Investigation on the Benefits and Satisfaction Degree of the Electronic Official Document On-line Submission and Approval System-A Case Study of a Medical Center in Southern Taiwan

Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiwan,and to find out whether there are any differences between medical institutions and general government personnel.Methods:A cross-sectional study was conducted to investigate satisfactory outcome with questionnaires.The subjects were administrators,healthcare professionals and medical personnel of a medical center in the southern part of Taiwan who had signed electronic documents online.A total of 395 questionnaires were sent out,147 of which were valid,and the rate of collecting data survey was 37%.We analyzed with SPSS version 20.Results:The official document approval system was mainly used by administrative units and contractors,accounting for more than 50%of users.Besides,the frequency of use was at least more than once a week.As for the user’s perception of operating system,most people thought that it is easier to choose the format of official document and to set up the duty agent on leave,but in the part of the signing and approval process setting or modifying,it was considered more difficult,accounting for 38.1%.In terms of perceptual usefulness,the average value was 3.81,which showed that the user agreed that the system has met the needs of daily official documents.When some users of service area encountered problems with their use,the clerical staff were able to provide services immediately and have the professional ability to resolve problems,in order to agree to the majority,accounting for 53.7%.In addition,nearly 60%of users rated the official document system positively,with an average of 3.84 satisfaction,which was higher than the certified value of 3,conforming to the standards for satisfaction with the use of official documents.In addition,the role authorization,perceptual easy-to-use and service area were significant(p<0.05).The perceptual usefulness of Subordinate units was also significant(p=0.016).The frequency of use,perceptual easy-to-use,perceptual usefulness,service area and satisfaction were significantly different(p<0.05).The correlation coefficient between perceptual usefulness and user satisfaction was 0.833,indicating that there was a high correlation.The daily usage frequency of contractors was higher than supervisors.However,supervisors had the highest frequency of use every quarter(p=0.135).There was no significant difference between contractors and supervisors in the frequency of use.Conclusion:It is suggested that education and training on the operation of the electronic official document on-line submission and approval system should be conducted,which can enhance the education and training of supervisors and medical personnel.Continually,invite supervisors and medical personnel to provide advices on the official document system as a reference for future improvements of the system.

Potential and role of artificial intelligence in current medical healthcare

Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of AI technology and machine learning in medicine have allowed medical practitioners to provide patients with better quality of services;and current advancements have led to a dramatic change in the healthcare system.However,many efficient applications are still in their initial stages,which need further evaluations to improve and develop these applications.Clinicians must recognize and acclimate themselves with the developments in AI technology to improve their delivery of healthcare services;but for this to be possible,a significant revision of medical education is needed to provide future leaders with the required competencies.This article reviews the potential and limitations of AI in healthcare,as well as the current medical application trends including healthcare administration,clinical decision assistance,patient health monitoring,healthcare resource allocation,medical research,and public health policy development.Also,future possibilities for further clinical and scientific practice were also summarized.

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients:A technical review

Situs inversus(SI)is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs.Since the 1990s,more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy.In these cases,the major problem is to overcome is the left-right condition for right-handed surgeons.Laparoscopic common bile duct exploration(LCBDE),an alternative to treat patients with bile duct stones,has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography.Recent updated meta-analyses revealed that a shorter postoperative hospital stay,fewer procedural interventions,cost-effectiveness,a higher stone clearance rate,and fewer perioperative complications are additional advantages of LCBDE.However,the technique is technically demanding,even for skilled laparoscopic surgeons.Conducting LCBDE in patients with difficult situations,such as SI,is more complex than usual.We herein review published SI patients with choledocholithiasis treated by LCBDE,including our own experience,and this paper focuses on the technical aspects.

Effects of areca nut consumption on cell differentiation of osteoblasts, myoblasts, and fibroblasts

Areca nut is used worldwide as a hallucinogenic addicting drug along the tropical belt.Arecoline,a toxic compound,is the most important alkaloid in areca nuts.The adverse effects of oral uptake and chewing of areca nut are well known.For example,the possibility of cancer caused by chewing areca nuts is widely discussed.Chewing areca nut has other adverse effects on other organs,including abnormal cell differentiation,oral cancer,and several other diseases.The use of areca nut is also associated with low birthweight.Skeletal musculature is the largest organ in the body and is attached to the bones.During embryo development,the differentiation of bone and muscle cells is critical.In this article,we reviewed the effects of areca nut and arecoline on embryonic cell differentiation,particularly osteoblasts,myoblasts,and fibroblasts.

Optimizing Big Data Retrieval and Job Scheduling Using Deep Learning Approaches

Big data analytics in business intelligence do not provide effective data retrieval methods and job scheduling that will cause execution inefficiency and low system throughput.This paper aims to enhance the capability of data retrieval and job scheduling to speed up the operation of big data analytics to overcome inefficiency and low throughput problems.First,integrating stacked sparse autoencoder and Elasticsearch indexing explored fast data searching and distributed indexing,which reduces the search scope of the database and dramatically speeds up data searching.Next,exploiting a deep neural network to predict the approximate execution time of a job gives prioritized job scheduling based on the shortest job first,which reduces the average waiting time of job execution.As a result,the proposed data retrieval approach outperforms the previous method using a deep autoencoder and Solr indexing,significantly improving the speed of data retrieval up to 53%and increasing system throughput by 53%.On the other hand,the proposed job scheduling algorithmdefeats both first-in-first-out andmemory-sensitive heterogeneous early finish time scheduling algorithms,effectively shortening the average waiting time up to 5%and average weighted turnaround time by 19%,respectively.

Implementation of Rapid Code Transformation Process Using Deep Learning Approaches

Our previous work has introduced the newly generated program using the code transformation model GPT-2,verifying the generated programming codes through simhash(SH)and longest common subsequence(LCS)algo-rithms.However,the entire code transformation process has encountered a time-consuming problem.Therefore,the objective of this study is to speed up the code transformation process signi􀀀cantly.This paper has proposed deep learning approaches for modifying SH using a variational simhash(VSH)algorithm and replacing LCS with a piecewise longest common subsequence(PLCS)algorithm to faster the veri􀀀cation process in the test phase.Besides the code transformation model GPT-2,this study has also introduced MicrosoMASS and Facebook BART for a comparative analysis of their performance.Meanwhile,the explainable AI technique using local interpretable model-agnostic explanations(LIME)can also interpret the decision-making ofAImodels.The experimental results show that VSH can reduce the number of quali􀀀ed programs by 22.11%,and PLCS can reduce the execution time of selected pocket programs by 32.39%.As a result,the proposed approaches can signi􀀀cantly speed up the entire code transformation process by 1.38 times on average compared with our previous work.

Underrecognition and un-dertreatment of stress-related psychiatric disorders in physicians:Determinants,challenges,and the impact of the COVID-19 pandemic

Medical practitioners’duties are highly stressful and performed in a particularly challenging and competitive work environment.Stress and burnout among physicians have emerged as a worldwide public health problem in recent years.A high level of distress and burnout can lead to clinically significant behavioral health problems,such as stress-related psychiatric disorders.Mounting evidence shows that physicians have higher risks of insomnia,anxiety,and depression than the general population,especially during the coronavirus disease 2019 pandemic.However,the behavioral health problems of these vulnerable healthcare professionals are noteworthy for being underrecognized and undertreated.In this minireview,we summarize the current progress of studies on the prevalence and determinants of distress and stress-related psychiatric disorders among physicians and their healthcare-seeking behaviors.We discuss future research directions and the clinical approach that may maximize self-awareness and promote prompt and adequate treatment for clinically significant behavioral health problems of physicians.

Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire

BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.

亚太地区慢性乙型肝炎治疗共识(2012最新版)

自2008年至今,有大量关于慢性HBV感染的自然史和治疗的最新数据不断涌现。其中包括慢性HBV感染的无症状感染者,以社区为基础的队列研究,HBV基因型的作用,非药物诱导的自然HBV变异型毒株,无创性肝纤维化评估方法的应用,HBsAg定量在临床中的应用,更有效的新治疗药物和新治疗方案等等。来自亚太地区的专家审查和评估了相关数据,并共同商讨了近年来报道的最有意义的发现,基于此,对2008年版的亚太地区慢性乙型肝炎治疗共识进行修订,同时对2008年版治疗指南定义的关键词组进行了修订。修订后的指南包括以下几方面内容:一般治疗,肝纤维化评价适应证,何时开始治疗或停药,初始抗病毒治疗药物的选择,如何监测治疗中和治疗后的患者。关于特殊人群的治疗建议中包括了对妊娠妇女,已发生耐药,合并其他病毒感染,肝功能失代偿,接受免疫抑制治疗、化疗,肝移植或肝细胞癌患者的具体治疗建议。

Diagnosis of Helicobacter pylori infection: Current options and developments

Accurate diagnosis of Helicobacter pylori(H. pylori) infection is a crucial part in the effective management of many gastroduodenal diseases. Several invasive and non-invasive diagnostic tests are available for the detection of H. pylori and each test has its usefulness and limitations in different clinical situations. Although none can be considered as a single gold standard in clinical practice,several techniques have been developed to give the more reliable results. Invasive tests are performed via endoscopic biopsy specimens and these tests include histology,culture,rapid urease test as well as molecular methods. Developments of endoscopic equipment also contribute to the real-time diagnosis of H. pylori during endoscopy. Urea breathingtest and stool antigen test are most widely used noninvasive tests,whereas serology is useful in screening and epidemiological studies. Molecular methods have been used in variable specimens other than gastric mucosa. More than detection of H. pylori infection,several tests are introduced into the evaluation of virulence factors and antibiotic sensitivity of H. pylori,as well as screening precancerous lesions and gastric cancer. The aim of this article is to review the current options and novel developments of diagnostic tests and their applications in different clinical conditions or for specific purposes.

CYP2C19 polymorphism influences Helicobacter pylori eradication

The known factors that have contributed to the decline of Helicobacter pylori(H.pylori)eradication rate include antibiotic resistance,poor compliance,high gastric acidity,high bacterial load,and cytochrome P450 2C19(CYP2C19)polymorphism.Proton pump inhibitor(PPI)is important in the eradication regimen.The principal enzyme implicated in the metabolism of PPIs is CYP2C19.The effects of PPI depend on metabolic enzyme,cytochrome P450 enzymes,and CYP2C19 with genetic differences in the activity of this enzyme(the homozygous EM,heterozygous EM(Het EM),and poor metabolizer).The frequency of the CYP2C19 polymorphism is highly varied among different ethnic populations.The CYP2C19genotype is a cardinal factor of H.pylori eradication in patients taking omeprazole-based or lansoprazolebased triple therapies.In contrast,the CYP2C19 polymorphism has no significant effect on the rabeprazolebased or esomeprazole-based triple therapies.The efficacy of levofloxacin-based rescue triple therapy might be also affected by the CYP2C19 polymorphism,but CYP2C19 genotypes did not show obvious impact on other levofloxacin-based rescue therapies.Choice of different PPIs and/or increasing doses of PPIs should be individualized based on the pharmacogenetics background of each patient and pharmacological profile of each drug.Other possible factors influencing gastric acid secretion(e.g.,IL-1β-511 polymorphism)would be also under consideration.

Dual specimens increase the diagnostic accuracy and reduce the reaction duration of rapid urease test

AIM:To evaluate the influence of multiple samplings during esophagogastr oduodenoscopy(EGD) on the accuracy of the rapid urease test,and the validity of newly developed rapid urease tests,HelicotecUT plus test and HelicotecUT test,CLO test and ProntoDry test.METHODS:A total of 355 patients undergoing EGD for dyspepsia were included.Their Helicobacter pylori(H.pylori) treatment status was either nave or eradicated.Six biopsy specimens from antrum and gastric body,respectively,were obtained during EGD.Single antral specimens and dual(antrum+body) specimens were compared.Infection status of H.pylori was evaluated by three different tests:culture,histology,and four different commercially available rapid urease tests(RUTs)-including the newly developed HelicotecUT plus test and HelicotecUT test,and established CLO test and ProntoDry test.H.pylori status was defined as positive when the culture was positive or if there were concordant positive results among histology,CLO test and ProntoDry test.RESULTS:When dual specimens were applied,sensitivity was enhanced and RUT reaction time was signif icantly reduced,regardless of their treatment status.Thirty minutes were enough to achieve an agreeable positive rate in all the RUTs.Both newly developed RUTs showed comparable sensitivity,specif icity and accuracy to the established RUTs,regardless of patient treatment status,RUT reaction duration,and EGD biopsy sites.CONCLUSION:Combination of antrum and body biopsy specimens greatly enhances the sensitivity of rapid urease test and reduces the reaction duration to 30 min.

Leptin in hepatocellular carcinoma

The risk factors for hepatocellular carcinoma (HCC) development have been established,and include chronic hepatitis B and C,heavy alcohol consumption,and aflatoxins.In fact,5%-30% of patients with HCC still lack a readily identifiable risk factor.It has been reported that the majority of "cryptogenic" HCC may be attributed to nonalcoholic fatty liver disease,the hepatic presentation of the metabolic syndrome (MS).Obesity is associated with the development of the MS.Recently,adipose tissue has been considered as an endocrine organ because of its capacity to secrete a variety of cytokines,which are collectively known as the adipokines.Leptin,the product of the obese gene,is mainly produced by adipose tissue.Since leptin was first characterized in 1994,accumulated literature has demonstrated the involvement of this adipokine in several areas of human physiology.After binding to its receptor,leptin initiates a cascade of signaling events and subsequent cellular effects.In addition to being the regulatory mediator of energy homeostasis,several in vitro studies have demonstrated the fibrogenic role of leptin in the liver.Furthermore,the deregulated expression of leptin and its receptor have been demonstrated to be associated with a variety of metabolic disorders as well as human cancers.Most importantly,direct evidence supporting the inhibitory and/or activating role of leptin in the process of carcinogenesis and progression of human HCC has been accumulating rapidly.This review aims to provide important insights into the potential mechanisms of leptin in the development of HCC.Hopefully,further investigations will shed light on a new therapeutic target in HCC.

Superior mesenteric artery syndrome in a diabetic patient with acute weight loss

Superior mesenteric artery(SMA)syndrome is an un- common disease resulting compression of the third portion of the duodenum from the superior mesenteric artery.This disease shares many common manifestations with diabetic gastroparesis,including postprandial fullness,nausea,vomiting,and bloating.Therefore,it is often overlooked in diabetic patients.Here,we report a 41-year-old man with poorly controlled diabetic mellitus who developed SMA syndrome due to rapid weight loss. The diagnosis was confirmed by computed tomography and an upper gastrointestinal series.His condition improved after parenteral nutrient,strict sugar control, and gradual weight gain.

Clinical proteomics identifies potential biomarkers in Helicobacter pylori for gastrointestinal diseases

The development of gastrointestinal diseases has been found to be associated with Helicobacter pylori(H. pylori) infection and various biochemical stresses in stomach and intestine. These stresses, such as oxidative, osmotic and acid stresses, may bring about bidirectional effects on both hosts and H. pylori, leading to changes of protein expression in their proteomes. Therefore, proteins differentially expressed in H. pylori under various stresses not only reflect gastrointestinal environment but also provide useful biomarkers for disease diagnosis and prognosis. In this regard, proteomic technology is an ideal tool to identify potential biomarkers as it can systematically monitor proteins and protein variation on a large scale of cell's translational landscape, permitting in-depth analyses of host and pathogen interactions. By performing twodimensional polyacrylamide gel electrophoresis(2-DE) followed by liquid chromatography-nanoESI-mass spectrometry(nanoLC-MS/MS), we have successfully pinpointed alkylhydroperoxide reductase(AhpC), neutrophil-activating protein and non-heme iron-binding ferritin as three prospective biomarkers showing upregulation in H. pylori under oxidative, osmotic and acid stresses, respectively. Further biochemical characterization reveals that various environmental stresses can induce protein structure change and functional conversion in the identified biomarkers. Especially salient is the antioxidant enzyme AhpC, an abundant antioxidant protein present in H. pylori. It switches from a peroxide reductase of low-molecular-weight(LMW) oligomers to a molecular chaperone of high-molecular-weight(HMW) complexes under oxidative stress. Different seropositivy responses against LMW or HMW AhpC in H. pylori-infected patients faithfully match the disease progression from disease-free healthy persons to patients with gastric ulcer and cancer. These results has established AhpC of H. pylori as a promising diagnostic marker for gastrointestinal maladies, and highlight the utility of clinical proteomics for identifying disease biomarkers that can be uniquely applied to disease-oriented translational medicine.

Association between Helicobacter pylori seropositivity and digestive tract cancers

AIM:To explore the role of Helicobacter pylori(H pylori) infection on the risk of digestive tract cancers. METHODS:In total,199 oral squamous-cell carcinoma(SCC),317 esophageal SCC,196 gastric cardia and non-cardia adenocarcinoma and 240 colon adenocarcinoma patients were recruited for serum tests of H pylori infection.Two hospital-and one community-based control groups were used for the comparisons.H pyloriseropositivity was determined by an enzyme linked immunosorbent assay method against H pylori IgG. RESULTS:Presence of H pylori infection was significantly inversely associated with esophageal SCC[adjusted odds ratio(AOR):0.315-0.472,all P-value< 0.05]but positively associated with gastric adenocarcinoma(both cardia and non-cardia)(AOR:1.636-3.060, all P-value<0.05)in comparison to the three control groups.Similar results were not found in cancers of the oral cavity and colon. CONCLUSION:Our findings support the finding that H pylori seropositivity is inversely associated with esophageal SCC risk,but increases the risk of gastric cardia adenocarcinoma.

A new look at anti-Helicobacter pylori therapy

With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.

2011 update on esophageal achalasia

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years.First,the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes.The most favorable outcome is predicted for patients receiving treatment for type Ⅱ achalasia (achalasia with compression).Patients with typeⅠ(classic achalasia) and type Ⅲ achalasia (spastic achalasia) experience a less favorable outcome.Second,the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD).Although the follow-up period was not long enough to reach a convincing conclusion,it merits the continued use of PD as a generally available technique in gastroenterology.Third,the novelendoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia,but it requires increased experience and cautious evaluation.Despite all this good news,the bottom line is a real break-through from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

Short-term Celecoxib intervention is a safe and effective chemopreventive for gastric carcinogenesis based on a Mongolian gerbil model

AIM:To evaluate the optimal intervention point of a selective cyclooxygenase-2(COX-2) inhibitor,Celecoxib,for inhibiting Helicobacter pylori(H pylori)-associated gastric carcinogenesis in Mongolian gerbils(MGs).METHODS:One hundred and twelve MGs were divided into six groups(A-F).One hundred gerbils were inoculated with H pylori(groups A-E).Twelve gerbils were inoculated with vehicle broth only(group F).After 4 wk,they were given N'-methyl-N' -nitro-N-nitroso-guanidine(MNNG)(50 μg/mL) in the drinking water for 20 wk.In groups B-E,the animals were given the stock Celecoxib(10 mg/kg per day) diet from the 21st,31st,21st and 41st week respectively.The periods of administering Celecoxib were 30,20,20,and 15 wk respectively.On the 51st week,the animals were sacrificed for histological examination.Local PCNA expression was examined by the immunohistochemistry method.The expression of COX-2 protein was assessed by Western Blot.Analysis used the χ2 test.The difference was regarded as signifi cant when P value was less than 0.05.RESULTS:Seventeen percent(17/100) of H pylori-infected MGs developed gastric cancer.All of these lesions were well-differentiated adenocarcinoma.The incidence rates of adenocarcinoma in groups A-F were 40%,0%,0%,20%,25%,and 0% respectively.The inflammatory scores were higher in group B than in other groups.There was no inflammatory response noted in group F.Celecoxib treatment resulted in a significant reduction in the proliferation of H pylori-infected mucosal cells(groups B,C and D)(P < 0.01).The expression of COX-2 protein was significantly attenuated in the groups which were Celecoxib-treated for more than 20 wk(groups B,C,D).The groups treated with Celecoxib had a significantly lower rate of advanced gastric cancer(34% vs 75%,P<0.001) There were no sudden deaths in any of the groups.CONCLUSION:Short-term treatment with Celecoxib has an anti-carcinogenic effect,and resulted in less severe inflammation and inhibited the invasive degree of gastric cancer.

Conservative pulp treatment for Oehlers type Ⅲ dens invaginatus: A case report

BACKGROUND Diverse presentations of dens invaginatus (DI) and root canal treatment with an immature open apex often pose challenges to dentists. Adequate treatment planning for DI is the main reason for successful approach, i.e., we should consider the shape and depth of the concave folding, the condition of the original pulp, and the growth stage of the root formation. CASE SUMMARY A 9-year-old girl complained of severe pain of the right maxillary incisor (tooth 12) when chewing for two weeks. Following clinical and radiographic examinations, Oehlers type III DI of tooth 12, with an immature open apical foramen and a symptomatic periapical pathosis, was diagnosed. Cone-beam computed tomography verified the specific spatial and stereoscopic data regarding the communication between the main root canal and pseudo root canal of the involved tooth. After removing the source of infection, a mineral trioxide aggregate was selected to fill and seal the pseudo root canal;additionally, pulp capping of the main canal was performed through the interconnections between the root canals in the middle segment to preserve pulp vitality and enable continual root formation and eventual root apex closure. CONCLUSION We propose to conduct main root canal pulp capping for DI with communication between the main and pseudo root canals.