Objective To investigate the short and long term effects of preincision of pancreatic duct sphincter in different types of patients with difficult intubation by endoscopic retrograde cholangiopancreatography(ERCP).Method A retrospective study was conducted on 100 patients with difficulty in ERCP intubation from January 2019 to June 2020.Patients were divided into a control group(50 cases)and a study group(50 cases)according to different treatment methods.The control group underwent routine ERCP intubation without pancreaticotomy,while the study group underwent preincision of pancreatic duct sphincter on the basis of routine ERCP intubation.Calculate the successful intubation time,successful intubation rate,and length of hospital stay for two groups;Enzyme linked immunosorbent assay was used to detect postoperative C-reactive protein(CRP),interleukin-6(IL-6),and blood amylase levels in two groups of patients;Calculate the incidence of complications related to pre incision surgery in two groups of patients;Follow up the incidence of reflux cholangitis and recurrent pancreatitis in two groups of patients at 3,6,and 12 months after surgery,and evaluate the long-term efficacy of the two groups of patients.Result Compared with the control group,the study group showed a shorter in successful intubation time,and an increase in successful intubation rate(P<0.05).There was no difference in hospital stay between the two groups(P>0.05);Compared with the control group,the study group showed a decrease in CRP,IL-6 and blood amylase levels on the first day after surgery(P<0.05);The postoperative complication rate of patients in the control group was 14.0%,including 4 patients with acute pancreatitis,2 patients with bleeding,and 1 patient with perforation.The postoperative complication rate of patients in the study group was 2.0%,with 1 patient with bleeding.Compared with the control group,the postoperative complication rate of patients in the study group decreased(P<0.05);Compared with the control group,the incidence of reflux cholangitis in the study group decreased at 12 months after surgery,and the incidence of recurrent pancreatitis decreased at 3,6,and 12 months after surgery(P<0.05).Conclusion Preincision of the pancreatic duct sphincter has a mild impact on systemic inflammation in patients with difficult ERCP intubation,with normal blood amylase indicators and no increase in the incidence of postoperative pancreatitis.It can improve the success rate of intubation and has significant long-term efficacy.It is a safe and effective technique which is worth recommending.

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.

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.

Saliva testing is a vital method for clinical applications, for its noninvasive features, richness in substances, and the huge amount. Due to its direct anatomical connection with oral, digestive, and endocrine systems, clinical usage of saliva testing for these diseases is promising. Furthermore, for other diseases that seeming to have no correlations with saliva, such as neurodegenerative diseases and psychological diseases, researchers also reckon saliva informative. Tremendous papers are being produced in this field. Updated summaries of recent literature give newcomers a shortcut to have a grasp of this topic. Here, we focused on recent research about saliva biomarkers that are derived from humans, not from other organisms. The review mostly addresses the proceedings from 2016 to 2022, to shed light on the promising usage of saliva testing in clinical diagnostics. We recap the recent advances following the category of different types of biomarkers, such as intracellular DNA, RNA, proteins and intercellular exosomes, cell-free DNA, to give a comprehensive impression of saliva biomarker testing.
Humans ; Saliva/metabolism* ; Biomarkers/metabolism* ; RNA ; Exosomes/metabolism*

Objective:To study the expression of Proline rich protein11 (PRR11) in breast cancer and its relationship with clinical biological behavior, prognosis and survival.Methods:A prospective analysis method was used to select 80 patients with breast cancer from Jan. 2018 to Jan. 2019. Immunohistochemical S-P method was used to detect the expression of PRR11 in cancer tissues. Patients with positive expression of PRR11 were set as the study group ( n=47) and the patients with negative expression of PRR11 were set as the control group ( n=33) . All patients were followed up for 3 years to analyze and compare the survival rates of patients with positive and negative expression of PRR11. The relationship between PRR11 expression and clinical biological behavior, prognosis and survival was analyzed by Cox risk ratio review model. Results:80 patients were followed up for 3 years. It was found that the prognosis of patients with negative PRR11 expression was significantly better than that of patients with positive PRR11 expression ( χ2=5.75, P<0.001) . Chi square test was used to analyze the correlation between the expression of PRR11 and tumor size, TNM stage, lymph node metastasis, distant metastasis, histological grade, Ki67 expression and hormone receptor status ( P<0.05) . The expression of PRR11 in breast cancer tissues with larger tumors, distant metastasis and later staging was relatively high ( P<0.05) . Univariate Cox regression analysis showed that histological grade, TNM stage and PRR11 were independent risk factors affecting the prognosis of breast cancer patients ( P<0.001) . The AUC of prognosis prediction in patients with breast cancer was 0.812, and the 95% CI was 0.635-0.796. When PRR11 expression was positive, the sensitivity was 81.47%, and the specificity was 85.57%. Conclusions:The expression of PRR11 is relatively high in the late stage breast cancer tissue. The expression of PRR11 is closely related to the clinical biological behavior of breast cancer size, TNM stage and lymph node metastasis. The survival rate of patients with high PRR11 expression is low, and the positive expression of PRR11 is an independent risk factor affecting the prognosis of breast cancer patients. PRR11 detection has preferable clinical application value in predicting the prognosis of breast cancer.

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.
Child ; Child, Preschool ; Consensus ; Dental Caries/prevention & control* ; Dental Caries Susceptibility ; Humans ; Oral Health

Objective:To investigate the application value of hybrid approach in laparoscopic radical resection of left hemicolon cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 96 patients with left hemicolon cancer who were admitted to Henan Provincial People′s Hospital between January 2015 and March 2018 were collected. There were 52 males and 44 females, aged from 29 to 75 years, with an average age of 61 years. Patients underwent laparoscopic radical resection of left hemicolon cancer. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative pathological examination; (3) postoperative chemotherapy; (4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival, tumor recurrence and metastasis of patients up to October 2019. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Results:(1) Surgical situations and postoperative recovery: all the 96 patients underwent laparoscopic radical resection of left hemicolon cancer with hybrid approach. Of 96 patients, 5 underwent laparoscopic multiple organ resection including 2 combined with splenectomy, 2 combined with gastric wall wedge resection, 1 combined with splenectomy and distal pancreatectomy; 7 underwent hand-assisted laparoscopic surgery including 5 undergoing multiple organ resection due to tumor invasion, 2 combined with terminal ileostomy due to poor exposure caused by severe obstruction in proximal intestinal canal; 84 underwent laparoscopic-assisted surgery. There was no intraoperative conversion to laparotomy. Of 96 patients, 3 received posterior ileum anastomosis, 2 received rotating ascending colon anastomosis, 91 received in situ anastomosis. Operation time, volume of intraoperative blood loss, and time to first flatus were 140 minutes (range, 70-250 minutes), 50 mL (range, 30-140 mL), 2 days (range, 1-4 days), respectively. Of 96 patients, 5 had postoperative incision infection, 5 had pulmonary infection, 3 had adhesive intestinal obstruction, 1 had anastomotic leakage, and they were cured after conservative treatment. Duration of postoperative hospital stay of the 96 patients was 8 days(range, 5-27 days). (2) Postoperative pathological examination: of the 96 patients, the number of lymph nodes dissected and length of surgical specimen were 19 (range, 13-25) and 35 cm (range, 25-50 cm). All the 96 patients had negative surgical margin. Pathological T staging of 96 patients: 5 patients were in pT1 stage, 46 in pT2 stage, 37 in pT3 stage, 8 in pT4 stage. Pathological N staging of 96 patients: 32 patients were in pN0 stage, 47 in pN1 stage, 17 in pN2 stage. Pathological types of 96 patients: 7 patients had mucinous adenocarcinoma, 16 had poorly differentiated adenocarcinoma, 46 had moderately differentiated adenocarcinoma, and 27 had well differentiated adenocarcinoma. (3) Postoperative chemotherapy: 68 of the 96 patients underwent standard chemotherapy of XELOX regimen, and 28 had no chemotherapy. (4) Follw-up: 86 patients were followed up for 19-58 months, with a median time of 11 months. During the follow-up, all the 86 patients survived, of which 82 had no tumor recurrence, 3 survived with tumor after detection of liver metastasis, and 1 survived with tumor after detection of liver and pulmonary metastasis.Conclusion:The hybrid approach is safe and feasible in the laparoscopic radical resection of left hemicolon cancer.

Primary bile acids were reported to augment secretion of chemokine (C‒X‒C motif) ligand 16 (CXCL16) from liver sinusoidal endothelial cells (LSECs) and trigger natural killer T (NKT) cell-based immunotherapy for liver cancer. However, abundant expression of receptors for primary bile acids across the gastrointestinal tract overwhelms the possibility of using agonists against these receptors for liver cancer control. Taking advantage of the intrinsic property of LSECs in capturing circulating nanoparticles in the circulation, we proposed a strategy using nanoemulsion-loaded obeticholic acid (OCA), a clinically approved selective farnesoid X receptor (FXR) agonist, for precisely manipulating LSECs for triggering NKT cell-mediated liver cancer immunotherapy. The OCA-nanoemulsion (OCA-NE) was prepared

Objective To determine the occurrence and clinical characteristics of ectopic pituitary adenoma (EPA) in China.Methods The study are done by searching systematically and comprehensively on major Chinese and English medical literature databases and conference papers before 2015,which are only limited to collected,summarized,sorted and analyzed EPA cases that reported by Chinese authors in English or Chinese occurred in China.Results ① Among the 86 Chinese articles and 27 English articles related to ectopic pituitary adenoma (EPA) gathered by the author,except for cases that have been confirmed as repeated reports,a total of 73 EPA cases were found.Of 70 cases with complete data,31 were male cases,accounting for 44.29％;39 were female cases,accounting for 55.71％;the ratio is 1:1.3.The frequency of EPA occurrence according to the location of the lesion,from high to low in turn,was sphenoid sinus (31 cases,42.47％),nasopharynx (7 cases,9.59％),suprasellar region (7 cases,9.59％),clivus (5 cases,6.85％),followed by the third ventricle,sphenoid sinus/clivus,nasal cavity,and the temporal lobe of the brain,with the same incidence of 4.11％.According to the functional properties of EPA,the frequency of different secreting hormones adenoma was PRL-ma(21 cases,28.77％),NF-ma (21 cases,28.77％),ACTH-ma (15 cases,20.55％),GH-ma (10 cases,13.70％),TSH-ma (2 cases,2.74％) and FSH-ma (1 cases.1.37％).Three cases of EPA were uncertain in their property due to lack of information.The incidence of PRL and nonfunctional tumors was the highest,which was different from what was reported in other countries.Among them,one case of EPA was in pineal region and one in parapharyngeal space,which was even more rare and were never reported abroad.(② Except for 3 cases with incomplete medical records,15 out of 70 cases of EPA were accompanied by empty sella,accounting for 21.43％,among which 11 (73.33％) cases involved the sphenoid sinus,and 3 (20％) cases involved clivus.The sphenoid sinus and clivus cases together accounted for 93.33％.(③ 29 out of the 69 cases of EPA with complete record were invasive pituitary adenomas,accounting for 42.03％ and including 1 case of pituitary adenocarcinoma,which accounted for 1.45％.(④ All cases were treated with surgery as the first choice,and some of them were treated with radiotherapy or drug therapy.Conc lusion Ectopic pituitary adenoma is extremely rare.By the end of 2015,the total number of cases reported in China is only 73,which are mostly located in the sphenoid sinus,suprasellar region and nasopharynx.In the functional classification,the most common types are still PRL adenoma and nonfunctional adenoma as in situ pituitary adenoma.42.03％ of EPA adenomas are invasive.Surgical resection of EPA is the first choice and some cases can be treated with radiotherapy and drug therapy.

Objective To evaluate the clinical curative effect and prognosis of hand-assisted laparoscopic (HALS) and laparoscopic assisted surgery for Siewert Ⅱ,Ⅲ gastroesophageal junction adenocarcinoma (AEG).Methods A retrospective analysis of 105 patients with advanced Siewert type Ⅱ and Ⅲ AEG between Jan 2012 and Jan 2013 was made on the operation time,amount of blood loss,number of lymph nodes dissected,postoperative complications,postoperative hospital stay and postoperative 5-year survival rate.Results HALS resulted in significantly shorter operation time and the average postoperative hospital stay [(203±54) min比(283±72) min,t=-4.902,P=0;(10±4) d 比(13±3)d,t=-0.939,P =0.002] for advanced Siewert type Ⅱ and Ⅲ AEG.There was no conversion to open surgery in HALS group,while there was 3 cases in laparoscopy assisted surgery group (x2 =4.118,P =0.042).5 year overall survival (OS) in HALS group was 46.7％ (95％ CI39.98-53.88),and it was 60.9％ for stage Ⅱ patients 37.8％ for stage Ⅲ.5 years OS rate was not significantly different between the two groups.Conclusion HALS compared with laparoscopy assisted surgery in the treatment of advanced Siewert type Ⅱ and type Ⅲ AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery are not significantly different between the two groups.