Objective:To evaluate the efficacy and analyze the causes of complications of allogeneic decellularized dermal matrix grafts in the treatment of gingival recession using tunneling technology.Methods:Sixty patients with single or multiple gingival re-cession were randomly divided into an allogeneic decellularized matrix(ADM)group and a connective tissue(SCTG)group.Tunne-ling technique(TUN)were used in both groups to cover the root surface,and the gingival margin position,gingival margin morpholo-gy,and mucogingival junction position of the affected teeth at 1 week,3 weeks,3 months,and 6 months after surgery were observed.Check and record the gingival recession depth(RD)and mean root coverage(MRC)at the implant site before and 6 months after surgery.Record patient satisfaction at 3 weeks and 6 months after surgery.Results:Compared with the traditional SCTG group,the MRC of the ADM group was significantly lower before surgery and 6 months after surgery(P＜0.05).The satisfaction level of the ADM group was higher 3 weeks after surgery,with a significant difference compared to the SCTG group(P＜0.05).But 6 months after surgery,the satisfaction levels of the two groups tended to be consistent,with no significant difference.After TUN+ADM surgery,there was 1 case of abscess infection lesion,and another 3 cases showed local tissue necrosis at the gingival margin one week after surgery.After 3 months of treatment,the gingival color of these 4 patients was pink and tough texture,without swelling and bleeding.Conclusion:Although ADM is slightly inferior to SCTG in the treatment of gingival recession,it may be related to poor postoperative tissue healing complications.However,as long as it is handled properly,long-term follow-up observations have shown that gingival tissue can still achieve complete healing.TUN+ADM is a highly effective treatment for gingival recession and is suitable for further clinical application.

Objective:To evaluate the efficacy and analyze the causes of complications of allogeneic decellularized dermal matrix grafts in the treatment of gingival recession using tunneling technology.Methods:Sixty patients with single or multiple gingival re-cession were randomly divided into an allogeneic decellularized matrix(ADM)group and a connective tissue(SCTG)group.Tunne-ling technique(TUN)were used in both groups to cover the root surface,and the gingival margin position,gingival margin morpholo-gy,and mucogingival junction position of the affected teeth at 1 week,3 weeks,3 months,and 6 months after surgery were observed.Check and record the gingival recession depth(RD)and mean root coverage(MRC)at the implant site before and 6 months after surgery.Record patient satisfaction at 3 weeks and 6 months after surgery.Results:Compared with the traditional SCTG group,the MRC of the ADM group was significantly lower before surgery and 6 months after surgery(P＜0.05).The satisfaction level of the ADM group was higher 3 weeks after surgery,with a significant difference compared to the SCTG group(P＜0.05).But 6 months after surgery,the satisfaction levels of the two groups tended to be consistent,with no significant difference.After TUN+ADM surgery,there was 1 case of abscess infection lesion,and another 3 cases showed local tissue necrosis at the gingival margin one week after surgery.After 3 months of treatment,the gingival color of these 4 patients was pink and tough texture,without swelling and bleeding.Conclusion:Although ADM is slightly inferior to SCTG in the treatment of gingival recession,it may be related to poor postoperative tissue healing complications.However,as long as it is handled properly,long-term follow-up observations have shown that gingival tissue can still achieve complete healing.TUN+ADM is a highly effective treatment for gingival recession and is suitable for further clinical application.

With the increasing demand for beauty,the treatment of gingival recession has become a common request among patients.Clinically,gingival recession is mainly treated by surgery.The common surgical methods include free gingival grafting,pedicled flap technology and double flap technology(subepithelial connective tissue transplantation combined with coronally advanced flaps).If patients with indications are selected,satisfactory surgical results will be ob-tained.However,there are still some shortcomings in the above mentioned methods,such as the root coverage effect not being satisfactory.In recent years,researchers have put forward some improved schemes to minimize the shortcomings of the above methods to treat different degrees of gingival recession.A gingival unit graft containing gingival papilla and free gingiva can improve the blood supply of the recipient area and improve the effect of root coverage.It can obtain bet-ter root coverage for slight retraction,widening of the angular gingiva and deepening of the vestibular sulcus,but there may be issues with inconsistent color and shape of the gingiva after surgery,as well as poor aesthetic effects.Modified coronally advanced flaps,flaps prepared by the technique of half-thickness,full-thickness and half-thickness,and modi-fied coronally advanced envelope flap technology are designed with the most serious retraction teeth as the center in the case of multiple gingival retractions,both of which can improve the effect of root covering.Tunnel technology and modi-fied tunnel technology,without severing the gingival papilla and tunneling the gingival flap to accommodate the graft,can effectively reduce tissue damage and promote wound healing.This paper reviews the literature and summarizes the outcome of the modified surgery techniques in the treatment of gingival recession.These treatment options for gingival recession are proposed with the aim of improving clinical work,and some suggestions for the treatment of gingival reces-sion to achieve a stable root coverage effect are put forward.In the future,the development direction of mucogingival surgery is to reduce trauma and have a stable curative effect.

Objective To construct and apply a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.Methods Based on evidence summaries and expert consultation,a management plan for microaspiration of oropharyngeal secretions in ICU intubated patients was constructed,consisting of 19 items covering 7 aspects including identification of risk factors,position management,tube and cuff selection,cuff management,mechanical ventilation management,pain and sedation management,removal of oropharyngeal and subglottic secretions,and oral care.Convenience sampling was used to select 141 ICU intubated patients from a tertiary A comprehensive hospital in Suzhou from June,2022 to September,2023.Patients were divided into an experimental group(n=72)and a control group(n=69)according to the wards.The experimental group received the management plan for microaspiration of oropharyngeal secretions in ICU intubated patients.The control group received the nursing bundle for ventilator associated pneumonia(VAP).The incidence and time from intubation to microaspiration and VAP,duration of mechanical ventilation,ICU length of stay,and disease outcome were compared between the 2 groups.Results The incidence of microaspiration of oropharyngeal secretions,the duration of mechanical ventilation,time from intubation to microaspiration showed significant differences between the 2 groups(P<0.05).There were no significant differences in the incidence of ventilator associated pneumonia,ICU length of stay,and disease outcome between the 2 groups(P>0.05).The time from intubation to VAP in the experimental group was 7.5 days,and that in the control group was 3.8 days.Conclusion The application of the management plan for microaspiration of orophaiyngeal secretions in ICU intubated patients is beneficial for reducing the incidence of microaspiration,delaying the time from intubation to microaspiration and VAP,and shortening the duration of mechanical ventilation.

Objective:To investigate the predictive value of the changes of platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in the therapeutic efficacy of the neoadjuvant treatment for breast cancer.Methods:The clinical data of 72 breast cancer patients who received neoadjuvant therapy in Nantong Tumor Hospital between February 2020 and January 2022 were retrospectively analyzed and the changes of PLR and NLR before and after neoadjuvant therapy were also analyzed. The receiver operating characteristic (ROC) curves were used to assess the predictive value of PLR, NLR and their changes in pathological complete remission (pCR) after neoadjuvant therapy.Results:The area under the ROC curve of PLR and NLR before the treatment, the difference in PLR before and after the treatment (ΔPLR), the difference in NLR before and after the treatment (ΔNLR) in predicting pCR was 0.520, 0.505,0.724 and 0.686,and the corresponding cut-off value was 269.231, 2.559, -2.840 and -1.457; the patients were divided into high and low groups according to the cut-off values. NLR before the treatment was not correlated with clinicopathological characteristics (all P > 0.05),while PLR before the treatment was correlated with tumor size ( P = 0.029), and ΔPLR was correlated with progesterone receptor expression ( P = 0.025), human epidermal growth factor receptor 2 (HER2) expression ( P < 0.001), molecular subtype ( P < 0.001), N stage ( P = 0.002), clinical stage ( P = 0.002) and treatment modality ( P < 0.001). ΔNLR was associated with HER2 expression ( P = 0.002), molecular subtype ( P = 0.024), tumor size ( P = 0.007), neural invasion ( P = 0.006), N stage ( P = 0.006), clinical stage ( P = 0.016) and treatment modality ( P = 0.014). ΔPLR and ΔNLR were influencing factors for patients achieving pCR after neoadjuvant therapy (all P < 0.05). Conclusions:Stage Ⅲ invasive breast cancer patients with higher ΔPLR and ΔNLR after neoadjuvant therapy have better prognosis.

Objective:To assess the effects of heart valve replacement under extracorporeal circulation(ECC)on left ventricular function and regulatory T cells in elderly patients with rheumatic heart disease(RHD).Methods:113 elderly patients with rheumatic heart disease receiving ECC heart valve replacement at our hospital from September 2018 to September 2020 were selected retrospectively as subjects.Another 113 healthy people from the same period were selected as the control group.Patients in the observation group received ECC heart valve replacement.Left heart function and regulatory T cells were compared between the two groups.Results:Before surgery, the left atrial transverse diameter(LA)of RHD patients was significantly increased compared with the control group[(56.2±9.3)mm vs.(29.4±3.5)mm, t=28.670, P<0.001], and the left ventricular end diastolic diameter(LVDD)[(32.4±7.7)mm vs.(38.4±8.5)mm, t=5.561, P<0.001], left ventricular ejection fraction(LVEF)[(58.4±11.5)% vs.(65.6±10.5)%, t=4.915, P<0.001]and cardiac output(CO)[(3.7±2.6)L/min vs.(4.7±1.6)L/min, t=3.482, P<0.001]were significantly decreased compared with the control group.There were no significant changes in left heart function parameter values 10 min and 1 day after surgery(all P>0.05).One month after surgery, the inner diameter of pulmonary artery(PA)[(25.2±3.8)mm vs.(31.2±5.6)mm, t=9.659, P<0.001]and LA[(46.2±7.8)mm vs.(56.2±9.3)mm, t=8.758, P<0.001]were decreased compared with those before surgery, while changes in right ventricular end diastolic inner diameter(RVDD)and left ventricular end diastolic inner diameter(LVDD)were not significant, and there were no significant differences in LVEF, CO and LVFS(all P>0.05).The proportion of CD25 + CD4 + T cells in lymphocytes and the proportion of CD4 + CD25 + Foxp3 + Treg cells in CD4 + T cells in RHD patients before surgery were significantly lower than those in the control group( P<0.01).The proportions decreased 10 min and 1 day after surgery, but increased 3 days after surgery and returned to preoperative levels 7 days after surgery, but were still significantly lower than those in the control group( P<0.05). Conclusions:After ECC heart valve replacement in elderly RHD patients, the left atrium will shrink for a short time and tricuspid regurgitation can recover, with reduced damage of cellular immune function, but its contractile function remains unchanged.

Objective : To evaluate the effects of root calculus residue and root cement preservation by ultrasonic subgingival scaling and root planing (SRP) with or without perioscopy. Methods : Twelve teeth extracted due to severe periodontitis were randomly divided into three groups with four teeth in each group: ① Endoscope-assisted SRP group. The root surfaces of the affected teeth were cleaned with an EMS ultrasonic treatment instrument. ② Traditional SRP group. The affected teeth were treated by ultrasonic subgingival scaling and hand root planing with a Gracey curette. ③ Untreat group. The above operations were performed by the same senior physician. Under local anesthesia, each tooth was scraped for 10 minutes and then extracted. The residual amount of calculus on the root surface after plaque staining was observed and recorded. The thickness of the retained cementum at 1/3 of the root neck was measured. Results: The residual rate of calculus on the root surface was the lowest in the endoscope-assisted SRP group, which was significantly different from the traditional SRP group and the untreated group (P < 0.001). Histological observation showed that the mean residual cementum thickness at 1/3 of the root neck increased gradually from the cemento-enamel junction (CEJ), 2.5 mm below the CEJ and 5 mm below the CEJ. Ultrasound SRP assisted by endoscopy caused less damage to the cementum and preserved the cementum better than traditional subgingival scaling (P < 0.001). Conclusion Compared with traditional SRP therapy, endoscope-assisted SRP treatment can remove subgingival plaque and calculus more effectively and can better preserve the cementum of the root surface.

Objective:To explore the surgical method and effect of en bloc pelvic resection and anal preservation after radical radiotherapy for cervical cancer.Methods:Clinical data of 20 cervical cancer patients with central recurrence after radical radiotherapy underwent en bloc pelvic resection in the Tumor Hospital of Zhengzhou University and Hainan Provincial People′s Hospital from January 2013 to December 2017 were retrospectively analyzed. The operative time, intraoperative blood loss, length of stay, postoperative anal function and postoperative complications were evaluated.Results:The median operation time of 20 patients with anal preservation after en bloc pelvic resection was 135.2 min, the median intraoperative blood loss was 680 ml, and the median hospitalization time was 16.5 days. Among them, 18 patients had good postoperative healing, and the anal function gradually returned to normal within 6 months after surgery, defecated 1~2 times per day.One patient showed incomplete adhesion between the external colon and the anus. One patient presented with pre-sacral infection. Postoperative pathology confirmed the recurrences in 20 patients, of which 11 cases were squamous cell carcinoma, 7 cases were adenocarcinoma, 2 cases were adenosquamous cell carcinoma.Conclusions:It is safe and reliable to preserve anus after en bloc pelvic resection for cervical cancer patients with radical radiotherapy. The anus function is good enough to improve the postoperative life quality of patients significantly.

Objective:To explore the surgical method and effect of en bloc pelvic resection and anal preservation after radical radiotherapy for cervical cancer.Methods:Clinical data of 20 cervical cancer patients with central recurrence after radical radiotherapy underwent en bloc pelvic resection in the Tumor Hospital of Zhengzhou University and Hainan Provincial People′s Hospital from January 2013 to December 2017 were retrospectively analyzed. The operative time, intraoperative blood loss, length of stay, postoperative anal function and postoperative complications were evaluated.Results:The median operation time of 20 patients with anal preservation after en bloc pelvic resection was 135.2 min, the median intraoperative blood loss was 680 ml, and the median hospitalization time was 16.5 days. Among them, 18 patients had good postoperative healing, and the anal function gradually returned to normal within 6 months after surgery, defecated 1~2 times per day.One patient showed incomplete adhesion between the external colon and the anus. One patient presented with pre-sacral infection. Postoperative pathology confirmed the recurrences in 20 patients, of which 11 cases were squamous cell carcinoma, 7 cases were adenocarcinoma, 2 cases were adenosquamous cell carcinoma.Conclusions:It is safe and reliable to preserve anus after en bloc pelvic resection for cervical cancer patients with radical radiotherapy. The anus function is good enough to improve the postoperative life quality of patients significantly.

Objective To compare the efficacy and safety of mesalazine oral plus enema or only oral admin-istration in the treatment of ulcerative colitis .Methods 114 patients with ulcerative colitis were selected , and they were randomly divided into the observation group and treatment group according to random number table , with 57 cases in each group .The observation group was given mesalazine oral treatment ,and the treatment group was given mesalazine oral plus enema .The changes of CRP ,Fid,MPV after treatment were compared between the two groups .The situation of mucosa under colonoscopy , effective rate and the incidence of adverse reactions were compared between the two groups.Results After treatment,the CRP,Fid levels in the treatment group were lower than those in the observation group [(3.17 ±1.48)mg/L vs.(6.14 ±2.53)mg/L,(2.14 ±0.17)g/L vs.(2.91 ±0.27)g/L],the MPV in the treatment group was higher than that in the observation group [(10.93 ±0.59) fL vs.(10.21 ± 1.21)fL],the differences were statistically significant (t=7.650,18.220,4.038,all P<0.05).The total remission rate of the treatment group was higher than that of the observation group (100.00%vs.78.95%) (χ2 =13.412,P<0.001).The total effective rate of treatment group was higher than that of the observation group (89.47% vs .75.44%) (χ2 =3.881,P=0.049).The incidence rate of adverse reactions in the treatment group was lower than that in the observation group (3.51%vs.26.32%) (χ2 =11.683,P=0.001).Conclusion Mesalazine oral plus enema in the treatment of ulcerative colitis has good effect ,minor adverse reactions,high safety,which is worthy of clinical application .