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*

ObjectiveTo investigate the effect of different doses of Jiedu Tongluo Shengjin prescription （JTSP） on serum interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） and forkhead box P3 （FoxP3） in submandibular gland of NOD/Ltj mice with Sjögren's syndrome， and to explore the mechanism of JTSP on immune regulation in NOD/Ltj mice. MethodThirty NOD/Ltj mice （eight weeks old） were randomly divided into model group， JTSP low-dose group， JTSP medium-dose group， JTSP high-dose group and hydroxychloroquine group， and were administrated with normal saline， JTSP 9， 18， and 36 g·kg^-1， and hydroxychloroquine 60 mg·kg^-1 daily， respectively from the age of 12 weeks. Six ICR mice were given an equal amount of normal saline by gavage as the control group. During the experiment， daily water consumption and saliva secretion of mice at the age of 9， 12， 16 weeks were recorded. After 4 weeks of administration， submandibular gland and spleen tissues were dissected to calculate corresponding indexes. The pathological morphology of submandibular gland was observed by hematoxylin-eosin （HE） staining. Meso Scale Discovery （MSD） and immunohistochemistry were employed to detect the serum levels of IL-6， TNF-α and IL-10， and the expression and distribution of FoxP3 in submandibular gland， respectively. The protein expression of FoxP3 in mouse submandibular gland was determined by Western blot， and the mRNA expressions of FoxP3 and TNF-α were determined by real-time polymerase chain reaction （Real-time PCR）. ResultCompared with the control group， the model group presented increased daily water consumption， decreased saliva secretion， lowered submandibular gland index， elevated pathological score of submandibular gland， up-regulated serum IL-6 and TNF-α and mRNA expression of TNF-α while down-regulated serum IL-10 and protein and mRNA expressions of FoxP3 in submandibular gland （P<0.05）. Compared with the conditions in model group， daily water consumption in JTSP groups was reduced while saliva secretion was increased， especially in medium-dose and high-dose groups （P<0.05）， and there was an increase in the submandibular gland index of JTSP medium-dose group （P<0.05） while a decrease in the spleen index of JTSP high-dose group （P<0.05）. Additionally， JTSP groups had lower pathological score of submandibular gland than the model group （P<0.05）， especially high-dose group， as well as lower serum IL-6 and TNF-α and mRNA expression of TNF-α while higher serum IL-10 （P<0.05）. JTSP at medium and high doses up-regulated the protein and mRNA expressions of FoxP3 in submandibular gland （P<0.05）. ConclusionJTSP may inhibit the secretion of inflammatory cytokines by regulating the stability of FoxP3⁺ regulatory T （Treg） cells， thus alleviating the systemic immune inflammation in Sjögren's syndrome.

【Objective】 To study the fairness of blood bank resources allocation in China, aimed at providing references for reasonable allocation of blood bank resources. 【Methods】 A questionnaire survey was conducted among 32 provincial blood centers and 321 regional central blood banks across China in August 1~25, 2018. Resource allocation of blood banks in China was analyzed using descriptive methods, and the fairness of resource allocation were analyzed using Lorenz curve, Gini coefficient and Theil index. 【Results】 Blood bank resources and services showed an overall upward trend from 2013 to 2017. The fairness of institutional coverage was optimal in 2017 according to the Lorenz curve and Gini coefficient, suggesting the allocation of blood bank resources according to the population was better than geographic area. The fairness of health technicians staffing was the worst from the perspective of geographic area. The total Theil index was 0.448 5~0.526 7, and the differences was contributed more by intra group comparison than that of inter group. 【Conclusion】 The unbalanced development underlying in the provincial and regional blood centers has been observed, and the service capacity needs to be further improved. The resource allocation varies greatly among regions, and it is recommended to optimize the regional planning of blood bank resources.

Objective:To explore the influence of different mental status (evaluated by Likert scale) on the first success rate, image artifacts and examination time of cone beam CT (CBCT) in infants and young children.Methods:Prospective analysis of children aged 1-6 years (98 cases) who underwent CBCT examination, before the examination, the children were scored in seven aspects: activity, adaptability, attention, mood, gender, age and parents′ attitude, and the total score was calculated, The total score was used as the test variable, and the success rate of the first examination, the artifact of the image and whether the examination time was longer than 2 minutes were used as the state variable. Using SPSS 16.0 to draw the ROC curve, the area under curve (AUC), significance, maximum Yoden′s index and their corresponding diagnostic (evaluation) critical values were obtained.Results:The success rate of the first examination was 78.6%(77/98), the AUC was 0.949 ± 0.025, the significance P < 0.05, the maximum Yoden′s index was 0.766, the corresponding critical value of diagnosis (evaluation) was 15; the artifact-free rate was 67.3%(66/98), the AUC was 0.873±0.038, the significance P < 0.05, the maximum Yoden′s index was 0.549, and the corresponding critical value of diagnosis (evaluation) was 15; the proportion of examination time in 2 minutes was 80.6%(79/98), the AUC was 0.854 ± 0.039, the significant P < 0.05, the maximum Yoden′s index was 0.614, and the corresponding critical value of diagnosis (evaluation) was 14. Conclusions:The Likert scale scoring method based on Thomas′s temperament analysis theory has certain application value in the psychological evaluation of children before cone-beam CT examination. For children whose total score is greater than or equal to 14, sedation or psychological counseling should be carried out before examination in order to effectively improve the success rate of examination and reduce the occurrence rate of artifacts in images, further more to reduce radiation dosage and increase the examination circulation of CBCT in children.

PURPOSE: This study aimed to evaluate the effect of delayed lactogenesis II on early milk volume in mothers expressing milk for their preterm infants. METHODS: 142 mothers with preterm infants participated in a longitudinal cohort study, the milk volumes over 14 days postpartum between mothers with delayed lactogenesis II (≥ 72 hours) and mothers with non-delayed lactogenesis II(< 72 hours) were compared using Wilcoxon's rank sum tests. RESULTS: The prevalence of delayed lactogenesis II among mothers of preterm infants was 36.0% (36/100). There existed negative correlations between the onset of lactogenesis II and the daily milk volumes(r(s) = −0.525~−0.354, p = .002 ~ p < .001). The milk volumes in every 24-hour of the 14 days postpartum in delayed group were significantly less than that in non-delayed group (p = .002 ~ p < .001). After controlling for the covariates, pregnancy-induced hypertension syndrome, delayed expression initiation, shorter daily sleeping time were found to be the risk factors for delayed lactogenesis II. CONCLUSION: Delayed lactogenesis II was associated with lower milk volume in early postpartum period. Women who were at risk for delayed lactogenesis II need targeted interventions and additional support during pregnancy and postpartum.
Cohort Studies ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Newborn ; Infant, Premature ; Lactation ; Milk ; Milk, Human ; Mothers ; Postpartum Period ; Pregnancy ; Premature Birth ; Prevalence ; Risk Factors

Objective: To discuss the success rate and image quality in pediatric patients who used chloral hydrate before their cone beam computed tomography exam. Methods: 1752 patients aged 1 to 6 were selected for this retrospective study. They were divided into sedated group (219 cases) and non-sedated group (1 533 cases). The success rate and image quality were compared between two groups. Results: The sedated group had a higher success rate to non-sedated group: 99.5%(218/219) vs. 90.4% (1 386/1 533). The motion artifact in sedated group was lower than non- sedated group with I degree: 4.8% (15/314) vs. 20.1%(327/1 630) and II degree: 0.3%(1/314) vs. 12.2%(199/1 630). Conclusion Giving chloral hydrate to pediatric patients before their CBCT exam would improve both success rate and image quality, and reduce unnecessary radiation expose.

Objective To explore the milk production and its regularity in mothers with preterm infants hospitalized in NICU during periods of mother-infant separation,and to analyze the associating factors.Methods Totally 122 mothers with preterm infants hospitalized in NICU were recruited from February to December,2017.Continuous measurements of daily breast milk production were performed.The maternal lactation related comprehensive questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were used.The Pearson correlation analysis and multiple linear regression analysis were conducted using the Statistical Analysis Systems (version 9.2).Results The milk volumes for the first 14 days postpartum showed a trend of rising among mothers.The mean milk volume on day 14 postpartum was (535.43±256.97) ml.The mean initiation time of lactogenesis stage Ⅱ was (68.23±26.42) h.The correlation coefficient of lactation between day 4 and day 14 was 0.707 0(P＜0.01).The multiple linear regression analysis revealed that the pregnancy induced hypertension syndrome,initiation time of lactogenesis stage Ⅱ,EPDS score,gestational age,maternal age were the influencing factors of milk volume for mothers during periods of mother-infant separation.Conclusion The milk volume of mothers with preterm infants was relatively lower compared with mothers with full-term infants during the early stage postpartum,and the onset of lactogenesis stage Ⅱ was later.In clinical nursing work,healthcare providers should pay special attention to mothers with older maternal age,smaller gestational age,pregnancy induced hypertension syndrome,higher EPDS score,and later initiation time of lactogenesis stage Ⅱ.

Objective To analyze and explore the correlation between the onset time of lactogenesisⅡ and lactation yield of the early stage after delivery in preterm's mothers by continuously determining the lactation yield of the early stage after delivery in hospitalized preterm's mothers and the onset time of lactogenesisⅡin neonatal intensive care unit (NICU). Methods We measured lactation yield and recorded the onset time of lactogenesis Ⅱ from 100 premature labour puerpera with hospital delivery of Obstetrics Department at a class Ⅲgrade A general hospital in Shandong Province. The relative factors of delayed onset of lactogenesis Ⅱ (DOL Ⅱ) were investigated with the preterm's mothers lactation-related factors comprehensive questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Results The mean onset time of lactogenesis Ⅱ of hospitalized preterm's mothers in NICU were (68.23±26.42) hours. The incidence of DOL Ⅱ was 36% (36/100). The onset time of lactogenesis Ⅱwas negatively related to the lactation yield 14 days after delivery (r=-0.525--0.354, P<0.01). The lactation yield 14 days after delivery of onset delay group of lactogenesis Ⅱ was less than that of non-delayed group (Z=-4.89--3.10, P<0.01). The influencing factors of DOL Ⅱ included whether they were combined with pregnancy-induced hypertension syndrome (OR=4.589, P< 0.01), hours of sleep (OR=0.649, P<0.01) and the first breast-feeding (OR=1.120, P<0.01). Conclusions The incidence of DOL Ⅱ is high in hospitalized preterm's mothers of NICU.The DOL Ⅱ affects the lactation yield of the early stage after delivery in preterm's mothers. Medical workers should pay attention to the onset time of lactogenesis Ⅱ, correct pregnancy-induced hypertension syndrome in time, increase hours of sleep of puerpera and promote the first breast-feeding early enough so as to reduce or prevent the DOL Ⅱand to improve the lactation condition of premature labour puerpera.

Objective To investigate the clinical efficacy of combined use of calcineurin inhibitor in the treatment of lupus nephritis in induction or maintenance,which is resistant to mycophenolate mofetil.Methods Sixty-six cases of children with lupus nephritis were selected from February 2014 to September 2016 in Huazhong University of Science and Technology,Tongji Medical College Affiliated Wuhan Children's Hospital.The randomized method was used to divide them into the control group and the observation group randomly.Among them,31 cases in the control group were given glucocorticoid,cyclophosphamide combined with traditional medicine for treatment;35 cases in observation group were given glucocorticoid,mycophenolate mofetil,tacrolimus (calcine phosphatase inhibitor) multi-target therapy for treatment.The clinical effect of 2 groups before and after treatment were compared,and the incidence of adverse reactions in the treatment of 2 groups of children were compared.Results After treatment,the levels of systemic lupus erythematosus disease activity index (SLEDAI),serum creatinine and 24 h urine protein [(6.05 ± 1.04) scores,(45.08 ± 18.52) μmol/L,(0.96 ±0.30) g/L] in the observation group were lower than those in the control group [(11.09 ±2.33) scores,(95.33 ±36.74) μmol/L,(2.05 ±0.74) g/L],and the differences were statistically significant (t =3.097,3.356,3.871,all P ＜ 0.05).Serum complement C3,plasma albumin levels [(1.05 ± 0.28) g/L,(63.24 ± 12.98) g/L] were higher than those in the control group [(0.34 ±0.10) g/L,(35.45 ±6.74) g/L],and the differences were statistically significant (t =4.124,3.567,all P ＜ 0.05).After treatment,the levels of serum complement C3 and plasma albumin were significantly higher between 2 groups than those before treatment,the differences were statistically significant (all P ＜ 0.05).The incidence of adverse reaction (14.29％,5/35 cases) in the observation group was lower than that in the control group (38.71％,12/31 cases),and the difference was statistically significant (x2 =5.128,P ＜ 0.05).Conclusion Multi-target combination therapy and traditional cyclophosphamide therapy can effectively control lupus nephritis in children,but the clinical effect of multi-target combination therapy is better and the adverse reaction is less.