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.

Objective:To investigate the alterations in brain dynamic functional network connectivity (dFNC) and their significance in Parkinson's disease (PD) patients with postural instability/gait difficulty (PIGD).Methods:Ninety PD patients admitted to Department of Neurology, First Affiliated Hospital of Nanjing Medical University from May 2016 to August 2019 were recruited, and 54 healthy controls matched with gender and age were chosen; their clinical data and resting-state functional MRI (rs-fMRI) data were collected. PD patients were divided into PD with PIGD (PD-PIGD) group ( n=49) and PD without PIGD (PD-non-PIGD) group ( n=41) according to Unified Parkinson's Disease Rating Scale (UPDRS) scores. Independent component analysis (ICA), sliding window method and k-means clustering were used to analyze the dFNC and compare among groups. Correlations of dFNC alterations with clinical scales were verified by partial correlation analysis. Results:Four repeated recurring functional connectivity states were identified, and PD-PIGD patients had high frequency in state 3 (44%) and state 2 (23%) of the low dFNC. In terms of dFNC time attributes, PD-PIGD patients had longer mean dwell time in state 3 than PD-non-PIGD patients and had lower number of transitions in state 3 than PD-non-PIGD patients and healthy controls, with significant differences ( P<0.05); PD-PIGD patients had significantly higher fractional windows and statistically longer mean dwell time in state 2 than healthy controls ( P<0.05). In terms of dFNC strengths, compared with healthy controls, PD-PIGD patients showed significantly decreased functional connectivity within default mode network (DMN, between medial superior frontal gyrus and precuneus) and auditory network (AN, between superior temporal gyrus and middle temporal gyrus), but significantly increased functional connectivity between sensorimotor network (SMN, supplementary motor area) and DMN (precuneus) in state 2 ( P<0.05, false discovery rate [FDR]-corrected). Partial correlation analysis indicated positive correlation between mean dwell time in state 3 and PIGD scores in PD-PIGD patients ( r=0.450, P=0.039). Conclusion:PD-PIGD patients exhibit specific dFNC, mainly characterized by low connectivity of the brain functional network and prolonged dwell time; local functional network domains often separate between DMN, AN and SMN networks and within the networks.

Objective:To explore the application value of ultrasound in the early noninvasive monitoring of acute compartment syndrome model, and to provide reference for further clinical applications.Methods:This was a prospective self-controlled study. A model of healthy volunteers with acute compartment syndrome was established by cuff compression. The random method was used to determine the experimental side and the control side. The experimental side cuff was given 0, 20, 30, 40, 50, 60, 70, and 80 mmHg pressure in sequence, while the control side cuff was kept uncompressed at all times. Each pressure on the experimental side lasted for 5 min, during which the ultrasound was used to measure the blood flow waveform and vascular structure of the bilateral popliteal artery, popliteal vein and dorsal plantar artery. Statistical analysis was performed using repeated measures analysis of variance and multivariate analysis of variance.Results:The study included 25 healthy volunteers. There was no statistically significant difference in calf circumference and anterior tibial compartment thickness ( P = 0.314 and 0.678). During compression, the volunteers' heart rate and blood pressure were stable ( P = 0.235 and 0.358). On the experimental side, the maximum blood flow velocity of the popliteal artery during systole increased with the increase of pressure ( P<0.001), and the minimum blood flow velocity of the popliteal artery increased with the increase of pressure ( P<0.001). When pressurized by 30 mmHg, the maximum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side [(73 ± 19) cm/s vs (59 ± 14) cm/s, P=0.023)]. When pressurized by 20 mmHg, the minimum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side [(-28 ± 8) cm/s vs (-22 ± 6) cm/s, P=0.012)]. With the increase of pressure, the diastolic retrograde arterial flow ratio of the experimental side gradually increased ( P <0.001), and when the pressure was increased by 20 mmHg, the diastolic retrograde arterial flow ratio of the experimental side of the popliteal artery increased significantly [(0.42 ± 0.14) cm/s vs (0.30 ± 0.12) cm/s, P=0.009)]. The systolic prograde arterial flow ratio of the dorsal artery in the experimental side decreased with the increase of pressure ( P = 0.024). Conclusions:Increased limb compartment pressure can significantly change the arterial flow waveform of the proximal and distal arteries, and ultrasound can be used as an early monitoring tool for acute compartment syndrome.

Objective:To explore the feasibility of bedside ultrasound in monitoring gastric residual volume and predicting feeding intolerance during enteral nutrition in critically ill patients in intensive care unit.Methods:The data of critically ill patients admitted to emergency intensive care unit of the Second Affiliated Hospital of Zhejiang University School of Medicine from April 2018 to September 2018 were retrospectively analyzed. The following patients were finally included in this study: (1) abdominal computed tomography during the stay of emergency intensive care unit was performed due to the requirement of disease evaluation and management; (2) bedside ultrasound was performed to measure the gastric antrum cross-sectional area at 30 min prior to or after abdominal computed tomography. The outline of stomach wall in the imaging of abdominal computed tomography was traced with the help of VOLUME-Work Flow medical imaging software to calculate the value of gastric residual volume. The relationship between gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions and gastric residual volume was evaluated by Pearson correlation analysis. The difference of gastric antrum cross-sectional area between those critically ill patients with or without feeding intolerance was compared by independent-sample t test. The predictive value of gastric antrum cross-sectional area under different body positions on feeding intolerance during enteral nutrition was analyzed by ROC curve. Results:Totally, forty-two patients were enrolled and analyzed in this study, in which the mean age was (53±13) y, mean body mass index was (21.5±2.8) kg/m 2 and mean acute physiology and chronic health evaluation was 17.0±6.9. The value of gastric residual volume was (314.5±126.6) mL, and the values of gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions were (7.11±4.13) cm 2, (4.22±2.66) cm 2, (8.36±4.58) cm 2, respectively. The correlation analysis indicated that gastric residual volume was positively associated with gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions ( r=0.543, 0.604 and 0.618, respectively; all P<0.001). During enteral nutrition, 15 patients experienced feeding intolerance while 27 patients hadn’t feeding intolerance, in which the gastric antrum cross-sectional areas under semi-sitting, horizontal and right-lateral positions were significantly increased in those patients with feeding intolerance than those patients without feeding intolerance [semi-sitting: (8.53±4.07) cm 2vs (4.60±2.76) cm 2; horizontal position: (5.15±2.75) cm 2vs (2.61±1.32) cm 2; right-lateral position: (10.32±4.06) cm 2vs (4.95±3.20) cm 2, all P<0.005] . ROC curve analysis showed that the area under ROC curves of gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions for predicting feeding intolerance during enteral nutrition were 0.815, 0.833 and 0.849, respectively; when its values≥3.917 cm 2, 3.395 cm 2 and 4.402 cm 2 were used as the cut-off points, the sensitivities were 92.0%, 69.6% and 92.3%, and the corresponding specificities were 69.2%, 92.3% and 71.4%, respectively. Conclusions:Bedside gastric ultrasound could accurately evaluate the status of gastric residual volume in critically ill patients, and effectively predict their occurrence of feeding intolerance during enteral nutrition.

Objective: To summarize the research progress on the application of tranexamic acid (TXA) in traumatic orthopedic surgery in recent years. Methods: The domestic and foreign literature in recent years was reviewed, and the efficacy and safety of TXA in traumatic orthopedic surgeries with different regimen, dose and route of administration were comprehensively summarized and compared. Results: The application of TXA in traumatic orthopedic surgeries increased gradually in recent years. Intravenous or topical administration of TXA efficaciously reduced blood loss and transfusion requirements during hip fracture surgery without significantly increasing the risk of thromboembolic events. However, the efficacy was not clear in other traumatic orthopedic surgeries such as pelvic and acetabular fractures. Conclusion: More studies are needed to confirm the efficacy and safety of TXA in traumatic orthopedic surgeries.

Objective: To investigate the resuscitation effect of aortic balloon occlusion (ABO) on the traumatic cardiac arrest (TCA) in swine. Methods: Twenty-seven male domestic swine weighing (32.7±3.8)kg were utilized. After 40% of estimated blood volume was removed within 20 minutes, the animals were subjected to 5 minutes of untreated ventricular fibrillation and then 5 minutes of cardiopulmonary resuscitation. Additionally, fluid resuscitation was initiated coincident with the beginning of cardiopulmonary resuscitation. The animals were randomly divided into model group (n=12) and ABO group (n=15). Once cardiopulmonary resuscitation was implemented, aortic balloon was concurrently inflated to stop the blood flow of descending thoracic aorta at the level of the diaphragm in the ABO group. In the model group, aortic balloon was placed in the same position without inflation. During cardiopulmonary resuscitation, the changes of coronary perfusion pressure (CPP), forehead's regional cerebral oxygen saturation (rSO₂) and pressure of end-tidal CO₂ (PETCO₂) were continuously monitored, and the rate of return of spontaneous circulation (ROSC), duration of cardiopulmonary resuscitation, number of shocks and dose of epinephrine were recorded. At 5 minutes after successful resuscitation, the levels of arterial blood gas, lactate and jugular venous blood oxygen saturation (SjvO₂) were measured. Results: Compared with the model group, the values of CPP, rSO₂ and PETCO₂ during cardiopulmonary resuscitation were significantly increased in the ABO group [CPP: (33.5±5.6)mmHg vs. (23.1±5.2)mmHg at 1 minute, (35.3±6.0)mmHg vs. (26.8±7.4)mmHg at 2 minutes, (36.3±6.3)mmHg vs. (28.2±6.3)mmHg at 3 minutes, (40.1±7.1)mmHg vs. (30.5±6.2)mmHg at 4 minutes, (38.1±7.5)mmHg vs. (29.8±5.3)mmHg at 5 minutes; rSO₂: (45.4±5.2)% vs. (39.2±5.1)% at 1 minute, (47.2±3.6)% vs. (42.0±6.4)% at 2 minutes, (47.7±3.0)% vs. (41.5±5.4)% at 3 minutes, (47.0±2.5)% vs. (42.1±5.9)% at 4 minutes, (47.1±2.0)% vs. (41.5±7.4)% at 5 minutes; PETCO₂: (17.0±3.5)mmHg vs. (12.7±4.2)mmHg at 1 minute, (18.5±3.7)mmHg vs. (14.5±2.7)mmHg at 2 minutes, (20.7±5.3)mmHg vs. (15.5±3.2)mmHg at 3 minutes, (18.7±4.5)mmHg vs. (14.9±3.5)mmHg at 4 minutes, (18.2±3.2)mmHg vs. (14.5±4.2)mmHg at 5 minutes] (all P<0.05). The rate of ROSC was significantly higher in the ABO group than in the model group[100%(15/15) vs. 75%(9/12)] (P<0.05). Additionally, shorter duration of cardiopulmonary resuscitation, less number of shocks and lower doses of epinephrine were observed in the ABO group when compared with the model group[duration of cardiopulmonary resuscitation: 5(5, 5)minutes vs. 5(5, 12.5)minutes, number of shocks: 1(1, 1)times vs. 1(1, 4)times, dose of epinephrine: 0.62(0.62, 0.74)mg vs. 0.64(0.59, 2.59)mg] (all P<0.05). At 5 minutes after resuscitation, the level of arterial lactate was significantly decreased and the value of SjvO₂ was significantly increased in the ABO group compared with the model group[Lactate: (9.6±0.8)mmol/L vs. (10.8±1.4)mmol/L; SjvO₂: (50.0±8.6)% vs. (37.9±16.3)%] (both P<0.05). Conclusions In a swine model of TCA, ABO can increase cardiac and cerebral perfusion during cardiopulmonary resuscitation and improve the efficacy of cardiopulmonary resuscitation. It might provide a novel and effective method for the resuscitation of TCA in the clinical setting.

Objective To study the effect of high-flow oxygen insuffiation (HFOI) via nasal cannula in reduction in re-intubation rate,length of ICU stay and improvement of respiratory function in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score (LUS).Methods Single center randomized(random number) clinical trial was carried out in one intensive care units in China from May 2016 to May 2017 including critically ill patients ready for planned extubation with high-risk factors for re-intubation assessed by LUS when the LUS ≥ 14 was considered to be high risk.The comparisons of the length of ICU stay,re-intubation rate in case of respiratory failure,respiratory rate pulse rate SaO2 PaO2/FiO2 of patients at 6 h,24 h and 48 hours after extubation were made between HFOI and conventional oxygen therapy (COT) group.Results During the study period,32 patients were enrolled in the study.Of them,15 were assigned in HFOI group and 17 in COT group.The length of ICU stay (8.0±2.4)days vs.(10.9±3.5) days and re-intubation rate (6.7％ vs.23.5％) were significantly different between two groups (P＜0.05).The respiratory rate pulse rate SaO2 and PaO2/FiO2 of patients at 6 h after ex-tubation in HFOI group were improved than those in COT group (P＜0.05);and the SaO2 and PaO2/FiO2 of patients 24 h and 48 h after ex-tubation in HFOI group had much more improvement than those in COT group (P＜0.05).Conclusion Among high-risk adults who assessed by lung ultrasound score,high-flow oxygen therapy could reduce re-intubation rate length of ICU stay and improve the respiratory function.High-flow oxygen therapy may offer advantages for these patients.

Objective: To explore the risk factors associated with interleukin 6 (IL-6) level in serum after total knee arthroplasty (TKA). Methods: A retrospective study was made on the clinical data of 273 patients underwent primary unilateral TKA between July 2015 and April 2017. There were 50 males and 223 females with an average age of 66.3 years (range, 36-89 years), and the body mass index (BMI) was (25.5±3.7) kg/m 2. Of them, 256 patients suffered with osteoarthritis, and the other 17 patients with rheumatoid arthritis. Univariate analysis was made to find the related factors between IL-6 level in serum at 1 day after operation and preoperative data including gender, age, BMI, diagnosis, comorbidities, preoperative American Society of Anesthesiologists (ASA) grade, preoperative varus or valgus deformity, range of motion of the knee, preoperative level of C-reactive protein (CRP) and IL-6 in serum, operation time, intraoperative blood loss, usage of drainage tube and catheter, and dosage of tranexamic acid and dexamethasone used on day of operation. Furthermore, the multiple linear regression analysis was performed to identify the risk factors. Results: The operation time was (79.7±15.6) minutes, and the intraoperative blood loss was (107.8±25.3) mL. Drainage tubes were used in 111 patients and catheters were used in 41 patients after operation. The dosage of tranexamic acid and dexamethasone used on day of operation were (3.2±0.8) g and (15.1±6.6) mg, respectively. The levels of IL-6 in serum were (4.48±3.05), (42.65±37.09), and (28.21±26.44) pg/mL before operation and at 1 and 3 days after operation, respectively. Univariate analysis showed that the level of IL-6 in serum at 1 day after operation was significantly higher in variables as follows: age, diagnosis, history of lung infection, range of motion, preoperative levels of CRP and IL-6 in serum, intravenous dosage of tranexamic acid and dexamethasone on day of operation ( P<0.05). Multiple linear regression analysis showed that range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were significant risk factors ( P<0.05). Conclusion: Range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were independent risk factors that resulted in increased level of IL-6 in serum at 1 day after TKA.

Objective To explore the effects of multiple intravenous tranexamic acid (Ⅳ-TXA) administrations after total knee arthroplasty (TKA) on fibrinolytic activity and inflammatory response in an enhanced recovery after surgery (ERAS) program and to assess the efficacy and safety of Ⅳ-TXA.Methods One hundred and forty-one severe knee osteoarthritis patients following primary unilateral TKA from January 2016 to April 2017 were investigated retrospectively.The patients were divided into following three groups based on the dosage of Ⅳ-TXA after surgery:40 patients received ≤3 g Ⅳ-TXA after surgery (group T1),50 patients received 4 g (group T2) and the other 51 patients received ≥5 g Ⅳ-TXA (group T3).The total blood loss (TBL),hidden blood loss (HBL),transfusion rate,maximum hemoglobin (Hb) drop,the incidence of intramuscular venous thrombosis,deep vein thrombosis (DVT) and pulmonary embolism (PE),fibrinolysis parameters [fibrin(-ogeu) degradation products (FDP),D-dimer],and inflammation markers [C-reactive protein (CRP),interleukin-6 (IL-6)] during perioperative period were evaluated.In addition,correlation analyses between the dosage of Ⅳ-TXA and fibrinolysis parameters and inflammation markers were conducted.Results The mean TBL,HBL and maximum Hb drop in group T2 (537.16±270.43 ml,431.36±271.99 ml,19.68± 10.68 g/L) and T3 (541.31±290.00 ml,439.94±290.71 ml,20.24±8.48 g/L) were lower than those in group T1 (748.22±394.34 ml,P=0.012,0.013;636.47±388.14 ml,P=0.011,0.015;25.88± 11.77 g/L,P=0.005,0.010,respectively).No patient needed transfusion in all groups.There was no statistically difference in the incidence of intramuscular venous thrombosis of lower limbs among three groups (P＞ 0.05).No episode of DVT or PE occurred in any group in two weeks after surgery.There were negative correlation between the dosage of Ⅳ-TXA and FDP at postoperative day 1 and day 3 (r=-0.191,P=0.025;r=-0.291,P=0.001) and D-dimer on postoperative day 3 (r=-0.176,P=0.048).Moreover,the CRP (r=-0.184,P=0.036) and IL-6 (r=-0.269,P=0.002) level in serum on postoperatire day 1 also showed a negative relationship with the dosage of Ⅳ-TXA after surgery.Conclusion The multiple Ⅳ-TXA (≥4 g) after surgery can further reduce the TBL,HBL and maximum Hb drop following primary TKA in ERAS program without increasing the risk of thrombotic events.Most importantly,the effect of anti-fibrinolysis will be enhanced and may have an anti-inflammatory effect with the dosage of Ⅳ-TXA increased.

Objective:To observe the therapeutic efficacy of acupuncture plus heat-sensitive moxibustion in treating chronic pelvic inflammatory disease (CPID), for selecting an effective acupuncture-moxibustion method in treating chronic pelvic inflammation. Methods:Eighty CPID subjects were enrolled and divided into two groups by randomized single-blind method, 40 in each group. The observation group was intervened by acupuncture plus heat-sensitive moxibustion, while the control group was by acupuncture plus box-moxibustion, once every other day, 10 sessions as a treatment course, but the period time was skipped. The therapeutic efficacy was observed after 3 treatment courses. Results:The recovery rate was 45.0% and the total effective rate was 95.0% in the observation group, versus 20.0% and 80.0% in the control roup. There were significant differences in comparing the recovery rate and the total effective rate between the two groups (P<0.05). Conclusion:Acupuncture plus heat-sensitive moxibustion can produce a higher therapeutic efficacy in treating CPID than acupuncture plus box-moxibustion, and this is an easy-to-operate and safe method without adverse effect.