Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Objective To carry out a joint simulation exercise of tabletop deduction for the staff performing overseas medical services on hospital ships,so as to improve the infection prevention and control.Methods Sixty mission members were selected by convenience sampling to carry out joint simulation drills for tabletop deduction.The effects of the drills were assessed by the survey on the satisfaction and participation of mission members,before-and-after control study,and mission execution.Results Overseas medical service tasks were successfully completed through the desktop-propelled joint simulation drills.The total score of response for infectious emergencies,prevention score,preparedness score,and rescue score after training were higher than those before training(P<0.05).There were high degrees of participation and satisfaction in the drills(≥4.5 points).Conclusion The tabletop deduction and simulation exercise achieve good results in the infection prevention and control of hospital ships.The scheme of tabletop deduction combined with simulation drills will be optimized to continuously improve the infection prevention and control of hospital ships.

Objective To explore the mechanism of methyltransferase METTL3 in premature ovarian failure(POF)using a POF mouse model,providing a theoretical basis for the pathological research and clinical treatment of POF.Methods C57BL/6 female mice aged 6 to 8 weeks were selected for the study.The experimental group consisted of mice with a premature ovarian failure(POF)model established using the D-galactose metabolic method,while the control group comprised normal mice subjected to the same intervention with an equal volume of physiological saline.The levels of sex hormones were measured using ELISA,and histopathological changes in ovarian tissue were observed through HE staining to verify the successful establishment of the POF mouse model and to explore the correlation between METTL3 and POF at the tissue level.Additionally,stable transgenic mouse granulosa cell lines with METTL3 overexpression and knockdown were constructed at the cellular level.Cell proliferation and apoptosis were assessed using CCK-8 and FITC/PI dual staining methods to clarify the regulatory role of METTL3 in granulosa cell apoptosis and its impact on the occurrence of POF.Results The POF mouse model was successfully established.TUNEL staining revealed a significant increase in apoptotic granulosa cells in the ovarian tissue of the POF group(P＜0.05),which also exhibited high expression of METTL3.In cellular experiments,stable transcriptional cell lines of mouse granulosa cells with METTL3 overexpression and knockdown were successfully constructed.Upregulation of METTL3 expression promoted granulosa cell apoptosis and inhibited their proliferation(P＜0.05).Conclusion METTL3 participates in the development of POF by promoting granulosa cell apoptosis.

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.

Objective: To understand the current situation and influencing factors of Internet addiction among college students after returning to school during the COVID-19 epidemic, and to provide scientific basis for timely intervention measures to adjust the risk factors of Internet addiction. Methods: A cluster sampling method was adopted to conduct a questionnaire survey among 2 700 college students who firstly returned to college using general condition questionnaire and Internet Addiction scale. Results: The detection rate of Internet addiction disorder was 32.4% among returning college students, moreover, the detection rate of Internet addiction in male students(36.0%) was higher than that in female students (31.2%) (χ 2=5.42,P<0.05). The degree of Internet addiction was negatively correlated with the physical health score (r-s=-0.20) and mental health score (r-s=-0.24) of college students (P<0.01). Multivariate Logistic regression analysis showed that compared with introversion, neutral (OR=0.67, 95%CI=0.55-0.82) and extroverted college students (OR=0.59, 95%CI=0.48-0.74) were protective factors for Internet addiction; compared with no exercise, physical exercise ≥3 times or more per week (exercise 3-4 times：OR=0.67, 95%CI=0.51-0.87; ≥5 times：OR=0.67, 95%CI=0.50-0.90) were the protective factors for Internet addiction among college students; family loss during the epidemic was a risk factor for Internet addiction among college students (OR=1.34, 95%CI=1.12-1.60); the risk of Internet addiction was 2.13 times higher for college students who actively sought psychological help than for those who did not seek psychological help (95%CI=1.14-3.96); college students who did not want to go back to school had 1.50 times the risk of Internet addiction as those who did (95%CI=1.26-1.77). Conclusion The current situation of college students online behaviors during COVID-19 is not optimistic, and should arouse sufficient attention from society and universities. In addition, college students returning to school should take more physical exercises and psychological counseling to detect and intervene in psychological problems in time, reduce their psychological burden, and enhance their psychological quality.

Objective To understand the situation of iodine nutrition in school children aged 8-10 and pregnant women in Jinping County of Guizhou Province,and to provide a scientific reference for control of iodine deficiency disorders (IDD).Methods Based on Surveillance Scheme of IDD of Guizhou Province (2012),no less than 40 children aged 8-10 and 20 pregnant women were chosen as the research subjects according to the east,west,south,north,and centre 5 directions in Jinping County of Guizhou Province in 2015;a total of 222 children aged 8-10 (half males and half females) and 111 pregnant women were chosen.Arsenic and cerium catalysis spectrophotometry method (WS/T 107-2006) was used to detect urinary iodine content of children and pregnant women;direct titration was used to detect edible salt iodine content from pregnant women.Results The median of urinary iodine of children was 252.0 μg/L in Jinping County in 2015,＜ 100 μg/L accounted for 12.16％ (27/222),100-199 μg/L accounted for 23.42％ (52/222),200-299 μg/L accounted for 27.03％ (60/222),and ≥ 300 μg/L accounted for 37.39％ (83/222);the medians of urinary iodine of children aged 8,9 and 10 were 225.5,252.0 and 286.0 μg/L,respectively;the medians of urinary iodine of male and female children were 237.0 and 255.0 μg/L,respectively;the median of urinary iodine of pregnant women was 198.0 μg/L,＜ 150 μg/L accounted for 35.14％ (39/111),150-249 μg/L accounted for 33.33％ (37/111),and ≥250 μg/L accounted for 31.53％ (35/111);the median of salt iodine from pregnant women was 27.8 mg/kg,21-39 mg/kg accounted for 94.59％ (105/111),the coverage rate of iodized salt was 100.00％ (111/111),the consumption rate of qualified iodized salt was 94.59％ (105/111).Conclusions The median of urinary iodine of children in Jinping County is high,the iodized salt coverage and qualified iodized salt consumption rates are up to the requirements,and the salt iodization standards are still have some space for downward adjustment.

Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.

Objective Conducting reading therapy to enrich the content of health education, to meet the knowledge needs of the patients during hospitalization and to enhance the patients'confidence with diseases, thus to improve patients' the quality of life and satisfaction. Methods Patients with breast cancer who had surgery were selected between January 2014 to December 2014. They were randomly divided into the control group ( traditional health education ) and the intervention group according to the random number method. Patients in the intervention group read the related information provided by the research team, coached, information platform and salon during perioperative and rehabilitation period. They selected the method of"read-centric and interactive reading therapy" which is combined with each as intervention. Results No statistic difference was found between the scores of SAS and SDS on admission (P>0. 05). After the reading therapy, scores of SAS and SDS were (44. 02 ± 4. 81), (45. 66 ± 3. 78) and were all lower than those in the control group (64.52 ±6.89) and (63.67 ±4.92) (t=17.25, 18.25;P<0.05). The satisfactions of the patients and their families in the intervention group were (97. 6 ± 2. 1), which were higher than that in the control group (91.4 ± 1. 2). The difference was statistically significant (t = -18. 13,P <0. 05). Conclusions Using reading therapy in breast cancer patients during perioperative period can be in line with modern "biology-psychology-social medicine" model, provide effective measures for health education and psychological care, enrich the forms and content of health education, significantly improve patients' and their families' satisfaction and mental state during perioperative and rehabilitation period. And it makes psychological care of cancer patients more feasible.