Endo-periodontal lesions(EPLs)involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms,including unique anatomical and microbiological characteristics and multiple contributing factors.This etiological complexity leads to difficulties in determining patient prognosis,posing great challenges in clinical practice.Furthermore,EPL-affected teeth require multidisciplinary therapy,including periodontal therapy,endodontic therapy and others,but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy.By compiling the most recent findings on the etiology,pathogenesis,clinical characteristics,diagnosis,therapy,and prognosis of EPL-affected teeth,this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

To summarize the nursing experience of a child with severe cardiopulmonary failure caused by fulminant myocarditis who underwent autologous vascular bypass grafting after severe lower limb ischemia during extracorporeal membrane oxygenation therapy.The key points of nursing include:①keeping the distal perfusion tube unobstructed before surgery to avoid aggravation of ischemia of the affected limb;physical precautions for deep vein thrombosis are strictly implemented to ensure the patency of the saphenous vein.②intraoperative nursing cooperation for the conversion of venous-arterial-venous extracorporeal membrane oxygenation to venous-venous extracorporeal membrane oxygenation.③on the premise of ensuring systemic perfusion after surgery,the blood pressure should be strictly controlled to prevent the rupture of the grafted vessel;to strengthen the management of coagulation to prevent bleeding and thrombosis;different position management of both lower limbs to keep the grafted blood vessels patency;to develop individualized exercise programs to enhance nutrition and promote rapid recovery;to give individualized psychological nursing care including childlike fun and sense of security,and eliminate children's negative emotions;to develop systematic health guidance and follow-up to improve the quality of family care for children.After treatment and nursing care,the postoperative grafted blood vessels were well anastomosed with no limb ischemia,and there was no swelling of the limb in the saphenous vein donor area.After 41 days of the treatment,the extracorporeal membrane oxygenation was withdrawn.The child recovered and discharged after 122 days;after 2 years of follow-up,the child could walk normally and recovered well.

Abstract Childhood overweight and obesity has become a serious public health problem. Family, as the primary environment in which children grow up, is closely related to their overweight and obesity. With the continuous development of social economy, grandparents gradually participate in family feeding, and play an imortant role in family feeding. The oresent paper systematically reviews grandparents feeding awareness, feeding behaviors, feeding styles and feeding environment choices, in order to provide a reference for improving intergenerational feeding and reducing the incidence of overweight and obesity in children.

Objective:To explore the methods and effect of applying specialized training and multimedia education in key infection-related departments of a hospital to intervene standard precautions for clinical practice interns.Methods:Based on the cases of nosocomial infection at home and abroad, the Science and Education Section and Infection Management Section designed and produced videos about standard precautions and occupational protection. The content of these videos covered two fields including knowledge training and skill training, with emphasis on enhancing awareness of profession risks and skills of hospital infection control and occupational protection of 196 medical students through specialized training in key infection-related departments. The training effect of standard precautions education for the two groups of students was evaluated from the theoretical test scores, questionnaire survey on their attitude and compliance to standard precautions, and the incidence of their occupational exposure to needle stab wound. SPSS 18.0 was performed for t test and chi-square test. Results:Apart from the knowledge of the unfavorable factors of implementing standard precautions, there were significant differences between the experimental group and the control group in six aspects: theoretical test scores, hospital infection risk cognition, significance cognition of standard precautions, favorable factors of implementing standard precautions, self-efficacy evaluation and self-evaluation of compliance to standard precautions ( P<0.05). And there was significant difference in the incidence of occupational exposure to needle stab wound between the experiment group and control group (1.02% vs. 7.14%; χ2=4.69, P<0.05). Conclusion:Various teaching interventions of standard precautions during the entire internship period have expanded and deepened the contents of school education, enabling the students to form good occupational risk awareness and coping skills to protect the patients and themselves.

Objective:To investigate the relationship between angiopoietin-like protein 4(ANGPTL4) and vascular endothelial growth factor(VEGF) in serum and lower limb arterial lesions in Type 2 diabetes mellitus.Methods:Using the method of retrospective cohort study, 164 inpatients with type 2 diabetes admitted to the Department of Endocrinology, Dahua hospital, Xuhui District, Shanghai from October 2017 to December 2018 were selected as the type 2 diabetes group, and 69 healthy people in the same period were collected as the normal control group.According to the ankle brachial index<0.9, diabetic patients were divided into two groups: the group without lower extremity artery disease and the group with lower extremity artery disease.The levels of ANGPTL4 and VEGF in serum were measured by enzyme-linked immunosorbent assay.Results:(1)Compared with the normal control group: the concentration of ANGPTL4 in serum of lower extremity arterial disease group and no lower extremity arterial disease group((44.78±15.15), (47.46±10.43) μg/L) were lower than that of normal control group((52.87±12.74) μg/L), the difference was statistically significant (all P<0.05). The serum VEGF concentration in lower extremity arterial disease group and no lower extremity arterial disease group((340.98±76.18), (314.83±75.30) ng/L) were higher than that in normal control group((282.58±81.4) ng/L), the difference was statistically significant(all P<0.05). (2)Compared with no lower extremity arterial disease group: the concentration of ANGPTL4 in serum of lower extremity arterial disease group was lower than that of no lower extremity arterial disease group, but the difference was not statistically significant( P>0.05). The serum VEGF concentration in lower extremity arterial disease group was higher than that in no lower extremity arterial disease group, the difference was statistically significant( P<0.05). (3)Correlation analysis: Diabetes mellitus and diabetic course>10 years( OR 4.594, 95% CI2.540-8.311, P<0.001), fasting blood glucose>8 mmol/L( OR 2.353, 95% CI1.023-5.416, P=0.044), glycosylated hemoglobin>8%( OR 6.442, 95% CI 2.874-14.441, P<0.001) and the increase of VEGF( OR 3.745, 95% CI1.566-8.953, P=0.003) are risk factors for lower limb arterial disease in type 2 diabetes, while the increase of ANGPTL( OR 0.154, 95% CI0.064-0.372, P<0.001) can reduce the occurrence of lower limb arterial disease in type 2 diabetes. Conclusion:ANGPTL4 is a protective factor and VEGF is a risk factor of type 2 diabetes mellitus.Both of them influence each other and participate in its occurrence and development.

Objective: To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis. Methods: The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results: (1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was determined by ultrasound, vascular plastic surgery was perfomed to avoid stenosis. (3) Follow-up: 10 patients were followed up for 6-12 months, with a median follow-up time of 8 months. One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery, and was not removed stones by choledochoscope. The patient had no recurrent symptoms after T-tube removal. The other 9 patients had no residual stones. Conclusion RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis, and the surgical treatment can be safe and effective.

Objective To observe the clinical efficacy of treatment of chronic pelvic inflammatory disease with Kangfu Xiaoyan suppository combined ceftriaxone.Methods84 cases of chronic pelvic inflammatory disease in our hospital from June 2015 to August 2016 were randomly divided into observation group and control group, with 42 cases in each group.The control group were treated with ceftriaxone sodium alone,on the basis of the control group, the observation group was treated with Kangfu Xiaoyan suppository.After treatment, the changes tumor necrosis factor-α (TNF-α), transforming growth factor β1 (TGF-β1), interleukin 8,1β (IL-8, IL-1β) and clinical symptom score in the two groups were recorded and analyzed.Results①After two weeks of treatment, the total effective rate of observation group was 92.86%, significantly higher than that of the control group(76.19%), and the difference was statistically significant (P<0.05).②After treatment,the levels of TNF-α, TGF-β1 in the observation group[(0.80±0.23)μg/L, (12.43±1.98)μg/mL) were better than the control group[(1.81±0.35)μg/L,(19.01±2.24)μg/mL], and the differences were statistically significant (P<0.05);③After treatment,the abdominal pain, vaginal symptom score of observation group[(1.57±0.11),(1.45±0.15) points] were lower than the control group[(2.05±0.17),(2.16±0.20) points], and the differences were statistically significant (P<0.05).ConclusionKangfute Xiaoyan Suppository combined with ceftriaxone sodium in the treatment of chronic pelvic inflammatory disease, curative effect is exact, compared with the single application of ceftriaxone sodium in the treatment without obvious adverse reactions, can effectively improve the symptoms of patients with chronic pelvic inflammatory disease, it is worthy of further research and application.

It is complicated to decide the treatment plan of hopeless anterior teeth in esthetic zone due to severe periodontitis, periodontal-endodontic combined lesion or teeth trauma.The optional treatment plan for this kind of teeth includes retention after periodontal treatment, extraction and implant treatment, extraction and prosthodontic treatment and so on.To make an appropriate treatment plan, patients'' periodontal conditions, periodontal biotype, local anatomy, esthetic demand, economic condition and social psychological status should be comprehensively considered.A combine of periodontal, endodontic and orthodontic therapy may achieve a good treatment effect in hopeless anterior teeth with severe periodontal destruction, tooth extrusion and occlusal trauma.In this case, a 20-year-old female who presented with symptoms of bleeding on brushing and upper incisors loosening for 1 month came to the Department of Periodontology, Peking University School and Hospital of Stomatology.The clinical examinations revealed that the patient''s right upper incisor had signs of mobility (Ⅲ°), intrusion of 1-2 mm, and probing depth (PD) of 9-10 mm.The periapical radiograph showed that the alveolar bone of right upper incisor absorbed horizontally to the apex.And the patients showed Angle Ⅱ° malocclusion with Ⅱ° overbite in anterior teeth and maxillary protrusion.A diagnosis of aggressive periodontitis and Angle Ⅱ° malocclusion was made.The treatment of this patient lasts for 5 years which include periodontal initial therapy, orthodontic therapy, guided tissue regeneration (GTR) of right upper incisor and supportive periodontal therapy and the clinical result is fine.A hopeless upper incisor was successfully retained and the longtime clinical condition was stable.The strategy of retention of hopeless upper anterior teeth, the relationship of periodontal treatment and orthodontic treatment, and the indications of periodontal and orthodontic combined therapy were also discussed on the basis of this case.Generally, the positive factors in retention of hopeless teeth includes young age, absence of systemic conditions, strong motivation for maintaining the tooth, single root anatomy, integrated dentition, good response to cause-related therapy, intrabony alveolar bone defect, thick periodontal biotype, and regular supportive periodontal therapy.And in the progress of orthodontic therapy, regular supportive periodontal therapy and good plaque control is extremely important.

Objective To explore the neuropsychological development in twin premature infants,and to analyze the risk factors for the retardation of development.Methods The premature infants hospitalized in the Neonatal Ward First Affiliated Hospital of Kunming Medical University from Jun.2010 to Jun.2012 were divided into study groups of twin premature infants and a control group of singleton premature infants.The neuropsychological development of 88 premature infants was evaluated at corrected gestational age of 1 year old by Bayley scales of infant development.According to normal lab findings of the Bayley scales of infant development,the premature infants were then divided into abnormal neuropsychological development group [mental development index(MDI) ≤79 scores] and normal neuropsychological development group (MDI ＞ 79 scores),and the data of 2 groups were statistically analyzed.Results The frequency distribution of MDI score in study group showed a skewed distribution,of which 59％ (27/46 cases) had abnormal neuropsychological development (MDI ≤ 79 scores); However,the frequency distribution of MDI score in control group showed an approximate normal distribution,of which only 12％ (5/42 cases) for abnormal neuropsychological development.Head circumference,body length,body weight,MDI,psycho-motor development index of twin premature infants of one-year old were lower than those of the singleton premature infants of the same age,and the differences were statistically significant (all P ＜0.05).The single factor analysis demonstrated that the risk factors for abnormal neuropsychological development (MDI ≤ 79 scores) of twin premature infants were gestational age,birth weight,mother' s gcstational age,the cultural degree of parents,mode of feeding,neonatal hyperbilirubinemia,neonatal hypoglycemia and neonatal sepsis.Multiple regression analysis showed that neonatal hyperbilirubinemia was the independent risk factor for abnormal neuropsychological development of twin premature infants.Conclusions At same gestational age,neuropsychological development of twin premature infants lagged behind singleton premature infants.Neonatal hyperbilirubinemia may be the risk factors for neuropsychological development of twin premature infants,so the earlier management of neonatal hyperbilirubinemia may be beneficial for the neuropsychological development of twin premature infants.

Objective To investigate the relationship of homocysteine and blood glucose wavy coefficient with type 2 diabetic nephropathy.Methods Glycosylated hemoglobin A1c (HbA1c),fasting blood glucose(FBG),fasting C-peptide,homocysteine(Hcy),blood-fat and 24h urinary albumin quantitative (UAlb) of 154 patients with type 2 diabetes were determined,and the blood glucose wavy coefficient were calculated after blood glucose monitored by a continuous glucose monitoring system (CGMS).The patients were divided into two groups according to the quantity of UAlb:high UAlb group (n =81 ) and normal UAlb group( n =73 ).Then the difference were compared between two groups and multiple regression analysis was done between UAlb and a variety factors.Results The course of disease in high UAlb group were significantly longer than that in normal UAlb group ( (9.68 ± 7.31 ) years vs ( 5.44 ± 3.65 ) years,t =3.427,P ＜ 0.05 ).There were significant difference on HbA1c [ ( 9.61 ± 2.44 ) ％ vs ( 8.69 ± 2.35 ) ％,t =2.162 ],blood glucose wavy coefficient [ ( 3.06 ± 0.85 ) vs (2.58 ± 0.91 ),t =2.437],low density lipoprotein-cholesterol (LDL-C) [ (3.46 ± 0.83 )mmol/L vs ( 3.01 ± 0.84 ) mmol/L,t =2.596 ],UAlb [ ( 129.64 ± 118.5 ) mg/24 h vs ( 18.14 ± 3.54 )mg/24 h,t =6.421 ),UA ( ( 335.02 ± 90.39 ) mmol/L vs ( 287.00 ± 92.03 ) mmol/L,t =2.541 ) and Hcy [ ( 15.55 ± 4.53 ) mmol/L vs ( 13.12 ± 4.44 ) mmol/L,t =2.603 ] between the two groups ( P ＜ 0.05 or P ＜0.01 ).Pearson analysis showed that the courses of disease,LDL-C,UA,Hcy and blood glucose wavy coefficient were positively correlated with UAlb ( r =0.363,0.270,0.220,0.252,0.236 respectively ; P =0.000,0.008,0.033,0.014,0.022,respectively).And the multiple regression analysis indicated that UAlb was related with courses of disease(β =0.344,P =0.000),Hcy(β =0.244,P =0.011 ) and blood glucose wavy coefficient(β =0.229,P =0.012).Conclusion The elevation of serum Hcy and blood glucose wavy coefficient are risk factors to type 2 diabetic nephropathy.Lowering Hcy concentration and reducing the glucose variability may be a new way to prevent the occurrence of type 2 diabetic nephropathy.