Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.

Objective:To explore the risk factors for depression in patients with cognitive impairment and construct a prediction model to preliminarily validate the predictive performance of the model, aiming to provide medical and nursing staff with a screening tool for high-risk groups.Methods:From January 2020 to December 2021, convenience sampling was used to select 1 130 patients with cognitive impairment admitted to the Affiliated Brain Hospital of Nanjing Medical University as the research subject. The research subjects were divided into a modeling group ( n=791) and a validation group ( n=339) at a ratio of 7∶3. The influencing factors of depression in patients with cognitive impairment were determined using binomial Logistic regression and a risk prediction model was established. The predictive performance of the prediction model was tested using the receiver operating characteristic (ROC) curve. Results:The incidence of depression in 1 130 patients with cognitive impairment was 51.3% (580/1 130). Binomial Logistic regression analysis showed that the influencing factors for depression in patients included age, Activities of Daily Living Scale score, Hamilton Anxiety Scale score, Pittsburgh Sleep Quality Index score, and Lewy Body Composite Risk score ( P<0.05). In the modeling group, the area under the ROC curve was 0.921, the Youden index was 0.716, the sensitivity was 0.834, the specificity was 0.882, and the prediction accuracy was 0.858. In the validation group, the area under the ROC curve was 0.896, the Youden index was 0.651, the sensitivity was 0.824, the specificity was 0.827, and the prediction accuracy was 0.825. Conclusions:The depression risk prediction model can effectively predict the risk of depression in patients with cognitive impairment, and can provide a screening tool for high-risk groups for medical and nursing staff.

Objective To investigate the serum vitamin and trace element levels in children with short stature and their correlation with bone age. Methods Levels of serum VA and VD, and trace elements Ca, Fe, Zn, Mg, Cu, Pb and Cd were measured in 322 children who were referred for height consultation. Bone ages were evaluated and the correlation between bone age and serum vitamin and trace element levels was analyzed. Results The VA and VD deficiency rates of these 322 children were 22.05% and 34.16%, respectively. The deficiency rates of trace elements Ca, Fe and Zn were14.29%, 21.43% and 6.83%, respectively. The Pb excess rate was as high as 42.55%. The rates of bone age (BA) retardation in Group Ⅰ (short) and Group Ⅱ (slightly short) were 49.38% and 37.57%, respectively, which was significantly higher than that of Group Ⅲ (normal). The Ca level of BA retardation children was lower than that of the normal BA children in Group I. The VD level of BA retardation children was lower than that of the normal BA children in Group Ⅱ. BA was negatively correlated with VD, Ca, and Cu levels in children (r=-0.241; r=-0.136; r=-0.162), and positively correlated with Fe (r=0.286) . Conclusion There were significant abnormalities of vitamins and trace elements in short children. Children's bone age had a certain correlation with serum vitamin D, calcium, copper, and iron levels. Serum vitamin and trace element levels in children should be monitored to guide a reasonable diet to better promote child growth and development.

Antipsychotic medication is the primary treatment for schizophrenia, which is effective on ameliorating positive symptoms and can reduce the risk of recurrence, but it has limited efficacy for negative symptoms and cognitive dysfunction. The negative symptoms and cognitive dysfunction seriously affects the life quality and social function for the patients with schizophrenia. Currently, there is plenty evidence that antipsychotic drugs combined with adjuvant therapy drugs can effectively improve the negative symptoms and cognitive dysfunction. These drugs include anti-oxidants, nicotinic acetylcholine receptors and neuro-inflammatory drugs (anti-inflammatory drugs, minocycline), which show potential clinical effects.
Anti-Inflammatory Agents/therapeutic use* ; Antipsychotic Agents/therapeutic use* ; Cognitive Dysfunction/etiology* ; Humans ; Minocycline/therapeutic use* ; Schizophrenia/drug therapy*

To examine the efficacy and safety for metformin in treating antipsychotic-induced dyslipidemia.
 Methods: Two randomized placebo-controlled trials were included in the analysis. A total of 201 schizophrenia patients with dyslipidemia after treatment with an antipsychotic were collected, and the patients were divided into two groups: a 1 000 mg/d metformin group (n=103) and a placebo group (n=98). The clinical symptoms and metabolic indicators such as body weight, blood glucose, and blood lipids were assessed at baseline, the 12th week and the 24th week after treatment respectively.
 Results: After metformin treatment, the mean difference in the low-density lipoprotein cholesterol (LDL-C) value between the metformin group and the placebo group was from 0.16 mmol/L at baseline to -0.86 mmol/L at the end of the 24th week, which was decreased by 1.02 mmol/L 
(P<0.01). At the 24th week, the LDL-C was more than 3.37 mmol/L in 25.3% patients in the metformin group, which was significantly lower than that in the placebo group (64.8%) (P<0.01). Compared with the placebo group, there were significant changes in the weight, body mass index (BMI), insulin, insulin resistance index, total cholesterol and triglyceride, and high-density lipoprotein cholesterol (HDL-C) in the metformin group (all P<0.05). The treatment effects on weight and insulin resistance appeared at the 12th week and further improved at the 24th week, but the effects on improving dyslipidemia only significantly occurred at the end of the 24th week.
 Conclusion: The metformin treatment is effective in improving antipsychotic-induced dyslipidemia and insulin resistance, and the effect to reduce the antipsychotic-induced insulin resistance appears earlier than the effect to improve dyslipidemia.
Antipsychotic Agents ; adverse effects ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Double-Blind Method ; Dyslipidemias ; chemically induced ; drug therapy ; Humans ; Hypoglycemic Agents ; Metformin ; therapeutic use

Objective: To understand the pollution characteristics and assess the pollution health risks of heavy metals in atmospheric PM_2.5 in Lanzhou. Methods: According to the regional characteristics of air pollution and industrial distribution characteristics in Lanzhou, atmospheric PM_2.5 was sampled monthly in Chengguan and Xigu Districts from January, 2015 to December, 2016. Detected the concentration of PM_2.5 and 12 kinds of elements (Sb, Al, As, Be, Cd, Cr, Hg, Pb, Mn, Ni, Se and Tl) by weighing method and inductively coupled plasma mass spectrometry. Enrichment factor and geo-accumulation index were used to describe the pollution characteristics, while health risk assessment was conducted using the recommended United States Environmental Protection Agency (USA EPA) model. The health risks of non-carcinogens were evaluated by non-cancer hazard quotient (HQ), the non-carcinogenic risk was considered to be negligible when HQ<1, HQ>1 meant a health risk. With a single contaminant cancer Risk value to evaluate the health risks of carcinogens, when the Risk value between 10^-6 to10^-4 as an acceptable level. Results: The daily average concentrations of PM_2.5 was 83.0 μg/m³, 77.0 μg/m³ in Chengguan and Xigu Districts, respectively, during the sampling periods, and the concentration of PM_2.5 in winter/spring was higher than summer/fall in both districts. The concentration of Al in PM_2.5 was the highest and other elements in descending order: Pb, Mn, As, Sb/Cd, Tl in both districts. Enrichment factor results showed that Al and Mn were mainly affected by natural factors, the rest of five elements were all typical man-made pollution elements and according to geo-accumulation index pollution level of Cd was the strongest in the winter. The results of health risk assessment showed that Mn had the highest non-cancer risks (HQ>1) and affected the health of the children seriously. HQ reached up to 2.44 and 1.79 in Chengguan and Xigu Districts, respectively. Pb, As, Sb, Cd had slight health impact (HQ<1), could be negligible. The cancer risks range of As, Cr were 6.33×10^-6 to 6.46×10^-5 between the acceptable level of risk (10^-6 to 10^-4), which indicated that As and Cd had potential cancer-risks. Conclusions The pollution level of atmospheric PM_2.5 and the heavy metals in it was still grim;the non-cancer risks caused by multiple metals on children deserved attention. Although the cancer risks of As and Cd were between the acceptable level of risk, the potential cancer risk still shall not be ignored.

Background:Drug-induced liver injury( DILI)is a kind of commonly seen diseases,in which typical clinical manifestations are lacking and misdiagnosis and missed diagnosis are frequently occurred. Aims:To investigate the clinical characteristics of patients with DILI. Methods:Clinical data of patients with DILI at Zhongshan Hospital,Xiamen University from January 2014 to December 2015 were collected. Clinical characteristics were retrospectively analyzed and the relationship between clinical characteristics and prognosis was investigated. Results:A total of 51 patients with DILI were enrolled,the ratio of male to female was 1∶ 1. 32,the average age at diagnosis was(50. 6 ± 17. 9)years old,the highest proportion(43. 1% )of patients were aged 60 and older. Hepatocellular damage was the main type of liver injury (84. 3% ). Chinese herbs,cardiovascular drugs,hormone and endocrine drugs were the most common drugs causing DILI, which accounted for 51. 0% ,19. 6% and 9. 8% ,respectively. Concomitant diseases of DILI covered many systems. The clinical manifestation of DILI was atypical,and the laboratory examination also lacked specificity. The positivity rate of autoimmune antibody was 5. 9% . Most patients had good prognosis,and the cure rate and improvement rate were 21. 6%and 66. 7% ,respectively. The mortality rate was 5. 9% with the cause of death being liver failure. Levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin,prothrombin time(PT) and international normalized ratio( INR) at admission were correlated significantly with prognosis( P ﹤ 0. 05 ). Conclusions:DILI commonly occurs in elderly population,and inappropriate use of Chinese herbs maybe the important cause. The clinical manifestation of DILI is not typical,and most patients have good prognosis. Levels of ALT,AST, TBIL,albumin,PT and INR at admission are correlated significantly with prognosis.

Objective To evaluate and compare the applicability and accuracy of POSSUM , P-POSSUM and Thora-coscore in predicting the postoperative mortality of thoracic surgery patients .Methods We collected the clinical data of 1 450 thoracic surgery patients during March 2012 to August 2013 in the Second Xiangya Hospital.We used the 3 kinds of risk sco-ring system to calculate the predicted postoperative mortality in these patients .Then we used H-L test and the area under the ROC curve to evaluate and compare their degrees of compliance and validities of identification independently .Results Within 1 450 cases,20 patients (1.4%) died in 30 days after surgery, POSSUM overestimated the mortality (3.84%,P<0.001), while the P-POSSUM (1.05%/1.10%) and Thoracoscore (0.90%) underestimated the mortality, P>0.05.The area under the ROC curve of POSSUM, P-POSSUM ( two kinds of death prediction formula ) and Thoracoscore to predict postoperative mortality in all thoracic surgery patients was 0.774,0.777,0.777 and 0.831 independently, P <0.05; the area under the ROC curve to predict postoperative mortality in patients after lung surgery was 0.755,0.771,0.771,0.849 independently, P<0.05; the area under the ROC curve to predict postoperative mortality of patients with esophageal surgery was 0.640,0.650,0. 650,0.764 independently, only Thoracoscore P<0.05;the area under the ROC curve to predict postoperative mortality of pa-tients with mediastinal and other surgical was 1.000,1.000,1.000,0.854 independently, only Thoracoscore P<0.05.Con-clusion Thoracoscore scoring system is the most suitable risk scoring system to predict postoperative mortality in thoracic sur-gery patients with high predictive accuracy and good identification validity .

Objective To identify the patient-specific and surgery-specific risk factors related to the development of surgical site cranioplasty infection after decompressive craniectomy.Methods A consecutive cohort of 319 patients who had undergone cranioplasty following decompressive craniectomy for stroke or trauma at a single institution from January 2009 to June 2015 was retrospectively established.Logistic regression analysis was performed to predict determinants related to infection following cranioplasty.Results Cranioplasty infection occurred in 11 patients (3.4％).Logistic regression analysis identified that previous temporalis muscle resection (OR=20.21,95％CI:2.09-135.38,P=0.003),preoperative subgaleal fluid collection (OR=34.51,95％CI:2.65-226.39,P=0.001),and operative time (＞150 min) (OR=6.62,95％CI:0.96-37.43,P=0.044) were significantly associated with the development ofcranioplasty infection.Patient age,gender,indications for craniectomy,and time interval between initial craniectomy and cranioplasty were not predictors of the development of cranioplasty infection.Conclusions Long surgical time (＞150 min),presence of preoperative subgaleal fluid collection,and craniectomy with temporalis muscle resection may be risk factors for graft infection after cranioplasty.Surgical techniques should be developed to reduce operative time and avoid temporalis muscle resection when possible.In addition,meticulous dural closure aimed at reducing the formation of subgaleal fluid collection is important for the prevention of graft infections after cranioplasty.