Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Objective:To discuss the clinical curative effect of the treatment of bundling bone fragment with figure-of-eight suture through double bone tunnels in the chronic bong mallet finger.Methods:A retrospective analysis was performed on patients with chronic bong mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from May 2021 to February 2023. During the procedure, made into transverse double bone tunnels on the base of the distal phalanx with 0. 8 mm Kirschner wire, bundling bone fragment with figure-of-eight suture through double bone tunnels, then fixed with Kirschner wire elastic compression. Removal of the Kirschner wire 3 weeks after the procedure, the active flexion and extension range of the joints of the affected finger and the corresponding finger were measured at the last follow-up, then the range of motion (ROM) of the distal interphalangeal joint (DIPJ) and total action movement (TAM) of the fingers (affected and healthy finger) were recorded. The curative effects were evaluated according to the TAM system of the American Association of Hand Surgeons, including 4 grades: excellent, good, fair, and poor. SPSS 13. 0 software was used for statistical analysis of the data, and the measurement data conforming to normal distribution were expressed as Mean ± SD. The ROM of DIPJ and TAM of the affected finger were compared with the corresponding healthy finger 6 months after surgery by a paired sample t test. P<0. 05 indicates that the difference is statistically significant. Results:A total of 30 patients (30 digits) were enrolled, including 19 males and 11 females, and the age ranged from 18 to 62 years old, with an average age of 31 years old. The time from injury to operation was 24 to 65 days (mean of 35 days) . According to Wehbe and Schneider classification, there were 8 cases of type Ⅰa, 6 cases of type Ⅰb, 7 cases of type Ⅱa, 5 cases of type Ⅱb, 2 cases of type Ⅲa and 2 cases of type Ⅲb. All incisions healed well, the intraoperative blood loss was minimal, with no infection. All 30 cases were followed up for 6 to 7 months. All fractures were well aligned and healed, malformed fingers were completely corrected, and no needle tunnel infection or needle breakage were observed. At the last follow-up, the differences of the ROM of the DIPJ [ (30. 2±3. 5) °vs. (30. 4±3. 3) °, t=2. 57, P=0. 463] and the TAM [ (235. 3± 3. 6) ° vs. (237. 7± 4. 2) °, t=1. 78, P= 0. 247 ] between the affected and healthy fingers were not statistically significant. Finger function assessment: 27 cases were excellent, and 3 cases were good, and the excellent and good rate was 100%. Conclusion:Satisfactory therapeutic outcome for the treatment of chronic bong mallet finger deformity can be achieved by bundling bone fragment with figure-of-eight suture through double bone tunnels. It is an effective and practical method.

Objective:To discuss the clinical curative effect of the treatment of bundling bone fragment with figure-of-eight suture through double bone tunnels in the chronic bong mallet finger.Methods:A retrospective analysis was performed on patients with chronic bong mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from May 2021 to February 2023. During the procedure, made into transverse double bone tunnels on the base of the distal phalanx with 0. 8 mm Kirschner wire, bundling bone fragment with figure-of-eight suture through double bone tunnels, then fixed with Kirschner wire elastic compression. Removal of the Kirschner wire 3 weeks after the procedure, the active flexion and extension range of the joints of the affected finger and the corresponding finger were measured at the last follow-up, then the range of motion (ROM) of the distal interphalangeal joint (DIPJ) and total action movement (TAM) of the fingers (affected and healthy finger) were recorded. The curative effects were evaluated according to the TAM system of the American Association of Hand Surgeons, including 4 grades: excellent, good, fair, and poor. SPSS 13. 0 software was used for statistical analysis of the data, and the measurement data conforming to normal distribution were expressed as Mean ± SD. The ROM of DIPJ and TAM of the affected finger were compared with the corresponding healthy finger 6 months after surgery by a paired sample t test. P<0. 05 indicates that the difference is statistically significant. Results:A total of 30 patients (30 digits) were enrolled, including 19 males and 11 females, and the age ranged from 18 to 62 years old, with an average age of 31 years old. The time from injury to operation was 24 to 65 days (mean of 35 days) . According to Wehbe and Schneider classification, there were 8 cases of type Ⅰa, 6 cases of type Ⅰb, 7 cases of type Ⅱa, 5 cases of type Ⅱb, 2 cases of type Ⅲa and 2 cases of type Ⅲb. All incisions healed well, the intraoperative blood loss was minimal, with no infection. All 30 cases were followed up for 6 to 7 months. All fractures were well aligned and healed, malformed fingers were completely corrected, and no needle tunnel infection or needle breakage were observed. At the last follow-up, the differences of the ROM of the DIPJ [ (30. 2±3. 5) °vs. (30. 4±3. 3) °, t=2. 57, P=0. 463] and the TAM [ (235. 3± 3. 6) ° vs. (237. 7± 4. 2) °, t=1. 78, P= 0. 247 ] between the affected and healthy fingers were not statistically significant. Finger function assessment: 27 cases were excellent, and 3 cases were good, and the excellent and good rate was 100%. Conclusion:Satisfactory therapeutic outcome for the treatment of chronic bong mallet finger deformity can be achieved by bundling bone fragment with figure-of-eight suture through double bone tunnels. It is an effective and practical method.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Aim To investigate the protective effect of carnosine on BV2 cell damage induced by oxygen-glu-cose deprivation/reperfusion(OGD/R)and its role in mediating pyrodeath through the ROS/NLRP3/GSDMD pathway.Methods BV2 cells were randomly divided into the control group(Con),model group(OGD/R),carnosine group(OGD/R+CAR),inhibitor group(OGD/R+MCC950),and carnosine+inhibitor group(OGD/R+CAR+MCC950).The cell survival rate was detected by MTT assay.The release rate of lactate dehydrogenase(LDH)in cell supernatant was detected by microenzyme labeling method.Cell damage was as-sessed using Hoechst 33342/SYTOX Green staining.ROS levels in cells were detected by DCFH-DA.The nucleation level of NF-κB p65 was observed by immu-nofluorescence.The protein expression levels of NLRP3,ASC,cleaved caspase-1,and GSDMD-N were detected by Western blot.The levels of IL-1 β and IL-18 in the supernatant were detected by ELISA.Results Com-pared with Con group,the survival rate of cells in the OGD/R group was significantly reduced,LDH release was significantly raised,cell morphology was damaged,and the positive rate of SYTOX Green was significantly elevated with ROS level in cells.The fluorescence in-tensity of NF-κB p65 in the nucleus increased,and the protein expression levels of NLRP3,ASC,cleaved caspase-1,GSDMD-N increased significantly,and the levels of IL-1 β and IL-18 in the cell superserum in-creased significantly.Compared with the OGD/R group,the survival rate of cells in other groups in-creased significantly,the LDH release rate significantly decreased,and the cell damage was improved to a cer-tain extent.The positive rate of SYTOX Green and ROS production in cells significantly decreased,and the fluorescence intensity of NF-κB p65 in nucleus markedly decreased.The expression levels of related proteins and the levels of IL-1 β and IL-18 in cell super-natant significantly decreased.Conclusion Carnosine can protect BV2 cells from OGD/R-induced damage by inhibiting oxidative stress and NF-κB activation,then inhibiting NLRP3/GSDMD signaling pathway.

OBJECTIVE: To explore the effect of recombinant human thrombopoietin (rhTPO) on hematopoietic reconstruction in allogeneic hematopoietic stem cell transplantation (allo-HSCT) model. METHODS: The C57BL/6 mice were employed as the donors, and BALB/c mice as recipients. The bone marrow mononuclear cells of the donor mice were extracted and pretreated, which then were injected with 5×10⁶ per mouse through the tail vein of the recipient to establish an allo-HSCT model. The implantation of hematopoietic stem cells in the recipient mice was detected by flow cytometry on the 28^th day after transplantation. Next, the successfully modeled recipient mice were randomly divided into experimental group and control group. The rhTPO was injected into mice in the experimental group on the first day after transplantation, while the saline was injected into mice in the control group. Both groups were injected for 14 consecutive days. The peripheral blood and bone marrow hematopoiesis of the two groups were observed on day 1, 3, 7, 14, and 21 after transplantation. RESULTS: The expression rate of H-2K^b in the bone marrow of recipient mice was 43.85% (>20%) on the 28^th day after transplantation, which indicated that the recipient mice were successfully chimerized. Meanwhile, counts of PLTs on the day 3, 7, 14, and 21 after transplantation in the experimental group were higher than those in the control group with statistical significances (P<0.05). In addition, hematopoietic function of bone marrow was suppressed in both groups on day 1, 3 and 7 after transplantation, but hematopoietic bone marrow hyperplasia was better in the experimental group than in the control group. On day 14 and 21 after transplantation, the hematopoietic function of bone marrow in the two groups was recovered, and the experimental group showed more obvious than the control group. CONCLUSION rhTPO can effectively stimulate the production of PLTs and facilitate the recovery of white blood cells and hemoglobin after allo-HSCT, and promote hematopoietic recovery and reconstitution of bone marrow.
Humans ; Animals ; Mice ; Thrombopoietin ; Mice, Inbred C57BL ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Bone Marrow ; Recombinant Proteins ; Mice, Inbred BALB C

Objective: Functional near infrared spectroscopy (fNIRS) was used to assess brain oxygenated hemoglobin (Oxy Hb) activation in college students with different sleep quality under the verbal fluency task (VFT), so as to better provide a theoretical basis for the neural mechanism for sleep quality improvement of college students. Methods: A simple random sampling method was used to investigate 96 college students from one university during 2020 and 2021. According to the results of the Pittsburgh Sleep Quality Index(PSQI), participants were divided into 3 groups: good sleep quality group( n =45), moderate group( n =33), and poor group( n =18). The 53 channel near infrared spectroscopy to collect cerebral blood oxygen signals under the VFT task. Association between oxygenated hemoglobin with sleep quality was analyzed. Results: About 18.75% of college students reported sleep quality problems, including long sleep latency (0.97±0.97) and poor subjective sleep quality (0.96±0.72). There was a significant negative correlation between PSQI score and average oxygenated hemoglobin (Avg HbO) index of dorsolateral prefrontal lobe ( r =-0.23, P =0.03). The Avg HbO index differed significantly between good and poor sleep quality groups on dorsolateral prefrontal lobe( P =0.05). Conclusion This study verified that there is a positive correlation between sleep quality and cognitive ability among college students. The fNIRS technique could accurately collect blood oxygen signals from dorsolateral prefrontal lobe during cognitive tasks, which proves to be an effective tool for identifying sleep quality of college students.

Objective:To explore the imaging features of intraductal pancreatic neuro-endocrine tumor (PNET).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with intraductal PNET who were admitted to the First Affiliated Hospital of Naval Medical University (Changhai Hospital of Shanghai) from January 2013 to October 2020 were collected. There were 7 males and 10 females, aged (47±13)years. Preoperative contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the pancreas was performed on patients. Observation indicators: (1) imaging features of intraductal PNET, including ① imaging features of CT and ② imaging features of MRI; (2) treatment and histopathological examination of intraductal PNET. Measurement data with normal distribution were described as Mean± SD and count data were described as absolute numbers. Results:(1) Imaging features of intraductal PNET. ① Imaging features of CT: 17 patients underwent preoperative contrast-enhanced CT of pancreas. There were 9 cases with tumor located in the head of the pancreas, 5 cases with tumor located in the neck of the pancreas and 3 cases with tumor located in the body and tail of the pancreas. The tumor diameter of the 17 patients was (8.7±2.5)mm, with a range of 5.2?15.5 mm. The tumor shape was round-like in the 17 patients. All the 17 patients showed isodensity on plain CT and markedly enhancement in arterial, venous and portal phases on enhanced CT. The degree of enhancement of tumor was higher than surrounding normal pancreatic parenchyma. All tumors of 17 patients were located at the truncation of main pancreatic duct (MPD) dilation, showing abrupt change in caliber of MPD without the "beak sign". The diameter of dilated MPD was (11.4±5.3)mm, with a range of 4.5?22.5 mm. Other imaging manifestations of the 17 patients included 11 cases with pancreatic parenchymal atrophy, 1 case with retention cyst, 1 case with choledochal dilation, 1 case with calcification, and all cases without cystic degeneration or hemorrhage. ② Imaging features of MRI: preoperative contrast-enhanced MRI was performed in 14 patients. Five cases showed slightly low signal but 9 cases showed unclear on T1-weighted imaging. Five cases showed low signal, 2 cases showed slightly high signal but 7 cases showed unclear on T2-weighted imaging. Of the 14 patients, 9 cases showed diffusion limited on diffusion weighted imaging and 5 cases showed unlimited diffusion. Nine cases showed marked enhancement in tumor higher than in normal pancreatic parenchyma, but 5 cases were unclear on contrast-enhanced MRI. (2) Treatment and histopathological exmination of intraductal PNET: all the 17 patients underwent surgical treatment, including 9 cases with pancreaticoduodenectomy, 4 cases with distal pancreatectomy and splenectomy, 4 cases with pancreatic segmentectomy. Postoperative histopatho-logical examination results showed 10 cases of G1 and 7 cases of G2, including 1 case of G2 with lymph node metastasis, 1 case of G2 with lymph node and liver metastasis. The pathological gross showed that the tumor body was mainly located in the pancreatic duct and blocked the pancreatic duct, with upstream pancreatic dilation. There were pancreatic acinar atrophy and fibrous tissue hyperplasia. The tumor was grayish-yellow or brownish red, solid, medium in texture and well-defined with the surrounding tissues. Microscopically, the tumor of 17 patients was mainly located in the pancreaic duct and invaded into surrounding pancreatic parenchyma. The cells of tumor were polygonal with a central nucleus, but the mitosis was rare. The cytoplasm was eosinophilic or hyaline. The tumor stroma was mainly collagen fiber with abundant capillary network.Conclusions:The imaging features of intraductal PNET are small size, marked enhancement on contrast-enhanced CT and MRI. The tumor obstructs the MPD with distal MPD dilation and pancreatic parenchyma atrophy.

OBJECTIVE: To explore the influencing factors of low back pain and the relationship of the influence of bad working posture, weight load and frequency of load and the dose-response relationship among the occupational workers of key industries in China. METHODS: A total of 57 501 employees from 15 key industries in China were selected as research subjects using stratified cluster sampling method. The occurrence of low back pain in the past one year, as well as occupational factors such as job type, labor organization and work posture were investigated by using the Chinese version Musculoskeletal Disorders Questionnaire. RESULTS: The prevalence of low back pain in the occupational population of key industries in China was 16.4%(9 448/57 501). Multivariate Logistic regression analysis showed that the risk of low back pain in females was higher than that in males(P<0.01). Married, obese, occasional and frequent smokers, and a history of lower back disease were associated with increased risk of low back pain(all P<0.05). The risk of low back pain was associated with older age, higher education level, and lower frequency of physical exercise(all P<0.01). The risk of low back pain was higher with longer working time, greater back curvature, and the high frequency of long standing and sitting position work, uncomfortable working posture, repeated operation per minute, and lifting>5 kg weight(all P<0.01). CONCLUSION: The influencing factors of low back pain in the occupational population of key industries in China include bad working posture, high frequency load, weight load and other individual factors. There is a dose-response relationship with low back posture load and frequency of load.

Objective:To investigate the imaging features of undifferentiated pancreatic carcinoma (UCOGCP) with osteoclast-like giant cells.Methods:CT and MRI data of 4 pathologically diagnosed UCOGCP patients admitted in the First Affiliated Hospital of Naval Medical University from December 2014 to January 2019 were retrospectively analyzed. The tumor location, major length, shape, border, density or signal, capsule, calcification, hemorrhage, cystic degeneration, degree of enhancement, as well as the presence or absence of pancreatic duct dilatation, pancreatic parenchymal atrophy, peripheral vascular invasion, lymph node and organ metastasis were recorded.Results:Of 4 UCOGCP patients, 1 case had the mass located in head of pancreas, 2 cases in body of pancreas , and 1 in tail of pancreas. The length of tumor ranged from 3.3 cm to 13.0 cm, and the average was 8.8 cm.3 cases were round-like, and 1 was irregular; 2 tumors were well defined with capsules, 2 with unclear border. 4 cases showed solid-cystic masses, 3 of which had cystic separation. 4 cases showed heterogeneous low density on unenhanced CT, and 1 case had spotted calcification. The solid component of the mass was mild enhanced on enhanced CT, and partial solid component of the mass showed obvious enhancement in 2 cases. 2 cases showed mixed low signal on T 1WI, 1 of which had small patchy high signal indicating hemorrhage. 2 cases showed mixed high signal on T 2WI, and high signal on DWI. 2 cases had major pancreatic duct dilation. 1 case had pancreatic parenchyma atrophy. 1 case had descending duodenum invasion. 3 cases had peripheral vascular invasion, including portal vein, splenic artery, and splenic vein. 1 case had tumor thrombosis in the portal vein and splenic vein. 1 case was associated with pancreatogenous portal hypertension. Conclusions:The imaging features of UCOGCP showed a large solid-cystic mass with hemorrhage and calcification. The solid component of the mass was mild enhanced and the partially solid component was obviously enhanced. The combination of its imaging characteristics and clinical data can improve the accuracy of diagnosis.