Objective:The purpose of this study was to explore the critical values of monitored indexes of perioperative major adverse cardiac events(MACE), so as to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function to further improve the perioperative safety of elderly patients with biliary diseases.Methods:The clinical data of 246 elderly patients with biliary diseases in our hospital from May 2016 to February 2022 were collected.According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.The differences of clinical data, the monitoring indexes of postoperative cardiac function, and the coagulation function between the two groups were compared and analyzed.Logistic regression was used to analyze the independent risk factors of perioperative MACE, the cut-off value of the receiver operating characteristic(ROC)curve was calculated, and the Logistic multivariate prediction model was established.Results:In the MACE compared with the non-MACE group, age, postoperative complications and mortality, postoperative hospital stay, and the levels of postoperative high sensitivity troponin-I(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and D-dimer(D-D)were significantly increased(all P<0.05). Multivariate Logistic regression showed that postoperative BNP and D-D were two independent risk factors for perioperative MACE, and their cut-off values in the ROC curve were 382.65 pg/mL and 0.975mg/L respectively.The Logistic multivariate prediction model established by the Logistic regression equation was P= ex/(1+ ex), X=-5.710+ 0.003X 1+ 0.811X 2, where X 1 was the postoperative BNP level and X 2 was the postoperative D-D level.The accuracy, specificity and sensitivity of this prediction model for predicting perioperative MACE were 96.3%(237/246), 100.0%(235/235), and 18.2%(2/11). Conclusions:The Logistic multivariate prediction model established in this study can effectively predict the occurrence of perioperative MACE in elderly patients.Postoperative BNP and D-D were two independent risk factors for perioperative MACE.The cut-off values of BNP and D-D in the ROC curve could be used as critical values for monitoring perioperative MACE.Therefore, it is of great clinical significance to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function, and further improve the perioperative safety of elderly patients with biliary diseases.

Dental Caries is a kind of chronic oral disease that greatly threaten human being's health. Though dentists and researchers struggled for decades to combat this oral disease, the incidence and prevalence of dental caries remain quite high. Therefore, improving the disease management is a key issue for the whole population and life cycle management of dental caries. So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification. Dentists should perform oral examination and establish dental records at each visit. When treatment plan is made on the base of caries risk assessment and carious lesion activity, we need to work out patient‑centered and personalized treatment planning to regain oral microecological balance, to control caries progression and to restore the structure and function of the carious teeth. And the follow-up visits are made based on personalized caries management. This expert consensus mainly discusses caries risk assessment, caries treatment difficulty assessment and dental caries treatment plan, which are the most important parts of caries management in the whole life cycle.
Consensus ; Dental Care ; Dental Caries/prevention & control* ; Humans ; Prevalence

Objective:To understand the epidemiological characteristics of group A rotavirus (RVA) infection in hospitalized children under 5 years of age with diarrhea in 2019, and to provide reference for the surveillance of RVA.Methods:Stool samples and clinical information of hospitalized children under 5 years of age with diarrhea were collected from sentinel hospitals in 20 provinces in 2019. RVA nucleic acid detection and genotyping were performed according to the rotavirus detection method in the National Viral Diarrhea Surveillance Program.Results:A total of 5 395 viral diarrhea samples were collected, 5 038 were tested, and 1 247 diarrhea samples showed RVA positive results (1 247/5 038, 24.75%). The positive rate of RVA in Fujian province was the lowest (30/319, 9.40%), and the positive rate of RVA was the highest in Henan province (182/338, 53.85%). The positive rate of RVA in male and female children was 25.24%(762/3 019)and 24.02%(485/ 2 019), respectively. There was no significant gender distribution of RVA infection ( χ2 = 0.96, P=0.326). Children aged 12 to 17 months were mainly susceptible to RVA (342/1 033, 33.11%), and the positive rate of RVA in children aged 48 to 59 months was lower (35/227, 15.42%). RVA infection showed significant age distribution characteristics ( χ2 = 86.78, P<0.001). RVA infection had significant difference between urban and rural areas ( χ2 = 20.92, P<0.001) and seasonal characteristics ( χ2 =411.42, P<0.001). RVA genotyping showed that G9P[8] type (994/1 122, 88.59%) was the dominant epidemic strain. Conclusions:In 2019, the main genotype of RVA infection in hospitalized children under 5 years of age with diarrhea was G9P[8], and RVA infection had significant age, region and season characteristics.

Objective To study protective and therapeutic measures to improve perioperative safety in extremely elderly patients with biliary diseases.Methods A retrospective case-control study was conducted.The clinical data of elderly patients with biliary diseases treated at the Department of General Surgery,Beijing Electric Power Hospital,from July 2013 to December 2018,were collected.According to age,the patients were divided into the high age (HA) group (≥80.0 years) and the middle-low age (MLA) group (60.0～79.0 years).The related indexes of perioperative safety such as preoperative coexisting diseases,functions of liver,kidney,heart and lung,surgical procedures,intraoperative blood loss,operation time,postoperative hospital stay and postoperative hospital stay were analyzed and compared between the two groups.Results Of the 372 included patients,there were 168 males and 204 females,aged 60.0 to 96.0 (72.0 ± 8.6) years.There were 69 elderly patients (37 males and 32 females) aged 80.0 to 96.0 (84.4 ±3.8) years in the HA group.There were 303 patients in the middle and lower age group (131 men and 172 women),aged 60.0 to 79.0(68.4 ±5.8) years (MLA group).(1) Preoperative coexisting diseases were significantly increased in the HA compared with the MLA group (all P ＜ 0.05),including the proportion of coexisting coronary heart disease [34.8％ (24/69) vs.18.5％ (56/303)],hypertension [68.1％ (47/69)vs.46.9％ (142/303)],chronic bronchitis with emphysema [17.4％ (12/69) vs.3.6％ (11/303)],hypoproteinemia [39.1％ (27/69) vs.26.7％ (81/303)],and anemia [42.0％ (29/69) vs.11.9％ (36/303)].(2) Laboratory examinations:the functions of liver,kidney,heart,lung and blood coagulation were significantly worse in the HA compared with the MLA group (P ＜ 0.05).(3) Surgical procedures:the proportion of open cholecystectomy with transcystic common bile duct exploration (OC + OTCBDE) was higher [17.4％ (12/69) vs.6.9％ (21/303)],while laparoscopic cholecystectomy (LC) was lower [43.5％ (30/69) vs.62.7％ (190/303)],in the HA compared with the MLA group (P ＜0.05,totally).(4) Operative effects:the intraoperative blood loss [30.0 (20.0,75.0) ml vs.20.0 (10.0,30.0) ml],operation time [90.0(72.5,137.5) min vs.77.0(55.0,115.0) min],postoperative hospital stay [10.0(6.0,18.0) d vs.7.0(4.0,11.0) d],and length of hospitalization [17.0(11.5,23.0) d vs.13.0(9.0,19.0) d] were significantly increased or prolonged in the HA compared with the MLA group (all P ＜0.05).(5) Postoperative complications:the incidence of postoperative complications was significantly higher [30.4％ (21/69) vs.12.2％ (37/303)] in the HA compared with the MLA group (P ＜ 0.05).(6) Therapeutic outcomes:there was a cure rate of 95.7％ (66/69) in the HA group,and 97.7％ (296/303)in the MLA group.No significant difference in the therapeutic effects was found between the two groups (P ＞ 0.05).Conclusions Operation in extremely elderly patients with biliary diseases is safe and feasible.The key is to take measures such as actively treating preoperative coexisting diseases,strictly mastering operative indications,reasonably selecting surgical procedures,accurately carrying out precise operation,strictly monitoring and dealing with intraoperative emergency,timely preventing and treating postoperative complications,and especially focusing on maintaining cardiopulmonary function during the perioperative period.

Objective:To observe the natural course of patients with simple traumatic intraparenchymal contusions and hematomas (TIPHs), and analyze the risk factors for TIPHs progression.Methods:Using a prospective observational study, 69 patients with TIPHs in Affiliated Xiaolan Hospital, Southern Medical University from July 2018 to January 2020 were selected. The gender, age, cause of injury, compound injury status, combined injury and Glasgow coma score (GCS) were recorded. The plasma levels of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), international normalized ratio (INR), D-dimer, platelet, hemoglobin at admission were detected. The occurrence of hypoxemia and high intracranial pressure were observed. The time of the first CT examination, volume of the first CT hematoma, time of the control CT examination, volume of the control CT hematoma, and lesion morphology, multifocality, subarachnoid hemorrhage (SAH), edema zone and cortical distance showed in the first CT examination were recorded. The risk factors of progression in patients with TIPHs were analyzed.Results:Among 69 patients with TIPHs, TIPHs progression was in 28 cases (progression group), and the progression rate was 40.58%; TIPHs progression was not in 41 cases (non-progression group). There were no statistical differences in gender composition, age, PT, APTT, INR, hemoglobin, cause of injury, compound injury, incidence of hypoxemia, incidence of high intracranial pressure, incidence of SAH, incidence of edema zone, incidence of irregular lesions, time of the first CT examination, time of the control CT examination and volume of the first CT hematoma between 2 groups ( P>0.05). The GCS, cortical distance and Fbg in progression group were significantly lower than those in non-progression group, the TT, platelet, multifocality rate and volume of the control CT hematoma were significantly higher than those in non-progression group, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that cortical distance <1 cm, Fbg<2 g/L and multifocality were independent risk factors affecting the progression in patients with TIPHs ( OR = 6.723, 5.515 and 4.827; P<0.05). The model had a sensitivity of 71.43% (20/28), a specificity of 92.68% (38/41), and an accuracy of 84.06% (58/69) in judging the progression of TIPHs. Conclusions:Based on the risk factors for the progression of TIPHs, predicting these patients in advance can provide necessary intervention measures for high-risk patients, which will help to reduce the rate of progression and improve the prognosis of patients.

Objective:To observe the natural course of cerebral contusion and laceration combined with hematoma formation and analyze the risk factors for its progression.Methods:Patients with cerebral contusion and laceration combined with hematoma formation admitted to our hospital from September 2017 to March 2020 were prospectively selected; and they were divided into progressive and non-progressive groups according to progression of cerebral contusion and laceration combined with hematoma formation. The clinical data of the two groups of patients were compared, and multivariate Logistic regression was used to analyze the independent influencing factors for progressive cerebral contusion and laceration combined with hematoma formation.Results:A total of 197 patients with cerebral contusion and laceration combined with hematoma formation were included in this study, of which, 61 were treated with craniotomy and 136 were treated conservatively; 85 patients had progressive cerebral contusion and laceration combined with hematoma formation and 112 patients had non-progressive cerebral contusion and laceration combined with hematoma formation. As compared with those in the non-progressive group, the baseline Glasgow Coma Scale (GCS) scores of the progressive group were lower, hematoma volume by second CT scan was larger, distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex was shorter, platelet count and thrombin time increased, fibrinogen (FIB) content decreased, and proportion of patients with multiple lesions in the first CT scan was higher in the progressive group, with significant differences ( P<0.05). Multivariate Logistic regression analysis showed that the distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex<1 cm, plasma FIB<2 g/L, multiple lesions of cerebral contusion and laceration or hematoma on first CT scan were risk factors for progression in patients with cerebral contusion and laceration combined with hematoma formation ( OR=6.654, 95%CI: 1.391-35.089, P=0.025; OR=5.617, 95%CI: 1.136-28.022, P=0.034; OR=4.629, 95%CI: 1.178-20.071, P=0.031). Conclusion:The patients with short distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex, low plasma FIB, and multiple lesions of cerebral contusion and laceration or hematoma on first CT scan are prone to have progressive cerebral contusion and hematoma formation.

Objective To realize the tactile and slip sensory functions for electromyogram controlled prosthetic hand. Methods The piezoelectric membrane polyvinylidence floride (PVDF) was used to construct a transducer for the tactile and slip sensory feedback. The fea-ture and piezoelectric response of PVDF and its mechanism of signal production were studied. The feedback control system was designed and a prototype for testing the tactile and slip sensor function was constructed and tested. Results and Conclusion The signal response of PVDF sensor is obviously, and the PVDF sensor can be used in practice.

Objective To investigate the clinical value of continuously detecting serum and pelvic drainage fluid C-reactive protein (CRP) and drainage fluid matrix metalloproteinase-9 (MMP-9) in the early diagnosis of anastomotic leakage after anterior resection of low rectal cancer.Methods The levels of CRP and MMP-9 in serum and pelvic drainage fluid were measured on postoperative 1,3,5,7 d in 158 patients with low rectal cancer anterior resection.The patients were divided into the anastomotic group (n=9) and non-anastomotic leakage group (n=149).The differences in the detection values between the two groups were compared and analyzed statistically.Results Among 158 cases,anastomotic leakage occurred in 9 cases.The correlation analysis of serum and drainage fluid CRP detection value and postoperative days (POD) in the two groups showed the POD 3,POD 5 and POD 7 difference was statistically significant (P＜0.05).The ROC curve analysis showed that the accuracy of the serum and drainage fluid CRP continuous detection for diagnosing the anastomotic leakage on postoperative 3 d was middle,which on postoperative 5,7 d was higher.The patients with CRP detection value ＞ 128.23 mg/L and drainage fluid CRP ＞89.93 mg/L on postoperative 5 d and those with CRP detection value＞113.71 mg/L and drainage fluid CRP＞81.75 mg/L on postoperative 7 d developed the anastomotic leakage.The drainage fluid MMP-9 detection value had no statistical difference between the anastomotic leakage group and the non-anastomotic leakage group (P＞0.05).Conclusion Continuous detection of serum and drainage fluid CRP level can be used for early diagnosing postoperative anastomotic leakage in low rectal cancer anterior resection.The drainage fluid MMP-9 continuous detection has no relation with early diagnosis of anastomotic leakage after low rectal cancer anterior resection.

Objective To explore the related risk factors of anastomotic leakage after low rectal cancer anterior resection op-eration .Methods The clinical data of 158 patients with low rectal cancer anterior resection operation in this hospital from January 2011 to June 2016 were retrospectively analyzed .The clinical features and treatment factors were performed the univariate and mult-ivariate correlation analysis .Results The total incidence rate of anastomotic leakage was 5 .7% (9/158) .The univariate analysis showed that the age ,sex ,body mass index(BMI) ,preoperative concurrent disease ,tumor stage ,location ,pathological type ,preopera-tive intestinal obstruction and surgical mode (laparoscopy and laparotomy) had no significant correlation with postoperative anasto-motic leakage (P>0 .05) .Preventive ileostomy did not affect the incidence rate of anastomotic leakage (P=0 .694) .Postoperative placement of anorectal decompression tube could reduce the incidence rate of anastomotic leakage (P=0 .047) .The univariate and multivariate analysis showed that postoperative diarrhea was an independent risk factor for anastomotic leakage occurrence (OR=10 .522 ,P=0 .001) .Conclusion Postoperative early diarrhea is an independent risk factor for anastomotic leakage occurrence after rectal cancer anterior resection operation .Postoperative placement of anorectal decompression tube can reduce the incidence rate of anastomotic leakage .

Cholelithiasis is a kind of common and multiple diseases.In recent years,traditional laparotomy has been challenged by a minimally invasive surgery.Through literature review,the therapeutic method,effect,and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows.(1) For intrahepatic bile duct stones,the operation may be selected by laparoscopic liver resection,laparoscopic common bile duct exploration (LCBDE),or percutaneous transhepatic cholangioscopy.(2) For concomitant gallstones and common bile duct stones,the surgical approach can be selected as follows:laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation,LC plus laparoscopic transcystic common bile duct exploration,LC plus LCBDE,and T-tube drainage or primary suture.(3) For concomitant intrahepatic and extrahepatic bile duct stones,laparoscopic liver resection,choledochoscopy through the hepatic duct orifice on the hepatectomy cross section,LCBDE,EST,and percutaneous transhepatic cholangioscopic lithotripsy could be used.According to the abovementioned principle,the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.