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*

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Objective:To investigate the effects of temporal interference electrical fields(TI)on motor cortical excitabili-ty and motor learning abilities in healthy adults,in order to provide evidence for the application of TI stimula-tion in human. Method:A randomized crossover double-blind design was used with healthy adults participants.Experiment l:twenty subjects completed transcranial magnetic stimulation(TMS)testing to assess changes in cortical excit-ability indicators before and after stimulation,including motor evoked potentials(MEP),resting motor thresh-old(RMT),short-interval intracortical inhibition(SICI),and intracortical facilitation(ICF).Experiment 2:sixteen subjects completed the random reaction time task(RRTT)and the serial reaction time task(SRTT),with performance indicators including average reaction time(RT),first implicit learning(FIL),and second im-plicit learning(SIL).The effects of TI stimulation on cortical excitability and motor learning abilities were evaluated using a two-factor repeated measures analysis of variance. Result:Experiment 1:there were significant interactions between stimulation condition and time on MEP(F=28.787,P＜0.001,ηP2=0.602)and RMT(F=23.524,P＜0.001,ηP2=0.580),while SICI and ICF showed no significant interaction effects.Experiment 2:compared to sham stimulation,FIL in SRTT was significantly im-proved after TI stimulation(F=4.601,P=0.049,ηP2=0.235),while there was no significant interaction effect in the RRTT task. Conclusion:Variable frequency TI stimulation can significantly increase cortical excitability in the primary mo-tor cortex,and this regulatory effect may contribute to enhancing motor learning performance in healthy adults.

OBJECTIVE: To compare the effectiveness of Achillon Achilles tendon suture guide combined with circuit suture under the perineural channel and Krachow suture with posterolateral incision of Achilles tendon in the treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture. METHODS: The clinical data of 38 patients with Kuwada type Ⅱ acute closed Achilles tendon rupture who met the selection criteria between January 2020 and December 2023 were retrospectively analyzed. Krachow suture via posterolateral incision was used in 24 cases (traditional group), and Achillon Achilles tendon suture guide combined with circuit suture via perineural channel was used in 14 cases (minimally invasive group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, time from injury to operation, characteristics of Achilles tendon injury (broken end distance, stump length), and preoperative Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score between the two groups ( P>0.05). The operation time, incision length, hospital stay, and complications (re-tear, incision infection, sural nerve irritation, deep venous thrombosis) were recorded. ATRS score and AOFAS ankle and hindfoot function score were used to evaluate the effectiveness before operation and at 3 and 6 months after operation. RESULTS: All patients successfully completed the operation. The operation time, incision length, and hospital stay in the minimally invasive group were significantly shorter than those in the traditional group ( P<0.05). Patients in both groups were followed up 8-16 months, with an average of 12.7 months. There was no sural nerve injury or re-tear of Achilles tendon in both groups. In the traditional group, 1 case had incision infection,1 case had suture rejection, and 1 case had intermuscular venous thrombosis; in the minimally invasive group, no incision healing complication, suture knot discomfort, or thrombosis occurred. There was no significant difference in the incidence of complications between the two groups ( P=0.283). The ATRS score and AOFAS ankle and hindfoot function score of the two groups were improved after operation, but there was no significant difference ( P>0.05). Except that there was no significant difference in AOFAS ankle and hindfoot function scores between the two groups at 6 months after operation ( P>0.05), the ATRS scores and AOFAS ankle and hindfoot function scores in the minimally invasive group were significantly better than those in the traditional group at other time points ( P<0.05). CONCLUSION The treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture with Achillon Achilles tendon suture guide combined with circuit suture via the perineural channel has similar ankle function comparable to traditional operation, but the incision is smaller and the incidenc of incision infection is lower, which is beneficial for patients to recover early ankle function.
Humans ; Achilles Tendon/injuries* ; Suture Techniques ; Retrospective Studies ; Tendon Injuries/surgery* ; Rupture/surgery* ; Sutures ; Male ; Treatment Outcome ; Female ; Minimally Invasive Surgical Procedures/methods* ; Adult

Objective:To investigate the application of serum creatinine to prealbumin ratio (Scr/PA) in the diagnosis of patients with heart failure complicated with renal failure.Methods:This was a case-control study. Patients with chronic heart failure and heart failure complicated with renal failure admitted to Dalian Central Hospital from January 5, 2020 to April 23, 2023 were retrospectively analyzed, and Scr/PA was calculated. The general data and laboratory examination indexes of the two groups were compared. According to the data type, t test, Wilcoxon rank sum test and χ 2 test were used for comparison between the two groups. The risk factors of heart failure complicated with renal failure were analyzed by univariate and multivariate logistic regression analysis, and Spearman correlation analysis was used to analyze the correlation between Scr/PA and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and hemoglobin (HGB). ROC curve was used to determine the predictive value of Scr/PA and NT-proBNP for heart failure complicated with renal failure. Results:Compared with the heart failure group, Triglyceride [1.25 (0.94, 1.81) mmol/L vs. 1.07 (0.76, 1.46) mmol/L, Z=-2.159, P=0.031], D-dimer [2.30 (1.53, 4.67) mg/L vs. 1.63 (0.64, 2.96) mg/L, Z=-2.339, P=0.02],NT-proBNP [18 500 (9 575, 30 000) pg/ml vs. 4 865 (1 600, 9 800) pg/ml, Z=-5.637, P<0.001], Scr/PA [0.233 (0.188, 0.351) mg/mg vs 0.064 (0.044, 0.103) mg/mg, Z=-8.197, P<0.001] were higher in heart failure complicated with renal failure group. While albumin [(33.9±5.2) g/L vs. (36.3±4.3) g/L, t=-2.173, P=0.008], estimated glomerular filtration rate[12.86 (7.88, 17.40) ml/(1 min×1.73 m 2) vs. 65.82 (48.66, 86.32) ml/(1 min×1.73 m 2), Z=-9.794, P<0.001], and HGB [(91±24) g/L vs. (123±23) g/L, t=-7.489, P<0.001] were lower. Univariate logistic regression analysis showed that albumin ( OR=0.900, 95% CI 0.830-0.975, P=0.010), HGB ( OR=0.948, 95% CI 0.930-0.966, P<0.001), Scr/PA ( OR=1.639, 95% CI 1.346-1.957, P<0.001) were associated with heart failure complicated with renal failure. Multivariate logistic regression analysis showed that only Scr/PA was an independent risk factor for heart failure complicated with renal failure. The correlation coefficients of Scr/PA with NT-proBNP and HGB were r=0.578 and r=-0.559, respectively (all P<0.001). The area under the AUC curve of Scr/PA and NT-proBNP for predicting heart failure complicated with renal failure was 0.927 (95% CI: 0.881-0.973, P<0.001) and 0.797 (95% CI: 0.717-0.877, P<0.001), respectively. Conclusions:Scr/PA is an independent risk factor for heart failure complicated with renal failure, and it has a good correlation with NT-proBNP and HGB. Scr/PA is superior to NT-proBNP in predicting heart failure complicated with renal failure.

Due to the virtues of no stutter peaks, low rates of mutation, and short amplicon sizes, insertion/deletion (InDel) polymorphism is an indispensable tool for analyzing degraded DNA samples from crime scenes for human identifications (Wang et al., 2021). Herein, a self-developed panel of 43 InDel loci constructed previously by our group was utilized to evaluate the genetic diversities and explore the genetic background of the Han Chinese from Beijing (HCB) including 301 random healthy individuals. The lengths of amplicons at 43 InDel loci in this panel ranged from 87 to 199 bp, which indicated that the panel could be used as an effective tool to utilize highly degraded DNA samples for human identity testing. The loci in this panel were validated and performed well for forensic degraded DNA samples (Jin et al., 2021). The combined discrimination power (PD) and combined probability of exclusion (PE) values in this panel indicated that the 43 InDel loci could be used as the candidate markers in personal identification and parentage testing of HCB. In addition, population genetic relationships between the HCB and 26 reference populations from five continents based on 19 overlapped InDel loci were displayed by constructing a phylogenetic tree, principal component analysis (PCA), and population genetic structure analysis. The results illustrated that the HCB had closer genetic relationships with the Han populations from Chinese different regions.
Beijing ; China ; Forensic Genetics/methods* ; Gene Frequency ; Genetics, Population ; Humans ; INDEL Mutation ; Phylogeny

Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation with the three-dimensional configuration of the skin ligament.Methods:(1) Tweleve fresh adult cadaver specimens, including seven males and five females, aged 54-87 years old, were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the mid-face (cheek, nose, orbital eyelid). (2) A retrospective study was conducted with the data of mid-face soft tissue defects admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flaps. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences in flap size and aspect ratio in different parts of the mid-face. The measurement data were described by Mean±SD or M( Q1, Q3). Results:(1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal cutaneous ligaments run down the nose alar. (2) The clinical study included 18 patients, including eight males and ten females, aged (64.6±23.4) years old. All flaps survived uneventfully. The average flap size was 10.6(8.0, 18.0) cm 2, and the average advancing distance was 2.8(2.0, 4.0) cm. Statistical analysis showed a correlation between the flap advancement distance, the flap incision area ( r=-0.71, P=0.022), and the flap aspect ratio ( r=-0.58, P=0.012). There was no correlation with the defect area ( r=-0.23, P=0.365); the aspect ratios of the cheek, nose, and orbital lid flaps were 2.1(1.9, 2.3), 2.0(1.6, 3.5), 3.5(3.0, 4.0), and the differences were statistically significant ( H=6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing mid-face soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.

Objective:To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation with the three-dimensional configuration of the skin ligament.Methods:(1) Tweleve fresh adult cadaver specimens, including seven males and five females, aged 54-87 years old, were selected. After dehydration and degreasing of the cadaver head with acetone, plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin, using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the mid-face (cheek, nose, orbital eyelid). (2) A retrospective study was conducted with the data of mid-face soft tissue defects admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021. All patients were repaired with local perforator advancement flaps. The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance, flap area, flap aspect ratio, and defect size. The Kruskal-Wallis test was used to analyze the differences in flap size and aspect ratio in different parts of the mid-face. The measurement data were described by Mean±SD or M( Q1, Q3). Results:(1) Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles, and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different. The upper eyelid skin ligaments run along the eyelid, while the upper nasal cutaneous ligaments run down the nose alar. (2) The clinical study included 18 patients, including eight males and ten females, aged (64.6±23.4) years old. All flaps survived uneventfully. The average flap size was 10.6(8.0, 18.0) cm 2, and the average advancing distance was 2.8(2.0, 4.0) cm. Statistical analysis showed a correlation between the flap advancement distance, the flap incision area ( r=-0.71, P=0.022), and the flap aspect ratio ( r=-0.58, P=0.012). There was no correlation with the defect area ( r=-0.23, P=0.365); the aspect ratios of the cheek, nose, and orbital lid flaps were 2.1(1.9, 2.3), 2.0(1.6, 3.5), 3.5(3.0, 4.0), and the differences were statistically significant ( H=6.59, P=0.037). Conclusions:The local perforator advancement flap is an ideal method for repairing mid-face soft tissue defects. The differences in the construction of the skin ligaments in different parts of the mid-face will affect the ease of advancement of the flaps and other characteristics in each part, which may be the reasons for affecting the aspect ratio of the flap design.

Objective:To explore the application value of whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation.Methods:From October 2018 to May 2021, 16 diabetics underwent whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation at First Affiliated Hospital of Sun Yat-sen University.The whole process was guided by ultrasound for completing percutaneous portal vein puncture catheterization, islet infusion monitoring, bleeding prevention and ablation hemostasis after bleeding.Results:Ten patients [8 males and 2 females with a mean age of(45.9±21.1)years]underwent 16 islet transplants, including one islet(5 cases), two islets(4 cases)and three islets(1 case). A single puncture was successfully performed without damage to other extrahepatic organs, persistent portal hypertension, portal vein embolism or infection.Bleeding at liver puncture site occurred in 3 cases and ultrasound radiofrequency ablation was performed for immediate hemostasis.Among them, postoperative blood glucose stabilized at 4~12 mmol/l post-operation.And 5 cases(31.3%)achieved insulin independence for>2 months and 10 cases(62.5%)lowered insulin dosage by>50% as compared with preoperative level.The level of fasting C-peptide recovered or was higher than normal in 10 cases(62.5%)and became obviously elevated in the remainders.In 11 cases(68.8%)of them, liver transaminase was briefly and mildly elevated post-operation, and no other complications were observed.Conclusions:The whole-process ultrasound-guided percutaneous portal vein islet transplantation is both safe and feseasible.It avoids the injury of transplanted kidney caused by contrast agent and radiological radiation to operator and patient.It is a method of islet transplantation worth a wider popularization.

Objective: To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis. Methods: This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed. Results: During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO₂, PaCO₂, and PaO₂/FiO₂; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05). Conclusion Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.