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*

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

[Objective] To explore the predictive value of HALP score for prognosis in patients with multiple myeloma (MM). [Methods] A retrospective analysis was conducted on laboratory indicators and related clinical data of newly diagnosed multiple myeloma (NDMM) patients, treated at the Affiliated Hospital of North Sichuan Medical College from January 2016 to October 2023, prior to their first treatment. The HALP score was calculated, and the optimal cutoff value for HALP was determined using X-tile software. Survival analysis was performed using Kaplan-Meier curves for high HALP and low HALP groups. Univariate and multivariate analyses were conducted using the Cox regression model, and a forest plot was generated using Graphpad Prism to illustrate factors that may impact patient prognosis. The predictive ability of HALP score combined with β2-microglobulin and ECOG score for prognosis in MM patients was evaluated using receiver operating characteristic curve (ROC) analysis. [Results] A total of 203 MM patients were included, with the optimal cutoff value for HALP score being 29.15 (P<0.05). Among them, 101 patients were in the low HALP score group, and 102 patients were in the high HALP score group. The results of univariate and multivariate analysis using the Cox regression model showed that a HALP score <29.15 was an independent risk factor for progression-free survival (PFS) and overall survival (OS) (P<0.05). ROC curve analysis indicated that the combination of HALP score with β2-microglobulin and ECOG score had a higher predictive value for prognosis in MM patients compared to using HALP score alone. [Conclusion] The HALP score is closely related to the prognosis of patients with NDMM. A low HALP score indicates a poorer prognosis, while the combination of HALP score with β2-microglobulin and ECOG score provides a higher predictive value when assessed together.

Objective:To investigate Beijing residents′ preferences, marginal willingness to pay (mWTP), and utilization probabilities regarding the traditional Chinese medicine (TCM) health management services provided by community health service institutions, and to provide references for promoting the application and dissemination of TCM health management at the grassroots level.Methods:A questionnaire was designed based on a discrete choice experiment involving six attributes influencing residents′ utilization of TCM health management services: medical insurance coverage, technical effectiveness, service provider, physician seniority, treatment modality, and individual average out-of-pocket cost. A multi-stage stratified random sampling method was used to select 800 residents from three community health service institutions across three administrative districts of Beijing. The survey was conducted from November to December 2024. A mixed logit model was employed to analyze the factors influencing service utilization preferences, mWTP, and utilization probabilities.Results:A total of 733 valid questionnaires were included in the analysis. All six attributes significantly influenced residents′ service utilization preferences ( P<0.05). Residents showed stronger preferences for services with lower individual average out-of-pocket costs ( β=-0.214), combination therapies involving both internal medication and external treatments ( β=0.314), provision by senior-level professionals ( β= 0.522), fixed service providers ( β=0.851), longer treatment courses with better efficacy ( β=1.323), and services covered by medical insurance ( β=1.843). When services were covered by insurance, featured longer courses with better efficacy, and involved fixed service providers, the probability of service utilization increased to 76.52%. Heterogeneity in service utilization preferences was observed across different ages, genders and chronic health conditions ( P<0.05). Conclusions:Medical insurance coverage, technical efficacy and doctor service continuity are the most influential factors affecting residents′ service utilization. Optimizing the combination of TCM health management service attributes can enhance residents′ willingness to utilize these services. It is recommended to develop multi-tiered medical security strategies, selectively include high-value TCM health management services into insurance coverage, strengthen physician-patient trust, and design differentiated " disease prevention" service packages for residents with different characteristics to improve overall population health.

Objective:To investigate Beijing residents′ preferences, marginal willingness to pay (mWTP), and utilization probabilities regarding the traditional Chinese medicine (TCM) health management services provided by community health service institutions, and to provide references for promoting the application and dissemination of TCM health management at the grassroots level.Methods:A questionnaire was designed based on a discrete choice experiment involving six attributes influencing residents′ utilization of TCM health management services: medical insurance coverage, technical effectiveness, service provider, physician seniority, treatment modality, and individual average out-of-pocket cost. A multi-stage stratified random sampling method was used to select 800 residents from three community health service institutions across three administrative districts of Beijing. The survey was conducted from November to December 2024. A mixed logit model was employed to analyze the factors influencing service utilization preferences, mWTP, and utilization probabilities.Results:A total of 733 valid questionnaires were included in the analysis. All six attributes significantly influenced residents′ service utilization preferences ( P<0.05). Residents showed stronger preferences for services with lower individual average out-of-pocket costs ( β=-0.214), combination therapies involving both internal medication and external treatments ( β=0.314), provision by senior-level professionals ( β= 0.522), fixed service providers ( β=0.851), longer treatment courses with better efficacy ( β=1.323), and services covered by medical insurance ( β=1.843). When services were covered by insurance, featured longer courses with better efficacy, and involved fixed service providers, the probability of service utilization increased to 76.52%. Heterogeneity in service utilization preferences was observed across different ages, genders and chronic health conditions ( P<0.05). Conclusions:Medical insurance coverage, technical efficacy and doctor service continuity are the most influential factors affecting residents′ service utilization. Optimizing the combination of TCM health management service attributes can enhance residents′ willingness to utilize these services. It is recommended to develop multi-tiered medical security strategies, selectively include high-value TCM health management services into insurance coverage, strengthen physician-patient trust, and design differentiated " disease prevention" service packages for residents with different characteristics to improve overall population health.

Speckle tracking echocardiography(STE)can be used to quantitatively evaluate cardiac function,detect abnormalities of the global and local cardiac wall motion,also help to understand the subtle changes of myocardial function,having high value for early diagnosis of cardiac remodeling after myocardial infarction(MI)and predicting risk and development of heart failure.The research progresses of STE for evaluating cardiac remodeling and heart failure after MI were reviewed in this article.

Acute myocarditis(AM)may rapidly progress to fulminant myocarditis(FM),but lacks special clinical presentation.Multimodal echocardiography combined conventional transthoracic echocardiography,two-dimensional and three-dimensional speckle tracking imaging,myocardial contrast echocardiography and so on is helpful to detecting AM in early stage and assessing the severity,being of great value for clinical decision-making and prognostic evaluation.The research progresses of multimodal echocardiography in AM were reviewed in this article.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Trabecular network, as the first resistance site of the aqueous humor outflow pathway, plays an important role in the regulation of intraocular pressure.Alteration of the biomechanical properties of trabecular meshwork may affect the aqueous humor outflow of filtration system and is of great importance in the pathogenesis of primary open-angle glaucoma (POAG).There may be a correlation between intraocular pressure and mechanical properties of trabecular meshwork, but the current research shows that the mechanical properties of trabecular meshwork are mainly affected by genetic and gene mutation, age, extracellular matrix and cytoskeleton components, lysophosphatidic acid, low dexamethasone, Rho-related protein kinase inhibitors and other factors.In addition, other intraocular diseases may affect the mechanical properties of trabecular meshwork.Under mechanical traction, the strain produced by trabecular meshwork may indicate the molecular mechanism of aqueous outflow, the regulation mechanism of outflow pathway and the pathogenesis of POAG under high intraocular pressure.The biomechanical properties of trabecular meshwork will provide a more powerful theoretical and experimental basis for the early diagnosis and treatment of glaucoma.This paper reviews the status of research on trabecular meshwork biomechanical measurement methods, influencing factors and sensing pathways of trabecular meshwork cell, in order to further elaborate the etiology, pathogenesis and treatment of POAG.

Goniotomy (GT) is a safe and effective type of minimally invasive glaucoma surgery (MIGS) extensively utilized in China.It is particularly suited for treating primary open-angle glaucoma and advanced primary angle-closure glaucoma.Although GT is generally safe, hyphema and postoperative intraocular pressure (IOP) spikes remain common complications after GT.Currently, there is no standardized protocol for managing these issues, which can impact clinicians' assessment of surgical outcomes and potentially affect the prognosis.Therefore, it is crucial to establish comprehensive and detailed management protocols for perioperative hyphema and IOP spike following GT.This will guide clinical practitioners in managing complications appropriately and systematically, thereby promoting the further development and refinement of MIGS.To address these concerns, several domestic glaucoma treatment experts along with members of the Glaucoma Society of Ophthalmology, Guangdong Medical Association reviewed existing literature and held recommendation meetings to develop a guideline for managing perioperative hyphema and IOP spikes following GT.It includes defining perioperative hyphema in GT, discussing its high-risk factors and outcomes, exploring methods for prevention prior to surgery and techniques to reduce bleeding during the procedure, and managing postoperative hemorrhage.Additionally, it covers defining IOP spikes after GT, investigates their causes and contributing factors, and outlines management strategies and anticipated outcomes to provide a valuable resource for clinicians.