Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

ObjectiveTo investigate the trends and significant determinants of delayed HIV diagnosis （DHD） among newly reported HIV/AIDS cases in Xuhui District， Shanghai between 2018 and 2022. MethodsIn the newly reported HIV/AIDS cases， patients died within one year without accident， HIV/AIDS cases with CD₄ cell count <200 cells·μL^-1， and AIDS cases with a CD₄ cell count between 200 to 499 cells·μL^-1 were defined as delayed diagnosis. Univariate and multivariate logistic analysis were employed to explore the influencing factors of DHD. ResultsAmong the 862 newly reported HIV/AIDS cases， The DHD rate was 39.79% without statistically significant difference by year（χ²=4.508， P=0.342）. Patients with CD₄ cell count <200 cells·μL^-1 contributed the largest proportion of DHD. During 2018‒2022， the DHD rate declined among HIV/AIDS patients who were younger than 35 years old or 45‒65 years old， never married， original diagnosis from tertiary specialized hospitals. Patients who were 65 years or older， married or divorced， with heterosexual transmitted HIV/AIDS， and original diagnosis from other types of testing and tertiary metropolitan hospital， had sustainably higher DHD rates. The number of HIV screening and diagnosed from voluntary counseling and testing （VCT） decreased during the COVID-19 epidemic， while the DHD rate increased sharply. Multivariate logistic regression analysis suggested the DHD rates were higher among older age， other types of testing（OR=3.805， 95%CI： 2.260‒6.406）and pre-operative testing（OR=2.411， 95%CI： 1.424‒4.081）. Patients who received CD₄ test in 15 days had a higher DHD rate compared to the cases received CD₄ test exceeding 90 days （OR=0.336， 95%CI： 0.216‒0.522）. ConclusionThere is no significant decrease of delayed HIV diagnosis rate in Xuhui District in recent years， and the number of HIV tests has decreased in 2022. Monitoring of newly reported HIV/AIDS should be conducted continuously. Expansion of HIV antibody screening should be conducted in non-infectious departments and inpatient departments in healthcare institutions， particularly metropolitan hospitals. Assistance should be provided to clinicians and elderly patients for improving their ability to recognize and perceive the risk of HIV/AIDS， in order to enhance early diagnosis and subsequent treatment.

Severe fever with thrombocytopenia syndrome（SFTS）is a newly emerging infectious disease caused by a novel bunyavirus virus（SFTSV），characterized by fever，thrombocytopenia，leukopenia，and gastrointestinal symptoms. Since the first report of SFTS patients in China in 2010，SFTS cases have been reported in Japan，South Korea and other countries with increasing incidence areas and case numbers. In addition to tick bites，close contact with domestic animals or SFTS patients can also lead to SFTSV infection. SFTS progresses rapidly，and can cause multiple organ failure leading to death in severe patients，with a case fatality rate of up to 5%-30%. In recent years，with the development of medical and health undertakings and the increase of research on the disease，the case fatality rate has decreased year by year. There are no specific drug and effective vaccine for treatment of SFTS，and the application timing and clinical efficacy of antiviral therapy and immunotherapy are controversial. Therefore，symptomatic and supportive therapy is the main treatment，and early diagnosis and early treatment can reduce the severity and fatality rate of the disease.

Severe fever with thrombocytopenia syndrome（SFTS）is a newly emerging infectious disease caused by a novel bunyavirus virus（SFTSV），characterized by fever，thrombocytopenia，leukopenia，and gastrointestinal symptoms. Since the first report of SFTS patients in China in 2010，SFTS cases have been reported in Japan，South Korea and other countries with increasing incidence areas and case numbers. In addition to tick bites，close contact with domestic animals or SFTS patients can also lead to SFTSV infection. SFTS progresses rapidly，and can cause multiple organ failure leading to death in severe patients，with a case fatality rate of up to 5%-30%. In recent years，with the development of medical and health undertakings and the increase of research on the disease，the case fatality rate has decreased year by year. There are no specific drug and effective vaccine for treatment of SFTS，and the application timing and clinical efficacy of antiviral therapy and immunotherapy are controversial. Therefore，symptomatic and supportive therapy is the main treatment，and early diagnosis and early treatment can reduce the severity and fatality rate of the disease.

Mycobacterium avium- intracellulare complex is the term of a group of slow growing nontuberculous mycobacterium related to human infections, which has received more and more attention in recent years, and become an important public health issue. This article reviews the progress on clinical diagnosis and treatment of the infections caused by Mycobacterium avium- intracellulare complex.

The "Lübeck disaster", twins studies, adoptees studies, and other epidemiological observational studies have shown that host genetic factors play a significant role in determining the host susceptibility to Mycobacterium tuberculosis infection and pathogenesis of tuberculosis. From linkage analyses to genome-wide association studies, it has been discovered that human leucocyte antigen (HLA) genes as well as non-HLA genes (such as SLC11A1, VDR, ASAP1 as well as genes encoding cytokines and pattern recognition receptors) are associated with tuberculosis susceptibility. To provide ideas for subsequent studies about risk prediction of MTB infection and the diagnosis and treatment of tuberculosis, we review the research progress on tuberculosis susceptibility related genes in recent years, focusing on the correlation of HLA genes and non-HLA genes with the pathogenesis of tuberculosis. We also report the results of an enrichment analysis of the genes mentioned in the article. Most of these genes appear to be involved in the regulation of immune system and inflammation， and are also closely related to autoimmune diseases.
Humans ; Genome-Wide Association Study ; Tuberculosis/genetics* ; Gene Expression Regulation ; Cytokines/genetics* ; Autoimmune Diseases ; Mycobacterium tuberculosis/genetics* ; Genetic Predisposition to Disease

Tuberculosis (TB) is an ancient infectious disease. Before the availability of effective drug therapy, it had high morbidity and mortality. In the past 100 years, the discovery of revolutionary anti-TB drugs such as streptomycin, isoniazid, pyrazinamide, ethambutol and rifampicin, along with drug combination treatment, has greatly improved TB control globally. As anti-TB drugs were widely used, multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis emerged due to acquired genetic mutations, and this now presents a major problem for effective treatment. Genes associated with drug resistance have been identified, including katG mutations in isoniazid resistance, rpoB mutations in rifampin resistance, pncA mutations in pyrazinamide resistance, and gyrA mutations in quinolone resistance. The major mechanisms of drug resistance include loss of enzyme activity in prodrug activation, drug target alteration, overexpression of drug target, and overexpression of the efflux pump. During the disease process, Mycobacterium tuberculosis may reside in different microenvironments where it is expose to acidic pH, low oxygen, reactive oxygen species and anti-TB drugs, which can facilitate the development of non-replicating persisters and promote bacterial survival. The mechanisms of persister formation may include toxin-antitoxin (TA) modules, DNA protection and repair, protein degradation such as trans-translation, efflux, and altered metabolism. In recent years, the use of new anti-TB drugs, repurposed drugs, and their drug combinations has greatly improved treatment outcomes in patients with both drug-susceptible TB and MDR/XDR-TB. The importance of developing more effective drugs targeting persisters of Mycobacterium tuberculosis is emphasized. In addition, host-directed therapeutics using both conventional drugs and herbal medicines for more effective TB treatment should also be explored. In this article, we review historical aspects of the research on anti-TB drugs and discuss the current understanding and treatments of drug resistant and persistent tuberculosis to inform future therapeutic development.
Humans ; Pyrazinamide/therapeutic use* ; Isoniazid/therapeutic use* ; Antitubercular Agents/therapeutic use* ; Tuberculosis, Multidrug-Resistant/microbiology* ; Mycobacterium tuberculosis/genetics* ; Tuberculosis/drug therapy* ; Rifampin/therapeutic use* ; Mutation ; Drug Resistance, Multiple, Bacterial/genetics*

Despite the achievements obtained worldwide in the control of tuberculosis in recent years, many countries and regions including China still face challenges such as low diagnosis rate, high missed diagnosis rate, and delayed diagnosis of the disease. The discovery strategy of tuberculosis in China has changed from "active discovery by X-ray examination" to "passive discovery by self-referral due to symptoms", and currently the approach is integrated involving self-referral due to symptoms, active screening, and physical examination. Active screening could help to identify early asymptomatic and untreated cases. With the development of molecular biology and artificial intelligence-assisted diagnosis technology, there are more options for active screening among the large-scale populations. Although the implementation cost of a population-based active screening strategy is high, it has great value in social benefits, and active screening in special populations can obtain better benefits. Active screening of tuberculosis is an important component of the disease control. It is suggested that active screening strategies should be optimized according to the specific conditions of the regions to ultimately ensure the benefit of the tuberculosis control.
Humans ; Artificial Intelligence ; Tuberculosis/prevention & control* ; Mass Screening ; China