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 observe the efficacy of different dosage of midazolam oral solution in re-lieving anxiety in children undergoing laparoscopic high ligation of the hernia sac with oblique inguinal her-nia.Methods A total of 120 children,93 males and 27 females,aged 2-6 years,78-120 cm in height and 11-25 kg in weight,ASA physical statusⅠ orⅡ,were selected to perform laparoscopic high ligation of inguinal oblique hernia sac under general anesthesia.According to random number table method,the chil-dren were divided into three groups:the oral midazolam 0.25 mg/kg group(group M1),0.5 mg/kg group(group M2),and 0.75 mg/kg group(group M3)30 minutes before anesthesia,40 children in each group.Modified Yale preoperative anxiety scale-short form(mYPAS-SF)was recorded at premedication,parental separation,and immediate induction of anesthesia.Induction compliance checklist(ICC)score,recovery time,extubation time,PACU residence time,pediatric anesthesia emergence delirium scale(PAED)and the modified face,legs,activity,cry and consolability scale(FLACC)30 minutes after operation were also recorded.Results Compared with before taking medication,mYPAS-SF scores in groups M2 and M3 at parental separation and immediate induction of anesthesia were significantly decreased(P＜0.05).Com-pared with group M1,mYPAS-SF scores at parental separation and immediate induction of anesthesia and ICC scores at immediate induction of anesthesia were significantly lower in groups M2 and M3(P＜0.05),the recovery time,extubation time and PACU resident time in groups M2 and M3 were significantly pro-longed,PAED score was decreased significantly within 30 minutes after operation(P＜0.05).Compared with group M2,the awakening time and extubation time in group M3 were significantly prolonged.(P＜0.05).Conclusion Oral midazolam 0.5 mg/kg or 0.75 mg/kg 30 minutes before anesthesia can effectively alleviate the preoperative anxiety of children,improve the degree of cooperation in anesthesia in-duction,and reduce the occurrence of postoperative agitation,the recovery time and extubation time pro-longed in children with oral midazolam 0.75 mg/kg.Therefore,an oral solution of midazolam 0.5 mg/kg was a more appropriate dose for preoperative antianxiety regimen in children.

Blood-brain barrier (BBB) damage after ischemia significantly influences stroke outcome. Compound LFHP-1c was previously discovered with neuroprotective role in stroke model, but its mechanism of action on protection of BBB disruption after stroke remains unknown. Here, we show that LFHP-1c, as a direct PGAM5 inhibitor, prevented BBB disruption after transient middle cerebral artery occlusion (tMCAO) in rats. Mechanistically, LFHP-1c binding with endothelial PGAM5 not only inhibited the PGAM5 phosphatase activity, but also reduced the interaction of PGAM5 with NRF2, which facilitated nuclear translocation of NRF2 to prevent BBB disruption from ischemia. Furthermore, LFHP-1c administration by targeting PGAM5 shows a trend toward reduced infarct volume, brain edema and neurological deficits in nonhuman primate

In most mammalian central nervous system diseases, axons are damaged.Due to the limited ability of damaged neurons to promote axonal regeneration, the formation of glial scar and the release of inhibitory nutrients, it is difficult to regenerate axons of damaged neurons. The purpose of this study was to investigate the effect of cerebroprotein hydrolysate for injection (II) (CBL) on neuritogenesis and its underlying mechanism. Immunofluorescence staining was used to detect the axon length of mouse neuroma cells (Neuro-2a) and mouse primary cortical neuronal cells. Western blotting was used to detect the expression of phosphorylated TrkB protein in Neuro-2a cells and mouse primary cortical neuronal cells. The results showed that CBL could increase the axon length of Neuro-2a cells or mouse primary cortical neuronal cells, and that the phosphorylation level of TrkB in neuronal cells was significantly increased when 5 μg/mL CBL was applied to neuronal cells for 1 h. In conclusion, CBL can promote neuritogenesis, and increase the expression of phosphorylated TrkB, which may be related to the activation of TrkB signaling pathway.

【Objective】 To explore the effect mechanism of Salvia miltiorrhiza and safflower on combined anti-ischemic stroke and verify relevant action targets in middle cerebral artery occlusion (MCAO) rat model based on network pharmacology. 【Methods】 ①Traditional Chinese Medicine Systems Pharmacology (TCMSP) and GeneCards databases were used to screen the active components, component targets and ischemic stroke targets of Salvia miltiorrhiza and safflower respectively. The above data were imported into STRING database for protein interaction network analysis, and Cytoscape3.8.0 software was used to construct protein interaction network (PPI) and component target interaction network. Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation analysis of target genes were performed using David online analysis tool. ② In this experiment, a rat model of ischemic stroke was prepared by using improved MCAO method, and immunohistochemical method and Real-time quantitative polymerase chain reaction (REAL-TIME PCR) to detect the positive expressions of NLRP3 inflammatory body and NF P65 protein in the brain tissue of rats in each group so as to explore the functional mechanism of anti-inflammation reaction against cerebral ischemia injury. 【Results】 ① A total of 87 effective components, corresponding to 253 targets, 1448 targets for ischemic stroke and 161 targets related to drugs and diseases, were screened from the Salvia milticorrhiza and safflower drug pairs. We obtained 730 biological processes, 81 cell components and 128 molecular functions through GO analysis, and 127 signal pathways through KEGG analysis. ②Immunohistochemical method and Real-time PCR determination results showed that compared with control group rats, model group rats had significantly increased tissue NLRP3 inflammatory body and NFkBp65 protein expressions (P<0.01). Compared with those in the model group, NLRP3 inflammatory body and NFkBp65 protein expressions significantly decreased in Dan red compatibility groups and nim horizon groups (P<0.01). 【Conclusion】 Compatibility of effective components in salvia miltiorrhiza, and carthamus tinctorius can further downregulate the release of inflammatory corpuscle NLRP3 through NFkB signaling pathway by blocking inflammatory lesions and thus plays the role of fighting against inflammatory damage.

Objective Comparation of the effects of intravenous lidocaine and dexmedetomidine on coughing during extubation after endoscopic thyroidectomy. Methods 60 patients who underwent endoscopic thyroidectomy were randomly divided into group L, group D and group C, each group included 20 cases. Group L were given a loading lidocaine 1.5 mg/kg over 10 minutes before anesthesia induction, followed by a continuous intravenous lidocaine 1.5 mg/ (kg·h) until 30 min before the end of surgery. Group D were given a loading dexmedetomidine 0.5μg/kg over 10 minutes before anesthesia induction, followed by a continuous intravenous dexmedetomidine 0.4 μg/ (kg · h) until 30 min before the end of surgery. Group C were given intravenous infusion of equal volume normal saline. The incidence and severity of coughing were recorded within 2 minutes after extubation. Hemodynamic variables were measured at T0 (before anaesthesia induction) , T1 (immediately after extubation) , and T2 (5 min after extubation). The volume of drainage was recorded within 24 hours after surgery. Results The incidence and grade of cough were significantly lower in group L and group D than in group C (P < 0.05). Compared with group L and group D, MAP and HR were significantly increased in group C at T1 and T2 (P < 0.05). Compared with group C, the volume of drainage was significantly reduced in group L and group D within 24 hours after surgery (P < 0.05).Conclusion Intravenous lidocaine and dexmedetomidine can effectively inhibit coughing during extubation period after endoscopic thyroidectomy, and there is no significant difference between the two treatments.

OBJECTIVE： To establish a method for simultaneous determination of gallic acid， cinnamic acid and catechin in 3 processed products of Rheum officinale. METHODS： RP-HPLC method was established. The determination was performed on Thermo ScientificTM Hypersil GOLD Dim column with mobile phase consisted of methanol-0.1％ phosphoric acid solution （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelength was set at 278 nm， and the column temperature was 30 ℃. The sample size was 10 μL. RESULTS： The linear range of gallic acid， cinnamic acid and catechin were 0.126 2-1.262 0 μg（r＝0.999 9）， 0.036 2-0.362 0  μg（r＝0.999 9） and 0.177 9-1.779 4 μg（r＝0.999 8）， respectively. Quantitative limits were 25.4， 28.2， 62.5 ng， and detection limits were 6.2， 3.6， 11.8 ng， respectively. RSDs of precision， stability， repeatability and durability tests were all less than 3％. The recoveries ranged from 94.64％-102.71％（RSD＝2.74％， n＝9）， 95.35％-102.49％（RSD＝2.44％， n＝9）， 93.56％-103.66％（RSD＝3.27％， n＝9）. The determination results showed that the contents of gallic acid and cinnamic acid in prepared R. officinale were higher， and the order of both were prepared R. officinale＞steamed R. officinale＞raw R. officinale. The content of catechin in raw R. officinale was higher， and the order of it was raw R. officinale＞ steamed R. officinale＞prepared R. officinale. CONCLUSIONS： The method is sensitive， reliable and reproducible. It can be used to determine the contents of gallic acid， cinnamic acid and catechins in 3 processed products of R. officinale simultaneously.

Objective To investigate the effect of different pressure CO2pneumoperitoneum on postoperative gastroeuteric function in female patients undergoing gynecological laparoscopic surgery. Methods A total of 120 female patients,aged 30-60 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective gynecological laparoscopic surgery were randomly into three groups (n=40 in each).The pressure of CO2pneumoperitoneum were set at 6-8,9-11 and 12-14 mm Hg in group L,group M and group H,respectively.All patients were detected on an empty stomach of serum concentrations of D-lactic acid 6 hours before operation and after opration.In addition,pH,PaCO2and PaO2were recor-ded before anesthesia (T1),before pneumoperitoneum (T2),1 hour after pneumoperitoneum (T3)2 hours after pneumoperitoneum (T4)and 1 hour (T5)after stopping pneumoperitoneum.The time of pneumoperitoneum,the time of first flatus,intake and defecation,length of primary hospital stays after operation were recorded.Results Compared with 6 hours before operation,the serum concen-trations of D-lactic acid were obviously increased at postoperative 6 hours in all groups (P<0.05). Compared with group L,the serum concentrations of D-lactic acid at 6 hours after operation were ob-viously increased in group M and group H (P<0.05).PaO2in three groups was not different at T1-T5.Compared with group L,pH at T3,T4was significantly decreased in group M and group H (P<0.05).Compared with group L,PaCO2was significantly increased at T3-T5in group M and group H (P<0.05 ).Compared with group L,the time of first flatus,intake and defecation,length of primary hospital stays after operation were obviously delayed in group M and group H(P<0.05). Conclusion The low pressure of CO2pneumoperitoneum can reduce the damage of CO2pneumoper-itoneum on postoperative gastroeuteric function and avail the recovery of parents’postoperative gas-troeutericfunction in female patients undergoing gynecological laparoscopic surgery.

Objective To observe the long-term prognosis and analyze the predictive factors of esophageal cancer patients treated with three-dimensional radiotherapy.Methods A total of 373 patients with esophageal squamous carcinoma who received three-dimensional radiotherapy were retrospectively enrolled in this study.Among these,231 cases received three dimensional conformal radiotherapy (3D-CRT) and the other 142 received intensity modulated radiotherapy (IMRT);202 cases received radiotherapy alone,and the other 171 received chemoradiotherapy;249 cases received involved-field irradiation(IFI),and the other 124 received elective nodal irradiation(ENI);60 cases received a total radiation dose of 50-60 Gy,and the other 313 received 60-70 Gy.Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS).The Logrank single factor analysis and Cox multivariate analysis were used to evaluate predictive factors of PFS and OS.Results The 1-,3-,5-year OS and PFS were 69.4％,33.7％,22.9％ and 63.8％,32.8％,22.4％,respectively.The median OS and PFS were 22.7 months (95％ CI 18.6-25.4 months) and 19.2 months (95％ CI 16.7-21.3 months) respectively.Univariate analysis showed that age,gender,tumor location,three-dimensional technology (3D-CRT vs.IMRT),chemotherapy,prophylactic irradiation to lymphatic drainage area and irradiation dose did not influence OS and PFS (P ＞ 0.05).T-stage,N-stage,TNM-stage and gross tumor volume (GTV) were significantly correlated to OS and PFS (x2 =5.836-14.526,P ＜ 0.05).The multivariate analysis showed that N-stage and GTV were independent predictive factors of OS and PFS (x2 =5.345-12.216,P ＜0.05).The OS and PFS of patients with two fields of lymph node metastases were worse than those with only one lymph node field metastasis (x2 =4.467,4.169,P ＜ 0.05).Conclusions The long-term efficacy for esophageal cancer patients could be significantly improved through 3D-CRT technology.N-stage and tumor volume were independent prognostic factors of OS and DFS.The number of lymph node metastasis field is significantly related to prognosis.

Objective To investigate the risk factors for acute radiation esophagitis andpneumonitis after radiation therapy in esophageal cancer (EC) patients with diabetes or hypertension.Methods A total of 373 EC patients receiving three dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were included in this study.Among these patients,42 showed concurrent with diabetes and 99 with hypertension.Radiation esophagitis or pneumonitis in patients with or without diabetes,and with or without hypertension were monitored in the 1-year follow up,respectively.Results The prevalence of grade 1,2,3 and 4 radiation esophagitis in diabetes and non-diabetes patients was 40.5％,38.1％,14.3％,4.8％ and 66.2％,27.8％,2.7％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in diabetes and non-diabetes patients was 31.0％,16.7％,9.5％ and 30.8％,15.7％,1.2％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes (x2 =13.573,12.279,P ＜ 0.05).The prevalence of grade 1,2,3 and 4 radiation esophagitis in hypertension and non-hypertension patients was 49.5％,38.4％,8.1％,3.0％ and 68.2％,25.5％,2.6％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in hypertension and non-hypertension patients were 30.3％,18.2％,5.1％ and 31.0％,15.0％,1.1％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension (x2 =5.695、5.422,P ＜ 0.05).Diabetes is an independent risk factor for grade 3 or above acute radiation esophagitis and pneumonitis.Conclusions Diabetes or hypertension might be risk factors for severe radiation esophagitis and pneumonitis in EC patients receiving radiation therapy.