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*

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*

Objective:To construct an evaluation system for the operation quality of the equipment of the urological department based on the pressure-state-response(PSR)model,so as to explore it's application effect in the evaluation for the operation quality of the equipment of urological department.Methods:Based on the PSR model,the analytic hierarchy process was used to determine the weights of index,and the fuzzy evaluation method was adopted to evaluate the management efficiency for equipment.A total of 160 devices of clinical use in the Urological Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2024 were selected.According to different management modes,the random number table was adopted to equally distribute these devices into conventional management mode(80 devices)and management mode with evaluation system(model evaluation)for operation quality of the equipment of the urological department(80 devices).A self-made questionnaire was used to investigate the satisfaction of the usage managers in the urological department and operation room,department of medical equipment,and department of managing infection for the clinical services of the two kinds of management modes.The infection situations,management quality of equipment operation,and the score of operation quality in using equipment between two kinds of management modes were compared.Results:The average repair rate of equipment failure,risk rate of infection,inefficiency rate of cleaning,and problem rate of quality inspection in the management mode with model evaluation were respectively(1.58±0.69)%,(1.98±0.69)%,(1.10±0.78)%and(1.01±0.70)%,all of which were lower than those in the conventional management mode,and the differences of them were statistically significant(t=7.879,6.663,7.863,14.601,P<0.05).In the 120 patients who adopted the management mode with model evaluation,the infection rates of using equipment in laparoscopic minimally invasive surgery,endoscopic surgery for stone,resectoscopic surgery and flexible ureteroscope were respectively 2.50%,3.33%,4.17%and 3.33%,all of which were lower than those in the conventional management mode,and the differences between the two kinds of modes were statistically significant(x2=6.696,6.916,5.154,7.101,P<0.05).The scores of the standardization of using equipment,effectiveness of cleaning and disinfection,recognition of emergency management,and qualification of controlling infection in the management mode with model evaluation were significantly higher than those in the conventional management mode,and the differences were statistically significant(t=22.198,11.806,9.385,18.071,P<0.05).The satisfaction scores of the managers involved in using equipment in the operation room of urology,department of medical equipment and department of managing infection for the management mode with model evaluation were all higher than those of the conventional management mode,and the differences were statistically significant(t=14.426,14.916,14.707,P<0.05).Conclusion:The quality evaluation system of equipment operation of the urological department based on the PSR model can reduce the failure rate of equipment,and improve the usage efficiency of equipment,and ensure the medical safety of patients.

Objective This study aims to explore the application effectiveness of the PDCA cycle method in preventing and reducing internal errors in the intravenous drug dispensing center(PIVAS).Methods Internal error data from our hospital's PIVAS in 2020 and 2021 were collected.The data from 2020 represented the pre-implementation of the PDCA cycle,while the data from 2021 represented the post-implementation period.The changes in internal errors and error rates before and after imple-mentation were compared.Results After implementing the PDCA cycle management measures,the annual error rate decreased from 0.887％o in 2020 to 0.681‰ in 2021,a decrease of 23.22％.Conclusion The PDCA cycle method can effectively reduce the occurrence of internal errors,improve work accuracy,and ensure the safety of clinical drug use in PIVAS.

BACKGROUND:Studies have shown that immune cells are involved in all processes of ischemic stroke,in which cuproptosis also plays a key role.OBJECTIVE:To screen diagnostic biomarkers related to the progression of ischemic stroke through bioinformatics,and analyze and validate cuproptosis-related genes closely related to the occurrence and development of ischemic stroke.METHODS:The GSE16561 microarray was obtained from the GEO database,containing data from 39 cases of ischemic stroke(ischemic stroke group)and 24 controls(control group).Differentially expressed genes from the ischemic stroke microarray data were analyzed.Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed.By using LASSO and Random Forest methods,key genes affecting the occurrence and development of ischemic stroke were screened,and a diagnostic model was established and validated.Differential gene analysis was performed through immune cell infiltration and weighted gene co expression network.The differentially expressed immune-related genes were intersected with cuproptosis genes to obtain the hub genes related to cuproptosis immunity.In vitro cell experiments were conducted to divide rat hippocampal neurons into a normal group and an ischemic stroke group,and qPCR experiments were performed to verify the results.RESULTS AND CONCLUSION:(1)573 differentially expressed genes were obtained by differential analysis.Differentially expressed genes were mainly enriched in biological processes,such as positive regulation of immune response,and signaling pathways such as lipid and atherosclerosis.(2)Machine learning methods were used to screen diagnostic genes such as MFN2,PKM2,CREG1,and FOXO3A,which may have some diagnostic value for ischemic stroke.(3)Immune infiltration analysis revealed resting plasma cells,NK cells,macrophages,etc.,indicating that immune cells play a certain role in the pathogenesis of ischemic stroke.(4)Weighted gene co-expression network analysis combined with immune infiltration analysis obtained 118 key module genes,which were intersected with cuproptosis genes to obtain 2 cuproptosis and immune characteristic genes.The correlation analysis between four diagnostic genes and Hub genes showed that the expression of FOXO3A and MFN2,PKM2 and BCL2L1,MTF1 and MFN2,ATP7B and BCL2L1 were correlated.(5)The qPCR results showed significant differences in the genes MTF1 and ATP7B between the ischemic stroke group and the blank group.To conclude,ATP7B and MTF1 can serve as characteristic genes for cuproptosis in ischemic stroke.It is possible to improve ischemic stroke by intervening in ATP7B and MTF1 to regulate cuproptosis.

Objective:To construct an evaluation system for the operation quality of the equipment of the urological department based on the pressure-state-response(PSR)model,so as to explore it's application effect in the evaluation for the operation quality of the equipment of urological department.Methods:Based on the PSR model,the analytic hierarchy process was used to determine the weights of index,and the fuzzy evaluation method was adopted to evaluate the management efficiency for equipment.A total of 160 devices of clinical use in the Urological Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2024 were selected.According to different management modes,the random number table was adopted to equally distribute these devices into conventional management mode(80 devices)and management mode with evaluation system(model evaluation)for operation quality of the equipment of the urological department(80 devices).A self-made questionnaire was used to investigate the satisfaction of the usage managers in the urological department and operation room,department of medical equipment,and department of managing infection for the clinical services of the two kinds of management modes.The infection situations,management quality of equipment operation,and the score of operation quality in using equipment between two kinds of management modes were compared.Results:The average repair rate of equipment failure,risk rate of infection,inefficiency rate of cleaning,and problem rate of quality inspection in the management mode with model evaluation were respectively(1.58±0.69)%,(1.98±0.69)%,(1.10±0.78)%and(1.01±0.70)%,all of which were lower than those in the conventional management mode,and the differences of them were statistically significant(t=7.879,6.663,7.863,14.601,P<0.05).In the 120 patients who adopted the management mode with model evaluation,the infection rates of using equipment in laparoscopic minimally invasive surgery,endoscopic surgery for stone,resectoscopic surgery and flexible ureteroscope were respectively 2.50%,3.33%,4.17%and 3.33%,all of which were lower than those in the conventional management mode,and the differences between the two kinds of modes were statistically significant(x2=6.696,6.916,5.154,7.101,P<0.05).The scores of the standardization of using equipment,effectiveness of cleaning and disinfection,recognition of emergency management,and qualification of controlling infection in the management mode with model evaluation were significantly higher than those in the conventional management mode,and the differences were statistically significant(t=22.198,11.806,9.385,18.071,P<0.05).The satisfaction scores of the managers involved in using equipment in the operation room of urology,department of medical equipment and department of managing infection for the management mode with model evaluation were all higher than those of the conventional management mode,and the differences were statistically significant(t=14.426,14.916,14.707,P<0.05).Conclusion:The quality evaluation system of equipment operation of the urological department based on the PSR model can reduce the failure rate of equipment,and improve the usage efficiency of equipment,and ensure the medical safety of patients.

Objective This study aims to explore the application effectiveness of the PDCA cycle method in preventing and reducing internal errors in the intravenous drug dispensing center(PIVAS).Methods Internal error data from our hospital's PIVAS in 2020 and 2021 were collected.The data from 2020 represented the pre-implementation of the PDCA cycle,while the data from 2021 represented the post-implementation period.The changes in internal errors and error rates before and after imple-mentation were compared.Results After implementing the PDCA cycle management measures,the annual error rate decreased from 0.887％o in 2020 to 0.681‰ in 2021,a decrease of 23.22％.Conclusion The PDCA cycle method can effectively reduce the occurrence of internal errors,improve work accuracy,and ensure the safety of clinical drug use in PIVAS.

BACKGROUND:Studies have shown that immune cells are involved in all processes of ischemic stroke,in which cuproptosis also plays a key role.OBJECTIVE:To screen diagnostic biomarkers related to the progression of ischemic stroke through bioinformatics,and analyze and validate cuproptosis-related genes closely related to the occurrence and development of ischemic stroke.METHODS:The GSE16561 microarray was obtained from the GEO database,containing data from 39 cases of ischemic stroke(ischemic stroke group)and 24 controls(control group).Differentially expressed genes from the ischemic stroke microarray data were analyzed.Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed.By using LASSO and Random Forest methods,key genes affecting the occurrence and development of ischemic stroke were screened,and a diagnostic model was established and validated.Differential gene analysis was performed through immune cell infiltration and weighted gene co expression network.The differentially expressed immune-related genes were intersected with cuproptosis genes to obtain the hub genes related to cuproptosis immunity.In vitro cell experiments were conducted to divide rat hippocampal neurons into a normal group and an ischemic stroke group,and qPCR experiments were performed to verify the results.RESULTS AND CONCLUSION:(1)573 differentially expressed genes were obtained by differential analysis.Differentially expressed genes were mainly enriched in biological processes,such as positive regulation of immune response,and signaling pathways such as lipid and atherosclerosis.(2)Machine learning methods were used to screen diagnostic genes such as MFN2,PKM2,CREG1,and FOXO3A,which may have some diagnostic value for ischemic stroke.(3)Immune infiltration analysis revealed resting plasma cells,NK cells,macrophages,etc.,indicating that immune cells play a certain role in the pathogenesis of ischemic stroke.(4)Weighted gene co-expression network analysis combined with immune infiltration analysis obtained 118 key module genes,which were intersected with cuproptosis genes to obtain 2 cuproptosis and immune characteristic genes.The correlation analysis between four diagnostic genes and Hub genes showed that the expression of FOXO3A and MFN2,PKM2 and BCL2L1,MTF1 and MFN2,ATP7B and BCL2L1 were correlated.(5)The qPCR results showed significant differences in the genes MTF1 and ATP7B between the ischemic stroke group and the blank group.To conclude,ATP7B and MTF1 can serve as characteristic genes for cuproptosis in ischemic stroke.It is possible to improve ischemic stroke by intervening in ATP7B and MTF1 to regulate cuproptosis.

Objective:To analyze the effect of biofeedback electrical stimulation on the prevention of stress urinary incontinence and pelvic floor muscle strength during postpartum rehabilitation.Methods:A total of 200 parturients who gave birth in Ningde Municipal Hospital of Ningde Normal University from October 2021 to April 2022 were included as research objects and divided into the control group and the observation group according to different rehabilitation programs, with 100 cases in each group. The control group was given routine rehabilitation, and the observation group was given biofeedback electrical stimulation on the basis of the control group, the parturients in the two groups were treated for 3 months. The occurrence of stress urinary incontinence in the two groups was compared, and the pelvic floor muscle strength before and after treatment were compared between the two groups. The scores of International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) were compared between the two groups.Results:The total incidence of stress urinary incontinence in the observation group was lower than that in the control group: 4.00%(4/100) vs. 15.00%(15/100), there was statistical difference( χ2 = 9.00, P<0.05). After treatment, the muscle strength grade, class Ⅰ muscle fiber, class Ⅱ muscle fiber and average voltage of pelvic floor muscle in the observation group were higher than those in the control group: (3.85 ± 0.27) grades vs. (3.74 ± 0.32) grades, (10.23 ± 1.17) μV vs. (8.84 ± 1.13) μV, (11.56 ± 0.19) μV vs. (10.98 ± 0.24) μV, (18.12 ± 3.24) μV vs. (14.69 ± 3.01) μV, there were statistical differences ( P<0.05). After treatment, the scores of ICI Q-SF and PFIQ-7 in the observation group were lower than those in the control group: (7.02 ± 1.26) scores vs. (8.26 ± 1.15) scores, (18.96 ± 4.31) scores vs. (24.17 ± 5.62) scores, there were statistical differences ( P<0.05). Conclusions:The application of biofeedback electrical stimulation in postpartum rehabilitation can reduce the incidence of stress urinary incontinence, improve postpartum pelvic floor muscle strength, and reduce the impact of stress urinary incontinence and pelvic floor muscle disorder on daily life.

OBJECTIVE To observe the short-term efficacy and safety of venetoclax combined with homoharringtonine and cytarabine in the treatment of acute myeloid leukemia （AML）. METHODS The data of 40 newly diagnosed AML patients admitted to our hospital from October 2022 to November 2023 were retrospectively collected and divided into observation group and control group according to treatment plan， with 20 cases in each group. The patients in the control group were given Daunorubicin hydrochloride for injection+Cytarabine for injection， and the patients in the observation group were given Venetoclax tablets+ Homoharringtonine injection+Cytarabine for injection. The patients in both groups were given relevant medicine， with 28 days as one cycle. The short-term efficacy， negative rate of minimal residual disease （MRD）， duration of granulocyte deficiency， duration of platelet （PLT） ＜20×109 L－1， transfusion volume of suspended red blood cells and platelet， and the occurrence of adverse drug reactions were evaluated in both groups after 1 cycle of induction chemotherapy. RESULTS The complete remission or complete remission with incomplete hematologic recovery （CR/CRi） rate in the observation group was significantly higher than control group （P＜0.05）， and the negative rate of MRD in the observation group was also significantly higher than control group （P＜0.05）. However， in low-， medium- and high-risk patients， there was no statistical significance in CR/CRi rates between the two groups （P＞0.05）. There were no significant differences in the duration of agranulocytosis， the duration of PLT ＜20×109 L－1， the amount of suspended red blood cell transfusion， the amount of platelet transfusion， the incidence of hematologic toxicity and the incidence of non-hematologic toxicity between 2 groups （P＞0.05）. CONCLUSIONS Venetoclax combined with homoharringtonine and cytarabine show good short-term efficacy and safety in the treatment of AML.