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*

This consensus document aims to define a standardized protocol for visual function and imaging examinations preceding vitreoretinal surgery. Preoperative examination can significantly aid physicians in defining surgical indications, evaluating patients' conditions, and providing substantial support for designing surgical plans and predicting prognoses. Compiled by a collaborative expert group representing the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medicine Education Association, in tandem with the Ophthalmology Committee of International Association of Translational Medicine, this consensus integrates recent advancements and research in vitreoretinal surgery from both global and domestic contexts. Following numerous rounds of deliberations and the integration of the latest clinical data, these consensuses have been formulated with the objective of offering support in standardizing preoperative examinations for vitreoretinal surgery, with the broader aim of enhancing medical quality, optimizing resource usage, providing decision-making support, and ensuring the protection of patient rights. This document predominantly encompasses an in-depth review of preoperative examinations for vitreoretinal procedures, which includes, but is not limited to, principles, methodologies, and related precautions of ultra-wide-angle fundus imaging, fluorescein angiography, indocyanine green angiography, ophthalmic B-ultrasound examinations, ultrasound biomicroscopy, optical coherence tomography, optical coherence tomography angiography, orbital CT scan, orbital MRI, ophthalmic electrophysiology tests such as electroretinogram and visually evoked potentials and visual field.

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ²=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ²=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.
Female ; Humans ; Adult ; Middle Aged ; Cervix Uteri/pathology* ; Uterine Cervical Neoplasms/pathology* ; Papillomavirus Infections/diagnosis* ; Cell Wall Skeleton ; Persistent Infection ; Powders ; Uterine Cervical Dysplasia/pathology* ; Immunotherapy ; Papillomaviridae

Objective:To investigate the clinical characteristics of patients with acute aortic dissection (AAD) through a retrospective and observational study, and to construct an early warning model of AAD that could be used in the emergency room.Methods:The data of 11 583 patients in the Emergency Chest Pain Center from January to December 2019 were retrospectively collected from the Chest Pain Database of Zhongshan Hospital Affiliated to Fudan University. Inclusion criteria: patients with chest pain who attended the Emergency Chest Pain Center between January and December 2019. Exclusion criteria were 1) younger than 18 years, 2) no chest/back pain, 3) patients with incomplete clinical information, and 4) patients with a previous definite diagnosis of aortic dissection who had or had not undergone surgery. The clinical data of 9668 patients with acute chest/back pain were finally collected, excluding 53 patients with previous definite diagnosis of AAD and/or without surgical aortic dissection. A total of 9 615 patients were enrolled as the modeling cohort for early diagnosis of AAD. The patients were divided into the AAD group and non-AAD group according to whether AAD was diagnosed. Risk factors were screened by univariate and multivariate logistic regression, the best fitting model was selected for inclusion in the study, and the early warning model was constructed and visualized based on the nomogram function in R software. The model performance was evaluated by accuracy, specificity, sensitivity, positive likelihood ratio and negative likelihood ratio. The model was validated by a validation cohort of 4808 patients who met the inclusion/exclusion criteria from January 2020 to June 2020 in the Emergency Chest Pain Center of the hospital. The effect of early diagnosis and early warning model was evaluated by calibration curve.Results:After multivariate analysis, the risk factors for AAD were male sex ( OR=0.241, P<0.001), cutting/tear-like pain ( OR=38.309, P<0.001), hypertension ( OR=1.943, P=0.007), high-risk medical history ( OR=12.773, P<0.001), high-risk signs ( OR=7.383, P=0.007), and the first D-dimer value ( OR=1.165, P<0.001), Protective factors include diabetes( OR=0.329, P=0.027) and coronary heart disease ( OR=0.121, P<0.001). The area under the ROC curve (AUC) of the early diagnosis and warning model constructed by combining the risk factors was 0.939(95 CI:0.909-0.969). Preliminary validation results showed that the AUC of the early diagnosis and warning model was 0.910(95 CI:0.870-0.949). Conclusions:Sex, cutting/tear-like pain, hypertension, high-risk medical history, high-risk signs, and first D-dimer value are independent risk factors for early diagnosis of AAD. The model constructed by these risk factors has a good effect on the early diagnosis and warning of AAD, which is helpful for the early clinical identification of AAD patients.

Objective: To compare the postoperative efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in treating huge massive rotator cuff injury. Methods: The clinical data of 74 patients with unilateral massive rotator cuff injury admitted to Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University, from January 2019 to September 2021 were retrospectively analyzed. There were 39 males and 35 females, aged (60.2±7.8) years (range: 42 to 77 years). During operation, 44 patients were treated with single double-row suture bridge technique (the simple group), and 30 patients were treated with double-row suture bridge technique combined with type Ⅱ "Chinese way" treatment (the combined group). In the simple group, only internal and external row anchors were used to fix the fractured rotator cuff, while in the combined group, the biceps long head tendon was first transposed to the footprint area and fixed with an internal row anchor tail thread, and then the remaining rotator cuff fracture was repaired with double-row suture bridge technique. The operation conditions were recorded. The range of motion of shoulder joint, visual analogue scale (VAS), American Society for Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley shoulder joint score before operation, 6 months after operation and at the last follow-up were compared between the two groups. Postoperative complications and imaging results were recorded. The difference values of each observation index before and after operation were calculated. The repeated measures analysis of variance was used for repeated measurement data, and LSD multiple comparison method was used for the data at different time points in the two groups. Results: All the patients successfully completed the operation, and no serious complications occurred during or after operation. The patients were followed up for (14.6±5.4) months (range: 6 to 24 months). In all patients, the shoulder range of motion, VAS, ASES score, UCLA score and Constant-Murley shoulder score at 6 months after operation and at the last follow-up were significantly improved compared with those before operation (all P<0.01), and the results at the last follow-up were also better than those at 6 months after operation (all P<0.01). The results of the combined group at 6 months after operation and at the last follow-up (all P<0.01) were better than those of the single group. At 6 months after operation and at the last follow-up, the anteroposternal X-ray showed no significant progress in the degeneration of shoulder joint. Of the 27 patients who completed MRI during follow-up, 14 patients re-injured of reconstructed rotator cuff tissue (type Ⅳ and type Ⅴ) was found in 14 cases, the incidence was 22.7% (10/44) in the simple group and 13.3%(4/30) in the combined group. There was no significant difference between the two groups(χ²=1.026, P=0.311). Conclusion: Compared with the simple double-row suture bridge technique, the method of double-row suture bridge technique combined with type Ⅱ "Chinese way" for repairing massive rotator cuff injury has better effect on improving the short-term pain symptoms, joint range of motion, restoring joint function, and has lower incidence of complications.
Humans ; Rotator Cuff Injuries/surgery* ; East Asian People ; Retrospective Studies ; Treatment Outcome

Objective:To analyze the clinical features of patients with pyogenic liver abscess (PLA) and the application of mNGS in PLA, thus to provide reference for clinical diagnosis and treatment.Methods:The demographic and clinical data of 549 patients with liver abscess admitted to Zhongshan Hospital Affiliated to Fudan University from December 2015 to June 2020 were analyzed retrospectively. According to the detection of Klebsiella pneumoniae in 246 patients with positive etiological test results, the patients were divided into two groups: KPLA group and nKPLA group, and clinical characteristics of the two groups were compared. At the same time, the application value of mNGS in PLA was analyzed.Results:Among the 549 patients, the main clinical symptom of PLA was fever ( n= 503, 91.6%) and other clinical symptoms included chills and abdominal pain. Most patients had a single abscess ( n= 464, 84.5%) located in the right lobe ( n = 368, 67.0%), with a size between 5 and 10 cm ( n= 341, 62.1%). A total of 246 patients had positive etiological test results, including 202 KPLA patients which was the main pathogen of liver abscess. The prevalence of diabetes and fatty liver was higher in KPLA patients ( P < 0.05), but there were more culture of liver positive factors in nKPLA patients ( P < 0.001). Among the 109 patients with traditional microbiological results, 92 patients were suspected to KPLA (Klebsiella pneumoniae), of which 14 patients (15.2%) were multidrug resistant (MDR) infection; 17 patients were suspected to nKPLA, of which 10 patients (58.8%) were MDR infection; the incidence of MDR infection in patients with nKPLA was significantly higher than that in patients with KPLA ( P < 0.05). The positive rate of mNGS in plasma was 85.2%, the positive rate of traditional microbial culture in plasma was 14.8%, the positive rate of mNGS in pus was 96.2% and traditional microbial culture in pus was 65.4%. The positive rate of traditional culture was significantly lower than that of mNGS ( P < 0.05). Conclusions:PLA is usually manifested as fever, single and at the right lobe of the liver. Klebsiella pneumoniae is the most common pathogenic bacteria of PLA, which is more common in patients with diabetes and fatty liver, while non-Klebsiella pneumoniae is relatively more common in patients with culture of liver positive factors. The positive detection rate of mNGS is high, which has a unique advantage in pathogen detection.

Objective:Evaluation of combined inflammatory and coagulation markers for early identification of DIC in septic patients.Methods:This study was a single-center, retrospective, observational study involving 356 patients with sepsis. Sepsis was defined by the diagnostic criteria of Sepsis version 3.0. Definition of DIC was from the International Society on Thrombosis and Hemostasis (ISTH) DIC Score. Inflammatory biomarkers, including tumor necrosis factor (TNF)-α, interleukin (IL)-1β,2R,6,8,10, etc. and biomarkers of coagulation, like platelet (PLT), international normalized ratio (INR), D-dimer, fibrinogen (Fib), etc. were included in this study.Results:Among 356 patients with sepsis, 301 patients did not develop DIC (non-DIC) during hospitalization, 32 patients had DIC on the day of admission (overt-DIC), and 23 patients developed DIC within 1 week of admission (pre-DIC). Compared to non-DIC patients, pre-DIC patients had lower platelet counts and fibrinogen ( P < 0.05), higher levels of INR and D-dimer ( P < 0.05), higher levels of cytokines (TNF-α、IL-1β、IL-2R、IL-8、IL-10) and procalcitonin ( P < 0.05), higher APACHEⅡ and SOFA scores ( P < 0.05). Using receiver operating characteristics (ROC) analysis, we found that some biomarkers of coagulation and inflammation could discriminate pre-DIC from non-DIC patients. The area under the curve (AUC) of INR in the ROC analysis was 0.773 (95% CI: 0.696-0.851), the AUC of IL-2R was 0.700 (95% CI: 0.599-0.798) which is highest among inflammation markers, the highest AUC was obtained from the combination of platelets, INR, Fib, D-dimer and IL-2R (AUC = 0.843; 95% CI: 0.758-0.928). Kaplan-Meier survival curve suggested that high level of IL-2R (> 1064.5 U/mL) was a valuable predictor of 28-day mortality in septic patients. Conclusion:Inflammatory marker, IL-2R, is related to the occurrence of DIC in septic patients and has predictive value for pre-DIC. Combination of coagulation (platelets, INR, Fib, D-dimer) and inflammatory markers (IL-2R) can help to identify pre-DIC state in septic patients.

Through systematic review of literature, Delphi expert consultation and expert discussion meeting, the Nursing expert consensus on application of cardiopulmonary resuscitation machine in treating patients with in- hospital cardiac arrest was formulated. Finally, 8 parts of the application specifications including evaluation before boarding, cooperation during boarding, detection and management after boarding, cooperation during weaning, quality control and training, and fault handling were formed, in order to provide guidance and reference for the application of cardiopulmonary resuscitation machine in treating patients with in-hospital cardiac arrest.

PURPOSE: Venous thromboembolism (VTE) is a major health issue among hip fracture patients. This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient's drug compliance and reduce the incidence of VTE in hip fracture patients. METHODS: This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform (study group) between January 2016 and September 2017. All the patients included in the both groups were hip fracture patients who had an age over 50 years, treated with surgery, and hospitalized ≥ 48 h. Patients were excluded if they admitted to hospital due to old fractures, had a severe bleeding after 72 h of admission, diagnosed with any type of VTE, or refused to participate in the study. The information platform was divided into medical, nursing, and patient interface. Based on the information platform, medical practitioners and nurses could perform risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up, and other aspects of nursing interventions for patients. This study compared essential characteristics, drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. SPSS 18.0 software (IBM Corp., NY, and USA) was used for statistical analysis. RESULTS: Altogether 1177 patients were included in the control group, and 491 patients in the study group. Regarding baseline data, patients in the study group had more morbidities than those in the control group (p < 0.05). The difference of drug compliance between the two groups was statistically significant (p < 0.001): 761 (64.7%) of the patients in the control group and only 30 (6.1%) patients in the study group had poor drug compliance. In terms of VTE, 10.7% patients (126/1177) in the control group had VTE, and the rate in the study group was 7.1% (35/491), showing a statistically significant difference (p = 0.02). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 days vs. 13.7 days, p < 0.001). Subgroup analyses of the study group showed that the incidence of VTE in patients with poor, partial, and good compliances were 56.7% (17/30), 5.8% (10/171), and 2.8% (8/290), respectively, revealing a significantly huge difference (p < 0.001). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE. The mobile application may be an effective tool to prevent VTE in hip fracture patients.
Humans ; Middle Aged ; Venous Thromboembolism/epidemiology* ; Retrospective Studies ; Risk Factors ; Hip Fractures/surgery* ; Incidence