Objective To evaluate the predictive value of different machine learning models constructed in a multicenter environment for potential organ donors and verify their clinical application feasibility. Methods The study included 2 000 inpatients admitted to five domestic tertiary hospitals from January 2020 to December 2023, who met the criteria for potential organ donation assessment. They were randomly divided into a training set and an internal validation set (7∶3). Another 300 similar patients admitted to the First Affiliated Hospital of Harbin Medical University from January 2024 to April 2025 were included as an external validation set. The area under the curve (AUC), sensitivity, specificity, accuracy and F1-score of three models were compared, and the consistency of the potential organ donor determination process was tested. Multivariate logistic regression analysis was used to identify predictive factors of potential organ donors. Decision curve analysis (DCA) was employed to verify the resource efficiency of each model, and the threshold interval and intervention balance point were assessed. Results Apart from age, there were no significant differences in other basic characteristics among the centers (all P>0.05). The consistency of the potential organ donor determination process among researchers in each center was good [all 95% confidence interval (CI) lower limits >0]. In the internal validation set, the XGBoost model had the best predictive performance (AUC=0.92, 95% CI 0.89-0.94) and the best calibration (P=0.441, Brier score 0.099). In the external validation set, the XGBoost model also had the best predictive performance (AUC=0.91, 95% CI 0.88-0.94), outperforming logistic regression and random forest models. Multivariate logistic regression showed that mechanical ventilation had the greatest impact (odds ratio=2.06, 95% CI 1.54-2.76, P<0.001). DCA indicated that the XGBoost model had the highest net benefit in the threshold interval of 0.2-0.6. The “treat all” strategy only had a slight advantage at extremely low thresholds. The recommended threshold interval, which balances intervention costs and clinical benefits, considers ≥50% positive predictive value (PPV) and ≤50 referrals per 100 high-risk patients. Conclusions The XGBoost model established in a multicenter environment is accurate and well-calibrated in predicting potential organ donors. Combined with DCA, it may effectively guide the timing of clinical interventions and resource allocation, providing new ideas for the assessment and management of organ donation after brain death.

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*

Objective:To investigate the efficacy of azacitidine combined with CAG regimen in the treatment of acute myeloid leukemia (AML) patients who are not suitable for intensive chemotherapy.Methods:A retrospective case-series study was conducted. A total of 67 AML patients with newly diagnosed elderly, treatment-related secondary and myelodysplastic syndromes or myeloproliterative neoplasms primary transformation who were not suitable for intensive chemotherapy were selected from Heze Municipal Hospital from January 2020 to December 2023. Azacitidine combined with CAG regimen was given for treatment, and the efficacy and adverse reactions of the patients were observed.Results:Among the 67 patients, there were 32 females and 35 males with the median age [ M ( Q1, Q3)] of 68 (65, 72) years old. There were 40 cases in the high-risk group, 13 cases in the medium-risk group, and 14 cases in the low-risk group. After 1 course of treatment with azacitidine combined with CAG regimen, the overall response rate (ORR) was 38.8% (26/67), with a complete remission (CR) rate of 20.9% (14/67), a complete remission rate with incomplete recovery of blood cell count (CRi) of 11.9% (8/67), and a partial remission (PR) rate of 6.0% (4/67). After 4 courses of treatment, the ORR was 59.7% (40/67), with a CR rate of 56.7% (38/67) and a CRi rate of 3.0% (2/67). There were no PR patients. All patients in the low-risk and medium risk groups achieved at least CRi, while the ORR in the high-risk group was 40.0% (16/40). There was a statistically significant difference in efficacy between different risk groups ( P < 0.001). The patient had mild adverse reactions, mainly pain and grade 1-2 hematological adverse reactions. Conclusions:AML patients who are intolerant to intensive chometherapy are effectively treated with azacitidine combined with CAG regimen, and the adverse reactions are mild.

Objective To investigate the impact of quercetin(Que)on postherpetic neuralgia(PHN)and chemokine ligand 3(CCL3,namely MIP-1α)/C-C chemokine receptor 1(CCR1)/C-C chemokine receptor 5(CCR5)signaling pathway in rats.Methods Sixty rats were divided into the control group(Con),the PHN group(model group),the L-Que(30 mg/kg)group,the M-Que(60 mg/kg)group,the H-Que(120 mg/kg)group and the H-Que+pathway activator MIP-1α(120 mg/kg Que+0.4 mg/kg recombinant MIP-1α)group.The mechanical paw withdrawal threshold(PWT)and thermal pain threshold(TWL)of rats were detected in each group.The kit was used to detect adenosine,Adenine ribonucleotide(AMP),adenosine diphosphate(ADP)and tumor necrosis factor in spinal dorsal horn samples-α(TNF-α),and interleukin-1 β(IL-1 β)levels in spinal dorsal horn samples.HE staining was applied to observe the pathological sections of spinal dorsal horn.Immunofluorescence staining was used to detect the activation of microglia in spinal dorsal horn.Western blot assay was applied to detect MIP-1α/CCR1/CCR5 signaling pathway protein expression.Results In the PHN group,the dorsal horn of the spinal cord was ruptured,the arrangement of nerve bundles was disordered,and inflammatory cell infiltration,edema,and slight atrophy of neurons appeared.Compared with the Con group,the PWT value,adenosine,AMP and ADP levels were obviously decreased in the PHN group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1-positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).After treatment with Que,the disordered arrangement of nerve bundles was improved,the infiltration of inflammatory cells was reduced,and the phenomenon of neuronal atrophy disappeared.Compared with the PHN group,the PWT value,adenosine,AMP and ADP levels were obviously increased in the L-Que group,the M-Que group and the H-Que group(P＜0.05).TWL value,TNF-αand IL-1β levels,the number of Iba1-positive microglia,and MIP-1α,CCR1 and CCR5 protein levels were obviously decreased(P＜0.05).The effect of Que was dose dependent.Compared with the H-Que group,PWT value,adenosine,AMP and ADP levels were obviously decreased in the H-Que+MIP-1α group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1 positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).Conclusion Que may reduce the inflammatory response in rats by inhibiting the MIP-1α/CCR1/CCR5 signaling pathway,thereby reducing PHN.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Objective To evaluate the clinical efficacy of fluoroscopy-guided posterior medial branch release of lumbar spinal nerves in the treatment of facet articular low back pain in the elderly patients.Methods A total of 102 elderly patients with facet articular low back pain,who were admitted to the Department of Pain,Wuhan Municipal First Hospital of China from January 2017 to December 2018,were randomly divided into release group and conservative group.The patients of release group was treated with fluoroscopy-guided posterior medial branch release of lumbar spinal nerves,and the patients of conservative group was treated with analgesic drugs combined with physiotherapy.The preoperative and the postoperative one-week,one-month,3-month,6-month,12-month,24-month low back pain scores as well as the improvement of lumbar spine function were compared between the two groups.Results In the release group,the postoperative one-week,one-month,3-month,6-month,12-month,24-month visual analogue scores(VAS)were significantly decreased,and the differences were statistically significant(all P＜0.05),which were significantly lower than those in the conservative group,and the differences were statistically significant(all P＜0.05).In the release group,the postoperative one-week,one-month,3-month,6-month,12-month,24-month RM Q scores and Oswestry dysfunction indexes were strikingly decreased,and the differences were statistically significant(P＜0.05),which were significantly lower than those in the conservative group(P＜0.05).No procedure-related complications occurred in both groups.Conclusion For the treatment of facet articular low back pain in the elderly patients,fluoroscopy-guided posterior medial branch release of lumbar spinal nerves is clinically safe and feasible with excellent short-term and medium-long-term effect.

Objective To analyze the relationship between the expression of serum DNA methyltransferase 1(DNMT1)messenger RNA(mRNA)and long non-coding RNA(LncRNA)urothelial carcinoembryonic antigen 1(UCA1)levels and pregnancy outcomes in patients with hypertensive disorder complicating pregnancy(HDCP).Methods A total of 195 HDCP patients treated in Handan Maternal and Child Health Hospital from March 2021 to August 2023 were selected as the case group,and 195 healthy pregnant women were regarded as the control group.Clinical data of all pregnant women were collected,and biochemical indicators were detected 1 day before delivery.Serum DNMT1 mRNA and LncRNA UCA1 levels were detected by fluorescence quantitative PCR.The case group was divided into pregnancy induced hypertension(PIH)group,mild preeclampsia(PE)group,and severe PE group based on their condition.HDCP patients were divided into good pregnancy outcome group and bad pregnancy outcome group according to the adverse pregnancy outcome at delivery.Clinical data,biochemical indexes,serum DNMT1 mRNA and LncRNA UCA1 levels were compared between control group and case group.The serum DNMT1 mRNA and LncRNA UCA1 levels of HDCP patients with different severity were compared.The clinical data,biochemical indexes,serum DNMT1 mRNA and LncRNA UCA1 levels of HDCP patients with different pregnancy outcomes were compared.The correlation between serum DNMT1 mRNA and LncRNA UCA1 in HDCP patients,factors affecting pregnancy outcomes in HDCP patients,and the predictive value of serum DNMT1 mRNA and LncRNA UCA1 in adverse pregnancy outcomes in HDCP patients were analyzed.Results Compared with control group,the levels of systolic blood pressure,diastolic blood pressure and white blood cell count in case group were increased,while the levels of serum DNMT1 mRNA(0.72±0.18 vs 1.00±0.04)and LncRNA UCA1(0.61±0.16 vs 1.00±0.02)were decreased,and the differences were statistically significant(t=40.651,32.595,7.837,21.205,33.775,all P＜0.001).Serum DNMT1 mRNA(0.85±0.20,0.74±0.18,0.50±0.15)and LncRNA UCA1(0.77±0.18,0.58±0.16,0.43±0.13)levels in PIH group,mild PE group and severe PE group were decreased successively,and the differeences were statistically significant(F=52.687,64.030,all P＜0.001).Serum DNMT1 mRNA in HDCP patients was positively correlated with LncRNA UCA1(r=0.582,P＜0.001).Compared with good pregnancy outcome group,the severity of HDCP,systolic blood pressure,diastolic blood pressure and white blood cell count were increased in the bad pregnancy outcome group,and the serum DNMT1 mRNA(0.80±0.20 vs 0.59±0.15)and LncRNA UCA1(0.72±0.17 vs 0.43±0.14)levels were decreased,and the differences were statistically significant(x2=18.386,t=2.615～12.290,all P＜0.05).Severe PE[OR(95％CI)=1.708(1.193～2.445)],systolic blood pressure[OR(95％CI)=1.495(1.090～2.049)]and diastolic blood pressure[OR(95％CI)=1.621(1.076～2.442)]were risk factors for adverse pregnancy outcomes in HDCP patients,while DNMT1 mRNA[OR(95％CI)=0.833(0.725～0.957)]and LncRNA UCA1[OR(95％CI)=0.796(0.696～0.909)]were protective factors for adverse pregnancy outcomes in HDCP patients(all P＜0.05).The area under curve(AUC)predicted by the combination of DNMT1 mRNA and LncRNA UCA1 for adverse pregnancy outcomes in HDCP patients was greater than that predicted by DNMT1 mRNA alone and LncRNA UCA1 alone(0.926 vs 0.832,0.844),and the differences were statistically significant(Z=2.932,2.345,all P＜0.05).Conclusion Both serum DNMT1 mRNA and LncRNA UCA1 levels are low in HDCP patients,which is related to the degree of disease and pregnancy outcome.DNMT1 mRNA combined with LncRNA UCA1 detection may have a better predictive effect on adverse pregnancy outcome.

Objective:To develop the Surgical Readiness Scale for Female Patients with Stress Urinary Incontinence (SUI) and test its predictive performance.Methods:Based on the theory of "patient-centered" during the perioperative period, an initial scale was formed through literature review, semi-structured interviews, expert consultation, and pre-survey. From January 2021 to December 2022, convenience sampling was used to select 585 female SUI patients who underwent elective surgical treatment at the First Affiliated Hospital of Zhengzhou University as participants for a survey to test the reliability and validity of the scale.Results:A total of 585 questionnaires were distributed, and 560 valid questionnaires were collected, with a valid response rate of 95.73% (560/585). The Surgical Readiness Scale for Female Patients with SUI included four dimensions and 28 items. The content validity index of the scale was 0.975. Cronbach's α coefficient of the total scale was 0.909, and Cronbach's α coefficients of each dimension were 0.928, 0.822, 0.958, and 0.880, respectively. The total split-half reliability coefficient was 0.712, and the split-half reliability coefficients for each dimension were 0.921, 0.808, 0.941, and 0.841, respectively. Two exploratory factor analysis showed a cumulative variance contribution rate of 64.25%. Confirmatory factor analysis showed that the chi-square degree of freedom ratio was 1.680, the mean square root of asymptotic residuals was 0.056, the goodness of fit index was 0.840, the modified goodness of fit index was 0.811, and the comparative goodness of fit index was 0.944. The convergence validity and discriminant validity values were within a reasonable range, indicating good fit of the model.Conclusions:The Surgical Readiness Scale for Female Patients with SUI has good reliability and validity, and can be used as an effective evaluation tool for the surgical readiness of female SUI patients.