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.

IMPACT de la déprivation sociale sur les difficultés psychosociales au décours d’un cancer pédiatrique:uneétude prospective IMPACT of the Social Deprivation on Psychosocial Difficulties of Pediatric Cancer Survivors:A Prospective Study

The posttreatment period is a key part of the management of pediatric cancer.During this time,school and psychological difficulties have been described in childhood cancer survivors(CCS)and can be prognostic for the success of social reintegration.This study estimated the influence of the household’s socioeconomic status(SES)on these psychosocial difficulties.This study is based on a prospective multicentric database and focused on children who received a psychosocial evaluation during their follow-up from 2013 to 2020.We retrieved data on school and psychological difficulties.Household SES was estimated by a social deprivation score.Data from1003 patients were analyzed.School difficulties were noted in 22%of CCS.A greater social deprivation was significantly associated with school difficulty.Tumor relapse,treatment with hematopoietic stem cell transplantation,and central nervous system(CNS)tumors remained significant risk factors.In the subgroup of CNS tumors,school difficulties were increased and associated with greater social deprivation.Psychological difficulties were not associated with the deprivation score.There is a link between SES and school difficulties in CCS.Further investigations should be carried out for children with CNS tumors,which is the population of the greatest concern.

Linking 24-h Movement Behavior Guidelines to Cognitive Difficulties,Internalizing and Externalizing Problems in Preterm Youth

Background:Given the heightened risk of developmental challenges associated with preterm birth,it is crucial to explore interventions that may ameliorate potential adverse outcomes.This study aimed to examine whether meeting the 24-h movement behavior(24-HMB)guidelines,which include recommendations on physical activity(PA),screen time(ST),and sleep(SL),is related to indicators of cognitive difficulties,internalizing problems(e.g.,depression and anxiety),and externalizing problems(e.g.,difficulties in making friends and arguing)in a sample of preterm youth(children and adolescents born preterm).Methods:In this cross-sectional study,data from 3410 preterm youth(aged 6 to 17 years)were included for data analyses.Multivariable logistic regression was used to investigate associations between meeting the 24-HMB guidelines and the above-mentioned health outcomes,while controlling for sociodemographic and health-related factors.Results:The prevalence of meeting 24-HMB guidelines varied across independent and integrated components of the 24-HMB guidelines.Meeting the ST guideline alone(p<0.05)and integrated guidelines(i.e.,ST+SL and ST+SL+PA)were associated with fewer cognitive difficulties and reduced internalizing and externalizing problems(p<0.05).Specifically,meeting the SL guideline alone and integrated guidelines(i.e.,SL+ST)were associated with lower odds of depression and anxiety(p<0.01).Additionally,meeting independent,and integrated(PA and/or ST)guidelines were associated with less pronounced difficulties in making friends and arguing(p<0.05).Meeting 24-HMB guidelines in an isolated and integrated manner are linked to better cognitive performance and fewer internalizing and externalizing problems in preterm youth.Conclusion:Results suggest that advocating for the implementation of the 24-HMB guidelines may reduce cognitive challenges and behavioral issues,which is of high relevance for improving public health.Future longitudinal studies in preterm youth should investigate how modifying specific 24-HMB behaviors,especially ST,influence cognitive difficulties,internalizing and externalizing problems in this vulnerable population.

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.

Teaching Legal Englishfor Law Studentsin China:Difficultiesand Solutions

Teaching legal English for law students in China is difficult.For one thing,many Chinese law students have trouble moreor less in learning English,because the English language is not their mother tongue.For another,legal English differs a great dealfrom everyday English in many respects,including terminology,phrasing,linguistic structure,and linguistic conventions,whichmakes legal English teaching for law students in China by far harder.To solve difficulties undermining teaching legal English forlaw students in China,the author of this paper holds that in his or her actual legal English teaching,the teacher should boost lawstudents basic English teaching,expose them to cases study of specialized legal English terminology and linguistic structures andconventions.

The Effect of Topic Familiarity and Linguistic Difficulty on EFL Listening Comprehension

As a highly integrative and demanding receptive skill,listening comprehension presents a challenge to both learners and researchers.The study reported in this paper is listening comprehension objective-factor research.Manipulating topic factors,the study investigated the effect of topic familiarity and linguistic difficulty on EFL(English as a foreign language)listening comprehension of learners at different proficiency levels.

Information-Theoretic Analysis for the Difficulty of Extracting Hidden Information

The difficulty of extracting hidden information, which is essentially a kindof secrecy, is analyzed by information-theoretic method. The relations between key rate, messagerate, hiding capacity and difficulty of extraction are studied in the terms of unicity distance ofstego-key, and the theoretic conclusion is used to analyze the actual extracting attack on LeastSignificant Bit(LSB) steganographic algorithms.

The Difficulties and Mechanism Innovation of Constructing China's Rural Multiplex Financial System

This paper expounds the necessity of constructing China's rural multiplex financial system as follows.First,overcome the bottleneck effect arising from the shortage of capital in the process of development of rural small and medium-sized enterprise,and increase farmers' income;second,provide capital support for rural modern industrial development,and promote rural economic development;third,rationally allocate capital,master the money flow and coordinate urban-rural development.The paper also profoundly analyzes the difficulties of constructing China's rural multiplex financial system as follows.First,the existing rural financial system structure is irrational and the function is unsound;second,non-governmental financial market is disorderly and the organization is unsound;third,the rural financial system is simple and the overhaul of rural credit cooperatives system has not yet been done;fourth,the construction of rural system of financial laws and regulations is laggard,and the construction of rural multiplex financial system lacks good social environment.The specific thoughts,measures and countermeasures of constructing mechanism innovation of China's rural multiplex financial system are put forward as follows.First,increasingly perfect legal system and provide legal support for constructing China's rural multiplex financial system;second,quicken the overhaul of rural credit cooperatives system and perfect its function in China's rural multiplex financial system;third,strengthen the degree of support and development,and change the situation of simple structure of rural financial system;fourth,reinforce administrative supervision and perfect public services,and standardize the rural financial market order.

Difficulties Experienced in Trauma Nursing Practice by Expert Emergency Nurses in Japan

The objective of this study was to determine the difficulties experienced in trauma nursing practice by expert emergency nurses in Japan. Ten nurses who worked at emergency and critical care centers in Japan were directly involved in nursing patients were selected by purposive sampling and underwent semi-structured interviews regarding the difficulties they experienced in trauma nursing. The nurses were specialists in critical care nursing or were certified emergency nurses. The interview responses were analyzed by the qualitative descriptive method. The following six categories of difficulties associated with the direct care of trauma patients and their family members encountered in trauma nursing practice were identified: [Initial handling of highly urgent trauma patients], [Understanding and observing the condition of patients who are in the treatment stage], [Judging when to transition to end-stage care for patients difficult to save], [Mitigating suffering and expanding safe activities of daily living for trauma patients], [Transitional care with a long-term perspective for trauma patients], and [Relationships with the family members of patients who died]. Three categories of difficulties related to the role of the expert nurse in trauma nursing practice were identified: [Person-to-person coordination and cooperation for a trauma patient], [Playing an educational role for the nursing staff], and [Pursuing expertise in trauma nursing and gaining empirical knowledge]. The findings suggested a need to establish systems for training and consultative support and opportunities to create meaning by reflecting on fulfillment and nursing practice.

An Analysis on Mental Health Education of College Students with Financial Difficulties

With the enrollment expansion of college and continuous reform of college education system and college charging system,the number of college students with financial difficulties is increasing. The college students with family financial difficulties not only bear the huge economic burden,but also bear the huge pressure of learning and mental stress,and they have many kinds of psychological problems including psychological distress of tension and anxiety,psychological conflict of self-respect and self-abasement,conflict of desire for interpersonal interaction and self-containment and strong vanity and dependence mentality. This paper puts forward the corresponding recommendations to solve these problems.

Analysis of drilling difficulty of extended-reach wells based on drilling limit theory

With the continuous increase in vertical depths and horizontal displacements of directional wells,the difficulties of drilling operations continue to increase,and more accurate methods of drilling difficulty evaluation are needed.In this paper,a drilling difficulty evaluation method is built by combining drilling limit model and expert evaluation.Firstly,the concept of drilling difficulty index is introduced,and the method to calculate drilling difficulty index is established.Next,the meanings of five drilling difficulty levels are explained and the optimization design method with drilling difficulty as the target is built.At last,the theoretical model is applied to the extended-reach drilling of the Liuhua oilfield in the South China Sea,in which drilling difficulties are evaluated and the relationship between drilling difficulty and development control radius is revealed.The results indicate that extended-reach drilling in the Liuhua oilfield is on the“normal”difficulty level on average,rotary drilling in 8_(1/2)-in.section is the most difficult,and the main constraint conditions are excessive torque and high friction.Through technology upgradation,the drilling difficulties are decreased,the development control radius increases from 6.6 to 11.4 km,and the maximum horizontalto-vertical ratio increases from 5.3 to 8.7.Then,the development wells in marginal oilfields and adjustment wells in old oilfields can be drilled on“normal”difficulty level.Therefore,technology upgradation,especially drilling rig upgradation,is the most important development direction for extended-reach drilling in the South China Sea.

Genome-wide association studies of hypertension:Achievements,difficulties and strategies

Estimated from family studies,the heritability of hypertension ranges from 31%to 68%.Linkage studies and candidate gene association studies were once widely used to investigate the genetic mechanisms of hypertension.However,results from these studies could only explain 1%-2%heritability.With the technological advances and subsequently the accomplishment of the Human Genome Project,genome-wide association studies(GWA studies)have been applied to find genome-wide significant signals for many common diseases.Current GWA studies of hypertension have identified dozens of hypertension or blood pressure associated variants.However,different GWA study identified different variants and the results could hardly be replicated in other studies.Therefore,a debate took place on whether GWA studies will unlock the genetic basis of hypertension and whether we shall continue throwing millions of dollars on GWA studies.This review gives a short introduction to the history of genetic study on hypertension and summarizes the current findings for GWA studies of hypertension or blood pressure.Finally,we will discuss that debate and try to find alternative strategies and technologies that may hold a greater chance to make progress in understanding the genetic risk factors of hypertension and blood pressure regulation.

The Strengths and Difficulties Questionnaire： A Pilot Study on the Reliability and Validity of the Self-report Version to Measure the Mental Health of Zambian Adolescents

The study had the objective of exploring the feasibility of using the self-report SDQ-Y （youth version of strengths and difficulties questionnaire） to assess the emotional and behavioural well being of adolescents in Zambia. This was a cross sectional study of Lusaka school children （n = 420） aged 11-15 years using the self-report SDQ-Y and a demographic questionnaire. It was found that compared to a UK normative sample, Zambian adolescents were almost twice as likely to have total difficulties scores in the abnormal range （O.R. 1.9）. It was found that there was a significant difference in the total SDQ scores （Z = -2.67, P = 0.008） with children reporting health problems having significantly higher scores. Children reporting health problems also had significantly more emotional problems （Z = -2.78, P = 0.005）. There was a trend for children with health problems to score higher on the hyperactivity scale （Z = -1.9 P = 0.053）. The internal consistency of SDQ subscales ranged from low to moderate. It can be concluded that SDQ is a useful instrument for use with Zambian adolescents, in particular, the total difficulties score and the emotional difficulties score performed well in this sample and could potentially be used to screen for mental health problems or to examine the impact of interventions.

Study on fasART neuro-fuzzy networks for distinguishing the difficulty degree of top coal caving in steep seam

Distinguishing the difficulty degree of top coal caving was a precondition of the popularization and application of the roadway sub-level caving in steep seam. Because of complexity and uncertainty of the coal seam, the expression of influence factors was diffi-culty with exact data. According to the fuzzy and uncertainty of influence factors, triangular fuzzy membership functions were adopted to carry out the factors ambiguity, of which the factors not only have the consistency of semantic meaning, but also dissolve sufficiently expert knowledge. Based on the properties and structures of fasART fuzzy neural net-works of fuzzy logic system and practical needs, a simplified fasART model was put for-ward, stability and reliability of the network were improved, the deficiency of learning sam-ples and uncertainty of the factors were better treated. The method is of effective and practical value was identified by experiments.

An Analysis and Corresponding Strategies of Memory Difficulties Caused by Psychological Factors in Consecutive Interpreting

This paper is composed of three parts.The first part presents Gile’s effort model and memory mechanism in consecutive interpreting.In the second part and the third part,the author analyzes the psychological factors that cause memory difficulties and proposes corresponding strategies on the basis of the analysis.At last,the author draws a conclusion based on the discussion of the whole paper that sufficient preparation,appropriate pressure and perceived memory can avoid memory difficulties caused by psychological factors.