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 compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To investigate the pathogen spectrum of acquired immunodeficiency syndrome (AIDS) patients with pulmonary opportunistic infections in the local area, and to evaluate the clinical application of metagenomic next-generation sequencing (mNGS) in these patients.Methods:From January to December 2021, AIDS patients with pulmonary infections admitted to Zhongnan Hospital of Wuhan University were enrolled. Their bronchoalveolar lavage fluid (BALF) was subjected to mNGS and coventional pathogen detection.Routine pathogen detection methods included smear, culture, polymerase chain reaction (PCR), and immunochromatographic colloidal gold. Fisher′s exact probability method was used for statistical analysis.Results:A total of 69 patients were included, and all of them were tested positive for mNGS. Among them, 53 cases (76.8%) were positive for fungi and viruses, 40 cases (58.0%) were positive for bacteria (excluding Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM)), six cases were positive for MTB, 11 cases were positive for NTM, and seven cases were positive for other pathogens. Mixed infections with two or more pathogens were found in 89.9%(62/69) of the patients. Among the conventional pathogen detections of BALF, 79.7%(55/69) of the patients were positive for pathogens, including 42 cases positive for Pneumocystis jirovecii PCR, 16 cases positive for BALF culture, nine cases positive for MTB PCR, and five cases positive for Cryptococcus antigen. The total detection rate of mNGS was 100.0%(69/69), which was higher than that of the conventional pathogen detection rate of 79.7%(55/69), and the difference was statistically significant (Fisher′s exact probability method, P<0.001). The specificity of mNGS detection was 88.4%. Combining clinical and two detection methods, the top five pathogens were Pneumocystis jirovecii (62.3%(43/69)), Candida (29.0%(20/69)), MTB (20.3%(14/69)), NTM and Talaromyces marneffei (15.9%(11/69), each). Fifty-three patients (76.8%) had co-infection with virus. Conclusions:The main cause of pulmonary infection in AIDS patients in this area is mixed infection, and Pneumocystis jirovecii is the most common pathogen. mNGS could significantly improve the pathogen detection rate in AIDS patients with pulmonary infections.

Objective To explore the potential mechanism of Jiangzhihugan capsule (JZHG) for fatty liver (FL), and to provide a theoretical guideline for the clinical application of JZHG. Methods TCMSP and TCMID databases were used to search for the active components and targets of JZHG. GeneCards and OMIM database were used to search the FL related targets. The intersection method was used to identify the common targets of JZHG and FL. Cytoscape software was applied for the construction of active compounds-targets network map. Protein-protein interaction network was constructed by STRING software. Gene ontology functional enrichment analysis and KEGG pathway enrichment analysis were conducted with Bioconductor database and R software. Results 46 potential active components were screened out from JZHG. 7406 targets were retrieved through GeneCard and OMIM database. 118 genes were obtained from the intersection of component-target and disease-target. These genes were mainly involved with the response to oxidative stress, apoptosis, inflammatory response, hormone resistance and other biological processes. The mechanism was related to PI3K-Akt signaling pathway, human cytomegalovirus infection, microRNAs in cancer, etc. Conclusion The mechanism of active ingredients for FL in JZHG may be due to improving lipid metabolism and reducing liver fat accumulation through anti-oxidative stress and anti-inflammatory effects.

Objective To establish a HPLC method for simultaneous determination of quercitrin, luteoloside, rutin and 2,3,5,4'-tetrahydroxystilbene-2-O-β-D-glucoside in Yangxue Anshen syrup. Methods Waters symmetry C₁₈ column (250 mm×4.6 mm, 5 μm) was used with 0.1% acetic acid (A) and methanol (B) as the mobile phase. Gradient elution was performed at a flow rate of 1.0 ml/min, 0-15 min, 95%-90%A; 15-35 min, 90%-70%A; 35-55 min, 70%-60%A; 55-85 min, 60%-50%A; 85-95 min, 10%A. The detection wavelengths were 256 nm and 320 nm. Column temperature was 30 ℃ and the injection volume was 10 μl. Results Quercitrin, luteoloside, rutin and 2,3,5,4'-tetrahydroxystilbene-2-O-β-D-glucoside showed good linear relationship within the range of 10-300, 5.0-150.0, 5.0-150.0, 20.0-600.0 µg/ml(r≥0.9989), respectively. The average recovery was (96.75±1.41)%, (99.61±1.01)%, (97.18±1.96)% and(99.12±0.97)% (n=6), respectively. Conclusion The established method is simple, accurate and stable, which can be used for the simultaneous determination of 4 components in Yangxue Anshen syrup.

Herba Monochasmae savatii, whole plant of the Monochasma savatier Franch. or Monochasma sheareri Franch. ex Maxim., scrophulariaceae, was first found in "Zhiwu Mingshi Tukao". It has the effects of clearing heat and detoxicating, dispelling wind and relieving pain, cooling the blood and stopping bleeding, etc. This review used Monochasma savatier Franch. or Monochasma sheareri Franch. ex Maxim. as the subject term to search CNKI, PubMed and SciFinder, and reviewed the classification of medicinal material, medicinal standards, chemical components, biological activities and pharmacological effects of Herba Monochasmae savatii in recent years to provide a basis for the research, development and clinical rational application.

Objective To investigate the main chemical constituents of the low polarity extracts from pinusmassoniana Lamb. leaves and their synergetic activity with fluconazole against fluconazole-resistant Candida albicans. Methods The pinusmassoniana leaves were extracted with 80% ethanol, and then the extracts were extracted by petroleum ether to obtain the low polarity extracts. The chemical components were detected by GC-MS and elucidated by the comparison with the standard mass spectral data. The relative contents in percentage were calculated using the area normalization method. The minimal inhibitory concentrations (MIC₈₀) of fluconazole-resistant Candida albicans strains by the low polarity extracts in combination with fluconazole were determined by checkerboard microdilution assay. Results 30 components were detected from the low polarity extracts, and 17 components were identified. The minimum inhibitory concentration (MIC₈₀) of the 80% ethanol extracts, the low polarity extracts and the petroleum ether extracts from the pinusmassoniana leaves combined with fluconazole against fluconazole-resistant Candida albicans were 7.81 μg/ml, 31.25 μg/ml and >250 μg/ml, respectively. Conclusion The 80% ethanol extracts of pinusmassoniana leaves and its low polarity extracts have synergistic activity combined with fluconazole onfluconazole-resistant Candida albicans. The diterpenoids (53.99%) may be the effective components of the low polarity extracts.

Objective:This clinical study describes the surgical methods and clinical effects for large skin and soft tissue defects of the extremities.Methods:Between October 2005 and February 2019, the patients with large skin and soft tissue defects of the extremities were hospitalized in the Department of Hand Surgery of the Orthopedic Hospital of Taizhou. The choice of flaps for primary phase repair was determined by the degree and the type of defect, including anterolateral thigh (ALT) flap, latissimus dorsi myocutaneous flap (LDMF), combined free ALT flap and osteocutaneous fibula flap and vascularized iliac osteocutaneous flap based on superficial circumflex iliac artery (SCIA). The donor site was primarily closed. And the appearance and function of donor and recipient sites were followed up.Results:Forty-five cases were performed in this study. There were 33 males and 12 females. The ages of the patients ranged from 21 to 65 years with an average of 35.2 years. The size of the defects ranged from 7 cm×6 cm to 32 cm×12 cm, with bone defects in 14 cases. The recipient sites included the free ALT flap in 17 (ranged from 11 cm×7 cm to 30 cm×12 cm), LDMF in 14 (ranged from 10 cm×7 cm to 32 cm×12 cm), ALT (ranged from 9 cm×6 cm to 16 cm×8 cm) + osteocutaneous fibula flap(ranged from 6 cm×4 cm to 9 cm×5 cm ) in 6, and iliac osteocutaneous flap based on SCIA (ranged from 7 cm×6 cm to 13 cm×8 cm). Among the 45 cases, 44 cases survived. There was one case with dorsal foot defect, which reconstructed by ALT flap, had vascular crisis after surgery. Although the vascular exploration was timely, the flap eventually necrotic. The ALT flap on the other side was successfully reapplied. Patients were followed up for average 4 years (ranging from 1-13 years), and all of them were satisfied with the function and final aesthetic outcomes. The two-point discrimination of the flap was 5 mm to 10 mm. The donor site healed well. There was no obvious scar hyperplasia except the latissimus dorsi donor.Conclusions:According to the size and depth of the large area of skin and soft tissue defects of extremities, and whether there are tendon, muscle and bone defects, a reasonable scheme is selected for repair, which can obtain good appearance and function after surgery, and less damage to the donor site.

Objective:This clinical study describes the surgical methods and clinical effects for large skin and soft tissue defects of the extremities.Methods:Between October 2005 and February 2019, the patients with large skin and soft tissue defects of the extremities were hospitalized in the Department of Hand Surgery of the Orthopedic Hospital of Taizhou. The choice of flaps for primary phase repair was determined by the degree and the type of defect, including anterolateral thigh (ALT) flap, latissimus dorsi myocutaneous flap (LDMF), combined free ALT flap and osteocutaneous fibula flap and vascularized iliac osteocutaneous flap based on superficial circumflex iliac artery (SCIA). The donor site was primarily closed. And the appearance and function of donor and recipient sites were followed up.Results:Forty-five cases were performed in this study. There were 33 males and 12 females. The ages of the patients ranged from 21 to 65 years with an average of 35.2 years. The size of the defects ranged from 7 cm×6 cm to 32 cm×12 cm, with bone defects in 14 cases. The recipient sites included the free ALT flap in 17 (ranged from 11 cm×7 cm to 30 cm×12 cm), LDMF in 14 (ranged from 10 cm×7 cm to 32 cm×12 cm), ALT (ranged from 9 cm×6 cm to 16 cm×8 cm) + osteocutaneous fibula flap(ranged from 6 cm×4 cm to 9 cm×5 cm ) in 6, and iliac osteocutaneous flap based on SCIA (ranged from 7 cm×6 cm to 13 cm×8 cm). Among the 45 cases, 44 cases survived. There was one case with dorsal foot defect, which reconstructed by ALT flap, had vascular crisis after surgery. Although the vascular exploration was timely, the flap eventually necrotic. The ALT flap on the other side was successfully reapplied. Patients were followed up for average 4 years (ranging from 1-13 years), and all of them were satisfied with the function and final aesthetic outcomes. The two-point discrimination of the flap was 5 mm to 10 mm. The donor site healed well. There was no obvious scar hyperplasia except the latissimus dorsi donor.Conclusions:According to the size and depth of the large area of skin and soft tissue defects of extremities, and whether there are tendon, muscle and bone defects, a reasonable scheme is selected for repair, which can obtain good appearance and function after surgery, and less damage to the donor site.