Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Objective:To investigate the impact of ginseng alcohol extract(GEE)on improving sleep quality in the aged Drosophila model by regulating the redox balance,and to elucidate its associated mechanism.Methods:Thirty-two male drosophila melanogaster(7-days-old)were randomly selected as young group,while 64 male Drosophila melanogaster flies(35-days-old)were randomly assigned to aged model group(n=32)and GEE group(n=32).The sleep parameters,including total sleep duration,daytime sleep duration,night sleep duration,0-4 h of sleep duration after lights off(ZT0-4 sleep duration),deep sleep duration,sleep episodetimes,sleep fragmentation,and the activity parameters such as the total number of locomotor activity daytime locomotor activity amount and nighttime locomotor activity amount were analyzed using the DAM2 Drosophila behavioral analysis system 7 d after administration.The grouping of the drosophila was as above,and there were 100 drosophila ineach group.The differentially expressed proteins in drosophila brain tissue were screened,identified,and functionally analyzed using two-dimensional fluorescence difference gel electrophoresis(2D-DIGE)and matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF/TOF-MS)proteomic methods.The grouping of the drosophila was as above,and there were 100 drosophila in each group.The activities of superoxide dismutase(SOD),catalase(CAT),and glutathione peroxidase(GSH-Px)and the levels of lipid peroxidation product(MDA)in brain tissue of the drosophila were determined using assay kits.Results:Compared with young group,the total sleep duration daytime sleep duration and night sleep cluration of the drosophila in agaed group were decreased(P<0.05 or P<0.01);and the sleep rhythm amplitude was shortened.Compared with aged group,the total sleep duration and daytime and nighttime sleep durations of the drosphila in GEE group were lengthened(P<0.01).Compared with young group,the ZT0-4 sleep duration deep sleep duration and sleep fragment of the drosophila in aged group were decreased(P<0.05 or P<0.01),and the sleep rhythm amplitude was shortened.Compared with young group,the ZT0-4 sleep duration,deep sleep duration,and single sleep fragment of the drosphila in GEE group were significantly prolonged(P<0.01),and the sleep amplitude was increased.Compared with young group,there was no significant difference in diurnal spontaneous activity or total spontaneous activity of the drosophila in aged group(P>0.05),while the nocturnal spontaneous activity was significantly increased(P<0.05).Compared with aged group,the diurnal spontaneous activity,nocturnal spontaneous activity,and total spontaneous activity of the drosophila in GEE group were significantly decreased(P<0.05 or P<0.01).A total of 47 differentially expressed proteins were selected in the 2D-DIGE electrophoretic mapping.Compared with young group,the expressions of 47 differentially expressed protein sites in aged group were down-regulated mainly including glutathione S-transferase,peroxiredoxin 1 and dihydrolipoic dehydrogenase,which were related to redox balance.Compared with young group,the activities of SOD,CAT and GSH-Px in brain tissue of the drosophila in aged group were decreased(P<0.05 or P<0.01),and the level of MDA was increased(P<0.01);compared with aged group,the activities of SOD,CAT and GSH-Px in brain tissue of the drosphila in GEE group were increased(P<0.05 or P<0.01),and the MDA level was decreased(P<0.05).Conclusion:GEE has improvement effect on the sleep quality of aged drosophila,and its possible mechanism may be related to upregulating the activities of antioxidant enzymes,inhibiting the accumulation of lipid peroxidation products,and maintaining redox balance.

Objective:Exploring the efficacy of indocyanine green（ICG）near-infrared fluorescence（NIRF）imaging technology in robotic-assisted laparoscopic partial nephrectomy for children with duplicated kidneys.Methods:A retrospective analysis was conducted on the medical records of 7 children with duplicated kidneys admitted to Guizhou Provincial People's Hospital from December 2023 to September 2024，including 3 males and 4 females. The patients with a median age of 36（2，132）months. All cases of duplicated kidneys were located at the renal pole，with 5 on the left side and 2 on the right side. All 7 patients had a history of worsening hydronephrosis，with 4 having a history of urinary tract infection and 1 accompanied by urinary incontinence（urine leakage outside the normal voiding period）. Preoperative diagnosis was confirmed via enhanced CT of the urinary tract，diuretic renal dynamic imaging（SPECT），and voiding cystourethrography. One case had an ectopic ureteral opening. One case had recurrent urinary tract infections following ureteral cyst fenestration surgery，and five cases had terminal ureteral obstruction. All seven cases showed that the functional capacity of the duplicated upper kidney was <10%. All 7 cases underwent robot-assisted laparoscopic repeated nephrectomy of the upper kidney using ICG-NIRF technology. Intraoperative ICG fluorescence imaging was performed in three stages：a catheter was inserted through the lower kidney ureter，and after the first injection of ICG，green fluorescence was observed in the lower kidney ureter. Under fluorescence guidance，the upper and lower ureters were anatomically dissected；The second ICG injection via intravenous administration revealed the vessels supplying the upper kidney，and the blood supply to the upper kidney was blocked；After the third ICG injection via intravenous administration，the normal lower kidney showed fluorescence imaging，while the ischemic upper kidney did not. The upper kidney was resected along the anatomical boundary between the upper and lower kidneys.Results:All 7 surgeries were successfully completed，with an average surgical time of（155.1 ± 22.7）min；Intraoperative blood loss was（12.5 ± 8.7）ml；postoperative hospital stay was（5.2 ± 1.7）days. Postoperative follow-up duration was（9.2 ± 3.5）months，with preoperative concomitant urinary tract infection and post-micturition dribbling symptoms resolved. No cases of ureteral stump effusion or urinary leakage were observed postoperatively. At the 3-month postoperative follow-up SPECT examination，no loss of lower kidney function was detected.Conclusions:The application of ICG-NIRF imaging technology in robotic-assisted laparoscopic heminephrectomy for children with duplicated kidneys is easy to perform and safe. Its main advantage is the ability to clearly identify normal ureters，blood vessels of non-functional kidneys，and the boundary between the upper and lower halves of the kidney，thereby guiding the optimization of surgical strategies.

Objective:Exploring the efficacy of indocyanine green（ICG）near-infrared fluorescence（NIRF）imaging technology in robotic-assisted laparoscopic partial nephrectomy for children with duplicated kidneys.Methods:A retrospective analysis was conducted on the medical records of 7 children with duplicated kidneys admitted to Guizhou Provincial People's Hospital from December 2023 to September 2024，including 3 males and 4 females. The patients with a median age of 36（2，132）months. All cases of duplicated kidneys were located at the renal pole，with 5 on the left side and 2 on the right side. All 7 patients had a history of worsening hydronephrosis，with 4 having a history of urinary tract infection and 1 accompanied by urinary incontinence（urine leakage outside the normal voiding period）. Preoperative diagnosis was confirmed via enhanced CT of the urinary tract，diuretic renal dynamic imaging（SPECT），and voiding cystourethrography. One case had an ectopic ureteral opening. One case had recurrent urinary tract infections following ureteral cyst fenestration surgery，and five cases had terminal ureteral obstruction. All seven cases showed that the functional capacity of the duplicated upper kidney was <10%. All 7 cases underwent robot-assisted laparoscopic repeated nephrectomy of the upper kidney using ICG-NIRF technology. Intraoperative ICG fluorescence imaging was performed in three stages：a catheter was inserted through the lower kidney ureter，and after the first injection of ICG，green fluorescence was observed in the lower kidney ureter. Under fluorescence guidance，the upper and lower ureters were anatomically dissected；The second ICG injection via intravenous administration revealed the vessels supplying the upper kidney，and the blood supply to the upper kidney was blocked；After the third ICG injection via intravenous administration，the normal lower kidney showed fluorescence imaging，while the ischemic upper kidney did not. The upper kidney was resected along the anatomical boundary between the upper and lower kidneys.Results:All 7 surgeries were successfully completed，with an average surgical time of（155.1 ± 22.7）min；Intraoperative blood loss was（12.5 ± 8.7）ml；postoperative hospital stay was（5.2 ± 1.7）days. Postoperative follow-up duration was（9.2 ± 3.5）months，with preoperative concomitant urinary tract infection and post-micturition dribbling symptoms resolved. No cases of ureteral stump effusion or urinary leakage were observed postoperatively. At the 3-month postoperative follow-up SPECT examination，no loss of lower kidney function was detected.Conclusions:The application of ICG-NIRF imaging technology in robotic-assisted laparoscopic heminephrectomy for children with duplicated kidneys is easy to perform and safe. Its main advantage is the ability to clearly identify normal ureters，blood vessels of non-functional kidneys，and the boundary between the upper and lower halves of the kidney，thereby guiding the optimization of surgical strategies.

Objective To improve the level of diagnosis and treatment through analyzing the clinical characteristics,treatment and prognosis with testicular torsion in children.Methods We conducted a retrospective analysis of 221 boys with testicular torsion,who received trearment from May 2003 to May 2023 at the Children's Hospital of Chongqing Medical University and Guizhou Provincial People's Hospital.Data analysed included:clinical characteristics,treatment progress and outcome.Results The peak onset age of testicular torsion in children was infancy and prepuberty(71％).The incidence of left side(77％)was higher than that of right side(23％).The first symptoms were mainly scrotal pain and swelling(62％),but some cases mainly manifested lower abdominal pain and inguinal pain(11％).The rate of misdiagnosis and mistreatment of patients in basic hospitals was high.Scrotal color Doppler ultrasonography is the first choice for assistant examination,and mainly showed none or dramatically decrease of blood supply in testis,and abnormal axial direction.The golden time for testicular torsion diagnosis was within 8 hours.The chief pathological manifestation were interstitial hyperemia,edema and seminiferous tubules degeneration within 8 hours,and hemorrhagic necrosis or infarction over 8 hours.Conclusions Children Testicular torsion occurs more frequently in infancy and prepuberty,torsion position in the left side is more than that in right side.The main symptoms are scrotal pain and swelling,as well as lower abdominal or inguinal pain.Testicular pathological lesion is closely associated with the diagnosis time and degree of torsion.

Lichen sclerosus in children often leads to serious complications due to lack of early understanding and management of the disease. This paper reports a case of Lichen sclerosus in children with severe malformation of the urethral meatus of the penis. The patient was treated at a local hospital for preputial stenosis and dysuria, and cicatricial phimosis was considered. During the operation, due to the rigid inner plate of the foreskin, the penile head of the foreskin was severely adherent and could not be separated, and the circumcising operation failed. Only the narrow ring of the foreskin on the back of the penis was cut to solve the difficulty of urination, resulting in serious malformations of the meatus of the penile head. Subsequently, the patient was treated in our hospital for cicatricial adhesion release, circumcision and external urethral ostium plastic surgery. The postoperative pathology showed sclerosing lichenoid degeneration. After 1 year follow-up, the appearance was satisfactory and urination was smooth.

Lichen sclerosus in children often leads to serious complications due to lack of early understanding and management of the disease. This paper reports a case of Lichen sclerosus in children with severe malformation of the urethral meatus of the penis. The patient was treated at a local hospital for preputial stenosis and dysuria, and cicatricial phimosis was considered. During the operation, due to the rigid inner plate of the foreskin, the penile head of the foreskin was severely adherent and could not be separated, and the circumcising operation failed. Only the narrow ring of the foreskin on the back of the penis was cut to solve the difficulty of urination, resulting in serious malformations of the meatus of the penile head. Subsequently, the patient was treated in our hospital for cicatricial adhesion release, circumcision and external urethral ostium plastic surgery. The postoperative pathology showed sclerosing lichenoid degeneration. After 1 year follow-up, the appearance was satisfactory and urination was smooth.

Objective : To investigate the effect of miR-135a-5p on the expression levels of insulin-like factor 3 (INSL3) and testosterone in the testicular tissues of flutamide-induced cryptorchidism mouse． Methods : A model of flutamide-induced cryptorchidism in mouse was constructed，and the experiment was divided into normal control group，flutamide group，flutamide + miR-135a-5p knockdown group and flutamide + miR-135a-5p overexpression group. RT-qPCR was used to detect the expression levels of miR-135a-5p and INSL3 mRNA．Western blot was em- ployed to assess the protein expression level of INSL3．ELISA was performed to measure the expression level of tes- tosterone. Results : The expression levels of miR-135a-5p，INSL3 mRNA and protein and testosterone were significantly down-regulated in the testis of cryptorchid mice by flutamide (P＜0. 05) ．Knockdown of miR-135a-5p could downregulate the expression of INSL3 mRNA，INSL3 protein and testosterone (P ＜0. 01 ) ，while overexpression of miR-135a-5p had the opposite result． Conclusion miR-135a-5p decreased in flutamide-induced cryptorchidism mouse testicular tissues，and overexpression of miR-135a-5p could restore the expression levels of INSL3 and testosterone.

Objective: To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL) with the all-seeing needle system(Microperc)for the treatment of upper urinary calculi in children. Methods: Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People′s Hospital was performed, including 18 boys and 7 girls.The age of patients was (6.4±3.9) years(10 months-14 years), and 4 cases were less than 3 years old.Among them, 3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 mm). Stone fragmentation was performed by using a 200 μm holmium(YAG laser fiber). Results: All patients were successfully treated in stage I. In 6 patients, access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL (10-12Fr) was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was (60.8±15.1) min (40-100 min). The mean postoperative drop in hemoglobin was (7.5±5.4) g/L, and no patient required blood transfusion.The hospital stay was (4.9±1.2) days (3-6 days). There were residual fragments in 3 patients, and the overall stone-free rate at 4 weeks was 88%(22/25 cases). Four cases had a fever(Clavien grade Ⅰ) complications, while no grade Ⅱ and grade Ⅲ complications were observed. Conclusions Microperc can establish a surgical channel through visual images quickly and safely, and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery, but also for patients with mild hydronephrosis and children with calculus.

Objective To explore the efficacy of Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children.Methods From February 2014 to August 2016,12 children with congenital monstrositas of vesicoureteral junction obstruction who were treated with pneumoeystoscopic Cohen ureteric reimplantation in Guizhou Provincial People's Hospital were selected.In these cases,8 males and 4 females,their ages ranged from 2 months past 1 year to 11 years,and the average age was 5.26 years.In the 12 patients,there were 6 cases with left vesicoureteral junction obstruction,and 1 case with right vesicoureteral junction obstruction,1 case with left ureter cyst and duplication of ureter ectopic opening,1 case with right duplex kidney and ureter cyst,1 case with right primary vesicoureteric reflux and left vesicoureteral junction obstruction,2 cases with bilateral primary vesicoureteric reflux and 1 case with ureter cyst.A foley catheter and ureteral stent was indwelled in each patient but no bladder fistula was made.All of the patients underwent pneumocystoscopic Cohen ureteric reimplantation.The stenting catheters were removed in 1-3 months after surgery.B ultrasonography was used to follow the degree of the dilatation of ureter and hydronephrosis.Urinalysis was conducted to detect the urinary tract infection.Intravenous urography examination was conducted to detect anastomotic stenosis.Voiding cystourethrography was performed to show ureteral reflux.Results All procedures were accomplished without conversion.The duration of operations ranged from 100 to 330 min (mean 207 min).All patients were followed up for 3 to 10 months,but no urinary tract infection and anastomotic obstruction occurred,and B ultrasonography showed that hydronephrosis or dilatation of ureter were improved in different degrees or disappeared.Two cases of ureteral reflux occurred in the early follow-up,and these cases recovered after being given symptomatic treatment.Conclusions The pneumocystoscopic Cohen ureteric reimplantation is a safe and effective option for congenital malformation of vesicoureteral junction in children.