Objective·To explore the efficacy of the XP-Endo Shaper(XPS)and Reciproc(RC)engine-driven nickel-titanium file systems in removing root canal fillings,and to provide evidence for clinical application.Methods·The maxillary first permanent molars were obtained from patients who visited the Department of General Dentistry,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,between March and September 2022,which required tooth extraction due to periodontal disease.A total of 30 mesiobuccal or distobuccal root canals with moderate curvature were selected and randomly divided into the RC file group(control group,n=15)and the XPS file group(experimental group,n=15).All root canals were first negotiated and shaped using M3-PRO nickel-titanium files,followed by root canal obturation with bioceramic paste using the single-cone technique.Then,RC files(R25)were used in the control group,while XPS files were used in the experimental group to remove the root canal obturation.Cone Beam Computed Tomography(CBCT)scans were performed before and after the removal procedures.The time required for obturation removal,the percentage of residual obturation volume,the amount of apical debris extrusion,and the degree of instrument deformation were recorded.Independent-sample t-tests and chi-square test were used to compare the differences between the two groups.Results·The XPS group required slightly more time(118.87±18.58)s than the RC group(107.93±14.79)s,but the difference between two groups was not statistically significant.The XPS group had a lower percentage of residual obturation volume(7.51±8.06)%compared to the RC group(15.02±14.63)%,but the difference was not statistically significant.The XPS group had significantly less apical debris extrusion(6.15±1.42)mg than the RC group(8.29±2.01)mg,with a statistically significant difference(P=0.002).Both groups exhibited varying degrees of instrument deformation,but yet no instrument separation occurred in either group.Conclusion·The RC engine-driven nickel-titanium files were slightly more time-efficient in removing root canal fillings,whereas the XPS files achieved a higher canal cleanliness and produced less apical debris extrusion.As there was no significant difference in removal time,and considering the superior cleaning performance and reduced risk of postoperative complications,the XPS file system appears more suitable for removing root canal fillings in moderately curved root canals.

Objective·To explore the efficacy of the XP-Endo Shaper(XPS)and Reciproc(RC)engine-driven nickel-titanium file systems in removing root canal fillings,and to provide evidence for clinical application.Methods·The maxillary first permanent molars were obtained from patients who visited the Department of General Dentistry,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,between March and September 2022,which required tooth extraction due to periodontal disease.A total of 30 mesiobuccal or distobuccal root canals with moderate curvature were selected and randomly divided into the RC file group(control group,n=15)and the XPS file group(experimental group,n=15).All root canals were first negotiated and shaped using M3-PRO nickel-titanium files,followed by root canal obturation with bioceramic paste using the single-cone technique.Then,RC files(R25)were used in the control group,while XPS files were used in the experimental group to remove the root canal obturation.Cone Beam Computed Tomography(CBCT)scans were performed before and after the removal procedures.The time required for obturation removal,the percentage of residual obturation volume,the amount of apical debris extrusion,and the degree of instrument deformation were recorded.Independent-sample t-tests and chi-square test were used to compare the differences between the two groups.Results·The XPS group required slightly more time(118.87±18.58)s than the RC group(107.93±14.79)s,but the difference between two groups was not statistically significant.The XPS group had a lower percentage of residual obturation volume(7.51±8.06)%compared to the RC group(15.02±14.63)%,but the difference was not statistically significant.The XPS group had significantly less apical debris extrusion(6.15±1.42)mg than the RC group(8.29±2.01)mg,with a statistically significant difference(P=0.002).Both groups exhibited varying degrees of instrument deformation,but yet no instrument separation occurred in either group.Conclusion·The RC engine-driven nickel-titanium files were slightly more time-efficient in removing root canal fillings,whereas the XPS files achieved a higher canal cleanliness and produced less apical debris extrusion.As there was no significant difference in removal time,and considering the superior cleaning performance and reduced risk of postoperative complications,the XPS file system appears more suitable for removing root canal fillings in moderately curved root canals.

【Objective】 To objectively evaluate the quality control level of blood testing process in blood banks through quantitative monitoring and trend analysis, and to promote the homogenization level and standardized management of blood testing laboratories in blood banks. 【Methods】 A quality monitoring indicator system covering the whole process of blood collection and supply, including blood donation service, blood component preparation, blood testing, blood supply and quality control was established. The questionnaire Quality Monitoring Indicators for Blood Collection and Supply Process with clear definition of indicators and calculation formulas was distributed to 17 blood banks in Shandong province. Quality monitoring indicators of each blood bank from January to December 2022 were collected, and 31 indicators in terms of blood testing were analyzed using SPSS25.0 software. 【Results】 The proportion of unqualified serological tests in 17 blood bank laboratories was 55.84% for ALT, 13.63% for HBsAg, 5.08% for anti HCV, 5.62% for anti HIV, 18.18% for anti TP, and 1.65% for other factors (mainly sample quality). The detection unqualified rate and median were (1.23±0.57)% and 1.11%, respectively. The ALT unqualified rate and median were (0.74±0.53)% and 0.60%, respectively. The detection unqualified rate was positively correlated with ALT unqualified rate (r=0.974, P<0.05). The unqualified rate of HBsAg, anti HCV, anti HIV and anti TP was (0.15±0.09)%, (0.05±0.04)%, (0.06±0.03)% and (0.20±0.05)% respectively. The average unqualified rate, average hemolysis rate, average insufficient volume rate and the abnormal hematocrit rate of samples in 17 blood bank laboratories was 0.21‰, 0.08‰, 0.01‰ and 0.02‰ respectively. There were differences in the retest concordance rates of four HBsAg, anti HCV and anti HIV reagents, and three anti TP reagents among 17 blood bank laboratories (P<0.05). The usage rate of ELISA reagents was (114.56±3.30)%, the outage rate of ELISA was (10.23±7.05) ‰, and the out of range rate of ELISA was (0.90±1.17) ‰. There was no correlation between the out of range rate, outrage rate and usage rate (all P>0.05), while the outrage rate was positively correlated with the usage rate (r=0.592, P<0.05). A total of 443 HBV DNA positive samples were detected in all blood banks, with an unqualified rate of 3.78/10 000; 15 HCV RNA positive samples were detected, with an unqualified rate of 0.13/10 000; 5 HIV RNA positive samples were detected, with an unqualified rate of 0.04/10 000. The unqualified rate of NAT was (0.72±0.04)‰, the single NAT reaction rate [(0.39±0.02)‰] was positively correlated with the single HBV DNA reaction rate [ (0.36±0.02) ‰] (r=0.886, P<0.05). There was a difference in the discriminated reactive rate by individual NAT among three blood bank laboratories (C, F, H) (P<0.05). The median resolution rate of 17 blood station laboratories by minipool test was 36.36%, the median rate of invalid batch of NAT was 0.67%, and the median rate of invalid result of NAT was 0.07‰. The consistency rate of ELISA dual reagent detection results was (99.63±0.24)%, and the median length of equipment failure was 14 days. The error rate of blood type testing in blood collection department was 0.14‰. 【Conclusion】 The quality monitoring indicator system for blood testing process in Shandong can monitor potential risks before, during and after the experiment, and has good applicability, feasibility, and effectiveness, and can facilitate the continuous improvement of laboratory quality control level. The application of blood testing quality monitoring indicators will promote the homogenization and standardization of blood quality management in Shandong, and lay the foundation for future comprehensive evaluations of blood banks.

Objective To evaluate the acceptability and effectiveness of different doses of midazolam oral solution in sedating infants during echocardiographic studies.Methods Two hundred and fourty patients aged 1 to 3 years who underwent echocardiographic study in sedation in our hospital were enrolled in this study.After recording the baseline data of all infants,they were randomly divided into four groups:0.3 mg·kg-1 midazolam oral solution group(M1 group),0.5 mg·kg-1 midazolam oral solution group(M2 group),0.7 mg·kg-1 midazolam oral solution group(M3 group)and 0.5 mL·kg-1 10%chloral hydrate administrated rectally group(C group),60 case per group,and the sedation was performed in the corresponding method of each group.The 5-point facial hedonic and Ramsay scales were used to evaluate acceptability and effectiveness in sedation.The onset time and duration time of sedation were recorded.Results Compared with the C group,the 5-point facial hedonic scale scores in M1,M2,and M3 groups increased during sedation(F=17.50,P<0.017).The onset time of sedation in the M1 and M2 groups was longer than that in the C group(P<0.017),and the duration time of sedation in the M1 and M2 groups was shorter than that in the C group(P<0.017).There was no significant difference in the onset time(P=0.85)and duration time(P=0.50)of sedation between the M3 and C groups.The onset time of sedation in the M1and M2groups was longer than that in the M3 group(P<0.017),and the duration time of sedation in the M1 and M2 groups were shorter than that in the M3 group(P<0.017).Conclusions The acceptability of infants with midazolam oral solution sedation under echocardiographic study was better than that of 10%chloral hydrate administrated rectally.There were fewer adverse reactions with the midazolam oral solution.The 0.7 mg·kg-1 midazolam oral solution had a rapid onset of sedation and definite effect.

Objective:To investigate the effect of estrogen supplementation therapy on vaginal microbiota and local immunity of postmenopausal high-risk human papillomavirus (HPV) infected women.Methods:A total of 74 postmenopausal women who underwent gynecological examinations or visits at Department of Gynecology, Shanghai Ruijin Rehabilitation Hospital from June 2018 to June 2023 were included in this study. According to HPV test, they were divided into the high-risk HPV-negative women (normal group, n=14) and the high-risk HPV-positive women ( n=60). A randomized controlled clinical trial was designed. Within the high-risk HPV-positive women, they were further randomly assigned by using the random number table method to the experimental group (high-risk HPV-positive women receiving low-dose estrogen therapy orally, n=30) and control group (high-risk HPV-positive women not receiving low-dose estrogen therapy, n=30). Vaginal microbiota composition and expression of inflammatory cytokines in vaginal lavage fluid were measured using fluorescence quantitative PCR and enzyme-linked immunosorbent assay at baseline (week 0), 4th week, and 8th week after enrollment. Results:There were no significant differences in age, menopausal time, body mass index, systolic pressure, diastolic pressure, heart rate, pH value and vaginal cell maturation index (VMI) among the normal group, the experimental group and control group (all P>0.05) which indicated the baseline was comparable. After estrogen treatment, the pH value of the experimental group at 4th and 8th weeks (5.27±0.13, 4.84±0.15) was significantly lower than that at week 0 (6.59±0.17, all P<0.001), while the vaginal cell maturation index (VMI) at 4th and 8th weeks (41.62±2.62, 58.28±2.16) was significantly higher than that at week 0 (25.97±2.60, all P<0.001). The quantitative results showed no significant differences in the abundance of Escherichia coli among the normal group, the experimental group, and control group, and within each group at different time points (all P>0.05). The abundance of Gardnerella and Atopobium in the experimental group was significantly higher at week 0 compared with 4th week and 8th week (all P<0.001). However, after estrogen treatment, the abundance of Gardnerella and Atopobium in the experimental group at 4th week was significantly lower than those in control group (all P<0.001), with no significant difference compared with the normal group (all P>0.05). There were no significant differences in the abundance of Prevotella, L. Gasseri, and L. Iners among the normal group, the experimental group, and control group at week 0, 4th week and 8th week (all P>0.05). The abundance of L. Crispatus and L. Jensenii in the experimental group and control group at week 0 was significantly lower than that in the normal group (all P<0.001). The abundance of L. Crispatus in the experimental group at 4th week and 8th week was significantly higher than that in control group (all P<0.001), with no significant difference compared with the normal group ( P>0.05). There were no significant differences in the concentrations of interleukin (IL)-6, IL-8, and interferon (IFN)-α in vaginal lavage fluid among the normal group, the experimental group, and control group (all P>0.05). The concentration of IL-1β in the experimental group and control group was significantly higher than that in the normal group ( P<0.001), with no significant difference between the experimental group and control group ( P>0.05). The concentration of tumor necrosis factor alpha (TNF-α) in the experimental group at 8th week was significantly lower than that at week 0 ( P<0.001), while there was no significant difference in TNF-α concentration after week 4 compared with week 0 ( P>0.05). Compared with the experimental group at week 0, the concentration of chemokine C-X-C motif ligand 14 (CXCL14) and IFN-β significantly decreased after 8 weeks of estrogen treatment (all P<0.001), with no significant change after 4 weeks of treatment ( P>0.05). Compared with the normal group, the concentration of IFN-γ inducible protein 16 in the experimental group and control group significantly increased (all P<0.001), with no significant difference between the experimental group and control group ( P>0.05). Conclusion:HPV infection can increase the abundance of Gardnerella and Atopobium in the vagina of postmenopausal women and decrease the abundance of L. Crispatus and L. Jensenii, which further disrupts the homeostasis of microorganisms in the vaginal microenvironment. Estrogen replacement therapy has a certain improvement effect on vaginal flora and local immunity in postmenopausal women with high-risk HPV infection.

Objective:To investigate the effect of estrogen supplementation therapy on vaginal microbiota and local immunity of postmenopausal high-risk human papillomavirus (HPV) infected women.Methods:A total of 74 postmenopausal women who underwent gynecological examinations or visits at Department of Gynecology, Shanghai Ruijin Rehabilitation Hospital from June 2018 to June 2023 were included in this study. According to HPV test, they were divided into the high-risk HPV-negative women (normal group, n=14) and the high-risk HPV-positive women ( n=60). A randomized controlled clinical trial was designed. Within the high-risk HPV-positive women, they were further randomly assigned by using the random number table method to the experimental group (high-risk HPV-positive women receiving low-dose estrogen therapy orally, n=30) and control group (high-risk HPV-positive women not receiving low-dose estrogen therapy, n=30). Vaginal microbiota composition and expression of inflammatory cytokines in vaginal lavage fluid were measured using fluorescence quantitative PCR and enzyme-linked immunosorbent assay at baseline (week 0), 4th week, and 8th week after enrollment. Results:There were no significant differences in age, menopausal time, body mass index, systolic pressure, diastolic pressure, heart rate, pH value and vaginal cell maturation index (VMI) among the normal group, the experimental group and control group (all P>0.05) which indicated the baseline was comparable. After estrogen treatment, the pH value of the experimental group at 4th and 8th weeks (5.27±0.13, 4.84±0.15) was significantly lower than that at week 0 (6.59±0.17, all P<0.001), while the vaginal cell maturation index (VMI) at 4th and 8th weeks (41.62±2.62, 58.28±2.16) was significantly higher than that at week 0 (25.97±2.60, all P<0.001). The quantitative results showed no significant differences in the abundance of Escherichia coli among the normal group, the experimental group, and control group, and within each group at different time points (all P>0.05). The abundance of Gardnerella and Atopobium in the experimental group was significantly higher at week 0 compared with 4th week and 8th week (all P<0.001). However, after estrogen treatment, the abundance of Gardnerella and Atopobium in the experimental group at 4th week was significantly lower than those in control group (all P<0.001), with no significant difference compared with the normal group (all P>0.05). There were no significant differences in the abundance of Prevotella, L. Gasseri, and L. Iners among the normal group, the experimental group, and control group at week 0, 4th week and 8th week (all P>0.05). The abundance of L. Crispatus and L. Jensenii in the experimental group and control group at week 0 was significantly lower than that in the normal group (all P<0.001). The abundance of L. Crispatus in the experimental group at 4th week and 8th week was significantly higher than that in control group (all P<0.001), with no significant difference compared with the normal group ( P>0.05). There were no significant differences in the concentrations of interleukin (IL)-6, IL-8, and interferon (IFN)-α in vaginal lavage fluid among the normal group, the experimental group, and control group (all P>0.05). The concentration of IL-1β in the experimental group and control group was significantly higher than that in the normal group ( P<0.001), with no significant difference between the experimental group and control group ( P>0.05). The concentration of tumor necrosis factor alpha (TNF-α) in the experimental group at 8th week was significantly lower than that at week 0 ( P<0.001), while there was no significant difference in TNF-α concentration after week 4 compared with week 0 ( P>0.05). Compared with the experimental group at week 0, the concentration of chemokine C-X-C motif ligand 14 (CXCL14) and IFN-β significantly decreased after 8 weeks of estrogen treatment (all P<0.001), with no significant change after 4 weeks of treatment ( P>0.05). Compared with the normal group, the concentration of IFN-γ inducible protein 16 in the experimental group and control group significantly increased (all P<0.001), with no significant difference between the experimental group and control group ( P>0.05). Conclusion:HPV infection can increase the abundance of Gardnerella and Atopobium in the vagina of postmenopausal women and decrease the abundance of L. Crispatus and L. Jensenii, which further disrupts the homeostasis of microorganisms in the vaginal microenvironment. Estrogen replacement therapy has a certain improvement effect on vaginal flora and local immunity in postmenopausal women with high-risk HPV infection.

Background: Disrupted circadian rhythms have been associated with the development of irritable bowel syndrome (IBS). In some IBS patients, the symptoms may present with circadian fluctuations. Enterochromaffin cells (EC cells) and tryptophan hydroxylase 1 (TPH1) - 5 - hydroxytryptamine (5 - HT) signaling pathway are currently recognized as the key pathophysiological mechanism of IBS. Aims: To explore whether Bmal1, the core circadian clock gene, is involved in the occurrence of IBS by regulating TPH1-5-HT signaling pathway in EC cells. Methods: Normal Sprague-Dawley (SD) rats and IBS-model SD rats, as well as wild type (WT) and intestine-specific Bmal1 knockout (Bmal1

Objective:To study the surgical safety and efficacy of preoperative neoadjuvant therapy with immune checkpoint inhibitors combined with anti-angiogenic drugs in patients with China liver cancer staging(CNLC)-Ⅱb and Ⅲa resectable hepatocellular carcinoma.Methods:The data of 129 patients with Ⅱb and Ⅲa hepatocellular carcinoma who underwent surgery at the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were analyzed. All patients were divided into two groups: the neoadjuvant therapy group( n=14,13 males and 1 female,aged (55.4±12.6)years(range:34 to 75 years)) received immune combined targeted therapy before surgery,immune checkpoint inhibitor camrelizumab was administered intravenously at a dose of 200 mg each time,every 2 weeks for 3 cycles,anti-angiogenesis drug apatinib was taken orally and continuously with a dose of 250 mg for 3 weeks and the conventional surgery group( n=115,103 males and 12 females,aged (55.8±12.0)years(range:21 to 83 years)) did not receive antitumor systemic therapy before surgery. There were 3 patients with CNLC-Ⅱb,11 with CNLC-Ⅲa in the neoadjuvant group;28 patients with CNLC-Ⅱb,87 with CNLC-Ⅲa in the conventional group. Student′s t test or rank-sum test was used to compare the differences between two groups for quantitative data, Fisher′s exact probability method was used to compare the differences of proportions between two groups, and Log-rank test was used to compare survival differences between two groups. Results:The 1-year recurrence rate in the neoadjuvant group was 42.9%,and the 1-year recurrence rate in the conventional group was 64.0%,with a statistically significant difference between the two groups(χ2=3.850, P=0.050);The 1-year survival rate in the neoadjuvant group was 100% and that in the conventional group was 74.2%,with a statistically significant difference between the two groups(χ2=5.170, P=0.023). According to the stratified analysis of the number of tumors,for single tumor,the 1-year recurrence rate in the neoadjuvant group was 25.0%,and that in the conventional surgery group was 71.0%,and the difference between the two groups was statistically significant(χ2=5.280, P=0.022). For multiple tumors, the 1-year recurrence rate in the neoadjuvant group was 66.7%,and the 1-year recurrence rate in the conventional surgery group was 58.9%,with no significant difference between the two groups(χ2=0.110, P=0.736). The operative time,intraoperative blood loss,and postoperative hospital stay in the neoadjuvant group were similar to those in the conventional group,and their differences were not statistically significant. Conclusions:Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs as a neoadjuvant therapy for resectable hepatocellular carcinoma can reduce the 1-year recurrence rate and improve the 1-year survival rate,especially for those with solitary tumor. Limited by the sample size of the neoadjuvant group,the safety of immune combined targeted therapy before surgery cannot be observed more comprehensively,and further studies will be explored.

Objective:To study the surgical safety and efficacy of preoperative neoadjuvant therapy with immune checkpoint inhibitors combined with anti-angiogenic drugs in patients with China liver cancer staging(CNLC)-Ⅱb and Ⅲa resectable hepatocellular carcinoma.Methods:The data of 129 patients with Ⅱb and Ⅲa hepatocellular carcinoma who underwent surgery at the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were analyzed. All patients were divided into two groups: the neoadjuvant therapy group( n=14,13 males and 1 female,aged (55.4±12.6)years(range:34 to 75 years)) received immune combined targeted therapy before surgery,immune checkpoint inhibitor camrelizumab was administered intravenously at a dose of 200 mg each time,every 2 weeks for 3 cycles,anti-angiogenesis drug apatinib was taken orally and continuously with a dose of 250 mg for 3 weeks and the conventional surgery group( n=115,103 males and 12 females,aged (55.8±12.0)years(range:21 to 83 years)) did not receive antitumor systemic therapy before surgery. There were 3 patients with CNLC-Ⅱb,11 with CNLC-Ⅲa in the neoadjuvant group;28 patients with CNLC-Ⅱb,87 with CNLC-Ⅲa in the conventional group. Student′s t test or rank-sum test was used to compare the differences between two groups for quantitative data, Fisher′s exact probability method was used to compare the differences of proportions between two groups, and Log-rank test was used to compare survival differences between two groups. Results:The 1-year recurrence rate in the neoadjuvant group was 42.9%,and the 1-year recurrence rate in the conventional group was 64.0%,with a statistically significant difference between the two groups(χ2=3.850, P=0.050);The 1-year survival rate in the neoadjuvant group was 100% and that in the conventional group was 74.2%,with a statistically significant difference between the two groups(χ2=5.170, P=0.023). According to the stratified analysis of the number of tumors,for single tumor,the 1-year recurrence rate in the neoadjuvant group was 25.0%,and that in the conventional surgery group was 71.0%,and the difference between the two groups was statistically significant(χ2=5.280, P=0.022). For multiple tumors, the 1-year recurrence rate in the neoadjuvant group was 66.7%,and the 1-year recurrence rate in the conventional surgery group was 58.9%,with no significant difference between the two groups(χ2=0.110, P=0.736). The operative time,intraoperative blood loss,and postoperative hospital stay in the neoadjuvant group were similar to those in the conventional group,and their differences were not statistically significant. Conclusions:Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs as a neoadjuvant therapy for resectable hepatocellular carcinoma can reduce the 1-year recurrence rate and improve the 1-year survival rate,especially for those with solitary tumor. Limited by the sample size of the neoadjuvant group,the safety of immune combined targeted therapy before surgery cannot be observed more comprehensively,and further studies will be explored.

An epidemiological investigation was carried out on a local cluster of outbreak caused by imported cases of Coronavirus Disease 2019 (COVID-19) in rural areas of Chengdu in December 2020, to find out the source of infection and the chain of transmission. According to
COVID-19 ; Disease Outbreaks ; Epidemics ; Humans ; Quarantine ; SARS-CoV-2