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 evaluate the efficacy and safety of Tuina(Chinese therapeutic massage)in the treatment of functional dyspepsia(FD)in children and adults. Methods:Related articles in PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,Web of Science,China Biology Medicine Disc(CBM),Wanfang Academic Journal Full-text Database(Wanfang),China National Knowledge Infrastructure(CNKI),and Chongqing VIP Database(CQVIP)were collected.The retrieval time was from each database's start to March 2022.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.A meta-analysis was then performed using the RevMan 5.4 software. Results:A total of 19 clinical trials were included,9 of which encompassed studies on adults while 10 were on children with FD,comprising a total of 1961 patients.The findings of the meta-analysis showed that the effective rate of FD in children and adults treated with Tuina was significantly higher than that in the control group[risk ratio(RR)=1.15,95%confidence interval(CI)(1.09,1.21),P<0.001],[RR=1.13,95%CI(1.06,1.21),P<0.001].In addition,the effective rate of FD in children and adults treated with Tuina combined with other treatments was significantly higher than that in the control group[RR=1.14,95%CI(1.07,1.21),P<0.001],[RR=1.12,95%CI(1.02,1.24),P=0.02].In terms of single symptoms,Tuina improved epigastric burning sensation score in adults[standardized mean difference(SMD)=-0.41;95%CI(-0.79,-0.02);Z=2.08;P=0.04]compared with that of the Western medicine group.Compared with children treated with oral Chinese medications(CM)or Chinese patent medicine(CPM),children with FD demonstrated lower scores of epigastric pain[SMD=-0.38,95%CI(-0.56,-0.19);Z=3.96;P<0.001],postprandial fullness[SMD=-0.30,95%CI(-0.50,-0.10);Z=2.88;P=0.004],and early satiety[SMD=-0.26,95%CI(-0.47,-0.06);Z=2.54;P=0.01]after receiving Tuina combined with CM or CPM treatment.No adverse events were reported in the Tuina treatment group,and the follow-up indicated that the symptom scores in the Tuina group improved. Conclusion:Compared with the control group,both Tuina and Tuina combined with other treatments are shown to have better effective rates,lower incidence of adverse events,and better follow-up outcomes.The study results suggest that Tuina may be a clinically viable complementary therapy.However,due to limitations in the number and quality of the included studies,the above conclusions should be verified by further high-quality studies.

β-N-acetylglucosaminidases (NAGases) can convert natural substrates such as chitin or chitosan to N-acetyl-β-D glucosamine (GlcNAc) monomer that is wildly used in medicine and agriculture. In this study, the BcNagZ gene from Bacillus coagulans DMS1 was cloned and expressed in Escherichia coli. The recombinant protein was secreted into the fermentation supernatant and the expression amount reached 0.76 mg/mL. The molecular mass of purified enzyme was 61.3 kDa, and the specific activity was 5.918 U/mg. The optimal temperature and pH of the BcNagZ were 75 °C and 5.5, respectively, and remained more than 85% residual activity after 30 min at 65 °C. The Mie constant Km was 0.23 mmol/L and the Vmax was 0.043 1 mmol/(L·min). The recombinant BcNagZ could hydrolyze colloidal chitin to obtain trace amounts of GlcNAc, and hydrolyze disaccharides to monosaccharide. Combining with the reported exochitinase AMcase, BcNagZ could produce GlcNAc from hydrolysis of colloidal chitin with a yield over 86.93%.
Acetylglucosamine ; Acetylglucosaminidase ; Bacillus coagulans ; Chitin ; Chitinases ; Hydrogen-Ion Concentration ; Recombinant Proteins/genetics*

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.

The clinical data of a child with bronchial Dieulafoy disease treated in Wuhan Children′s Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, was analyzed retrospectively.The patient was a 9-month-old boy, who was admitted to hospital due to " intermittent hematemesis vomiting blood for 6 hours" . Chest CT suggested ground-glass opacity in both lungs.Electronic bronchoscopy showed that the neoplasm bulged into the lumen at the opening of the right inferior lobar bronchus, and fresh blood oozed from the basal segment of the neoplasm during the operation.Bronchial arteriography and transcatheter bronchial artery embolization were performed due to recurrent hemoptysis, during which the patient was diagnosed with bronchial arterial vascular malformation and finally diagnosed with bronchial Dieulafoy disease after consulting the relevant literatures.The disease is infrequent and characterized by rupture hemorrhage of bronchial submucosal malformed artery, the etiology and pathogenesis of which are still unclear, and it may be related to congenital vascular malformation in children.Bronchoscopy for hemoptysis of unknown cause in children should be performed with caution.If small and smooth protruded nodular lesions are seen under the bronchoscope, the bronchial Dieulafoy disease should be considered, and the lesions should not be touched too much or subjected to biopsy blindly.Fatal massive hemorrhage can be avoided by bronchial arteriography and bronchial artery embolization.

Objective:To analyze the surgical methods of operable breast cancer and analyze the follow-up results.Methods:A retrospective analysis of the clinical and pathological data of 636 operable breast cancer patients admitted to Zibo First Hospital from July 2008 to April 2018, including the clinical stage, pathological staging. Analyze of the proportion of four surgical methods, and through follow-up, analyze the treatment effect of different surgical methods.Results:All patients are female, aged 26-80 years, the clinical stage of 636 patients: Tis 18 cases, stage Ⅰ 143 cases, stage Ⅱ 354 cases, stage Ⅲ 114 cases, stage Ⅳ 7 cases. There are four types of surgery: ① breast conserving surgery + sentinel lymph node biopsy in 124 cases (19.50%); ② breast conserving surgery + axillary lymph node dissection in 39 cases (6.13%); ③ mastectomy + sentinel lymph node biopsy in 163 cases (25.63%); ④ modified radical surgery in 310 cases (48.74%). Sentinel lymph node biopsy in 427 cases (67.14%), success in 404 patients (94.61%); all patients with lymph node negative 384 cases (60.38%). Follow-up for 1 to 9 years, 11 cases of local recurrence after breast-conserving surgery, It accounted for 6.75% of breast-conserving surgery; 43 cases of local recurrence of chest wall after mastectomy, accounting for mastectomy 9.09%; 33 cases of recurrence and metastasis of axillary lymph nodes and supraclavicular lymph nodes, 4 cases of axillary recurrence after sentinel lymph node biopsy.Conclusions:The proportion of breast-conserving surgery in this group of patients was high and the local recurrence rate of breast-conserving surgery was less than that of mastectomy group; the proportion of simple modified radical surgery declined further; patients with axillary lymph node metastasis were less in the whole group. The choice of reasonable operation method is an important factor to improve the prognosis of breast cancer.

OBJECTIVE:To observe clinical efficacy and safety of levofloxacin and azithromycin in the treatment of community acquired mycoplasma pneumonia (CAMP).METHODS:A total of 108 patients with CAMP were randomly divided into group A and group B (n=54).Group A received intravenous administration of levofloxacin (0.6 g,qd) and group B intravenous administration of azithromycinin (0.5 g,qd) for 7 days.The clinical efficacy and ADR of 2 groups were observed.RESULTS:The total effective rates of group A and group B were 83% and 56%,there was significant difference between 2 groups (P0.05).CONCLUSION:The clinical efficacy of levofloxacin in the treatment for CAMP is better than that of azithromycin.Levofloxacin and azithromycin have good safety.

OBJECTIVE:To investigate the effect of outer membrane protein on drug resistance of 59 strains of cefoxitin-resistant Escherichia coli.METHODS:PCR method was performed on test strains to identify OmpF gene.The outer membrane protein(OMP) profiles were studied by sodium dodecyl sulphate polyacrylamide gel electrophoresis(SDS-PAGE).Sensitivity of 20 kinds of antibiotics to test strains was tested by Microdilution.RESULTS:Among 59 strains of Escherichia coli,OmpF gene were positive in 29 strains(49%),of which 20 strains were among 25 strains which produced AmpC enzyme.30 OmpF gene-negative strains had not occurred OmpF protein bands,of which 13 strains missed OmpC protein bands simultaneously.Among 29 strains of OmpF gene-positive bacteria,4 stains missed OmpF protein bands.59 strains were all resistant to many types of antibiotics.CONCLUSION:Deletion of OmpF gene and protein is the main reason for non-AmpC enzyme production strains resistant to cefoxitin.Porin loss bring about primarily cefoxitin-resistant property but little impact on other antibiotics.