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*

Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.

Objective:To explore the feasibility of autosegmentation and reconstruction of interstitial needles in intracavitary / interstitial brachytherapy (IC-ISBT) for cervical cancer based on deep learning.Methods:The data of 180 treatment plans from 98 patients who received IC-ISBT were retrospectively collected and divided into the training, validation, and testing sets in a 16:1:1 ratio. Masks of needles were created using the dwell positions of radiation sources, and a 3D U-Net model was trained. The performance of the model was evaluated using the Dice similarity coefficient (DSC). Absolute and relative accuracy rates were used to assess the results of this method, and the position bias was used to evaluate the precision of predictions in the transversal plan of CT scans. Wilcoxon rank-sum test was performed to evaluate the reconstruction efficiency by comparing the time required for automated versus manual reconstruction.Results:DSC of the model was 0.93 ± 0.02. The absolute and relative accuracy rates were 0.44 ± 0.09 and 0.95 ± 0.03, respectively. The distance deviation on the CT horizontal plane was (0.58 ± 0.54) mm. The average time of autosegmentation and reconstruction was (6.2 ± 0.4) s, leading to a significant reduction in time consumption compared with manual construction ( P<0.001). Conclusions:Based on deep learning, using the dwell positions of radiation sources for data annotation, combined with post-processing algorithms, accurate automated segmentation and digital reconstruction of needles in IC-ISBT three-dimensional CT images can be achieved, significantly improving reconstruction efficiency.

Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.

Objective:To explore the feasibility of autosegmentation and reconstruction of interstitial needles in intracavitary / interstitial brachytherapy (IC-ISBT) for cervical cancer based on deep learning.Methods:The data of 180 treatment plans from 98 patients who received IC-ISBT were retrospectively collected and divided into the training, validation, and testing sets in a 16:1:1 ratio. Masks of needles were created using the dwell positions of radiation sources, and a 3D U-Net model was trained. The performance of the model was evaluated using the Dice similarity coefficient (DSC). Absolute and relative accuracy rates were used to assess the results of this method, and the position bias was used to evaluate the precision of predictions in the transversal plan of CT scans. Wilcoxon rank-sum test was performed to evaluate the reconstruction efficiency by comparing the time required for automated versus manual reconstruction.Results:DSC of the model was 0.93 ± 0.02. The absolute and relative accuracy rates were 0.44 ± 0.09 and 0.95 ± 0.03, respectively. The distance deviation on the CT horizontal plane was (0.58 ± 0.54) mm. The average time of autosegmentation and reconstruction was (6.2 ± 0.4) s, leading to a significant reduction in time consumption compared with manual construction ( P<0.001). Conclusions:Based on deep learning, using the dwell positions of radiation sources for data annotation, combined with post-processing algorithms, accurate automated segmentation and digital reconstruction of needles in IC-ISBT three-dimensional CT images can be achieved, significantly improving reconstruction efficiency.

Objective:To assess the diagnostic efficiency of long-read sequencing (LRS) for the determination of CYP21A1P/ CYP21A2 and TNXA/ TNXB fusion genotypes among children with 21-hydroxylase deficiency (21-OHD) and explore their clinical characteristics. Methods:LRS sequencing was carried out on 30 children diagnosed with 21-OHD at the Department of Endocrinology, Fujian Children′s Hospital between November 2022 and September 2023 by clinical symptoms or conventional Sanger sequencing combined with multiple ligation-dependent probe amplification (MLPA). The results of the two methods were compared. Clinical data of the children were collected and analyzed. This study has been approved by the Medical Ethic Committee of the Fujian Children Hospital(Ethic No. 2022ETKLR10024).Results:Of the 30 children with 21-OHD, 11 (36.7%) were found to carry CYP21A1P/ CYP21A2 and TNXA/ TNXB fusion genes by LRS. The most common type of fused CYP21A1P/ CYP21A2 gene was CH-1 (61.5%), and 1 (3.3%) was found to harbor TNXA/ TNXB CH-1. 11 cases (36.7%) were found to carry large deletions by Sanger sequencing combined with MLPA, with the most common one being CYP21A2 exons 1-3 del (61.5%), which was followed by CYP21A2 exons 1-7 del (23.1%). Follow up of 11 patients carrying a fusion gene revealed that 6 were sale wasting (SW) types, 5 were simple virilizing (SV) types, whilst no non-classical (NC) type was found. Four girls had presented with central precocious puberty (CPP). One child carrying TNXA/ TNXB CH-1 had presented with CAH-X syndrome. Conclusion:Compared with Sanger sequencing combined with MLPA detection method, LRS sequencing was able to differentiate the subtypes of CYP21A1P/ CYP21A2 and TNXA/ TNXB fusion genes, pinpoint the breakpoints of the deletions, and directly determine the cis-trans position without the need to analyze the genotype of the pedigree members, which has provided a reliable method for the typing of 21-OHD. As some fusion genes may retain 21-hydroxylase activity, female carriers may have a higher incidence of CPP.

OBJECTIVE: To assess the diagnostic efficiency of long-read sequencing (LRS) for the determination of CYP21A1P/CYP21A2 and TNXA/TNXB fusion genotypes among children with 21-hydroxylase deficiency (21-OHD) and explore their clinical characteristics. METHODS: LRS sequencing was carried out on 30 children diagnosed with 21-OHD at the Department of Endocrinology, Fujian Children's Hospital between November 2022 and September 2023 by clinical symptoms or conventional Sanger sequencing combined with multiple ligation-dependent probe amplification (MLPA). The results of the two methods were compared. Clinical data of the children were collected and analyzed. This study has been approved by the Medical Ethics Committee of the Fujian Children's Hospital (Ethic No. 2022ETKLR10024). RESULTS: Of the 30 children with 21-OHD, 11 (36.7%) were found to carry CYP21A1P/CYP21A2 and TNXA/TNXB fusion genes by LRS. The most common type of fused CYP21A1P/CYP21A2 gene was CH-1 (72.7%), and 1 (3.3%) was found to harbor TNXA/TNXB CH-1. Eleven cases (36.7%) were found to carry large deletions by Sanger sequencing combined with MLPA, with the most common one being CYP21A2 exons 1-3 del (72.7%), which was followed by CYP21A2 exons 1-7 del (18.2%). Follow up of 11 patients carrying a fusion gene revealed that 6 were sale wasting (SW) types, 5 were simple virilizing (SV) types, whilst no non-classical (NC) type was found. Four girls had presented with central precocious puberty (CPP). One child carrying TNXA/TNXB CH-1 had presented with CAH-X syndrome. CONCLUSION Compared with Sanger sequencing combined with MLPA detection method, LRS sequencing was able to differentiate the subtypes of CYP21A1P/CYP21A2 and TNXA/TNXB fusion genes, pinpoint the breakpoints of the deletions, and directly determine the cis-trans position without the need to analyze the genotype of the pedigree members, which has provided a reliable method for the typing of 21-OHD. As some fusion genes may retain 21-hydroxylase activity, female carriers may have a higher incidence of CPP.
Humans ; Steroid 21-Hydroxylase/genetics* ; Adrenal Hyperplasia, Congenital/genetics* ; Child ; Female ; Male ; Child, Preschool ; Tenascin/genetics* ; Infant ; Genotype ; Sequence Analysis, DNA/methods* ; Pseudogenes

Objective To investigate the impact of cardiomyocyte ferroptosis on acute myocardial infarction(AMI)and its relationship with the expression of long non-coding RNA(lncRNA)GAS5.Methods An AMI model was established in eighteen male SD rats(6-8 weeks old),and then the subjected rats were randomly divided into blank control group,sham operation group,and model group,6 animals in each group.In 2 weeks after surgery,echocardiography was used to evaluate heart function,and TTC staining,HE staining and TUNEL staining were employed re-spectively to observe myocardial infarct area,histopathological changes of myocardial tissues and apoptosis in cardiomyocytes.Serum Fe2+concentration was measured with an iron ion detection kit.The expression levels of lncRNA GAS5,nuclear factor erythroid-derived 2-like 2(Nrf2),and glutathione peroxidase 4(GPX4)in myocardial tissues were detected with QT-PCR.Linear corre-lation analysis was performed to investigate the relationship between the expression of lncRNA GAS5,Nrf2 and GPX4 with Fe2+concentration.Western blotting was conducted for the protein levels of ferroptosis-related proteins,glutathione peroxidase 4(GPX4),nuclear factor erythroid-derived 2-like 2(Nrf2),glucose-regulated protein 78(GRP78),and cysteinyl aspartate specific proteinase 12(Caspase-12)in myocardial tissues.Results Western blotting revealed obvious in-creases in the protein levels of ferroptosis related proteins GRP78(1.11±0.13 vs 0.51±0.08,P＜0.01)and Caspase-12(1.23±0.05 vs 0.92±0.07,P＜0.05)and a decrease in those of ferroptosis inhibitor GPX4(0.27±0.11 vs 0.68±0.10,P＜0.01)and Nrf2(0.30±0.12 vs 0.58±0.04,P＜0.05)in the model group than the sham operation group.Additionally,QT-PCR showed that the mRNA levels of GPX4 and Nrf2 were notably lower,indicating cardiomyocyte ferroptosis,while that of lncRNA GAS5 was remarkably higher in the myocardial tissues of the model group than the sham operation group(P＜0.01).What's more,the expression of lncRNA GAS5 had a positive correlation with serum Fe2+concentration(P＜0.05).Conclusion AMI is closely associated with cardiomyocyte ferroptosis.lncRNA GAS5 is involved in the regulation of ferroptosis by Nrf2/GPX4 signaling pathway,which thus mediating the occurrence of heart failure after AMI.

Objective To explore the effect of health education based on LEARNS model in patients with urinary incontinence after laparoscopic radical prostatectomy. Methods A total of 76 patients with urinary incontinence after laparoscopic radical prostatectomy admitted to Fujian Cancer Hospital from February 2022 to December 2023 were selected and divided into control group and observation group according to random number table method,with 38 cases in each group. Patients in control group received routine health education,while patients in observation group received health education based on LEARNS model. Both groups were intervened for one month. Urinary control ability,pelvic floor muscle training knowledge level,pelvic floor muscle training accuracy rate and quality of life of two groups were compared before and after intervention. Results After the intervention,International Consultation on Incontinence questionnaire-urinary incontinence short form (ICIQ-UI SF) scores of patients in both groups were significantly lower than before intervention,and scores of pelvic floor muscle training knowledge questionnaire and 36-item short form health survey (SF-36) were significantly higher than before intervention (P<0.05). The ICIQ-UI SF score of observation group was significantly lower than that of control group,and the scores of pelvic floor muscle training knowledge questionnaire and SF-36 were significantly higher than those of control group (P<0.05). The correct rate of pelvic floor muscle training in observation group was significantly higher than that in control group (92.11％ vs. 68.42％,x2=6.727,P=0.009). Conclusion Health education based on LEARNS model can effectively improve the knowledge level and correct rate of pelvic floor muscle training of urinary incontinence patients after radical prostatectomy,improve the urinary control ability and quality of life of patients.

Objective To explore the effect of health education based on LEARNS model in patients with urinary incontinence after laparoscopic radical prostatectomy. Methods A total of 76 patients with urinary incontinence after laparoscopic radical prostatectomy admitted to Fujian Cancer Hospital from February 2022 to December 2023 were selected and divided into control group and observation group according to random number table method,with 38 cases in each group. Patients in control group received routine health education,while patients in observation group received health education based on LEARNS model. Both groups were intervened for one month. Urinary control ability,pelvic floor muscle training knowledge level,pelvic floor muscle training accuracy rate and quality of life of two groups were compared before and after intervention. Results After the intervention,International Consultation on Incontinence questionnaire-urinary incontinence short form (ICIQ-UI SF) scores of patients in both groups were significantly lower than before intervention,and scores of pelvic floor muscle training knowledge questionnaire and 36-item short form health survey (SF-36) were significantly higher than before intervention (P<0.05). The ICIQ-UI SF score of observation group was significantly lower than that of control group,and the scores of pelvic floor muscle training knowledge questionnaire and SF-36 were significantly higher than those of control group (P<0.05). The correct rate of pelvic floor muscle training in observation group was significantly higher than that in control group (92.11％ vs. 68.42％,x2=6.727,P=0.009). Conclusion Health education based on LEARNS model can effectively improve the knowledge level and correct rate of pelvic floor muscle training of urinary incontinence patients after radical prostatectomy,improve the urinary control ability and quality of life of patients.