1.Bacterial contamination of platelets apheresis: a single-center retrospective analysis
Yuanyuan LUO ; Chunya MA ; Lihui FU ; Zeshan WANG ; Yang YU
Chinese Journal of Blood Transfusion 2025;38(2):233-237
[Objective] To evaluate the risk of bacterial contamination of platelets apheresis and improve the clinical diagnosis rate of transfusion-transmitted bacterial infections. [Methods] A retrospective analysis was conducted on 11 cases involving bacterial contamination detected in apheresis platelets during quality inspections at our center from 2021 to 2023, as well as cases of transfusion-transmitted bacterial infection (TTBI) caused by platelet transfusion. The return of positive platelet bacteria test results and clinical transfusion adverse reactions were statistically analyzed. [Results] There were 9 donors with bacteria-contaminated platelets, of which 3 were reported as clinical transfusion reaction, 4 were detected by quality sampling, and 2 were identified by appearance detection before transfusion. The bacterial contamination rate of platelets was about 0.08% (9/10 762). The contaminated platelets were involved in 11 cases of TTBI, with an incidence of TTBI of approximately 0.05% (11/21 916). Only 3 cases of transfusion reactions were clinically reported, while the rest were case tracking with positive results of platelet bacterial test from quality sampling. The clinical return rate of TTBI was 27.27% (3/11), with an average reporting time of 8.12 hours after the occurrence of transfusion reactions. The majority of the contaminated platelets were detected at the end stage of storage, with 55.56% (5/9) of platelets collected on the 4th day after collection. Partial contaminated platelets were identified through quality sampling, with a positive rate of 2.78% (4/144). [Conclusion] The platelet bacterial contamination rate is high, but with low clinical return rate. It is recommended to conduct routine platelet bacterial monitoring and improve clinical diagnostic level.
2.Evaluation of the efficacy and safety of cryopreserved deglycerolized red blood cells infusion based on propensity score matching method
Wei YANG ; Fanfan FU ; Lei NIU ; Tingchen XU ; Xin ZHANG ; Hongmei SHI ; Lihui FU ; Chunya MA ; Yang YU
Chinese Journal of Blood Transfusion 2025;38(4):531-536
[Objective] To compare the efficacy and safety of deglycerolized red blood cells (DRBC) and suspended red blood cells (SRBC) based on the propensity score matching (PSM) method, so as to provide evidence for the rational use of DRBC resources in clinical practice. [Methods] A total of 89 patients who received DRBC transfusion and 2 916 patients who received SRBC transfusion in our hospital from January 2023 to September 2024 were included. A 1∶1 nearest neighbor PSM was used to balance covariates such as gender, age, and body mass index (BMI). The changes of hemoglobin (Hb), red blood cell (RBC) count, hematocrit (HCT), and inflammatory markers such as white blood cell (WBC) count, neutrophil (NE) count, C-reactive protein (CRP), and Interleukin-6(IL-6) in the last 72 hours after transfusion were analyzed by SPSS 26.0 and R software to evaluate clinical efficacy and transfusion safety. [Results] The baseline of the two groups was balanced after PSM (P>0.05). There was no significant difference in the total effective rate between the DRBC group (80.9%) and the SRBC group (86.5%) (P>0.05). In the SRBC group, WBC (×10
/L) increased from 9.634±6.742 to 10.147±6.835, CRP (mg/dL) increased from 5.468±4.647 to 6.174±6.114, and IL-6(pg/mL) decreased from 213.733±587.191 to 157.255±552.626. In the DRBC group, WBC (×10
/L) decreased from 11.123±7.880 to 11.011±8.549, CRP (mg/dL) decreased from 5.729±4.761 to 5.326±4.466, and IL-6(pg/mL) decreased from 238.806±639.060 to 152.255±266.558. Compared with the before treatment, the differences between the SRBC group and DRBC group were not statistically significant (P>0.05). Among all patients included in the statistics, the overall incidence of transfusion adverse reactions was 0.205% (6/2 916) in the SRBC group, and no adverse reactions occurred in the DRBC group. The incidence in the SRBC group was higher than that in the DRBC group. [Conclusion] Based on PSM analysis, there was no significant difference in the efficacy and safety of DRBC transfusion compared with SRBC transfusion, which can provide evidence-based support for routine application.
3.Clinical Effect of Xiaozhi Hugan Capsules in Treatment of Patients with Non-alcoholic Steatohepatitis and Its Impact on Serum IL-6 and MCP-1
Xiaoyan LIU ; Suping MA ; Qingliang MA ; Chunxiao LI ; Lihui ZHANG ; Huaxin CHEN ; Wenxia ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):185-192
ObjectiveTo observe the clinical effect of Xiaozhi Hugan capsules in treating patients with non-alcoholic steatohepatitis (NASH) combined with phlegm-dampness and blood stasis syndrome and its effects on serum interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1). MethodsA total of 124 patients with NASH combined with phlegm-dampness and blood stasis syndrome who were admitted to the Department of Spleen, Stomach, and Hepatobiliary Diseases, the First Affiliated Hospital of Henan University of Chinese Medicine from July 2020 to December 2022 were selected. According to the random number table method, patients were randomly divided into an observation group (62 cases) and a control group (62 cases). The treatment duration was 6 months. The observation group received Xiaozhi Hugan capsules orally, while the control group received polyene phosphatidylcholine capsules. The efficacy indicators included alanine aminotransferase (ALT), aspartate aminotransferase (AST), controlled attenuation parameter (CAP), liver stiffness measurement (LSM), traditional Chinese medicine (TCM) syndrome scores (discomfort/dull pain/distending pain in liver region, fatigue, etc.), body mass index (BMI), waist-to-height ratio (WHtR), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglycerides (TG), homeostatic model assessment for insulin resistance (HOMA-IR) [including fasting blood glucose (FBG) and fasting insulin level (INS)], free fatty acids (FFA), IL-6, and MCP-1. Adverse drug reactions were recorded. ResultsAfter treatment, the total effective rate in the observation group was 92.3% (48/52), while that in the control group was 75.5% (39/49). The total effective rate in the observation group was higher than that in the control group (χ2=5.339, P<0.05). After treatment, the TCM syndrome scores in both groups were significantly reduced (P<0.05), and the post-treatment scores in the observation group were better than those in the control group (P<0.05). After treatment, the levels of ALT, AST, TC, FFA, fasting insulin (FINS), HOMA-IR, MCP-1, IL-6, CAP, LSM, BMI, and WHtR were decreased (P<0.05) significantly in both groups, and the observation group showed superior improvement in the above indicators compared to the control group (P<0.05). The observation group exhibited significant reductions in TG and FBG (P<0.05) and an increase in HDL-C (P<0.05), while no significant changes were observed in the control group. The observation group was superior to the control group after treatment (P<0.05). No severe adverse reactions occurred in either group during the treatment. ConclusionXiaozhi Hugan capsules have significant clinical efficacy in treating patients with NASH combined with phlegm-dampness and blood stasis syndrome. It reduces hepatic steatosis, lowers liver stiffness, inhibits the expression of serum inflammatory factors, and alleviates liver inflammation. No obvious adverse reactions occur, suggesting it is suitable for clinical application.
4.Clinical Effect of Xiaozhi Hugan Capsules in Treatment of Patients with Non-alcoholic Steatohepatitis and Its Impact on Serum IL-6 and MCP-1
Xiaoyan LIU ; Suping MA ; Qingliang MA ; Chunxiao LI ; Lihui ZHANG ; Huaxin CHEN ; Wenxia ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):185-192
ObjectiveTo observe the clinical effect of Xiaozhi Hugan capsules in treating patients with non-alcoholic steatohepatitis (NASH) combined with phlegm-dampness and blood stasis syndrome and its effects on serum interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1). MethodsA total of 124 patients with NASH combined with phlegm-dampness and blood stasis syndrome who were admitted to the Department of Spleen, Stomach, and Hepatobiliary Diseases, the First Affiliated Hospital of Henan University of Chinese Medicine from July 2020 to December 2022 were selected. According to the random number table method, patients were randomly divided into an observation group (62 cases) and a control group (62 cases). The treatment duration was 6 months. The observation group received Xiaozhi Hugan capsules orally, while the control group received polyene phosphatidylcholine capsules. The efficacy indicators included alanine aminotransferase (ALT), aspartate aminotransferase (AST), controlled attenuation parameter (CAP), liver stiffness measurement (LSM), traditional Chinese medicine (TCM) syndrome scores (discomfort/dull pain/distending pain in liver region, fatigue, etc.), body mass index (BMI), waist-to-height ratio (WHtR), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglycerides (TG), homeostatic model assessment for insulin resistance (HOMA-IR) [including fasting blood glucose (FBG) and fasting insulin level (INS)], free fatty acids (FFA), IL-6, and MCP-1. Adverse drug reactions were recorded. ResultsAfter treatment, the total effective rate in the observation group was 92.3% (48/52), while that in the control group was 75.5% (39/49). The total effective rate in the observation group was higher than that in the control group (χ2=5.339, P<0.05). After treatment, the TCM syndrome scores in both groups were significantly reduced (P<0.05), and the post-treatment scores in the observation group were better than those in the control group (P<0.05). After treatment, the levels of ALT, AST, TC, FFA, fasting insulin (FINS), HOMA-IR, MCP-1, IL-6, CAP, LSM, BMI, and WHtR were decreased (P<0.05) significantly in both groups, and the observation group showed superior improvement in the above indicators compared to the control group (P<0.05). The observation group exhibited significant reductions in TG and FBG (P<0.05) and an increase in HDL-C (P<0.05), while no significant changes were observed in the control group. The observation group was superior to the control group after treatment (P<0.05). No severe adverse reactions occurred in either group during the treatment. ConclusionXiaozhi Hugan capsules have significant clinical efficacy in treating patients with NASH combined with phlegm-dampness and blood stasis syndrome. It reduces hepatic steatosis, lowers liver stiffness, inhibits the expression of serum inflammatory factors, and alleviates liver inflammation. No obvious adverse reactions occur, suggesting it is suitable for clinical application.
5.Study of diagnostic value of circRNA9226 combined with tumor markers in lung adenocarcinoma
Wei ZHOU ; Yangcong QI ; Zhangsheng ZHAO ; Lihui QIAN ; Youli MA ; Yinyu MU
China Modern Doctor 2025;63(17):16-19
Objective To investigate the value of peripheral blood circRNA9226 combined with tumor markers for the diagnosis of lung adenocarcinoma.Methods A total of 30 patients with lung adenocarcinoma who were admitted to the Affiliated Lihuili Hospital of Ningbo University from December 2022 to January 2023 were selected as case group.Additionally,twenty healthy individuals who underwent physical examinations during the same period were selected as control group.The expression levels of circRNA9226,carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,and albumin(Alb)were compared between two groups.The diagnostic efficacy of circRNA9226 and CEA for lung adenocarcinoma was evaluated by receiver operating characteristic(ROC)curve,and the correlation between circRNA9226 and other indicators was analyzed.Results The peripheral blood circRNA9226 expression levels in case group was higher than that in control group(P<0.05).The sensitivity of circRNA9226 and CEA for diagnosing lung adenocarcinoma was 83.3%and 46.7%,respectively,with specificity of 90.0%and 100.0%.Area under the curve(AUC)was 0.897 and 0.776,respectively.When both tests were combined,the sensitivity was 93.3%,accuracy was 92.0%,and AUC was 0.918,showing a significant improvement in both sensitivity and accuracy compared to single tests.The correlation analysis results showed that circRNA9226 was positively correlated with CEA concentration(r=0.371,P<0.05)and negatively correlated with Alb concentration(r=-0.548,P<0.05).Conclusion Peripheral blood circRNA9226 has advantages in distinguishing lung adenocarcinoma from healthy controls,and combined with CEA can further improve the diagnostic efficacy.
6.Monitoring results on iodine nutrition status of children in water borne iodine excess areas of Hebei Province from 2018 to 2023
YIN Zhijuan, JIA Lihui, TIAN Shenqian, GAO Xuejie, XU Ning, XU Dong, MA Jing
Chinese Journal of School Health 2025;46(9):1252-1256
Objective:
To investigate the iodine nutrition status of children in water borne iodine excess areas in Hebei Province, so as to provide references for scientific prevention and control of water borne iodine excess hazards.
Methods:
From March to September each year during 2018 to 2023, a cross sectional survey was conducted in 39 water borne iodine excess counties (measured in 2017) from 5 cities (Cangzhou, Hengshui, Xingtai, Handan and Langfang) in Hebei Province. The survey included the detection of iodine content in residents drinking water, the measurement of thyroid volume in children aged 6-12, the detection of salt iodine and urinary iodine. The iodine nutrition status and water iodine distribution of 6-12 year-old children were evaluated from different perspectives such as years, gender, and age. Kruskal-Wallis H- test, Mann-Whitney U test and Chi square test were used for group comparison.
Results:
A total of 38 755 children were surveyed from 2018 to 2023, and 1 270 drinking water samples were tested across the province. The mass volume concentration of iodine in water showed a decreasing trend over the years ( Z= -30.87, P <0.01). Among 38 470 salt samples monitored from children s home, 24 790 were not non iodized salt, with a non iodized salt rate of 64.44%. A total of 31 989 urine samples were collected from children aged 8-10 years, with the median urine iodine was 245.94 μg/L. Comparing the results of urinary iodine in children from different years, the median urinary iodine from 2018 to 2023 were 328.0, 339.3, 267.8, 279.1, 291.3, 186.5 μg/L, respectively, with statistically significant differences ( H= 4 138.40 , P <0.01). Further pairwise comparisons showed that the median urinary iodine of children in 2023 was lower than in all other years ( Z =-51.59 to -11.41, all P <0.01). Among children aged 6-12 years, 1 150 cases of goiter were detected and the rate of goiter was 3.0%; and the goiter rates in boys and girls were 2.8% and 3.1%, with no significant difference between the sexes ( χ 2= 2.76, P >0.05). There were significant differences in the rate of goiter among different years and ages ( χ 2=324.02, 191.61, both P <0.05).
Conclusions
With the progress of water reform in water borne iodine excess areas of Hebei Province, children s iodine nutrition has reduced from excessive state to suitable state. It is necessary to continue to expand the coverage of water based iodine reduction projects, and strengthen the monitoring of iodine nutrition status of key populations in water borne iodine excess areas.
7.Study on the Mechanism of Danhe Liuwei Dihuang Decoction in Ovariectomized NAFLD Rats Based on ERα/PGC1α/PPARα
Chenlu ZHAO ; Suping MA ; Fangdong SHANG ; Sutong LIU ; Lihui ZHANG ; Yuanyuan ZHENG ; Wenxia ZHAO
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(3):792-800
Objective To explore the effect on the expression of ERα/PGC1α/PPARα pathway,the therapeutic effect of Danhe Liuwei Dihuang Decoction on ovariectomized NAFLD rats was observed.Methods 60 female non-pregnant SPF SD rats were randomly divided into sham operation group(Sham),model group(Model),estrogen group(E2),traditional Chinese medicine high,medium and low dose group(DHR-H/M/L).Sham group was given normal diet after sham operation,and the other groups were given high-fat,high-fructose and high-cholesterol diet(HF/HF/HC)after bilateral ovariectomy to prepare postmenopausal NAFLD model.The Sham group and the Model group were given normal saline by gavage,and the other groups were given corresponding doses of drugs by gavage.The intervention time was 12 weeks,and the experimental period was 14 weeks.The general condition and body weight of rats in each group were recorded.HE staining of uterus was used to observe the morphology of uterus,HE staining of liver and oil red O staining were used to observe steatosis.Serum liver function(ALT,AST)and lipid metabolism indexes(TG,TC)were measured by automatic biochemical analyzer.The levels of serum E2 and free fatty acid(FFA)and the expression of FFA and TG in liver tissue were detected by ELISA.The mRNA and protein expressions of ERα,PGC1α and PPARα in liver tissues were detected by RT-PCR and Western blot.Results Compared with the Model group,by Danhe Liuwei Dihuang Decoction,the body weight and liver weight of ovariectomized NAFLD rats significantly decreased,liver fat deposition significantly decreased,E2 level increased,ALT,AST,TG,TC,FFA and liver tissue homogenate FFA,TG content significantly decreased,liver ERα,PGC1α,PPARα mRNA and protein expression up-regulated(P<0.05 or P<0.01).Conclusion Danhe Liuwei Dihuang Decoction can improve liver steatosis in postmenopausal NAFLD model rats.The mechanism may be related to up-regulating the expression of ERα/PGC1α/PPARα signaling pathway to promote liver FFA oxidation and reduce liver TG deposition.
8.Study of diagnostic value of circRNA9226 combined with tumor markers in lung adenocarcinoma
Wei ZHOU ; Yangcong QI ; Zhangsheng ZHAO ; Lihui QIAN ; Youli MA ; Yinyu MU
China Modern Doctor 2025;63(17):16-19
Objective To investigate the value of peripheral blood circRNA9226 combined with tumor markers for the diagnosis of lung adenocarcinoma.Methods A total of 30 patients with lung adenocarcinoma who were admitted to the Affiliated Lihuili Hospital of Ningbo University from December 2022 to January 2023 were selected as case group.Additionally,twenty healthy individuals who underwent physical examinations during the same period were selected as control group.The expression levels of circRNA9226,carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,and albumin(Alb)were compared between two groups.The diagnostic efficacy of circRNA9226 and CEA for lung adenocarcinoma was evaluated by receiver operating characteristic(ROC)curve,and the correlation between circRNA9226 and other indicators was analyzed.Results The peripheral blood circRNA9226 expression levels in case group was higher than that in control group(P<0.05).The sensitivity of circRNA9226 and CEA for diagnosing lung adenocarcinoma was 83.3%and 46.7%,respectively,with specificity of 90.0%and 100.0%.Area under the curve(AUC)was 0.897 and 0.776,respectively.When both tests were combined,the sensitivity was 93.3%,accuracy was 92.0%,and AUC was 0.918,showing a significant improvement in both sensitivity and accuracy compared to single tests.The correlation analysis results showed that circRNA9226 was positively correlated with CEA concentration(r=0.371,P<0.05)and negatively correlated with Alb concentration(r=-0.548,P<0.05).Conclusion Peripheral blood circRNA9226 has advantages in distinguishing lung adenocarcinoma from healthy controls,and combined with CEA can further improve the diagnostic efficacy.
9.Study on the Mechanism of Danhe Liuwei Dihuang Decoction in Ovariectomized NAFLD Rats Based on ERα/PGC1α/PPARα
Chenlu ZHAO ; Suping MA ; Fangdong SHANG ; Sutong LIU ; Lihui ZHANG ; Yuanyuan ZHENG ; Wenxia ZHAO
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(3):792-800
Objective To explore the effect on the expression of ERα/PGC1α/PPARα pathway,the therapeutic effect of Danhe Liuwei Dihuang Decoction on ovariectomized NAFLD rats was observed.Methods 60 female non-pregnant SPF SD rats were randomly divided into sham operation group(Sham),model group(Model),estrogen group(E2),traditional Chinese medicine high,medium and low dose group(DHR-H/M/L).Sham group was given normal diet after sham operation,and the other groups were given high-fat,high-fructose and high-cholesterol diet(HF/HF/HC)after bilateral ovariectomy to prepare postmenopausal NAFLD model.The Sham group and the Model group were given normal saline by gavage,and the other groups were given corresponding doses of drugs by gavage.The intervention time was 12 weeks,and the experimental period was 14 weeks.The general condition and body weight of rats in each group were recorded.HE staining of uterus was used to observe the morphology of uterus,HE staining of liver and oil red O staining were used to observe steatosis.Serum liver function(ALT,AST)and lipid metabolism indexes(TG,TC)were measured by automatic biochemical analyzer.The levels of serum E2 and free fatty acid(FFA)and the expression of FFA and TG in liver tissue were detected by ELISA.The mRNA and protein expressions of ERα,PGC1α and PPARα in liver tissues were detected by RT-PCR and Western blot.Results Compared with the Model group,by Danhe Liuwei Dihuang Decoction,the body weight and liver weight of ovariectomized NAFLD rats significantly decreased,liver fat deposition significantly decreased,E2 level increased,ALT,AST,TG,TC,FFA and liver tissue homogenate FFA,TG content significantly decreased,liver ERα,PGC1α,PPARα mRNA and protein expression up-regulated(P<0.05 or P<0.01).Conclusion Danhe Liuwei Dihuang Decoction can improve liver steatosis in postmenopausal NAFLD model rats.The mechanism may be related to up-regulating the expression of ERα/PGC1α/PPARα signaling pathway to promote liver FFA oxidation and reduce liver TG deposition.
10.Expert consensus on digital intraoral scanning technology
Jie YOU ; Wenjuan YAN ; Liting LIN ; Wen-Zhen GU ; Yarong HOU ; Wei XIAO ; Hui YAO ; Yaner LI ; Lihui MA ; Ruini ZHAO ; Junqi QIU ; Jianzhang LIU ; Yi ZHOU
Journal of Prevention and Treatment for Stomatological Diseases 2024;32(8):569-577
Digital intraoral scanning is a hot topic in the field of oral digital technology.In recent years,digital intra-oral scanning has gradually become the mainstream technology in orthodontics,prosthodontics,and implant dentistry.The precision of digital intraoral scanning and the accuracy and stitching of data collection are the keys to the success of the impression.However,the operators are less familiar with the intraoral scanning characteristics,imaging process-ing,operator scanning method,oral tissue specificity of the scanned object,and restoration design.Thus far,no unified standard and consensus on digital intraoral scanning technology has been achieved at home or abroad.To deal with the problems encountered in oral scanning and improve the quality of digital scanning,we collected common expert opin-ions and sought to expound the causes of scanning errors and countermeasures by summarizing the existing evidence.We also describe the scanning strategies under different oral impression requirements.The expert consensus is that due to various factors affecting the accuracy of digital intraoral scanning and the reproducibility of scanned images,adopting the correct scanning trajectory can shorten clinical operation time and improve scanning accuracy.The scanning trajec-tories mainly include the E-shaped,segmented,and S-shaped methods.When performing fixed denture restoration,it is recommended to first scan the abutment and adjacent teeth.When performing fixed denture restoration,it is recommend-ed to scan the abutment and adjacent teeth first.Then the cavity in the abutment area is excavated.Lastly,the cavity gap was scanned after completing the abutment preparation.This method not only meets clinical needs but also achieves the most reliable accuracy.When performing full denture restoration in edentulous jaws,setting markers on the mucosal tissue at the bottom of the alveolar ridge,simultaneously capturing images of the vestibular area,using different types of scanning paths such as Z-shaped,S-shaped,buccal-palatal and palatal-buccal pathways,segmented scanning of dental arches,and other strategies can reduce scanning errors and improve image stitching and overlap.For implant restora-tion,when a single crown restoration is supported by implants and a small span upper structure restoration,it is recom-mended to first pre-scan the required dental arch.Then the cavity in the abutment area is excavated.Lastly,scanning the cavity gap after installing the implant scanning rod.When repairing a bone level implant crown,an improved indi-rect scanning method can be used.The scanning process includes three steps:First,the temporary restoration,adjacent teeth,and gingival tissue in the mouth are scanned;second,the entire dental arch is scanned after installing a standard scanning rod on the implant;and third,the temporary restoration outside the mouth is scanned to obtain the three-di-mensional shape of the gingival contour of the implant neck,thereby increasing the stability of soft tissue scanning around the implant and improving scanning restoration.For dental implant fixed bridge repair with missing teeth,the mobility of the mucosa increases the difficulty of scanning,making it difficult for scanners to distinguish scanning rods of the same shape and size,which can easily cause image stacking errors.Higher accuracy of digital implant impres-sions can be achieved by changing the geometric shape of the scanning rods to change the optical curvature radius.The consensus confirms that as the range of scanned dental arches and the number of data concatenations increases,the scanning accuracy decreases accordingly,especially when performing full mouth implant restoration impressions.The difficulty of image stitching processing can easily be increased by the presence of unstable and uneven mucosal mor-phology inside the mouth and the lack of relatively obvious and fixed reference objects,which results in insufficient ac-curacy.When designing restorations of this type,it is advisable to carefully choose digital intraoral scanning methods to obtain model data.It is not recommended to use digital impressions when there are more than five missing teeth.


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