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

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Heatstroke, a life-threatening illness, poses a significant risk to human health, particularly in high-temperature and high-humidity environments. Timely and effective on-site management is critical for improving patient survival and prognosis. Rapid recognition, rapid assessment, and rapid cooling are the cornerstones of pre-hospital care. However, the absence of a standardized protocol for pre-hospital management of heatstroke has impeded the efficacy of treatment. This consensus, initiated by the Expert Group on Heatstroke Prevention of the People's Liberation Army, signifies a collaborative endeavor involving emergency medical personnel, nurses, and administrators from pre-hospital care, emergency departments, and intensive care units in both military and civilian domains. By systematically reviewing evidence-based medicine and clinical expertise in heatstroke prevention, on-site and in-transit care, as well as early treatment in emergency settings, the group has formulated the Expert consensus on pre-hospital emergency management of heatstroke (2024) after extensive discussions and iterative recommendations, which serve as a scientific and standardized framework for pre-hospital heatstroke emergency care. The consensus underscores the pivotal role of enhancing public awareness regarding heatstroke prevention and augmenting the rates of rapid recognition and rapid cooling for effective on-site heatstroke management. In high-risk industries, regions, or seasons for heatstroke, developing scientifically sound plans and conducting practical training can provide effective safety measures. Emergency personnel should undergo specialized training and assessments in knowledge and skills, ambulances should be equipped with effective cooling devices, and hospitals must maintain comprehensive emergency response capabilities. It is recommended to establish a regional heatstroke treatment network to optimize the allocation of emergency resources and streamline processes, thereby improving treatment outcomes and response times.
Heat Stroke/prevention & control* ; Humans ; Emergency Medical Services ; Consensus

OBJECTIVE To develop a long-acting light-protective nanogel with both physical barrier and chemical clearance functions， and evaluate its performance. METHODS The photoprotective nanogel composed of mussel mucin and sodium hyaluronate was constructed based on a fullerenol-cerium oxide composite nano system， namely fullerenol-cerium oxide nanogel （FCN）， and was characterized. The antioxidant capacity of FCN was evaluated using in vitro free radical scavenging experiments； its UV shielding ability was assessed by using an SPF value detector； its biosafety was assessed according to the requirements of the Guidelines for Drug Safety Evaluation； skin adhesion was assessed using small animal 3D live imaging technology； its sun protection ability was assessed through skin sunscreen detection and histopathological observation. RESULTS The average particle sizes of cerium oxide and fullerenol nanoparticles in FCN were about 20 and 10 nm， respectively， and FCN exhibited good UV absorption and free radical scavenging abilities. SPF value of FCN was 58.95±0.82， and the ultraviolet A protection level value was 6.21±0.15. No pathogenic colonies such as Staphylococcus aureus， were detected in the nanogel， and the contents of lead， arsenic， mercury and cadmium all met the standards for pharmaceutical excipients； FCN group did not show any irritating reactions such as erythema， edema， or desquamation； blood biochemical indicators of the FCN group were within the normal reference range. The material clearance rate of mice in the artificial sweat flushing group was less than 30%， while the material clearance rate of mice in the dry cleaning group reached about 92%. The mice in the protective group did not show obvious erythema or ulcer formation throughout the experiment. Histopathology showed that the fibers were arranged in an orderly manner， and the number of collagen fibers was close to that of the control group. CONCLUSIONS The FCN formulation constructed in this study meets the relevant requirements of the Chinese Pharmacopoeia， has good safety and skin compatibility， and achieves dual synergistic protection of UV shielding and free radical scavenging.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To analyze the detection status and its influencing factors of ovarian-adnexal masses in the physical examination population based on the Ovarian-Adnexal Imaging Reporting and Data System (O-RADS) of the American College of Radiology.Methods:This cross-sectional study retrospectively analyzed the clinical data of 24 316 physical examination participants who underwent gynecological color Doppler ultrasound examinations at the Health Management Center of Tianjin Medical University General Hospital from January to December 2021. The subjects were classified and followed-up according to O-RADS, and the detection rate and malignancy rate of ovarian-adnexal masses in different classifications were compared. According to O-RADS classification criteria, the physical examination population were divided into healthy control group (without ovarian-adnexal masses and O-RADS 1 class, 23 188 cases), benign group (O-RADS 2 class, 946 cases) and malignant group (O-RADS 3-5 class, 182 cases). The basic information of the three groups were compared, including age, body mass index (BMI), menopausal status, marital status, smoking history, drinking history, physical exercise, complete blood count, blood glucose, blood lipids, tumor markers, etc. The logistic regression was used to analyze the factors affecting the detection of ovarian-adnexal masses.Results:A total of 24 316 individuals were included, 1 678 with ovario-adnexal masses were screened, among the cases, there were 550 normal premenopausal ovaries (32.78%), and 1 128 cases were confirmed with pathological masses (67.22%). Of the 318 cases with follow-up records, the malignancy rate for O-RADS 4 class was 50%, and for O-RADS 5 class, it was 100%, according to the follow-up results. The age ( OR=1.320, 95% CI: 1.055-1.653), BMI ( OR=0.972, 95% CI: 0.954-0.989), carbohydrate antigen 125(CA125) ( OR=1.090, 95% CI: 1.023-1.161), postmenopausal ( OR=0.919, 95% CI: 0.892-0.947) and married and cohabiting ( OR=0.921, 95% CI: 0.895-0.949) were positively correlated with risk of ovarian-adnexal masses (all P0.05). Conclusions:The O-RADS classification system has high application value in evaluating the malignant risk of ovarian-adnexal masses; the age, BMI, CA125 levels, menopausal status, and marital status are significant influencing factors for the detection of ovarian-adnexal masses.

Background Prenatal exposure to chlorinated polyfluorinated ether sulfonic acid (Cl-PFESA, commercially known as F-53B) during pregnancy has been associated with fetal growth restriction and adverse birth outcomes. These effects may be mediated by structural and functional impairments of the placenta, potentially resulting from disrupted placental angiogenesis. However, the underlying mechanisms remain unclear. Objective To explore the impact of prenatal F-53B exposure on fetal development, placental pathology, and the expression of genes involved in angiogenesis by establishing an F-53B exposure animal model. Methods A total of 48 sexually mature female SD rats aged 8 weeks were selected, along with 24 proven male breeders. The rats were acclimatized for one week before mating. Pregnant rats were assigned to four groups: control (0 mg·kg⁻¹), low-dose (0.1 mg·kg⁻¹), medium-dose (1 mg·kg⁻¹), and high-dose (5 mg·kg⁻¹). Half of the pregnant rats in each group were administered the test substance by oral gavage once daily from gestational day (GD) 5.5 to GD17.5. The fetuses and placentas were dissected and weighed, and placental efficiency was calculated as the ratio of fetal weight to placental weight, reflecting the placenta’s capacity to supply nutrients to the fetus. Placental histopathological alterations were assessed after hematoxylin and eosin (HE) staining. Quantitative real-time polymerase chain reaction (qPCR) was conducted to assess the mRNA expression levels of angiogenesis-related genes, including hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor A (VEGFA) and its receptor (VEGFR2), as well as downstream genes in the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. To evaluate the potential impact of prenatal F-53B exposure on birth outcomes, including birth weight and gestational age, the remaining half of the pregnant rats in each group were continuously exposed to the test substance until delivery. Results F-53B exposure significantly reduced fetal weight across all exposure groups (P<0.05) and markedly increased the incidence of intrauterine growth restriction (P<0.01). Although placental weights did not differ significantly among groups, placental efficiency was significantly decreased in the high-dose group (P<0.05). The histological analysis after HE staining revealed disorganized trophoblast cell structure and a significant reduction in labyrinthine blood sinus area in the medium- and high-dose groups. The qPCR analysis showed that HIF-1α expression was significantly upregulated in the low-dose group (P<0.001), while VEGFA (P<0.01), PI3K (P<0.001), and AKT (P<0.05) expression levels were significantly downregulated in the medium- and high-dose groups. Conclusion Maternal exposure to F-53B during pregnancy may impair placental angiogenesis via VEGFA and its downstream PI3K/AKT signaling pathway, leading to placental pathological damage and increasing the risk of intrauterine growth restriction and reduced birth weight in fetuses.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program.Results A total of 589 746 respiratory isolates were collected from 2015 to 2021.Overall,82.6％of the isolates were Gram-negative bacteria and 17.4％were Gram-positive bacteria.The bacterial isolates from outpatients and inpatients accounted for(6.0±0.9)％and(94.0±0.1)％,respectively.The top microorganisms were Klebsiella spp.,Acinetobacter spp.,Pseudomonas aeruginosa,Staphylococcus aureus,Haemophilus spp.,Stenotrophomonas maltophilia,Escherichia coli,and Streptococcus pneumoniae.Each microorganism was isolated from significantly more males than from females(P＜0.05).The overall prevalence of methicillin-resistant S.aureus(MRSA)was 39.9％.The prevalence of penicillin-resistant S.pneumoniae was 1.4％.The prevalence of extended-spectrum β-lactamase(ESBL)-producing E.coli and K.pneumoniae was 67.8％and 41.3％,respectively.The overall prevalence of carbapenem-resistant E.coli,K.pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa,and Acinetobacter baumannii was 3.7％,20.8％,9.4％,29.8％,and 73.3％,respectively.The prevalence of β-lactamase was 96.1％in Moraxella catarrhalis and 60.0％in Haemophilus influenzae.The H.influenzae isolates from children(＜18 years)showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults(P＜0.05).Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance.Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.