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 analyze inpatients preferences for an unaccompanied ward and its influencing factors, for references for the implementation of unaccompanied ward management.Methods:Based on a convergent mixed research design, a convenience sampling method was used to select inpatients who visited a tertiary hospital from June to August 2024 as the survey subjects. A questionnaire survey was conducted on their willingness to choose the unaccompanied ward (provided by medical nursing staff). Meanwhile, using purposive sampling method, 10 inpatients and 11 accompanying family members were selected for semi-structured interviews about unaccompanied ward prference, and the interview topics were summarized and extracted. The results of quantitative and qualitative were compared and integrated.Results:The quantitative research results showed that among the 805 inpatients included, 125 patients (13.03%) chose medical caregivers, 382 patients (39.83%) chose their spouses, and 272 patients (28.36%) chose their children; 411 patients (24.54%) did not choose medical caregivers due to financial burden; 509 patients (63.23%) believed that the cost of an unaccompanied ward should be less than 120 yuan/day. The qualitative research results showed that the interview data formed three themes, including the driving factors of caregiving form selection intention, the emotional tendency of caregiving form selection intention, and the assessment of the benefits and drawbacks of caregiving form selection intention. The mixed research results showed that the majority of inpatients choose their spouse or children accompany them, and their willingness to choose medical caregivers is mainly influenced by service costs and family labor. However, its did not affect patients who are young or have difficulty caring for them; Influenced by traditional Chinese culture, patients tended to choose relatives to accompany them; The main reasons why patients did not choose unaccompanied wards were the economic burden and the mismatch between medical nursing staff services and their expectations.Conclusions:Inpatients tended to choose family members to accompany them. Their willingness to choose unaccompanied ward was influenced by economic burden, family labor, patient age, caregiving difficulty, and filial piety culture.

Objective:To explore the symptom improvement effect of a self-made eczema and dermatitis conditioning formula combined with Qingpeng ointment on damp heat type eczema.Methods:A prospective study was conducted on 70 patients with damp heat type eczema ffrom June 2023 to August 2024.Random number table method was used to divide them into two groups.Among them,35 cases were in the single group and treated with Qingpeng plaster alone,while the remaining 35 cases were in the combination group and treated with a self-made eczema and dermatitis conditioning formula orally combined with Qingpeng plaster.After one month of treatment,the clinical efficacy,TCM syndrome scores before and Post-treatment,disappearance time of main symptoms,and the long-term recurrence rate was also compared.Results:The total effective rate of the combined group was 91.43％,which was higher than that of the single group(71.43％,P＜0.05);Before treatment,there was no significant difference in the scores of TCM syndromes between the two groups(P＞0.05).Post-treatment,the scores of TCM syndromes related to the main symptoms(skin erythema,papules,blisters,obvious exudation,severe itching,and burning sensation in the skin lesions)and secondary symptoms(dry mouth,bitter mouth,yellow and red urine,sticky stool or constipation)in both groups decreased,and the combined group was lower than the single group(P＜0.05);The disappearance time of skin burning sensation,exudation,erythema,itching,and skin lesion related symptoms in the combined group was shorter than that in the single group(P＜0.05);Two groups of patients were followed up for six months Post-treatment,and there were no lost cases during the follow-up period.There was no difference between the combined group and the single group(x2=3.214,P=0.073).Conclusion:The combination of self-made eczema and dermatitis conditioning formula and Qingpeng ointment can improve the clinical efficacy of damp heat type eczema,reduce its TCM syndrome score,shorten the duration of main symptoms,and lower the long-term recurrence rate of patients.The mechanism may be related to the regulation of T lymphocyte subsets in eczema patients by the self-made eczema and dermatitis conditioning formula,and the reduction of the body's inflammatory response.

Objective:To explore the symptom improvement effect of a self-made eczema and dermatitis conditioning formula combined with Qingpeng ointment on damp heat type eczema.Methods:A prospective study was conducted on 70 patients with damp heat type eczema ffrom June 2023 to August 2024.Random number table method was used to divide them into two groups.Among them,35 cases were in the single group and treated with Qingpeng plaster alone,while the remaining 35 cases were in the combination group and treated with a self-made eczema and dermatitis conditioning formula orally combined with Qingpeng plaster.After one month of treatment,the clinical efficacy,TCM syndrome scores before and Post-treatment,disappearance time of main symptoms,and the long-term recurrence rate was also compared.Results:The total effective rate of the combined group was 91.43％,which was higher than that of the single group(71.43％,P＜0.05);Before treatment,there was no significant difference in the scores of TCM syndromes between the two groups(P＞0.05).Post-treatment,the scores of TCM syndromes related to the main symptoms(skin erythema,papules,blisters,obvious exudation,severe itching,and burning sensation in the skin lesions)and secondary symptoms(dry mouth,bitter mouth,yellow and red urine,sticky stool or constipation)in both groups decreased,and the combined group was lower than the single group(P＜0.05);The disappearance time of skin burning sensation,exudation,erythema,itching,and skin lesion related symptoms in the combined group was shorter than that in the single group(P＜0.05);Two groups of patients were followed up for six months Post-treatment,and there were no lost cases during the follow-up period.There was no difference between the combined group and the single group(x2=3.214,P=0.073).Conclusion:The combination of self-made eczema and dermatitis conditioning formula and Qingpeng ointment can improve the clinical efficacy of damp heat type eczema,reduce its TCM syndrome score,shorten the duration of main symptoms,and lower the long-term recurrence rate of patients.The mechanism may be related to the regulation of T lymphocyte subsets in eczema patients by the self-made eczema and dermatitis conditioning formula,and the reduction of the body's inflammatory response.

Objective:To analyze inpatients preferences for an unaccompanied ward and its influencing factors, for references for the implementation of unaccompanied ward management.Methods:Based on a convergent mixed research design, a convenience sampling method was used to select inpatients who visited a tertiary hospital from June to August 2024 as the survey subjects. A questionnaire survey was conducted on their willingness to choose the unaccompanied ward (provided by medical nursing staff). Meanwhile, using purposive sampling method, 10 inpatients and 11 accompanying family members were selected for semi-structured interviews about unaccompanied ward prference, and the interview topics were summarized and extracted. The results of quantitative and qualitative were compared and integrated.Results:The quantitative research results showed that among the 805 inpatients included, 125 patients (13.03%) chose medical caregivers, 382 patients (39.83%) chose their spouses, and 272 patients (28.36%) chose their children; 411 patients (24.54%) did not choose medical caregivers due to financial burden; 509 patients (63.23%) believed that the cost of an unaccompanied ward should be less than 120 yuan/day. The qualitative research results showed that the interview data formed three themes, including the driving factors of caregiving form selection intention, the emotional tendency of caregiving form selection intention, and the assessment of the benefits and drawbacks of caregiving form selection intention. The mixed research results showed that the majority of inpatients choose their spouse or children accompany them, and their willingness to choose medical caregivers is mainly influenced by service costs and family labor. However, its did not affect patients who are young or have difficulty caring for them; Influenced by traditional Chinese culture, patients tended to choose relatives to accompany them; The main reasons why patients did not choose unaccompanied wards were the economic burden and the mismatch between medical nursing staff services and their expectations.Conclusions:Inpatients tended to choose family members to accompany them. Their willingness to choose unaccompanied ward was influenced by economic burden, family labor, patient age, caregiving difficulty, and filial piety culture.

The immune microenvironment plays a key role in the development and progression of tumors.In recent years,with the rapid advancement of high-throughput sequencing technologies,researchers have gained a deeper under-standing of the composition and function of immune cells in the tumor microenvironment.However,traditional bulk sequenc-ing technologies are limited in resolving heterogeneity at the single-cell level,constraining a comprehensive understanding of the complexity of the tumor microenvironment.The advent of single-cell RNA sequencing technology has brought new opportunities to uncover the heterogeneity of the immune microenvironment in lung cancer.Currently,T-cell-centered im-munotherapy in clinical settings is prone to side effects affecting prognosis,such as immunogenic drug resistance or immune-related pneumonia,with the key factor being changes in the interactions between immune cells and tumor cells in the tumor microenvironment.Single-cell RNA sequencing technology can reveal the origins and functions of different subgroups within the tumor microenvironment from perspectives such as intercellular interactions and pseudotime analysis,thereby discovering new cell subgroups or novel biomarkers,providing new avenues for uncovering resistance to immunotherapy and monitoring therapeutic efficacy.This review comprehensively discusses the newest research techniques and advancements in single-cell RNA sequencing technology for unveiling the heterogeneity of the tumor micro environment after lung cancer immunotherapy,offering insights for enhancing the precision and personalization of immunotherapy.

Objective: To evaluate the predictive value of a multiparametric cardiac magnetic resonance (CMR) approach for ventricular remodeling in ST-segment-elevation myocardial infarction (STEMI) patients with mildly reduced or preserved left ventricular ejection fraction (LVEF). Methods: This study is a prospective cohort study. STEMI patients with acute LVEF>40% after primary percutaneous coronary intervention (PCI) in Beijing Anzhen Hospital from October 2019 to September 2021 were enrolled. All patients received acute (3-7 days) and follow-up (3 months) CMR post-PCI. According to absence or presence of ventricular remodeling, patients were divided into ventricular remodeling group and non-ventricular remodeling group. Basic clinical characteristics and CMR indicators were analyzed and compared between the two groups. Logistic regression and receiver operating characteristic (ROC) curves were used to explore the predictive performance of CMR high-risk attributes for ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF. The predictive value of combining multiple high-risk characteristics of CMR for ventricular remodeling was analyzed and compared with the traditional clinical risk factor model. Results: A total of 123 STEMI patients were enrolled (aged (57.1±11.1) years, 102 (82.9%) males). There were 97 cases (78.9%) patients in the non-ventricular remodeling group and 26 cases (21.1%) in the ventricular remodeling group. After adjustment for clinical risk factors, stroke volume<51.6 ml, global circumferential strain>-13.7%, infarct size>39.2%, microvascular obstruction>0.5%, and myocardial salvage index<43.9 were independently associated with ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF. The incidence of ventricular remodeling increased with the increasing number of CMR high-risk attributes (P<0.01). The number of CMR high-risk attributes ≥3 was an independent predictor of adverse remodeling (adjusted OR=5.95, 95 CI%: 2.25-15.72, P<0.01) in STEMI patients with mildly reduced or preserved LVEF. Furthermore, the number of CMR high-risk attributes had incremental predictive value over baseline clinical risk factors (area under curve: 0.843 vs. 0.696, P<0.01). Conclusions: In STEMI patients with mild reduced or preserved LVEF, 5 CMR characteristics are associated with ventricular remodeling. The combination of ≥3 CMR high-risk characteristics is an independent predictor of ventricular remodeling, which has incremental predictive value beyond traditional risk factors in this patient cohort.
Female ; Humans ; Magnetic Resonance Imaging, Cine ; Magnetic Resonance Spectroscopy ; Male ; Percutaneous Coronary Intervention ; Prospective Studies ; ST Elevation Myocardial Infarction/diagnostic imaging* ; Stroke Volume ; Ventricular Function, Left ; Ventricular Remodeling

Objective To investigate the feasibility of ovariectomized cynomolgus monkey as an animal model of postmenopausal dry eye.Methods Six healthy adult female cynomolgus monkeys (aged 4-6 years old)were selected.Cynomolgus monkeys were divided into ovariectomized group and sham operation group by random number table.Bilateral ovariectomy was performed in each cynomolgus of the ovariectomy group,and the same operation was operated in the sham group but the ovaries were not removed.The venous blood of the lower extremities of each cynomolgus monkey was collected before operation and at 1 month,3 and 6 months after operation respectively.The concentrations of estradiol and testosterone were measured by radioimmunoassay.At the above time points,tear-liquid osmotic pressure detector 5600 was used to detect the tear osmotic pressure of cynomolgus monkeys in each group,and dry eye related examinations,including Schirmer Ⅰ test (S Ⅰ t),corneal fluorescein staining and conjunctive impression cytology were performed.Results Preoperative and postoperative serum estradiol,testosterone concentrations in the ovariectomy group were lower than those in the sham operation group,but there were no significant differences between the two groups (Fgroup =5.16,P =0.09;Fgroup =1.46,P =0.29).There was no significant difference in the osmotic pressure between the two groups (Fgroup =0.83,P=0.37).The osmotic pressure in the 3 months after ovariectomy was higher than that in the 1 month after ovariectomy in the ovariectomy group,with a significant difference between them (t =5.12,P ＜ 0.05).There was no significant difference in S Ⅰ t between ovariectomized group and sham operation group (Fgroup =0.06,P=0.82),the S Ⅰ t in the 3 months after ovariectomy was lower than that in the 1 month after ovariectomy in the ovariectomy group,with a significant difference between them (t =1.13,P＜0.05).There was no corneal fluorescein staining at each time points before and after ovariectomy in each group.The conjunctive impression cytology examination showed that,in the ovariectomy group,the morphology of conjunctival epithelial cells was normal,the number of conjunctival goblet cells was large,the periodic acid Schiff staining was purple before and 1 month after ovariectomy,which were similar to those in the sham operation group;three months after ovariectomy,the conjunctiva epithelial cell body was larger and had diverse forms,goblet cells were shrinked;six months after ovariectomy,the shapes of conjunctival epithelial cells were diverse and not easily been distinguished,the number of goblet cells was distinctly decreased.Conclusions The ocular conjunctival cells in the ovariectomized cynomolgus monkey have abnormal changes in morphology,and tear osmotic pressure increase,the ocular surface dynamic changes are consistent with the decrease of serum estrogen level,so ovariectomized cynomolgus monkeys can be used as sex hormone-related dry eye animal models.

Adolescent ; Catheterization, Central Venous ; adverse effects ; Humans ; Jugular Veins ; Male ; Mammary Arteries ; injuries ; Subclavian Artery ; surgery

Aged ; Catheter Ablation ; methods ; Female ; Hematoma ; surgery ; Humans ; Thrombosis ; surgery