BACKGROUND:The preparation of curved root canals is a difficult point in root canal treatment,and the main way used in clinical preparation for curved root canals is to gradually deepen the technique,but this technique is prone to lateral penetration when preparing curved root canals,resulting in treatment failure.In view of this situation,some scholars have proposed the use of touch activation technology to prepare,but there are few studies on the influence of this technology combined with different mechanical nickel-titanium instruments on the forming effect of curved root canals at home and abroad.OBJECTIVE:To observe the shaping effect of WaveOneGold,Trunatomy and M3-Pro mechanized nitinol device preparation root canal by using resin simulated root canal step-down technology and tactile controlled activation.METHODS:60 single-bending resin simulated root canals were divided into 6 groups(r=10)according to the random number table method according to the nitinol instrument used.The A1 group was prepared with step-down+WaveOneGold;the A2 group was prepared with step-down+Trunatomy,and the A3 group was prepared with step-down+M3-Pro.Tactile controlled activation+WaveOneGold was used for preparation in group B1;tactile controlled activation+Trunatomy was used for group B2,and tactile controlled activation+M3-Pro was used for preparation in group B3.After the preparation was completed,the pre-preparation and posterior root canal images are obtained using a dental surgical microscope.The root canal offset was analyzed before and after preparation.RESULTS AND CONCLUSION:(1)When WaveOneGold was used,the root canal deviation at 1,4,and 7 mm from the apex was smaller with the tactile controlled activation technique than with the step-down technique(P＜0.05);when Trunatomy was used,the root canal deviation at 6,8,and 10 mm from the apex was smaller with the tactile controlled activation technique than with the step-down technique(P＜0.05);when M3-Pro was used,the root canal deviation at 1,2,and 3 mm from the apex was smaller with the tactile controlled activation technique than with the step-down technique(P＜0.05).(2)When the step-down technique was used,the root canal deviation at 1,4,5,and 7 mm from the apex was smaller with the Trunatomy than with the other two files(P＜0.05),and the root canal deviation at 1,2,3,and 6 mm from the apex was larger with the M3-Pro machine-made nickel-titanium instrument than with the other two files(P＜0.05);when the tactile controlled activation technique was used,the root canal deviation at 2,5,6,8,and 9 mm from the apex after preparation with the Trunatomy file was smaller than that of the other two groups(P＜0.05),and the root canal deviation at 1,4,5,6,and 7 mm from the apex after preparation with the M3-Pro file was larger than that of the other two groups(P＜0.05).(3)The results showed that the three files could cause root canal deviation when preparing root canals.The three files combined with the tactile controlled activation technique could reduce the root canal deviation at some sites of the root canal.The root canal deviation at some sites of the Trunatomy file was less than that of the other two files.

BACKGROUND:The preparation of curved root canals is a difficult point in root canal treatment,and the main way used in clinical preparation for curved root canals is to gradually deepen the technique,but this technique is prone to lateral penetration when preparing curved root canals,resulting in treatment failure.In view of this situation,some scholars have proposed the use of touch activation technology to prepare,but there are few studies on the influence of this technology combined with different mechanical nickel-titanium instruments on the forming effect of curved root canals at home and abroad.OBJECTIVE:To observe the shaping effect of WaveOneGold,Trunatomy and M3-Pro mechanized nitinol device preparation root canal by using resin simulated root canal step-down technology and tactile controlled activation.METHODS:60 single-bending resin simulated root canals were divided into 6 groups(r=10)according to the random number table method according to the nitinol instrument used.The A1 group was prepared with step-down+WaveOneGold;the A2 group was prepared with step-down+Trunatomy,and the A3 group was prepared with step-down+M3-Pro.Tactile controlled activation+WaveOneGold was used for preparation in group B1;tactile controlled activation+Trunatomy was used for group B2,and tactile controlled activation+M3-Pro was used for preparation in group B3.After the preparation was completed,the pre-preparation and posterior root canal images are obtained using a dental surgical microscope.The root canal offset was analyzed before and after preparation.RESULTS AND CONCLUSION:(1)When WaveOneGold was used,the root canal deviation at 1,4,and 7 mm from the apex was smaller with the tactile controlled activation technique than with the step-down technique(P＜0.05);when Trunatomy was used,the root canal deviation at 6,8,and 10 mm from the apex was smaller with the tactile controlled activation technique than with the step-down technique(P＜0.05);when M3-Pro was used,the root canal deviation at 1,2,and 3 mm from the apex was smaller with the tactile controlled activation technique than with the step-down technique(P＜0.05).(2)When the step-down technique was used,the root canal deviation at 1,4,5,and 7 mm from the apex was smaller with the Trunatomy than with the other two files(P＜0.05),and the root canal deviation at 1,2,3,and 6 mm from the apex was larger with the M3-Pro machine-made nickel-titanium instrument than with the other two files(P＜0.05);when the tactile controlled activation technique was used,the root canal deviation at 2,5,6,8,and 9 mm from the apex after preparation with the Trunatomy file was smaller than that of the other two groups(P＜0.05),and the root canal deviation at 1,4,5,6,and 7 mm from the apex after preparation with the M3-Pro file was larger than that of the other two groups(P＜0.05).(3)The results showed that the three files could cause root canal deviation when preparing root canals.The three files combined with the tactile controlled activation technique could reduce the root canal deviation at some sites of the root canal.The root canal deviation at some sites of the Trunatomy file was less than that of the other two files.

Objective To explore the surgical treatment experience of primary giant gastrointestinal stromal tumors(GIST)(with isolated lesions with a maximum diameter＞10 cm).Methods A retrospective analysis was conducted on the clinical and pathological data of 67 patients with primary giant GIST admitted from January 2018 to December 2024.Among them,35 cases underwent surgical operations after preoperative neoadjuvant therapy(25 effective cases and 10 ineffective cases)(neoadjuvant therapy group).Due to the initial diagnosis assessment expecting radical(R0)resection(13 cases),or preoperative complications(12 cases),or difficulty in obtaining a pathological diagnosis through puncture biopsy(7 cases),32 cases underwent direct surgery without neoadjuvant therapy(direct surgery group).Compare the general information,tumor condition,surgical condition,postoperative recovery,postoperative pathology,postoperative adjuvant therapy,and recurrence between two groups.Results Comparative analysis revealed that there was no statistically significant difference(P＞0.05)between the neoadjuvant therapy group and the direct surgery group in terms of gender,age,primary tumor location,initial maximum diameter,growth type,localized or locally advanced stage,and postoperative follow-up time.The maximum diameters of the tumors before surgery in the neoadjuvant therapy group and the direct surgery group were(12.4±7.1)cm and(18.2±5.0)cm respectively,and the operation times were(125.4±30.6)minutes and(153.0±31.7)minutes respectively.The intraoperative blood loss was(228.3±76.4)ml and(300.3±67.2)ml,respectively.The postoperative hospital stay was(9.1±2.6)days and(11.1±3.2)days,respectively.There was a statistically significant difference between the two groups(P＜0.05).The proportion of laparoscopic surgery in the neoadjuvant therapy group was 17.1％,which was higher than that in the direct surgery group(0),and the difference was statistically significant(P＜0.05).There was no statistically significant difference between the two groups in terms of the proportion of tumor rupture,combined organ resection,postoperative complications and postoperative recurrence(P＞0.05).Conclusion Primary giant gastrointestinal stromal tumors can mostly be reduced in size and progression through neoadjuvant therapy,improving the chances of minimally invasive surgery.However,there is also a risk of tumor progression during neoadjuvant therapy leading to increased surgical difficulty or even loss of curative surgical opportunities.

Objective To explore the covariant network features of iron deposition in Parkinson's disease with mild cognitive impairment(PD-MCI)based on quantitative susceptibility mapping(QSM).Methods Seventy-one patients with Parkinson's disease(PD)were divided into PD-MCI group(n=37)and PD with normal cognition(PD-NC)group(n=34).The differences of edge-connection and topological property parameters of the iron deposition covariant network between the two groups were compared,respectively.Results The iron deposition covariant network edge-connection analysis showed that there were significant difference in r values of the right globus pallidus-right cerebellar dentate nucleus,right globus pallidus-left putamen,and left hippo-campus-left substantia nigra between the two groups(P＜0.05).The global topological property analysis showed that when the sparsity was 0.47 and 0.48,respectively,the Cp in PD-MCI group was significantly higher than that in PD-NC group(P＜0.05).The node topological property analysis showed that there were significant differences in the node network property parameters of the left substantia nigra,left entorhinal cortex,left precentral gyrus,left putamen,left dentate nucleus,and right orbital frontal cortex between the two groups(P＜0.05).Conclusion The changes of covariant network topological properties based on QSM may be the neuropathological mechanism in PD-MCI at the level of large-scale iron metabolism network.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To explore the surgical treatment experience of primary giant gastrointestinal stromal tumors(GIST)(with isolated lesions with a maximum diameter＞10 cm).Methods A retrospective analysis was conducted on the clinical and pathological data of 67 patients with primary giant GIST admitted from January 2018 to December 2024.Among them,35 cases underwent surgical operations after preoperative neoadjuvant therapy(25 effective cases and 10 ineffective cases)(neoadjuvant therapy group).Due to the initial diagnosis assessment expecting radical(R0)resection(13 cases),or preoperative complications(12 cases),or difficulty in obtaining a pathological diagnosis through puncture biopsy(7 cases),32 cases underwent direct surgery without neoadjuvant therapy(direct surgery group).Compare the general information,tumor condition,surgical condition,postoperative recovery,postoperative pathology,postoperative adjuvant therapy,and recurrence between two groups.Results Comparative analysis revealed that there was no statistically significant difference(P＞0.05)between the neoadjuvant therapy group and the direct surgery group in terms of gender,age,primary tumor location,initial maximum diameter,growth type,localized or locally advanced stage,and postoperative follow-up time.The maximum diameters of the tumors before surgery in the neoadjuvant therapy group and the direct surgery group were(12.4±7.1)cm and(18.2±5.0)cm respectively,and the operation times were(125.4±30.6)minutes and(153.0±31.7)minutes respectively.The intraoperative blood loss was(228.3±76.4)ml and(300.3±67.2)ml,respectively.The postoperative hospital stay was(9.1±2.6)days and(11.1±3.2)days,respectively.There was a statistically significant difference between the two groups(P＜0.05).The proportion of laparoscopic surgery in the neoadjuvant therapy group was 17.1％,which was higher than that in the direct surgery group(0),and the difference was statistically significant(P＜0.05).There was no statistically significant difference between the two groups in terms of the proportion of tumor rupture,combined organ resection,postoperative complications and postoperative recurrence(P＞0.05).Conclusion Primary giant gastrointestinal stromal tumors can mostly be reduced in size and progression through neoadjuvant therapy,improving the chances of minimally invasive surgery.However,there is also a risk of tumor progression during neoadjuvant therapy leading to increased surgical difficulty or even loss of curative surgical opportunities.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To evaluate the value of biparametric MRI(bpMRI)radiomics for predicting postoperation Gleason score(GS)upgrade of prostate cancer(PCa).Methods Totally 344 PCa patients who underwent radical prostatectomy(RP)were retrospectively enrolled and divided into training set(n=241)and test set(n=103)at a ratio of 7∶3.T2WI,diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)map radiomics signatures were constructed based on preoperative bpMRI,respectively,then logistic regression(LR)algorithm was used to establish bpMRI radiomics model.Univariate and multivariate logistic regression analyses were performed to screen independent risk factors for postoperation GS upgrade of PCa,and a clinical model was constructed.Then a clinical-radiomics combined model was established based on clinical model and bpMRI radiomics model.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of each model for predicting postoperation GS upgrade of PCa.Results Elevated preoperative prostate imaging reporting and data system(PI-RADS)score and reduced biopsy Gleason grade group(GG)were both independent risk factors of postoperation GS upgrade of PCa(both P＜0.05).The AUC of bpMRI radiomics model and clinical-radiomics combined model for predicting postoperation GS upgrade of PCa were higher than that of single-sequence radiomics signatures and clinical model(all P＜0.05),while no significant difference was found between the former two(P＞0.05).The clinical-radiomics combined model demonstrated good efficacy for predicting postoperation GS upgrade of PCa with different biopsy GG before operation,with AUC ranging from 0.835 to 0.949 in training set and 0.803 to 0.948 in test set.Conclusion bpMRI radiomics model could effectively predict postoperation GS upgrade of PCa.