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 evaluate the prognostic value of radiation-induced lymphocytopenia in the survival of patients with primary hepatocellular carcinoma receiving radiation therapy. Methods The clinical data of 98 patients with unresectable primary hepatocellular carcinoma who received radiotherapy were retrospectively analyzed. The minimum absolute lymphocyte count (min ALC) was graded in accordance with CTCAE V4.0. The optimal threshold of min ALC for prognosis was calculated by using the receiver operating characteristic curve, and the correlation of min ALC with clinical characteristics and dosimetry parameters was analyzed. The Kaplan-Meier method was employed to analyze the survival of patients with different levels of min ALC. Univariate and multivariate Cox proportional regression models were applied to analyze prognostic factors. Results The baseline and min ALC of 98 patients during radiotherapy were 1.52×10⁹/L and 0.45×10⁹/L, respectively(P<0.001). The optimal cut-off value of min ALC for the prediction of the one-year survival rate was 0.38×10⁹/L. GTV, the mean dose of the liver and spleen, the V5 and V10 of the liver and spleen, and the V15 of the spleen were correlated with min ALC, and the V5 of the liver was an independent predictor of min ALC. The overall survival of patients with high min ALC was higher than that of patients with low min ALC. Independent prognostic factors were min ALC≤0.38×10⁹/L (HR=0.515, P=0.024), min ALC≥grade 3 (HR=0.576, P=0.032), tumor thrombus in the portal/vena cava, Child-Pugh grade A, increase of ≥2 points in the Child-Pugh score after radiotherapy, and received more than two other therapies. Conclusion Min ALC≤0.38×10⁹/L and min ALC≥grade 3 have independent prognostic value in patients with unresectable hepatocellular carcinoma receiving radiotherapy.

【Objective】 To comprehensively explore the serological characteristics of anti-PP1P^k and potential therapeutic strategies for recurrent miscarriage in p-blood type pregnant women. 【Methods】 Neutralization with pigeon egg white and human plasma, disruption of IgM antibodies by 2-mercaptoethanol reagent, and complement adding were conducted. Anti-PP1P^k titers under different processing conditions, media and temperatures were determined, and neutralizing effect of human plasma on anti-PP1P^k and its sensitization complement ability were analyzed. 【Results】 The titers of anti-PP1P^k in saline and column agglutination were 4 and 8, respectively. Low temperature increased titers, while β-mercaptoethanol treatment significantly reduced them. Pigeon egg white partially neutralized anti-PP1P^k antibodies. Human plasma was also capable of reducing anti-PP1P^k titers with neutralization capability surpassing that of pigeon egg white, and there were individual differences in neutralization capability. 【Conclusion】 The anti-PP1P^k was a blend of antibodies encompassing both IgM and IgG types, exhibiting cold reactivity, and having the potential for complement activation. Human plasma emerges as an effective modulator for diminishing the efficacy of anti-PP1P^k. Plasma transfusion holds promise as a therapeutic avenue for addressing recurrent miscarriages in pregnant individuals with the p phenotype.

Objective This study aims to compare and analyze three types of generative artificial intelligence(GAI)and explore their application value and existing problems in the field of stomatology in the Chinese context.Methods A total of 36 questions were designed,covering all the professional areas of stomatology.The questions encompassed various aspects including medical records,professional knowledge,and translation and editing.These questions were submitted to ChatGPT4-turbo,Gemini(2024.2)and ERNIE Bot 4.0.After obtaining the answers,a blinded evaluation was conducted by three experienced oral medicine physicians using a four-point Likert scale.The value of GAI in vari-ous application scenarios was evaluated.Results Gemi-ni scored 45,ERNIE Bot scored 38,and ChatGPT scored 33 for clinical documentation and image production.For research assistance,Gemini achieved 45,ERNIE Bot had 39,and ChatGPT scored 35.Teaching assistance capabilities were rated at 54 for ERNIE Bot,50 for Gemini,and 48 for ChatGPT.In patient consultation and guidance,Gemini scored 78,ERNIE Bot scored 59,and ChatGPT scored 48.Over-all,the total scores were 218,190,and 164 for Gemini,ERNIE Bot,and ChatGPT,respectively.Among GAI applica-tions,the top scoring categories were article translation and polishing(26),patient-doctor communication documentation(23),and popular science content creation(23).The lowest scoring categories were literature search and reporting(13)and image generation(12).Conclusion In the Chinese context,the application value of GAI is the highest for Gemini,followed by ERNIE Bot and ChatGPT.GAI shows significant value in translation,patient-doctor communication,and popular science writing.However,its value in literature search,reporting,and image generation remains limited.

Radiotherapy is one of the main treatment methods for malignant tumors, which can cause the radiation damage to normal tissues. Radiation-induced skin injury (RISI) is one of the main adverse reactions caused by radiotherapy. The main clinical manifestations of RISI are dermatitis, ulcer, erosion and necrosis, which seriously affect the quality of life and treatment effect of tumor radiotherapy patients, and even affect the overall survival of patients. The pathological mechanism of RISI is still unclear. Some studies have shown that inflammation and oxidative stress are the main causes of RISI. RISI can be divided into acute and chronic RISI according to the different onset time, and different treatment strategies can be formulated according to the severity of the injury. In this article, clinical manifestations, classification, pathogenesis, prevention and treatment of RISI are comprehensively summarized.

Objective To investigate the performance of different methods in common autoantibody detec-tion,and to provide basis for the detection strategy of autoantibody.Methods A total of 2 657 cases were in-cluded in this study,whose serum antinuclear antibody(ANA)by indirect immunofluorescence method(IIF)and antinuclear antibody spectrum(ANAs,a total of 15 antibodies)by immunoblot method(IB)were tested simultaneously,and anti-double strand DNA antibody(anti-dsDNA antibody)were tested by IIF,enzyme linked immunosorbent assay(ELISA)and IB.ANCA and ANCA spectrum[anti-myeloperoxidase antibody(anti-MPO antibody),anti-protease 3 antibody(anti-PR3 antibody)]were tested by IIF and ELISA respec-tively in 2 348 cases.Results Firstly,the detection rate of ANA was significantly higher than that of ANAs(57.77％vs.30.64％,P＜0.001).Among the specimens detected with ANA,40.78％detected at least one specific antibody positive.Among the specimens detected with ANAs positive,ANA was not detected in 23.10％of cases.Secondly,the ANA positive cases were mainly of lower titers,and cases with titer of ≤1∶320 accounted for 84.95％of the total detected cases.But the higher the titer,the higher the detection rate of ANAs specific antibodies(29.63％in 1∶100,48.56％in 1∶320,77.78％in 1∶1 000,92.42％in≥1∶3 200).Thirdly,among the specimens detected ANAs positive,the composition ratios of anti-Scl-70,anti-PM-Scl and anti-PCNA antibodies in ANA positive cases was significantly lower than those in ANA negative cases(P＜0.001).Fourthly,the detection rate of anti-dsDNA antibody by ELISA was the highest(4.14％),which was significantly higher than those by IIF or IB(both P＜0.001),and the difference in detection efficacy of the latter two methods was also statistically significant(P＜0.001).Even so,the IIF and IB for the detection of anti-dsDNA antibody still had a certain complementary effect on ELISA.Fifthly,the positive rate of ANCA by IIF was significantly higher than that of ANCA spectrum(9.16％vs.2.43％),but among those who were detected anti-MPO antibodies and/or anti-PR3 antibodies positive,47.37％were ANCA negative.Conclusion Different methods for detecting autoantibodies have significantly different detection efficacy,and it is partic-ularly necessary to adopt correct detection strategies based on evidence-based medicine.

Background and Objectives: The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods: A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results: The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in postPCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

Periodontitis is a common chronic infectious oral disease, which is characterized by gingival inflammation,pocket formation, alveolar bone loss and tooth mobility. Psoriasis is a common chronic inflammatory skin disease, whose pathological features in skin lesions are excessive proliferation of epidermal cells, parakeratosis of the derma, and the infiltration of inflammatory cells. Both periodontitis and psoriasis are closely related to the interleukin(IL)-23/helper T cell 17(Th17)/IL-17 axis in their immunopathological mechanisms. The risk factors of psoriasis include smoking, vitamin D deficiency, obesity, emotional stress, etc, of which most factors are also common risk factors of periodontitis. The present article reviews the research advances in the interaction of the two diseases and their possible common mechanisms from three aspects, i.e. clinical study, IL-23/Th17/IL-17 pathway and common risk factors, which may be helpful to provide new ideas for clinical diagnosis and treatment.

Objective To explore the clinical characteristics of patients with autoimmune glial fibrillary acidic protein(GFAP) astrocytosis with central nervous system inflammation as the main manifestation.Methods Twenty-one patients with autoimmune GFAP astrocytosis with positive cerebrospinal fluid GFAP antibody were collected from January 2017 to April 2020.The clinical data of 14 patients with cerebrospinal fluid GFAP antibody positive were retrospectively analyzed.Results Among the 14 patients,4 were female and 10 were male.The age of onset was(42±16) years old.The main clinical manifestations of the patients were headache(13/14),fever(13/14),disturbance of consciousness(11/14),mental symptoms(10/14),epilepsy(4/10),defecation disorder(8/14),hypoxemia(6/14),limb paralysis(2/14),etc.MRI showed abnormal enhancement of intracranial meninges in 13 cases(13/14) and spinal cord involvement in 5 cases(5/14).Conclusion There are more males than females with autoimmune GFAP astrocytosis with cerebrospinal meningitis and other central system inflammation.MRI manifestations are complex.Intracranial and spinal cord can be involved at the same time.Intracranial lesions mainly involve meninges,which can be combined with cerebral cortex damage.In myelopathy,both the spinal cord and the spinal cord are involved,and the spinal cord membrane is mainly involved.

Objective To study the influence of conflict vessels of trigeminal neuralgia (TN) in microvascular decompression (MVD) efficacy.Methods The clinical data of 86 patients accepted MVD for TN,admitted to our hospital from July 2008 to August 2012,were retrospectively analyzed.According to the number of offending vessels under intranperative microscope,the patients were divided into single offending vessel group and multi-offending vessels group;the clinical features,distributions of offending vessels,imaging results and surgical findings of the two groups were compared.Results Forty-nine patients (57.0％) were enrolled to single offending vessel group,and 37 (43.0％) were enrolled to multi-offending vessels group;ratio of offside pain was higher than that of left side in both two groups.Conflict vessels in the single offending vessel group mainly were superior cerebellar artery (SCA,n=29,59.2％) and anterior inferior cerebellar artery (AICA,n=19,38.8％);conflict vessels in the multi-offending vessels group mainly were SCA+AICA (n=21,56.8％) and SCA+ petrosal vein (n=8,21.6％).Follow-up at 6 months after the operation showed an efficient outcome of 96.5％:the effective rate of single offending vessel group was 98.0％ while that of multi-offending vessels group was 94.6％ with significant difference(x2=0.003,P=0.958).No mortality or severe complications,such as hearing loss,cerebellar bleeding or cerebellar infarction,were recorded.Conclusions MVD is a safe and effective treatment for TN.MVD on multiple conflict vessels TN and that on single conflict vessel TN have approximate efficacy.