Endodontic microsurgery is a vital treatment modality for teeth with persistent periradicular pathoses that have not responded to nonsurgical retreatment. The principle is to determine the reason for failure, completely eliminate the infection and promote periapical healing. Within recent years, endodontic microsurgery has evolved to become standardized and presents with a high success rate. However, its outcome is still influenced by many factors, including anatomy, periodontal condition, crown-to-root ratio, occlusion, the type of periradicular lesion, and prosthesis. Moreover, endodontists always concentrate on “the apex”, paying little attention to the general preoperative evaluation, accurate diagnosis, and comprehensive treatment plan. This article reviews the latest literature on these issues and the clinical experience of our research group and discusses the correlation between endodontic microsurgery and other oral disciplines, including periodontology, prosthodontics, oral implantology, oral and maxillofacial surgery and orthodontics. The oral interdisciplinary assessment should be made with comprehensive consideration of the root canal system, periradicular lesion, adjacent anatomical relationships, periodontal condition, occlusion, and esthetic rehabilitation. Based on these findings, the continuity of treatment will be optimized, and the best treatment plan will be proposed to provide clinical strategies for the diagnosis and treatment of complex periradicular diseases.

Objective:To investigate the correlation between subclinical hypothyroidism(SCH)and the degree of coronary artery stenosis in patients with coronary heart disease.Methods:From March 2018 to September 2019, 138 patients undergoing coronary angiography in our hospital were randomly selected and their serum thyroxine(FT4)and high-sensitivity thyroid stimulating hormone(sTSH)levels were measured.Based on the levels of FT4 and sTSH, patients were divided into the SCH group and the normal group.Combined with coronary angiography results, the correlation between the SCH and the number of coronary lesions were analyzed.Results:Patients in the SCH group were associated with significantly higher levels of cholesterol(TC)[(5.83±1.27)mmol/L vs.(5.02±1.22)mmol/L, t=3.746, P=0.000], triglyceride(TG)[(3.29±1.74)mmol/L vs.(2.17±1.68)mmol/L, t=3.769, P=0.000], low-density lipoprotein cholesterol(LDL-C)[(3.81±1.02)mmol/L vs.(3.24±1.08)mmol/L, t=3.092, P=0.001], and high-density lipoprotein cholesterol(HDL-C)[(1.13±0.27)mmol/L vs.(1.02±0.25)mmol/L, t=2.4459, P=0.008]than those in the normal group.There were significant differences in sTSH levels between patients with multivessel, double vessel or single vessel disease when grouped by the number of coronary lesions, and between those with severe, moderate or mild coronary artery stenosis when grouped by disease severity(all P<0.05). Multiple regression analysis showed that SCH, TC, and LDL-C were factors affecting the number of coronary lesions( P<0.05). Conclusions:SCH is an important factor that causes the occurrence and progression of coronary artery stenosis in patients with coronary heart disease, mainly by affecting lipid metabolism.

Teaching rounds is an important part of clinical teaching practice, therefore, we established a demonstration team for teaching ward rounds. By formulating standard operation procedure for teaching rounds and encouraging innovation on teaching models, the team played a demonstration role in the clinical teaching rounds, which not only made up the shortcomings in teaching, but also improved the teaching level of clinical teachers and the quality of clinical training.

Objective To studythe labor analgesia effect incombination of water acupuncture andremifen-tanil patient-controlled intravenous analgesia (PCIA) and impact on mother and baby. Methods 90 Ninety sin-gle birth primiparous women were randomly divided into three groups (n = 30), groupⅠ, groupⅡ, groupⅢ. Content of β-endorphin, stress hormone levels,VAS scores were recorded at T0 and T1; adverse circumstance, Apgar score of newborn and neonatal behavioral neurological assessment were recorded. Results Comparing with groupⅢ or T0, at T1 β-EP in the groupⅠwas gone up, while ACTH、 COR and VAS scores were lower in the groupⅠand groupⅡ; adverse circumstance in the groupⅠreduced than that in the groupⅡ. The VAS scores inThe groupⅠand groupⅡand Apgar score and NBNA assessment in three groups were not significantly different. Conclusion Combination of water acupuncture and remifentanil patient-controlled intravenous analgesia iseffec-tive. Ithas no adverse effects on mother and baby. It is an ideal method of labor analgesia.

Objective To investigate the feasibility and safety of OLV anesthesia about infant lung resection of CCAM by video-assisted thoracicscopy. Methods Endo-tracheal intubation was performed after 43 CCAM infants had undergone rapid intravenous induction. One side of lungs was ventilated by injecting 4 ~ 6 mmHg CO2 for the construction of artificial pneumothorax, and the side lung was compressed forming OLV. SpO2, ECG, MAP, PETCO2, T, PaO2, PaCO2, bleeding volume and urine volume were monitored. The numerical value of SpO2, PaO2, HR, MAP, PETCO2, and PaCO2 were recorded at scheduled intervals. Results Compared with 5min after induction,the PaO2,HR and MAP of the infants significantly reduced; the PETCO2 and PaCO2 significantly increased at OLV at 10 min and 60 min. Compared with OLV at 10 min, the PaO2, PETCO2 significantly increased at OLV 60 min. Conclusion Appropriate respiratory management and drug usage are feasible and safe for infant surgery of CCAM by video-assisted thoracicscopy.

Objective To evaluate left atrial(LA)function in patients with prophase essential hypertension (EH)by left atrial volume tracking(LAVT)method.Methods Thirty prophase EH patients and 35 healthy subjects(control group)were enrolled in this study.Ultrasound LAVT(Hitachi EUB-6500)was applied to display and analyze the LA volume loop imaging on the standard LV apical two and four chamber views.The maximal LA volume at end-systole(LAVmax),LA volume at the onset of ECG-P wave(LAVP),the minimal LA volume at end-diastole(LAVmin)from the LA volume loop were recorded,and body surface area was used to revise these volume indexs(LAVImax,LAVIp,LAVImin).LA pass,act and total empting volume(LAVIpass,LAVIact,LAVItotal)and empting rate(%LAVIpass,%LAVIact,%LAVItotal),effective pass and act erupting rate(%eLAVIpass,%eLAVIaet),and the proportionality of pass empting volume and act empting volume were caculated.Results The LAVIp,LAVIact,LAVItotal,%LAVIact,%LAVItotal,%eLAVIact in the prophase EH group were significantly higher than those in the control group,wheras the LAVIpass,%LAVIpass,%eLAVIpass,LAVIpass/act were lower(all P＜0.05,or P＜0.01).Conclusions The LA volume change in prophase EH is the act empting volume increased at end-diastole in main,LAVT is a potientially useful tool to evaluate the function of LA.

Objective To assess the motion asynchrony of left ventricle(L V)wall in patients with chronic heart failure(CHF)by ultrasound two dimensional speckle-tracking imaging(2D-STI).Methods Thirty-seventy patients with CHF were divided into two groups:CHF1 group,22 with QRS≤120 ms;CHF2 group,15 with QRS ＞120 ms.Thirty healthy subjects(control group)were enrolled.2D-STI was applied to display and analyze the strain rate imaging on the three standard LV apical views and parasternal LV short-aix views,respectively.The time from the onset of QRS complexes to peak strain rate during systole(Tsrs)and early-diastole(Tsre)were measured from the longitudinal,radial and circumferential vector respectively(Tsrsl,Tsrel,Tsrsr.Tsrer,Tsrsc,Tsrec).The standard deviation of all above parameters(Tsrsl-SD.Tsrel-SD,Tsrsr SD,Tsrer-SD,Tsrsc-SI).Tsrec-SD)and the maximal temporal difference(Tsrsl-diff.Tsrel-diff,Tsrsr-diff,Tsrer-diff,Tsrsc-diff,Tsrec-diff)of 18 segments were calculated as indicator of dyssynchrony.Results The systolic dyssynehrony indices Tsrsl-SD,Tsrsl-diff,Tsrsr-SD,Tsrsr-diff,Tsrsc-SD Tsrsc-diff and diastolic dyssynchrony indices Tsrel-SD,Tsrel-diff,Tsrer-SD,Tsrer-diff,Tsrec-SD,Tsrec-diff were significantly higher in the CHF1 and CHF2 group than those in the control group(all P＜0.05).Compared with the values in the CHF1 group,the systolic indices of dyssynchrony and the radial and circumferential diastolic indicator of dyssynchrony in CHF2 group were longer(P＜0.05).Conclusions The longitudinal,radial and circumferential systolic and diastolic dyssynchrony of the LV were commonly existed in patients with CHF,regardless of QRS duration.2D-STI is a potientially useful tool to evaluate the systolic and diastolic synchrony of the LV wall motion in patients with CHF.

Objective To observe hemodynamic changes in patients with primary hypertension with wave intensity (WI). Methods Carotid arteries of 36 patients with primary hypertension and 30 age-matched normal controls were examined with imaging technique of WI. The following parameters were measured: the first wave peak in early ejection (W1), the second wave peak in late ejection (W2), the negative area during the mid-ejection (NA), the interval between the R wave of the ECG and the first peak of W1 (R-1st), the interval between the first peak and the second peak (1~(st)-2~(nd)), the ratio of R-1st and a cardiac cycle time R-1_(HR)~(st)) and the ratio of 1~(st)-2~(nd) , as well as one cardiac cycle time (1~(st)-2(_(HR)~(nd)). Results ①W1 in primary hypertension group increased compared with those of normal controls (P＜0.01), while no significant difference of W2, NA, R-1st, 1~(st)-2~(nd), R-1_(HR)~(st), 1~(st)-2_(nd)~(HR) was detected (P＞0.05). ②Both W1 and W2 correlated positively with pulse pressure (PP) and systolic blood pressure (SBP) (r=0.66, 0.55, P＜0.01;r=0.62, 0.44, P＜0.01). W1, W2 and age, DBP were not related significantly (P＞0.05). Conclusion The hemodynamic parameters of WI technology provide a new way to evaluate the dynamics of the heart and vascular system and their interaction.

Objective To evaluate left atrial(LA) function in patients with prophase type 2 diabetes mellitus(T2DM) combinated with or without hypertension using left atrial volume tracking method(LAVT). Methods Thirty-one simple T2DM(T2DMI group) ,21 T2DM accompany with hypertension(T2DM2 group) and forty-five healthy subjects (control group) were enrolled in this study. Ultrasound LAVT(EUB-6500, Hitachi Medical Corporation) was applied to display and analyzed the LA volume loop imaging on the standard LV apical two and four chamber views. The maximal and the minimal LA volume (LAVmax, LAVmin) and the volume before LA contraction (LAVp) were recorded from the LA volume loop. The body surface area was used to correct these volume indexs. The LA reservoir function was assessed by calculating the total of LA filling volume (LAVItotal) and the expansion index(iLAVIe). The passive and active emptying percentage of the total emptying volume(LAVIpass, LAVIact) and the emptying index(iLAVIpass,iLAVIact) were caculated as the parameters of the LA conduit and booster pump function. Results Compared with the values in the control group, the LAVhotal,LAVIact were significantly higher and the LAVlpass,iLAVlpass were lower in the T2DM group (all P<0.05) ,while the iLAVIact was higher only seen in the T2DM2 group(P<0. 05). The LAVlact, iLAVIact were higher and the LAVIpass was lower in T2DM2 group than those in the T2DM1 group (all P<0.05). Conclusions The LA conduit hypofunction in primary in the prophase T2DM,when combinated with hypertension the LA constriction function compensatorily increased, LAVT can evaluate the function of LA in patients with T2DM accurately and rapidly.

Objective To investigate the expression levels of DNA methyltransferases 1, 3A and 3B in CD4+ T cells of MRL/lpr mice, and explore their relationship with the expression levels of methylation-sensitive genes (ITGAL, CD70). Methods CD4+ T ceils were isolated from spleens of 16-week-old MRL/lpr and BALB/c control mice by anti-CIM antibody labeled magnetic beads. Transcription levels of DNA methyhransferases 1, 3A and 3B and methylation-sensitive genes(ITGAL, CD70) were measured by real-time mice when compared with BALB/c control mice and the difference was significant (P<0.05), while the expression of DNMTI and DNMT3A showed a tendency of decrease (P>0.05). The mRNA expression of CD70 was significantly higher (P<0.01), but the expression of ITGAL had no significant difference between the two P<0.01 ). Conclusion Decreased expression of DNMT3B may attribute to the elevated expression of methylation-seusitive gene CD70, thus lead to the dysfunction of CD4+ T cell and play an important role in the pathogenesis of SLE.