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.

The dental operative microscope has been widely employed in the field of dentistry, particularly in endodontics and operative dentistry, resulting in significant advancements in the effectiveness of root canal therapy, endodontic surgery, and dental restoration. However, the improper use of this microscope continues to be common in clinical settings, primarily due to operators' insufficient understanding and proficiency in both the features and established operating procedures of this equipment. In October 2019, Professor Jingping Liang, Vice Chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, organized a consensus meeting with Chinese experts in endodontics and operative dentistry. The objective of this meeting was to establish a standard operation procedure for the dental operative microscope. Subsequently, a consensus was reached and officially issued. Over the span of about four years, the content of this consensus has been further developed and improved through practical experience.
Humans ; Dentistry, Operative ; Consensus ; Endodontics ; Root Canal Therapy ; Dental Care

Isochrysis galbana is considered an ideal bait for functional foods and nutraceuticals of humans because of its high fucoxanthin(Fx)content.However,multi-omics analysis of the regula-tory networks for Fx biosynthesis in I.galbana has not been reported.In this study,we report a high-quality genome assembly of I.galbana LG007,which has a genome size of 92.73 Mb,with a contig N50 of 6.99 Mb and 14,900 protein-coding genes.Phylogenetic analysis confirmed the monophyly of Haptophyta,with I.galbana sister to Emiliania huxleyi and Chrysochromulina tobinii.Evolutionary analysis revealed an estimated divergence time between I.galbana and E.huxleyi of～133 million years ago.Gene family analysis indicated that lipid metabolism-related genes exhibited significant expansion,including IgPLMT,IgOAR1,and IgDEGS1.Metabolome analysis showed that the content of carotenoids in I.galbana cultured under green light for 7 days was higher than that under white light,and β-carotene was the main carotenoid,accounting for 79.09％of the total carotenoids.Comprehensive multi-omics analysis revealed that the content of β-carotene,antheraxanthin,zeaxanthin,and Fx was increased by green light induction,which was significantly correlated with the expression of IgMYB98,IgZDS,IgPDS,IgLHCX2,IgZEP,IgLCYb,and IgNSY.These findings contribute to the understanding of Fx biosynthesis and its regulation,pro-viding a valuable reference for food and pharmaceutical applications.

Objective:To analyze the occupational health monitoring data of workers in Zhoushan City, and provide scientific basis for health monitoring and the formulation of occupational disease prevention measures.Methods:From January 2016 to November 2019, the occupational health examination data of 37826 workers in Zhoushan City were collected to analyze the change trend of the detection rate of suspected occupational diseases and occupational contraindications, and to compare the health monitoring status of workers with different social characteristics such as enterprise scale and economic type.Results:From 2016 to 2019, the detection rate of suspected occupational diseases showed a downward trend (χ 2trend=21.09, P<0.05) . The occupational health examination of on-the-job workers in Zhoushan were mainly small enterprises (59.72%, 22591/37826) , private economic enterprises (65.32%, 24707/37826) , male (82.03%, 31028/37826) , 30-49 years old (59.11%, 22359/37826) , and exposed to noise (67.06%, 25365/37826) . The detection rates of occupational contraindications and suspected occupational diseases were higher in micro enterprise, male, over 60 years old, exposed to occupational hazards for more than 49 months, and exposed to chemical and physical hazards at the same time. The detection rates of occupational contraindications and suspected occupational diseases were significantly different among different enterprise scale, economic type, gender, age and occupational hazard factors ( P<0.05) . Among benzene workers with occupational contraindications and suspected occupational diseases, the detection rate of A/G abnormality in female workers was higher than that in male workers ( P=0.04) , and there was no significant difference in other genders ( P>0.05) . Conclusion:It is necessary to pay more attention to the workers working in small and private enterprises in Zhoushan City, strengthen the occupational health supervision of male workers who are over 60 years old who are exposed to benzene, noise and other occupational hazards, standardize the occupational health inspection, and effectively protect the health of the occupational population.

Objective:To analyze the occupational health monitoring data of workers in Zhoushan City, and provide scientific basis for health monitoring and the formulation of occupational disease prevention measures.Methods:From January 2016 to November 2019, the occupational health examination data of 37826 workers in Zhoushan City were collected to analyze the change trend of the detection rate of suspected occupational diseases and occupational contraindications, and to compare the health monitoring status of workers with different social characteristics such as enterprise scale and economic type.Results:From 2016 to 2019, the detection rate of suspected occupational diseases showed a downward trend (χ 2trend=21.09, P<0.05) . The occupational health examination of on-the-job workers in Zhoushan were mainly small enterprises (59.72%, 22591/37826) , private economic enterprises (65.32%, 24707/37826) , male (82.03%, 31028/37826) , 30-49 years old (59.11%, 22359/37826) , and exposed to noise (67.06%, 25365/37826) . The detection rates of occupational contraindications and suspected occupational diseases were higher in micro enterprise, male, over 60 years old, exposed to occupational hazards for more than 49 months, and exposed to chemical and physical hazards at the same time. The detection rates of occupational contraindications and suspected occupational diseases were significantly different among different enterprise scale, economic type, gender, age and occupational hazard factors ( P<0.05) . Among benzene workers with occupational contraindications and suspected occupational diseases, the detection rate of A/G abnormality in female workers was higher than that in male workers ( P=0.04) , and there was no significant difference in other genders ( P>0.05) . Conclusion:It is necessary to pay more attention to the workers working in small and private enterprises in Zhoushan City, strengthen the occupational health supervision of male workers who are over 60 years old who are exposed to benzene, noise and other occupational hazards, standardize the occupational health inspection, and effectively protect the health of the occupational population.

Objective:To construct an ICU nursing monitoring and evaluation scale for patients with multiple trauma and to test its reliability and validity.Methods:According to the literature review and semi-structured interview method, the item pool was developed, and the initial evaluation scale was established by Delphi method and analytic hierarchy process. A total of 180 patients with multiple trauma were selected for nursing monitoring and evaluation to verify the reliability and validity of the scale.Results:The ICU nursing monitoring and evaluation scale for patients with multiple trauma included 29 items in 5 dimensions including trauma assessment, relevant physiological scores, age, previous chronic diseases and treatment measures. The Cronbach's ɑ coefficient of total scale was 0.889 and the correlation coefficient of scorers was 0.942. The content validity index of all items in the scale ranged from 0.867 to 1.000 and the total content validity index was 0.948. Exploratory factor analysis extracted a total of 5 common factors and the cumulative variance contribution rate reached 65.878%. The area under the receiver operating characteristic curve was 0.894. When the cut off value was 21.5, the sensitivity of the scale was 0.855 and the specificity was 0.745.Conclusions:The scale has good reliability and validity, which can be used as a reference tool for the assessment of severe multiple trauma and prognosis prediction in ICU.

Objective To evaluate the left ventricular diastolic function of patients with normal left ventricular ejection fraction ( LVEF) by echocardiography and real‐time cardiac catheter measurement ,and improve the accuracy and reliability of echocardiographic diagnosis . Methods One hundred and twenty patients with know n or suspected coronary artery disease w ho underwent coronary angiography and left ventricular catheterization were prospectively selected from July 2017 to January 2018 in the Affiliated Hospital of Jiangsu University . According to the left ventricular end diastolic pressure ( LVEDP) real‐time measurement ,the patients were divided into groups of LVEDP ≤15 mm Hg ( 43 cases ) and LVEDP ＞ 15 mm Hg ( 77 cases) . General data were compared and the difference of echocardiographic parameters between the two groups were analyzed ,and the ROC curve of each echocardiographic parameter for diagnosing LVEDP was draw n . Results T he parameters including flow propagation velocity ( VP) ,the ratio of filling fraction of E and A ( E/A) ,early diastolic filling deceleration time ( DT ) ,the duration of mitral A ( A‐dur ,) mitral annulus velocity at the septal side ( e′sep) ,systolic pulmonary venous flow velocity ( PVs) ,diastolic pulmonary venous flow velocity ( PVd ) and PVs/PVd were used to the diagnosis of the increasing of LVEDP ,however their accuracies were low ( AUC between 0 .5～0 .7) . T he parameters including left atrial volume index ( LAVI ) , tricuspid regurgitation ( T Rmax ) ,mitral annulus velocity in lateral wall of left ventricle ( e′lat ) ,average e′,E/e′sep ,E/e′lat ,average E/e′,velocity of pulmonary vein atrial reversal ( PVa) ,pulmonary vein atrial reversal duration ( Pva‐dur) ,the difference between the duration of pulmonary venous A wave and mitral A wave( PvaD‐AD) were also used to the diagnosis of the increasing of LVEDP , but their accuracies were still poor ( AUC between 0 .7～0 .9 ) . According to the real‐time left ventricular pressure measurement and different parameters of echocardiography ,the multivariate regression equation :LVEDP＝ 0 .292 LAVI + 0 .35 PVa + 0 .04 T Rmax + 0 .075 ( PvaD‐AD ) －0 .109 PVs －6 .773 was put forward as a correction standard ,the accuracy of the diagnosis of LVEDP was significantly improved ( AUC ＝0 .922) . Conclusions T he assessment of left ventricular diastolic function needs to be performed comprehensively with multiple parameters . T he multiple regression equation can accurately evaluate left ventricular diastolic function in patients with normal LVEF .

Objective To investigate the changes of brain function and cognitive function in patients with acute cerebellar stroke using amplitude of low-frequency fluctuation (ALFF) and functional connection (FC).Methods The cognitive function assessment and resting state functional magnetic resonance (rs-fMRI) scan were performed on patients with acute cerebellar stroke hospitalized in Taizhou People's Hospital or Nanjing Brain Hospital from May 2017 to June 2018.The differences of ALFF and FC values were compared.Pearson correlation analysis was used to understand the correlation between FC values and cognitive function scores.A total of 32 patients with acute cerebellar stroke and 34 healthy controls were included.Results Compared with the healthy controls,the scores of Montreal Cognitive Assessment (23.97 ± 6.04 vs 26.56 ± 2.93,t=-2.237,P=0.029),the Rey Auditory Verbal Learning Test (RAVLT;3(2) vs 6(2),Z=-4.136,P=0.000) were significantly lower,and the time consuming of Trail Making Test(TMT)-B ((251.56 ± 112.62) s vs (164.76± 52.37) s) was significantly higher (t=4.054,P=0.000) in the patients with acute cerebellar stroke.The rs-fMRI results showed significant group differences in ALFF values at the four brain regions,including the right frontal lobe,left hippocampus,right cingulate gyrus and cerebellum posterior lobe.The regions that showed significant group differences were set as regions of interest (ROIs),and then the functional connectivity between ROIs and the whole brain were analyzed.The results showed significant positive correlation between the RAVLT scores and the FC values from the left hippocampus to the left frontal lobe (r=0.272,P=0.031).The FC values from the right cingulate gyrus to right inferior parietal lobule were found to be correlated positively with the scores on the TMT-B (r=0.410,P=0.023).Conclusions The patients with cerebellar stroke had cognitive impairment,mainly in memory and executive function.The changes of ALFF and FC values in related brain area from cerebellar stroke enrich our understanding of cerebellar involvement in cognitive performance.

Objective To study the characteristics of cognitive function changes in patients with cerebellar infarction, and to clarify the association between cerebellar infarction and cognitive function. Methods A total of 106 patients with cerebellar infarction, admitted to our hospital from June 2017 to December 2018, and 55 healthy subjects recruited at the same time were chosen. National Institute of Health Stroke Scale (NIHSS) was used to evaluate neurological deficits, and modified International Cooperative Ataxia Rating Scale (ICARS) was used to evaluate balance function. The cognitive function differences of the two groups were compared by Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Patients with cerebellar infarction were divided into different subgroups according to different courses of disease, different infarction sites and different cerebellar hemispheres to further compare the cognitive functions of the subjects. Results (1) In terms of cognitive function evaluation, the scores of MoCA and Rey auditory word learning test (RAVLT) in the cerebellar infarction group were significantly lower than those in the control group, and the time consumption of Trail Making Test (TMT)-B was significantly longer than that in the control group (P<0.05). (2) MoCA and RAVLT scores in the acute cerebellar infarction group were significantly lower than those in the non-acute cerebellar infarction group (P<0.05). (3) There were significant differences in ICARS scores, MoCA scores, RAVLT scores and TMT-B time consumption between the anterior cerebellar infarction group and the posterior cerebellar infarction group (P<0.05). (4) The time consumption of TMT-B of right cerebellar infarction patients was significantly longer ([258.85 ±55.96] s) than that in left cerebellar infarction patients ([198.22 ±40.43] s, P<0.05). Conclusions There are cognitive dysfunctions, especially memory and executive function, in patients with cerebellar infarction, which is correlated with the disease period and location of cerebellar infarction, but not with infarct volume. Cognitive dysfunction is more obvious in patients with acute cerebellar infarction, posterior cerebellar infarction and right cerebellar infarction than those in patients with non-acute cerebellar infarction, anterior cerebellar infarction and left cerebellar infarction.

Objective To investigate the relationship between plasma endothelin-1 and nitric oxide levels and hearing impairment in elderly patients with hyperuricemia (HUA). Methods The clinical data of 174 physical examination elderly from September 2013 to March 2016 were retrospectively analyzed. Among them, the HUA was in 81 cases (HUA group), and no HUA was in 93 cases (control group). The pure tone hearing and high stimulation rate of auditory brainstem response were tested, and the plasma endothelin and nitric oxide levels were detected. Results The pure tone hearing of 250, 500, 1 000,2 000, 4 000 and 8 000 Hz in HUA group were significantly higher than those in control group: (33.03 ± 12.09) dB vs. (28.49 ± 9.89) dB, (35.56 ± 13.47) dB vs. (27.31 ± 9.34) dB, (38.81 ± 14.94) dB vs. (29.78 ± 9.39) dB, (43.62 ± 16.45) dB vs. (37.06 ± 12.66) dB, (51.07 ± 18.36) dB vs. (46.29 ± 15.15) dB and (65.75 ± 18.76) dB vs. (57.71 ± 20.26) dB, and there were statistical differences (P＜0.01). The Ⅰ wave, Ⅲ wave, Ⅴ wave latency and Ⅰ to Ⅲ wave, Ⅰ to Ⅴwave intervals in HUA group were significantly longer than those in control group: (2.10 ± 0.26) ms vs. (2.03 ± 0.24) ms, (4.11 ± 0.38) ms vs. (3.89 ± 0.31) ms, (5.94 ± 0.31) ms vs. (5.69 ± 0.29) ms, (2.01 ± 0.26) ms vs. (1.86 ± 0.22) ms and (3.83 ± 0.28) ms vs. (3.65 ± 0.25) ms, and there were statistical differences (P＜0.01). There was no statistical difference inⅢtoⅤwave interval between 2 groups (P＞0.05). The Ⅴ wave threshold value in HUA group was significantly higher than that in control group:(45.61 ± 11.18) dB vs. (41.98 ± 9.37) dB, and there was statistical difference (P＜0.05). The plasma endothelin-1 level in HUA group was significantly higher than that in control group: (16.96 ± 3.45) ng/L vs. (11.64 ± 3.81) ng/L, the plasma nitric oxide level was significantly lower than that in control group:(0.98 ± 0.66) μmol/L vs. (1.36 ± 1.08) μmol/L, and there were statistical differences (P＜0.05 or＜0.01). Conclusions Elevated plasma endothelin-1 level and reduced nitric oxide level may be a possible mechanism for hearing impairment in elderly patients with hyperuricemia.