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 investigate the efficacy of micro-video based on WeChat platform combined with bilingual standardized patients on clinical practice of dermatovenerology in international medical students.Methods:A total of 56 international clinical medical students from China Medical University who had their clinical practice class from May 2017 to June 2017 in Shengjing Hospital of China Medical University were selected as research objects, and were randomly divided into the experimental group and the control group. New teaching method of micro-video based on WeChat platform combined with bilingual standardized patients was applied in the experimental group and the traditional teaching method was used in the control group. After courses, the theoretical examination, clinical case assessment and satisfaction degree of the two groups were compared to assess the learning effect. All statistical analyses were performed with the independent sample t-test and Chi-square test with SPSS 21.0 software.Results:There was no significant difference in the theoretical test scores between two groups ( t=1.48, P=0.144), but the scores of the clinical case test in the experimental group were significantly better than those in the control group ( t=2.22, P=0.031). Results of satisfaction survey showed that more foreign students preferred new teaching methods, with a statistically significant difference ( χ2=7.24, P=0.007); in terms of consolidating theoretical knowledge ( χ2=4.766, P=0.029), motivating learning interest ( χ2=4.073, P=0.044), enhancing clinical practice skills ( χ2=4.667, P=0.031), promoting communication ability with patients ( χ2=6.411, P=0.011) and improving learning effect ( χ2=4.667, P=0.031), foreign students were more satisfied with new teaching methods, with a statistically significant difference. Conclusion:In the dermatovenerology clinical practice among international medical students, application of micro-video based on WeChat platform combined with bilingual standardized patients can improve the teaching effect, which can be further popularized and applied as a new teaching method.

Objective: To construct the public health performance evaluation index system for the county medical community, so as to provide reference for the assessment of the public health work in the county medical community. Methods: According to the 2019 Public Health Tasks of Zhejiang Province and the current status of the county medical community's public health work, a framework was developed. Twenty experts from universities, CDCs, and county medical community were invited to construct the index system after two rounds of Delphi expert consultation, and the index weight was determined by the analytic hierarchy process. Results : The experts aged ( 46.10±6.41 ) years and worked for ( 23.85±7.37 ) years, all of whom had a bachelor degree or above, and 18 had associate senior titles or above. The response rates of two rounds of consultation was both 100.00%; the authority coefficient was 0.811; the values of Kendall's W all had statistical significance ( P<0.05 ) , which in the second round were higher than those in the first round. The public health performance evaluation index system for county medical community finally included 10 first-level indexes, among which priority diseases surveillance and management weighed most ( 0.165 7 ) ; 32 second-level indexes, among which food-borne diseases surveillance, infectious diseases/public health emergencies reporting and infectious diseases/public health emergencies response weighed the top three ( 0.071 5, 0.064 7, 0.063 8 ); 120 third-level indexes, among which the timely reporting rate of food safety incidents, the reporting rate of infectious diseases and the information response rate of infectious diseases/public health emergencies weighed the top three ( 0.039 4, 0.022 1, 0.021 7 ). Conclusion The public health performance evaluation index system of the county medical community has been established, which can provide reference for the health administrative departments.

OBJECTIVE:To evaluate therapeutic efficacy and safety of valaciclovir versus acyclovir in the treatment of herpes zoster,and to provide evidence-based reference in clinic.METHODS:Retrieved from PubMed,Medline,CJFD,VIP and Wanfang Database,randomized controlled trials (RCTs) about valaciclovir (trial group) versus acyclovir (control group) in the treatment of herpes zoster were included.The data was analyzed statistically by using Rev Man 5.3 software after data extraction and quality evaluation by Cochrane systematic reviewer manual 5.1.0.RESULTS:A total of 12 RCTs were included,involving 1 059 patients.The result of Meta-analysis showed that:total response rate [OR =4.64,95 ％ CI (2.99,7.20),P＜ 0.001] and cure rate [OR =2.93,95％CI(2.13,4.03),P＜0.001] of trial group were significantly higher than those of control group;the incidence of postherpetic neuralgia in trial group [OR=0.39,95％CI(0.22,0.69),P=0.001] was significantly lower than control group,with statistical significance.There was no statistical significance in the incidence of ADR between 2 groups [OR=0.79,95％CI(0.49,1.29),P=0.35].CONCLUSIONS:Therapeutic efficacy of valaciclovir is better than that of acyclovir in the treatment of herpes zoster,can significantly reduce the incidence of postherpetic neuralgia.Both have similar safety.

Objective To investigate the effect of education in pregnant women’s school on primipara mode of delivery and puerperal behavior.Methods Two hundred and twenty cases who delivered in our hospital and paid postpartum visits were divided into observation group and control group equally according to whether they had attended the pregnant women’s school.The observation group included those having attended the school and the control those who had not.The two groups were compared in terms of primipara mode of delivery and puerperal behavior.Results The rates of maternal vaginal delivery and cesarean section rate in observation group were 71.8%and 28.2%,both significantly higher than those of the control group(52.7%and 47.3%)(P<0.01).The rate of caesarean section due to social factors in the observation group was significantly lower than that of the control group(P<0.05).Besides,the observation group had higher rates of puerperiumal shampoo, showering, eating vegetables and fruits,brushing,use of air-conditioners than the control group did(all P<0.01).Conclusions Prenatal maternal health education in the pregnant women’s school affects puerperous behavior.It suggests that prenatal parturients actively participate in related education on maternal health care,which can help establish a good pregnancy and puerperium maternal behavior,reduce maternal cesarean section and thus help them live through puerperium.

Objective To evaluate the roles of Toll-like receptor 2 (TLR2),TLR4 and myeloid differentiation factor 88 (MyD88) in immune recognition and immune mediation in sporotrichosis by detecting their expressions in skin lesions of sporotrichosis.Methods Biopsy specimens were obtained from the skin lesions of 19 patients with sporotrichosis and normal skin of 12 healthy human controls.Immunohistochemistry was performed to observe the expressions of TLR4 and MyD88,and real-time fluorescence-based quantitative PCR to quantify the expressions of TLR2 and MyD88 mRNAs.Data were expressed as mean ± standard error.Statistical analysis was done with the SPSS17.0 software.Independent samples t-test was conducted to compare the parameters between the lesional and control specimens.A p-value of less than 0.05 was considered to be statistically significant.Results TLR4 and MyD88 were mainly observed in the whole epidermis except the stratum corneum as well as plasma cells and lymphocytes in the dermis and subcutaneous tissue in lesional skin.However,TLR4 was nearly absent and MyD88 was weakly expressed in the dermis and subcutaneous tissue in normal skin.The expression levels of TLR4 and MyD88 were significantly higher in the lesional skin than in the control skin (TLR4,63.767 ± 3.829 vs.5.167 ± 3.246,t =4.82,P ＜ 0.05; MyD88,57.236 ± 4.744 vs.10.588 ± 1.640,t =3.30,P ＜ 0.05).Similarly,the lesional skin showed significantly stronger expressions of TLR2 and MyD88 mRNAs compared with the normal skin (TLR2,1.974 ± 1.452 vs.1.430 ± 1.073,P ＜ 0.05; MyD88,2.028 ± 2.061 vs.0.688 ± 0.422,P ＜ 0.05).Conclusion Sporothrix may induce the development of sporotrichosis by interacting with host immune system via TLR signaling pathways.

ObjectiveTo explore the roles of Toll-like receptor (TLR) 3,7 and 9 in the pathogenesis of pityriasis rosea.MethodsThis study recruited 40 patients with pityriasis rosea and 40 normal human controls.Reverse transcription-PCR was carried out to detect the expressions of TLR3,7 and 9 in peripheral blood lymphocytes of these subjects.ResultsThe mRNA expressions of TLR3,7 and 9 in peripheral blood lymphocytes were significantly higher in patients with pityriasis rosea than in the normal human controls (Z =4.239,3.745,2.658,all P ＜ 0.05).There was a positive correlation between the expression of TLR3 and TLR7(r =0.574,P ＜ 0.01 ) as well as between that of TLR3 and TLR9 (r =0.551,P ＜ 0.01 ) in the patients,while there was no correlation between TLR7 and TLR9 expression in the patients or between the expressions of TLR3,TLR7 and TLR9 in the controls.ConclusionVirus infection might be involved in the pathogenesis of pityriasis rosea via TLR pathways.

The concept and framework of network toxicology and network toxicology of traditional Chinese medicine has been proposed in this paper. The related tools and technologies have been briefly introduced, and the prospects for network toxicology of traditional Chinese medicine are forecasted.
Animals ; Drug Interactions ; Drugs, Chinese Herbal ; analysis ; toxicity ; Humans ; Medicine, Chinese Traditional

Objective To explore the association between HLA-A and B alleles and alopecia areata.Methods HLA-A and-B alleles were studied by LABTypeTM SSO in 44 patients with alopecia areata and 200 healthy controls.Results The frequencies of HLA-A＊11（χ2=6.08,P 〈 0.05）,HLA-B＊13（χ2=29.80,P 〈 0.01）,HLA-B＊40（χ2=8.04,P 〈 0.01）,HLA-B＊46（χ2=5.86,P 〈 0.05）and HLA-B＊51（χ2=8.82,P 〈 0.01）alleles were significantly increased in alopecia areata patients compared with the control.Conclusion HLA-A＊11,HLA-B＊13,HLA-B＊40,HLA-B＊46 and HLA-B＊51 might be the susceptible alleles of the patients with alopecia areata.

Objective: To establish a method for determinating icarin content in Naoling Granule. Methods: Water-soluble ethyl-acetate-extracting polyamide column purification was adopted. The content of icarin was determined by HPLC. C18 column was used, mobile phase was methanol:0.1mol/mL sodium phosphate dibasic (6:5) and detection wavelength was at 270nm. Results: Icarin has a good linearity in the range of 0.24～1.2?g ( r=0.9998). The average recovery was 98.23 %and RSD was 1.2 %(N=5). Conclusion: The method was simple with good reproducibility and can be used for the content determination of icarin in Naoling Granule.