Objective:To investigate whether residual dental follicles in the alveolar socket after extraction of impacted mandibular third molars affect the periodontal health of adjacent mandibular second molars, in order to provide clinical reference for the management of residual dental follicles after third molar extraction.Methods:A total of 82 patients who underwent bilateral impacted mandibular third molar extraction at the Department of Oral Surgery, School and Hospital of Stomatology Wuhan University, from November 1, 2020, to November 30, 2022, were included in the study. Using a self-controlled method, each patient′s bilateral mandibular third molars were randomly divided into two groups: Group A underwent third molar extraction with thorough removal of residual dental follicle tissue, while Group B underwent third molar extraction without any treatment of the remaining dental follicle tissue. Operation time and adverse reactions were recorded. Clinical and radiographic examinations were performed at 6-month follow-up to evaluate the periodontal parameters and alveolar bone height of the bilateral mandibular second molars, and differences between the two groups were compared.Results:All patients had successful bilateral mandibular third molar extractions, and no serious complications occurred intraoperatively or postoperatively. There were no statistically significant differences in surgical time, postoperative pain, or facial swelling between the two groups ( P>0.05). At the 6-month follow-up, the probing depth on the distal aspect of the mandibular second molars in Group A [2.67 (2.00, 3.67) mm] was significantly less than that in Group B [4.00 (3.00, 5.00) mm] ( Z=-6.55, P<0.001). The clinical attachment loss on the distal aspect of the mandibular second molars in Group A [1.00 (0.00, 3.00) mm] was less than that in Group B [3.00 (2.00, 5.00) mm] ( Z=-5.99, P<0.001). The distance from the alveolar crest to the cementoenamel junction on the distal aspect of the mandibular second molars in Group A [(1.86±1.34) mm] was less than that in Group B [(3.04± 1.89) mm] ( t=-6.87, P<0.001). In patients aged≥20 years, the probability of recovery of alveolar bone height to normal level on the distal aspect of the mandibular second molars in Group A [42.3% (11/26)] was significantly higher than that in Group B [0 (0/26)] ( P<0.01), while there was no statistically significant difference between Group A [63.3% (19/30)] and Group B [46.7% (14/20)] in patients aged<20 years ( P>0.05). Conclusions:Residual dental follicles in the alveolar socket after extraction of impacted mandibular third molars adversely affect the periodontal health of adjacent teeth. Thorough removal of residual dental follicles during impacted mandibular third molar extraction is beneficial for the postoperative recovery of alveolar bone height of the distal aspect of the mandibular second molars, especially in patients aged≥20 years.

Corneal confocal microscopy (CCM) is a non-invasive, simple and rapid visual corneal imaging technique, which can directly conduct real-time collection and quantitative analysis of corneal nerve fibers. Studies have shown that CCM can be used in the diagnosis and prognosis evaluation of degenerative diseases, demyelinating diseases, degenerative diseases and other types of diseases of the central nervous system. In this paper, the recent advance in CCM in neurological diseases is summarized to provide new ideas for their diagnosis and prognosis evaluation.

Objective:To systematically evaluate the qualitative researches on symptom burden and psychological experience of patients with myasthenia gravis, so as to provide references for improving the support system of this population and promoting their physical and mental health.Methods:Qualitative researches on symptom burden and psychological experience in patients with myasthenia gravis were searched on PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, Scopus, Proquest, Ovid, Wiley Online Library, Springer Link, China National Knowledge Infrastructure, VIP, Wanfang Dadabase and China Biology Medicine disc. The search period was from the establishment of the database to December 31, 2022. The quality evaluation criteria of Evidence-Based Health Care Center of Joanna Briggs Research Institute (JBI) in Australia was used to evaluate the quality of the literature, and the Meta-synthesis of the literature was performed using the pooled integration method.Results:A total of 8 studies were included, 66 study results were extracted, 10 new categories were summarized, and 4 integrated results were synthesized, including patients with myasthenia gravis suffering from physical symptoms leading to mental fatigue and cognitive impairment, effects of myasthenia gravis on physical, social, psychological functions and work in patients, difficulties and challenges encountered in the course of treatment and attitude , behavior change, responsibility and mission assumption and personal growth achievement.Conclusions:Patients with myasthenia gravis have serious symptom burden and psychological distress. Clinical nursing staff should attach importance to patient symptom management, pay attention to their physical and mental feelings, provide multi-dimensional social support, help patients actively face disease challenges and achieve personal growth.

Corneal confocal microscopy (CCM) is an in vivo corneal imaging technique, which can directly quantify corneal nerve fibers in real time. It has the characteristics of non-invasive, objective and high sensitivity. CCM can not only be used for the diagnosis and treatment evaluation of corneal diseases, but also plays an important role in the diagnosis and prognosis evaluation of some peripheral and central nervous system diseases, such as diabetes peripheral neuropathy and Parkinson's disease. In addition, the changes of corneal nerve fibers can indirectly reflect the severity of ischemic cerebrovascular disease, and it is expected to become a noninvasive bioimaging marker of ischemic cerebrovascular disease. This article reviews CCM and its application in ischemic cerebrovascular disease, in order to provide better means for early diagnosis and prognosis evaluation of ischemic cerebrovascular disease.

Prostaglandin E2 (PGE2) is a bioactive polyunsaturated fatty acid produced by arachidonic acid, and it is mainly metabolized in the liver and has an important regulatory effect on various liver diseases. Prostaglandin E synthases (PGESs) are important terminal rate-limiting enzymes in the PGE2 synthesis pathway and are involved in the development and progression of liver disease. This article mainly summarizes the role of PGESs in liver injury, hepatitis, and liver cancer in existing studies, hoping to provide a reference for further research on the role of PGESs in liver diseases.

Objective: To study the mechanism of Heshi-Gejiugao on the nerve endocrine immune network in the treatment of perimenopausal syndrome. Methods: A total of 100 patients with perimenopausal syndrome were randomly divided into treatment group and control group, 50 cases in each group. The control group was only given general treatment, while the treatment group was treated with Heshi-Gejiugao on the basis of general treatment for 30 days. The clinical efficacy, Kupperman score, nerve, endocrine and immune related indexes of the two groups before and after treatment were observed. Results: The total effective rate was 96.0% (48/50) in the treatment group and 50.0% (25/50) in the control group. There was significant difference between the two groups (χ²=37.639, P<0.01). The Kupperman score (17.52 ± 2.73 vs. 24.22 ± 6.87, t=6.409) in the treatment group was significantly lower than that in the control group (P<0.01). After treatment, NE (1 878.08 ± 931.57 ng/m vs. 1 278.43 ± 866.32 ng/ml, t=3.331), DA (1 568.56 ± 597.15 ng/ml vs. 1 183.62 ± 798.72 ng/ml, t=2.729) in the treatment group were significantly higher than those in the control group (P<0.05); E₂ (42.12 ± 9.77 pg/ml vs. 35.91 ± 12.55 pg/ml, t=2.761), FSH (62.70 ± 15.96 mIU/ml vs. 72.67 ± 30.18 mIU/ml, t=2.065), LH (33.88 ± 12.18 mIU/ml vs. 42.93 ± 9.83 mIU/ml, t=4.089) were significantly lower than those of the control group (P<0.05). CD3⁺ (1 087.34/μl ± 432.19/μl vs. 918.27/μl ± 199.72/μl, t=2.511), CD4⁺ (738.16/μl ± 326.75/μl vs. 588.43/μl ± 212.55/μl, t=2.716) and CD4/CD8 (1.87 ± 0.56 vs. 1.16 ± 0.55), t=6.483) were significantly higher than those of the control group (P<0.05); CD8⁺ (788.32/μl ± 214.56/μl vs. 976.37/μl ± 318.62/μl, t=3.462) was significantly lower than that of the control group (P<0.05). Conclusions Heshi-Gejiugao can reduce the symptoms and improve the quality of life by regulating the multi target and multi direction of the neuroendocrine immune network of perimenopausal patients.

Objective    To assess the predictive abilities of postoperative regional oxygen saturation (rSO2) measured by near-infrared spectroscopy (NIRS) and lactate level for early postoperative outcome in children undergoing congenital heart disease surgery. Methods    A total of 73 children (43 males, 30 females, mean age of 91±18 days) undergoing cardiovascular surgery were enrolled from December 2016 to September 2017. The 73 children were divided into an early poor outcome group and a without poor outcome group. Binary logistic regression method was used to determine the independent factors of predicting early poor outcome. Receiver operating characteristic curve was used to identify the optimal cutoff values. Results    The early poor outcome rate was 47%. By regression analyses, nadir splanchnic rSO2 values, peak lactate level were 2 independent factors of predicting poor outcome. For nadir splanchnic rSO2 alone, the area under the ROC curve for poor outcome were 0.897. For peak lactate alone, the area under the ROC curve for poor outcome was 0.867. After combination of nadir splanchnic rSO2 and peak lactate, the area under the ROC curve for poor outcome increased to 0.944 (P<0.05). Conclusion    Combining the parameter of nadir splanchnic rSO2 and peak lactate during the first postoperatively 24 hours yielded to a more accurate predictive ability for early outcome in children undergoing congenital cardiac surgery.

Objective To explore whether using of exogenous pulmonary surfactant( PS) can im-prove recovery of infants suffering postoperative acute respiratory distress syndrome after cardiac surgery and whether kinetic analysis of pulmonary functional change can be helpful to indicate an appropriate dosing scheme. Methods Nineteen infants received an exogenous PS( Curosurf,100 mg/kg,treatment group) due to acute respiratory distress syndrome after cardiac surgery for congenital heart defects. They were compared with 24 patients without its administration despite the same postoperative complication( control group) . Oxy-genation index( OI) and ventilation index( VI) were calculated and fitted with a monoexponential function be-fore and after its use. Other outcomes including chest radiography,duration of mechanical ventilation,inten-sive care unit and hospitalization were also analyzed. Results All infants who received PS survived,whereas three infants in the control group died. The duration of mechanical ventilation and hospitalization were signifi-cantly shorter after PS administration[(21. 3 ± 9. 2) d vs. (31. 1 ± 13. 4) d,t=6. 520,P=0. 004;(30. 2 ± 13. 2)d vs. (41. 3 ± 16. 5)d,t=2. 185,P=0. 03]. The infants received either one (13 cases,subgroup A) or two doses (6 cases,subgroup B) before successful weaning from the ventilator. After the first dose was ad-ministered,the maximal rates of OI and VI change were significantly higher of infants in the subgroup A[OI:(2. 9 ±1. 7) vs. (1. 0 ± 0. 8),t =3. 012,P =0. 02;VI:(16. 6 ± 9. 6) vs. (5. 8 ± 5. 6),t =2. 980,P =0. 02]. Twelve hours after the first dose,both parameters in the subgroup B deteriorated and a second dose was administered 24 h later. Conclusion Exogenous PS is an efficient medication for infants suffering acute respiratory distress syndrome after cardiac surgery. Kinetics analysis of functional change after initial surfac-tant use may be referred for early determination of an optimal dosing scheme.

Objective: To explore the effects of microRNA-34a on regulating silent information regulator 1 (SIRT1) and influence of SIRT1 on myocardial damage of rats with severe burns at early stage. Methods: (1) Twenty-four Sprague-Dawley (SD) rats were divided into sham injury (SI) group, simple burns (SB) group and SIRT1 agonist (SA) group according to the random number table (the same grouping method below), with 8 rats in each group. Rats in groups SB and SA were inflicted with 30% total body surface area full-thickness scald (hereinafter referred to as burns) on the back, and rats in group SI were sham injuried on the back. Immediately after injury, rats in groups SI and SB were intraperitoneally injected with normal saline of 50 mL/kg, and rats in group SA were intraperitoneally injected with normal saline of 50 mL/kg and 1 mg/mL resveratrol of 50 mg/kg. At 6 h post injury, abdominal aortic blood was collected to make serum and myocardial tissue of rats was collected. (2) Myocardial cells of twelve neonatal SD rats were collected and divided into microRNA-34a mimic control (MMC) group, microRNA-34a mimic (MM) group, microRNA-34a inhibitor control (MIC) group, and microRNA-34a inhibitor (MI) group, which were respectively transfected with gene sequences of mimic control, mimic, inhibitor control, and inhibitor of microRNA-34a. The microRNA-34a expression level and protein expression level of SIRT1 in myocardial cells were respectively detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blotting. Another batch of myocardial cells were divided into microRNA-34a inhibitor control+ burn serum (MCB) group, microRNA-34a inhibitor+ burn serum (MB) group, and microRNA-34a inhibitor+ burn serum + EX527 (MBE) group. Myocardial cells in group MCB were transfected with gene sequence of inhibitor control, and myocardial cells in the later groups were transfected with gene sequence of inhibitor of microRNA-34a. After transfection of 48 h, myocardial cells in group MBE were cultured in Dulbecco′s modified Eagle′s medium (DMEM) solution for 6 hours, with serum in group SB of volume fraction of 10% and final amount-of-substance concentration of 1 mol/L, and myocardial cells in the other 2 groups were cultured in DMEM solution with serum from rats of group SB of volume fraction of 10%. The protein expression levels of myocardial cells of SIRT1, cleaved-caspase-3, and Bax were detected by Western blotting. (3) Myocardial tissue from (1) was collected to detect expression levels of microRNA-34a and mRNA of SIRT1 in groups SI and SB by real-time fluorescence quantitative RT-PCR. Morphology of myocardial tissue of rats in groups SI, SB, and SA was observed with biological image navigator. The mRNA expression levels of interleukin 1β (IL-1β) and tumor necrosis factor (TNF-α) of rats in groups SI, SB, and SA were detected by real-time fluorescence quantitative RT-PCR. The expression levels of cleaved-caspase-3, and Bax of myocardial tissue of rats in groups SI, SB, and SA were detected by Western blotting. Data were processed with one-way analysis of variance and least-significant difference test. Results: (1) After transfection of 48 h, the expression level of microRNA-34a of myocardial cells in group MM was 4.67±0.92, significantly higher than 1.03±0.04 in group MMC (P<0.01); the protein expression level of SIRT1 of myocardial cells in group MM was 0.35±0.06, significantly lower than 1.12±0.11 in group MMC (P<0.01). After transfection of 48 h, the expression level of microRNA-34a of myocardial cells in group MI was 0.26±0.07, significantly lower than 1.33±0.07 in group MIC (P<0.01); the protein expression level of SIRT1 of myocardial cells in group MIC was 1.12±0.16, significantly lower than 1.74±0.34 in group MI (P<0.01). At 6 h after culture, compared with those in group MCB, the SIRT1 protein expression level of myocardial cells in group MB was significantly increased (P<0.05), while cleaved-caspase-3 and Bax protein expression levels of myocardial cells in group MB were significantly decreased (P<0.05). Compared with those in group MB, the SIRT1 protein expression level of myocardial cells in group MBE was with no significantly statistical difference (P>0.05), and cleaved-caspase-3 and Bax protein expression levels were significantly increased (P<0.05). (2) At 6 h post injury, compared with that in group SI, the microRNA-34a expression level of myocardial tissue in group SB was significantly increased (P<0.01), and the mRNA expression level of SIRT1 of myocardial tissue in group SB was significantly decreased (P<0.01). At 6 h post injury, myocardial cells in group SI arranged neatly with normal nucleus and no inflammatory cells infiltration; myocardial cells in group SB arranged disorderly, with no abnormal nucleus, and obvious inflammatory cells infiltration; myocardial cells in group SA arranged neatly, with normal nucleus and little inflammatory cells infiltration. At 6 h post injury, compared with those in group SB, the mRNA expression levels of IL-1β and TNF-α, and the protein expression levels of cleaved-caspase-3 and Bax of myocardial tissue in groups SI and SA were significantly decreased (P<0.01). Conclusions The microRNA-34a expression level of myocardial tissue of rats with severe burns at early stage increases, which decreases the expression level of SIRT1, and increases the expression levels of IL-1β, TNF-α, cleaved-caspase-3 and Bax, leading to obvious myocardial damage. Activation of SIRT1 can alleviate myocardial damage of rats with severe burns at early stage through decreasing expression levels of IL-1β, TNF-α, cleaved-caspase-3, and Bax.

Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6％ (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.