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*

Sjögren's syndrome (SS) is an autoimmune disease characterized primarily by oral and periocular dryness. Astragalus-Salvia (AS) and Ophiopogon-Dendrobium (OD) represent two frequently utilized herb pairs in SS treatment. While the combination of AS-OD herb pairs demonstrates clinical efficacy in alleviating SS symptoms, its underlying mechanism remains unclear. This investigation sought to assess the therapeutic effects and elucidate the potential mechanisms of AS-OD in non-obese diabetic (NOD)/Ltj mice with SS. The study utilized NOD/Ltj mice as SS models, administering AS-OD treatment for 10 weeks at doses of 113.1, 226.2, and 339.3 mg·d^-1·20 g^-1. Results demonstrated that AS-OD improved SS symptoms, evidenced by enhanced salivary flow rate, decreased anti-SSA/Ro and anti-SSB/La antibody levels, increased swimming duration, and reduced lactate (LA) and blood urea nitrogen (BUN) levels in NOD/Ltj mice. AS-OD reduced lymphocyte infiltration, enhanced Aquaporin-5 (AQP5) expression in the submandibular gland, decreased inflammatory cytokine levels in the submandibular gland, and reduced the T helper type 17/regulatory T lymphocyte (Th17/Treg) cell ratio in the spleen. Transcriptomic and proteomic analyses indicated AS-OD's involvement in regulating phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) and Janus kinase 3/signal transducer and activator of transcription 3 (JAK1/STAT3) pathways, with inhibitory effects validated in both NOD/Ltj mice submandibular gland and A-253 cells. Furthermore, AS-OD enhanced cell viability and reduced A-253 cell apoptosis through the PI3K/AKT pathway. In A-253 cells, AS-OD reduced inflammatory cytokine levels, CXC chemokine ligand 9/10 (CXCL9/10), and T-cell chemotaxis by inhibiting the JAK1/STAT3 pathway. AS-OD mitigates SS by suppressing inflammation and immune responses through the PI3K/AKT and JAK1/STAT3 pathways.
Animals ; STAT3 Transcription Factor/genetics* ; Sjogren's Syndrome/immunology* ; Mice, Inbred NOD ; Proto-Oncogene Proteins c-akt/genetics* ; Phosphatidylinositol 3-Kinases/genetics* ; Mice ; Drugs, Chinese Herbal/administration & dosage* ; Signal Transduction/drug effects* ; Janus Kinase 1/genetics* ; Humans ; Female ; Astragalus Plant/chemistry* ; Male

OBJECTIVE: To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. METHODS: Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. RESULTS: TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. CONCLUSION TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.
Humans ; Artificial Limbs ; Muscle, Skeletal ; Neurosurgical Procedures ; Plastic Surgery Procedures ; Prosthesis Implantation

American medical insurance is mainly composed of public medical insurance borne by the government and private medical insurance. The main cause of death in this country are ischemic heart disease, Alzheimer’s disease, and lung cancer. The motality rate mainly caused by drug use disorders, chronic kidney disease and Alzheimer’s disease. The development of Chinese herbal medicine is relatively slow and difficult. The education system has covered Traditional Chinese Medicine (TCM). However, there still exist certain challenges of the development of TCM acupuncture faces the challenge of localization; Chinese herbal medicine still lacks standardization and TCM education needs to be standardized. Based on the current situation, it is suggested to focus on the development of acupuncture and moxibustion, to promote the registration and declaration of Chinese herbal medicine products for treating difficult diseases, and to strengthen the international exchange of TCM education, so as to promote the development and spread of TCM in the United States.

Objective To investigate the status of quality control of dental X-ray equipment in Beijing Dongcheng District, to explore the problems involved in radiation protection. Methods 41 medical dental X-ray machines were detected in Beijing Dongcheng District in accordance with Specification for testing of quality control in dental X-ray equipment (WS 581—2017). Results The qualified rate was higher in imported machines (100%) than that in domestic machines (76.92%), the overall qualified rate was 92.68%. In performance detection, the qualified rates were 100% except for the deviation of loading time (92.68%) and tube voltage (95.12%). No leakage was detected in 41 dental institutes. Conclusion The overall status of dental X-ray machines was good in Beijing Dongcheng District. More attention was paid to shield protection than to quality control of dental X-ray machines. Therefore, health administration should take measures to strengthen advocation of WS 581—2017, and improve radiation protection through routine equipment performance test, supervision of X-ray protection and radiation health education.

Objective: To investigate the effect of adding glutathion(GSH) to tumescent solution on autologous fat graft survival. Methods: 14 male and female New Zealand rabbits were divided into experimental group and control group randomly, 7 in each group. Experimental group: The donor areas of the rabbits were injected with 3 ml of tumescent solution with GSH. Control group: The donor areas of the rabbits were injected with 3 ml regular tumescent solution. DCFH-DA probe was used for fluorescent staining of harvested fat cells. Then stained fat cells were measured for the intracellular reactive oxygen species(ROS)content by fluorescence microplate. The grafts were harvested at 3 months after transplantation and assessed by general observation, volume measurement, wet weight measurement, HE staining for the number of fat cells, and CD34 immunohistochemical staining for the measurement of micro-vascular density. T test was performed by using SPSS 24.0. Results: The intracellular ROS content of harvested fat cells in experimental group was lower than that in control group, and the difference was statistically significant (P<0.05). At 3 months after transplantation, the wet weight of fat grafts in experimental group was (1133.21±87.97) mg and that in control group was (718.79±79.27) mg. The volume of fat grafts in experimental group was (1.00±0.04) ml and that in control group was (0.59±0.03) ml. The number of fat cells in experimental group was (746.6±15.7)/10 high magnification vision and that in control group was (350.1±32.4)/10 high magnification vision. The density in group experimental was (8.1±2.0)/high magnification vision and that in control group was (6.7±2.4)/high magnification vision. The grafts′ volume, wet weight, and the number of fat cells in experimental group were higher than those in control group, and the differences were statistically significant (P<0.05). The difference of micro-vascular density between experimental group and control group had no statistical significance (P>0.05). Conclusions The addition of GSH to tumescent solution optimizes the process of autologous fat harvest, thereby improving the survival of fat graft.

Objective: To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation. Methods: Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018, including 86 males and 31 females. The average age was 35.56 years with a range from 17 to 68 years. Patients were divided into two groups according to different surgical methods: laparoscopic group (n=56) and open group (n=61). Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer, while patients in the open group received open repair for perforated gastroduodenal ulcer. Comparison of two groups of patients with operation time, intraoperative blood loss, postoperative first anal exhaust time, analgesic utilization rate, length of hospital stay, the body′s inflammatory response [preoperative and 24 h, 72 h, 120 h of postoperative peripheral white blood cell (WBC)], C-reactive protein level (CRP), postoperative complications (postoperative incision infection, incision dehiscence, gastric duodenal fistula, abdominal abscess, adhesion intestinal obstruction and lung infection). Measurement data were expressed as mean±standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test. Results: All the patients in the two groups successfully completed the operation, and there were no cases transferred to laparotomy in the laparoscopic group. Intraoperative blood loss[(15.3±9.5) ml vs (30.5±11.3) ml, P<0.001], time of first anal exhaust[(56.5±9.8) h vs (83.8±15.6) h, P<0.001], analygesic utilization rate (10.71% vs 52.46%, P<0.005), and length of hospital stay [(7.5±1.5) d vs (10.0±3.4) d, P<0.001] of the laparoscopic group were significantly better in the open group, the differences were statistically significant. The WBC and CRP at 24 h, 72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC: 24 h, (14.55±3.44) ×10⁹/L vs (16.02±4.12) ×10⁹/L, P=0.020; 72 h, (10.25±2.32) ×10⁹/L vs (14.22±3.29) ×10⁹/L, P<0.001; 120 h, (8.12±3.11)×10⁹/L vs (11.58±2.33) ×10⁹/L, P<0.001. CRP: 24 h, (50.35±13.73) mg/L vs (80.11±13.56) mg/L, P<0.001; 72 h, (29.37±7.81) mg/L vs (53.57±8.05) mg/L, P<0.001; 120 h, (17.71±7.01) mg/L vs (34.35±7.72) mg/L, P<0.001], the differences were statistically significant. There was no significant difference in operation time and postoperative complications between the two groups (P>0.05). Conclusion Compared with open gastroduodenal ulcer perforation repair, laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller, and the body′s inflammatory response are lighter, postoperative complications is no statistical significance, but will look from actual data, the cases of complications is less, is now a better surgical treatment of gastroduodenal ulcer perforation.

Objective: To construct a novel carrier with core-shell structure-inner core of pFGF2-EGFP-loaded TACS coated by hydroxybutyl chitosan (HBC), and to explore its effects on granular fat graft survival. Methods: The core-structured particles (TACS-pFGF2-EGFP) and core-shell-structured particles (HBC@ TACS-pFGF2-EGFP) were prepared to explore the release pattern of pFGF2-EGFP of these particles. The expression of FGF2 protein was detected by Western-Blot in 293T cells transfected with the sustained - release microspheres in vitro. Cell proliferation assay demonstrated that 10μg/ml pFGF2 plasmid could promote 293T cells growth. Eighteen New Zealand white rabbits were used for adipose tissue transplantation experiment. Rabbit left ear was treated as experimental group, 2 ml fat granules and HBC@TACS-pFGF2-EGFP were implanted; rabbit right ear was used as control group, 2 ml fat granules and HBC@TACS-empty plasmids were transplanted. The specimens were harvested at 4, 8, 12 weeks separately after fat transplantation. Gross view, HE staining, and immunohistochemical staining were performed to observe graft survival, biological characteristics, and neovascular density. Results: HBC@TACS-pFGF2-EGFP particles could sustained release Pfgf2 gene in vitro, and successfully express FGF2 protein after transfecting 293T cells. At different time points after transplantation, the volume of adipose tissues was gradually reduced with time. The fat volume and survival rate of adipose tissues in the experimental group were significantly higher than that in the control group (P<0.05). HE staining showed that the arrangement of new adipocytes in the experimental group was more regular than that in the control group. Immunohistochemistry staining showed that the micro vessel density and FGF2 protein expression level in the adipose tissue of the experimental group were higher than those in the control group (P< 0.05). Conclusions HBC@TACS-pFGF2-EGFP particles with sustained release of FGF2 can improve the survival of granule fat transplantation.

Objective To compare the effects of BOSU ball exercise and treadmill walking on lower limbs function in patients after stroke. Methods 40 patients more than 6 months after stroke were randomly divided into BOSU ball group (n=20) and treadmill group (n=20), who accepted BOSU ball or treadmill exercise on the basis of routine rehabilitation. They were assessed with Berg Balance Scale (BBS), 30-s chair stand (CS-30), sit and reach (SR), 6 minutes walk test (6MWT) and modified Barthel Index (MBI) before and 12 weeks after treatment. Results The scores of all the assessment improved in both groups after treatment (P<0.05), and the socres of BBS and MBI improved more in the BOSU ball group than in the treadmill group (P<0.05). Conclusion BOSU ball exercise can improve more of the balance and activities of daily living in post-stroke patient than treadmill walking.

Objective To analyze factors contributing to the quality of life of earthquake victims with nonunion fracture in limbs after medical rehabilitation and to provide a clinical reference for future disasters.Methods Thirty-one wounded who sustained their injuries in the Sichuan earthquake completed the short form-36(SF-36)questionnaire 2 weeks before their amputation,and after 3,6 and 12 months of medical rehabilitation.The SF-36scores were compared with Sichuan population norms.Stepwise multiple linear regression was used to highlight variables which influenced their functional recovery and their physical and mental health.Results The physical and mental health composite scores of the 31 victims were significantly lower than Sichuan population norms before medical rehabilitation,but they had a significant increasing trend after 3,6 and 12 months of treatment.Their scores on all the domains remained significantly lower than Sichuan population norms at a later follow-up.Smoking,external fixations and chronic diseases were related to their recovery of physical function.Age,permanent housing,family income and casualties among family members were related to their mental health recovery.Conclusion The quality of life of patients with nonunion fracture caused by earthquake can be improved significantly through medical rehabilitation.But social factors should be considered in addition to medical rehabilitation after an earthquake.