Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

The complex anatomy and variations of the biliary system make biliary surgery the operation with the lowest error tolerance in abdominal surgery. With the advent of surgery 4.0 represented by artificial intelligence, 5G technology, and medical big data, biliary surgery has ushered in new development opportunities. Although surgery 4.0 provides high-precision navigation tools for biliary surgery, most of its potential remains untapped. The reason lies in that current technical applications mainly focus on single clinical scenarios. Only by expanding multi-dimensional application scenarios guided by clinical needs can biliary surgery achieve leapfrog development with the help of surgery 4.0. In this process, it is more necessary to cultivate compound and innovative surgical talents through medical-education collaboration, continuously injecting innovative momentum into the deep integration of surgery 4.0 technology and the field of biliary surgery.

Periodontal homeostasis is regulated by the complex interplay between the gingival epithelial barrier, the extracellular matrix of soft tissues, the bone coupling system, and immune responses within the periodontal region. Gingival epithelial cells are primarily composed of keratinocytes and a small proportion of non-keratinocytes, and they are integral to the formation of the gingival epithelial barrier. This epithelial barrier plays a fundamental role in defending against pathogens, exogenous substances, and mechanical stress. This study aims to explore the intrinsic connections between gingival epithelial cells and periodontal homeostasis. Research has shown that gingival epithelial cells participate in maintaining periodontal homeostasis through multiple pathways: ① gingival epithelial cells respond to the inflammatory environment by undergoing proliferation, migration, epithelial-mesenchymal transition, and forming apoptosis-mediated neutrophil extracellular traps; ② when gingival inflammation damages the epithelial barrier, lipopolysaccharides cannot be easily removed, and gingival epithelial cells play a defensive role by activating innate immune responses; ③ the interactions of gingival epithelial cells with oral microbiota and immune cells are essential for maintaining periodontal homeostasis. Thus, gingival epithelial cells are closely associated with periodontal homeostasis. However, the crucial role and mechanisms of gingival epithelial cells in the maintenance of periodontal homeostasis are not clear, which provides novel insights for the research of periodontal homeostatic medicine.

OBJECTIVE To explore the association of postoperative biliary tract infection with expressions of soluble cluster of differentiation 14 subtype(sCD14-ST),procalcitonin(PCT),Toll-like receptor(TLR)4 and TLR2 in malignant obstructive jaundice(MOJ)patients undergoing percutaneous transhepatic cholangial drainage(PTCD).METHODS A total of 105 MOJ patients who underwent PTCD in Shengjing Hospital Affiliated to China Medical University form Nov.2021 to Nov.2023 were enrolled in the study and were divided into the infection group with 31 cases and the non-infection group with 74 cases according to the status of postoperative biliary tract infection.The etiological characteristics and drug resistance rates of the infection group were statistically analyzed.The levels of peripheral blood sCD14-ST,PCT,TLR4 and TLR2 were compared between the two groups,and the values of sCD14-ST,PCT,TLR4 and TLR2 in diagnosis of postoperative biliary tract infection in the MOJ patients under-going PTCD wee analyzed.RESULTS Totally 53 strains of pathogens were isolated from 31 patients of the infec-tion group,among which gram-negative bacteria were dominant.Escherichia coli and Enterococcus faecalis were respectively the major species of the gram-negative and gram-positive bacteria.The E.coli was mainly resistant to ampicillin and sensitive to imipenem;the E.faecalis was mainly resistant to ciprofloxacin,tetracycline,erythro-mycin and was sensitive to vancomycin.There were significant differences in the levels of sCD14-ST,PCT,TLR4 and TLR2 between the two groups(P＜0.05);the sCD14-ST level of the infection group was(41.12±13.14)ng/ml,higher than(29.35±9.17)ng/ml of the non-infection group(t=5.248,P＜0.001).The area under the curve(AUC)value of the joint detection of sCD14-ST,PCT,TLR4 and TLR2 was higher than that of the single detec-tion in diagnosis of postoperative biliary tract infection in the MOJ patients undergoing PTCD(P＜0.05).CONCLUSIONS The gram-negative bacteria are the major pathogens isolated from the MOJ patients with postop-erative biliary tract infection.Imipenem and vancomycin are recommended for treatment of the E.coli and E.fae-calis infections.The patients show abnormal expressions of sCD14-ST,PCT,TLR4 and TLR2.The joint detec-tion of the four indexes has high diagnostic value.

OBJECTIVE To explore the association of postoperative biliary tract infection with expressions of soluble cluster of differentiation 14 subtype(sCD14-ST),procalcitonin(PCT),Toll-like receptor(TLR)4 and TLR2 in malignant obstructive jaundice(MOJ)patients undergoing percutaneous transhepatic cholangial drainage(PTCD).METHODS A total of 105 MOJ patients who underwent PTCD in Shengjing Hospital Affiliated to China Medical University form Nov.2021 to Nov.2023 were enrolled in the study and were divided into the infection group with 31 cases and the non-infection group with 74 cases according to the status of postoperative biliary tract infection.The etiological characteristics and drug resistance rates of the infection group were statistically analyzed.The levels of peripheral blood sCD14-ST,PCT,TLR4 and TLR2 were compared between the two groups,and the values of sCD14-ST,PCT,TLR4 and TLR2 in diagnosis of postoperative biliary tract infection in the MOJ patients under-going PTCD wee analyzed.RESULTS Totally 53 strains of pathogens were isolated from 31 patients of the infec-tion group,among which gram-negative bacteria were dominant.Escherichia coli and Enterococcus faecalis were respectively the major species of the gram-negative and gram-positive bacteria.The E.coli was mainly resistant to ampicillin and sensitive to imipenem;the E.faecalis was mainly resistant to ciprofloxacin,tetracycline,erythro-mycin and was sensitive to vancomycin.There were significant differences in the levels of sCD14-ST,PCT,TLR4 and TLR2 between the two groups(P＜0.05);the sCD14-ST level of the infection group was(41.12±13.14)ng/ml,higher than(29.35±9.17)ng/ml of the non-infection group(t=5.248,P＜0.001).The area under the curve(AUC)value of the joint detection of sCD14-ST,PCT,TLR4 and TLR2 was higher than that of the single detec-tion in diagnosis of postoperative biliary tract infection in the MOJ patients undergoing PTCD(P＜0.05).CONCLUSIONS The gram-negative bacteria are the major pathogens isolated from the MOJ patients with postop-erative biliary tract infection.Imipenem and vancomycin are recommended for treatment of the E.coli and E.fae-calis infections.The patients show abnormal expressions of sCD14-ST,PCT,TLR4 and TLR2.The joint detec-tion of the four indexes has high diagnostic value.

Objective:To retrospectively analyze the efficiency of laparoscopic and endoscopic cooperative surgery(LECS)for early gastric cancer treatment.Methods:We retrospectively collected data from patients with early gastric cancer who underwent LECS at the Peking University Cancer Hospital&Institute between May,2013 and April,2024.Patients underwent endoscopic submucosal dissection(ESD)with laparoscopic lymph node biopsy,classical LECS,and other modified procedures.Additionally,clinical and pathological characteristics,post-operative recovery indicators,complications,and survival outcomes of the patients were analyzed.Results:Nine patients(median age:64 years),including six male(66.7% )and three female(33.3% )patients,were involved in this study.Biopsy revealed that all patients had well-differentiated gastric cancer.Five patients(55.6% )underwent ESD with laparoscopic lymph node biopsy,and four patients(44.4% )under-went laparoscopically assisted endoscopic full-thickness resection and sentinel lymph node biopsy.Average anesthesia time was(351.2±91.4)min,and average blood loss was(34.4±15.1)mL.After surgery,three patients(33.3% )experienced complications,with one case each of gastric stasis(CD2),intra-abdominal infection(CD2),and gastrointestinal perforation(CD3).The median follow-up time was 52 months,and no cases of disease recurrence or death were observed.Conclusions:Overall,this study highlights the efficiency of LECS for early gastric cancer treatment.Future studies should assess its oncological safety,along with other technical aspects,patient selection criter-ia,and accuracy of sentinel lymph node biopsy,to facilitate widespread application of LECS.

Objective Taking typical cases of Western medicine as an example,this paper explores the connection between Chinese and Western medicine on the understanding of tongue elephants.Methods After collecting the literature with tongue diagram attached to the clinical imaging column published in NEJM magazine,extracting the symptoms,signs and Western medicine disease information recorded in the literature,the tongue diagram was diagnosed from three aspects:tongue quality,tongue moss and sublingual meridians,and whether the symptoms and signs of tongue correspond to a certain diagnosis result,and the results were analyzed.Results A total of 48 articles were included,including 6 literature on abnormal tongue dynamics,which could correspond to abnormal tongue morphology in traditional Chinese medicine.Thirty-four cases of abnormal tongue shape were found.Among them,12 cases could be diagnosed with corresponding TCM tongue diagnosis,including 7 cases of abnormal tongue shape and 5 cases of abnormal coating.The remaining 22 cases were secondary changes in tongue structure.There were 8 articles on abnormal tongue color,including 1 abnormal tongue color,1 abnormal sublingual chord,and 6 abnormal lichen color.Conclusion Starting from the form and function,explore the connection between Chinese medicine and Western medicine in their understanding of tongue diagnosis,and promote the objectification and standardization of Chinese medicine tongue diagnosis.