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*

With the growing emphasis on maternal and child oral health, the significance of managing oral health across preconception, pregnancy, and infancy stages has become increasingly apparent. Oral health challenges extend beyond affecting maternal well-being, exerting profound influences on fetal and neonatal oral development as well as immune system maturation. This expert consensus paper, developed using a modified Delphi method, reviews current research and provides recommendations on maternal and child oral health management. It underscores the critical role of comprehensive oral assessments prior to conception, diligent oral health management throughout pregnancy, and meticulous oral hygiene practices during infancy. Effective strategies should be seamlessly integrated across the life course, encompassing preconception oral assessments, systematic dental care during pregnancy, and routine infant oral hygiene. Collaborative efforts among pediatric dentists, maternal and child health workers, and obstetricians are crucial to improving outcomes and fostering clinical research, contributing to evidence-based health management strategies.
Humans ; Pregnancy ; Female ; Infant ; Consensus ; Mouth Diseases/therapy* ; Pregnancy Complications/therapy* ; Oral Health ; Infant, Newborn ; Delphi Technique ; Oral Hygiene

Objective:To investigate the effects of 177Lu-prostate specific membrane antigen (PSMA)-I&T combined with poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor (PARPi) fluzoparib on the proliferation and migration of prostate cancer cells and the tumor inhibitory effects. Methods:177Lu-PSMA-I&T was synthesized. Cytotoxicity assay, colony formation assay, 5-ethynyl-2′-deoxyuridine (EdU) cell proliferation assay, Transwell cell migration assay, and terminal-deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay, flow cytometry were performed to detect apoptosis and cell cycles. 22RV1 tumor-bearing mice models ( n=16) were established, and were randomly divided into 4 groups: control group (no treatment; n=4), fluzoparib monotherapy group (6mg/kg; n=4), 177Lu-PSMA-I&T monotherapy group (14.8MBq; n=4) and combination group (14.8MBq 177Lu-PSMA-I&T+ 6mg/kg fluzoparib; n=4). All mice were treated for 14 d. Tumor volume and body mass changes of tumor-bearing mice were observed and recorded. After the treatment, 18F-FDG PET/CT was performed to evaluate the tumor′s uptake of 18F-FDG. Effects of 177Lu-PSMA-I&T combined with fluzoparib on cell and tumor-bearing mice were observed. One-way analysis of variance and the least significant difference t test were used to analyze the data. Results:At half maximal inhibitory concentrations (IC 50) of 177Lu-PSMA-I&T (13.06MBq/ml) and fluzoparib (72.13μmol/L), compared to the fluzoparib monotherapy group and the 177Lu-PSMA-I&T monotherapy group, the combination treatment significantly enhanced the anti-tumor effect on 22RV1 cells, inhibited the DNA synthesis rate and colony-forming ability of 22RV1 cells, reduced cell migration rate, increased the percentage of DNA damage, resulted in a higher proportion of cells arrested in the G2/M phase and increased the apoptosis rate ( F values: 9.77-162.20, t values: 2.98-21.60, all P<0.05). Compared to the fluzoparib monotherapy group and the 177Lu-PSMA-I&T monotherapy group, the combination treatment resulted in a significant reduction in relative tumor volume (RTV%) 14 d post-administration and markedly decreased 18F-FDG uptake ( F values: 25.28 and 67.42, t values: 4.64-8.61, P values: 0.001-0.009). Conclusion:The combination of 177Lu-PSMA-I&T and fluzoparib can inhibit prostate cancer cell proliferation and migration, suppress tumor growth and metabolism, and demonstrates synergistic effects more effectively.

Objective To investigate the risk factors for recurrent laryngeal nerve lymph node(RLN-LN)metastasis in patients with esophageal cancer.Methods A total of 174 esophageal cancer patients who underwent minimally invasive resection of esophageal cancer were selected.They were divided into metastatic group(n=43)and non-metastatic group(n=131)based on postoperative pathological examination to determine whether RLN-LN had metastasized.The influencing factors of RLN-LN metastasis were analyzed,and the nomogram prediction model was constructed,and verified.Results The differences between the non-metastatic group and the metastatic group in tumor location,tumor diameter,tumor differentiation degree,pathological T stage,vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9),B-cell lymphoma-2(Bcl-2),cytokerantin-19-fragment(CYFRA21-1),RLN-LN short diameter,and RLN-LN short diameter/multiplanar reconstruction(MPR)longest diameter were statistically significant(P＜0.05).The levels of serum VEGF,MMP-9,Bcl-2,and CYFRA21-1 were significantly positively correlated with RLN-LN short diameter and RLN-LN short diameter/MPR longest diameter(P＜0.05).Tumor location,tumor differentiation degree,pathological T stage,and RLN-LN short diameter/MPR longest diameter were independent influencing factors for RLN-LN metastasis(P＜0.05).The constructed nomogram prediction model had good discrimination,accuracy,and clinical applicability.Conclusion RLN-LN short diameter/MPR longest diameter,tumor location,tumor differentiation degree,and pathological T stage are independent influencing factors for RLN-LN metastasis.The nomogram model established based on this has good predictive value.

Objective To investigate the risk factors for recurrent laryngeal nerve lymph node(RLN-LN)metastasis in patients with esophageal cancer.Methods A total of 174 esophageal cancer patients who underwent minimally invasive resection of esophageal cancer were selected.They were divided into metastatic group(n=43)and non-metastatic group(n=131)based on postoperative pathological examination to determine whether RLN-LN had metastasized.The influencing factors of RLN-LN metastasis were analyzed,and the nomogram prediction model was constructed,and verified.Results The differences between the non-metastatic group and the metastatic group in tumor location,tumor diameter,tumor differentiation degree,pathological T stage,vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9),B-cell lymphoma-2(Bcl-2),cytokerantin-19-fragment(CYFRA21-1),RLN-LN short diameter,and RLN-LN short diameter/multiplanar reconstruction(MPR)longest diameter were statistically significant(P＜0.05).The levels of serum VEGF,MMP-9,Bcl-2,and CYFRA21-1 were significantly positively correlated with RLN-LN short diameter and RLN-LN short diameter/MPR longest diameter(P＜0.05).Tumor location,tumor differentiation degree,pathological T stage,and RLN-LN short diameter/MPR longest diameter were independent influencing factors for RLN-LN metastasis(P＜0.05).The constructed nomogram prediction model had good discrimination,accuracy,and clinical applicability.Conclusion RLN-LN short diameter/MPR longest diameter,tumor location,tumor differentiation degree,and pathological T stage are independent influencing factors for RLN-LN metastasis.The nomogram model established based on this has good predictive value.

Objective:To investigate the effects of 177Lu-prostate specific membrane antigen (PSMA)-I&T combined with poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor (PARPi) fluzoparib on the proliferation and migration of prostate cancer cells and the tumor inhibitory effects. Methods:177Lu-PSMA-I&T was synthesized. Cytotoxicity assay, colony formation assay, 5-ethynyl-2′-deoxyuridine (EdU) cell proliferation assay, Transwell cell migration assay, and terminal-deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay, flow cytometry were performed to detect apoptosis and cell cycles. 22RV1 tumor-bearing mice models ( n=16) were established, and were randomly divided into 4 groups: control group (no treatment; n=4), fluzoparib monotherapy group (6mg/kg; n=4), 177Lu-PSMA-I&T monotherapy group (14.8MBq; n=4) and combination group (14.8MBq 177Lu-PSMA-I&T+ 6mg/kg fluzoparib; n=4). All mice were treated for 14 d. Tumor volume and body mass changes of tumor-bearing mice were observed and recorded. After the treatment, 18F-FDG PET/CT was performed to evaluate the tumor′s uptake of 18F-FDG. Effects of 177Lu-PSMA-I&T combined with fluzoparib on cell and tumor-bearing mice were observed. One-way analysis of variance and the least significant difference t test were used to analyze the data. Results:At half maximal inhibitory concentrations (IC 50) of 177Lu-PSMA-I&T (13.06MBq/ml) and fluzoparib (72.13μmol/L), compared to the fluzoparib monotherapy group and the 177Lu-PSMA-I&T monotherapy group, the combination treatment significantly enhanced the anti-tumor effect on 22RV1 cells, inhibited the DNA synthesis rate and colony-forming ability of 22RV1 cells, reduced cell migration rate, increased the percentage of DNA damage, resulted in a higher proportion of cells arrested in the G2/M phase and increased the apoptosis rate ( F values: 9.77-162.20, t values: 2.98-21.60, all P<0.05). Compared to the fluzoparib monotherapy group and the 177Lu-PSMA-I&T monotherapy group, the combination treatment resulted in a significant reduction in relative tumor volume (RTV%) 14 d post-administration and markedly decreased 18F-FDG uptake ( F values: 25.28 and 67.42, t values: 4.64-8.61, P values: 0.001-0.009). Conclusion:The combination of 177Lu-PSMA-I&T and fluzoparib can inhibit prostate cancer cell proliferation and migration, suppress tumor growth and metabolism, and demonstrates synergistic effects more effectively.

Specific tumor-targeted gene delivery remains an unsolved therapeutic issue due to aberrant vascularization in tumor microenvironment (TME). Some bacteria exhibit spontaneous chemotaxis toward the anaerobic and immune-suppressive TME, which makes them ideal natural vehicles for cancer gene therapy. Here, we conjugated ZIF-8 metal-organic frameworks encapsulating eukaryotic murine interleukin 2 (Il2) expression plasmid onto the surface of VNP20009, an attenuated Salmonella typhimurium strain with well-documented anti-cancer activity, and constructed a TME-targeted Il2 delivery system named Il2/ZIF-8@Salmonella. Both in vitro and in vivo experiments demonstrated that Il2/ZIF-8@Salmonella maintained the tumor-targeting feature of bacteria, and could be effectively phagocytosed by intratumoral macrophages, thus leading to the expression and secretion of IL2 in TME. The detailed analysis of tumor immune microenvironment (TIME) showed that one dose of combinatorial Il2/ZIF-8@Salmonella achieved synergistic actions on a potent remodeling of TIME, marked by the activation of cytotoxic T cells and M1-polarization of macrophages in TME, thus leading to significant anti-tumor effects in melanoma, orthotopic hepatocellular carcinoma, and pulmonary metastasis models. More importantly, Il2/ZIF-8@Salmonella exhibited high safety to major organs and hematopoietic systems. Taken together, we report a novel plasmid/ZIF-8@Salmonella system that simultaneously achieves effective TME-targeted delivery of therapeutic gene, as well as synergistic re-activation of TIME.

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.

Hemangioma of the penile head is rare. This paper reported a patient, 16 years old, who was admitted to hospital due to the discovery of multiple masses on the head of the penis for more than two years. Physical examination showed that three vascular mass-like masses were distributed along the coronal sulcus at the 3, 9, and 12 points of the penile head, and the larger one was about 10 mm×5 mm size, blue-purple, soft, and painless. Ultrasound examination suggested that the patient had a penile head hemangioma. Surgical resection was performed, and the postoperative pathological diagnosis was penile head hemangioma.The follow-up of 3 months showed that the wound healed well without recurrence, and the penile head appearance was not obviously deform.

Objective:To explore the pattern of lymph node metastasis in the lung lobes of stage Ⅱa non-small cell lung cancer (NSCLC) and the lymph node dissection method during complete video-assisted thoracoscopic lobectomy surgery (cVATS) .Methods:A total of 244 patients with NSCLC who underwent cVATS treatment at Nanjing Tongren Hospital Affiliated to Southeast University School of Medicine from January 2015 to November 2018 were selected. Patients admitted from January 2015 to April 2018 were defined as the training set ( n=183), and patients admitted from May 2018 to November 2018 were defined as the validation set ( n=61). The training set was used to build the model, and the validation set was used to evaluate the performance of the model. In the training set, patients were divided into systematic meditational lymphadenectomy (SML) group ( n=93) and lobe-specific systematic node dissection (LSND) group ( n=90) based on lymph node dissection methods. The lymph node metastasis rate of patients in the training set was calculated, and the clinical data of patients with ( n=55) and without ( n=128) lymph node metastasis were compared. Multivariate logistic regression was used to analyze the influencing factors of lymph node metastasis, and a nomogram prediction model was constructed based on the results of the multivariate analysis, and the model was validated. Clinical data, perioperative clinical indicators, overall survival (OS), and incidence of postoperative complications were compared between the SML group and LSND group in the training set. Results:In the training set, the lymph node metastasis rate of 183 patients with NSCLC was 30.05% (55/183), with a total of 328 metastatic lymph nodes; from the 2nd to the 13th groups of lymph nodes, the 10th (15.60%, 44/282), the 11th (22.79%, 98/430), and the 12th to the 13th (15.25%, 61/400) groups had the highest lymph node metastasis rate. Multivariate analysis showed that maximum tumor diameter ( OR=2.71, 95% CI: 1.82-4.09, P<0.001), CT imaging features ( OR=2.49, 95% CI: 1.59-6.99, P=0.001), degree of differentiation ( OR=2.06, 95% CI: 1.11-3.81, P=0.010), serum carcinoembryonic antigen (CEA) ( OR=1.87, 95% CI: 1.42-2.58, P=0.015), and pleural invasion ( OR=1.81, 95% CI: 1.07-3.07, P=0.021) were all independent influencing factors for the occurrence of lymph node metastasis in Ⅱa NSCLC patients. The C-index of the training set and the validation set were 0.91 (95% CI: 0.88-0.97) and 0.89 (95% CI: 0.84-0.96), respectively, and the calibration curves of the two sets were well fitted to the ideal curves. Receiver operating characteristic curve analysis showed that, the area under curve of the nomogram prediction model used for differential diagnosis of patients in the training and validation sets were 0.92 (95% CI: 0.87-0.96) and 0.91 (95% CI: 0.85-0.98), respectively. There were statistically significant differences in surgical time [(203.08±38.26) min vs. (177.14±22.18) min, t=5.59, P<0.001], intraoperative blood loss [(458.14±65.04) ml vs. (426.08±26.58) ml, t=4.34, P<0.001], thoracic drainage volume [(1 200.14±226.58) ml vs. (1 114.38±164.34) ml, t=2.92, P=0.004], extubation time [(6.57±1.28) d vs. (5.02±1.12) d, t=8.71, P<0.001], hospital stay [(15.02±1.29) d vs. (12.08±1.57) d, t=13.86, P<0.001) between the SML group and the LSND group in the training set. There was no statistically significant difference in OS rate between two groups of patients at 1 year (96.77% vs. 96.67%), 3 years (84.95% vs. 86.67%), and 5 years (75.27% vs. 77.78%) ( χ2=0.16, P=0.689). There was a statistically significant difference in the overall incidence of adverse reactions [18.28% (17/93) vs. 7.78% (7/90) ] between two groups of patients ( χ2=4.43, P=0.035) . Conclusion:Intrapulmonary segment lymph node accounts for a considerable proportion in the metastasis process of NSCLC, with the highest degree of lymph node metastasis rate in groups 10, 11, and 12-13. Maximum tumor diameter, CT imaging features, degree of differentiation, serum CEA, and pleural invasion are all independent influencing factors for the occurrence of lymph node metastasis in NSCLC patients. Compared with SML, LSND has less trauma and a lower incidence of adverse reactions.