inside and outside the kindergarten vary greatly among different children. Screen time at the age of 2 and the sports facilities around the commuinty are key factors influencing the physical activity pattern. It is recommended to implement personalized intervention plans in collaboration with schools and families for different types of children.

Objective To investigate the effect of progesterone receptor membrane component 1(PGRMC1)mediated autophagy on the sensitivity of liver cancer cells to 125I particles irradiation.Methods Hepatoma cell lines Huh7 and LM3 were exposed to different doses(0,2,4,6 and 8 Gy)of 125I particles,and cell autophagy was observed by transmission electron microscopy(TEM).Then,autophagy inhibitor chloroquine(CQ),agonist rapamycin(Rapa),and PGRMC1 inhibitor AG-205 were used respectively to verify that PGRMC1-mediated autophagy plays a key role in the sensitivity of hepatocellular carcinoma cells to 125I particle irradiation.Cell proliferation,colony formation and apoptosis were detected by CCK-8 assay,clonal formation test and flow cytometry,respectively.The expression levels of PGRMC1,microtubule-associated protein light chain 3-Ⅰ(LC3-Ⅰ),LC3-Ⅱ and p62 were detected by Western blotting.Results Different doses of 125I particles irradiation significantly decreased the proliferation and clonogenesis of Huh7 and LM3 cells(P＜0.05),and increased the apoptotic cells(P＜0.01),in a dose-dependent manner.Compared with the 0 Gy group,the ratio of LC3-Ⅱ/LC3-Ⅰ in Huh7 and LM3 cells was obviously increased,and the expression of p62 was significantly down-regulated in the 6 Gy group.The proliferation capacity and clonal formation ability of Huh7 and LM3 cells were decreased significantly,and their apoptotic cells were increased notably in the 6 Gy+CQ group than the 6 Gy group,while the above results were on the contrary in the 6 Gy+Rapa group.The 6 Gy+AG205 group had notably decreased LC3-Ⅱ/LC3-Ⅰ ratio in the Huh7 and LM3 cells,up-regulated p62 expression,reduced cell proliferation capacity and clone formation ability,and enhanced cell apoptosis when compared with the 6 Gy group,and the above results of the 6 Gy+PGRMC1 group were opposite.Conclusion Increment of PGRMC1 induced by 125I irradiation can promote autophagy,increase the proliferation and clonogenesis,and reduce the apoptosis in hepatocellular carcinoma cells.

OBJECTIVE To analyze the pharmaceutical service process in a fracture patient complicated by fat embolism syndrome （FES） following postoperative fracture， aiming to provide a reference for clinical treatment and pharmaceutical service for similar patients. METHODS Clinical pharmacist participated in the entire treatment process of a patient with FES following postoperative fracture. Based on the patient’s clinical manifestations and test results， literature was reviewed to assist clinical physicians in formulating the therapeutic regimen of glucocorticoids. For the drug-related adverse reactions of renal function impairment and reduced platelet count that occurred during the treatment， suspicious drugs were analyzed and disposed of accordingly. RESULTS The clinical pharmacist recommended Hydrocortisone sodium succinate for injection （100 mg， q8 h， ivgtt， for about one week followed by a gradual dose reduction） for treating FES. The Vancomycin hydrochloride for injection used in this case was assessed as “very probably” associated with the adverse drug reactions of renal function impairment and thrombocytopenia. The clinical physician adopted the pharmacist’s medication recommendations， and the patient’s condition stabilized after treatment， with improvement in adverse reactions， and was discharged from the hospital. CONCLUSIONS The use of glucocorticoids in treating FES has a definite therapeutic efficacy. Clinical pharmacists should individualize the medication plan based on the patient’s pathological state and distinguish it from postoperative sepsis. Meanwhile， drug-induced adverse reactions in the kidney and blood system should be closely monitored.

Carbapenem-resistant enterobacteriaceae(CRE), also known as "super bacteria", has been emerging for several years as a major public-health concern worldwide. The production of carbapenemases is the most crucial resistance mechanism in CRE. The genes encoding carbapenemases can be transmitted by via plasmids, representing a primary cause of nosocomial infections and the widespread proliferation of antibiotic resistance. Carbapenemases, particularly the class A β-lactamases, have long been considered the most crucial resistance mechanism. However, the stealthy dissemination of OXA-48-like carbapenemases presents a more significant threat. OXA-48-like carbapenemases family members have complex composition, with variable hydrolytic activities against β-lactam drugs. They generally demonstrate weaker hydrolytic activity against carbapenems, leading to challenges in detection, which pose significant obstacles in clinical diagnosis, treatment, infection control. Therefore, this review focuses on the OXA-48-like carbapenemases family composition, epidemiology, hydrolytic activity, crystal structure, transmission mode and detection method.

Objective:To summarize the clinical features and genetic characteristics of Congenital bile acid synthetic disorder type 3 (BASD3) disorder caused by CYP7B1 gene variation.Methods:This was a case series study. Clinical data and genetic results of 2 cases of congenital bile acid synthetic disorder type 3 caused by CYP7B1 gene variations in the Department of Infectious Diseases, Children′s Hospital of Fudan University at Xiamen and Department of Pediatrics, Women and Children′s Hospital, School of Medicine, Xiamen University from January 2021 to December 2023 were retrospectively collected and analyzed. Literature up to December 2023 was searched from electronic databases of China National Knowledge Infrastructure (CNKI), Wanfang Data and PubMed with the combined keywords of " Congenital bile acid synthetic disorder type 3""Oxysterol 7-alpha-hydroxylase""Oxysterol 7α-Hydroxylase Deficiency""BASD3" and "CYP7B1 liver" both in Chinese and English. The main clinical features and genetic characteristics of BASD3 disorder caused by CYP7B1 gene variations were summarized.Results:Two BASD3 patients, 1 male and 1 female, were admitted at the ages of 3 months and 18 days, and 2 months and 7 days, respectively. Both patients presented with neonatal cholestasis and hepatomegaly. Biochemical evidence indicated direct hyper-bilirubinemia with elevated aminotransferase levels, while gamma-glutamyltransferase (GGT) and total bile acid levels were normal or nearly normal. Patient 1 was a compound heterozygotes of the CYP7B1 gene variants c.525-526insCAAGTTGG(p.Asp176GInfs*15) and c.334C>T(p.Arg112Ter). Patient 1 jaundice resolved and liver function tests normalized after oral administration of chenodeoxycholic acid (CDCA). Patient 2 was homozygous for variant c.334C>T(p.Arg112Ter) in CYP7B1 gene. Patient 2 was in liver failure status already and not reactive to oral CDCA administration. Patient 2 received living-related liver transplantation for enhanced abdominal CT revealed a liver tumor likely vascular origin. Literature review revealed no cases of BASD3 reported in Chinese literature, including 2 patients in this study, while 12 patients (9 males and 3 females) were reported in 9 English literatures. All of the 12 manifested jaundice and hepatosplenomegaly in infancy, with cirrhosis, liver failure, kidney enlargement, hypoglycemia, and spontaneous bleeding in some cases, polycystic kidney disease was demonstrated in 5 cases of them. The c.334C>T (p.Arg112Ter) of the CYP7B1 gene was homozygous in 4 cases and compound heterozygous in 2 cases. Among the 12 children, 6 cases received CDCA treatment, while 6 cases not. Four survived with their native liver in the 6 cases who received CDCA therapy, while none in the 6 cases not received CDCA therapy.Conclusions:BASD3 is a rare hereditary cholestatic disorder. Markedly elevated levels of conjugated bilirubin and aminotransferases, with normal or nearly normal GGT and total bile acid levels can serve as diagnostic clue. c.334C>T is the most common pathogenic variant of the CYP7B1 gene. Timely administration of CDCA may save the liver.

Objective:To explore the application effect of intelligent referral mode in examinees with major positive results in physical examinations in a health medical center.Methods:A cross-sectional study was conducted from January 2022 to December 2023 with subjects receiving physical examinations. Those subjects with major positive results from January 2022 to December 2022 in the Health Medical Center of the Second Affiliated Hospital of Chongqing Medical University were selected as the routine referral group, and those with major positive results from January 2023 to December 2023 were selected as the intelligent referral group. The routine referral group received routine health education from the chief inspector in the health medical center, suggesting them to get outpatient consultation. On the basis of ordinary referral, the intelligent referral group received health education from a referral team composed of nurses and specialists based on internet technology to digitally integrate and share patients′ medical records, examination results, imaging data and other medical information. The subects in the intelligent referral group were provided with a green channel for outpatient consultation and medical treatment immediately. The visiting rate, hospitalization rate, average visiting time, and overall satisfaction of the subjects after being notified of abnormal results were compared between the two groups. According to the positive results, the subjects were divided into four subgroups: ultrasound examination group, radiology group, clinical laboratory group and blood pressure group.Results:After the notification, there were significant differences in hospital visit rate (84.8% vs 67.2%, χ 2=168.4), hospitalization rate (48.8% vs 36.5%, χ 2=17.80), average visit time (116 min vs 301 min, Z=-15.82), and overall satisfaction score (9.70±0.62 vs 8.29±1.26, t=-33.47) between intelligent referral group and general referral group (all P<0.01). The classification statistics of major abnormal results showed that the consultation rates in subjects with ultrasound, radiology, clinical laboratory and blood pressure abnormities in the intelligent referral group were all higher than those in the general referral group (87.9% vs 70.4%, 89.9% vs 70.6%, 80.6% vs 60.2%, 57.2% vs 41.3%, respectively; χ 2=41.91, 39.37, 19.37, 6.20, all P<0.05); the hospitalization rates in subjects with ultrasound, radiology and blood pressure abnormities in the intelligent referral group were all higher than those in the general referral group (66.8% vs 64%, 55.7% vs 42.2%, 18.7% vs 11.2%, respectively; χ 2=16.86, 11.91, 8.68, all P<0.05); the mean consultation times in subjects with ultrasound, radiology and clinical laboratory abnormities in the intelligent referral group were all significantly shorter than those in the general referral group (96 min vs 308 min, 110 min vs 300 min, 122 min vs 286 min, Z=-11.38, -9.27, -7.63, all P<0.01); the overall satisfaction scores in subjects with ultrasound examination, radiology, clinical laboratory and blood pressure abnormities in the intelligent referral group were all higher than those in the general referral group (9.69±0.60 vs 8.36±1.21, 9.09±0.62 vs 8.26±1.27, 9.74±0.69 vs 8.25±1.31; 9.68±0.59 vs 8.34±1.35, respectively; t=-18.47, -18.52, -14.42, -11.77, all P<0.01). Conclusions:The application of intelligent referral mode can improve the visiting rate and hospitalization rate of examinees with major positive results of physical examination, shorten their visiting time, and thus improve their satisfaction.