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*

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To systematically retrieve,evaluate and integrate evidences about the assessment and management of perioperative pain in patients with acute aortic dissection.Methods PIPOST model was used to identify themes of assessment and management of perioperative pain.The literatures in the themes was systematically searched through the databases of UpToDate,JBI,BMJ Best Practice,practice guide REgistration for trans RAREncy(PREPARE),Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),Scottish Intercollegiate Guidelines Network(SIGN),New Zealand Guidelines Group(NZGG),Registered Nurses'Association of Ontario(RNAO),Australian Clinical Practice Guidelines(ACPG),American Heart Association(AHA),European Society of Cardiology(ESC),the Chinese Cochrane Center,Medlive,Cochrane library,PubMed,SinoMed,CNKI,Wangfan Data,and VIP.The retrieved literatures were evaluated and the evidences that met the inclusive criteria were extracted from the literatures by researchers who had trained for evidence-based study.Results A total of 17 studies,including 5 guidelines,3 expert consensus,6 systematic reviews and 3 randomised controlled trials were included in this study.Totally,29 pieces of best evidence were extracted in the assessment and management of pain in perioperative patients with acute aortic dissection,including pain assessment,basic principles of pain management,medication intervention strategies of pain management,non-medication intervention strategies of pain management,pain evaluation,education of pain management and organising pain management.Conclusion Evidences in assessment and management of pain in perioperative patients with acute aortic dissection can provide references and guidance for clinical practice.

Objective:To analyze the operational efficiency of the oncology department in multi-campus hospital, providing reference for rational resource allocation and efficiency enhancement.Methods:A certaion tertiary grade A Hospital is a multi-campus public hospital with integrated management. This study focused on its oncology department, with 9 wards located in different campus as decision-making units. Data from 2020 to 2022 were extracted from the hospital′s medical records management system, disease diagnosis-related groups management system, and hospital information system. The super-efficiency DEA model and Malmquist index model were used to evaluate efficiency variations of the oncology department in different time slots and decision-making units. Identifying input redundancies and output deficiencies in wards not achieving constant returns to scale through projection value analysis. Selecting the total number of medical staff and the actual total number of bed-days occupied as input indicators, while bed utilization rate, discharge rate, and case mix index as output indicators.Results:From 2020 to 2022, the wards with a DEA super-efficiency value greater than 1 were 0, 2, and 4, respectively, showing a gradual increase in overall efficiency. In 2022, wards S3, S4, S7, and S9 achieved constant returns to scale with super-efficiency values of 1.001, 1.005, 1.113, and 1.112, respectively. The other five wards had zero input redundancy, but some suffered from insufficient outputs. For example, wards S5 and S8 should increase their bed utilization rates by 5% and 4%, respectively. Wards S1 and S8 needed to increase their annual discharge numbers by 24% and 1%, respectively, while wards S2 and S6 should increase their annual case mix index by 21% and 20%, respectively. From 2020 to 2021, the Malmquist index of the oncology department was 0.959, while from 2021 to 2022 it rose to 1.030, and the Malmquist index of each ward was greater than 1.Conclusions:By implementing integrated management across multiple campus, the operational efficiency of the oncology department has been comprehensively improved. The use of the super efficient DEA-Malmquist index model to evaluate the operational efficiency of departments has practical significance.

The antimalarial activity of artemisinin and its derivatives have been widely recognized.A deep scientific research had produced many patent documents.In order to formulate strategies on research and patent application rationally,it is necessary to carry an analysis existing patent application systematically.Necessary patent bibliographic information was searched and downloaded using professional patent database.And then,patent and industrial pattern within were extracted comprehensively.Main subjects included artemisinin,artemisinic acid and arteannuin B.The results showed that through a series of statistical analysis,information on life cycle of artemisinin patent applications,application efficiency preferences,excellent applications and high value patents was obtained.It was concluded that in this field,the patent technology life cycle is in mature stage.Among them,artemisinin has a relatively large space for development.The most popular applications are anti-parasite,anti-tumor and anti-infection.The core theme of internal reference is to treat skin diseases and to suppress cancer.

Objective To analyze the correlation of metabolic syndrome (MS) and its components with a future development of diabetes mellitus (DM) in elderly patients. Methods In 2007, the cohort study was carried out among the 2001 baseline population. The criteria which was proposed by international diabetes federation in 2005 was referred to diagnose MS. Results MS predicted the future development of DM (RR = 4. 70, 95% CI:3.23～6.85). Among MS components, fasting glucose exhibited the highest association with DM. The univariate analysis showed that while fasting glucose was more than 5. 6 mmol/L, the RR(95% CD was 9. 68(6. 59～ 14.23). And multiple factors analysis showed that while fasting glucose was 5.60 mmol/L～6. 09 mmol/L, the RR(95% CD was 5. 49(3. 38～8. 92). While glucose level was more than 6. 1 but less than 7.0 mmol/L, the RR(95% CI) increased to 14.44(9.29～22.44). However, along with the increasing of cluster number of MS components from 1,2,3,4 to 5, the corresponding RR increased from 2. 92, 5. 67, 12. 28, 19. 52 to 37. 83. Conclusions MS increases the risk of DM. Among MS components, fasting glucose level is the strongest risk indicator of DM.

BACKGROUND: The cluster of multiple metabolic disorders, namely raised blood pressure, overweight or obesity, raised triglyceride level, reduced high density lipoprotein cholesterol (HDL-C) level were the predictor of type 2 diabetes mellitus (DM). However, similar data especially the old people's data is relatively rare in China.OBJECTIVE: To analyze the relationship between the components of metabolic syndrome (MetS), their clusters and the risk of diabetes among Chinese old population.DESIGN: Cross-sectional study.SETTING :Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Public Health.PARTICIPANTS: The study was carried out from February 2001 until November 2001.4 499 volunteers aged 60 and over were recruited from the academic institutes in Beijing Xicheng, Haidian and Shijingshan districts through cluster sampling methods. They were selected after excluding those who did not have integral data.METHODS: Diabetes was considered when fasting glucose was ≥7.0 mmol/L and was treated for or diagnosed as DM. Chi-square tests were performed to compare the categorical data. Age and sex adjustment were taken in the comparison of the levels of blood pressure, waist circumference (WC), The body mass index (BMI), and lab variables, Multifactor stepwise (backward)Logistic regression analyses were used to select the factors which would have association with the risk of DM. When analyzing the relationship between number of clustering of the traits of MetS and DM, the group without any metabolic abnormalities was set as control group. The dummy variables were set for 1,2,3,4 clusters of metabolic abnormalities. The Logistic regression model was used again to test the relationship and adjusted by age and the family history of DM.MAIN OUTCOME MEASURES: The blood glucose, waist, BMI, blood pressure, triglyceride (TG), HDL-C, and family history of diabetes of subjects.RESULTS: 4 444 people in the mean age of 65±5 were retrieved. 556cases of DM were found in this survey. Age, family history of diabetes,systolic blood pressure, waist and TG were independently associated with the risk of DM, with OR (95%CI) being 1.02 (1.00-1.04), 3.48(2.76-4.39), 1.02 (1.01-1.02), 1.03 (1.00-1.03), 1.13 (1.05-1.21), respectively. When TG was not in the model, HDL-C was also inversely associated with DM (OR=0.67, 95%CI 0.49-0.91). The risk of DM increased with clustering of abdominal obesity, raised blood pressure, raised TG, and reduced HDL-C level in individuals.CONCLUSION: In addition to age and genetic factors, metabolic factors, especially their clusters are closely related to the risk of diabetes. Therefore, the features of MetS are important indicators for the risk of DM in aged people.

Objective:To probe the influence ofrelated index ofmetabolic syndrome on TCM clinical syndrome.Methods:A statistical factor analysis was made to related index ofmetabolic syndrome in 1 231 random people ofphysical examination.To probe the influence ofsyndrome differentiation offive zang on common factor.Results:The results indicated that there were close relationship between liver and lipid,heart and blood pressure, kidney and fasting plasma glucose.There were neither evident mutuality between abdominal circumference and syndromes offive zang,nor between related index ofmetabolic syndrome and the lung or the spleen.Conclusion:Regulation ofthe liver,heart and kidney in TCM may be the key to prevention and treatment ofmetabolic syndrome.