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:It aims to systematically evaluate the current status of knowledge,attitude,and practice(KAP)regarding universal commercial medical insurance among residents of the sample province from the demand-side perspective.Methods:Utilizing a quota sampling method,face-to-face surveys were conducted via the Questionnaire Star platform to collect demographic characteristics and KAP data of the participants.Comparisons of differences among different groups were made using t-tests,analysis of variance,and chi-square tests.Furthermore,multiple linear regression and structural equation modeling were utilized to analyze the influencing factors of KAP,as well as the pathways among these three factors.Results:Out of the 415 valid questionnaires collected,there were notable differences in KAP among respondents with diverse demographic backgrounds.Regression analysis revealed that education level,frequency of health check-ups,and engagement in other commercial health insurances significantly influenced knowledge;education level,involvement in other commercial health insurances,and self-assessed health status were pivotal in shaping attitudes;whereas age,education level,frequency of health check-ups,and participation in other commercial health insurances were critical in affecting practice.The path analysis results indicate that knowledge of universal commercial medical insurance has a significant direct association with attitude(β=0.379,P＜0.001)and practice(β=0.323,P＜0.001).It also influences practice through attitude as a mediator(β=0.016,P＜0.001),but the direct effect of attitude on practice is not significant(β=0.04,P=0.403).Conclusion:While residents in the sample province exhibit a positive attitude towards universal commercial medical insurance,there is a need to enhance their level of knowledge and engagement in practice.It is recommended to strengthen targeted educational and promotional measures to promote the healthy and sustainable development of universal insurance.

BACKGROUND: The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system. METHODS: This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China. RESULTS: At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained. CONCLUSION: In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system. TRIAL REGISTRATION ClinicalTrials.gov , NCT03656848.
Humans ; Cost-Benefit Analysis ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Angiography/methods* ; Middle Aged ; Aged ; Coronary Artery Disease/surgery* ; Quality-Adjusted Life Years ; Fractional Flow Reserve, Myocardial/physiology*

Objective To analyze the correlation between serum circular RNA-ATAD1(circ-ATAD1)and microRNA-140-3p(miR-140-3p)expression and the prognosis of cervical cancer patients.Methods From March 2018 to March 2020,a total of 146 patients with cervical cancer(study group),146 patients with benign uterine lesions(benign uterine lesions group),and 146 healthy people who underwent the physical examina-tion(control group)in Cangzhou Hospital of Integrated TCM-WM·Hebei were selected as the research sub-jects.Real-time quantitative PCR was used to detect serum levels of miR-140-3p and circ-ATAD1.The Kap-lan-Meier method was used to analyze the correlation between serum circ-ATAD1 and miR-140-3p expression and the prognosis of cervical cancer patients.Multivariate Cox regression model was used to analyze the influ-encing factors of prognosis of cervical cancer patients.Results The serum circ-ATAD1 level in the study group was significantly higher than those in the control group and benign uterine lesion group(P＜0.05),and miR-140-3p was significantly lower than those in the control group and benign uterine lesion group(P＜0.05).The proportions of patients with low expression of miR-140-3p and high expression of circ-ATD1 in the cervical cancer patients with vaginal infiltration,lymph node metastasis,and FIGOstage Ⅲ-Ⅳ were higher than those in the cervical cancer patients with no vaginal infiltration,no lymph node metastasis,and FIGO stage Ⅰ-Ⅱ(P＜0.05).The 3-year survival rate of cervical cancer patients with high circ-ATD1 expression was lower than that of patients with low circ-ATD1 expression(30.14％vs.64.38％,P＜0.001).The 3-year survival rate of cervical cancer patients with high miR-140-3p expression was higher than that of patients with low miR-140-3p expression(61.64％vs.32.88％,P＜0.001).FIGO stage,circ-ATAD1,lymph node metas-tasis and miR-140-3p were factors affecting the prognosis of cervical cancer patients(P＜0.05).Conclusion The serum level of circ-ATAD1 in patients with cervical cancer is significantly increased and the level of miR-140-3p is significantly decreased,the two are closely related to lymph node metastasis and FIGO stage in patients with cervical cancer,and are influencing factors for the prognosis of cervical cancer patients.

Given that ovarian stimulation is vital for assisted reproductive technology (ART) and results in elevated serum estrogen levels, exploring the impact of elevated estrogen exposure on oocytes and embryos is necessary. We investigated the effects of various ovarian stimulation treatments on oocyte and embryo morphology and gene expression using a mouse model and estrogen-treated mouse embryonic stem cells (mESCs). Female C57BL/6J mice were subjected to two types of conventional ovarian stimulation and ovarian hyperstimulation; mice treated with only normal saline served as controls. Hyperstimulation resulted in high serum estrogen levels, enlarged ovaries, an increased number of aberrant oocytes, and decreased embryo formation. The messenger RNA (mRNA)‍-sequencing of oocytes revealed the dysregulated expression of lysine-specific demethylase 6b (Kdm6b), which may be a key factor indicating hyperstimulation-induced aberrant oocytes and embryos. In vitro, Kdm6b expression was downregulated in mESCs treated with high-dose estrogen; treatment with an estrogen receptor antagonist could reverse this downregulated expression level. Furthermore, treatment with high-dose estrogen resulted in the upregulated expression of histone H3 lysine 27 trimethylation (H3K27me3) and phosphorylated H2A histone family member X (γ-H2AX). Notably, knockdown of Kdm6b and high estrogen levels hindered the formation of embryoid bodies, with a concomitant increase in the expression of H3K27me3 and γ-H2AX. Collectively, our findings revealed that hyperstimulation-induced high-dose estrogen could impair the demethylation of H3K27me3 by reducing Kdm6b expression. Accordingly, Kdm6b could be a promising marker for clinically predicting ART outcomes in patients with ovarian hyperstimulation syndrome.
Female ; Mice ; Demethylation/drug effects* ; Embryonic Stem Cells ; Estrogens/administration & dosage* ; Gene Expression/drug effects* ; Histones/metabolism* ; Jumonji Domain-Containing Histone Demethylases/metabolism* ; Mice, Inbred C57BL ; Oocytes ; Ovary/drug effects* ; Reproductive Techniques, Assisted ; Animals

Objective:To construct a nomogram model for predicting the occurrence of acute kidney injury (AKI) in patients with cardiac arrest (CA) after cardiopulmonary resuscitation (CPR), and to verify its validity for early prediction.Methods:The study retrospectively included patients aged 18 years and older who received CPR for CA and were admitted to the emergency room of Tianjin Medical University General Hospital from February 2016 to September 2023. The general information, underlying diseases, resuscitation related indicators, and first laboratory test results of patients were collected. The patients were randomly divided into training and validation groups at a ratio of 7:3. AKI diagnosis was based on the diagnostic criteria of the Kidney Disease Improving Global Outcomes. Univariate and multivariate logistic regression models were used to identify independent risk factors for AKI in patients with cardiac arrest, and a nomogram was constructed on the basis of the independent risk factors. The predictive performance was evaluated by the area under the curve (AUC) of the receiver operating characteristic. The calibration curve, decision curve and clinical impact curve were used to evaluate the model. Bootstrap and cross validation methods were used for internal validation.Results:A total of 527 patients with cardiac arrest were included in the study, 230 patients developed AKI, with an AKI incidence of 43.6%. There was no statistically significant difference in clinical baseline data between the training and validation groups (all P>0.05), indicating comparability between the two groups of data. Multivariate logistic analysis revealed that age ( OR=1.346, 95% CI: 1.197-1.543, P<0.001), CA to CPR time ( OR=2.214, 95% CI: 1.512-3.409, P=0.016), adrenaline dosage ( OR=1.921, 95% CI: 1.383-2.783, P=0.004), APACHE-Ⅱ score ( OR=1.531, 95% CI: 1.316-1.820, P<0.001), baseline creatinine ( OR=1.137, 95% CI: 1.090-1.196, P<0.001), and lactate ( OR=2.558, 95% CI: 1.680-4.167, P<0.001) were the independent risk factors for AKI in patients with cardiac arrest. Initial defibrillable rhythm ( OR=0.214, 95% CI: 0.051-0.759, P=0.023) was a protective factor for AKI in patients with cardiac arrest. A nomogram prediction model was constructed based on the above variables. The AUC of the training group was 0.943 (95% CI: 0.921-0.965) and that of the validation group was 0.917 (95% CI: 0.874-0.960). This prediction model demonstrated good discrimination, calibration and clinical applicability. Conclusions:A nomogram predictive model was constructed on the basis of age, CA to CPR time, initial defibrillable rhythm, adrenaline dosage, the APACHE-Ⅱ score, and baseline creatinine and lactate levels. This nomogram has good predictive value for the early occurrence of AKI in patients with cardiac arrest after cardiopulmonary resuscitation, which can provide new strategies for the early identification of AKI and precise intervention.

Objective:To develop and validate an interactive network dynamic nomogram for early prediction of poor neurological prognosis in patients with post-cardiac arrest brain injury (PCABI).Methods:A retrospective study was conducted on hospitalized patients who achieved return of spontaneous circulation after cardiac arrest at Tianjin Medical University General Hospital between January 2020 and April 2024. Patients were classified into favorable and poor prognosis groups based on the Glasgow-Pittsburgh Cerebral Performance Category at discharge. Eligible patients were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of poor neurological outcomes in PCABI, which were subsequently used to develop a nomogram prediction model. The predictive performance of the nomogram was evaluated by comparing its area under the curve (AUC) of receiver operating characteristic with those of individual predictors using the DeLong test. Model calibration and clinical utility were assessed using calibration curves and decision curve analysis, respectively. Internal validation was conducted, and an interactive dynamic nomogram was developed using web-based visualization techniques.Results:A total of 276 PCABI patients were enrolled (training set: 196; validation set: 80), with 82 cases (29.7%) classified as poor prognosis. Multivariate logistic regression analysis identified age ( OR=1.071, 95% CI: 1.021-1.124, P=0.005), APACHEⅡ score ( OR=1.746, 95% CI: 1.393-2.190, P<0.001), initial shockable rhythm ( OR=0.142, 95% CI: 0.025-0.819, P=0.029), defibrillation ( OR=0.228, 95% CI: 0.060-0.869, P=0.030), cardiopulmonary resuscitation duration ( OR=2.116, 95% CI: 1.487-3.010, P<0.001), and lactate level ( OR=1.392, 95% CI: 1.005-1.927, P=0.047) as independent predictors of poor neurological outcomes in PCABI. A nomogram prediction model was developed based on these factors, achieving an AUC of 0.965 (95% CI: 0.939-0.989) in the training cohort and 0.987 (95% CI: 0.967-1.000) in the internal validation cohort. The nomogram demonstrated significantly superior predictive performance compared to individual predictors ( P<0.001) and exhibited excellent discrimination, calibration, and clinical net benefit. The interactive dynamic nomogram, developed through web-based visualization, further enhanced its applicability in clinical practice. Conclusions:The interactive network dynamic nomogram, developed based on age, APACHEⅡ score, initial shockable rhythm, defibrillation, cardiopulmonary resuscitation duration, and lactate level, demonstrated favorable predictive value for poor neurological outcomes in PCABI. This tool facilitates clinical application and offers a novel strategy for early identification and targeted interventions in high-risk patients.

Objective To investigate the effects of miR-126 on myocardial remodeling and macrophage polarization after acute myocardial infarction(AMI).Methods(1)Twenty-one rats were divided into a sham operation group and an AMI group.The AMI group was further divided into postoperative days 1,3,5,7,9,and 11 days(AMI-1,AMI-3,AMI-5,AMI-7,AMI-9,AMI-11),with 3 rats in each group,and postoperative day 3 was selected for subsequent study.(2)Thirty rats were randomly divided into three groups:sham operation group,AMI group and miR-126 overexpression group,with 10 rats in each group.RT-qPCR was used to detect the expression levels of miR-126 mRNA.2,3,5-Triphenyltetrazole chloride(TTC)staining was used to detect the infarct size.Myocardial fibrosis was detected by Masson staining.The cross-sectional area of the myocardium was determined by H&E staining.Immunofluorescence staining was used to detect the protein levels of CD86 and CD206 in myocardial tissue.Western blotting was used to detect the protein levels of CD86 and CD206 in myocardial tissue.The levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and IL-6 in serum were detected by ELISA kit.Results Compared with the sham operation group,the expression level of miR-126 mRNA in myocardial tissue of rats in the AMI group was significantly decreased on postoperative day 1(P<0.05),reached the lowest level on postoperative day 3.And then although it rose to a certain extent,it remained lower than that of the sham operation group on postoperative day 11(P<0.05),and postoperative day 3 was selected for further study.Compared with the sham operation group,the expression of miR-126 mRNA in myocardial tissue of the AMI group was decreased(P<0.05),and the myocardial fibrosis,infarct size and myocardial cross-sectional area were increased(P<0.05).The expression of CD86 protein in myocardial tissue was increased and the expression of CD206 protein was decreased(P<0.05).The serum levels of TNF-α,IL-6 and IL-1β were increased(P<0.05).Compared with the AMI group,the rats in the miR-126 overexpression group had a significant increase in the mRNA expression of miR-126 in myocardial tissue(P<0.05),a significant reduction in myocardial fibrosis,infarct size,and myocardial cross-sectional area(P<0.05),a significant reduction in the expression of CD86 protein in myocardial tissue,and a significant increase in the expression of CD206 protein(P<0.05).The serum levels of TNF-α,IL-6 and IL-1β were significantly decreased(P<0.05).Conclusion Over-expression of miR-126 can improve myocardial remodeling and promote M2 macrophage polarization in AMI rats.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

OBJECTIVE: To explore the effectiveness of arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release in the treatment of non-traumatic elbow stiffness. METHODS: The clinical data of 15 patients with non-traumatic elbow stiffness treated with arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release between April 2019 and September 2023 were retrospectively analyzed. There were 6 males and 9 females with an average age of 46 years ranging from 34 to 56 years. The causes included rheumatoid arthritis in 3 cases, gouty arthritis in 2 cases, loose bodies in 3 cases, and elbow osteoarthritis in 7 cases. There were 4 cases with ulnar neuritis and 3 cases with synovial osteochondromatosis. The duration of elbow stiffness ranged from 6 to 18 months, with an average of 10 months. The operation time and intraoperative blood loss were recorded. The effectiveness was evaluated by visual analogue scale (VAS) score, range of elbow motion (maximum flexion, maximum extension, and total flexion and extension), Mayo score, and Hospital for Special Surgery (HSS) elbow score. RESULTS: The operation time was 60-90 minutes, with an average of 65 minutes, and the intraoperative blood loss was 40-100 mL, with an average of 62 mL. All patients were followed up 13-18 months, with an average of 14 months. There was no complication such as vascular and nerve injury, poor wound healing, collateral ligament injury, elbow joint space narrowing, osteophyte proliferation, or loose body formation around the joint. At last follow-up, the elbow range of motion (maximum flexion, maximum extension, and total flexion and extension), VAS score, and Mayo score significantly improved when compared with those before operation ( P<0.05). The HSS elbow score was 85-95, with an average of 92; 12 cases were excellent, 3 cases were good, and the excellent and good rate was 100%. CONCLUSION Arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release is an effective way to treat non-traumatic elbow stiffness, which has the advantages of small trauma, short operation time, and good effectiveness. It can carry out early elbow rehabilitation training and significantly improve elbow function.
Humans ; Male ; Female ; Arthroscopy/methods* ; Adult ; Middle Aged ; Elbow Joint/physiopathology* ; Retrospective Studies ; Range of Motion, Articular ; Treatment Outcome ; Ulnar Nerve/surgery* ; Operative Time