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 compare the effects of early orthodontic intervention and conventional sequential periodontal-orthodontic treatment to periodontal health in patients with stage Ⅳ periodontitis.Methods:A total of 30 patients with stage Ⅳ periodontitis, who underwent combined periodontal and orthodontic therapies at the Department of Periodontology, the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2018 to August 2024, were included. Patients who underwent early orthodontic intervention were initiated simultaneously or within one month after supragingival scaling and subgingival root planning ( n=15). While patients in control group accomplished supragingival scaling, subgingival root planning, and corresponding periodontal surgeries to achieve inflammation control before starting orthodontic treatment ( n=15). Periodontal parameters, including clinical attachment loss (CAL), probing depth (PD), and bleeding on probing (+) % [BOP (+) %], were measured at baseline, one year after orthodontic treatment, and at the end of combined periodontal-orthodontic therapy respectively. Improvements in periodontal parameters and differences in tooth loss between the two groups were compared. Results:After receiving combined periodontal-orthodontic treatment, the CAL of the early orthodontic intervention group significantly decreased from (4.39±0.90) mm before treatment to (2.41±0.35) mm at the end of treatment ( t=7.92, P<0.001). Similarly, the PD significantly reduced from (4.20±1.04) mm before treatment to (2.20±0.38) mm at the end of treatment ( t=7.01, P<0.001). The BOP(+)% also showed a significant improvement, decreasing from 89.29% (68.00%, 100.00%) before treatment to 13.04% (7.14%, 17.86%) at the end of treatment ( Z=-3.41, P<0.001). There were no statistically significant differences between the early orthodontic intervention group and control group in terms of baseline mean CAL, mean PD, and BOP(+)% ( t=1.30, P=0.205; t=1.28, P=0.212; Z=0.58, P=0.559). Furthermore, the improvements in CAL and PD between the two groups were not significantly different compared to baseline ( Z=-1.10, P=0.272; Z=-0.93, P=0.351). However, the number of missing teeth was significantly lower in the early orthodontic intervention group than in the control group (χ2=3.96, P=0.047). The duration of combined periodontal-orthodontic treatment in the early orthodontic intervention group was [33.13 (23.37, 36.20) months], which was significantly shorter than that in the control group [37.47 (32.33, 50.90) months] ( Z=2.07, P=0.037). Conclusions:Both early orthodontic intervention and conventional periodontal-orthodontic treatment significantly improved CAL, PD, and BOP(+)% in stage Ⅳ periodontitis patients. Early orthodontic intervention contributed to the preservation of natural teeth and shortened the treatment duration of stage Ⅳ periodontitis.

Objective To explore the potential mechanism of propofol in relieving postoperative pain in rats through p38 mitogen-activated protein kinase(MAPK)signaling pathway.Methods A postoperative neuropathic pain model was constructed by transient clamping with vascular clips,and thir-ty-six SD rats were randomly divided into four groups using a random number table method:control group(untreated),surgery group(receiving PELD treatment),surgery+propofol treatment group[re-ceiving PELD treatment and an intravenous injection of propofol at 1.5 mg/(kg·min)through the lat-eral tail vein of the rats],and surgery+propofol+p38MAPK agonist Diprovocim group[receiving PELD treatment,with an intravenous injection of 1.5 mg/(kg·min)propofol and 5 nmol/L of the p38MAPK agonist Diprovocim through the lateral tail vein of the rats].After 14 d of continuous drug administration,the rats were tested for mechanical nociceptive thresholds using the Von-Frey test probe,and thermal nociceptive thresholds were detected by the Hargreaves experiment;the activation of spinal cord dorsal horn glial cells was detected by immunofluorescence assay;p38 phosphorylation(p-p38),MAPK phosphorylation(p-MAPK)and downstream interleukin-1 β(IL-1β),P53,and CHOP protein expression levels were detected by immunoprotein blotting assay(Western blotting).Results Rats in the surgery group exhibited neuropathic pain 12 hours postoperatively ollowing probe stimulation,with pain peaking on postoperative day 10 and gradually subsiding thereafter.Rats in the surgery+propofol treatment group also experienced neuropathic pain 12 hours postoperatively,but the pain intensity decreased at 24 hours,and gradually subsided by postoperative day 14.Rats in the surgery+propofol+p38MAPK agonist Diprovocim group developed neuropathic pain 12 hours postoperatively,with no significant decrease in pain threshold at 24 hours,and pain peaked on post-operative day 10 before gradually subsiding.Compared with the control group,the surgery group showed increased levels of P53 protein,p-p38 and p-MAPK in the posterior horn of the spinal cord,increased expression of downstream interleukin-1 β(IL-1 β)and CHOP proteins,and enhanced glial cell activation on the operated side(P＜0.05).When compared with the surgery group,the surgery+propofol treatment group exhibited decreased levels of p-p38,p-MAPK,and downstream IL-1 β,P53,and CHOP protein expression,as well as reduced glial cell activation(P＜0.05).Compared with the surgery+propofol treatment group,the surgery+propofol+p38MAPK agonist Diprovocim group showed decreased expression levels of IL-1 β,P53,and CHOP proteins and levels of p-p38,p-MAPK(P＜0.05).Conclusion Propofol can relieve postoperative pain in rats through p38MAPK signaling pathway.

Objective:To explore impacts of remifentanil on neuroinflammation in rats with cerebral infarction by regulating CC chemokine macrophage inflammatory protein-1α(MIP-1α)/CC chemokine receptor 1(CCR1)signaling pathway.Methods:Rats were randomly grouped into sham group,model group,remifentanil group,MIP-1α Ab group(MIP-1α neutralizing antibody,10 μg)and HY-U00350 group(CCR1 antagonist,100 μg),improved Longa suture method was applied to prepare a rat cerebral infarction model.Neural function scoring method was applied to evaluate neural function of rats;ELISA was applied to detect serum levels of TNF-α,IL-6 and IL-1β;HE staining was applied to observe pathological changes in rat hippocampal tissue,TTC staining method was applied to detect area of cerebral infarction in rats,TUNEL staining was applied to detect apoptosis rate of rat brain cells;RT-qPCR was applied to detect expressions of MIP-1α mRNA and CCR1 mRNA;Western blot was applied to detect expressions of MIP-1α and CCR1 proteins in rat brain tissue.Results:Compared with sham group,hippocampal neuron structure was seriously damaged in model group,neurological function score,levels of TNF-α,IL-6 and IL-1β,apoptosis rate,percentage of cerebral infarction area,expres-sions of MIP-1α,CCR1 gene and protein were obviously increased(P<0.05);compared with model group,morphological damage of neurons in remifentanil group,MIP-1α Ab group and HY-U00350 group was obviously reduced,neurological function score,levels of TNF-α,IL-6 and IL-1β,apoptosis rate,percentage of cerebral infarction area,expressions of MIP-1α,CCR1 gene and protein were obviously reduced(P<0.05);compared with remifentanil group,indicators of rats in MIP-1α Ab group had no statistical significance(P>0.05),levels of MIP-1α gene and protein obviously increased in HY-U00350 group,other indicators were also not statistically obvious(P>0.05).Conclusion:Remifentanil can reduce neuroinflammation in rats with cerebral infarction,which may be related to inhibition of MIP-1α/CCR1 signaling pathway.

Objective:To compare the effects of early orthodontic intervention and conventional sequential periodontal-orthodontic treatment to periodontal health in patients with stage Ⅳ periodontitis.Methods:A total of 30 patients with stage Ⅳ periodontitis, who underwent combined periodontal and orthodontic therapies at the Department of Periodontology, the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2018 to August 2024, were included. Patients who underwent early orthodontic intervention were initiated simultaneously or within one month after supragingival scaling and subgingival root planning ( n=15). While patients in control group accomplished supragingival scaling, subgingival root planning, and corresponding periodontal surgeries to achieve inflammation control before starting orthodontic treatment ( n=15). Periodontal parameters, including clinical attachment loss (CAL), probing depth (PD), and bleeding on probing (+) % [BOP (+) %], were measured at baseline, one year after orthodontic treatment, and at the end of combined periodontal-orthodontic therapy respectively. Improvements in periodontal parameters and differences in tooth loss between the two groups were compared. Results:After receiving combined periodontal-orthodontic treatment, the CAL of the early orthodontic intervention group significantly decreased from (4.39±0.90) mm before treatment to (2.41±0.35) mm at the end of treatment ( t=7.92, P<0.001). Similarly, the PD significantly reduced from (4.20±1.04) mm before treatment to (2.20±0.38) mm at the end of treatment ( t=7.01, P<0.001). The BOP(+)% also showed a significant improvement, decreasing from 89.29% (68.00%, 100.00%) before treatment to 13.04% (7.14%, 17.86%) at the end of treatment ( Z=-3.41, P<0.001). There were no statistically significant differences between the early orthodontic intervention group and control group in terms of baseline mean CAL, mean PD, and BOP(+)% ( t=1.30, P=0.205; t=1.28, P=0.212; Z=0.58, P=0.559). Furthermore, the improvements in CAL and PD between the two groups were not significantly different compared to baseline ( Z=-1.10, P=0.272; Z=-0.93, P=0.351). However, the number of missing teeth was significantly lower in the early orthodontic intervention group than in the control group (χ2=3.96, P=0.047). The duration of combined periodontal-orthodontic treatment in the early orthodontic intervention group was [33.13 (23.37, 36.20) months], which was significantly shorter than that in the control group [37.47 (32.33, 50.90) months] ( Z=2.07, P=0.037). Conclusions:Both early orthodontic intervention and conventional periodontal-orthodontic treatment significantly improved CAL, PD, and BOP(+)% in stage Ⅳ periodontitis patients. Early orthodontic intervention contributed to the preservation of natural teeth and shortened the treatment duration of stage Ⅳ periodontitis.

Objective:To explore impacts of remifentanil on neuroinflammation in rats with cerebral infarction by regulating CC chemokine macrophage inflammatory protein-1α(MIP-1α)/CC chemokine receptor 1(CCR1)signaling pathway.Methods:Rats were randomly grouped into sham group,model group,remifentanil group,MIP-1α Ab group(MIP-1α neutralizing antibody,10 μg)and HY-U00350 group(CCR1 antagonist,100 μg),improved Longa suture method was applied to prepare a rat cerebral infarction model.Neural function scoring method was applied to evaluate neural function of rats;ELISA was applied to detect serum levels of TNF-α,IL-6 and IL-1β;HE staining was applied to observe pathological changes in rat hippocampal tissue,TTC staining method was applied to detect area of cerebral infarction in rats,TUNEL staining was applied to detect apoptosis rate of rat brain cells;RT-qPCR was applied to detect expressions of MIP-1α mRNA and CCR1 mRNA;Western blot was applied to detect expressions of MIP-1α and CCR1 proteins in rat brain tissue.Results:Compared with sham group,hippocampal neuron structure was seriously damaged in model group,neurological function score,levels of TNF-α,IL-6 and IL-1β,apoptosis rate,percentage of cerebral infarction area,expres-sions of MIP-1α,CCR1 gene and protein were obviously increased(P<0.05);compared with model group,morphological damage of neurons in remifentanil group,MIP-1α Ab group and HY-U00350 group was obviously reduced,neurological function score,levels of TNF-α,IL-6 and IL-1β,apoptosis rate,percentage of cerebral infarction area,expressions of MIP-1α,CCR1 gene and protein were obviously reduced(P<0.05);compared with remifentanil group,indicators of rats in MIP-1α Ab group had no statistical significance(P>0.05),levels of MIP-1α gene and protein obviously increased in HY-U00350 group,other indicators were also not statistically obvious(P>0.05).Conclusion:Remifentanil can reduce neuroinflammation in rats with cerebral infarction,which may be related to inhibition of MIP-1α/CCR1 signaling pathway.

Objective:To retrieve, evaluate, and summarize the evidence on fertility management for cervical cancer patients of childbearing age, providing a basis for clinical medical and nursing staff to carry out fertility management for cervical cancer patients.Methods:The evidence on fertility in cervical cancer patients included clinical decision-making, guidelines, summary of evidence, expert consensus, and systematic review, which were systematically searched on domestic and international evidence-based medicine databases, clinical decision-making systems, guideline websites, professional association websites, medical literature service websites, and databases such as UpToDate, Cochrane Library, British Medical Journal (BMJ) Best Practice, China Guidelines Network, China National Knowledge Infrastructure, WanFang Med Online, China Biology Medicine disc, and VIP. The search period was from database establishment to March 1, 2023. Two researchers who received evidence-based nursing knowledge training independently conducted literature screening and quality evaluation, and jointly discussed with clinical experts on the literature that met the requirements to complete evidence extraction and summary.Results:A total of 11 articles were included, including three clinical decision-making, four guidelines, three expert consensus, and one systematic review. A total of 30 pieces of best evidence were summarized from six aspects, including fertility assessment and safety, fertility preservation methods, fertility preservation surgery and anti-tumor treatment, fertility timing, pregnancy management and follow-up, and special treatment for pregnancy with cervical cancer.Conclusions:The evidence on fertility management for cervical cancer patients of childbearing age provides a basis for clinical medical and nursing staff to provide fertility guidance for cervical cancer patients. In clinical application, factors such as patient willingness and condition should be fully considered, and personalized treatment plans should be provided to maximize patient benefits.

Feature extraction methods and classifier selection are two critical steps in heart sound classification. To capture the pathological features of heart sound signals, this paper introduces a feature extraction method that combines mel-frequency cepstral coefficients (MFCC) and power spectral density (PSD). Unlike conventional classifiers, the adaptive neuro-fuzzy inference system (ANFIS) was chosen as the classifier for this study. In terms of experimental design, we compared different PSDs across various time intervals and frequency ranges, selecting the characteristics with the most effective classification outcomes. We compared four statistical properties, including mean PSD, standard deviation PSD, variance PSD, and median PSD. Through experimental comparisons, we found that combining the features of median PSD and MFCC with heart sound systolic period of 100-300 Hz yielded the best results. The accuracy, precision, sensitivity, specificity, and F1 score were determined to be 96.50%, 99.27%, 93.35%, 99.60%, and 96.35%, respectively. These results demonstrate the algorithm's significant potential for aiding in the diagnosis of congenital heart disease.
Humans ; Heart Sounds ; Neural Networks, Computer ; Algorithms ; Heart Defects, Congenital

Objective To investigate the clinical effect of remimazolam combined with remifentanil in patients undergoing laryngoscope vocal cord surgery under general anesthesia.Methods A total of 180 patients undergoing laryngoscope vocal cord surgery under general anesthesia from January to August 2022,77 males and 103 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ were select-ed.The patients were divided into four groups using a random number table method:propofol group(group C),remimazolam 1.0 mg·kg-1·h-1 group(group R1),remimazolam 1.5 mg·kg-1·h-1 group(group R2),and remimazolam 2.0 mg·kg-1·h-1 group(group R3),45 patients in each group.Group C main-tained by intravenous infusion of propofol 5 mg·kg-1·h-1,groups R1,R2,and R3 were maintained by intravenous infusion of remimazolam 1.0,1.5,and 2.0 mg·kg-1·h-1,respectively.All patients were combined with remifentanil 0.2 μg·kg-1·min-1.HR,MAP,and BIS were recorded before anesthesia in-duction(T1),immediately after laryngoscope insertion(T2),immediately at the end of anesthesia mainte-nance(T3),and at tracheal extubation(T4).The onset time of sedation,awakening time,sedation-agita-tion score at extubation and Ramsay score 5 minutes after extubation were recorded.The intraoperative use of ephedrine and nitroglycerin were recorded.The number of injection pain and remedy sedations were recor-ded,the occurrence of adverse reactions such as nausea and vomiting,respiratory depression within 1 hour after extubation,and intraoperative awareness were recorded.Results Compared with group C,MAP at T3,BIS at T2 and T3 were significantly increased,MAP at T4 was significantly decreased,the onset time of sedation was significantly prolonged,the use of ephedrine and the incidence of injection pain were signifi-cantly decreased in group R1(P＜0.05),HR and MAP were significantly decreased at T2 and T4,MAP was significantly increased at T3,the onset time of sedation,awakening time,extubation time were signifi-cantly prolonged,the use of ephedrine and the incidence of injection pain were significantly reduced in group R2(P＜0.05),HR and MAP were significantly decreased at T2 and T4,the onset time of sedation,awakening time,extubation time were significantly prolonged,Ramsay score was significantly increased in group R3(P＜0.05).Compared with group R1,HR and MAP were significantly decreased at T2 and T4,BIS was significantly decreased at T2 and T3,the awakening time and extubation time were significantly pro-longed in group R2(P＜0.05),HR at T2 and T4,MAP at T2-T4,BIS at T2 and T3 were significantly de-creased,the awakening time and extubation time were significantly prolonged,Ramsay score was significant-ly increased in group R3(P＜0.05).Compared with group R2,MAP at T3 was significantly decreased and Ramsay score was significantly increased in group R3(P＜0.05).There were no significantly differences between the rates of nitroglycerin usage,rescue sedation,nausea and vomiting,and respiratory depression in the four groups.Conclusion Remimazolam can be safely used for anesthesia induction and maintenance in laryngoscope vocal cord surgery.The maintenance of remimazolam 1.5 mg·kg-1·h-1 combined with remifentanil can better maintain the hemodynamics stability during the surgery than remimazolam 1.0 and 2.0 mg·kg-1·h-1.

Objective:To understand the potential categories of self-efficacy in stress injury management of nurses in operating room and analyze the characteristics of different categories of nurses.Methods:A cross-sectional survey was conducted from June to August 2022. A total of 469 operating room nurses from 12 Grade A hospitals in Guangxi, Sichuan, Guizhou, Yunnan, Shanxi, Xinjiang and Chongqing were selected by convenient sampling method as subjects. General data questionnaire, proactive personality Inventory, Caring behavior Inventory, transformational leadership inventory, nursing clinical Decision scale and nurses stress injury management self-efficacy scale were used to investigate. Potential profile was used to analyze nurses' self-efficacy in stress injury management, and multiple Logistic regression was used to analyze different potential factors.Results:The self-efficacy of nurses in the management of stress injury in operating room could be divided into three potential profiles: poor self-efficacy group (23.9%, 112/469), medium self-efficacy group (33.0%, 155/469) and good self-efficacy group (43.1%, 202/469). Proactive personality, caring behavior, transformational leadership, nursing clinical decision-making and educational background were the factors influencing self-efficacy of operating room nurses in stress injury management (all P<0.05). Conclusions:There are three potential profiles of self-efficacy in the management of stress injury in operating room nurses. Nursing managers can give targeted intervention strategies according to different characteristics of nurses to improve their self-efficacy.