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.

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.

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.

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。

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。

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。

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。

困难静脉评估量表在不同年龄血管通路管理中的应用进展

困难静脉通路(difficult intravenous access,DIVA)是指因为多种因素,如患者肢体肥胖、肢体局部肿胀、血管反复穿刺、静脉使用高渗液、刺激性药物等,使患者的血管无法直视或触摸不到充盈的静脉,而造成临床护士在建立静脉通路时出现穿刺困难的状态[1-2],且穿刺失败次数≥3次的情况[1,3-4]。2008年YEN等[5]研究发现,DIVA发生率为32.8%。DIVA带来的反复静脉穿刺会增加血管药物外渗、静脉炎、感染等并发症的风险,并增加患者痛苦及护士工作量,打击护士工作信心[6]。研究显示[7],12%的患者需要2次尝试才能成功建立静脉通路,而4%和3%的患者分别需要3次和4次及以上的穿刺来建立静脉通路。穿刺前有效识别DIVA对于降低反复静脉穿刺,提高穿刺成功率有重要意义。困难静脉量表是识别DIVA、降低反复穿刺率的有效工具[5],可协助临床护理人员对困难静脉进行评估和判断,并根据DIVA评分等级选择超声等可视化辅助工具,提高第一次穿刺成功率[4]。

按病种分类的疾病诊疗难度测度及应用研究

本研究首次界定了按病种分类的疾病诊疗难度的内涵,运用按病种的疾病发生概率、平均总费用与治愈好转率对病种诊疗难度系数进行测算。采用七县(市)区2017年新农合医保报销数据计算住院病种诊疗难度系数,并绘制“病例数—诊疗难度系数”分布图与拟合曲线,结果符合病种发生的实际状况。对其中两个样本县分别计算相同病种的诊疗难度系数,并进行配对资料秩和检验,计算结果不存在显著差异(P=0.73),提示该算法结果稳健,能够较好地描绘病种的发生与分布规律。测度结果能够用于明确医疗机构病种诊疗范围,刻画医疗服务供给与需求行为,但也存在较为依赖样本量、权重确定较为主观等问题。

教育治理现代化视域下高校“双肩挑”制度的设置依据、运行困境与优化策略

在高校人力资源优化配置中,“双肩挑”制度设置具有一定的理论与现实依据,其有利于优化人才选拔与队伍结构、降低管理与用人成本、提升教学与管理质量、克服行政意识和官僚作风、促进不同类型人员职业发展,但同时也面临着角色定位、时间冲突、岗位设置、资源配置、激励不足等现实困境。“双肩挑”制度的优化首先需要合理设置高校“双肩挑”岗位、科学制定“双肩挑”岗位目标以及有效匹配“双肩挑”岗位教师,同时在制度运行中重视对“双肩挑”干部的选拔和培育、建立合理的“双肩挑”干部考评机制、完善“双肩挑”干部的任期与转换制度和健全对“双肩挑”干部的激励机制。

他诊与自诊维度下的高校辅导员队伍建设状况调研

加强辅导员队伍建设是高校思想政治教育的重要课题。新时代高校辅导员队伍建设得到了更高程度的重视,也取得了显著的成效,但依然存在一系列问题。加强辅导员队伍建设始终关系着高校立德树人根本任务的落实效果,文章从学工部门管理干部、辅导员队伍自身两个视角开展调研,分析辅导员队伍建设的现状、困境及解决的路径,为进一步完善辅导员队伍建设提供一定的参考。

智能书写分析与识别平台用于6~12岁儿童书写能力评估的研究报告

目的通过人工智能分析书写能力评估数据,准确评估小学生的书写质量和能力,为精准筛查和评估书写困难者提供数据支撑。方法采用横断面研究,使用SHARP书写智能分析平台对福建省福州市闽江师范高等专科学校附属实验小学一到六年级(总计1085名)学生进行书写能力评估。评估指标包括书写速度、书写控制、书写统合、纸上时间比率、书写成果准确性和书写总体表现。结果女生在书写控制、书写统合、纸上时间比率、书写成果准确性和书写总体表现上优于男生(P<0.05)。右利手在书写统合、纸上时间比率和书写总体表现3项指标上优于左利手(P<0.05)。小学生书写能力发展趋势:①在书写速度上,一到六年级总体呈逐步加快的趋势,随着年级的增长,一到四年级相邻年级之间书写速度逐步加快(P<0.05),五到六年级之间书写速度逐步加快(P<0.05),但四到五年级之间书写速度的增长差异无统计学意义(P>0.05);②在书写控制能力上,一到六年级总体呈逐步发展的趋势,三年级书写控制能力表现优于二年级(P<0.05),五年级书写控制能力表现优于四年级(P<0.05),其余相邻年级之间差异无统计学意义(P>0.05);③在书写统合能力和纸上时间比率方面,随着年级的增长,一到四年级相邻年级之间高年级学生的发展优于低年级(P<0.05),四到五、五到六年级之间差异无统计学意义(P>0.05);④在书写成果准确性上,二年级优于一年级(P<0.05),四年级优于三年级(P<0.05),其余相邻年级之间差异无统计学意义(P>0.05);⑤在书写总体表现上,二年级表现优于一年级(P<0.05),其余相邻年级之间差异均无统计学意义(P>0.05)。书写控制、书写统合和书写成果准确性与书写总体表现之间呈显著负相关(r>-0.5),纸上时间比率与书写总体表现之间呈高度正相关(r=0.575),纸上时间比率与书写统合之间呈高度负相关(r=-0.999)。书写成果准确性仅能解释书写总体表现的39.1%变化原因,书写成果准确性、纸上时间比率、书写控制和书写统合能力共同解释书写总体表现的71.8%变化原因。结论在小学阶段,女生的书写能力普遍优于男生,但性别和优势手仍无法预测书写的总体表现。书写能力各测量指标随着年级的增高表现趋于成熟,书写速度大约在四到五年级时进入一个短暂的平台期后继续发展;书写控制能力在二到三年级、四到五年级时发展更为迅速,书写统合能力和在纸上时间比率约在四年级后进入相对稳定的平台期。书写成果准确性不适合单独作为书写总体表现的预测因素;书写控制、书写统合和纸上时间比率对书写总体表现具有较强的影响,可以综合作为书写总体表现的预测因素。

人与机器,谁的建议更容易被采纳?不同决策情境下建议者类型对建议采纳的影响研究

在数字经济时代,人类会更加面临“有限处理能力”和“无限增长信息”的矛盾,而利用机器帮助提高决策者决策质量是解决或缓解这一矛盾的途径之一。本研究从接纳建议的角度研究人们对于人机工作的态度,通过引入“机器”作为建议者,比较人们在接纳机器和人提出建议上的差别以及重要的认知条件。研究的主要发现包括:(1)决策者在主观决策情境中会倾向于人的建议,而在客观决策情境中则倾向于机器的建议;(2)在客观决策情境中,高认知闭合需要的个体对人和机器建议的采纳无显著差异,而低认知闭合需要的个体会更倾向于采纳机器的建议;(3)在客观预测情境中,决策者在困难任务时更倾向于采纳机器的建议,而在简单任务时,对人和机器建议的采纳无显著差异;(4)在主观决策情境中,对人的建议的采纳不受建议框架的影响,但对于机器提出的建议在负性建议框架描述更容易采纳。研究的理论贡献在于:丰富和完善了不同决策情境下建议者类型(人/机器)对建议采纳的影响的理论体系;研究的实践意义是:帮助决策者更充分地利用机器来辅助决策,更全面地了解机器建议过程中的作用机制与路径,提高了决策质量。

民间武术生存困境的历史归因与应对策略研究

文章主要运用文献资料法、逻辑推理法与背景分析法等研究方法,对导致困境的历史因素做详细探讨。结果表明:民间武术一直没有摆脱生存危机的困扰,但从未出现过类似于古希腊奥林匹克那种断代传承的现象。