Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.

This study aimed to investigate the efficacy and safety of apatinib plus programmed cell death protein 1 (PD-1) blockades for patients with metastatic colorectal cancer (CRC) who were refractory to the standard regimens. In this retrospective study, patients with metastatic CRC who received apatinib plus PD-1 blockades in clinical practice were included. The initial dosage of apatinib was 250 mg or 500 mg, and PD-1 blockades were comprised of camrelizumab, sintilimab and pembrolizumab. Efficacy and safety data were collected through the hospital’s electronic medical record system. From October 2018 to March 2022, a total of 43 patients with metastatic CRC were evaluated for efficacy and safety. The results showed an objective response rate of 25.6% (95% CI, 13.5%-41.2%) and a disease control rate of 72.1% (95% CI, 56.3%-84.7%). The median progression-free survival (PFS) of the cohort was 5.8 months (95% CI, 3.81-7.79), and the median overall survival (OS) was 10.3 months (95% CI, 5.75-14.85). The most common adverse reactions were fatigue (76.7%), hypertension (72.1%), diarrhea (62.8%), and hand-foot syndrome (51.2%).Multivariate Cox regression analysis revealed that Eastern Cooperative Oncology Group (ECOG) performance status and location of CRC (left or right-side) were independent factors to predict PFS of patients with metastatic CRC treated with the combination regimen. Consequently, the combination of apatinib and PD-1 blockades demonstrated potential efficacy and acceptable safety for patients with treatment-refractory metastatic CRC. This conclusion should be confirmed in prospective clinical trials subsequently.

Objective To apply intervention of integrated pharmaceutical care (IPC) for asthma-COPD overlap syn-drome patients,so as to reduce the side effects of drugs,enhance medication compliance,promote reasonable drug application,cut down the medical expenses in ACOS patients. Methods A total of 60 ACOS patients were randomly divided into IPC group (group A) (n=34) and contrast group(group B) (n=26).The patients in group A were given IPC measurements such as noso-comial guidance,classroom teaching,regular follow-up,life coaching and psychological advice.While the patients in group B were not given any intervention measures. Results In group A,patients' awareness rate of action and side-effects of drugs were ob-viously increased;Knowledges of inhalation preparation were greatly improved;the ratio of ADRs was significantly reduced;The FEV1 and the value added of FEV1 was dramatically improved.Furthermore,the differences showed statistical significance as com-pared with group B(P<0.05).Total medical costs and anti-bacterial drug costs per year were significantly lower in group A than group B. Conclusion IPC is beneficial to enhance drug compliance,promote reasonable drug application and bring down the medical expenses in ACOS patients.

Displaying Candida antarctica lipase B (CALB) on the cell surface of Aspergillus niger is effectively applied for the industries of food, cosmetics, pharmaceutical and so on. Displaying CALB using induced promoter of glucoamylase on the cell surface of A. niger SH-1 has some problems such as inhibiting its expression under high concentration of glucose, mycelium cleavage and decreasing enzyme activity in the later period of fermentation process. Displaying CALB manipulated by constitutive promoter from glyceraldehyde-3-phosphate dehydrogenase instead of glucoamylase on the cell surface of A. niger SH-1, called AN-GpdA, could solve the above problems effectively. Furthermore, it can not only use glucose, but also xylose as a sole carbon source. Enzyme activity of AN-GpdA using xylose for fermentation reached 1 100.28 U/g of dry cell. We also used lignocellulose such as the hydrolysate of bagasse for fermentation with good performance. The result would provide a novel strategy for the utilization of bagasse.

Objective: To investigate the application value of cardiovascular magnetic resonance tissue-tracking (CMR-TT) in the quantitative assessment of global and segmental myocardial strain after myocardial infarction. Methods: From June 2013 to June 2017, 45 patients with chronic myocardial infarction from the Second Affiliated Hospital of Nanchang University and eighteen normal volunteers as a control group were included in our research. All participants received CMR examination on a 3.0 T MRI scanner. Imaging protocol including FIESTA cine sequence (left ventricle short-axis planes, four chamber and two chamber long-axis planes) and late gadolinium enhancement (LGE). CMR-TT was undertaken using cvi 42 dedicated commercial software, global peak systolic circumferential, longitudinal, radial strains (GPCS, GPLS, GPRS) and segmental peak systolic circumferential, longitudinal, radial strains (PCS, PLS, PRS) in accordance with the American Heart Association's sixteen segment model were all derived. All segments were divided into five groups according to transmural extent expressed as enhanced area per segment: 0% as non-LGE segments group, 1 %-25 % as mild LGE segments group, 26%-50 % as moderate LGE segments group, 51%-75% as severe LGE segments group and >75% as complete LGE segments group. Two-independent samples t-test and Kruskal-Wallis H test were used, respectively, to compare means of 2 and 3 or more groups of continuous variables. Variables with normal distribution were presented as ±s, non-normal variables were reported as median (interquartile range). Results: Patients showed significant lower GPRS, GPCS and GPLS than the control group (15.13%±8.18%, -8.25%±3.23%, -7.11%±2.41% versus 32.41%±12.99%, -14.92%±3.32%, -11.50%±2.51%). PRS, PCS and PLS statistically significantly decreased with increasing extent of myocardial enhancement (t=-6.35,7.33,6.44, P<0.001).Segmental peak systolic strains of five groups were:PRS:24.87% (10.95%,39.02%), 13.26%(5.94%,24.24)%, 9.47%(4.01%,18.40%), 5.98%(-3.74%,11.86%), -2.65%(-6.62%,8.59%), respectively; PCS: -11.84%±5.34%, -8.60%±5.48%, -7.32%±5.59%, -5.30%±5.52%, -2.74%±5.24%, respectively; PLS: -9.47%±6.82%, -7.72%±6.22%, -7.07%±6.49%, -5.55%±5.95%, -3.54%±5.44%, respectively. The differences in the groups were statistically significant (H=164.47,166.61, 59.06, P<0.001). GPRS was positively correlated with LVEF(r=0.543, P<0.001), while GPCS and GPLS were both negatively associated with LVEF (r=-0.654, P<0.001; r=-0.682, P<0.001, respectively). Conclusions CMR-TT can quantitatively assess the severity of myocardial infarction accurately and reliably.Strain parameters have a good correlation with cardiac function indexes, this may be helpful in the recognition of left ventricular remodel after MI.

TCM gel paste is a new transdermal medicine delivery system, with a lot of advantages, which has been widely used in clinic. By searching domestic research literature about TCM gel paste in recent years, this article reviewed from patent overview, matrix, transdermal absorption enhancer, preparation technology, quality evaluation, clinical efficacy and safety, problems and prospects, with a purpose to provide references for clinical medication of TCM gel paste.

Objective To evaluate wall histological abnormalities 2 to 3 cm to the end in high or intermediate anal atresia in order to identify features that explain postoperative bowel dysfunctions.Methods Sixty anal atresia patients treated in the Capital Pediatric Institution between January 2008 and December 2012 were recruited in our study.36 patients were resected the terminal anal segment (3 cm).Compared with those 24 cases who were not.Resected samples were fixed for HE and immuno-histochemical stainings.Clinical data including sacral ratio (SR),age at operation,gender,bowel function were evaluated.Results There was no significant difference in patients' SR value,gender and age at operation between resected group and control group.The median follow-up period was 4.5 years.The rates of voluntary bowel movement,soiling (grade 1,2,3) were similar in both groups,however,the rates of severe constipation in resection group was significantly lower that in control group (3 ％ vs.21％,P ＜ 0.05) In the bowel wall of distal 2 cm anrectal canal,the connective tissue was found to be irregular and abnormally represented.Muscle coat was abnormal in all cases,showing the dysplasia circular and longitudinal layers.The number of enteric nervous system was significant fewer in distal 2cm anrectal canal than that in distal 3 cm(1.6 ±0.9 vs.5.6 ±1.8,t=11.715,P＜0.01).Conclusions Resection of terminal 3 cm at least of the atresia anal canal benefits postoperative bowel defecation function.

Objective To investigate the current status of agitated behaviors among institutionalized elderly with dementia. Methods The Cohen-Mansfield Agitation Inventory (CMAI) and General Information questionnaire were used to collect information of agitated behaviors among 141 institutionalized elderly with dementia in a long-term care facility in Guangzhou. Results Nearly 90.07％(127/141) of the elderly with dementia had the symptoms of agitation. Among the four categories of the agitated behaviors, the incidence for physically non-aggressive behaviors (82.27％, 116/141) was the highest, followed by physically aggressive behaviors (78.72％ , 111/141), verbally non- aggressive behaviors (74.47％, 105/141) and verbally aggressive behaviors (64.54％, 91/141). Spitting, repetitive sentences or questions, complaining occurred frequently. Conclusions The incidence of the agitated behaviors was high and the manifestation and types of agitated behaviors were varied, which should be paid attention to by the institution. It is necessary to develop the personalized, systematic, standardized nursing intervention to provide the support for caregivers and help the elderly with dementia to cope with agitation.

Human 5-lipoxygenase (5-LOX) is a well-validated drug target and its inhibitors are potential drugs for treating leukotriene-related disorders. Our previous work on structural optimization of the hit compound 2 from our in-house collection identified two lead compounds, 3a and 3b, exhibiting a potent inhibitory profile against 5-LOX with IC50 values less than 1 µmol/L in cell-based assays. Here, we further optimized these compounds to prepare a class of novel pyrazole derivatives by opening the fused-ring system. Several new compounds exhibited more potent inhibitory activity than the lead compounds against 5-LOX. In particular, compound 4e not only suppressed lipopolysaccharide-induced inflammation in brain inflammatory cells and protected neurons from oxidative toxicity, but also significantly decreased infarct damage in a mouse model of cerebral ischemia. Molecular docking analysis further confirmed the consistency of our theoretical results and experimental data. In conclusion, the excellent in vitro and in vivo inhibitory activities of these compounds against 5-LOX suggested that these novel chemical structures have a promising therapeutic potential to treat leukotriene-related disorders.

OBJECTIVETo explore the feasibility and efficacy of laparoscopic surgery in the treatment of children with persistent cloaca.

METHODSClinical data of 26 female children with high type persistent cloaca undergoing operation in the Capital Pediatric Institution between November 2005 and February 2015 were retrospectively analyzed. Mean age of these children was (1.4±1.6) years old. Distal end of rectum locating in the superior border of pubis was the standard of diagnosis. Laparoscopy-assisted anorectoplasty (LAARP), vaginoplasty and urethroplasty were performed in 17 cases (LAARP group), including 3-port laparoscopy in 12 cases and single-port laparoscopy in 5 cases. Abdominoperineal pull through (APPT), vaginoplasty and urethroplasty were performed in the other 9 cases (APPT group). Sacral ratio (SR), length of common channel, intraoperative blood loss, operation time, postoperative hospital stay, postoperative complications and bowel function were compared between two groups. Postoperative defecation was evaluated by the Krickenbeck standard.

RESULTSOperations were successfully performed in all patients and no case in LAARP group was transferred to open abdominal operation. There were no significant differences in SR value, length of common channel and age at operation between the two groups. As compared to APPT group, the mean operative time was shorter [(124.1±4.9) minutes vs. (131.8±3.2) minutes, P=0.000], the intraoperative blood loss was less [(10.5±2.1) ml vs. (16.2±2.7) ml, P=0.000], and the postoperative hospital stay was shorter [(5.7±0.5) days vs. (9.2±0.4) days, P=0.000] in LAARP group. In LAARP group, there were no significant differences in operation time, intraoperative blood loss and postoperative hospital stay between 3-port and single-port laparoscopic surgery (all P>0.05). The mean follow-up period was (4.0±2.8) months in LAARP group and (6.0±2.3) months of APPT group. There is one case have wound infection in ARRT patients. The rates of voluntary bowel movement, soiling, constipation (grade 1, 2, 3) were similar in both groups, however, the overall bowel function after LAARP was better than that of ARRT according to the Krickenbeck classification (10.7±0.2 vs. 9.7±1.2, P=0.047). Postoperative rectal mucosa prolapse was found in 2 cases of LAARP group and 1 case in APPT group. One case of APPT group developed wound infection. No urethrovaginal fistula relapse, anal stenosis or urethral stricture was found in all the cases.

CONCLUSIONSThe LAARP is safe and feasible in the treatment of persistent cloaca.