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*

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Dopaminergic neurons in the ventral tegmental area (VTA) play an important role in cognition, emergence from anesthesia, reward, and aversion, and their projection to the cortex is a crucial part of the "bottom-up" ascending activating system. The prelimbic cortex (PrL) is one of the important projection regions of the VTA. However, the roles of dopaminergic neurons in the VTA and the VTA^DA-PrL pathway under sevoflurane anesthesia in rats remain unclear. In this study, we found that intraperitoneal injection and local microinjection of a dopamine D1 receptor agonist (Chloro-APB) into the PrL had an emergence-promoting effect on sevoflurane anesthesia in rats, while injection of a dopamine D1 receptor antagonist (SCH23390) deepened anesthesia. The results of chemogenetics combined with microinjection and optogenetics showed that activating the VTA^DA-PrL pathway prolonged the induction time and shortened the emergence time of anesthesia. These results demonstrate that the dopaminergic system in the VTA has an emergence-promoting effect and that the bottom-up VTA^DA-PrL pathway facilitates emergence from sevoflurane anesthesia.
Anesthesia ; Animals ; Dopaminergic Neurons/metabolism* ; Rats ; Receptors, Dopamine D1/metabolism* ; Sevoflurane/pharmacology* ; Ventral Tegmental Area/metabolism*

Objective To investigate the transiliac-transsacral screw insertion pathway (TSIP) so as to provide an anatomical basis for clinical surgical practice.Methods CT scanning data of normal pelvis in 90 Chinese adults were selected by random number table.There were 45 males and 45 females,aged from 21 to 82 years (mean,53.88 years).After computed tomography scan,pelvic data of the 90 subjects were entered into Mimics software 16.0 for three-dimensional reconstruction.The outer frames of sacrum and ilium at sagittal plane were depicted.Maximum inscribed circle method was applied to determine the screw insertion pathways which traversed 1st (S1) and 2nd (S2) sacral segments,respectively.The diameters and lengths of screw pathways,the distances from screw insertion points to both anterior superior iliac spine and posterior superior iliac spine,as well as the angles between pathways and anatomic surface were measured.Results Most subjects had the condition of a trans-S1 TSIP (male 78％,female 76％),and all the tested pelvis had the condition of trans-S2 TSIP.There was no statistically significant difference between the left and right side parameters in male group,and so was in female group (P ＞0.05).TSIP radius:there was no statistically significant difference among male S1 [(5.52 ± 1.91)mm],male S2 [(5.35 ± 1.05)mm],and female S1 [(5.49± 1.34)mm] (P＞0.05),but each of them was greater than female S2 [(4.79 ± 1.40) mm] (P ＜ 0.05).TSIP length:male S1 [(158.25 ±9.84) mm] was larger than male S2 [(138.94 ± 9.75) mm],and female S1 [(154.91 ± 9.40) mm] was larger than female S2 [(141.01 ±8.60)mm].The screw insertion point was located at the outer ilium side.The distances from S1 to anterior superior iliac spine and to posterior superior iliac spine were (96.49 ±6.91)mm and (68.22 ±6.35)mm in males but (100.48 ±8.15)mm and (61.57 ±6.84) mm in females.The distances from S2 to anterior superior iliac spine and to posterior superior iliac spine were (114.43 ±8.77)mm and (49.62 ±8.54)mm in males but (114.75 ± 10.19)mm and (44.52 ±8.36)mm in females.Compared with those with a condition of TSIP in S1,a pelvis without a condition of an S1 TSIP had larger S2 TSIP radius.The S2 TSIP radius in one with such condition in male was (5.10 ±0.84)mm and that in one without such condition in male was (6.22 ± 1.27) mm.The corresponding female data was (4.37 ± 0.92)mm and (6.11 ± 1.84)mm (P ＜ 0.05).Both S1 and S2 TSIP were almost vertical to sagittal plane and parallel to coronal plane.Conclusions Anatomically,a S1 or S2 transiliactranssacral screw is available in most Chinese adults for sacroiliac joint fixation on both sides.Mimics software can be helpful to ensure the pathway of screw fixation,which provides reference for transiliactranssacral screw fixation technique.

Objective To know the distribution of pathogenic bacteria in the hospital ,and to provide scientific evidence for con‐trolling hospital infection and clinical medication .Methods Samples of the hospitalized patients and the data of bacteria culture and isolation in the hospital were collected and statistically analysed retrospectively from January 2011 to December 2013 .Bacterial iden‐tification and drug sensitivity test were carried out by using VITEK 2 Compact automated bacterial identification and drug sensitive system .The clinical distribution and drug resistance characteristics of the strains were analyzed by using WHONET5 .4 and SPSS17 .0 software .Results In the hospital ,71 929 specimens were received from 2011 to 2013 totally ,the detection rate of patho‐genic bacteria was 18 .5% .Sputum(62 .8% ) ,secretions and pus(11 .3% ) ,blood(10 .3% ) were the top three types of specimens which had larger positive numbers .Gram negative bacteria are the main kind of pathogenic bacteria in the hospital ,accounting for 73 .3% .Gram positive bacteria accounted for 25 .0% .E .coli(21 .1% ) ,Pseudomonas aeruginosa(14 .8% ) ,Acinetobacter baumannii (12 .5% ) ,Klebsiella pneumoniae (12 .2% ) and Staphylococcus aureus(11 .04% ) were the top five pathogenic bacteria .The drug resistance of the isolates were as follows .Gram‐negative bacteria showed resistance of different extents to broad‐spectrum penicil‐lins ,quinolones ,cephalosporins except for the 4th generationsand and aminoglycosides .Over 80% Staphylococcus aureus showed re‐sistance to penicillin ,erythromycin and clindamycin ,but the rate to Oxacillin were decreasing year by year .Enterobacteria were still most sensitive to carbapenems with a sensitive rate over 98 .6% .However ,the emergence of Carbapenem‐resistent enterobacteria from 2011 to 2013 was worthy of clinical attention .Conclusion The type of positive specimens were mainly sputum .Gram negative bacteria are the main pathogenic bacteria ,and have obvious multi-drug resistance .E .Coli is the superiority strains ,fungal infection rate are increasing year by year .Doctors and hospital infection controlling department should pay attention to the monitoring of bac‐terial resistance and improve the rational use of antimicrobial drugs .

Objective To evaluate the accuracy and reliability of O-arm-based thoracolumbar pedicle screw installation.Methods A retrospective review was conducted on 75 patients who had undergone thoracolumbar pedicle screw fixation assisted with O-arm navigation (navigation group,n =32) and C-arm fluoroscopy (fluoroscopy group,n =43) from March to October 2014.All the patients were assessed with X-ray and CT images after operation.Accuracy of screw installation in both groups was compared.In navigation group,screw directions were measured on the sagittal and axial images of intraoperative navigation and post-operative CT scanning to evaluate the concordance.Results In fluoroscopy group,a total of 206 pedicle screws were placed with the one-time success rate of 93.2％ and accuracy of 90.8％ for screw placement,and one misplaced screw (grade llⅢ) led to L3 nerve root symptom.In navigation group,a total of 226 pedicle screws were placed with the one-time success rate of 100％ and accuracy of 96.9％ for screw placement,and no screw was grade Ⅲ.Further,there were no significant differences in screw directions on the sagittal and axial images between intraoperative navigation and postoperative CT scanning (P ＞ 0.05).Conclusion O-arm navigation that provides high-resolution images and high precision improves the accuracy of thoracolumbar pedicle screw installation,and possesses good reliability.

Objective To investigate radiation risk perception and nuclear acceptance after the 60Co stuck source incident in June 2009 in Qixian County,Henan Province.Methods From March to April 2010,23 hamlets and 2 schools from 5 towns in Qixian County were selected,while 3 hamlets and 2 schools from 3 towns were used as control in Huixian County,1 35 km away where no any impact of the incident was found.Face-to-face questionnaire survey was conducted among three groups including mass public,elite public(representatives of public opinion,such as physicians,teachers,govemmental officials,administrative personnel,private entrepreneurs),and middie school students(the third grade students in junior middle schools and the first grade students in senior middle schools).Results A total of 1 340 valid questionnaires were collected.The public knowledge levels about radiation and nuclear power were low among all groups in two areas and public knowledge levels in Qixian County were higher than those in Huixian County.In both areas.the knowledge levels of the students were higher tIIan those among the elite public,and that among the general public were the lowest.The knowledge levels of males and those with higher educational levels were higher than those of females and those with lower educational levels.More than 40.0% of the respondents supported the idea to build nuclear power plants in China.but only a small part of them supported to build nuclear power plants in their own areas.The percentages of opponents against local nuclear power plant construction were especially higher among the students and those with higher educational levels.More than 60% of the mass public and elite public believed the explanation of the government.More than 80% of the respondents held negative attitudes towards the performance of the Qixian County Government in dealing with this incident.The student gave the lowest evaluation of the credibility and the specific performance of the local government,whereas the elite public placed themselves between the students and the mass public.The reasons why the local people left their homes to evade risk included rumors(67.2%),lack of radiation knowledge(61.9%),group psychology(59.2%),and failure of the government to inform the truth to the public in time(42.3%).Conclusions The public still fails to know enough about radiation and nuclear power.Although they trust the government,they are dissatisfied with the performance of the local government in dealing with the incident.The negative evaluation of the students is worth concerning.

Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39 patients with multi-level cervical disc herniation were treated with disc replacement and adjacent segment cage fusion at one stage. There were 29 patients with two level cervical disc herniation, nine with three level cervical disc herniation and one with four level cervical disc herniation. Of the patients, there were 17 male and 22 female, aged between 35 and 63 years ( mean age 47 years). The herniated disc was located at C3-4 and C4-5 in two patients, C4-5 and C5-6 in 15, C5-6 and C6-7 in nine, C4-5 and C6-7 in three, C3-4,C4-5 and C5-6 in four, C4-5, C5-6 and C6-7 in five and C3-4, C4-8 , C5-6 and C6-7 in one. There were 18 patients with myelopathy and 21 with radieulopathy. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated according to JOA score and odom' s criteria. Postoperative clinical symptoms and daily function were evaluated by using neck disability index (NDI) scale. Results Twenty-nine patients with bi-level cervical disc herniation underwent single level disc replacement and cage fusion on adjacent segment. Nine patients with three level disc herniation underwent single level disc replacement in seven and level cage fusion on adjacent segment in two. Twopatients underwent two level disc replacement and one level cage fusion. One patient with four level disc herniation was treated with two level disc replacement and two level cage fusion. The patients were followed up for from 6 moths to 3 years, which showed that definite stabilization was achieved for all disc with average range of motion for 9.3 degrees postoperatively. Solid fusion was achieved in all cage, with no subsidence or displacement of cage. The JOA score was increased from 9.1 to 13.2 at final follow up and the NDI (neck disability index) score decreased from 41.8 reduced to 29.5 at final follow up. The clinical success rate (excellent/good/fair) according to Odom' s Criteria was 85%. Conclusion Cervical disc replacement and cage fusion can attain definite stabilization and satisfactory mobility and provide a new effective treatment for cervical disc herniation. The long-term outcome needs further clinical followup.

ObjectiveTo retrospectively analyze the treatment of odontoid fractures using percutaneous and open anterior screw fixation,and compare the clinical and radiographic results of the two techniques.MethodsFrom March 2003 to May 2010,115 patients with odontoid fracture were treated with anterior screw fixation,and all patients were followed up.The mean age of the patients was 43.5 years (range,16-71).Forty-seven patients who underwent percutaneous anterior screw fixation were set as the percutaneous fixation group,including 42 cases of type Ⅱ odontoid fracture and 5 of rostral type Ⅲ fracture.Sixtyeight patients who received open anterior screw fixation were set as the open fixation group,composing of 61cases of type Ⅱ odontoid fracture and 7 of rostral type Ⅲ fracture.We compared the operative time,intraoperative blood loss,X-ray exposure time,fracture union and complications between the two groups.Results The average follow-up duration was 37.6 months with a range of 12-70 months.The gender,age,classification of odontoid fractures,time after the injuries and concomitant spinal injuries showed a similar pattern in both groups.The operating time and intra-operative blood loss in percutaneous fixation group were (40.3±9.5)min and (5.6±4.1) ml respectively,and in open fixation group were (62.9±15.3) min and (47.1±28.6) ml respectively,both of them were significantly superior in percutaneous fixation group than in open fixation group (P＜0.05).There was no statistical difference in radiation exposure time,fracture union and incidence of complication between the two groups.ConclusionComparing with open screw fixation,percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type Ⅱ and rostral type Ⅲ odontoid fractures with potential advantages.

Objective To evaluate the efficacy of the combination of percutaneous transhepatic embolization of gastroesophageal varices (PEGV) and partial splenic embolization(PSE) for the treatment of variceal bleeding. Methods Fifty patients with cirrhosis who fit in with the requirements of the study were randomly divided into dual-interventional group and surgical group. The patients in dual-interventional group were treated with PEGV together with PSE, and the patients in surgery group were treated with Hassab's operation. After the procedure all the patients in two groups were followed up periodically. The endoscopy, B ultrasonography, liver function tests and hematologic examinations were performed 24 months after the therapy, and the results were statistically analyzed. Results Fifty patients were enrolled in this study. The procedures of embolization and surgery were successful in all patients. In dual-interventional group, the whit eblood cell and platelet counts were (2.33±0.65) 10~9/L and (3.63±1.05) ×10~9/L respectively before the treatment and were (7.98±3.0) ×10~9/L and (163±91)× 10~9/L respectively 24 months after the treatment (P<0.05). The diameter of theportal vein was (1.47±0.25) cm before the treatment and was(1.31±0.23) cm 24 months after the treatment (P<0.05). The severity of esophageal varices decreased from grade Ⅲ to lower grade Ⅱ in 11 patients, and from grade Ⅱ to lower grade Ⅰ in 6 patients 24 months after procedure. Portal thrombosis occurred in 1 case. The recurrent bleeding rate was 16% (4/25) 24 months after treatment. Three patients died of the recurrent bleeding, one patient died of hepatic failure. In surgical group, the white blood cell and platelet counts were (2.2±0.60) ×10~9/L and (41±12.5) ×109/L before treatment, and were (9.3±2.56)×10~9/L and (321±12.5)×10~9/L 24 months after treatment (P<0.05). The diameter of the portal vein was (1.43±0.22) cm before the treatment and was (1.28±0.18) cm after the treatment (P<0.05). The severity of esophageal varices decreased from grade Ⅲ to lower grade Ⅱ in 13 patients, and from grade Ⅱ to lower grade Ⅰ in 7 patients. Four patients developed portal thrombosis after the procedure. The recurrent bleeding rate was 20%(5/25), 2 patients died of hepatic failure after the surgery, 2 died of recurrent bleeding. Conclusion In treating patients with cirrhosis, the combination of PGEV and PSE, regarded as dual-interventional therapy, is very effective, especially in controlling recurrent bleeding and in improving white blood cell and platelet counts.