Objective:To investigate the association of serum γ-glutamyltransferase (GGT) with stroke severity and outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Department of Neurology, Hefei Second People's Hospital (Guangde Road Branch) from January 2023 to December 2023 were included retrospectively. According to the baseline National Institutes of Health Stroke Scale score, the patients were divided into mild stroke group (≤8) and moderate to severe stroke group (>8); According to the modified Rankin Scale score at 3 months after onset, the patients were divided into a good outcome group (0-2) and a poor outcome group (>2). Multivariate logistic regression analysis was used to determine the independent influencing factors of stroke severity and outcome, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum GGT for poor outcome. Results:A total of 136 patients with AIS were included, with 42 patients (30.88%) in the mild stroke group and 94 (69.12%) in the moderate to severe stroke group; 80 patients (58.82%) in the good outcome group and 56 (41.18%) in the poor outcome group. Multivariate logistic regression analysis showed that higher serum GGT was an independent related factor for moderate to severe stroke (odds ratio [ OR] 1.075, 95% confidence interval [ CI] 1.017-1.135; P<0.05) and poor outcome ( OR 1.131, 95% CI 1.069-1.197; P<0.05). The ROC curve analysis showed that the area under the curve for predicting poor outcome by serum GGT was 0.820 (95% CI 0.747-0.892). Conclusion:Serum GGT is significantly correlated with the severity of stroke in patients with AIS, and has certain predictive value for poor short-term outcome.

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 observe the in vitro susceptibility test result of colistin(COL)combined with tigecycline(TGC),cefoperazone/sulbactam(SCF),ampicillin/sulbactam(SAM),meropenem(MEM),amikacin(AK)and levofloxacin(LEV),TGC combined with MEM,SCF,SAM and AK,SCF combined with MEM,AK to carbapenem-resistant Acinetobacter baumannii(CRAB),and screen the effective anti-infective therapy.Methods 58 CRAB strains were isolated from clinic specimens from Qingdao Eighth People's Hospital from January 2023 to December 2023.The minimal inhibitory concentration(MIC)of antimicrobial agents against CRAB strains was determined by the micro broth dilution method.A combined antimicrobial susceptibility test was performed by the chessboard dilution method.The fractional inhibitory concentration(FIC)index was calculated to determine the combined effect.Results The synergistic rates of COL and SCF was 70.69%,and the sum of synergistic rates and additive rates was 96.55%.The synergistic rates of COL and TGC,COL and SAM,COL and MEM,COL and AK,COL and LEV,TGC and SCF,TGC and SAM,TGC and MEM,TGC and AK,SCF and MEM,SCF and AK were 34.48%,65.52%,51.72%,37.93%,22.42%,27.59%,27.59%,37.93%,41.38%,48.28%and 25.86%,and the sum of synergistic rates and additive rates were 77.58%,91.38%,84.48%,65.52%,39.66%,67.25%,62.07%,58.62%,55.17%,82.76%and 74.14%,respectively.The range,MIC50 and MIC90 of 12 combination regimens for CRAB strains were decreased to some extent compared with those of each single drug.No antagonism effect was observed for all the combinations.Conclusion The sum of synergy rate and addition rate of COL combined with SCF is the highest,and the sum of synergy rate and addition rate of COL combined with LEV is the lowest,which could provide reference for clinical experience medication.

Objective:To assess the effects of recognition function of four-lead electrocardiogram(ECG)synchronization technique and multi-parameter fusion technique in reducing the number of false alarms and improving the quality of alarms in intensive care units(ICU).Methods:Four-lead ECG synchronization technique and multi-parameter fusion technique were used to strengthen the monitoring and assessment for the alarm of clinical monitors,and reduce the false alarm rate of monitors.The clinical alarm data of bed units corresponding to 48 monitors in clinical use of ICU,cardiovascular intensive care unit(CCU)and neurosurgery intensive care unit(NICU)of Hainan General Hospital from October 14 to December 27,2024 were selected.According to the opening and close of the four-lead ECG synchronization and multi-parameter fusion technique algorithm of the monitors,they were divided into group A(opened four-lead ECG synchronization and multi-parameter fusion),group B(opened four-lead ECG synchronization,but closed multi-parameter fusion),group C(closed four-lead ECG synchronization,but opened multi-parameter fusion)and group D(closed four-lead ECG synchronization and multi-parameter fusion),with 12 units in each group.The numbers of total alarms and false alarms generated by monitor of each bed unit among different optimization strategies were compared.Results:The numbers of average daily alarm of the monitors in groups A,B and C were respectively(134.2±32.4)cases,(392.5±68.2)cases and(583.4±126.5)cases,which were lower than those in group D(1 073.2±168.6),with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).The optimization rates of the alarm numbers in groups A,B and C were increased by 87.51%,63.47%and 45.67%,respectively.The rates of average false alarm of the monitors in groups A,B and C were respectively(1.04±0.15)%,(1.73±0.12)%and(2.07±0.08)%,which were lower than(3.76±0.2)%in group D,with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).Conclusion:Four-lead ECG synchronization technique and multi-parameter fusion technique can effectively optimize the number of alarms in ICU,and reduce the proportion of false alarms of monitors in department,and decrease fatigue of medical staffs for alarm.

Objective To observe the in vitro susceptibility test result of colistin(COL)combined with tigecycline(TGC),cefoperazone/sulbactam(SCF),ampicillin/sulbactam(SAM),meropenem(MEM),amikacin(AK)and levofloxacin(LEV),TGC combined with MEM,SCF,SAM and AK,SCF combined with MEM,AK to carbapenem-resistant Acinetobacter baumannii(CRAB),and screen the effective anti-infective therapy.Methods 58 CRAB strains were isolated from clinic specimens from Qingdao Eighth People's Hospital from January 2023 to December 2023.The minimal inhibitory concentration(MIC)of antimicrobial agents against CRAB strains was determined by the micro broth dilution method.A combined antimicrobial susceptibility test was performed by the chessboard dilution method.The fractional inhibitory concentration(FIC)index was calculated to determine the combined effect.Results The synergistic rates of COL and SCF was 70.69%,and the sum of synergistic rates and additive rates was 96.55%.The synergistic rates of COL and TGC,COL and SAM,COL and MEM,COL and AK,COL and LEV,TGC and SCF,TGC and SAM,TGC and MEM,TGC and AK,SCF and MEM,SCF and AK were 34.48%,65.52%,51.72%,37.93%,22.42%,27.59%,27.59%,37.93%,41.38%,48.28%and 25.86%,and the sum of synergistic rates and additive rates were 77.58%,91.38%,84.48%,65.52%,39.66%,67.25%,62.07%,58.62%,55.17%,82.76%and 74.14%,respectively.The range,MIC50 and MIC90 of 12 combination regimens for CRAB strains were decreased to some extent compared with those of each single drug.No antagonism effect was observed for all the combinations.Conclusion The sum of synergy rate and addition rate of COL combined with SCF is the highest,and the sum of synergy rate and addition rate of COL combined with LEV is the lowest,which could provide reference for clinical experience medication.

Objective To explore the impact of family sandplay therapy based on the narrative concept on family resilience and sense of meaning in life among gastric cancer patients.Methods A total of 104 gastric cancer patients were selected and randomly divided into control group and experi-mental group,with 52 patients in each group.The control group received routine nursing care,while the experimental group received family sandplay therapy based on the narrative concept in addition to routine nursing care.Both groups were assessed using the Chinese Family Resilience Assessment Scale(C-FRAS)and the Chinese Meaning in Life Questionnaire(C-MLQ)before the intervention and at 1 month and 3 months post-intervention.The scores of scales were compared.Results After interven-tion,the total C-FRAS score and score of each dimension were higher in the experimental group than those in the control group,and both the total C-FRAS score and score of each dimension showed an upward with time extension.The total C-MLQ score and score of each dimension were also higher in the experimental group compared with the control group(P＜0.05).Conclusion Family sandplay therapy based on the narrative concept can enhance family resilience and sense of meaning in life a-mong gastric cancer patients.

Objective:To assess the effects of recognition function of four-lead electrocardiogram(ECG)synchronization technique and multi-parameter fusion technique in reducing the number of false alarms and improving the quality of alarms in intensive care units(ICU).Methods:Four-lead ECG synchronization technique and multi-parameter fusion technique were used to strengthen the monitoring and assessment for the alarm of clinical monitors,and reduce the false alarm rate of monitors.The clinical alarm data of bed units corresponding to 48 monitors in clinical use of ICU,cardiovascular intensive care unit(CCU)and neurosurgery intensive care unit(NICU)of Hainan General Hospital from October 14 to December 27,2024 were selected.According to the opening and close of the four-lead ECG synchronization and multi-parameter fusion technique algorithm of the monitors,they were divided into group A(opened four-lead ECG synchronization and multi-parameter fusion),group B(opened four-lead ECG synchronization,but closed multi-parameter fusion),group C(closed four-lead ECG synchronization,but opened multi-parameter fusion)and group D(closed four-lead ECG synchronization and multi-parameter fusion),with 12 units in each group.The numbers of total alarms and false alarms generated by monitor of each bed unit among different optimization strategies were compared.Results:The numbers of average daily alarm of the monitors in groups A,B and C were respectively(134.2±32.4)cases,(392.5±68.2)cases and(583.4±126.5)cases,which were lower than those in group D(1 073.2±168.6),with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).The optimization rates of the alarm numbers in groups A,B and C were increased by 87.51%,63.47%and 45.67%,respectively.The rates of average false alarm of the monitors in groups A,B and C were respectively(1.04±0.15)%,(1.73±0.12)%and(2.07±0.08)%,which were lower than(3.76±0.2)%in group D,with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).Conclusion:Four-lead ECG synchronization technique and multi-parameter fusion technique can effectively optimize the number of alarms in ICU,and reduce the proportion of false alarms of monitors in department,and decrease fatigue of medical staffs for alarm.

BackgroundSibling relationships play a critical role in shaping anxiety symptoms in firstborn children. Anxiety symptoms often originate in early childhood and can persist into adolescence and adulthood. However， there is insufficient research on anxiety symptoms in preschool children， especially firstborn preschool children. ObjectiveTo explore the influencing factors of anxiety symptoms among firstborn preschool children， so as to provide references for the intervention of anxiety symptom for children in families with multiple children. MethodsFrom October to December 2021， a total of 8 449 children from 234 kindergartens in Longhua District of Shenzhen were included using a cluster sampling method. Sibling Inventory of Behavior （SIB） and Spence Preschool Anxiety Scale （SPAS） were used to investigate. Logistic regression analysis was used to identify influencing factors of anxiety symptoms in firstborn preschool children. ResultsA total of 8 419 （99.64%） valid questionnaires were collected. Anxiety symptoms were detected in 344（4.09%） firstborn preschool children. Statistically significant differences were observed between anxiety group and non-anxiety group in terms of household registration， monthly family income， maternal age， maternal education level， paternal education level， family living conditions and whether they are left-behind children （χ²/t=9.906， 33.490， 5.136， 13.485， 9.690， 17.332， 21.975， P<0.05 or 0.01）. Compared with non-anxiety group， children in the anxiety group scored higher on the SIB dimensions of rivalry， aggression and avoidance （t=165.322， 74.471， 286.419， P<0.01）， and lower on companionship， empathy and teaching （t=59.133， 42.417， 39.112， P<0.01）. Risk factors for anxiety symptoms in firstborn preschool children included left-behind children， as well as negative sibling relationships characterized by rivalry and avoidance （OR=1.195， 1.143， 1.260， P<0.05 or 0.01）. ConclusionFirstborn preschool children who are left-behind are more susceptible to anxiety symptoms. Negative sibling relationships， characterized by competition and avoidance， may also contribute to the emergence of anxiety symptoms in firstborn preschool children.

Objective To investigate the effect of inositol-requiring enzyme 1(IRE1)on cisplatin-induced ap-optosis of cochlear hair cells in mouse.Methods The cochlear basilar membranes of 500 healthy Kunming mice(3～5 days old)were isolated and cultured in vitro.After 24 hours,they were randomly divided into control group and cisplatin groups(4 μg/ml,8 μg/ml,16 μg/ml and 32 μg/ml),and cultured for another 24 hours.The loss of co-chlear hair cells was observed by fluorescein isothiocyanate(FITC)staining.The apoptosis of cochlear hair cells was observed by TRITC and Hoechst 33258 fluorescence staining.Western blot was used to detect the protein levels of p-IRE1α,p-JNK,Bax and caspase-3 in each group.Results Compared with control group,the hair cell loss and apoptosis rate of hair cells and the protein levels of p-IRE1α,p-JNK,Bax and caspase-3 were significantly increased in cisplatin groups(P＜0.01).Furthermore,the expression of p-IRE1α was positively correlated with the expres-sion of Bax and caspase-3 and with the apoptosis rate of hair cells(P＜0.05).Conclusion IREI may be involved in the regulation of cisplatin-induced apoptosis in cochlear hair cells.

Objective To analyze the distribution and drug resistance patterns of carbapenem-resistant Acinetobacter baumannii(CRAB),and evaluate the antimicrobial effects in vitro of colistin(COL)combined with cefoperazone/sulbactam(SCF),tigecycline(TGC),imipenem(IPM),meropenem(MEM),amikacin(AK),and levofloxacin(LEV)against CRAB to provide guidance for anti-infective therapy.Methods A total of 75 non-duplicate CRAB strains isolated from clinical specimens in 2022 were collected.WHONET 5.6 software was used for retrospective analysis of their clinical distribution and resistance profiles.Among them,25 strains were selected for combined antimicrobial susceptibility tests using broth microdilution to determine minimum inhibitory concentrations(MICs).The fractional inhibitory concentration(FIC)index was calculated based on checkerboard method to assess the combined effects.Results In 2022,a total of 145 Acinetobacter baumannii strains were isolated,including 75 CRAB(detection rate of 51.7％).CRAB was most prevalent in the patients over 70 years old(40.0％),mainly from blood(41.3％)and sputum(37.3％)specimens,and the intensive care unit was the top isolating department.All the 75 CRAB strains were resistant to piperacillin,piperacillin/tazobactam,ceftriaxone,1PM and MEM with resistance rates of 100％.The resistance rates for ampicillin/sulbactam,cefepime and tri-methoprim/sulfamethoxazole were all exceeded 95％.The resistance rates were 86.7％for LEV,82.7％for SCF,77.4％for AK,2.4％for TGC,and 0.0％for COL.The results of combined tests of 25 strains revealed the synergy rates of 92％and 80％for COL+SCF and COL+TGC respectively with sums of both synergy and additive rates of 100％.Synergy rates for COL combined with IPM,MEM,AK and LEV were 64％,72％,56％and 48％respectively.No antagonism was observed in any combination.Conclusion The drug resist-ance of CRAB exhibited high levels at our hospital,and the elderly and ICU patients were the major susceptible populations.Among all the combinations tests,COL+SCF showed optimal synergy while COL+LEV only had the lowest combined effect with the findings that warrants clinical consideration.