Objective:To observe the accuracy of electronic method(EM), handing method(HM) and X-raying method(X-RM) in measuring root canal working length. Methods:Total 31 root canal in vivo were measured with HM, X-RM and EM(by the electronic apical locators-Root ZX and Raypex-5 respectively), and the data were compared with the actual root canal working lengths which were obtained from the sectional view's constrictions of the extracted teeth by magnifying glass. Results:Accuracy of working length measured by Raypex-5 was 93.55%, Root ZX was 87.10%, HM was 35.48%, and X-RM was 48.39%. Significantly statistical differences (P

Objective To investigate the clinical efficacy of Bushen Tiaojing Recipe Extract(an extract preparation of Chinese herbal medicine with the actions of tonifying kidney and regulating menstruation) for the treatment of kidney deficiency type of premature ovarian failure (POF),and to observe the effect of the extract formula on sexual hormone levels of POF patients.Methods A total of 75 POF patients were randomly divided into Chinese medicine (CM) decoction group,CM extract group and western medicine (WM) group,25 cases in each group.CM decoction group was treated with the decoction of Bushen Tiaojing Recipe (a decoction recipe for tonifying kidney and regulating menstruation),CM extract group was treated with Bushen Tiaojing Recipe Extract,and WM group was treated with hormone replacement therapy(HRT).Twenty-eight days constituted one treatment course,and the treatment for the 3 groups lasted 3 continuous courses.After treatment,the patients were followed up for 3 months.Clinical efficacy of the 3 groups was evaluated,and clinical symptom scores,the improvement of menstruation and the changes ofsexual hormones ofestrogen(E2),follicle-stimulatinghormone(FSH) and luteinizing hormone (LH) were observed before and after treatment.Results (1) Two cases of each group dropped out,and a total of 69 patients completed the study.(2) The total effective rate of CM decoction group and CM extract group was 73.91％,78.26％ respectively,higher than 52.17％ of WM group (P ＜ 0.05).(3)After treatment,clinical symptoms of CM decoction group and CM extract group were obviously improved (P ＜ 0.05 or P ＜ 0.01 compared with those before treatment),while WM group only had an effect on improving the abnormal menstruation (P ＜ 0.01 compared with that before treatment).CM decoction group and CM extract group had better effect on improving the clinical symptoms than WM group (P ＜ 0.05 or P ＜ 0.01).(4) CM decoction group and CM extract group had higher menstrual improvement rate,shorter menstrual-improvement time and lower recurrence rate than WM group (P ＜0.05).(5) CM decoction group and CM extract group had better effect on increasing serum E2 level and decreasing FSH and LH levels than WM group (P ＜ 0.05 or P ＜ 0.01).(6) The adverse reaction incidence of CM decoction group and CM extract group was all 4.35％,lower than 13.04％ of WM group (P ＜ 0.05).Conclusion Bushen Tiaojing Recipe Extract has high drug concentration,and its effect is stable,mild and lasting,having the advantages of convenience for carrying and medication.The extract exerts certain clinical efficacy for the treatment of POF,and is effective on alleviating clinical symptoms,recovering normal menstruation,regulating serum sexual hormone levels,with lower abnormal menstruation relapse rate and less adverse reaction.

Objective: To summarize the nursing methods of one male patient with periodic psychosis. Methods: The nursing methods of a male patient with periodic psychosis were summarized and analyzed. Results: According to the change rule of the disease, different nursing measures were taken, no adverse nursing events occurred during the hospitalization, which improved the treatment compliance and treatment effect. Conclusions According to the condition characteristics of periodic psychosis, nursing by stages was put forward, which provided the basis for definite diagnosis and promoted the patients' condition recovery.

Objective:To investigate the role of receptor-interacting protein kinse3 (RIPK3)-mediated necroptosis in diabetic mellitus-caused abolition of cardioprotection induced by sevoflurane postconditioning in rats.Methods:Eighty rats with diabetes mellitus, aged 4-5 weeks, weighing 90-100 g, were divided into 4 groups ( n=20 each) using a random number table method: sham operation group (group Sham), myocardial ischemia-reperfusion (I/R) group (group I/R), sevoflurane postconditioning group (group SP) and sevoflurane postconditiong plus RIPK3 inhibitor GSK-872 group (group GSK). Myocardial I/R was induced by 40 min occlusion of the left anterior descending branch of the coronary artery followed by 120 min reperfusion.In group SP, 2.4% sevoflurane was inhaled for 15 min at the beginning of reperfusion.In group GSK, GSK-872 3.3 mg/kg (dissolved in normal saline) was intraperitoneally injected at 24 and 2 h before surgery, and the other treatments were similar to those previously described in group SP.After 120 min of reperfusion, blood samples from the abdominal aorta were collected for determination of concentrations of serum lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB). Myocardial tissues were taken for determination of percentage of myocardial infarct size (by TTC staining) and expression of RIPK3, phospho-Ca 2+ -calmodulin-dependent protein kinase Ⅱ (p-CaMKⅡ) and phospho-mixed lineage kinase domain-like protein (p-MLKL) (by Western blot), and the ultrastructure of myocardium was observed by transmission electron microscopy. Results:Compared with group Sham, the serum LDH and CK-MB concentrations and percentage of myocardial infarct size were significantly increased, the expression of RIPK3, p-MLKL and p-CaMKⅡ in myocardial tissues was up-regulated ( P<0.05), and the damage to cardiomyocytes was severe in group I/R.Compared with group I/R, no significant change was found in the parameters mentioned above in group SP ( P>0.05). Compared with group SP, the serum LDH and CK-MB concentrations and percentage of myocardial infarct size were significantly decreased, the expression of RIPK3, p-MLKL and p-CaMKⅡ in myocardial tissues was down-regulated ( P<0.05), and the damage to cardiomyocytes was reduced in group GSK. Conclusion:The mechanism of diabetic mellitus-caused abolition of cardioprotection induced by sevoflurane postconditioning is related to excessive activation of RIPK3-mediated necroptosis in rats.

Non-invasive brain stimulation (NIBS) is one of the fastest-growing fields of medicine today. Recent studies have highlighted the potential of NIBS as an innovative, safe, and cost-effective treatment method applied to insomnia. Starting from treatment mechanism and clinical effect, we summarize the current research status of repetitive transcranial magnetic stimulation and transcranial electrical stimulation, the two most common NIBSs used in insomnia treatment, and analyze the existing research limitations and its future development direction, in order to provide references for further promoting the clinical application of NIBS in insomnia treatment.

Insomnia is the second most common psychiatric disorder in clinical practice, and more than one-third of adults may experience different forms of insomnia during their lifetime, but the root causes behind insomnia need further clarification. Early evidences from twins and family studies had shown that insomnia can be attributed to genetics. In recent years, with the rapid development of gene sequencing technology, Nature Genetics had published several consecutive articles focusing on insomnia and genes, confirming that genetic factors played an important role in the occurrence and development of insomnia. Therefore, the recent research progresses on insomnia and circadian rhythm, cytokines, neurotransmitters, and other related genes were summarized in this review, which could help to understand the pathogenesis of insomnia and develop precise treatment strategies.

Objective To construct an objective analysis system of corneal nerve tortuosity and detect the changes of corneal subbasal nerve tortuosity in patients with dry eye and diabetes. Methods GradeⅠtoⅣnerve tortuosity were evaluated and 80 photos of each grade were randomly chosen from the in vivo confocal microscopy library. Nerve fibers were extracted,segmented and then analyzed by 6 tortuosity related parameters including L C, Seg L C mean,Cur mean,Specific p,ICM and SCC mean. After verifying the validaty of parameters above,a cross-sectional study was conducted. Subjects were collected from June,2018 to February,2019 in Peking University Third Hospital,and were divided into healthy control group (28 persons 56 eyes),dry eye without diabetes group (28 patients 56 eyes),diabetes without dry eye group(24 patients 48 eyes),diabetes with dry eye group (23 patients 46 eyes) . Basic and dry eye information includes sex,age,ocular surface disease index ( OSDI) ,tear film break-up time (TBUT),Schirmer Ⅰ test (SⅠt) and corneal fluorescence staining (CFS) score. Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) were detected in diabetic patients. Cochet-Bonnet examination (C-BE) was detected to evaluate corneal sensation and 2 corneal subbasal nerve photos of each eye were selected for effective tortuosity and density related parameters analysis. Data was analyzed by SPSS and diagnostic test were perfomed by MedCalc. This study followed the Declaration of Helsinki. This study protocol was approved by Ethic Committee of Peking University Third Hospital ( No. IRB00006761-M2017354 ) . Written informed consent was obtained from each subject prior to entering study cohort. Results L C,Seg L C mean,Cur mean,Specific p,ICM and SCC mean increased as the nerve tortuosity increased from Grade Ⅰ to Grade Ⅳ,with an overall significance among 4 groups (F=39. 100, 36. 367,57. 743,4. 043,6. 818,33. 493;all at P<0. 01). Among the above 6 parameters,Cur mean and L C of any two groups were of significant difference (all at P<0. 01). Twenty three to twenty eight persons were enrolled in each group of the cross-sectional study. Sex and age were comparable among 4 groups. Diagnostic criteria were met in dry eye and diabetes. Corneal sensation parameter C-BE decreased in diabetes without dry eye group and diabetes with dry eye group compared with healthy control group ( all at Adj P<0. 05 ) , other than in dry eye without diabetes group (AdjP≥0. 05). Nerve density of diabetes without dry eye group and diabetes with dry eye group was lower compared with healthy control group(all at P<0. 001),while no significant difference between dry eye without diabetes group and healthy control group(P≥0. 05). Among the effective parameters of tortuosity,L C,Cur mean,Seg L C mean and SCC mean of dry eye without diabetes group,diabetes without dry eye group,diabetes with dry eye group were higher compared with healthy control group ( all at P<0. 05 ) . Diagnostic tests of tortuosity related parameters all showed an area under curve (AUC) from 0. 5 to 0. 7. Conclusions L C and Cur mean can be used to analyze corneal nerve curvature more reliably. Compared with normal volunteers,patients of dry eye or diabetes show higher corneal subbasal nerve tortuosity.

In order to avoid international experts and scholars questioning the clinical effect of acupuncture, based on the traditional acupuncture theory and research reports, some questions are proposed from the research design, acupuncture effect and outcome explanation on the study ofpublished inin June 2017. And some thoughts and suggestions for the future development of the clinical acupuncture study are showed.

Objective To evaluate the diagnostic efficacy of Kwak and ACR( 2017 ) thyroid imaging reporting and data systems ( T I‐RADS ) for thyroid nodules . Methods Cases of thyroid nodule who underwent surgery from January 2015 to M arch 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR T I‐RADS classification methods . Totally ,12 712 thyroid nodules were observed ,7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study . T hyroid nodules with solid ,hypoechoic or very hypoechoic ,tall/wide ratio ≥ 1 , margin ill‐defined and microcalcification were classified as malignant signs of ultrasound . M alignant percentage was calculated and diagnostic tests were performed . Results ① T here was a statistical difference between the benign and malignant nodules in the two types of T I‐RADS classification ( P＜0 .01) . ② T he area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0 .89 and 0 .84 ,respectively . T he Youden index of Kwak and ACR were 0 .66 and 0 .57 ,respectively . ③Taking Kwak T I4B and ACR T R4 as critical points for malignancy ,the sensitivity ,specificity ,positive predictive value and negative predictive value of Kwak T I 4B were 75 .0% ,90 .9% ,83 .2% ,and 85 .9% , respectively . T he accuracy of Kwak T I4B was 84 .9% ; T he sensitivity ,specificity ,positive predictive value and negative predictive value of ACR T R4 were 88 .2% ,68 .9% ,62 .9% ,and 90 .8% ,respectively . T he accuracy of ACR T R4 was 76 .2% . T he Kappa value of Kwak TI4B and ACR T R4 was 0 .52 . T he χ2 value of Kwak T I4B and ACR T R4 was 2 174 .6 ( P ＜ 0 .01 ) . Conclusions T he diagnostic values of two T I‐RADS classification methods for thyroid malignant nodules are high . T he overall efficiency of Kwak T I‐RADS classification method is better than that of ACR TI‐RADS classification method .

Objective To identify the causative variants in 5 Chinese families with tuberous sclerosis complex(TSC)to provide genetic counseling and prenatal diagnosis.Methods Genetic counseling and clinical diagnosis were performed in 8 patients from five unrelated TSC families by teleconsultation.With informed consent obtained from the participants,3 to 5 mL peripheral blood samples were collected from the probands and their family mem-bers for the extraction of genomic DNA.Candidate pathogenic variants were screened by panel sequencing(PS).The candidate pathogenic variants found in TSC1 and TSC2 by PS were validated by PCR-Sanger sequencing and bioinformatics analysis.Results All the pathogenic mutations were identified in the probands and their available family members.Causative variants in TSC1 or TSC2 were detected in all patients,including three reported variants and two novel variants.The two novel variants,TSC2:c.245G＞A and TSC2:c.235delG,which were predicted to cause the nonsense variant p.(Trp82?)and the frameshift variant p.(Val79Lysfs27?)respectively was believed to introduce premature stop codons.The analysis of family co-segregation and bioinformatics were identified as very positive factors for pathogenicity.Conclusions This result provides more evidences for the genetic counseling and prenatal diagnosis in these families and expand the spectrum of TSC2 pathogenic variants.