Expert consensus on difficulty assessment of endodontic therapy

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system’s anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer

BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic cavities.Therefore,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical difficulties.AIM To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal cancer.METHODS We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for rectal cancer.Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)scans.Operative difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a nomogram.RESULTS Out of 162 patients,21(13.0%)were classified in the high surgical difficulty group,while 141(87.0%)were in the low surgical difficulty group.Multivariate logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection,intraoperative preventive ostomy,and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer(P<0.05).Conversely,the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was identified as a protective factor(P<0.05).A nomogram was subsequently constructed,demonstrating good predictive accuracy(C-index=0.834).CONCLUSION The surgical approach,intraoperative preventive ostomy,the sacrococcygeal distance,and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.

Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones

BACKGROUND For intrahepatic duct(IHD)stones,laparoscopic liver resection(LLR)is currently a reliable treatment.However,the current LLR difficulty scoring system(DSS)is only available for patients with hepatocellular carcinoma.AIM To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability.METHODS We used clinical data from 80 patients who received LLR for IHD stones.Forty-six of these patients were used in multiple linear regression to construct a scoring system.Another 34 patients from different centers were used as external validation.The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients.RESULTS The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort:Location of stones,number of stones≥3,stones located in the bile ducts of several grades,previous biliary surgery less than twice,distal bile duct atrophy.Subsequently,the data set was validated using a DSS developed from the variables.The following variables were identified as statistically significant in external validation:Operative time,blood loss,intraoperative transfusion,postoperative alanine aminotransferase,and Clavien-Dindo grading≥3.These variables demonstrated statistically significant differences in patients with three or more grades.CONCLUSION Patients with IHD stones have varying degrees of surgical difficulty,and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.

Effect of Mouth Opening Training Stick Combined with Oral Massage on Mouth Opening Difficulty in Head and Neck Cancer Patients after Treatment

Objective: To study the application effect of mouth-opening training sticks combined with oral massage on patients with mouth-opening difficulty after treatment for head and neck cancer. Methods: Using convenient sampling, 60 patients with mouth-opening difficulty after treatment for head and neck cancer admitted to the Oncology Department from February 2022 to October 2023 were selected for a 2-week exercise and nursing program. The patients were divided into a control group (February 1, 2022 to November 30, 2022) and an observation group (December 1, 2022 to October 31, 2023), with 30 patients in each group. The control group underwent routine mouth-opening functional exercises combined with cork for oral support training, while the observation group underwent routine mouth-opening functional exercises combined with oral massage and mouth-opening training sticks for oral support training. The mouth-opening degree, mouth-opening difficulty level, comfort level, compliance, and quality of life were observed in both groups. Results: Before the intervention, there were no statistically significant differences in mouth-opening degree and mouth-opening difficulty level between the two groups (P > 0.05). After the intervention, the mouth-opening degree, mouth-opening difficulty level, oral comfort level, compliance, and QLICP-HN scores in the observation group were all better than those in the control group, with statistically significant differences (P < 0.05). Conclusion: The combination of mouth-opening training sticks and oral massage with mouth-opening functional exercises can effectively improve the degree of mouth-opening difficulty, enhance oral comfort, increase compliance with mouth-opening exercises, and improve quality of life.

Text Difficulty,Working Memory Capacity and Mind Wandering During Chinese EFL Learners’Reading

This experimental study investigated how text difficulty and different working memory capacity(WMC)affected Chinese EFL learners’reading comprehension and their tendency to engage in task-unrelated thoughts,that is,mind wandering(MW),in the course of reading.Sixty first-year university non-English majors participated in the study.A two-factor mixed experimental design of 2(text difficulty:difficult and simple)×2(WMC:high/large and low/small)was employed.Results revealed that 1)the main and interaction effects of WMC and text difficulty on voluntary MW were significant,whereas those on involuntary MW were not;2)while reading the easy texts,the involuntary MW of high-WMC individuals was less frequent than that of low-WMC ones,whereas while reading the difficult ones,the direct relationship between WMC and involuntary MW was not found;and that 3)high-WMC individuals had a lower overall rate of MW and better reading performance than low-WMC individuals did,but with increasing text difficulty,their rates of overall MW and voluntary MW were getting higher and higher,and the reading performance was getting lower and lower.These results lend support to WM theory and have pedagogical implications for the instruction of L2 reading.

Ableism and (Neo)Racism in School Placement Processes in Quebec: School Personnel Interpretations of Immigrant Student Difficulties - A Secondary Publication

The school placement processes of students from immigrant backgrounds considered to be in“difficulty”is an international concern at the intersection of works relating to special education and those concerning the school experiences of students from immigrant backgrounds or racialized groups.The research problem of this article concerns the identification of these students as disabled or as having adjustment or learning difficulties.From a perspective anchored in Disability Critical Race Studies,this ethnographic study documents different interpretations of perceived difficulties made by school actors with regard to seven primary school students from immigrant backgrounds.Five interpretation types are presented:(1)medicalization by dismissal of cultural markers,(2)medicalization by professional constraint,(3)medicalization by cultural deficit,(4)precautionary wait,and(5)cultural differentialism.Our results help to shed light on the special education overrepresentation phenomenon regarding these students and to understand how ableism and(neo)racism contribute to it.

Teachers’ Perceptions of the Challenges and Strategies in Supporting Students with Reading Difficulties

The purpose of this study is to determine the teacher’s perceptions of the challenges and strategies in supporting students with reading difficulties.This study used qualitative method of research and descriptive approach as its research design,in addition to a set of structured interview questions administered through Google Forms to gather data from elementary teachers of Taal Central School,located at Taal Batangas.These structured interview questions were carefully designed to cover various dimensions of the study,including the types of challenges perceived by teachers,strategies employed,and possible solutions for addressing the problems encountered in the process of supporting students with reading difficulties.The results revealed that teachers faced several challenges when teaching students with reading difficulties such as emotional and motivational issues/factors,lack of resources or teaching aids,deficits in knowledge and skills,and problems with student engagement and participation.This study also showed common approaches utilized by the teachers in supporting students with reading difficulties,which were fostering a positive and supportive environment,adopting individualized and multifaceted approaches,and utilizing effective teaching tools and strategies.Lastly,teachers also concluded varied solutions in addressing the challenges perceived in teaching students with reading difficulties towards fostering reading proficiency.These include developing peer support,use of positive reinforcement,and parental involvement.Moreover,specialized resources,professional development for teachers,and specific teaching strategies are also highlighted as crucial components.By integrating these approaches,teachers concluded that it can create a supportive and effective learning environment tailored to the needs of students with reading difficulties.

Morbi-Mortality Linked to Unsafe Abortions—Difficulties in Accessing Safe Abortions in Cameroon: Meta-Analysis and Systematic Review

Background: Unsafe abortions are one of the leading causes of maternal mortality, especially in developing countries. In Cameroon, the maternal mortality rate remains high, and the scarcity of data on abortions leads to a lack of solid evidence to advocate on the extent of the abortions related complications. Our objective was to evaluate the unsafe abortions related complications, and to assess the difficulties of accessing safe abortions in our setting. Methods: We carried out a meta-analytic and systematic review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon. The keywords used for the search are seen in table I. Selection of studies was simultaneously done by two authors. Data were extracted through a form designed on Google Form. We used a random-effect model for proportion estimation, and The I2 and Q statistics to assess the extent of heterogeneity. Results: A total of 430 studies were identified, from which 28 were included and analysed. About 5% (95% CI: 3 - 7) of unsafe abortions leads to death. The contribution of unsafe abortions in maternal deaths was 23% (95% CI: 20 - 27). The rate of severe bleeding and/or anemia were 40% (95% CI: 18 - 63) and the rate of infection was 17% (95% CI: 7 - 28), dominated by pelvic infections, pelviperitonitis, severe sepsis, and septic shock. Case reports described uterine perforations, uterine rupture during the following pregnancy. Abortion was performed in the practitioner’s or patient’s home in 41.4% of cases, in a health center in 35.1% of cases, in a private clinic in 21.2% of cases, drugs selling places and in traditional healer clinics. The restriction of abortion laws, the stigma surrounding abortion and its consequences at any level of the society, lead to the underreporting of unsafe abortions and a deep reluctance to advocate for safe abortion services. Conclusion: The strengthening of awareness campaigns for provider behavior change communication, family planning, the de-stigmatization of abortions, the training of health personnel in post-abortion care, a multidisciplinary and multicentric action would contribute to the reduction in morbidity and mortality due to abortions.

Glucose-6-Phosphate Dehydrogenase Deficiency: Difficulties in Diagnosis at the Souro Sanou University Hospital, Burkina Faso

Glucose-6-phosphate dehydrogenase deficiency is the most common enzymopathy worldwide. The precise prevalence of G6PD is unknown in Burkina Faso. The objective of the study was to describe the difficulties to diagnose this disease at the Souro Sanou University hospital (CHUSS) in Bobo-Dioulasso. It involved five patients comprising one child with homozygous SS sickle cell disease, one adolescent screened following a family investigation, and three adults including a man and two women. Blood smear stained with May Grunwald Giemsa was performed to look for specific signs of G6PD-deficient red blood cell and brilliant cresyl Blue for Heinz Bodies. A microscope Olympus BX53 equipped with a Camera (XC10) and connected to a computer was used to read blood smears and capture images. Genes sequencing by Sanger method were performed in a specialized laboratory in molecular genetics. For each analysis, the protocol and instructions of the equipment and reagent manufacturer were applied. Of the five patients, three had anemia and only one had hyperreticulocytosis. Two patients had biological signs of hemolysis and one patient had an elevated CRP. Blood smear stained with MGG and cresyl blue showed specific signs of G6PD-deficient red blood cells and Heinz bodies in all patients. Biochemical analysis and molecular typing confirmed G6PD deficiency. The presence of G6PD-deficient red blood cells in the blood smear guides the diagnosis of G6PD deficiency. The diagnosis is biochemical and is based on the combined measurement of G6PD plus pyruvate kinase and/or hexokinase.

Transfer learning-based super-resolution in panoramic models for predicting mandibular third molar extraction difficulty: a multi-center study

Background:This study aims to predict the extraction difficulty of mandibular third molars based on panoramic images using transfer learning while employing super-resolution(SR)technology to enhance the feasibility and validity of the prediction.Methods:We reviewed a total of 608 preoperative mandibular third molar panoramic radiographs from two medical facilities:the First Affiliated Hospital of Zhengzhou University(n=509;456 in the training set and 53 in the test set)and the Henan Provincial Dental Hospital(n=99 in the validation set).We conducted a deep-transfer learning network on high-resolution(HR)panoramic radiographs to improve the longitudinal resolution of the images and obtained the SR images.Subsequently,we constructed models named Model-HR and Model-SR using high-dimensional quantitative features extracted through the Least Absolute Shrinkage and Selection Operator method.The models’performances were evaluated using the receiver operating characteristic curve(ROC).To assess the reliability of the model,we compared the results from the test set with those of three dentists.Results:Model-SR outperformed Model-HR(area under the curve(AUC):0.779,sensitivity:85.5%,specificity:60.9%,and accuracy:79.8%vs.AUC:0.753,sensitivity:73.7%,specificity:73.9%,and accuracy:73.7%)in predicting the difficulty of extracting mandibular third molars.Both Model-HR(AUC=0.821,95%CI 0.687–0.956)and Model-SR(AUC=0.963,95%CI 0.921–0.999)demonstrated superior performance compared to expert dentists(highest AUC=0.799,95%CI 0.671–0.927).Conclusions:Model-SR yielded superior predictive performance in determining the difficulty of extracting mandibular third molars when compared with Model-HR and expert dentists’visual assessments.

归脾汤加减治疗儿童学习困难型多动症的临床研究

目的观察归脾汤加减治疗儿童学习困难型多动症的临床疗效。方法91名符合DSM-Ⅳ儿童多动症标准的学习困难儿童,按照治疗方法分为两组,研究组45人,对照组46人。对照组进行心理行为矫正治疗,研究组在心理行为矫正治疗基础上口服加减归脾汤治疗。治疗2个月后,对两组疗效进行观察,采用Conners儿童行为问卷和Weiss功能性缺陷量表对治疗结果进行分析。结果Conners评分结果发现,研究组总有效率(88.89%)明显高于对照组(65.22%)(P<0.01);与对照组比较,治疗前研究组Conners评分无明显差异(P>0.05),治疗2个月后,研究组Conners评分明显降低(P<0.01);治疗后研究组各项多动症问题得分明显降低,多动症儿童学习困难情况有明显改善(P<0.01)。Weiss评分结果发现,治疗后,研究组的Weiss功能性缺陷量表各项指标评分均低于对照组,差异有统计学意义(P<0.05)。结论归脾汤加减治疗儿童学习困难型多动症有显著疗效,值得进一步推广应用。

高职高专院校高质量试点职教本科人才培养研究

职教本科是职业教育改革发展的必然结果,是经济社会高质量发展的应然需求,也是满足人们追求高层次职业教育的有效路径。高职高专院校试点职教本科人才培养,是服务国家发展战略、增强职业教育社会影响力和探索新型高职人才培养模式的客观需要。但是,由于受到政府、社会和学校等因素的影响制约,高职高专院校高质量试点职教本科教育面临着不少宏观层面和微观层面的现实性困境。对此,要完善政策体系建设,增强政策资源供给的有效性;引导社会树立正确职教观念,提升高职学生社会地位;深化产教协同育人,构建校企育人命运共同体;明确质量目标,强化专业特色发展;科学规划内部顶层设计,高效率使用育人资源;确立师资选拔培训机制,全面提升整体科研能力。

视频喉镜结合综合困难气道训练考核系统在急诊规范化培训住院医师气管插管培训中的应用研究

目的探讨视频喉镜结合综合困难气道训练考核系统在急诊规范化培训住院医师气管插管培训中的应用效果。方法选择2022年1月—2023年6月在首都医科大学宣武医院急诊科轮转的住院医师58人,随机分为对照组(n=28)和试验组(n=30)。对照组应用直接喉镜结合综合困难气道训练考核系统进行气管插管技能培训,试验组应用视频喉镜结合综合困难气道训练考核系统进行气管插管技能培训。培训结束后对两组住院医师进行气管插管技能考核,内容包括正常气道和困难气道的气管插管,分别比较两组住院医师气管插管时间、一次性插管成功率、喉镜对门齿的压力、气管插管位置正确率的区别。另外,分别对两组住院医师进行教学满意度问卷调查。结果普通气道气管插管中,试验组与对照组喉镜对门齿的压力和气管插管位置正确率的差异无统计学意义(P>0.05);一次性插管成功率试验组大于对照组,气管插管时间试验组小于对照组(均P<0.05)。在困难气道气管插管中,试验组的一次性插管成功率和气管插管位置正确率大于对照组(P<0.05),插管时间和喉镜对门齿的压力明显小于对照组(P<0.05)。调查问卷自评显示,试验组对气管插管自信心和学习兴趣大于对照组(P<0.05),满意度和技能评分两组差异无统计学意义(P>0.05)。结论应用视频喉镜结合综合困难气道训练考核系统对急诊规范化培训住院医师进行气管插管培训可以提高气管插管成功率,减少对门齿的损伤,提高住院医师的学习兴趣。

肝豆状核变性诊治难点与思路

肝豆状核变性(hepatolenticular degeneration,HLD)又称为Wilson病(Wilson’s disease,WD),是一种常染色体隐性遗传性疾病,是经过治疗可以得到有效控制的神经遗传性疾病之一。本病起病隐匿,基因突变类型多变而复杂,临床表现千变万化,可累及全身多个系统,不典型患者难以被识别或易被忽略而导致临床误诊或漏诊。早期诊断和及时、合理的治疗可以延缓疾病的进展,保证患者正常生活质量,使患者达到或接近正常寿命,如延误治疗或不恰当治疗可导致严重后遗症,甚至死亡。该文对WD诊断与治疗过程中易遇到的难点问题进行概述,并提出应对措施以供临床医师参考。

大党独有难题的认知逻辑与破解之道

时刻保持解决大党独有难题的清醒和坚定,中国共产党方能行稳致远。党以整体规模大、历史跨度大、志向抱负大等显著性特征展现“大的样子”,大党基于应有的“大的担当”肩负党内治理、国家治理、社会治理等治理任务。中国共产党作为大党,要实现高效能治党治国,必须从思想理念、政治整合、能力提升、精神状态、防错纠错、生态营造等方面剖析面临的独有难题,并给出有针对性的治理路径。大党独有难题的终极破解之道,依赖“大党之能”,借助能力涵养从领导权威、思想指南、本领本事、斗争精神、自我革命、人民支持上形成一揽子行动方略。

高中生英语学习困难的表现、原因与对策

改革开放以来,我国的外语教育取得了长足进步,但仍存在诸多问题。通过对来自全国30个省、自治区及直辖市的527名高中生进行调查研究及分析发现,50%以上的高中生在语法学习和词汇学习方面存在困难,30%以上的高中生在语音学习方面存在困难。学习困难主要表现在语法点混淆和语法运用、词汇记忆、基本读音上。在英语技能方面,高中生在说、写、听、读上依次存在学习困难。造成英语学习困难的原因包括语言交流及训练环境的缺失、技能本身难度、个人心理因素等。应对困难,可以从外语教学、教材使用、学生能力培养、测评体系完善等方面进行改进。

短视频生态下传统文化传播的困境与创新策略

短视频迎合了人们娱乐化的精神需求、碎片化的阅读习惯,是当下人们获取信息、娱乐以及社交的重要渠道。传统文化需要短视频赋能助力创造性转化和创新性发展。但同时,短视频传播传统文化面临创作主体水平有待加强、内容品质有待提升等困境,通过提升内容品质、注重内容表达创新、增强场景适配等策略可以突破困境,实现短视频产业与传统文化的协同发展,增强国家软实力,助力中华民族伟大复兴。

耳鼻咽喉头颈外科专业型硕士研究生培养的难点与对策

耳鼻咽喉头颈外科作为一门解剖复杂、病种繁多、发展飞速的学科,如何培养一名既具有专业技能又拥有临床科研能力的正确价值观的专业型硕士研究生,这一直是学科关注和探索的问题。本文分析了目前耳鼻咽喉头颈外科学专业型硕士的培养难点,即如何开展以胜任力为核心的临床教学、如何提高学生临床科研思维、如何开展思政教育并提高教师对思政教育的重视度,本文根据所在教研室的既往教学经验提出了相应的解决思路及策略探讨,为学科专业型硕士培养提供参考。

辽宁省冰雪产业发展历程、困境及对策研究

采用文献资料法,对辽宁省冰雪产业目前的困境及相应的实施路径进行研究。结果表明:辽宁省冰雪产业存在着运动参与人数偏低,冰雪项目消费偏高,场馆设施更新滞后,服务水平欠缺,知名度影响力不足等问题。针对这些问题提出重视冰雪人群培养,提高运动参与率;完善场馆设施,加快场馆的升级;重视学校冰雪教育,储备冰雪人才;提高整体服务质量,提升国内外知名度;注重人才的引进与培养,消除人才短缺的局面;以大数据为依托,梳理冰雪产业格局及发展脉络;加大政府扶持与资金的补助,提高竞争力;强化区域联动,提升辽宁省冰雪产业的发展力等相应的解决方案。旨在为辽宁省冰雪产业的整体发展提供参考,也为进一步提升辽宁省冰雪产业提供新思路。

星状神经节阻滞联合YS1001P治疗仪治疗急性脑梗死伴吞咽困难临床观察

目的探讨星状神经节阻滞联合YS1001P治疗仪治疗急性脑梗死伴吞咽困难的临床效果。方法选取河北北方学院附属第二医院急性脑梗死伴吞咽困难患者80例,按照随机数字表法分为2组,每组40例。2组均行卒中后对症治疗,包含控制血压和血糖、抗血小板聚集、调节脂代谢、改善脑循环、营养脑神经以及并发症的防治等,在此基础上采用吞咽和神经肌电刺激仪YS1001P治疗,研究组额外行星状神经节阻滞治疗,20 d后采用洼田饮水试验评价患者临床疗效。采用藤岛一郎吞咽障碍评分和电视X线透视下吞咽造影检查(videofluroscopic swallowing study,VFSS)比较治疗前和治疗后2组的吞咽功能,比较对照组和研究组治疗前后血清神经生长因子(nerve growth factor,NGF)和脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)含量变化情况。结果治疗后,研究组藤岛一郎吞咽障碍评分高于对照组(P<0.05),口腔期、咽期、误吸评分及VFSS评分总分高于对照组(P<0.05),洼田饮水试验分级优于对照组(P<0.05),研究组治疗总有效率95.00%高于对照组77.50%(P<0.05),研究组血清NGF和BDNF含量高于对照组(P<0.05)。结论星状神经节阻滞联合YS1001P治疗仪治疗急性脑梗死伴吞咽困难的临床效果较好,患者吞咽功能改善明显,其作用机制可能与提高神经营养水平有关。