Early correction of childhood malocclusion is timely managing morphological, structural, and functional abnormalities at different dentomaxillofacial developmental stages. The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion. This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence, aiming to provide general guidance on appropriate imaging examination selection, comprehensive and accurate imaging assessment for early orthodontic treatment patients.
Humans ; Malocclusion/diagnostic imaging* ; Child ; Consensus

Objective:To evaluate the incidence, clinical features, factors affecting initial diagnosis, efficacy, and safety of therapy and prognosis of small intestinal Dieulafoy lesions (DL).Methods:Clinical data including clinical background, diagnosis, and treatment details of patients who were admitted to the Department of Gastroenterology, Air Force Medical Center, for suspected small bowel bleeding, diagnosed as having small bowel DL and treated with balloon-assisted enteroscopy (BAE) were retrospectively analyzed from November 2017 to March 2024.Results:Among 800 patients, 30 cases (3.75%, 30/800, 17 males and 13 females) were diagnosed as having small intestine DL with the mean age of 60.90 years. Clinical symptoms included melena (56.67%, 17/30), hematochezia (43.33%, 13/30), and hemodynamic instability (30.00%, 9/30). Active bleeding occurred in 23 (76.67%) patients. Comorbidities existed in 70.00% (21/30) and 33.33% (10/30) used long-term antithrombotic agents. Diagnosis was confirmed after a single BAE in 63.33% (19/30) and after multiple BAEs (mean 1.6 procedures) in 36.67% (11/30). Lesions were predominantly located at jejunal. All patients achieved successful treatment with a single BAE procedure. The median follow-up period was 12.25 months (range: 5.25-23.00 months). Five cases (16.67%) experienced recurrent bleeding, with one case transfered to surgical intervention. Two cases (6.67%) reported post-operative symptoms of dizziness and fatigue, which resolved after symptomatic management. Multivariate analysis showed that long-term oral anticoagulant therapy ( OR=0.06, 95% CI: 0.01-0.73) was an independent predictor of single-session diagnosis. Conclusion:Small intestinal DL is rare and challenging to diagnose. Antithrombotic therapy may facilitate the diagnosis of DL at the first BAE. Jejunal localization is common, and combined endoscopic therapy (including clipping) is effective and safe.

Objective:To evaluate the incidence, clinical features, factors affecting initial diagnosis, efficacy, and safety of therapy and prognosis of small intestinal Dieulafoy lesions (DL).Methods:Clinical data including clinical background, diagnosis, and treatment details of patients who were admitted to the Department of Gastroenterology, Air Force Medical Center, for suspected small bowel bleeding, diagnosed as having small bowel DL and treated with balloon-assisted enteroscopy (BAE) were retrospectively analyzed from November 2017 to March 2024.Results:Among 800 patients, 30 cases (3.75%, 30/800, 17 males and 13 females) were diagnosed as having small intestine DL with the mean age of 60.90 years. Clinical symptoms included melena (56.67%, 17/30), hematochezia (43.33%, 13/30), and hemodynamic instability (30.00%, 9/30). Active bleeding occurred in 23 (76.67%) patients. Comorbidities existed in 70.00% (21/30) and 33.33% (10/30) used long-term antithrombotic agents. Diagnosis was confirmed after a single BAE in 63.33% (19/30) and after multiple BAEs (mean 1.6 procedures) in 36.67% (11/30). Lesions were predominantly located at jejunal. All patients achieved successful treatment with a single BAE procedure. The median follow-up period was 12.25 months (range: 5.25-23.00 months). Five cases (16.67%) experienced recurrent bleeding, with one case transfered to surgical intervention. Two cases (6.67%) reported post-operative symptoms of dizziness and fatigue, which resolved after symptomatic management. Multivariate analysis showed that long-term oral anticoagulant therapy ( OR=0.06, 95% CI: 0.01-0.73) was an independent predictor of single-session diagnosis. Conclusion:Small intestinal DL is rare and challenging to diagnose. Antithrombotic therapy may facilitate the diagnosis of DL at the first BAE. Jejunal localization is common, and combined endoscopic therapy (including clipping) is effective and safe.

OBJECTIVE To compare the efficacy and safety of lacosamide （LCM） and carbamazepine （CAR） as monotherapy in the treatment of adult patients with newly diagnosed epilepsy. METHODS By methods of retrospective analysis， 84 adult patients with newly diagnosed epilepsy， were admitted to the Department of Neurology， Huaihe Hospital of Henan University during Sept. 2020-Jun. 2022， were divided into the control group （40 cases， receiving CAR treatment） and the observation group （44 cases， receiving LCM treatment） according to different medication regimens. Total response rate， epilepsy seizure frequency， blood lipid levels， and the occurrence of adverse events （AEs） of patients were compared between the 2 groups. RESULTS In the first month after treatment， there was no statistically significant difference in the total response rate between the observation group （63.64%） and the control group （55.00%， P＞0.05）； the frequency of epilepsy seizure in both groups was significantly reduced compared to before treatment （P＜0.05）， but there was no statistically significant difference between 2 groups （P＞0.05）. In the third month after treatment， the total response rate of the observation group （90.91%） was significantly higher than control group （67.50%， P＜0.05）； the frequencies of epilepsy seizure in both groups were significantly reduced compared to before treatment， and the observation group was significantly lower than the control group （P＜0.05）. In the third month after treatment， the levels of total cholesterol （TC）， triglyceride （TG） and low-density lipoprotein cholestrol （LDL-C） in the control group and the level of LDL-C in the observation group were significantly higher than before treatment， and the levels of TC， TG and LDL-C in the observation group were significantly lower than those in the control group （P＜0.05）. There was no statistically significant difference in the incidence of AEs between the observation group （15.91%） and the control group （17.50%， P＞0.05）. CONCLUSIONS Both LCM and CAR have certain effects in the treatment of newly diagnosed epilepsy in adults， which can reduce the frequency of epilepsy seizure in patients and have comparable safety. Meanwhile， LCM has better long-term efficacy than CAR in treating newly diagnosed epilepsy in adults， and its impact on the patient’s blood lipid is smaller than CAR.

Objectives:This study aimed to analyze the clinical and molecular characteristics of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in patients with hematological diseases and to explore prognostic risk factors.Methods:This retrospective study included patients with hematologic diseases with CRE BSI at the Institute of Hematology and Blood Diseases Hospital from January 2015 to December 2022. The clinical features, carbapenemase test results, antimicrobial treatments, and outcomes were analyzed.Results:A total of 120 patients developed CRE BSI. Escherichia coli (58/120, 48.3%) was the most prevalent Enterobacteriaceae, followed by Klebsiella pneumoniae (52/120, 43.3%). A total of 93 CRE strains were tested for carbapenemase, of which 75 strains produced carbapenemase (metalloenzyme: 51 strains; serine enzyme: 24 strains). The 30-day mortality rate after BSI was 24.2% (29/120). Univariate analysis revealed significantly lower mortality in patients treated with the ceftazidime-avibactam-containing regimen than in those treated with other antibiotics (7.8% vs 36.2%, P<0.001). Moreover, initiating active therapy within 24 h of BSI onset significantly reduced mortality (15.0% vs 33.3%, P=0.019). The proportion of patients with CRE colonization receiving active therapy within 12 and 24 h was significantly higher compared with patients without colonization (12 h: 14.5% vs 34.1%, P=0.012; 24 h: 40.8% vs 65.9%, P=0.008). Multivariate analysis revealed that septic shock ( HR=24.436, 95% CI 4.148 - 143.966, P<0.001) and pulmonary infection ( HR=9.346, 95% CI 2.718-32.140, P<0.001) were independent risk factors for death within 30 days. Appropriate therapy was initiated within 24 h ( HR=0.225, 95% CI 0.059 - 0.851, P=0.028), and treatment with the ceftazidime-avibactam-containing regimen ( HR=0.082, 95% CI 0.018-0.362, P=0.001) significantly reduced mortality. Conclusion:The prognosis of CRE BSI in patients with hematological diseases is poor. Timely, appropriate therapy and receipt of a ceftazidime-avibactam-containing regimen can improve survival and prognosis.

Objectives:This study aimed to analyze the clinical and molecular characteristics of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in patients with hematological diseases and to explore prognostic risk factors.Methods:This retrospective study included patients with hematologic diseases with CRE BSI at the Institute of Hematology and Blood Diseases Hospital from January 2015 to December 2022. The clinical features, carbapenemase test results, antimicrobial treatments, and outcomes were analyzed.Results:A total of 120 patients developed CRE BSI. Escherichia coli (58/120, 48.3%) was the most prevalent Enterobacteriaceae, followed by Klebsiella pneumoniae (52/120, 43.3%). A total of 93 CRE strains were tested for carbapenemase, of which 75 strains produced carbapenemase (metalloenzyme: 51 strains; serine enzyme: 24 strains). The 30-day mortality rate after BSI was 24.2% (29/120). Univariate analysis revealed significantly lower mortality in patients treated with the ceftazidime-avibactam-containing regimen than in those treated with other antibiotics (7.8% vs 36.2%, P<0.001). Moreover, initiating active therapy within 24 h of BSI onset significantly reduced mortality (15.0% vs 33.3%, P=0.019). The proportion of patients with CRE colonization receiving active therapy within 12 and 24 h was significantly higher compared with patients without colonization (12 h: 14.5% vs 34.1%, P=0.012; 24 h: 40.8% vs 65.9%, P=0.008). Multivariate analysis revealed that septic shock ( HR=24.436, 95% CI 4.148 - 143.966, P<0.001) and pulmonary infection ( HR=9.346, 95% CI 2.718-32.140, P<0.001) were independent risk factors for death within 30 days. Appropriate therapy was initiated within 24 h ( HR=0.225, 95% CI 0.059 - 0.851, P=0.028), and treatment with the ceftazidime-avibactam-containing regimen ( HR=0.082, 95% CI 0.018-0.362, P=0.001) significantly reduced mortality. Conclusion:The prognosis of CRE BSI in patients with hematological diseases is poor. Timely, appropriate therapy and receipt of a ceftazidime-avibactam-containing regimen can improve survival and prognosis.

Objective:To explore the factors which influence the outcomes of two-stage radical surgery for the patients with perianal fistulizing Crohn′s disease (pfCD) .Methods:Clinical data of 31 pfCD patients who underwent two-stage radical surgery in the Sixth Affiliated Hospital of Sun Yat-sen University from March 2016 to June 2018 were analyzed retrospectively. All the patients got good drainage results comfirmed by MRI after the treatment of one-stage seton drainage and the following medical treatment. According to the outcome of two-stage radical surgery, the patients were divided into the healing group ( n = 23) and the failed group ( n = 8) . The clinical characteristics between the two groups were analyzed statistically. Wilcoxon rank sum test was used to analyze the difference in C-reactive protein (CRP) , erythrocyte sedimentation rate (ESR) , platelet (PLT) , body mass index (BMI) , hemoglobin (HB) and albumin (ALB) between before the one-stage seton drainage and before the two-stage radical surgery in each group. Results:The healing rate of pfCD after two-stage radical surgery was 74.2% (23/31) . The ratio of proctitis before the one-stage seton drainage (8.70% vs.50.00%, P = 0.026) , the ratio of multiple internal openings or multiple independent fistulas before the one-stage seton drainage (21.74% vs. 75.00%, P = 0.012) and the PLT before the two-stage radical surgery [240.0 (202.0, 277.0) × 10 9/L vs. 319.5 (247.3, 385.5) × 10 9/L, P = 0.04] in the healing group were significantly lower than those in the failed group. The variations of PLT [240.0 (202.0, 277.0) × 10 9/L vs. 300.9 (230.0, 413.0) × 10 9/L, P = 0.004], HB [136.0 (114.0, 144.0) g/L vs. 127.0 (107.0, 137.0) g/L, P = 0.004], ALB[43.10 (39.62, 47.41) g/L vs. 40.45 (36.58, 42.58) g/L, P = 0.011] and BMI [19.93 (17.99, 21.22) kg/m 2 vs. 18.22 (16.61, 19.38) kg/m 2, P<0.001] in the healing group before two-stage radical surgery showed better trends than those before one-stage seton drainage, while there was no significant variation trend of ESR and CRP between the two points in time (both P>0.05) . There were no sigificant differences in all indexes in the failed group between before one-stage seton drainage and before the two-stage radical surgery (all P>0.05) . Conclusions:Beside the initial proctitis and multiple internal openings or multiple independent fistulas, PLT level before the two-stage radical surgery for pfCD is also an influencing factor of surgical outcome. The situations of BMI, HB, ALB, and PLT before the two-stage radical surgery are better than those before the one-stage seton drainage may be used as the screening indications of the radical surgery.

Objective:To explore the factors which influence the outcomes of two-stage radical surgery for the patients with perianal fistulizing Crohn′s disease (pfCD) .Methods:Clinical data of 31 pfCD patients who underwent two-stage radical surgery in the Sixth Affiliated Hospital of Sun Yat-sen University from March 2016 to June 2018 were analyzed retrospectively. All the patients got good drainage results comfirmed by MRI after the treatment of one-stage seton drainage and the following medical treatment. According to the outcome of two-stage radical surgery, the patients were divided into the healing group ( n = 23) and the failed group ( n = 8) . The clinical characteristics between the two groups were analyzed statistically. Wilcoxon rank sum test was used to analyze the difference in C-reactive protein (CRP) , erythrocyte sedimentation rate (ESR) , platelet (PLT) , body mass index (BMI) , hemoglobin (HB) and albumin (ALB) between before the one-stage seton drainage and before the two-stage radical surgery in each group. Results:The healing rate of pfCD after two-stage radical surgery was 74.2% (23/31) . The ratio of proctitis before the one-stage seton drainage (8.70% vs.50.00%, P = 0.026) , the ratio of multiple internal openings or multiple independent fistulas before the one-stage seton drainage (21.74% vs. 75.00%, P = 0.012) and the PLT before the two-stage radical surgery [240.0 (202.0, 277.0) × 10 9/L vs. 319.5 (247.3, 385.5) × 10 9/L, P = 0.04] in the healing group were significantly lower than those in the failed group. The variations of PLT [240.0 (202.0, 277.0) × 10 9/L vs. 300.9 (230.0, 413.0) × 10 9/L, P = 0.004], HB [136.0 (114.0, 144.0) g/L vs. 127.0 (107.0, 137.0) g/L, P = 0.004], ALB[43.10 (39.62, 47.41) g/L vs. 40.45 (36.58, 42.58) g/L, P = 0.011] and BMI [19.93 (17.99, 21.22) kg/m 2 vs. 18.22 (16.61, 19.38) kg/m 2, P<0.001] in the healing group before two-stage radical surgery showed better trends than those before one-stage seton drainage, while there was no significant variation trend of ESR and CRP between the two points in time (both P>0.05) . There were no sigificant differences in all indexes in the failed group between before one-stage seton drainage and before the two-stage radical surgery (all P>0.05) . Conclusions:Beside the initial proctitis and multiple internal openings or multiple independent fistulas, PLT level before the two-stage radical surgery for pfCD is also an influencing factor of surgical outcome. The situations of BMI, HB, ALB, and PLT before the two-stage radical surgery are better than those before the one-stage seton drainage may be used as the screening indications of the radical surgery.

Objective:To compare the efficacy and safety of intermittent regional hepatic vascular inflow occlusion with Pringle’s maneuvre for laparoscopic anterior sectionectomy.Methods:From January 2014 to December 2018, 54 patients who underwent laparoscopic right anterior sectionectomy at the Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital, Soochow University were recruited into this study. The patients were 40 to 60 years old, and 27 were males and 27 females. Intermittent regional hepatic vascular inflow occlusion was carried out in 24 patients (the intermittent occlusion group). The remaining patients underwent Pringle’s maneuvre (the Pringle group). Postoperative liver function, intraoperative blood loss, intraoperative blood transfusion, operation time and postoperative complications between the two groups were compared.Results:Intraoperative hemorrhage and blood transfusion of the Pringle group (534±42)ml, (2.88±0.54)U were significantly higher than the intermittent occlusion group (374±21)ml, (1.86±0.29)U (all P<0.05). The operation time of the Pringle group was significantly shorter than the intermittent occlusion group ( P<0.05). Two patients developed CO 2 embolism in each group, which led to 2 patients in the intermittent occlusion group being converted to open operations. Postoperative hepatic function (except albumin) of the intermittent occlusion group was significantly better than the Pringle group, while the hospital stay of the intermittent occlusion group was significantly shorter than the Pringle group (all P<0.05). Six patients (25.0%) developed postoperative complications in the intermittent occlusion group versus 8 (26.7%) in the Pringle group ( P>0.05). Conclusion:Intermittent regional hepatic vascular inflow occlusion reduced intra-operative hemorrage and hepatic impairment, and shortened hospital stay. However, it required higher operation skills and it should gradually be promoted.

Objective:To evaluate partial splenectomy (LPS) in the treatment of benign solid tumors of the spleen.Methods:The clinical data of patients with benign solid tumors of spleen treated by laparoscopy from Jan 2010 to Jun 2018 in the Third Affiliated Hospital of Soochow University was retrospectively analyzed. Patients were divided into LPS group and laparoscopic total splenectomy (LTS) group.Results:There were 21 cases in LPS group and 25 cases in LTS group. Differences between the two groups, operative time, blood loss, transfusion rate, maintenance of drain, postoperative hospital stay, costs, postoperative WBC and platelet count, and postoperative complications such as hemorrhage, fever, splenic fossa effusion, pancreatic fistula, venous thrombosis were statistically insignificant. However, the postoperative incidence of thrombocythemia in the LPS group were significantly lower compared to the LTS group (χ 2 =4.293, P<0.05). Conclusions:Patients with benign solid tumors of the spleen will benefit more from LPS compared to LTS.