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 assess the effect of early nutritional intervention on the patients with respiratory diseases at nutritional risk. Methods A total of 130 patients with respiratory disease who were hospitalized in Shanghai Fifth People’s Hospital, Fudan University between May 2023 and December 2024 and had a nutritional risk screening 2002 score ≥3 points. Based on the initiation time of nutritional intervention, patients were divided into an early group (≤5 days, n＝65) and a late group (＞5 days, n＝65). Results In the early group, prealbumin (P-ALB) and retinol-binding protein (RBP) levels were significantly higher (P＜0.01), C-reactive protein (CRP), procalcitonin (PCT) levels were significantly lower after intervention (P＜0.05). Compared with the late group, the hospital costs were lower and hospital stays were shorter in the early group (P＜0.001). Spearman analysis showed ALB, P-ALB, and total protein (TP) were negatively correlated with hospital costs (r＝－0.37, －0.20, and－0.22, P＜0.05). RBP, ALB, P-ALB, and lymphocyte count (LYM) were negatively correlated with CRP (r＝－0.30, －0.26, －0.37, －0.18, P＜0.01), RBP, ALB, P-ALB, hemoglobin (HB), and TP were negatively correlated with PCT (r＝－0.23,－0.36, －0.40, －0.30, －0.19, P＜0.05). Conclusions For patients with respiratory diseases, early nutritional assessment should be underwent, and for patients with nutritional risk screening 2002 score ≥3 points, early nutritional intervention could improve the nutritional status and alleviate inflammatory response, promote recovery, shorten the hospital stays.

Objective:To explore the effect of hairy and enhancer of split related protein 2 (Hey2) on osteoclast differentiation through the activation of nuclear factor of activated T cells cytoplasmic 1 (NFATc1).Methods:RAW264.7 cells were induced with receptor activator of NF-κB ligand (RANKL) to differentiate into osteoclasts. Experimental groups were divided by different concentrations of RANKL (0, 10, 20, 50 μg/L) and different processing time (0, 3, 5, 7 days). Hey2 overexpression experiment was grouped as follows: blank control group, RANKL group, empty plasmid vector control group (Hey2-NC+RANKL), Hey2 overexpression group (Hey2-OE+RANKL); similarly, groups in Hey2 knockdown experiment were as follows: blank control group, RANKL group, negative control group (si-NC+RANKL), Hey2 knockdown group (si-Hey2+RANKL). Chromatin immunoprecipitation experiment groups were divided as non-specific IgG control group (IgG control group), non-specific IgG group (IgG RANKL group), Hey2-specific antibody control group (anti-Hey2 control group), Hey2-specific antibody group (anti-Hey2-RANKL group). For the different RANKL concentration groups and different induction time groups, real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the mRNA expressions of nuclear factor of NFATc1, cathepsin K (CTSK), and cellular feline osteosarcoma oncogene (c-Fos) and tartrate-resistant acid phosphatase (TRAP) staining was used to assess the formation of multinucleated osteoclasts. After Hey2 overexpression or knockdown, RT-qPCR and Western blotting were used to detect the gene and protein expressions of NFATc1, c-Fos, and CTSK. TRAP staining was used to evaluate the formation of multinucleated osteoclasts. Bioinformatics prediction (NCBI, JASPAR) and chromatin immunoprecipitation (ChIP) assay were used to validate the binding of Hey2 to the NFATc1 promoter region.Results:During the osteoclastic differentiation of RAW 264.7 cells induced by RANKL, the expression of Hey2 could be detected, and the expression level of Hey2 decreased with the increase of RANKL concentration and induction time. In the 50 μg/L RANKL group, the expression levels of Hey2 gene (0.18±0.00) and protein (0.22±0.02) were significantly lower than those in the control group (1.00±0.00, 0.52±0.01) ( t=41.67, 12.88; both P<0.001). In the 50 μg/L RANKL group inducted for 5 days, the expression levels of Hey2 gene (0.27±0.02) and protein (0.79±0.01) were significantly lower than those in the control group (1.00±0.00, 1.15±0.02) ( t=11.47, 108.60; both P<0.001). Hey2 overexpression significantly reduced the gene and protein expressions of NFATc1, c-Fos, and CTSK, as well as the production of TRAP-positive cells (all P<0.05). Hey2 knockdown significantly increased the gene and protein expressions of NFATc1, c-Fos, and CTSK, as well as the production of TRAP-positive cells (all P<0.05). After inducing RAW264.7 cells with 50 μg/L RANKL for 1 day, ChIP results showed that among the two sample groups treated with Hey2 antibody, the detection level of the NFATc1 promoter region (-400 to -200 bp) in the anti-Hey2-RANKL group (18.06±0.06) was significantly higher than that in the anti-Hey2 control group (13.37±0.36) ( t=12.56, P<0.001). Conclusions:Hey2 can bind to the downstream target gene NFATc1 at -400 to -200 bp region of the promoter. As a transcriptional repressor, Hey2 inhibits osteoclast differentiation.

To summarize the first aid and nursing experience of a patient with enterobacter aerogenes infection complicated by septic shock after oral floor cancer surgery. The patient was admitted to the Department of Oral and Maxillofacial Surgery at the Second Affiliated Hospital of Zhejiang University School of Medicine in August 2023. This patient who developed enterobacter aerogenes infection complicated by septic shock after surgery for oral floor cancer was treated with a comprehensive approach. In response to the patient's rapid onset, rapid progression of the condition, and critical situation, the following key points of nursing care were formulated and implemented: this included the rapid identification of septic shock, precise execution of emergency interventions; effectiveion of airway management, active prevention of airway obstruction; implement refined nursing care, awareness of leukocyte crisis, preventing secondary infection; establishing blood alert mechanism, implementing monitoring and protection management; implementing phased progressive nutritional support, improveing the nutritional status of patients. After 21 days of intensive treatment and nursing care, the patient made a full recovery and was discharged. A 6-month follow-up revealed that the patient remained in stable condition with no recurrence.

Objective:To explore the effect of hairy and enhancer of split related protein 2 (Hey2) on osteoclast differentiation through the activation of nuclear factor of activated T cells cytoplasmic 1 (NFATc1).Methods:RAW264.7 cells were induced with receptor activator of NF-κB ligand (RANKL) to differentiate into osteoclasts. Experimental groups were divided by different concentrations of RANKL (0, 10, 20, 50 μg/L) and different processing time (0, 3, 5, 7 days). Hey2 overexpression experiment was grouped as follows: blank control group, RANKL group, empty plasmid vector control group (Hey2-NC+RANKL), Hey2 overexpression group (Hey2-OE+RANKL); similarly, groups in Hey2 knockdown experiment were as follows: blank control group, RANKL group, negative control group (si-NC+RANKL), Hey2 knockdown group (si-Hey2+RANKL). Chromatin immunoprecipitation experiment groups were divided as non-specific IgG control group (IgG control group), non-specific IgG group (IgG RANKL group), Hey2-specific antibody control group (anti-Hey2 control group), Hey2-specific antibody group (anti-Hey2-RANKL group). For the different RANKL concentration groups and different induction time groups, real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the mRNA expressions of nuclear factor of NFATc1, cathepsin K (CTSK), and cellular feline osteosarcoma oncogene (c-Fos) and tartrate-resistant acid phosphatase (TRAP) staining was used to assess the formation of multinucleated osteoclasts. After Hey2 overexpression or knockdown, RT-qPCR and Western blotting were used to detect the gene and protein expressions of NFATc1, c-Fos, and CTSK. TRAP staining was used to evaluate the formation of multinucleated osteoclasts. Bioinformatics prediction (NCBI, JASPAR) and chromatin immunoprecipitation (ChIP) assay were used to validate the binding of Hey2 to the NFATc1 promoter region.Results:During the osteoclastic differentiation of RAW 264.7 cells induced by RANKL, the expression of Hey2 could be detected, and the expression level of Hey2 decreased with the increase of RANKL concentration and induction time. In the 50 μg/L RANKL group, the expression levels of Hey2 gene (0.18±0.00) and protein (0.22±0.02) were significantly lower than those in the control group (1.00±0.00, 0.52±0.01) ( t=41.67, 12.88; both P<0.001). In the 50 μg/L RANKL group inducted for 5 days, the expression levels of Hey2 gene (0.27±0.02) and protein (0.79±0.01) were significantly lower than those in the control group (1.00±0.00, 1.15±0.02) ( t=11.47, 108.60; both P<0.001). Hey2 overexpression significantly reduced the gene and protein expressions of NFATc1, c-Fos, and CTSK, as well as the production of TRAP-positive cells (all P<0.05). Hey2 knockdown significantly increased the gene and protein expressions of NFATc1, c-Fos, and CTSK, as well as the production of TRAP-positive cells (all P<0.05). After inducing RAW264.7 cells with 50 μg/L RANKL for 1 day, ChIP results showed that among the two sample groups treated with Hey2 antibody, the detection level of the NFATc1 promoter region (-400 to -200 bp) in the anti-Hey2-RANKL group (18.06±0.06) was significantly higher than that in the anti-Hey2 control group (13.37±0.36) ( t=12.56, P<0.001). Conclusions:Hey2 can bind to the downstream target gene NFATc1 at -400 to -200 bp region of the promoter. As a transcriptional repressor, Hey2 inhibits osteoclast differentiation.

To summarize the first aid and nursing experience of a patient with enterobacter aerogenes infection complicated by septic shock after oral floor cancer surgery. The patient was admitted to the Department of Oral and Maxillofacial Surgery at the Second Affiliated Hospital of Zhejiang University School of Medicine in August 2023. This patient who developed enterobacter aerogenes infection complicated by septic shock after surgery for oral floor cancer was treated with a comprehensive approach. In response to the patient's rapid onset, rapid progression of the condition, and critical situation, the following key points of nursing care were formulated and implemented: this included the rapid identification of septic shock, precise execution of emergency interventions; effectiveion of airway management, active prevention of airway obstruction; implement refined nursing care, awareness of leukocyte crisis, preventing secondary infection; establishing blood alert mechanism, implementing monitoring and protection management; implementing phased progressive nutritional support, improveing the nutritional status of patients. After 21 days of intensive treatment and nursing care, the patient made a full recovery and was discharged. A 6-month follow-up revealed that the patient remained in stable condition with no recurrence.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective:To explore the current status and correlation of occupational stress and burnout among pediatric nurses.Methods:From April 2023 to January 2024, convenience sampling was used to select 150 pediatric nurses from Taizhou Hospital of Zhejiang Province, East Campus of Taizhou Hospital of Zhejiang Province, and Taizhou Enze Medical Center as research subjects. The survey was conducted using the General Information Questionnaire, Chinese version of the Maslach Burnout Inventory General Survey, and Nurse Job Stressors Scale.Results:A total of 150 nurses were surveyed, and 149 valid questionnaires were collected, with a valid response rate of 99.33%. Pediatric nurses had high scores in emotional exhaustion and depersonalization dimensions in occupational burnout. The job stressors for pediatric nurses were ranked in order of their scores in each dimension, including workload and time management, work environment and resources, nursing profession and work, management and interpersonal relationships, and patient nursing. There were correlations between occupational burnout and occupational stress among pediatric nurses in multiple dimensions (all P<0.05) . Conclusions:Pediatric nurses have a relatively high level of occupational burnout and often face significant occupational stress. In the development of the healthcare system, attention should be paid to the occupational burnout and stress of pediatric nurses. The physical and mental health of pediatric nursing staff can be promoted and work efficiency can be improved by reducing the overloaded work of pediatric nurses, optimizing personnel allocation, and improving social support.

Objective:To explore a definition of healthy longevity in the Chinese population based on the Delphi method.Methods:Through a comprehensive literature review and expert consultation, the dimensions in the definition of healthy longevity were identified, and a preliminary list of questions was created. Experts in clinical medicine, public health, basic research, and the elderly care service industry, who had been working in the field of geriatric health for at least 5 years, were invited to participate in the Delphi survey from August to December 2022. The survey questionnaires were administered via email in two rounds, and experts were asked to select the optimal options from the provided questions. The active coefficients were expressed by the response rate, and a consensus was reached when the largest number of experts agreed for single-choice questions and more than 70% agreed for multiple-choice questions.Results:In the two rounds, the active coefficients were 96.00% (24/25) and 79.17% (19/24), respectively, and a consensus was finally reached on nine items, including age, physical health, common metabolic indicators, mental health, cognitive function, functional ability, social activity, self-rated health, and subjective well-being. Following discussions among the research team and experts, a final definition of healthy longevity was determined. Healthy longevity could refer to a state of good physical, psychological, cognitive function and social adaptation, as well as subjective well-being, in individuals aged 90 and above. Specifically, individuals with healthy longevity should be free from diseases associated with high disability rates and mortality, such as stroke, cancer, and Parkinson′s disease. They should also maintain reasonable levels of common non-communicable disease indicators, such as blood pressure and blood glucose, and exhibit favorable mental health and cognitive function using validated measurement tools. In addition, individuals with healthy longevity should engage in social interactions with friends and relatives, care for family members, and go out to do things. Meanwhile, with the ability to complete the visual and hearing functions of daily life and communication, and the ability to complete basic activities such as walking, eating, bathing, toileting, dressing, continence of urination, and bowel movement independently, they could rate themselves to be in good health and experience a relatively high level of life satisfaction.Conclusion:A definition of healthy longevity in the Chinese population is established through the two-round Delphi consultation.

Objective:To explore the implementation strategies for promoting healthy longevity among the elderly population in China based on the Delphi method.Methods:Through literature review and expert discussion, a framework for implementation strategies to achieve healthy longevity among the elderly was determined, and a preliminary checklist of implementation strategies was developed. The Delphi method was employed from August to December 2022, inviting 25 experts from various disciplines such as clinical medicine, public health, basic research, and the elderly care services industry. Experts were sent consultation questionnaires via email to assess the importance, feasibility, judgment basis and familiarity of each implementation strategy. Active coefficient, authority coefficient, and harmony coefficient were analyzed to ultimately determine the important and feasible implementation strategies for healthy longevity that were suitable for the Chinese elderly population.Results:The expert active coefficients of the two rounds were 96.00% (24/25) and 79.17% (19/24). The authority coefficients were (0.76±0.19) and (0.77±0.17). The average scores of importance were (4.32±0.84) and (4.36±0.82), and the corresponding scores of feasibility were (3.72±1.04) and (3.80±0.92). The harmony coefficients for the importance score were 0.269 ( χ 2=594.084, P<0.001) and 0.159 ( χ 2=193.624, P<0.001). The harmony coefficients for feasibility scores were 0.205 ( χ 2=452.008, P<0.001) and 0.167 ( χ 2=202.878, P<0.001). The final eight implementation strategies were identified after two rounds of consultation. Conclusion:Through two rounds of Delphi consultations, eight important and feasible implementation strategies for promoting healthy longevity that are suitable for the Chinese context have been proposed.