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.

Objective:To observe the clinical efficacy of combining repeated transcranial magnetic stimulation (rTMS) at low frequency with xing nao kai qiao acupuncture in the treatment of upper limb motor dysfunction after a stroke.Methods:Forty stroke survivors with upper limb motor dysfunction were randomly divided into a control group and a combination group, each of 20. All received basic neurological medication, conventional rehabilitation treatment, and xing nao kai qiao acupuncture. The combination group additionally received rTMS. Both groups were treated once a day, 5 days a week for 2 weeks consecutively. Before and after the treatment, both groups were evaluated using the Brunnstrom motor function stages, modified Ashworth spasticity grades, Fugl-Meyer upper limb motor function (FMA-UE) scoring, the modified Barthel index (MBI), and motor evoked potential (MEP) latency and amplitude.Results:The upper-limb and hand motor functioning of both groups improved significantly compared with before the treatment. The hand motor function staging of the combination group was then significantly better than among the control group. The average FMA-UE and MBI scores of both groups improved significantly, with significantly greater improvement in the combination group than in the control group. MEP latency and amplitude also improved significantly in both groups, with the average MEP latency and amplitude of the combination group superior to the control group′s averages.Conclusion:Supplementing xing nao kai qiao acupuncture with low-frequency rTMS can significantly improve the motor functioning, spasticity, and skill in the activities of daily living of stroke survivors with upper limb motor dysfunction.

Objective:To explore the construction and effect of biobank in biological research in nursing field.Methods:Through the establishment of a biological research plan for nursing in Affiliated Jinhua Hospital, Zhejiang University School of Medicine, the biobank in biological research for nursing was constructed from aspects of biological samples, instruments and equipment, operating software, biobanking team formation, personnel training and standardized process formulation.Results:In August 2020, the Nursing Department and Central Laboratory of Affiliated Jinhua Hospital, Zhejiang University School of Medicine established a biobank for biological research in the nursing field, formed a biobank team, conducted personnel training and formulated standardized procedures. From December 1, 2020 to June 30, 2021, biological samples were collected from 264 gastric cancer patients and 56 healthy controls, mainly including whole blood, serum and urine.Conclusions:The construction of biobank for biological research in nursing field can collect abundant biological samples, which lays a foundation for subsequent independent biological research in nursing field.

Taking the Department of Obstetrics and Gynecology as an example, this paper expounds a series of practices of online education, in the process from pre-course training, platform selection, curriculum design, to student evaluation, etc. From that, we can provide a reference for carrying out online teaching in response to the epidemic for clinical medical colleges which have not been exposed to the online course. Furthermore, it is a new attempt to explore a way to make a change of the traditional teaching method and deepen the reform of clinical teaching in our hospital after the epidemic, not only in professional medical education, but also in the popularization of medical knowledge.

Objective To evaluate the characteristics of left ventricular structure ,function ,myocardial mechanics ,hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy ( HCM ) using state‐of‐the‐art echocardiography . Methods A consecutive series of 85 adult HCM patients w ho were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected . According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography ,the patients were divided into three groups :patients with non‐obstructive HCM ( n ＝28) ,those with labile‐obstructive HCM ( n ＝27) ,and those with obstructive HCM ( n ＝ 30 ) . In addition ,16 normal family members of HCM patients were included as control group . T wo‐dimensional speckle tracking imaging ,tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states . Results ① As compared with the control group ,left ventricular end‐diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups ( all P ＜ 0 .05 ) . Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM , followed by labile‐obstructive and non‐obstructive HCM ,and the lowest in the control group ( all P ＜0 .05) . ②A t rest ,the left ventricular global longitudinal ,circumferential and radial strain ( GLS ,GCS and GRS) ,as well as the twist of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . As compared with the control group ,the GLS and twist decreased in the labile‐obstructive and non‐obstructive HCM ( all P ＜0 .05 ) ,but there were no significant changes of GCS and GRS ( all P ＞ 0 .05 ) . T he obstructive HCM had the lowest mitral annular plane systolic excursion ( M APSE ) and s′,and the longest systolic peaking time standard deviation( T s‐SD) and early diastolic peaking time standard deviation ( Te‐SD) ( all P ＜0 .05) . T he left ventricular diastolic function of obstructive HCM ( e′,the E/e′ratio and the left atrial volume index ) was the worst ,labile‐obstruction and non‐obstructive HCM were better ,and the control group was the best ( all P ＜ 0 .001 ) . ③ During exercise ,the GLS ,GCS ,GRS ,twist of the left ventricle and the M APSE were the lowest in the obstructive HCM ,which increased in the labile‐obstructive and non‐obstructive HCM ,and were best in the control group . T he T s‐SD and Te‐SD were the shortest in the control group ,were prolonged in non‐obstructive and labile‐obstruction HCM ,and were longest in obstructive HCM ( all P ＜ 0 .05 ) . Additionally ,the exercise time of the control group was the longest , followed by non‐obstructive and labile‐obstruction HCM ,and the shortest in the obstructive HCM ( all P ＜0 .05) . T he M ET s of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . Conclusions In obstructive HCM ,the left ventricular systolic strain and synchronization ,as well as the M APSE ,are significantly impaired in patients both at rest and during exercise . T he patients with labile‐obstructive and non‐obstructive HCM have reduced left ventricular GLS , twist ,and e′,but normal left ventricular GCS ,GRS ,synchrony ,and M APSE at rest ,which are all impaired during exercise .

Objective: To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography. Methods: A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states. Results: ①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05). ②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05). Conclusions In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.

OBJECTIVE: To compare the effect difference among the staged acupuncture combined with conventional rehabilitation, traditional acupuncture combined with conventional rehabilitation, and conventional rehabilitation in the patients with ischemic stroke hemiplegia. METHODS: A total of 145 patients with ischemic stroke hemiplegia were randomly assigned into an observation group (49 cases), a control group A (49 cases) and a control group B (47 cases). All the patients were received aspirin tablets 100 mg orally, once a day. The staged acupuncture according to Brunnstrom's theory combined with conventional rehabilitation were used in the observation group, at the acupoints in the meridian during the flaccid paralysis phase, at the acupoints in the antagonistic muscle and the tendon of spastic dominant muscle during the spasm stage, and at the acupoints in the meridian and Taixi (KI 3), Guanyuan (CV 4) and Qihai (CV 6) during the sequela stage. Conventional traditional acupuncture at the acupoints in the meridian combined with conventional rehabilitation were applied in the control group A. Simple conventional rehabilitation was used in the control group B. Patients in the observation group and the control group A were received acupuncture and rehabilitation once a day from Monday to Friday, 2 weeks as 1 course; patients in the control group B were received the same rehabilitation as the observation group. The indexes were observed before treatment and at the end of the 2nd, 4th, 6th and 8th weeks of treatment, including National Institutes of Health Stroke Scale (NIHSS), short form Fugl-Meyer motor function assessment (FMA) scale, Fugl-Meyer balance (FM-B) scale, comprehensive spasm scale (CSS) and modified Barthel index (MBI). RESULTS: Compared with those before treatment, except the MBI score in the control group B after 2 weeks' treatment, the NIHSS, FMA, FM-B and MBI scores were improved in all three groups at the end of the 2nd, 4th, 6th and 8th weeks of treatment (<0.01, <0.05). At the end of the 2nd week of treatment, the NIHSS and CSS scores were lower (<0.05, <0.01), the FMA, FM-B and MBI scores were higher (all <0.05) in the observation group and the control group A than those in the control group B. After 4, 6 and 8 weeks' treatment, the FMA, FM-B and MBI scores were higher (<0.05, <0.01), the NIHSS and CSS scores were lower (all <0.01) in the observation group than those of control group A and control group B; the FMA, FM-B and MBI scores in the control group A were higher than those in the control group B (<0.05, <0.01); the NIHSS and CSS scores in the control group A were lower than those in the control group B (<0.05, <0.01). CONCLUSION Staged acupuncture combined with conventional rehabilitation are consistent with the rehabilitation rule of patients with hemiplegia. They can improve motor function and the ability of daily life. They achieve better effect than traditional acupuncture combined with rehabilitation.
Acupuncture Therapy ; Brain Ischemia ; Hemiplegia ; therapy ; Humans ; Stroke ; Stroke Rehabilitation ; Treatment Outcome

Objective To evaluate the clinical efficacy and safety of 595-nm pulsed dye laser with topical timolol maleate 0.5％ solution for the treatment of superficial infantile hemangioma (IH).Methods Complete clinical data were collected from 156 infants with superficial IH,who received treatment with 595-nm pulsed dye laser combined with topical timolol maleate 0.5％ solution in the Department of Dermatology of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from July 2015 to July 2016,and analyzed retrospectively.Of the 156 patients,44 were males,and 112 were females,with an average age of 3.8 ± 0.7 months (range,24 days-1 year).These patients were treated with 595-nm pulsed dye laser every 5 weeks and topical application of timolol maleate solution twice a day.Each treatment with timolol maleate solution lasted 30 minutes.When the hemangioma regressed generally,the treatment with laser and timolol maleate solution was stopped.At weeks 5,10,15 and 30,the visual analogue scale (VAS) was used to evaluate the efficacy,and adverse reactions were recorded.These patients were followed up till 6 months after the end of treatment.The relationships of area and thickness of hemangioma with treatment duration,treatment sessions and VAS scores were analyzed.Results After 5-30 weeks of treatment,hemangiomas regressed to different extents,and the cure rate was 93.59％ (146/156).At weeks 5,10,15 and 30,the VAS scores were 3.12 ± 0.23,4.45 ± 0.52,5.45 ± 0.71 and 7.59 ± 1.64 respectively.Repeated-measures analysis of variance showed that the VAS scores all significantly increased over time (F =189.35,P ＜ 0.05) in the 3 groups with different initial thickness of hemangiomas (＜ 1 mm,1-3 mm,and ＞ 3 mm),and significantly differed among the above 3 groups at different time points (F =215.56,P ＜ 0.05),and the group with the initial thickness of hemangiomas ＜ 1 mm showed the highest VAS scores.The total treatment duration was significantly shorter in the group with the initial thickness of hemangiomas ＜ 1 mm (2.71 ± 0.58 months) than in those with the initial thickness of hemangiomas 1-3 mm (8.22 ± 0.67 months,P ＜ 0.05) and ＞ 3 mm (11.03 ± 0.72 months,P ＜ 0.05).The VAS scores also significantly differed among the 3 groups with different initial area of hemangiomas (＜ 3 cm2,3-9 cm2 and ＞ 9 cm2),and significantly increased over time in these groups;Kruskal-Wallis H test showed that there was a significant difference in the treatment sessions among the above 3 groups (H =10.45,P ＜ 0.01),and the group with the initial area of hemangiomas ＜ 3 cm2 showed the least treatment session.The adverse reactions were mild,and no adverse cardiovascular or respiratory events were observed.Conclusion The 595-nm pulsed dye laser combined with topical timolol maleate 0.5％ solution is effective and safe for the treatment of superficial IH.

Objective To evaluate the effect of amphotericin B on the production of tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) and activation of p38 mitogen-activated protein kinases (p38MAPK) in a human acute monocytic leukemia cell line (THP-1).Methods Cultured THP-1 cells were divided into several groups:blank control group receiving no treatment,amphotericin B groups treated with 2,4 and 8 mg/L amphotericin B separately,positive control group treated with 100 μg/L β-glucosan or 100 mg/L lipopolysaccharide.Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of TNF-α and IL-8 after the THP-1 cells were treated with different stimuli for some durations.Enzyme-linked immunosorbent assay (ELISA) was conducted to detect the level of TNF-α in the culture supernatant of THP-1 cells after 24-hour treatment with 8 mg/L amphotericin B,and Western blot analysis to measure the levels of p38MAPK and phosphorylated p38MAPK after 30-minute treatment with 8 mg/L amphotericin B.Results After 6-hour treatment with 2,4 and 8 mg/L amphotericin B separately,the mRNA levels of TNF-α in THP-1 cells (7.55 ± 1.17,19.47 ± 2.91,57.22 ± 0.65) and IL-8 (2.98 ± 0.04,5.22 ± 1.35,11.82 ± 1.66) were all significantly higher than those in the blank control group (TNF-α:1.00 ± 0.07,P ＜ 0.01,0.001,0.001 respectively;IL-8:1.01 ± 0.23,P ＜ 0.01,0.001,0.001 respectively).After the treatment with 8 mg/L amphotericin B for 1,3,6 hours,the mRNA levels of TNF-α (8.61 ± 0.30,10.75 ± 0.08,56.98 ± 2.43) and IL-8 (2.63 ± 0.28,5.35 ± 0.98,11.73 ± 1.18) in THP-1 cells were all significantly higher than those in the blank control group (TNF-α:1.18 ± 0.17,P ＜ 0.05,0.01,0.001;IL-8:1.23 ± 0.11,P ＜ 0.05,0.01,0.001).After 24-hour treatment with 8 mg/L amphotericin B,the level of TNF-α in the culture supernatant of THP-1 cells was significantly higher than that in the blank control group (4 039.06 ± 223.87 ng/L vs.96.31 ± 0.26 ng/L,P ＜ 0.001).Conclusion Amphotericin B can promote the p38MAPK phosphorylation and increase the levels of TNF-α and IL-8 in human THP-1 cells in vitro,suggesting its immunomodulatory effects.

Objective To explore the common clinical features and mechanism of HenochSchonlein purpura (HSP) in children,and provide evidence and guidance for clinical diagnosis,therapy and prognosis of HSP.Methods Prospective study.Totally 1 232 HSP children blood samples were collected during January 2010 to December 2013 in the Children's Hospital of Zhejiang University School of Medicine,and the levels of immunoglobulin,complement,T lymphocyte subsets and CRP were detected in the acute phase of HSP.The clinical data were analyzed with these indexes to explore the function of cellular and/or humoral immunity in the pathogenesis of HSP.In addition,this study detected serum IgA levels in 200 cases of sepsis rash,200 cases of urticarial and 200 cases of thrombocytopenic purpura patients and 400 cases of healthy children over the same period to our hospital respectively,in order to find out whether IgA is capable of differentiating allergic purpura rash from other similar skin rashes.Results Compared with healthy children,the IgA level was significantly higher [IgA:2.0 (0.6-7.5) g/L vs 1.1(0.6-2.1) g/L,Z =5.928,P =0.03].When IgA ＞ 1.44 g/L,the diagnostic sensitivity and specificity to differentiate allergic purpura patients from sepsis patients were 77.43 ％ (954/1 232) and 80.00％ (160/200),respectively.When IgA ＞ 1.53 g/L,the diagnostic sensitivity and specificity to distinguish from allergic purpura with urticaria patients were 72.57％ (894/1 232) and 74.51％ (149/200).When IgA ＞0.91 g/L,it had a 95.14％ sensitivity (1 172/1 232) and a 79.45％ specificity (159/200) for the differential diagnosis of allergic purpura and thrombocytopenic purpura patients.When IgA ＞ 1.33 g/L,the sensitivity of distinguishing allergic purpura patients from healthy children was 81.25％ (1 001/1 232),while the specificity was 95.00％ (380/400).Conclusions HSP children show cellular immune dysfunction.Th1/Th2 imbalance and over-activation of Th2 cells result in the increased synthesis and release of immune globulin,causing abnormalities in humoral immune.An increase in serum IgA level of HSP patients can differentiate HSP from other similar rashes.