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*

Objective To observe the in vitro susceptibility test result of colistin(COL)combined with tigecycline(TGC),cefoperazone/sulbactam(SCF),ampicillin/sulbactam(SAM),meropenem(MEM),amikacin(AK)and levofloxacin(LEV),TGC combined with MEM,SCF,SAM and AK,SCF combined with MEM,AK to carbapenem-resistant Acinetobacter baumannii(CRAB),and screen the effective anti-infective therapy.Methods 58 CRAB strains were isolated from clinic specimens from Qingdao Eighth People's Hospital from January 2023 to December 2023.The minimal inhibitory concentration(MIC)of antimicrobial agents against CRAB strains was determined by the micro broth dilution method.A combined antimicrobial susceptibility test was performed by the chessboard dilution method.The fractional inhibitory concentration(FIC)index was calculated to determine the combined effect.Results The synergistic rates of COL and SCF was 70.69%,and the sum of synergistic rates and additive rates was 96.55%.The synergistic rates of COL and TGC,COL and SAM,COL and MEM,COL and AK,COL and LEV,TGC and SCF,TGC and SAM,TGC and MEM,TGC and AK,SCF and MEM,SCF and AK were 34.48%,65.52%,51.72%,37.93%,22.42%,27.59%,27.59%,37.93%,41.38%,48.28%and 25.86%,and the sum of synergistic rates and additive rates were 77.58%,91.38%,84.48%,65.52%,39.66%,67.25%,62.07%,58.62%,55.17%,82.76%and 74.14%,respectively.The range,MIC50 and MIC90 of 12 combination regimens for CRAB strains were decreased to some extent compared with those of each single drug.No antagonism effect was observed for all the combinations.Conclusion The sum of synergy rate and addition rate of COL combined with SCF is the highest,and the sum of synergy rate and addition rate of COL combined with LEV is the lowest,which could provide reference for clinical experience medication.

Objective:To assess the effects of recognition function of four-lead electrocardiogram(ECG)synchronization technique and multi-parameter fusion technique in reducing the number of false alarms and improving the quality of alarms in intensive care units(ICU).Methods:Four-lead ECG synchronization technique and multi-parameter fusion technique were used to strengthen the monitoring and assessment for the alarm of clinical monitors,and reduce the false alarm rate of monitors.The clinical alarm data of bed units corresponding to 48 monitors in clinical use of ICU,cardiovascular intensive care unit(CCU)and neurosurgery intensive care unit(NICU)of Hainan General Hospital from October 14 to December 27,2024 were selected.According to the opening and close of the four-lead ECG synchronization and multi-parameter fusion technique algorithm of the monitors,they were divided into group A(opened four-lead ECG synchronization and multi-parameter fusion),group B(opened four-lead ECG synchronization,but closed multi-parameter fusion),group C(closed four-lead ECG synchronization,but opened multi-parameter fusion)and group D(closed four-lead ECG synchronization and multi-parameter fusion),with 12 units in each group.The numbers of total alarms and false alarms generated by monitor of each bed unit among different optimization strategies were compared.Results:The numbers of average daily alarm of the monitors in groups A,B and C were respectively(134.2±32.4)cases,(392.5±68.2)cases and(583.4±126.5)cases,which were lower than those in group D(1 073.2±168.6),with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).The optimization rates of the alarm numbers in groups A,B and C were increased by 87.51%,63.47%and 45.67%,respectively.The rates of average false alarm of the monitors in groups A,B and C were respectively(1.04±0.15)%,(1.73±0.12)%and(2.07±0.08)%,which were lower than(3.76±0.2)%in group D,with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).Conclusion:Four-lead ECG synchronization technique and multi-parameter fusion technique can effectively optimize the number of alarms in ICU,and reduce the proportion of false alarms of monitors in department,and decrease fatigue of medical staffs for alarm.

Objective:To investigate the association of serum γ-glutamyltransferase (GGT) with stroke severity and outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Department of Neurology, Hefei Second People's Hospital (Guangde Road Branch) from January 2023 to December 2023 were included retrospectively. According to the baseline National Institutes of Health Stroke Scale score, the patients were divided into mild stroke group (≤8) and moderate to severe stroke group (>8); According to the modified Rankin Scale score at 3 months after onset, the patients were divided into a good outcome group (0-2) and a poor outcome group (>2). Multivariate logistic regression analysis was used to determine the independent influencing factors of stroke severity and outcome, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum GGT for poor outcome. Results:A total of 136 patients with AIS were included, with 42 patients (30.88%) in the mild stroke group and 94 (69.12%) in the moderate to severe stroke group; 80 patients (58.82%) in the good outcome group and 56 (41.18%) in the poor outcome group. Multivariate logistic regression analysis showed that higher serum GGT was an independent related factor for moderate to severe stroke (odds ratio [ OR] 1.075, 95% confidence interval [ CI] 1.017-1.135; P<0.05) and poor outcome ( OR 1.131, 95% CI 1.069-1.197; P<0.05). The ROC curve analysis showed that the area under the curve for predicting poor outcome by serum GGT was 0.820 (95% CI 0.747-0.892). Conclusion:Serum GGT is significantly correlated with the severity of stroke in patients with AIS, and has certain predictive value for poor short-term outcome.

Objective To explore the impact of family sandplay therapy based on the narrative concept on family resilience and sense of meaning in life among gastric cancer patients.Methods A total of 104 gastric cancer patients were selected and randomly divided into control group and experi-mental group,with 52 patients in each group.The control group received routine nursing care,while the experimental group received family sandplay therapy based on the narrative concept in addition to routine nursing care.Both groups were assessed using the Chinese Family Resilience Assessment Scale(C-FRAS)and the Chinese Meaning in Life Questionnaire(C-MLQ)before the intervention and at 1 month and 3 months post-intervention.The scores of scales were compared.Results After interven-tion,the total C-FRAS score and score of each dimension were higher in the experimental group than those in the control group,and both the total C-FRAS score and score of each dimension showed an upward with time extension.The total C-MLQ score and score of each dimension were also higher in the experimental group compared with the control group(P＜0.05).Conclusion Family sandplay therapy based on the narrative concept can enhance family resilience and sense of meaning in life a-mong gastric cancer patients.

Objective To observe the in vitro susceptibility test result of colistin(COL)combined with tigecycline(TGC),cefoperazone/sulbactam(SCF),ampicillin/sulbactam(SAM),meropenem(MEM),amikacin(AK)and levofloxacin(LEV),TGC combined with MEM,SCF,SAM and AK,SCF combined with MEM,AK to carbapenem-resistant Acinetobacter baumannii(CRAB),and screen the effective anti-infective therapy.Methods 58 CRAB strains were isolated from clinic specimens from Qingdao Eighth People's Hospital from January 2023 to December 2023.The minimal inhibitory concentration(MIC)of antimicrobial agents against CRAB strains was determined by the micro broth dilution method.A combined antimicrobial susceptibility test was performed by the chessboard dilution method.The fractional inhibitory concentration(FIC)index was calculated to determine the combined effect.Results The synergistic rates of COL and SCF was 70.69%,and the sum of synergistic rates and additive rates was 96.55%.The synergistic rates of COL and TGC,COL and SAM,COL and MEM,COL and AK,COL and LEV,TGC and SCF,TGC and SAM,TGC and MEM,TGC and AK,SCF and MEM,SCF and AK were 34.48%,65.52%,51.72%,37.93%,22.42%,27.59%,27.59%,37.93%,41.38%,48.28%and 25.86%,and the sum of synergistic rates and additive rates were 77.58%,91.38%,84.48%,65.52%,39.66%,67.25%,62.07%,58.62%,55.17%,82.76%and 74.14%,respectively.The range,MIC50 and MIC90 of 12 combination regimens for CRAB strains were decreased to some extent compared with those of each single drug.No antagonism effect was observed for all the combinations.Conclusion The sum of synergy rate and addition rate of COL combined with SCF is the highest,and the sum of synergy rate and addition rate of COL combined with LEV is the lowest,which could provide reference for clinical experience medication.

Objective:To assess the effects of recognition function of four-lead electrocardiogram(ECG)synchronization technique and multi-parameter fusion technique in reducing the number of false alarms and improving the quality of alarms in intensive care units(ICU).Methods:Four-lead ECG synchronization technique and multi-parameter fusion technique were used to strengthen the monitoring and assessment for the alarm of clinical monitors,and reduce the false alarm rate of monitors.The clinical alarm data of bed units corresponding to 48 monitors in clinical use of ICU,cardiovascular intensive care unit(CCU)and neurosurgery intensive care unit(NICU)of Hainan General Hospital from October 14 to December 27,2024 were selected.According to the opening and close of the four-lead ECG synchronization and multi-parameter fusion technique algorithm of the monitors,they were divided into group A(opened four-lead ECG synchronization and multi-parameter fusion),group B(opened four-lead ECG synchronization,but closed multi-parameter fusion),group C(closed four-lead ECG synchronization,but opened multi-parameter fusion)and group D(closed four-lead ECG synchronization and multi-parameter fusion),with 12 units in each group.The numbers of total alarms and false alarms generated by monitor of each bed unit among different optimization strategies were compared.Results:The numbers of average daily alarm of the monitors in groups A,B and C were respectively(134.2±32.4)cases,(392.5±68.2)cases and(583.4±126.5)cases,which were lower than those in group D(1 073.2±168.6),with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).The optimization rates of the alarm numbers in groups A,B and C were increased by 87.51%,63.47%and 45.67%,respectively.The rates of average false alarm of the monitors in groups A,B and C were respectively(1.04±0.15)%,(1.73±0.12)%and(2.07±0.08)%,which were lower than(3.76±0.2)%in group D,with statistically significant differences(Z=3.45,2.94,2.52,P<0.05).Conclusion:Four-lead ECG synchronization technique and multi-parameter fusion technique can effectively optimize the number of alarms in ICU,and reduce the proportion of false alarms of monitors in department,and decrease fatigue of medical staffs for alarm.

Objective:To explore the molecular mechanism of dexmedetomidine(Dex)protecting ischemia/reperfusion(I/R)myocardium.Methods:Wild type mice were grouped into control(Control)group,sham operation(Sham)group,WT I/R group,WT Dex group,and Dectin-1 knock out mice were grouped into KO I/R group and KO Dex group in the in vivo study(n=6).TTC stain-ing was used to determine the myocardial infarction area(%)of the above six groups of mice.HE staining and pathological analyze was used to determine the myocardial injury.Serum TNF-α,IL-6 and IL-10 levels in mice were detected by ELISA.Flow cytometry(FCM)was used to count and sort of infiltrating M2 macrophages and neutrophils in myocardium.qPCR assay was used to determine the Dectin-1 mRNA expression in the above sorted cells.Results:TTC results showed that there was no myocardial infarction in the mice of Control group and Sham group.Compared with the WT I/R group,the infarct volume was significantly lower in WT Dex group,KO I/R group and KO Dex group(P<0.05).Compared with the KO I/R group,the infarct volume was reduced in KO Dex group(P<0.05).The results of HE staining showed that the myocardial fibers of the WT I/R group of mice were disorderly arranged,with a large number of broken myocardial fibers,while the myocardial fibers of the WT Dex group,KO I/R group and KO Dex group of mice had a little breakage,the structural damage was not significant,and the myocardial arrangement was relatively neat.The degree of myocardi-al injury of mice in KO Dex group were less than that in KO I/R group mice.ELISA results showed that compared with Sham group,the serum TNF-α and IL-6 levels of the mice in WT I/R group were significantly increased,and the IL-10 level was significantly de-creased.Compared with WT I/R group,serum TNF-α and IL-6 levels of the mice in WT Dex group and KO I/R group were significant-ly decreased,and IL-10 level was significantly increased.Compared with KO I/R group,the serum TNF-α and IL-6 levels of the mice in KO Dex group were significantly decreased,and the IL-10 level was significantly increased(P<0.05).FCM cell counting results showed that compared with Sham group,a large number of M2 macrophages and neutrophils were infiltrated in the myocardium of WT I/R group of mice(P<0.05).Compared with WT I/R group,the M2 macrophages and neutrophils infiltrated in the myocardium were significantly decreased in WT Dex group,KO I/R group and KO Dex group of mice(P<0.05).While there was no significant differ-ence between the KO I/R group and the KO Dex group mice(P>0.05).qPCR results showed that compared with Sham group,the ex-pression level of Dectin-1 mRNA in the myocardial infiltrated M2 macrophages and neutrophils were significantly up-regulated in WT I/R group of mice(P<0.05).While compared with WT I/R group,the expression level of Dectin-1 mRNA in Dex group of mice was sig-nificantly lower(P<0.05).Mice in KO I/R group and KO Dex group did not express Dectin-1.Conclusion:The protective mecha-nisms of Dex preconditioning on I/R injured myocardium involves reducing the infiltrating number of M2 macrophages and neutrophils in myocardium after I/R injury,which may be achieved by inhibiting the expression of Dectin-1.

Objective:To analyze the clinical data of histiocytic necrotizing lymphadenitis(HNL),comparing the similarities and differences between children and adults,to deepen the understanding of the disease by clinical physicians,and to improve diagnostic rate and reduce misdiagnosis and mistreat-ment.Methods:The clinical data of hospitalized patients with histiocytic necrotizing lymphadenitis diagnosed by biopsy from January 2010 to August 2023 in Peking University First Hospital were collec-ted,and the clinical features,laboratory examinations,pathological features,treatments with antibiotics and glucocorticoids,and prognosis of histiocytic necrotic lymphadenitis were analyzed.Grouped based on age,the differences of clinical characteristics,laboratory tests,treatment,and prognosis between the children group(＜16 years old)and the adult group(≥16 years old)were compared.Results:Among the 81 enrolled patients,there were 42 males and 39 females.The median age was 21(14,29)years,the median duration of disease was 20.0(13.0,30.0)days,and the median length of hospital stay was 13.0(10.0,15.0)days.The first symptoms were fever,lymphadenopathy,and both.All the patients had enlarged lymph nodes with different parts and sizes,96.3％(78 of 81)of the patients had cervical lymphadenopathy,50.6％(41 of 81)had bilateral cervical lymphadenopathy,55.6％(45 of 81)had supraclavicular,axillary or inguinal lymphadenopathy,and the median lymph node diameter was 20.0(20.0,30.0)mm.Only one patient had no fever,the other 80 patients had fever,the median peak body temperature was 39.0(38.0,39.8)℃.Accompanying symptoms:rash(8.6％,7/81),fatigue(34.6％,28/81),night sweating(8.6％,7/81),chills(25.3％,25/81),muscle soreness(13.6％,11/81),and joint pain(6.2％,5/81).There were 17 cases(21.0％,17/81)of hepatosplenomegaly,of which 12 cases(70.6％,12/17)were splenomegaly.68.8％(55/80)of patients had a decrease in white blood cell(WBC)count,with 47.5％(38/80)increased in lymphocyte(LY)proportion,53.4％(39/73)increased in high-sensitivity C-reactive protein(CRP),79.2％(57/72)increased in erythrocyte sedimentation rate(ESR),22.2％(18/81)increased in alanine transaminase(ALT),27.2％(22/81)elevated in aspartate transaminase(AST),and 81.6％(62/76)elevated in lactate dehydrogenase(LDH).All the 81 patients underwent lymph node biopsy,and 77.8％(63/81)of the patients showed that most of the structures in the lymph nodes were destroyed or disappeared,and 16.0％(13/81)of the lymph nodes were still in existence,hyperplasia and normal lymph node were 1.2％(1/81)respectively,and 3.7％(3/81)had normal lymph node structures.Immunohistochemical staining was performed in 67 cases.The percentages of CD3+and CD68(KP1)+were respectively 97.0％(65/67),and MPO+were 94.0％(63/67).In the study,51 patients(63.0％,51/81)were treated with glucocorticoid therapy after diagnosis.The median time for temperature to return to normal was 1.0(1.0,4.0)days after glu-cocorticoid therapy.when the glucocorticoid treatment worked best,the body temperature could drop to normal on the same day.There were significant differences in length of stay,predisposing factors,chills,the rate of increase in high-sensitivity CRP,antibiotic and glucocorticoid treatment between the adults and children groups(P＜0.05).Conclusion:In clinical practice,if there are cases with unexplained fever,su-perficial lymph node enlargement,and reduced white blood cells as clinical characteristics,and general anti-biotics treatment is ineffective,histiocytic necrotic lymphadenitis should be considered.Lymph node biopsy should be performed as early as possible to clarify the diagnosis,reduce misdiagnosis and mistreatment,and symptomatic treatment should be the main treatment.Glucocorticoids therapy has a definite therapeutic effect.

Objective To analyze the distribution and drug resistance patterns of carbapenem-resistant Acinetobacter baumannii(CRAB),and evaluate the antimicrobial effects in vitro of colistin(COL)combined with cefoperazone/sulbactam(SCF),tigecycline(TGC),imipenem(IPM),meropenem(MEM),amikacin(AK),and levofloxacin(LEV)against CRAB to provide guidance for anti-infective therapy.Methods A total of 75 non-duplicate CRAB strains isolated from clinical specimens in 2022 were collected.WHONET 5.6 software was used for retrospective analysis of their clinical distribution and resistance profiles.Among them,25 strains were selected for combined antimicrobial susceptibility tests using broth microdilution to determine minimum inhibitory concentrations(MICs).The fractional inhibitory concentration(FIC)index was calculated based on checkerboard method to assess the combined effects.Results In 2022,a total of 145 Acinetobacter baumannii strains were isolated,including 75 CRAB(detection rate of 51.7％).CRAB was most prevalent in the patients over 70 years old(40.0％),mainly from blood(41.3％)and sputum(37.3％)specimens,and the intensive care unit was the top isolating department.All the 75 CRAB strains were resistant to piperacillin,piperacillin/tazobactam,ceftriaxone,1PM and MEM with resistance rates of 100％.The resistance rates for ampicillin/sulbactam,cefepime and tri-methoprim/sulfamethoxazole were all exceeded 95％.The resistance rates were 86.7％for LEV,82.7％for SCF,77.4％for AK,2.4％for TGC,and 0.0％for COL.The results of combined tests of 25 strains revealed the synergy rates of 92％and 80％for COL+SCF and COL+TGC respectively with sums of both synergy and additive rates of 100％.Synergy rates for COL combined with IPM,MEM,AK and LEV were 64％,72％,56％and 48％respectively.No antagonism was observed in any combination.Conclusion The drug resist-ance of CRAB exhibited high levels at our hospital,and the elderly and ICU patients were the major susceptible populations.Among all the combinations tests,COL+SCF showed optimal synergy while COL+LEV only had the lowest combined effect with the findings that warrants clinical consideration.