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*

Neuroinflammation is a key contributor to the pathogenic cascades induced by hypoxic-ischemic (HI) insult in the neonatal brain. AD-16 is a novel anti-inflammatory compound, recently found to exert potent inhibition of the lipopolysaccharide-induced production of pro-inflammatory and neurotoxic mediators. In this study, we evaluated the effect of AD-16 on primary astrocytes and neurons under oxygen-glucose deprivation (OGD) in vitro and in mice with neonatal HI brain injury in vivo. We demonstrated that AD-16 protected against OGD-induced astrocytic and neuronal cell injury. Single dose post-treatment with AD-16 (1 mg/kg) improved the neurobehavioral outcome and reduced the infarct volume with a therapeutic window of up to 6 h. Chronic administration reduced the mortality rate and preserved whole-brain morphology following neonatal HI. The in vitro and in vivo effects suggest that AD-16 offers promising therapeutic efficacy in attenuating the progression of HI brain injury and protecting against the associated mortality and morbidity.
Animals ; Animals, Newborn ; Astrocytes/pathology* ; Brain/pathology* ; Brain Injuries/pathology* ; Glucose ; Hypoxia ; Hypoxia-Ischemia, Brain/drug therapy* ; Mice ; Neuroinflammatory Diseases ; Neuroprotective Agents/therapeutic use* ; Oxygen/therapeutic use*

Hyaluronic acid, also called hyaluronan(HA)is a biocompatible and biodegradable linear polysaccharide which is of interest for tumor targeting through cell surface CD44 receptors. It is widely applied in the field of tumor therapy as an anticancer drug delivery carrier, and has become a hot spot in the research of tumor targeted drug delivery system. In tumor drug therapy, the key to reduce toxicity is to actively target tumors by using anatomical, pathophysiological and microenvironmental differences between malignant tumors and normal tissues. Differentiation cluster 44(CD44)is a high-affinity receptor for HA, which can be marked as a tumor marker or a targeting receptor because it is overexpressed in tumor cells. The overexpression of CD44 receptors was observed in many tumors such as breast cancer, colorectal cancer, liver cancer and pancreatic cancer. The effect of hyaluronic acid drug nanocarriers on various tumors is briefly described, indicating that the overexpression of CD44 receptor is an ideal choice for the treatment of hyaluronic acid-based drug carriers. The CD44 ligand can increase the affinity of the nanocarrier for tumor cells by binding to the nano drug carrier. The HA structure is known for its potent tumor targeting effect due to the inclusion of CD44 ligand, which enhances uptake of tumor cells by the HA-CD44 receptor-mediated endocytosis pathway. The study reviewed the progression of hyaluronic acid nanomicelles in clinical tumor therapy and its release behavior. The percentage of drug release and release rate are the key factors in the overall efficacy of the treatment strategy. Therefore, a great number of studies have focused on inducing drug release in Cytosol by taking advantage of the difference between the internal and external environments of nanostructured micelles or through external stimulation post-treatment applications. The study proved that an acid environment is more favorable to achieve a greater release and drugs can be quickly and completely released in an oxygen-deficient environment. In addition, the great potential of hyaluronic acid nanomicelles in tumor therapy was also further identified in this article. In vitro and in vivo experimental studies have repeatedly shown that hyaluronic acid-based nanomicelles are a drug- and gene-specific targeting tumor delivery method, in combination with passive targeting, this active targeting strategy is a promising approach to providing chemotherapy drugs to CD44 overexpressing tumors. In conclusion, hyaluronic acid-based nanomicelles are biologically safe with great potential to drug release, blood compatibility and systemic tumor targeting which all implied it has good application prospects in clinical tumor treatment.

Objective To determine the median effective dose (ED50) of oxycodone inhibiting responses to laryngeal mask airway (LMA) insertion when combined with propofol in the adult female patients.Methods Female patients,aged 18-60 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective gynecologic surgery,were included.ED50 of oxycodone was determined by up-and-down sequential technique.Anesthesia was induced by target-controlled infusion of propofol at target plasma concentration of 3.0 μg/ml.Oxycodone was injected at the initial dose of 0.11 mg/kg after the target effect-site and plasma concentrations were balanced.LMA was inserted at 5 min following injection.When the response to LMA insertion was positive,the concentration of oxycodone was increased/decreased in the next patient.The difference between the two successive doses was 0.02 mg/kg.LMA insertion response was defined as occurrence of swallowing,biting on the LMA and bucking and/or body movement during insertion.Probit analysis was used to calculate the ED50 and 95％ confidence interval of oxycodone inhibiting responses to LMA insertion when combined with propofol.Results The ED50 (95％ confidence interval) of oxycodone inhibiting responses to LMA insertion was 0.095 (0.080-0.108) mg/kg when combined with propofol.Conclusion The ED50 of oxycodone inhibiting responses to LMA insertion is 0.095 mg/kg when combined with propofol in the adult female patients.

Objective To investigate the safety and effectiveness of different intravenous anesthesia methods for pediatric ERCP . Methods Data of 45 children undergoing ERCP at the Affiliated Hangzhou Hospital of Nanjing Medical University from August 2013 to July 2016, including intravenous anesthesia,the procedure of ERCP, adverse reactions and the waking time were retrospectively studied. Results A total of 45 patients in two groups under intravenous anesthesia successfully underwent ERCP . Seventeen patients ( 37. 8%) whose body weights were over 20 kg and the duration of surgery was predicted less than 30 minutes received deep sedation without airway intubation. Twenty?eight patients ( 62. 2%) with an initial weight of less than 20 kg and the duration of surgery was predicted more than 30 minutes received general anesthesia with airway intubation. In patients with deep sedation, the mean time of waking was 7. 2±6. 3 minutes, body movement reaction occurred in 1 case ( 5. 9%) and with transient decreasing of pulse blood oxygen ( beyond 95%) occurred in 2 cases ( 11. 8%) . In patients receiving endotracheal anesthesia with intubation, the mean waking time was 10. 5±8. 7 minutes without adverse reactions associated with anesthesia. Conclusion Both deep sedation and general anesthesia with airway intubation are safe for pediatric ERCP. However, general anesthesia with airway intubation is an ideal method ensuring the airway safety and oxygen supply for children less than 20 kg undergoing first?time ERCP or the duration of surgery lasting over 30 minutes.

BACKGROUND:The tensile and stress-relaxation mechanical properties of sciatic nerve injury after repaired with autologous nerve and poly(lactic acid-glycolic acid) (PLGA) scaffold are rarely reported. OBJECTIVE:To analyze the tensile and stress relaxation characteristics of sciatic nerve injury after the transplantation of autologous nerve and PLGA scaffold. METHODS:Sixty sciatic nerves were extracted from the fresh cadavers dead within 24 hours, processed into 35 mm samples, and were then randomly divided into three groups. The nerve samples in control group received no intervention;the nerves in artificial and autologous groups were modeled into 20 mm defects, followed by repaired with PLGA scaffold and autologous nerve, respectively. Afterwards, the tension and stress-relaxation tests were performed in each group. RESULTS AND CONCLUSION:The stress in each group descended fast at the first 600 seconds, then descended slowly and was closed to the horizontal level until 7200 seconds, and the stress-relaxation curves in each group were in logarithmic decrease. The order of the elastic limit load, elastic limit stress, maximum load, maximum stress, elastic limit strain and maximum strain during tension was as follows:control group>artificial group>autologous group (P<0.05). Our results indicate that the PLGA scaffold holds good tension and stress-relaxation properties, which meets the mechanical requirements of the biomaterials used for sciatic nerve repair.

Objective: To study the feasibility of ¹⁸F-fluoro-L-dihydroxyphenylalanine positron emission tomography/Computed tomography (¹⁸F-DOPA PET/CT) scanning in the localization and differential diagnosing of focal versus diffuse form of pancreas lesions in patients with hyperinsulinemic hypoglycemia (HH). Method: Twenty-four patients were diagnosed with HH between January, 2016 and February, 2017 in the Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children′s Hospital of Fudan University using an integrated clinical and biochemical diagnostic protocol, domestic ¹⁸F-DOPA PET/CT imaging technique were applied after MRI and ultrasound failed to detect pancreas lesions. Pancreas ¹⁸F-DOPA standardized uptake values (SUV) were measured, and pancreas′ lesions were dually analyzed via visual method and pancreas percentage SUV method. Among these patients, 9 patients received surgical pancreatic lesion resections, the correlations among surgical outcomes, histopathological findings and ¹⁸F-DOPA PET/CT scan results were analyzed. Result: Seven patients were detected with focal form of pancreas lesions, the mean peak of SUV was 4.7±1.7(2.6-7.1), and 17 patients were found to have diffuse form lesions after ¹⁸F-DOPA-PET/CT scanning. Among the 24 cases, 9 patients (7 showed focal and 2 showed diffuse ¹⁸F-DOPA PET/CT pancreatic uptake)were euglycemic without any medical support after surgery; the resected pancreatic tissue histopathological results were consistent with that of PET/CT imaging. Only one patient, who responded to medical treatment before surgery, had temporary hyperglycemia after operation. Conclusion Domestic ¹⁸F-DOPA PET/CT could successfully locate and differentiate the pancreatic lesions and thus improve the success of surgery.

OBJECTIVETo study tissue culture and plant regeneration of Withania somnifera.

METHODLeaves of W. somnifera were used for explants, effects of different plant growth substances on callus and shoot induction were studied, different medium and plant growth substances for rooting induction was optimized.

RESULT AND CONCLUSIONThe best plant growth substances combination for callus induction was MS + 1.0 mg x L(-1) 2,4-D + 0.1 mg x L(-1) KT. The optimal medium for germination was MS + 1.0 mg x L(-1) 6-BA + 0.1 mg x L(-1) NAA. The best medium and plant growth substances combination for rooting induction was 1/2MS + 0.5 mg x L(-1) NAA, transplant survival rate of plantlet reached 92% in humus soil-pearlite (1:1).

Culture Media ; pharmacology ; Plant Growth Regulators ; pharmacology ; Regeneration ; drug effects ; Tissue Culture Techniques ; Withania ; drug effects ; growth & development

OBJECTIVETo establish the induction method and culture system of hairy roots of Panax japonicus, and determine ginsenoside Re contents.

METHODHairy roots of P. japonicus was obtained through infecting pre-incubated terrestrial stem with the Agrobacterium tumefaciens strain C58C1; its enlarging culture was carried out on the 1/2MS medium, and growing characteristics were measured. The transformation of T-DNA was examined by PCR and ginsenoside Re content was determined by HPLC.

RESULTA. tumefaciens strain C58C1 could make terrestrial stem of P. japonicus bring about hairy roots, the max inductivity was 90% when infecting for 25 min. The PCR examination result showed that rolB genes could be inserted into the hair roots of P. japonicus. All hairy roots dould synthesize ginsenoside Re, among them, the max content was PJ8 with 60. 26 mg x g(-1).

CONCLUSIONIt was reported for the first time that the induction method and culture system of hairy roots of P. japonicus were established successfully, which provided a foundation for producing high content ginsenoside Re through culturing the hairy roots of P. japonicus.

Agrobacterium tumefaciens ; genetics ; physiology ; Cells, Cultured ; Culture Techniques ; methods ; Ginsenosides ; biosynthesis ; Panax ; genetics ; growth & development ; metabolism ; microbiology ; Plant Roots ; genetics ; growth & development ; metabolism ; microbiology