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*

Background:Nutritional risk is highly prevalent among gastric cancer patients,yet accurate screening tools remain lacking.Aims:To construct and validate a nutritional risk prediction model for gastric cancer inpatients.Methods:From August 2023 to July 2024,a total of 295 gastric cancer inpatients admitted to the First Hospital of Qinhuangdao were enrolled,and divided into the model group(n=206)and validation group(n=89)at a ratio of 7∶3.Nutritional screening was performed in the model group using the nutritional risk screening 2002(NRS 2002)score.Univariate analysis and multivariate Logistic regression analysis were employed to identify the independent risk factors for nutritional risk,and a prediction model was constructed.The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the consistency between the model constructed and NRS 2002 score.The predictive performance was assessed using ROC curve and validated in the independent cohort.Risk stratification was performed based on the cut-off value derived from the ROC curve,and the nutritional risk in different subgroups of the model group and validation group was assessed.Results:Multivariate Logistic regression analysis indicated that age≥68 years,body mass index(BMI)≤22 kg/m2,anorexia,dysphagia and anemia were the independent risk factors for nutritional risk in gastric cancer patients in the model group(all P<0.05).The prediction model had good consistency with the NRS 2002 score(P=0.567).ROC curve showed that the area under the curve(AUC)of the prediction model for predicting nutritional risk were 0.840(95%CI:0.785-0.895,P<0.001)for the model group and 0.895(95%CI:0.831-0.958,P<0.001)for the validation group when the cut-off value was set at 9.5 points.The proportion of patients with nutritional risk in high-risk subgroup was significantly higher than that in low-risk subgroup in both model group and validation group(P<0.001).Conclusions:The prediction model based on age,BMI,anorexia,dysphagia and anemia can effectively identify nutritional risk in gastric cancer inpatients and may serve as a clinical reference tool.

Background:Nutritional risk is highly prevalent among gastric cancer patients,yet accurate screening tools remain lacking.Aims:To construct and validate a nutritional risk prediction model for gastric cancer inpatients.Methods:From August 2023 to July 2024,a total of 295 gastric cancer inpatients admitted to the First Hospital of Qinhuangdao were enrolled,and divided into the model group(n=206)and validation group(n=89)at a ratio of 7∶3.Nutritional screening was performed in the model group using the nutritional risk screening 2002(NRS 2002)score.Univariate analysis and multivariate Logistic regression analysis were employed to identify the independent risk factors for nutritional risk,and a prediction model was constructed.The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the consistency between the model constructed and NRS 2002 score.The predictive performance was assessed using ROC curve and validated in the independent cohort.Risk stratification was performed based on the cut-off value derived from the ROC curve,and the nutritional risk in different subgroups of the model group and validation group was assessed.Results:Multivariate Logistic regression analysis indicated that age≥68 years,body mass index(BMI)≤22 kg/m2,anorexia,dysphagia and anemia were the independent risk factors for nutritional risk in gastric cancer patients in the model group(all P<0.05).The prediction model had good consistency with the NRS 2002 score(P=0.567).ROC curve showed that the area under the curve(AUC)of the prediction model for predicting nutritional risk were 0.840(95%CI:0.785-0.895,P<0.001)for the model group and 0.895(95%CI:0.831-0.958,P<0.001)for the validation group when the cut-off value was set at 9.5 points.The proportion of patients with nutritional risk in high-risk subgroup was significantly higher than that in low-risk subgroup in both model group and validation group(P<0.001).Conclusions:The prediction model based on age,BMI,anorexia,dysphagia and anemia can effectively identify nutritional risk in gastric cancer inpatients and may serve as a clinical reference tool.

With the continuous advancement of manned deep space exploration technology,the duration of astronauts'missions will significantly lengthen,posing new challenges for astronauts'health protection.Putting astronauts into a state of low metabolism through various means may be a feasible response.This article qualitatively explores the advantages,disadvantages,external opportunities,and threats of astronauts'low metabolic flights in deep space exploration missions through SWOT analysis,and puts forward relevant suggestions and strategies,thus providing important basis and reference for the research on astronauts'low metabolic flights in deep space exploration missions.

Objective:To explored the effect of 78c in treating collagen-induced arthritis (CIA) mice and to investigate its mechanism of effects.Methods:CIA mice model and CD38 +NK cells were treated with 78c. Cytokine concentrations and lymphocyte subtypes were measured in the mice peripheral blood and culture medium using flow cytometry. Mikenyi cell isolation kit was used to isolate CD4 + T cells and NK cells from peripheral blood mononuclear cells of healthy volunteers. CD38 + NK cells were enriched using the Miltenyi CD38 microbeads from the extracted NK cells. CD38 + NK cells with 78c pretreatment or not were cocultured with CD4 +T cells in transwells. The least significant difference (LSD) method was used for comparison between the two groups, and one-way analysis of variance was used for multi-group significance. Pearson correlation analysis was used for correlation analysis. Results:78c treatment significantly suppressed joint inflammation, inhibited the toe thickness of CIA mice, and reduced the number of while cell, neutrophils, platelets, and concentrations of IFN-γ, IL-6 and TNF-α ( t=6.10, P<0.001; t=4.00, P=0.002; t=3.09, P=0.012; t=2.31, P=0.043; t=3.58, P=0.005; t=2.68, P=0.002) in the CIA mice. The proportion of CD38 +NK cells decreased from (3.9±0.9)% to (2.4±0.3)% ( t=2.49, P=0.032), the proportion of regulatory T cell (Treg) increased from (0.81±0.33)% to (1.41±0.26)% ( t=2.74, P=0.021), and the concentration of IL-10 also increased from (99±37) pg/ml to (199±9) pg/ml( t=2.76 , P=0.020). The proportion of Treg in CD4 +T cells cocultured with 78c-pretreated CD38 +NK cells increased from (0.52±0.04)% to (0.69±0.08)% ( t=3.33, P=0.029) , the T helper cells (Th)17/Treg ratio decreased from (4.44±0.26) to (2.59±0.64) ( t=4.76 , P=0.009), and the Th1/Th2 ratio decreased from (14.8±1.6) to (8.1±1.3)( t=5.70 , P=0.005). Conclusion:78c can reduce the proportion of CD38 +NK cells, thereby reducing the inhibition of CD38 +NK cells on CD4 +T cell differentiation into Treg cells, leading to the restoration of immune balance. The results of this study suggest that 78c is a potential therapeutic agent for rheumatoid arthritis.

Objective:To evaluate the feasibility of 8E5 cells and CD19-CAR-Jurkat cells used as reference cells in the detection of lentiviral vector integration sites with different methods.Methods:Single clones of 8E5 cells and CD19-CAR-Jurkat cells were selected using limiting dilution method. Digital PCR was established to detect the copy number of HIV-1 in 8E5 cells and the copy number of CAR in CD19-CAR-Jurkat cells. High-throughput sequencing techniques (whole-genome resequencing, modified genome sequencing and probe hybridization capture) were used to detect integration sites in 8E5 cells and CD19-CAR-Jurkat cells, and optical genome mapping (OGM) technology was used for further confirmation.Results:Three clones of 8E5-D8 cells and six clones of CD19-CAR-Jurkat 2-6 cells were selected using the limiting dilution method. 8E5-D8 and CD19-CAR-Jurkat 2-6 were chosen as candidate cells based on their gene copy numbers detected by digital PCR and flow cytometry. These cells were then expanded and cryopreserved. Digital PCR showed that 8E5-D8 cells contained approximately 1 copy per cell, while CD19-CAR-Jurkat 2-6 cells contained approximately 13 copies per cell. High-throughput sequencing revealed one integration site in 8E5 cells and 13 integration sites in CD19-CAR-Jurkat cells, which matched the copy number detection results. All these integration sites were further confirmed at the submicroscopic level of chromosomes using OGM.Conclusions:Based on the insertion copy numbers and integration sites, 8E5-D8 cells and CD19-CAR-Jurkat 2-6 cells could be used as reference cells in further development of methods for detecting integration sites in CAR-T cell lentiviral vectors.

Objective:To investigate cases of delayed lactation initiation in women with transvaginal delivery and the influencing factors, in order to provide a basis for effective control of delayed lactation initiation and promotion of breastfeeding.Methods:Inpatients who were admitted to the obstetric ward of Affiliated Hospital of Jining Medical College from November 6, 2020 to January 16, 2021 were selected for the study using convenience sampling method and investigated by general information questionnaire and Chindbirth Experience Questionnaire (CEQ). Binary Logistic regression analysis was used to determine the factors influencing delayed lactation initiation.Results:The incidence of delayed lactation initiation in 622 women with transvaginal delivery was 38.75% (241/622). Binary Logistic regression analysis showed that age 20-35 years, full-term delivery, labor and delivery, use of labor analgesia, and good experience of transvaginal delivery were protective factors for delayed lactation initiation ( OR values were 0.012 to 0.868, all P<0.05); age >35 years, excessive weight gain during pregnancy, presence of pregnancy complications, use of induction of labor during delivery, long labor process, and damage to perineal skin after delivery were risk factors for delayed lactation initiation ( OR values were 1.097 to 13.235, all P<0.05). Conclusions:The high incidence of delayed lactation initiation in women with transvaginal delivery is influenced by a number of factors, which reminds the clinic that lactation in women after transvaginal delivery also needs to be taken into account, with priority assessment and prevention for those who are elderly (age≥35 years), primiparous, have other diseases during pregnancy, have gained too much weight during pregnancy, have preterm delivery, have a long duration of labor, have not received labor analgesia, have had a single or combined induction of labor, have had an episiotomy or perineal laceration during labor, and have a poor transvaginal delivery experience.

Objective To screen the proteins with decreased expression in the synovial tissues of rheumatoid arthritis (RA) patients by comparing their expression profiles with that of osteoarthritis (OA) and ankylosing spondylitis (AS) patients by a proteomic approach,and to explore the association of reduced expression with disease susceptibility by a single nucleotide polymorphism (SNP) analysis.Methods Proteins extracted from the synovial membranes (n=10 for each disease) were separated by 2-D electrophoresis.The proteins with significantly decreased expression in the RA samples were subjected to MALDI-TOF-MS.The results were verified using Western blotting.Tag SNPs located in the targeted gene were assessed using the Taqman assay in a cohort of 267 Chinese patients with RA and 160 healthy controls.The genotyping results were confirmed in a large cohort of 389 patients with RA and 371 healthy controls.SPSS 11.5 software package was used for one way ANOVA and Fisher's exact test.Results The expression of vitamin D-binding protein (VDBP) in the synovial membranes from patients with RA was significantly decreased when examined by proteomic approach.This result was confirmed by Western blotting analysis.The rs2282679 was significantly associated with RA (P=0.026 794).This result was confirmed in a large cohort of RA( OR=0.678 639,95％CI 0.54l 113-0.851 118,P=0.000 776).Conclusion Compared with samples from patients with OA and AS,RA patients' synovial tissues have low VDBP expression when examined by the proteomic method.The tag SNP rs2282679 located in VDBP is significantly associated with RA.The decreased expression and the genetic effect of VDBP in RA suggest that a novel pathogenic pathway,in which vitamin D contributes,may be involved in the arthritis process of RA.