Healthy dental pulp is essential for preserving teeth and maintaining their normal function. Vital pulp therapy (VPT) is widely used in clinical applications because it aims to preserve vital pulp and enhance the long-term survival of teeth. An accurate diagnosis of pulp vitality is a prerequisite for successful VPT. However, accurately assessing pulp viability remains challenging in clinical practice. Pulp viability is influenced by various factors, including the type of pulp exposure, caries status, periodontitis, trauma, treatment factors, patient age, and individual differences. Assessing pulp viability requires a comprehensive consideration of medical history and clinical manifestations, along with a combination of various auxiliary methods, such as pulp sensibility tests, pulp blood flow tests, imaging techniques and molecular diagnostics. In the future, the technology for assessing pulp vitality should evolve toward chairside, visualization, and precision techniques, to achieve consistency between clinical and histological diagnoses, thereby providing patients with the most effective treatment.

Objective:To investigate the clinical value of left ventricular shape index (SI) and eccentricity index (EI) in evaluating left ventricular remodeling.Methods:A retrospective analysis was performed on 324 patients (264 males, 60 females, age (62.5±11.8) years) diagnosed with myocardial infarction (MI) and 113 healthy controls (HC; 47 males, 66 females, age (57.8±10.7) years) who received gated myocardial perfusion imaging (GMPI) in First Hospital of Shanxi Medical University from January 2016 to September 2020. SI (end-diastolic SI (EDSI), end-systolic SI (ESSI)), EI and left ventricular function parameters (end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF), summed motion score (SMS), summed thickening score (STS), peak ejection rate (PER) and peak filling rate (PFR)) were obtained by quantitative gated SPECT (QGS) software. Propensity score (PS) inverse probability of treatment weighting (IPTW) was used to balance the intergroup covariates. The differences and correlations of EDSI, ESSI, EI and left ventricular function parameters between patients in MI group and HC group were analyzed. ROC curve analysis was used to evaluate the values of EDV, EDSI, ESSI and EI alone and in combination in the assessment of left ventricular systolic function impairment. Data were analyzed by independent-sample t test, Pearson correlation and Spearman rank correlation analyses, and Delong test. Results:After IPTW, EDSI and ESSI in MI group ( n=319) were higher than those in HC group ( n=133; EDSI: 0.66±0.09 vs 0.60±0.06; ESSI: 0.59±0.11 vs 0.47±0.07; t values: 8.05, 14.67, both P<0.001), and EI was lower than that in HC group (0.81±0.06 vs 0.85±0.03; t=-8.93, P<0.001). In both groups, there were significant correlations between EDSI and ESSI ( r values: 0.928, 0.873), between EDSI, ESSI and EI ( r values: from -0.831 to -0.641), between EDSI, ESSI and LVEF ( r values: from -0.627 to -0.201), between ESSI and EDV, ESV and SMS ( rs values: 0.336-0.584), between ESSI and -PER, PFR ( rs values: from -0.406 to -0.402, r values: from -0.352 to -0.325) (all P<0.01). ROC curve analysis showed that EDV (AUC: 0.895) and ESSI (AUC: 0.839) had the highest efficacy in evaluating left ventricular systolic function impairment in MI group and HC group, respectively. EDV-EDSI-ESSI-(1-EI) had higher efficacy in the assessment of impaired left ventricular systolic function in MI group (AUC: 0.956), which was higher than that of EDV or EDV-EDSI or EDV-ESSI or EDV-(1-EI) ( z values: from -2.64 to -2.18, P values: 0.008-0.029); EDV-EDSI-ESSI-(1-EI) also had high efficacy in HC group (AUC: 0.911), which was higher than that of EDV or EDV-EDSI or EDV-(1-EI) ( z values: from -2.60 to -2.43, P values: 0.009-0.015). Conclusions:In MI patients, the increase of SI and the decrease of EI indicate the increase of left ventricular sphericity and the aggravation of left ventricular remodeling. SI and EI have certain clinical application values in evaluating left ventricular morphology, predicting left ventricular remodeling and left ventricular systolic function impairment.

Objective:To develop and evaluate a nomogram prediction model for the 3-month mortality risk of patients with sepsis-associated acute kidney injury (S-AKI).Methods:Based on the American Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ), clinical data of S-AKI patients from 2008 to 2021 were collected.Initially, 58 relevant predictive factors were included, with all-cause mortality within 3 months as the outcome event. The data were divided into training and testing sets at a 7∶3 ratio. In the training set, univariate Logistic regression analysis was used for preliminary variable screening. Multicollinearity analysis, Lasso regression, and random forest algorithm were employed for variable selection, combined with the clinical application value of variables, to establish a multivariable Logistic regression model, visualized using a nomogram. In the testing set, the predictive value of the model was evaluated through internal validation. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the curve (AUC) was calculated to evaluate the discrimination of nomogram model and Oxford acute severity of illness score (OASIS), sequential organ failure assessment (SOFA), and systemic inflammatory response syndrome score (SIRS). The calibration curve was used to evaluate the calibration, and decision curve analysis (DCA) was performed to assess the net benefit at different probability thresholds.Results:Based on the survival status at 3 months after diagnosis, patients were divided into 7?768 (68.54%) survivors and 3?566 (31.46%) death. In the training set, after multiple screenings, 7 variables were finally included in the nomogram model: Logistic organ dysfunction system (LODS), Charlson comorbidity index, urine output, international normalized ratio (INR), respiratory support mode, blood urea nitrogen, and age. Internal validation in the testing set showed that the AUC of nomogram model was 0.81 [95% confidence interval (95% CI) was 0.80-0.82], higher than the OASIS score's 0.70 (95% CI was 0.69-0.71) and significantly higher than the SOFA score's 0.57 (95% CI was 0.56-0.58) and SIRS score's 0.56 (95% CI was 0.55-0.57), indicating good discrimination. The calibration curve demonstrated that the nomogram model's calibration was better than the OASIS, SOFA, and SIRS scores. The DCA curve suggested that the nomogram model's clinical net benefit was better than the OASIS, SOFA, and SIRS scores at different probability thresholds. Conclusions:A nomogram prediction model for the 3-month mortality risk of S-AKI patients, based on clinical big data from MIMIC-Ⅳ and including seven variables, demonstrates good discriminative ability and calibration, providing an effective new tool for assessing the prognosis of S-AKI patients.

Objective To investigate the changes and clinical significance of serum monocyte chemoattractant protein-1 (MCP-1) and prostaglandin E₂ (PGE₂) levels in children with functional dyspepsia (FD). Methods A retrospective study was conducted to enroll 89 FD children admitted from October 2022 to October 2023 as FD group, and 91 healthy children in the same period were selected as control group. The FD group was further divided into mild group (n=36), moderate group (n=33), and severe group (n=20) based on the severity of the disease. The serum levels of MCP-1 and PGE₂ were detected by enzyme-linked immunosorbent assay (ELISA). The severity of the disease was assessed by the Global Overall Symptom Score (GOSS), and gastric emptying was evaluated in all the children. Pearson and Spearman correlation analyses were performed to explore the correlations of serum MCP-1 and PGE₂ levels with gastric half-emptying time and FD symptom scores. Results The serum MCP-1 level in the FD group was significantly higher than that in the control group, while the PGE₂level was significantly lower (P < 0.05). In the severe group, the serum MCP-1 level was significantly higher while the PGE₂ level was significantly lower than that in the moderate and mild groups, and similar differences were significantly observed between the moderate and mild groups (P < 0.05). The gastric half-emptying time and postprandial 2-hour residual rate were significantly higher in the FD group than the control group (P < 0.05). Serum MCP-1 in FD children was positively correlated with gastric half-emptying time and postprandial 2-hour residual rate (P < 0.05), while serum PGE₂ was negatively correlated with these parameters (P < 0.05). Serum MCP-1 in FD children was significantly positively correlated with upper abdominal burning sensation, early satiety, belching, upper abdominal pain, and the total GOSS score (r=0.611, 0.509, 0.504, 0.491, 0.513; P < 0.05), while PGE2 was significantly negatively correlated with upper abdominal burning sensation, early satiety, belching, upper abdominal pain, acid reflux, and GOSS total score (r=-0.516, -0.561, -0.493, -0.533, -0.497, -0.482; P < 0.05). Conclusion Elevated serum MCP-1 and decreased PGE₂ levels in children with FD are closely related to the severity of the disease, gastric emptying, and some FD symptoms.

Objective To study the correlation between serum thioredoxin 1(TRX-1)and nucleotide-bind-ing oligomerization domain-like receptor protein 3(NLRP3)expression levels and functional dyspepsia(FD)in children.Methods A total of 45 children with FD who were admitted to Shijiazhuang Maternal and Child Health Hospital from May 2022 to June 2023 were enrolled as the FD group.Another 40 healthy children were selected as the control group.Real-time fluorescence quantitative PCR was used to measure the expression lev-els of serum TRX-1 and NLRP3 mRNA.Spearman correlation analysis was used to analyze the correlation be-tween the expression levels of serum TRX-1 mRNA,NLRP3 mRNA and FD related scores.Multivariate Lo-gistic regression was used to analyze the influencing factors of FD.Results The expression levels of TRX-1 mRNA and NLRP3 mRNA in FD group were higher than those in control group(P＜0.05).The mild and moderate FD groups had significantly lower serum TRX-1 mRNA and NLRP3 mRNA expression levels than the severe FD group,and the mild FD group had significantly lower serum TRX-1 mRNA and NLRP3 mRNA expression levels than the moderate FD group(P＜0.05).The expression levels of TRX-1 mRNA and NLRP3 mRNA in serum were positively correlated with egigastric pain,abdominal distension or epigastric discomfort,nausea and vomiting(P＜0.05),but were not correlated with early satiety,loss of appetite or food intake,and belching(P＞0.05).The expression level of serum NLRP3 mRNA was positively correlated with the total score(P＜0.05),while the expression level of serum TRX-1 mRNA was not correlated with the total score(P＞0.05).The increased levels of serum TRX-1 mRNA and NLRP3 mRNA were independent risk factors for FD(P＜0.05).Conclusion The expression levels of TRX-1 and NLRP3 may play an important role in the pathogenesis of FD.

Iron metabolism plays a regulatory role in various metabolic diseases, and excessive iron accumulation can increase the risk of metabolic diseases, especially type 2 diabetes mellitus (T2DM). Pathological processes such as iron deposition, iron overload, and ferroptosis can activate oxidative stress, lipid peroxidation, autophagy, and other processes, promote the amplification of inflammatory reactions and the reduction of antioxidant capacity, gradually decline the function of pancreatic islet β-cells, thereby promoting the occurrence and development of T2DM. Glucagon-like peptide-1 (GLP-1) is a physiological hormone secreted by intestinal L cells. GLP-1 analogs or GLP-1 receptor agonists can regulate the body's iron metabolism process, inhibit iron deposition, iron overload, and ferroptosis-related inflammatory reactions, promote the proliferation and differentiation of pancreatic islet β-cells, thereby reducing insulin resistance, inhibiting endothelial cell damage, and playing an important role in the prevention and treatmentof T2DM and its complications.

Objective:To explore the influencing factors of Internet + nursing service quality.Methods:Using a convenience sampling method, 290 nursing staff who had implemented Internet+ nursing services in Beijing and Tianjin were selected for a questionnaire survey from January to February 2022, and structural equation model was used to analyze the influencing factors and the path of action of service quality.Results:The structural equations constructed fit well, with gender, degree of service difficulty and degree of service motivation being direct influences on the quality of Internet+ nursing services, with degree of service difficulty also having an indirect effect on service quality through degree of service motivation.Conclusions:The quality of Internet+ nursing services is influenced by multiple factors and pathways. The relevant authorities can conduct a comprehensive assessment of the factors and pathways and manage them in a targeted manner to improve the quality of services.

Objective:To establish a disk (CD) microfluidic chip detection platform for the rapid detection of CALR-1 and CALR-2 mutations in patients with cerebral infarction, and summarize its clinical application value.Methods:Based on microfluidic technology and loop mediated isothermal amplification technology, a CD microfluidic chip detection platform for simultaneous detection of CALR-1 and CALR-2 gene mutations were established, and the sensitivity, specificity, repeatability and accuracy of the platform were verified. A total of 124 patients with cerebral infarction treated in Huashan Hospital, Shanghai Medical College, Fudan University from November 2019 to March 2021 were prospectively selected into the experimental group; and 80 healthy subjects were included in the control group. The CALR-1 and CALR-2 gene mutations in anticoagulant peripheral blood samples were detected by the CD microfluidic chip. Each chip could detect 4 samples at the same time and synchronously detect 3 indexes of each sample. The detection results could be obtained after isothermal amplification for 40 min. At the same time, sequencing method was used to verify the test results, and the consistency of the results of the two detection methods was compared.Results:Using this CD microfluidic chip platform, the synchronous amplification of 3 indexes in the sample could be completed within 40 min without the need of thermal circulation, and the whole detection process of the sample could be completed within 60 min. For samples with a high concentration of target nucleic acid, typical positive signals could be visualized after amplification for 10 min, and the test results would be available within 30 minutes after receiving the samples. The detection sensitivity of CD microfluidic chip method for CALR-1 and CALR-2 mutation load concentration was 1.0% and 0.5% respectively. Nonspecific amplification was not observed for the non-target nucleic acid samples, indicating the high specificity of this method. The coincidence rates of intra and inter batch repeatability were 100% (20/20) respectively. Two samples with CALR gene mutation were found in the cerebral infarction group, both of which were CALR-1 mutations (L367fs*46). There was no CALR-1 or CALR-2 mutation in the control group. The detection results of CD microfluidic chip method were completely consistent with the sequencing verification results (100% [204/204]).Conclusions:The CD microfluidic chip method could be used for the detection of CALR-1 and CALR-2 gene mutations in clinical samples of patients with cerebral infarction. This method has the advantages of high detection sensitivity, good detection specificity, fast detection speed and high detection flux, which is helpful to clarify the etiology of patients with cerebral infarction.

Objective:To construct the "Internet+ Obstetrical Nursing Service" quality evaluation index system, so as to provide a basis for evaluation of quality of "Internet+ Obstetrical Nursing Service".Methods:The overall study period was from March 1 to July 10, 2021. Taking Donabedian three dimensional theory and service quality (SERVQUAL) evaluation model as the theoretical basis, through literature retrieval and referring to relevant policies of "Internet+ Nursing Service" in China, the quality evaluation index system of "Internet+ Obstetrical Nursing Service" was initially formulated. The Delphi method was used to conduct 3 rounds of correspondence to 16 experts and the weight of each indicator was determined based on analytic hierarchy process.Results:In the three rounds of letter inquiries, the effective recovery rates of the questionnaires were 100.0% (16/16) , 100.0% (16/16) and 93.8% (15/16) , respectively. The expert authority coefficients were 0.847, 0.838 and 0.842, respectively. The Kendall's coordination coefficients were 0.125, 0.094 and 0.135, respectively. After three rounds of expert correspondence, a quality evaluation index system of "Internet+ Obstetrical Nursing Service" was finally established, including 3 first-level indicators, 11 second-level indicators and 64 third-level indicators.Conclusions:The quality evaluation index system of "Internet+ Obstetrical Nursing Service" constructed in this study has good scientificity, reliability and operability. Experts have a high degree of agreement on the evaluation results of the index, which can provide reference for the standardization of "Internet+ Obstetrical Nursing Service".

Objective:To construct the "Internet +" nurse core competency evaluation index system.Methods:Combined with the policy analysis and literature research, a preliminary item pool was formed. The semi-structured interview was conducted to form a preliminary "Internet+" nurse core competency evaluation index system. From June to August 2021, the Delphi method was used to conduct three rounds of consultation with 19 experts, and finally determine the contents of the index system. The weights of indicators at all levels were calculated in combination with analytic hierarchy process.Results:Among three rounds of expert consultation, the questionnaire recovery rates were 100%, 100%, and 94.7% respectively, and the expert authority coefficients were 0.862, 0.857, and 0.841, and the Kendall coefficients were 0.228, 0.296, and 0.295 with statistical differences ( P<0.001) . The finally established "Internet +" nurse core competency evaluation index system included 4 first-level indicators, 16 second-level indicators and 59 third-level indicators of professional knowledge, professional skills, comprehensive ability and personal characteristics. Conclusions:The constructed "Internet +" nurse core competency evaluation index system is reliable, scientific and practical, and can be used as a basis for evaluating "Internet +" nurses' service capabilities.