Maxillary molar with three roots and 3 to 4 canals is a common occurrence.However,in addition to common root canal anatomy,there may be significant differences in the number,distribution,and morphological structure of root canals.The success of root canal treatment is dependent on ensuring that all the intricate details associated with it are meticulously followed.Failure to locate all canals could have a negative effect on the treatment as it may lead to initiation or continuation of periapical pathology.Missed canals were the main reason for patients reporting back for nonsurgical root canal retreatment.Moreover,the bacteria residing in such canals could also result in persistence of symptoms.Root canal anatomy is complex,and the recognition of anatomic variations could be a challenge for clinicians.This article presents three cases of endodontic management of maxillary molars with atypical canal morphology.In the three cases of this study,the patients underwent cone beam computed tomographic(CBCT)examination before root canal treatment.The CBCT images revealed that the maxillary molars in case 1 and case 2 had 5 canals.Case 1:2 mesiobuccal(MB,MB2),two distobuccal(DB and DB2),and one palatal canal.Case 2:2 mesiobuccal(MB,MB2),one distobuccal(DB),and two palatal canals(MP and DP).In case 3,CBCT scan slices showed that the maxillary first molar presented as a C-shaped root canal with a rare tooth anomaly of taurodontism.Although C-shaped root canals were most frequently seen in the mandibular second molar,they might also appear in maxillary molars.A literature search revealed only a few case reports of C-shaped root canal systems in maxillary molars.Case 3 described the fusion between mesiobuccal and palatal roots of the maxillary first molar,forming a C-shaped mesiopalatal root canal.The above cases suggest that endodontists should always be aware of aberrancies in root canal sys-tem apart from the knowledge of normal root canal anatomy.CBCT as a means of diagnosis can be helpful for identifying and managing these complex root canal systems.This case series also highlights the impor-tance of magnification and illumination.Through using an endodontic microscope,clinicians can identify root canals that are difficult to locate or overlooked with normal vision.A correct access opening is a most important step to locate and negotiate the orifices of root canals.The use of ultrasonic tips can refine the access cavity and allow controlled and delicate removal of calcifications and other interferences to the ca-nal orifices,thereby helping to locate the extra orifices.

ObjectiveTo investigate the incidence of hypertension and its influencing factors in community-dwellers at risk for high blood pressure in Minhang District of Shanghai， and to provide scientific evidence for the community management. MethodsA retrospective cohort study was conducted using the electronic health records of community-dwellers at risk for high blood pressure in Minhang District， Shanghai from January 1， 2011 to December 31， 2017. The study end-point was the occurrence of hypertension，and the followup was finished in December 2021. A total of 17 265 community-dwellers at risk for high blood pressure were enrolled in our study. Log-rank test and Cox regression analysis were used to determine the influencing factors. ResultsAfter 6.04 years of follow-up， the hypertension incidence among community-dwellers at risk for high blood pressure in Minhang District of Shanghai was 25.5%. Family history of hypertension （HR=1.250， 95%CI： 1.168‒1.338）， family history of stroke （HR=1.295， 95%CI： 1.080‒1.553）， history of diabetes （HR=1.203， 95%CI： 1.076‒1.345）， daily smoking （HR=1.187， 95%CI： 1.087‒1.296）， overweight （HR=1.393， 95%CI：1.308‒1.484）， obesity（HR=1.903， 95%CI： 1.719‒2.106）， high values of normal blood pressure （HR=1.275， 95%CI： 1.195‒1.359） and advanced age （HR=1.033， 95%CI： 1.030‒1.036） were all risk factors. Emaciation （HR=0.649， 95%CI： 0.500‒0.840） was a protective factors. ConclusionBlood pressure monitoring should be strengthened for people elderly， with family history of hypertension， family history of stroke， diabetes or high values of normal blood pressure， so as to diagnose hypertension early. Timely intervention measures should be taken for community-dwellers with unhealthy lifestyles such as smoking， overweight and obesity.

Objective To assess the effect of ultrasonic thyroid artificial intelligence(AI)-assisted diagnostic system(AI-assisted diagnostic system)for diagnosing medullary thyroid carcinoma(MTC)compared with different physicians and taken papillary thyroid carcinoma(PTC)as the controls.Methods Totally 63 MTC,70 PTC and 62 benign thyroid nodules confirmed by pathology were enrolled.AI-assisted diagnostic system was utilized to analyze thyroid nodules and identify the likelihood of malignancy,and the probability value threshold was set at ≥0.40.All thyroid nodules were retrospectively reviewed and categorized by 3 physicians(1 senior physician,1 attending physician and 1 junior physician)according to Chinese thyroid imaging reporting and data system(C-TIRADS).The efficacy of AI-assisted diagnostic system and physicians for diagnosing MTC and PTC were evaluated.Results AI-assisted diagnostic system showed lower sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve(AUC)for diagnosing MTC and PTC compared with physicians.Significant differences of AUC were found between senior physician and AI-assisted diagnostic system,as well as between attending physician and AI-assisted diagnostic system for diagnosing MTC and PTC(all P＜0.01),while no significant difference of AUC was between junior physicians and AI-assisted diagnostic system(both P＞0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and AUC for AI-assisted diagnostic system for diagnosing MTC were all lower than those for diagnosing PTC,but the AUC was not significantly different(P＞0.05).Conclusion Ultrasonic thyroid AI-assisted diagnostic system had relatively high value for diagnosing MTC.

Objective:To investigate the status of medical care seeking delay and diagnosis delay of pulmonary tuberculosis (PTB) patients in Tongzhou District and Changping District of Beijing, analyze the related factors and put forward suggestions for early detection and scientific management of PTB patients.Methods:A retrospective epidemiological survey was conducted to collect the incidence data of PTB registered in Tongzhou and Changping from January 1 to December 31, 2021 by using the Chinese Tuberculosis Information Management System, and telephone interview were used for information supplement. Multivariate logistic regression model and decision tree model were used to analyze the influencing factors of medical care seeking delay and diagnosis delay of PTB patients.Results:In 2021, the medical care seeking delay time M( Q1, Q3) in the PTB patients in Tongzhou and Changping was 11 (5, 26) days, with a delay rate of 41.71%. Results from multivariate logistic regression model analysis revealed that factors influencing the medical care seeking delay included regular health check-up ( OR=0.033, 95% CI: 0.008-0.147), coughing for less than 2 weeks or showing any symptom of PTB before medical care seeking ( OR=0.378, 95% CI: 0.215-0.665), showing other symptoms before medical care seeking( OR=2.791, 95% CI: 1.710-4.555), no work or school in medical care seeking ( OR=2.990, 95% CI: 1.419-6.298). The diagnosis delay time M( Q1, Q3) in the PTB patients was 8 (0, 18) days, with a delay rate of 35.20%. Multivariate logistic regression model analysis revealed that the factors influencing the diagnosis delay of PTB included being diagnosed at a specialized tuberculosis hospital ( OR=0.426, 95% CI: 0.236-0.767) or a tuberculosis prevention and control institution ( OR=1.843, 95% CI: 1.061-3.202) and being traced as a source of infection ( OR=2.632, 95% CI: 1.062-6.521). The overall performance of the multivariate logistic regression model was comparable to that of the decision tree model, with the decision tree model exhibiting higher sensitivity but lower specificity. Conclusions:The medical care seeking delay rate and diagnosis delay rate of tuberculosis in Tongzhou and Changping were at low levels in 2021. However, it is still necessary to strengthen the health education and active screening, improve the public awareness of PTB prevention and control, and further improve the level of medical services and medical access to reduce the medical care seeking delay and diagnosis delay of PTB patients.

Objective:To analyze the relationship between health belief and the stages of parental decision-making on childhood 13-valent pneumococcal conjugate vaccine (PCV13) immunization in China.Methods:Cross-sectional multistage survey sampling method was used to select study subjects. The study subjects were parents who were aged 20-45 years and had one and more children ≤5 years old in three cities in China. A self-administered questionnaire designed based on health belief model was used to collect the information. Multinomial logistic regression analysis was used to assess the relationships between perceived susceptibility, perceived severity of illness, perceived effect of PCV13 and stages of parental decision-making on childhood PCV13 immunization.Results:A total of 1 716 valid questionnaires were returned (89.33%). The average age of the study subjects was (35.33±4.95) years, and 79.60% of them were women. In the study subjects, 48.31% had in action, 21.79% were in contemplation and 29.90% were in pre-contemplation. The multinominal logistic regression analysis indicated that high perceived susceptibility ( OR=0.14, 95% CI:0.09-0.22; OR=0.54, 95% CI:0.39-0.76), high perceived severity of illness ( OR=0.55, 95% CI:0.42-0.73), and high perceived effect of PCV13 ( OR=0.27, 95% CI:0.18-0.40; OR=0.51, 95% CI:0.32-0.81) were significantly lower in those who were in contemplation or pre-compared with those who had in action. For study subjects with low perceived susceptibility, high perceived effect of PCV13 might decrease the probabilities of contemplation ( OR=0.53, 95% CI:0.32-0.87) and pre-contemplation ( OR=0.27, 95% CI:0.18-0.41). For those with high perceived susceptibility, perceived severity of illness might decrease the probability of contemplation ( OR=0.43, 95% CI:0.23-0.82). Conclusions:Childhood PCV13 vaccination willingness and level is low in China. It is important to pay greater attention to the intervention on health belief in child parents, such as perceived effect of PCV13, perceived severity of illness, and perceived susceptibility, in health policy development and health promotion.

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 overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

Objective:To investigate effect of Gehua Jiecheng Decoction on IL-6/JAK2/STAT3 signaling pathway in colon tissue of ulcerative colitis with"inflammatory to cancer transformation"(UC-UCAC)mice of spleen deficiency and damp-heat type.Methods:Ten from 80 SPF C57BL/6 male mice were randomly selected as blank group and other 70 mice were selected as model group.After establishment of spleen deficient damp-heat model,mice were randomly divided into model group(1st,2nd and 3rd cycle),Gehua Jiecheng Decoction high,medium and low doses groups and mesalazine group,with 10 pieces per group.UC-UCAC transformation model was further established with azo methane oxide solution(AOM)/sodium glucan sulfate(DSS).Each group was treated with corresponding drugs for 4 weeks.General state of mice was observed.Score of disease activity index(DAI)was calculated.HE staining was used to observe colonic mucosa pathology of mice.EGFR,IL-6,JAK2,STAT3 and p-STAT3 proteins and genes expressions in mice colon tissues were detected by Western blot,IHC and RT-qPCR,respectively.Results:Compared with blank group,mice in model group(3rd cycle)were generally in a worse state,colon mucosal tissue was cancerous,DAI score,target proteins and genes expressions were significantly increased(P<0.01).Compared with model group(3rd cycle),general state of mice in all treatment groups were restored and colonic tissues pathology were improved to some extent.Target proteins and genes expressions in other treatment groups were significantly decreased except for Gehua Jiecheng Decoction low-dose group(P<0.01).Conclusion:Gehua Jiecheng Decoction may destroy tumor inflammatory microenvironment,repair damaged colonic mucosa tissue,delay inflamma-tion-cancer transformation process and prevent UCAC by inhibiting activation of IL-6/JAK2/STAT3 signaling pathway.

Objective:To investigate the placenta tissue expression levels of monocyte chemotactic protein-1 (MCP-1), nuclear factor-κBp65 (NF-κBp65) and proliferating cell nuclear antigen (PCNA) in pregnant women with gestational diabetes mellitus (GDM), and to analyze their correlation with pregnancy outcomes.Methods:The clinical data of 124 pregnant women with GDM from May 2020 to December 2021 in PLA Northern Theater General Hospital were retrospectively analyzed. Among them, 62 pregnant women were willing to receive treatment (treatment group), while 62 pregnant women were unwilling to receive treatment (untreated group). In addition, 80 healthy pregnant women in the same period were selected as the healthy control group. The natural birth rate, neonatal Apgar score and the incidences of macrosomia, neonatal hypoglycemia, neonatal hyperbilirubinemia were record. The placenta tissue expression levels of MCP-1, NF-κBp65 and PCNA were detected by immunohistochemical.Results:The natural birth rate in untreated group was significantly lower than that in treatment group and healthy control group: 24.19% (15/62) vs. 75.81% (47/62) and 88.75% (71/80), the natural birth rate in treatment group was significantly lower than that in healthy control group, and there was statistical difference ( P<0.05). The Apgar score in untreated group was significantly lower than that in treatment group and healthy control group: (8.45 ± 2.02) scores vs. (9.46 ± 2.59) and (9.71 ± 3.21) scores, the incidences of macrosomia, neonatal hypoglycemia and neonatal hyperbilirubinemia were significantly higher than those in treatment group and healthy control group: 35.48% (22/62) vs. 11.29% (7/62) and 3.75% (3/80), 29.03% (18/62) vs. 8.06% (5/62) and 2.50% (2/80), 24.19% (15/62) vs. 9.68% (6/62) and 2.50% (2/80), and there were statistical differences ( P<0.05); there were no statistical difference in the indexes treatment group and healthy control group ( P>0.05). The positive expression rates of MCP-1, NF-κBp65 and PCNA in untreated group were significantly higher than those in treatment group and healthy control group: 72.58% (45/62) vs. 25.81% (16/62) and 12.50% (10/80), 69.35% (43/62) vs. 27.43% (17/62) and 13.75% (11/80), 69.35% (43/62) vs. 24.19% (15/62) and 11.25% (9/80), the indexes in treatment group were significantly higher than those in healthy control group, and there were statistical differences ( P<0.05). Conclusions:The placenta tissue expression levels of MCP-1, NF-κBp65 and PCNA in pregnant women with GDM are associated with adverse pregnancy outcomes. After active treatment, the positive rates of the three indexes in pregnant women with GDM significantly decrease, and the prognosis got improved.

Objective:To construct a self-examination index system for hospital legal practice, and provide effective reference for the self-examination work of hospital practice in accordance with the law.Methods:From May 2021 to September 2022, a multi-dimensional and multi-level indicator system was initially constructed through literature review and expert interviews; Delphi expert consultation method was used to carry out a three-round questionnaire survey, experts were invited to assess the importance of indicators, and the weight values of indicators were processed by using analytic hierarchy process-fuzzy comprehensive evaluation method.Results:The Cs value of consulting experts′ familiarity with the survey content was 0.84, Ca value of judgment basis was 0.78, Cr value of authoritative evaluation was 0.81, and Kendall W value was 0.630. The index system of hospital self-examination included 5 first-level indexes, 19 second-level indexes, and 30 third-level indicators. The 5 first-level indicators included institutional practice, personnel practice, disinfection and prevention of infectious disease, online diagnosis and treatment, and anti-fraud insurance, with weights of 0.235, 0.186, 0.188, 0.185, and 0.206 respectively. Among the second-level indicators, the weights of rational use of medical insurance fund, internet hospital and internet diagnosis and treatment, organization qualification and practice behavior were the highest, with values of 0.206, 0.185, 0.122 and 0.113 respectively. Among the third-level indicators, the internet hospital physician qualification, whether the hospital had obtained the license to practice, cracking down on fraudulent insurance practices, real-name medical treatment, and reasonable and standardized use of health insurance costs had the highest weight, which were 0.185, 0.122, 0.076, 0.065, and 0.065, respectively. Conclusions:The self-examination index system of medical institutions is scientific, which could help the medical institutions to practice self-examination and ensure medical quality and safety.