Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery.Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients,and is widely recommended as a first-line clinical treatment.But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices.To address this issue,this consensus,based on a comprehensive literature review and clinical experiences of experts,systematically summarizes the indications,target patients,and contraindications of minimally invasive tooth extraction,the overall workflow of this procedure(preoperative preparation,surgical steps,postoperative management,postoperative instructions,medications,and follow-up),and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery.Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients,and is widely recommended as a first-line clinical treatment.But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices.To address this issue,this consensus,based on a comprehensive literature review and clinical experiences of experts,systematically summarizes the indications,target patients,and contraindications of minimally invasive tooth extraction,the overall workflow of this procedure(preoperative preparation,surgical steps,postoperative management,postoperative instructions,medications,and follow-up),and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Objective To explore the influencing factors of visual acuity recovery in patients with high myopia after posterior chamber phakic intraocular lens(ICL)implantation.Methods A prospective study was conducted on 210 pa-tients(420 eyes)with high myopia who underwent ICL implantation at the Second Affiliated Hospital of Zhengzhou Univer-sity from May 2021 to March 2023.The patients were divided into a good recovery group[best corrected visual acuity(BC-VA)recovery ≥0.3 D]and a poor recovery group(BCVA recovery＜0.3 D)based on their visual acuity recovery status three months after surgery.The baseline data of patients in the two groups were compared,and the factors affecting visual acuity recovery were analyzed using Logistic regression.The receiver operating characteristic(ROC)curve was used to an-alyze the predictive value of the Logistic regression model for poor visual acuity recovery in patients with high myopia after ICL implantation.Results Three months after surgery,149 patients(298 eyes)were in the good recovery group,and 61 patients(122 eyes)were in the poor recovery group.There were no significant differences in gender,age,years of myopi-a,body mass index,and academic performance between the two groups(all P＞0.05).The proportions of patients with corneal astigmatism＜1.30 D(55.74％),corneal diopter＜45 D(59.02％),Pittsburgh Sleep Quality Index(PSQI)＜7 points(63.93％),and average central radius of curvature[(7.82±0.27)mm]in the poor recovery group were lower than those in the good recovery group[83.89％,81.88％,85.91％,and(7.90±0.24)mm,respectively].The central flat me-ridian curvature(k1)of the anterior corneal surface[(43.27±1.43)D],steep meridian curvature(k2)of the anterior corneal surface[(44.84±1.53)D],and arch height[(628.49±67.28)μm]in the poor recovery group were higher than those in the good recovery group[(42.73±1.42)D,(44.12±1.47)D],and[(417.56±80.14)pm],with significant differences(all P＜0.05).Logistic regression analysis showed that corneal astigmatism,corneal diopter,k1,k2,arch height,and PSQI score were independent influencing factors of poor visual acuity recovery after ICL implantation in pa-tients with high myopia(all P＜0.05).ROC curve analysis showed that the area under the ROC curve for predicting poor visual acuity recovery after ICL implantation in patients with high myopia by Logistic regression model was 0.938(95％CI:0.896-0.966),the sensitivity was 83.61％,and the specificity was 91.95％(P＜0.05).Conclusion The visual acuity recovery after ICL implantation in patients with high myopia is affected by corneal astigmatism,corneal diopter,k1,k2,arch height,and PSQI score.The Logistic regression model based on these factors has high predictive value for visual acui-ty recovery after ICL implantation.

Objective:To investigate the safety, feasibility and accuracy of esophageal sponge cytology in esophageal carcinoma screening in high-incidence districts.Methods:Opportunistic screening for esophageal carcinoma was conducted on individuals aged 40-75 years with high-risk factors for esophageal carcinoma and visited out-patient clinic in Lianshui People's Hospital from May 2021 to June 2022. A new esophageal cell collector independently developed in China was used for esophageal sponge cytology sampling followed by cytopathological analysis. Atypical squamous cells or more severe lesions were defined as positive esophageal sponge cytology. Then gastroscopy was performed, and all suspicious areas under the endoscopy were biopsied for histopathological examination. Gastroscopy, biopsy histopathology and esophageal sponge cytology were conducted blindly in pairs. Outcome measures included adverse reactions during sampling, subject tolerability (using a visual simulation score), sampling quality, and diagnostic efficacy of esophageal sponge cytology using gastroscopy plus biopsy histopathology as the gold standard.Results:A total of 1 590 patients completed the screening program. During esophageal sponge cytology sampling, no serious adverse events were observed, and the adverse reactions were mainly manifested as vomiting during sampling [0.31% (5/1 590)] and sore throat after sampling [2.45% (39/1 590)], all of which resolved spontaneously without further medical intervention. The majority of subjects [98.62% (1 568/1 590)] reported good tolerance during the procedure. After sampling, 1 526 (95.97%) subjects had completely expanded sponge material, meeting the standard of good sampling quality. The scanning analysis of the digital pathology system showed that the number of sampled cells in 1 590 subjects ranged (2.01-4.00)×10 6, with a median of 3.48×10 6 cells, which could meet the requirements for interpreting cytological results. Using the positive esophageal sponge cytology for the diagnosis of esophageal carcinoma including high-grade intraepithelial neoplasia, esophageal squamous cell carcinoma and adenocarcinoma of esophagogastric junction, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 98.57% (69/70), 91.51% (1 391/1 520), 34.85% (69/198), 99.93% (1 391/1 392), and 91.82% (1 460/1 590), respectively. Conclusion:Esophageal sponge cytology presents promising diagnostic efficacy for esophageal carcinoma screening, offering a simple, safe, convenient, and effective approach in high-incidence esophageal carcinoma regions.

Objective:To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods:Data of 26 patients were retrospectively analyzed, who were admitted into the intensive care unit (ICU), Zhongda Hospital, Southeast University, due to choledocholithiasis induced by severe acute cholangitis and underwent cholangioscope-assisted bedside one-stage lithotomy and biliary drainage from June 2020 to February 2022. Clinical outcomes were analyzed.Results:The time interval from disease onset to endoscopic intervention was 36.2±15.5 hours, with 7.2±4.9 hours from ICU admission to endoscopic intervention. Technical success rate was 100.0% in one-stage stone removal and biliary drainage. Except for one mild pancreatitis, no other complication occurred. Acute physiology and chronic health evaluation (APACHE)Ⅱ and sequential organ failure assessment (SOFA) scores prior to endoscopic intervention were 25.2±6.6 and 11.9±3.5, respectively. APACHE Ⅱ scores at day 1, 3, and 7 after endoscopic intervention were 21.7±6.5, 17.2±6.8 and 12.7±7.7, respectively, and SOFA scores were 10.6±2.9, 8.4±3.0 and 5.4±3.7, respectively, all of them were lower than those before operation ( P<0.001). The lengths of ICU stay and total hospitalization were 9.7±5.0 days and 12.8±4.5 days, respectively. In-hospital mortality occurred in 3 (11.5%) patients. According to a 6-month follow-up, one patient died of pneumonia, and another died of acute myocardial infarction. No acute cholangitis re-occurred in those survivors. Conclusion:Newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage demonstrate significant improvements in prognosis, highlighting its safety in managing severe acute cholangitis.

Objective:To evaluate a newly designed basket fit for digital cholangioscope in non-radiation endoscopic lithotomy for common bile duct stones.Methods:Seventy-eight patients who underwent non-radiation endoscopic removal of common bile duct stones at Zhongda Hospital Southeast University between February and October 2021 were enrolled in the randomized controlled trial, and were randomly assigned into the new basket group ( n=35) and the conventional basket group ( n=43) by drawing lots. Procedures of cholangioscope-based biliary exploration and stone removal by baskets, volume of water irrigation, time lengths of biliary exploration, stone removal and whole endoscopic procedure, and adverse events were compared. Results:Compared with the conventional basket group, the new basket group needed less biliary explorations (1.08±0.28 VS 2.30±0.51, t=-12.535, P<0.001), smaller volume of water irrigation (46.14±11.89 mL VS 78.62±10.09 mL, t=-13.052, P<0.001), and shorter time of biliary exploration and stone removal (9.69±2.97 min VS 12.67±2.51 min, t=-4.815, P<0.001) and whole endoscopic procedure (30.17±7.19 min VS 33.44±6.69 min, t=-2.076, P=0.041). The incidence of adverse events was not significantly different between the two groups [5.7% (2/35) VS 11.6% (5/43), χ2=0.826, P=0.363]. Conclusion:This newly designed basket can facilitate digital cholangioscope-guided non-radiation endoscopic removal of common bile duct stones with the advantages of shorter operation time, less exploration time of choledochoscopy and smaller volume of water irrigation.

Objective:To study the main blood parameters of Leishmania-infected dogs with different clinical symptoms in the high incidence area of visceral leishmaniasis in Gansu Province, and to provide scientific basis for early diagnosis and monitoring of canine leishmaniasis. Methods:In May 2019, Wenxian County of Longnan City and Diebu County of Gannan Tibetan Autonomous Prefecture, the historical endemic areas of visceral leishmaniasis in Gansu Province, were selected as the investigation sites, and 40 dogs with positive Leishmania DNA were investigated. According to their clinical symptoms, they were divided into three groups: asymptomatic ( n = 17), minimally symptomatic ( n = 12) and symptomatic ( n = 11). At the same time, 10 healthy dogs were selected as controls. Major blood indexes were detected by an automatic animal blood five-classification cell analyzer. Results:Compared with the control group, the number of red blood cells, hemoglobin content, hematocrit, and the number of lymphocytes, monocytes and eosinophils in the asymptomatic, minimally symptomatic and symptomatic groups were decreased ( P < 0.05), while the number of white blood cells and neutrophils in minimally symptomatic and symptomatic groups were decreased ( P < 0.05). The above blood indexes were lower in the symptomatic group than those in the asymptomatic group. The number of red blood cells (control group vs symptomatic group) decreased from (6.82 ± 0.05) × 10 12/L to (4.19 ± 0.08) × 10 12/L, hemoglobin content decreased from (15.84 ± 0.74) g/L to (9.65 ± 0.18) g/L, hematocrit decreased from (46.41 ± 0.95)% to (27.86 ± 0.42)%, the number of white blood cells decreased from (14.90 ± 0.22) × 10 9/L to (10.23 ± 0.24) × 10 9/L, the number of neutrophils decreased from (7.25 ± 0.18) × 10 9/L to (6.18 ± 0.11) × 10 9/L, the number of lymphocytes decreased from (2.80 ± 0.07) × 10 9/L to (1.64 ± 0.06) × 10 9/L, the number of monocytes decreased from (1.13 ± 0.01) × 10 9/L to (0.53 ± 0.02) × 10 9/L, and the number of eosinophils decreased from (1.70 ± 0.06) × 10 9/L to (0.71 ± 0.03) × 10 9/L. Conclusion:Different clinical symptoms of Leishmania-infected dogs have different blood test results.

Objective:To analyze and predict the transmission risk of visceral leishmaniasis in Gansu Province based on an ecological niche model, providing a basis for the development of precise prevention and control measures and epidemic surveillance.Methods:The information of reported cases of visceral leishmaniasis in Gansu Province from 2015 to 2021 were collected from the National Infectious Disease Reporting Information Management System, and the longitude and latitude coordinates of the distribution points of cases and the data of 19 climate variables, 5 geographical variables and 2 socio-economic variables within the region were obtained. Based on an ecological niche model, a model for predicting the transmission risk of visceral leishmaniasis was constructed using the maximum entropy algorithm (MaxEnt), and its performance was evaluated by the area under the receiver operating characteristic curve (AUC). Then the importance of each environmental variable of the model was evaluated, and the distribution area of visceral leishmaniasis transmission risk in Gansu Province was predicted.Results:A total of 368 cases of visceral leishmaniasis were reported in Gansu Province from 2015 to 2021, of which 89.13% (328/368) were from Longnan City and Gannan Tibetan Autonomous Prefecture (Gannan Prefecture). The number of cases peaked in 2017 (79 cases, 21.47%). The model had high prediction accuracy (AUC = 0.985). The results of model analysis showed that the important climate variable affecting the distribution of visceral leishmaniasis was the average temperature in the coldest quarter (contribution value of 3.1), the geographical variables were land use type (contribution value of 52.6) and vegetation cover type (contribution value of 8.5), and the socio-economic variable was population size (contribution value of 14.3). The distribution results of transmission risk showed that high, medium and low risk areas exhibited a gradual transition from the southern part to the northwest part of Gansu Province. The high risk areas were mainly located in the central and southern parts of Longnan City and the southern part of Gannan Prefecture, accounting for 0.18% of the total area of the province. Medium and low risk areas accounted for 0.48% and 2.47% of the total area of the province, respectively; and areas with no risk accounted for 96.87%.Conclusions:The ecological niche model predicts that the spread of visceral leishmaniasis in Gansu Province is characterized by point like dispersion and local high aggregation distribution. It is necessary to strengthen monitoring and prevention and control of high-risk areas such as Longnan City and Gannan Prefecture.

Objective:To evaluate the efficacy and safety of digital cholangioscopy-assisted non-radiation endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones.Methods:Clinical data of patients who underwent digital cholangioscopy-assisted non-radiation ERCP for common bile duct stones from May 2019 to September 2021 were reviewed. The baseline data, the success rate of cannulation, the one-time success rate of endoscopic stone removal, the operation time, total hospital stay, complications, and recurrence of bile duct stones were analyzed.Results:A total of 170 patients were included, and bile duct stones were detected in 156 (91.8%) patients with the long diameter of 7.7±4.1 mm under preoperative imaging examination. Bile duct stones were detected under choledochoscopy and were successfully removed by using digital cholangioscopy through non-radiation ERCP. The success rate of cannulation was 100.0% (170/170) . The one-time success rate of endoscopic stone removal was 96.5% (164/170), and 6 patients (3.5%) received secondary stone removal for large stones (long diameter>30 mm).The time of biliary exploration and whole non-radiation ERCP were 9.6±2.7 min (6-24 min) and 35.9±17.3 min (13-85 min), respectively. The total hospital stay was 6.3±2.2 days (5-10 days). Postoperative pancreatitis occurred in 3 patients (1.8%), all of whom were mild and resolved after symptomatic treatment. No recurrence of bile duct stones was seen in any patient over 1-month postoperative follow-up.Conclusion:Digital cholangioscopy-assisted non-radiation ERCP is safe and effective for common bile duct stones without ray exposure, which is worth of promotion.

Objective:To investigate the medium- and long-term efficacy of peroral endoscopic myotomy (POEM) for esophageal diverticulum and the risk factors for postoperative recurrence.Methods:A retrospective study was conducted on 31 cases of esophageal diverticulum who were treated by POEM in Zhongda Hospital, Southeast University from May 1st 2016 to August 1st 2019. The Eckardt score, the operative success rate, and the recurrence rate after the operation were observed and recorded. Multivariate logistic regression analysis was performed to explore the risk factors for postoperative recurrence.Results:POEM was successfully completed in all 31 patients, who were followed up for 30.6±11.1 months (20-63 months). The Eckardt score before the operation was 8.2±2.4, and was 1.4±0.7, 1.4±1.1, 1.3±1.1, and 1.3±0.9 at 1, 6, 12 and 24 months, respectively after the operation, which significantly decreased at all follow-up time points ( P<0.001). The success rates at 1, 6, 12, and 24 months after the operation were 96.8% (30/31), 90.3% (28/31), 90.3% (28/31) and 90.3% (28/31), respectively. Three patients suffered symptom relapse, with an overall recurrence rate of 9.7% (3/31). Logistic regression analysis showed that the disease duration ( P=0.038, OR=1.041, 95% CI: 1.002-1.080) and preoperative Eckardt score ( P=0.024, OR=2.299, 95% CI: 1.117-4.728) were risk factors for postoperative recurrence of POEM. Conclusion:POEM is safe and effective for esophageal diverticulum. Patients with long disease duration and high preoperative Eckardt score are associated with recurrence.