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 clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective:To systematically evaluate the qualitative study of perinatal bereavement care by obstetric nurses and midwives, and explore the barriers to perinatal bereavement care, so as to promote the development of domestic perinatal bereavement care services.Methods:Systematic search of qualitative studies on the experience of obstetric nurses and midwives in caring for perinatal bereaved mothers in PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, China Biomedical Literature Service System, CNKI, Wanfang Database, and VIP database were searched from the establishment until June 30, 2024. The qualitative research quality evaluation was conducted using the 2016 version of the qualitative research quality assessment tool of the Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, and the results of the study were summarized and integrated using the pooled integration method.Results:A total of 14 studies were included, with 3 Chinese literatures and 11 English literatures. A total of 55 themes were extracted, which were summarized and combined into 8 new categories, and 3 integrated results were summarized: insufficient bereavement care ability, insufficient bereavement care confidence, and imperfect allocation of bereavement care resources.Conclusions:The knowledge popularization and training of bereavement care should be strengthened, the organizational support should be strengthened, the confidence of obstetric nurses and midwives in bereavement care should be enhanced, a special perinatal bereavement care team should be set up, and multidisciplinary resources should be integrated to ensure the continuity and coordination of perinatal bereavement care.

Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective:To analyze the differences in pediatric CT radiation dose and scanning parameter Settings between children's specialized hospitals and general hospitals, and to provide reference for the optimization strategy of pediatric CT radiation dose.Methods:From July to August 2022, a stratified sampling method was used to select 7 comprehensive hospitals and 2 children's hospitals in Tianjin, and on-site survey was conducted to collect the dose data of children's head, chest, and abdomen and pelvic CT examinations in these hospitals. The Wilcoxon rank sum test was used to analyze the differences in CTDI vol and DLP of the same age group and examination site among different types of hospitals, and the stepwise regression analysis method was used to analyze the effects of age, examination site, and scanning parameters on radiation dose CTDI vol and DLP. Results:The CTDI vol and DLP of head (1-<5, 5-<10, 10-<15 years old group), chest (5-<10, 10-<15 years old group) and abdomen (1-<5, 5-<10, 10-<15 years old group) in children's specialized hospitals were lower than those in general hospitals (head, 1-<5, 5-<10, 10-<15 years old group, CTDI vol: Z=-9.32, -6.17, -9.86, P<0.001, DLP, Z=-4.41, -4.14, -5.76, P<0.001; chest, 5-<10, 10-<15 years old group, CTDI vol: Z=-3.84, -5.35, P<0.001, DLP, Z=-3.59, -4.63, P<0.001; abdomen, 1-<5、5-<10 and 10-<15 years old group, CTDI vol: Z=-7.88, -7.78, -8.53, P<0.001, DLP, Z=-7.24, -5.92, -3.44, P<0.001). The CT radiation dose in children was positively correlated with age, tube voltage, tube current time product and scan length, and negatively correlated with pitch and hospital type (general hospital and children's hospital) . Conclusion:There are some differences in the CT radiation dose and scanning parameters between children's hospitals and general hospitals. The results indicate that there is still much room for improvement in the optimization of radiation dose in pediatric CT examination.

Objective:To systematically evaluate the qualitative study of perinatal bereavement care by obstetric nurses and midwives, and explore the barriers to perinatal bereavement care, so as to promote the development of domestic perinatal bereavement care services.Methods:Systematic search of qualitative studies on the experience of obstetric nurses and midwives in caring for perinatal bereaved mothers in PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, China Biomedical Literature Service System, CNKI, Wanfang Database, and VIP database were searched from the establishment until June 30, 2024. The qualitative research quality evaluation was conducted using the 2016 version of the qualitative research quality assessment tool of the Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, and the results of the study were summarized and integrated using the pooled integration method.Results:A total of 14 studies were included, with 3 Chinese literatures and 11 English literatures. A total of 55 themes were extracted, which were summarized and combined into 8 new categories, and 3 integrated results were summarized: insufficient bereavement care ability, insufficient bereavement care confidence, and imperfect allocation of bereavement care resources.Conclusions:The knowledge popularization and training of bereavement care should be strengthened, the organizational support should be strengthened, the confidence of obstetric nurses and midwives in bereavement care should be enhanced, a special perinatal bereavement care team should be set up, and multidisciplinary resources should be integrated to ensure the continuity and coordination of perinatal bereavement care.

Objective:To analyze the differences in pediatric CT radiation dose and scanning parameter Settings between children's specialized hospitals and general hospitals, and to provide reference for the optimization strategy of pediatric CT radiation dose.Methods:From July to August 2022, a stratified sampling method was used to select 7 comprehensive hospitals and 2 children's hospitals in Tianjin, and on-site survey was conducted to collect the dose data of children's head, chest, and abdomen and pelvic CT examinations in these hospitals. The Wilcoxon rank sum test was used to analyze the differences in CTDI vol and DLP of the same age group and examination site among different types of hospitals, and the stepwise regression analysis method was used to analyze the effects of age, examination site, and scanning parameters on radiation dose CTDI vol and DLP. Results:The CTDI vol and DLP of head (1-<5, 5-<10, 10-<15 years old group), chest (5-<10, 10-<15 years old group) and abdomen (1-<5, 5-<10, 10-<15 years old group) in children's specialized hospitals were lower than those in general hospitals (head, 1-<5, 5-<10, 10-<15 years old group, CTDI vol: Z=-9.32, -6.17, -9.86, P<0.001, DLP, Z=-4.41, -4.14, -5.76, P<0.001; chest, 5-<10, 10-<15 years old group, CTDI vol: Z=-3.84, -5.35, P<0.001, DLP, Z=-3.59, -4.63, P<0.001; abdomen, 1-<5、5-<10 and 10-<15 years old group, CTDI vol: Z=-7.88, -7.78, -8.53, P<0.001, DLP, Z=-7.24, -5.92, -3.44, P<0.001). The CT radiation dose in children was positively correlated with age, tube voltage, tube current time product and scan length, and negatively correlated with pitch and hospital type (general hospital and children's hospital) . Conclusion:There are some differences in the CT radiation dose and scanning parameters between children's hospitals and general hospitals. The results indicate that there is still much room for improvement in the optimization of radiation dose in pediatric CT examination.

With the transition of the medical model from the traditional biomedical model to the biopsychosocial one, there is a growing trend and requirement for oral operations that prioritize comfort, pain management, minimally invasive techniques, and visualization. Consequently, demands for comfortable dental treatments among individuals are increasing. However, initial periodontal therapy is often accompanied by pain, and patients′ reactions to pain range from nervousness to dental fear, such as irritability, hyperventilation, even nausea, vomiting, and refusal to cooperate, which make the implementation of initial periodontal therapy difficult or even impossible. This article will focus on three key steps: firstly, the preparation of the clinic, the acquisition of patients′ trust and the implementation of preventive sedation before treatment; secondly, the use of comfort operation and nursing, psychological intervention measures, local anesthesia, and sedation techniques during treatment; thirdly, the health education and follow-up after treatment. By addressing these aspects, we aim to clarify how to perform comfortable initial periodontal therapy step by step.

Objective:To understand the level of radiation doses from digital mammography in Tianjin and the associated influencing factors.Methods:The stratified quota sampling method was used for analysis of 374 digital mammography-examined individuals by using 12 digital mammography devices in 12 selected medical institutions. The examinations were carried out in terms of exposure positions[(craniocaudal (CC) and mediolateral oblique (MLO)], compressed breast thickness, tube voltage, time product of tube current (mAs) and target/filter.Results:The median age of the examined individuals in this survey was 43 years, the median tube voltage (kV) was 29 kV, the median tube current time product was 60.3 mAs, the median compressed breast thickness was 48 mm, and the median average glandular dose (AGD) was 1.32 mGy. The mean dose to the analyzed glandular tissue in the conditions of different target/filters varies in the descent order of Mo/Mo > Mo/Rh > Rh/Rh > W/Rh > W/Al, with the difference being statistically significant difference ( χ2=885.90, P<0.05). The mean dose to the glandular tissue increased with the increase in compressed breast thickness, and the difference was statistically significant ( χ2=31.58, 8.56, 76.13, 118.47, 24.09, P<0.05). Conclusions:The median average glandular dose in Tianjin was 1.32 mGy. This level is lower than in Guangxi province and Fuzhou city, similar to that in Beijing and Guangdong province, and lower than the national survey result of average breast dose. The efforts should be dedicated to further strengthening the research on the related factors of the average glandular dose in order to protect the health and safety of the examined individuals.

The incidence of lower extremity varicose veins is higher in the disease of venous system,and surgical treatment is the main treatment method of lower extremity varicose veins.With the advancement of technique and the development of minimally invasive concept,endovenous thermal ablation(EVTA)has become the first choice in the guidance of the treatment of lower extremity varicose veins depended on its series of advantages include small trauma,rapid recovery after surgery,low incidence of complication and high closure rate.At present,EVTA mainly includes intracavitary radiofrequency ablation(RFA),endovenous laser ablation(EVLA)and endovenous microwave ablation(EMA),which takes heat on target vessel through different thermal ablation equipment,and uses thermal energy to destruct the endothelial cells of blood vessel and collagen fibers in the vascular wall.Then,the contracted lumen forms the fibrous strands,thus reaches the aim that closes target vessel.Different EVTA surgical mode has different mechanism of action,therapeutic effect and incidence of complication,as well as the application range.This paper summarized the routinely surgical mode of EVTA and the clinical application of that in the past 5 years,which can provide references for reasonable choosing the mode of thermal ablation and the equipment,and can provide helps for preventing the complication of thermal injury.