Analysis of the causes of cage subsidence after oblique lateral lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To observe the cage subsidence after oblique lateral interbody fusion (OLIF) for lumbar spondylosis, summarize the characteristics of the cage subsidence, analyze causes, and propose preventive measures.@*METHODS@#The data of 144 patients of lumbar spine lesions admitted to our hospital from October 2015 to December 2018 were retrospectively analyzed. There were 43 males and 101 females, and the age ranged from 20 to 81 years old, with an average of (60.90±10.06) years old. Disease types:17 patients of lumbar intervertebral disc degenerative disease, 12 patients of giant lumbar disc herniation, 5 patients of discogenic low back pain, 33 patients of lumbar spinal stenosis, 26 patients of lumbar degenerative spondylolisthesis, 28 patients of lumbar spondylolisthesis with spondylolisthesis, 11 patients of adjacent vertebral disease after lumbar internal fixation, 7 patients of primary spondylitis in the inflammatory outcome stage, and 5 patients of lumbar degenerative scoliosis. Preoperative dual-energy X-ray bone mineral density examination showed 57 patients of osteopenia or osteoporosis, and 87 patients of normal bone density. The number of fusion segments:124 patients of single-segment, 11 patients of two-segment, 8 patients of three-segment, four-segment 1 patient. There were 40 patients treated by stand-alone OLIF, and 104 patients by OLIF combined with posterior pedicle screw. Observed the occurrence of fusion cage settlement after operation, conducted monofactor analysis on possible risk factors, and observed the influence of fusion cage settlement on clinical results.@*RESULTS@#All operations were successfully completed, the median operation time was 99 min, and the median intraoperative blood loss was 106 ml. Intraoperative endplate injury occurred in 30 patients and vertebral fracture occurred in 5 patients. The mean follow-up was (14.57±7.14) months from 6 to 30 months. During the follow-up, except for the patients of primary lumbar interstitial inflammation and some patients of lumbar spondylolisthesis with spondylolisthesis, the others all had different degrees of cage subsidence. Cage subsidence classification:119 patients were normal subsidence, and 25 patients were abnormal subsidence (23 patients were gradeⅠ, and 2 patients were gradeⅡ). There was no loosening or rupture of the pedicle screw system. The height of the intervertebral space recovered from the preoperative average (9.48±1.84) mm to the postoperative average (12.65±2.03) mm, and the average (10.51±1.81) mm at the last follow-up. There were statistical differences between postoperative and preoperative, and between the last follow-up and postoperative. The interbody fusion rate was 94.4%. The low back pain VAS decreased from the preoperative average (6.55±2.2 9) to the last follow-up (1.40±0.82), and there was statistically significant different. The leg pain VAS decreased from the preoperative average (4.72±1.49) to the final follow-up (0.60±0.03), and the difference was statistically significant (t=9.13, P<0.000 1). The ODI index recovered from the preoperative average (38.50±6.98)% to the latest follow-up (11.30±3.27)%, and there was statistically significant different. The complication rate was 31.3%(45/144), and the reoperation rate was 9.72%(14/144). Among them, 8 patients were reoperated due to fusion cage subsidence or displacement, accounting for 57.14%(8/14) of reoperation. The fusion cage subsidence in this group had obvious characteristics. The monofactor analysis showed that the number of abnormal subsidence patients in the osteopenia or osteoporosis group, Stand-alone OLIF group, 2 or more segments fusion group, and endplate injury group was higher than that in the normal bone mass group, OLIF combined with pedicle screw fixation group, single segment fusion group, and no endplate injury group, and the comparison had statistical differences.@*CONCLUSION@#Cage subsidence is a common phenomenon after OLIF surgery. Preoperative osteopenia or osteoporosis, Stand-alone OLIF, 2 or more segments of fusion and intraoperative endplate injury may be important factors for postoperative fusion cage subsidence. Although there is no significant correlation between the degree of cage subsidence and clinical symptoms, there is a risk of cage migration, and prevention needs to be strengthened to reduce serious complications caused by fusion of cage subsidence, including reoperation.

Correlation between monocyte to high-density lipoprotein cholesterol ratio and insulin resistance in male patients with type 2 diabetes mellitus combined with metabolic-related fatty liver disease / 中国热带医学

@#Abstract: Objective　To explore the correlation between monocyte to high-density lipoprotein cholesterol ratio (MHR) and insulin resistance (IR) in male patients with type 2 diabetes mellitus (T2DM) combined with metabolic-related fatty liver disease (MAFLD). Methods A total of 454 male patients with T2DM combined with MAFLD in National Metabolic Management Center (MMC) of the Affiliated Hospital of Jiangsu University from May 2018 to July 2020 were enrolled. The general clinical data of subjects were collected, blood routine and biochemical indexes were tested, homeostasis model insulin resistance index (HOMA-IR) was calculated, visceral fat area (VFA) and subcutaneous fat area (SFA) were measured. Accordingtothe MHR quartile, patients were divided into group Q1 (MHR≤0.38), group Q2 (0.38<MHR≤0.48), group Q3 (0.48<MHR≤0.64) and group Q4 (MHR>0.64) to compare the differences in measured indicators above. In addition, patients were divided into two groups according to HOMA-IR, HOMA-IR<2.5 and HOMA-IR≥2.5, and the differences in MHR were compared. Results The patients were divided into four groups according to MHR:group Q1 (n=115), group Q2 (n=110), group Q3 (n=120) and group Q4 (n=109). Fasting insulin (FINS) were respectively 6.17(4.20,9.76), 7.73(4.94,10.66), 8.92(5.32,11.33) and 9.13(5.25,12.27) mU/L, 2-hour postprandial insulin were 22.75(12.87,39.59), 27.55(16.44,39.77), 30.98(17.46,43.11) and 31.28(18.54,45.92) U/L. HOMA-IR were 3.12(1.63,4.25), 3.72(2.26,4.66), 3.87(2.48,5.44) and 3.95(2.42,5.31). Neutrophil (Neu) were 3.10(2.60,3.70), 3.20(2.50,3.93), 3.60(2.80,4.28), 4.20(3.30,5.00)×109/L. Subcutaneous fat area (SFA) were (181.27±53.60), (192.64±62.41), (199.53±61.40) and (203.69±71.51) cm2. They all increased gradually. However, the levels of high-density lipoprotein cholesterol (HDL-c) [1.18(1.06,1.35), 1.02(0.86,1.17), 0.96(0.80,1.03) and 0.80(0.69,0.92) mmol/L] and low-density lipoprotein cholesterol (LDL-c) [(3.00±0.79), (2.76±0.83), (2.67±0.85) and (2.59±0.92) mmol/L] decreased gradually. Pearson's or Spearman's correlation analysis showed that MHR was positively correlated with FINS, 2-hour postprandial insulin (2hINS), HOMA-IR, VFA and SFA (r=0.190, 0.153, 0.184, 0.114, 0.127, P<0.05). The coronary heart disease history, systolic blood pressure,diastolic blood pressure,fasting plasmaglucose (FPG), FINS, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood uric acid (Ur), body mass index (BMI), VFA, SFA and MHR of patients in group HOMA-IR≥2.5 were higher than group HOMA-IR<2.5 (P<0.05). Conclusion　MHR is positively correlated with IR in male patients with T2DM combined with MAFLD, and as MHR increases, the degree of IR is higher.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Current status of animal models of cataract classified by etiology / 国际眼科杂志(Guoji Yanke Zazhi)

Cataract is one of the major causes of vision loss and even blindness in patients, and surgery is the only effective method to treat it. The pathogenesis and precaution of cataract remain hot issues in ophthalmological research. With the maturation of biotechnology in recent years, modeling methods and species of experimental animals have become more diverse, which are still the mainstay of cataract mechanism research. However, the ideal animal model of cataract has yet to be constructed due to the complexity of human cataract etiology. Herein, the modeling principles, in vivo or in vitro modeling methods, characteristics, and existing problems of animal models of cataract are summarized according to etiology, providing the theoretical foundation for the construction of a comprehensive animal model that more closely resembles the human cataract.

Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Effect of Danggui Buxuetang on PKD1/NF-κB/MnSOD Signal Pathway in Bleomycin-induced Pulmonary Fibrosis in Rats / 中国实验方剂学杂志

Objective:To observe the effect of Danggui Buxuetang on lung histopathology and protein kinase D1 (PKD1), nuclear transcription factor-κB (NF-κB) and manganese superoxide dismutase (MnSOD)-mediated oxidative stress pathway in rats with pulmonary fibrosis induced by bleomycin, so as to explore the mechanism of intervention of pulmonary fibrosis.Method:Thirty-two male SPF SD rats were randomly divided into sham operation group, model group, Danggui Buxuetang group and prednisone group, with 8 rats in each group. Except the sham operation group, the other groups were prepared through the intratracheal instillation with bleomycin. After modeling for 24 h, the rats of Danggui Buxuetang group were administered with Danggui Buxuetang (0.81 g·kg-1). The rats of prednisone group were given aqueous solution of prednisone (0.005 g·kg-1). The rats of sham operation group and model group were given the same volume of saline. After 14 days of administration, blood was collected from the femoral artery, serum was separated, and the lungs were taken by thoracotomy. The pathological changes of rat lung tissues were observed by hematoxylin-eosin staining (HE) and Masson trichrome staining, and graded by Szapiel score and Ashcroft score at the same time. The content of serum malondialdehyde (MDA), and the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) were determined. Real-time fluorescent quantitative polymerase chain reaction (Real-time PCR) and Western blot were used to measure mRNA and protein expressions of PKD1, NF-κB, MnSOD.Result:Compared with the rats in sham operation group, the rats in model group had higher Szapiel scores and Ashcroft scores (P<0.05), higher serum MDA content , but lower SOD, CAT and GSH-Px activities(P<0.01), moreover, the rat lung tissues in model group had higher mRNA and protein expressions of PKD1, NF-κB and MnSOD (P<0.01) than those in sham operation group. Compared with the rats in model group, the Szapiel scores and Ashcroft scores of the rats in Danggui Buxuetang group were decreased significantly（P<0.05）. The serum MDA content was decreased significantly, and SOD, CAT, GSH-Px activities were increased, whereas mRNA and protein expressions of PKD1, NF-κB, MnSOD in the rat lung tissues were decreased（P<0.05，P<0.01）.Conclusion:Danggui Buxuetang can reduce the degree of pulmonary fibrosis by regulating the anti-oxidation pathway of PKD1/NF-κB/MnSOD mitochondrial nucleus and improving the body's antioxidant capacity.

Research on Natural Boundary of Traditional Geo-authentic Origin of Ligusticum chuanxiong via Soil Elements Characteristics Along Same Longitude / 中国实验方剂学杂志

Objective:To find the natural environmental boundary of the origin of the authentic Ligusticum chuanxiong by analyzing the distribution characteristics of soil elements in the traditional geo-authentic area and the southern continuous expanding areas along the same longitude. Method:The contents of 24 elements both in soil and plant L. chuanxiong samples were determined by using X-ray fluorescence spectrometry （XRF） and ICP-MS，etc. Spearman correlation test was used to evaluate the correlations of rhizosphere soil and each portion of L. chuanxiong，to screen out “characteristic elements”. Bray-Curtis similarity indexes based on all elements and "characteristic elements" were used for hierarchical cluster analysis of soil samples, to identify the sample range with similar soil element charateristics to the traditional geo-authentic area of L. chuanxiong. Result:K，Mg，Mn and Rb elements were significantly correlated in rhizosphere soil and plant L. chuanxiong. Geographical differentiation of all elements and four characteristic elements showed that there was a highest similarity between geo-authentic area and its neighbor plots S1-S6 (except plot S4) in soil elements distribution, followed by plots S14-S16. The middle section plots S7-S13 in the expansion areas were quite different from the traditional geo-authentic production areas. Conclusion:The soil element characteristics in the study areas were not completely controlled by geographical distance，but demonstrated the "fault" variation in the areas along longitude. This study provides a theoretical basis for the detrrmination of suitable cultivation area for Ligusticum Chuanxiong, and the natural boundary of its geo-authentic area may be extended an additional 60 km southward along longitude beyond the traditional origin. Additionally， K，Mg，Mn and Rb characteristic elements may be the potential markers to evaluate the suitable soil environment for cultivating L. chuanxiong.

Effects of T-2 toxin on expression of hepatocyte growth factor and its receptor in articular cartilage and epiphyseal cartilage of rats under selenium deficiency / 中华地方病学杂志

Objective:To observe the effects of T-2 toxin on expression of hepatocyte growth factor (HGF) and HGF receptor (C-Met) in articular cartilage and epiphyseal cartilage of rats under low selenium condition.Methods:Twenty-four healthy male SD rats weighted 60-80 g were randomly divided into conventional diet group (selenium content of 101.5 μg/kg) and low-selenium diet group (selenium content of 1.1 μg/kg), with 12 rats in each group. After 30 days of feeding, the conventional diet group was further divided into conventional group and T-2 toxin group (100 μg·kg -1·d -1), and the low-selenium diet group was further divided into low-selenium group and low-selenium+T-2 toxin group (100 μg·kg -1·d -1), with 6 rats in each group. After 30 days of feeding, the rats were sacrificed and the cartilage of knee joint was taken, the morphological changes of knee articular cartilage and epiphyseal cartilage were observed by HE staining under light microscope. Immunohistochemical method was used to detect the expression of HGF and C-Met in knee articular cartilage and epiphyseal cartilage, and positive expression rates of HGF and C-Met were calculated. Results:Under light microscope, chondrocytes of articular cartilage and epiphyseal cartilage in low-selenium+T-2 toxin group were sparse, and the necrosis and structural area were found in the deep layer, and the extracellular matrix of chondrocytes in the region was degraded and light stained, and proliferating granulation tissue was visible nearby. The positive expression rates of HGF in articular cartilage [(21.97 ± 6.90)%, (49.41 ± 8.24)%, (76.39 ± 5.88)%] and epiphyseal cartilage [(23.36 ± 12.49)%, (58.43 ± 14.48)%, (66.59 ± 10.83)%] of rats in low-selenium, T-2 toxin and low-selenium+T-2 toxin groups were higher than those in conventional group [(9.13 ± 6.01)%, (11.14 ± 4.67)%, P < 0.05]. The positive expression rates of C-Met in articular cartilage [(25.34 ± 7.53)%, (58.21 ± 12.54)%, (81.46 ± 7.89)%] and epiphyseal cartilage [(35.21 ± 4.71)%, (40.84 ± 2.03)%, (49.41 ± 6.29)%] of rats in low-selenium, T-2 toxin and low-selenium+T-2 toxin groups were higher than those in conventional group [(11.21 ± 5.11)%, (12.12 ± 4.71)%, P < 0.05]. Conclusion:T-2 toxin may affect the expression of HGF and C-Met in articular cartilage and epiphyseal cartilage of rats under low selenium condition.

Effects of T-2 toxin on expression of fibroblast growth factor 8 and fibroblast growth factor receptor 3 in articular cartilage and bone marrow of rats under low selenium condition / 中华地方病学杂志

Objective:To study the effects of T-2 toxin on expression of fibroblast growth factor 8 (FGF8) and fibroblast growth factor receptor 3 (FGFR3) in articular cartilage and subchondral marrow of rats under low selenium condition, and to explore the mechanism of deep cartilage injury and secondary complications in Kaschin-Beck disease (KBD).Methods:Twenty-four healthy male SD rats weighted 60 - 80 g were selected, they were divided into conventional feed group (selenium content of 101.5 μg/kg) and low-selenium feed group (selenium content of 1.1 μg/kg) by random number table method, with 12 rats in each group. After 30 days of feeding, the conventional feed group was further divided into control group and T-2 toxin group (100 μg·kg -1·d -1), and the low-selenium feed group was further divided into low-selenium group and low-selenium+ T-2 toxin group, with 6 rats in each group. After 30 days of feeding, the rats were sacrificed and the knee cartilage with cancellous bone was taken. Pathological changes of knee cartilage were observed by HE staining. Immunohistochemical method was used to detect the expression of FGF8 and FGFR3 in cartilage and subchondral marrow of knee joint, positive expression rates of FGF8 and FGFR3 in articular cartilage were calculated, and the integrated optical density (IOD) values of FGF8 and FGFR3 positive expression in subchondral marrow were analyzed by Image-Pro Plus 6.0 software. Results:Under light microscope, chondrocytes in low-selenium+ T-2 toxin group were sparse, and empty chondrocytes in the deep and middle layers of articular cartilage increased, and chondrocytes died and became red cell shadows. The extracellular matrix dissolved and was slightly stained in deep region, turning into necrotic and unstructurized areas. Proliferating granulation tissue was visible nearby. The positive expression rate of FGF8 in articular cartilage of rats in low-selenium+ T-2 toxin group [(88.61 ± 10.97)%] was higher than that in control, low-selenium and T-2 toxin groups [(10.35 ± 2.48)%, (19.26 ± 3.08)%, (58.89 ± 9.29)%, P < 0.05]; IOD value of FGF8 positive expression in subchondral marrow [(16.73 ± 1.72) × 10 6] was higher than that in control, low-selenium and T-2 toxin groups [(1.20 ± 0.41) × 10 6, (4.33 ± 0.97) × 10 6, (12.80 ± 1.12) × 10 6, P < 0.05]. The positive expression rate of FGFR3 in articular cartilage of rats in low-selenium+ T-2 toxin group [(89.76 ± 8.59)%] was higher than that in control, low-selenium and T-2 toxin groups [(13.18 ± 2.25)%, (21.15 ± 2.33)%, (32.55 ± 6.72)%, P < 0.05]; IOD value of FGFR3 positive expression in subchondral marrow [(16.50 ± 5.36) × 10 6] was higher than that in control, low-selenium and T-2 toxin groups [(7.58 ± 1.02) × 10 6, (10.73 ± 7.13) × 10 6, (9.83 ± 5.63) × 10 6, P < 0.05]. Conclusion:Under low selenium condition, T-2 toxin changes expression of FGF8 and FGFR3 in deep chondrocytes of articular cartilage and subchondral marrow in rats, elevated expression of FGF8 and FGFR3 may be involved in the occurrence and development of secondary changes in KBD.

Dental adhesive microtensile bond strength following a biofilm-based in vitro aging model

Abstract Laboratory tests are routinely used to test bonding properties of dental adhesives. Various aging methods that simulate the oral environment are used to complement these tests for assessment of adhesive bond durability. However, most of these methods challenge hydrolytic and mechanical stability of the adhesive- enamel/dentin interface, and not the biostability of dental adhesives. Objective To compare resin-dentin microtensile bond strength (μTBS) after a 15-day Streptococcus mutans (SM) or Streptococcus sobrinus (SS) bacterial exposure to the 6-month water storage (WS) ISO 11405 type 3 test. Methodology A total of 31 molars were flattened and their exposed dentin was restored with Optibond-FL adhesive system and Z-100 dental composite. Each restored molar was sectioned and trimmed into four dumbbell-shaped specimens, and randomly distributed based on the following aging conditions: A) 6 months of WS (n=31), B) 5.5 months of WS + 15 days of a SM-biofilm challenge (n=31), C) 15 days of a SM-biofilm challenge (n=31) and D) 15 days of a SS-biofilm challenge (n=31). μTBS were determined and the failure modes were classified using light microscopy. Results Statistical analyses showed that each type of aging condition affected μTBS (p<0.0001). For Group A (49.7±15.5MPa), the mean μTBS was significantly greater than in Groups B (19.3±6.3MPa), C (19.9±5.9MPa) and D (23.6±7.9MPa). For Group D, the mean μTBS was also significantly greater than for Groups B and C, but no difference was observed between Groups B and C. Conclusion A Streptococcus mutans- or Streptococcus sobrinus-based biofilm challenge for 15 days resulted in a significantly lower μTBS than did the ISO 11405 recommended 6 months of water storage. This type of biofilm-based aging model seems to be a practical method for testing biostability of resin-dentin bonding.

Effect of continual care on postoperative medication compliance of patients with osteoporotic vertebral compression fractures / 中华创伤杂志

Objective To investigate the effect of continual care on postoperative medication compliance of patients with osteoporotic vertebral compression fractures (OVCF) after vertebroplasty.Methods A retrospective case control study was performed to analyze the clinical data of 150 patients with OVCF who underwent vertebroplasty in Guizhou People's Hospital from January 2016 to May 2017.There were 38 males and 112 females,aged 47-88 years,with an average of 67.5 years.Seventy-five patients were given continual care such as telephone follow-up and home visit (continual care group).Seventy-five patients were given routine health education (routine care group) when they were discharged from hospital.Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) before operation,1 day,1,3,6 and 12 months after operation,as well as medication compliance and vertebral re-fracture at 1,3,6 and 12 months after operation were compared between the two groups.Results The preoperative VAS of the routine care group was 6 (6-7),1 (0-1),1 (1-3),2 (1-3) and 3 (2-5) points at 1 day and 1,3,6 and 12 months after operation,respectively.The preoperative ODI was 21 (18-27),0 (0-0),2 (1-4),5 (3-7),7 (5-10),10 (7-14) points at 1 day,1,3,6 and 12 months after operation.In the continual care group,VAS was 7 (6-7) points before operation,0 (0-1),1 (0-1),1 (0-2) and 2 (1-3) points at 1 day,1,3,6 and 12 months after operation,respectively.ODI of the continual care group was 18 (22-28) points before operation,0 (0-1),2 (0-4),4 (1-5),4 (3-6) and 6 (4-9) at 1 day,1,3,6 and 12 months after operation.The VAS and ODI of the two groups were lower than those before operation,and the scores of the continual care group were lower than those of the routine care group at 1,3,6 and 12 months after operation (P ＜ 0.05).The medication compliance rates of continual care group were 93％,89％,91％ and 84％ at 1,3,6 and 12 months after operation,while those of routine care group were 44％,40％,47％ and 40％ respectively (P ＜0.05).The incidence of vertebral re-fracture was 1％,1％,3％ and 3％ in continual care group and 3％,5％,5％ and 7％ in routine care group at 1,3,6 and 12 months after operation respectively (P ＜ 0.05).Conclusion Continual care can improve the medication compliance of OVCF patients after treatment with vertebroplasty,relieve pain,improve the quality of life,and reduce the incidence of vertebral re-fracture,which is worthy of clinical promotion.

Application of fracture liaison service model in patients with osteoporotic vertebral compression fractures / 中华创伤杂志

Objective@#To investigate the effects of fracture liaison service (FLS) model on the medication compliance of patients, quality of life, pain and re-fracture rate in patients with osteoporotic vertebral compression fracture (OVCF).@*Methods@#A prospective case control study was conducted to analyze the clinical data of 117 OVCF patients admitted to Department of Pain of Guizhou Provincial People's Hospital from January 2017 to September 2017. According to the random table method, patients were divided into control group (58 patients) and intervention group (59 patients). Routine nursing was adopted in the control group, and fracture liaison service mode was adopted in the intervention group on the basis of the control group until 3 months after discharge. Morisky scale was used to compare the medication compliance of patients on admission, at discharge, 1 month, and 3 months after discharge, and SF-36 was used to evaluate the quality of life. The SF-36 scale contained eight dimensions including physiological function, physiological performance, physical pain, overall health, vitality, social function, emotional function and mental health. Visual analogue scale (VAS) was used to evaluate the pain of patients. The re fracture rates of the two groups were compared.@*Results@#There were no significant differences between the two groups concerning gender, age, history of diabetes, history of hormone use, number of vertebral fractures, fracture site and cause of injury (P>0.05). In the intervention group, the medication compliance scores of patients in the first and third months after discharge were (5.5±2.0)points and (6.3±1.8)points, which were higher than those in the control group [(3.5±2.2)points and (3.3±1.8)points] (P<0.05). Within each group, there were significant differences among the medication compliance scores at the different time points of evaluation (on admission, at discharge, 1 month, and 3 months after discharge). The scores of the eight dimensions of the SF-36 scale in the intervention group were higher than those in the control group at 1st and 3rd months after discharge (P<0.05). Within each group, there were significant differences among the SF-36 scores at the different time points of evaluation. The pain scores of the intervention group at discharge and 1st and 3rd months after discharge were ( 3.1±1.7)points, (1.8±1.3)points, (1.4±1.3)points, all lower than those in the control group [(5.2±1.7)points, (3.6±1.6)points, (2.7±1.8)points] (P<0.05). Within each group, there were significant differences among the pain scores at the different time points of evaluation. At 1st and 3rd months after discharge, the re-fracture rates of the intervention group were both 2%, and the those of the control group were 3% and 9%, respectively, showing no significant difference between the two groups (P>0.05).@*Conclusion@#The FLS model can effectively alleviate the pain of OVCF patients, improve the medication compliance and quality of life of patients after discharge, but it cannot reduce the short-term re fracture rate after discharge.

Relationship between insulin-like growth factor-1 receptor down-regulation and Kaschin-Beck disease / 中华地方病学杂志

Objective To observe the expression level of insulin-like growth factor-1 receptor (IGF-1R) in the cartilage tissue of children with Kaschin-Beck disease (KBD) and T-2 toxin-poisoned rats under low selenium condition,and the effect of IGF-1R inhibitor on apoptosis of human normal chondrocytes (C28/I2 cells),and to investigate the role of IGF-1R in the pathogenesis of KBD.Methods The knuckles of dead children (5 cases) in the KBD areas,car accident death and congenital 6 finger deformity operation children (5 cases) in non-KBD areas in Shaanxi were collected,the expression of IGF-1R in the articular cartilage was detected by immunohistochemistry.Thirty-two male Sprague-Dawley rats with a body mass of 60-80 g were selected,according to the body mass,they were divided into the routine feed group (selenium content:101.5 μg/kg) and the low-selenium feed group (selenium content:1.1 μg/kg) by random number table method,16 rats in each group.After 30 days of feeding,the routine feed group was divided into control group and T-2 toxin group (100 ng·kg-1·d-1),the low-selenium feed group was divided into low selenium group and low selenium + T-2 toxin group,8 rats in each group,the expression of IGF-1R in the articular cartilage of the left knee joint was detected by immunohistochemistry after 30 days of feeding.C28/I2 cells were cultured in vitro and treated with T-2 toxin 0 (control),6,12,and 24 μg/L,and each concentration of T-2 toxin was accompanied with sodium selenite (+ 0.1 mg/L) for 72 h.Meanwhile,IGF-1R inhibitor with 0 (control),250,500,and 1 000 μg/L was treated on C28/I2 cells for 48 h.The expression levels of IGF-1R mRNA and protein in chondrocytes were detected by Real-time PCR and Western blotting,and the apoptosis of chondrocytes was detected by flow cytometry.Results Compared with the control group [(100.00 ± 0.00)％,(100.00 ± 0.00)％],the expression rates of IGF-1R positive cells in articular cartilage surface and middle layers [(72.71 ± 4.75)％,(36.33 ± 4.32)％] of children in KBD group were significantly reduced (t =12.852,32.650,P ＜ 0.01).Compared with control group [(100.00 ± 0.00)％,(100.00 ± 0.00)％,(100.00 ± 0.00)％],the expression rates of IGF-1R positive cells in articular cartilage middle layer [(20.83 ± 2.69)％,(26.45 ± 2.84)％,(20.34 ± 1.82)％],deep layer [(33.55 ± 5.66)％,(48.89 ± 8.39)％,(25.51 ± 7.50)％],and the expression rates of IGF-1R positive cells [(47.50 ± 1.47)％,(28.66 ± 3.58)％,(40.52 ± 6.78)％] in the hypertrophic layer of the metaphyseal plate of rats in low selenium,T-2 toxin,and low selenium + T-2 toxin groups were significantly reduced (P ＜ 0.01).C28/I2 cells were cultured in vitro,compared with the control group,IGF-1R mRNA and protein expression levels in each T-2 toxin groups were significantly reduced (P ＜ 0.05).The expression levels of IGF-1R mRNA (1.95 ± 0.35,2.44 ± 0.17,2.40 ± 0.15) in 6,12,24 μg/L T-2 toxin + 0.1 mg/L selenium groups were significantly higher than those in T-2 toxin groups (0.80 ± 0.08,0.63 ± 0.08,0.61 ± 0.11,t =-12.259,-11.279,-13.371,P＜ 0.05).The expression levels of IGF-1R protein (1.67 ± 0.70,1.07 ± 0.26) in 6,12 μg/L T-2 toxin + 0.1 mg/L selenium groups were significantly higher than those in T-2 toxin groups (0.52 ± 0.05,0.72 ± 0.05,t =-25.977,-10.776,P ＜ 0.05).Compared with the control group [(5.33 ± 0.85)％,(4.03 ± 1.15)％],C28/I2 cells early apoptosis rates [(8.26 ± 1.51)％,(13.00 ± 0.72)％,(13.19 ± 1.05)％] in each of IGF-1R inhibitor groups,and late apoptosis rates [(8.50 ± 0.71)％,(14.21 ± 1.10)％] in 500,1 000 μg/L IGF-1R inhibitor groups were increased significantly (P ＜ 0.05).Conclusions The expressions of IGF-1R in the cartilage tissue of KBD children and T-2 toxin-poisoned rats under low selenium condition are decreased.T-2 toxin decreases the expression of IGF-1R in chondrocytes,and selenium can partly inhibit the effect of T-2 toxin on IGF-1R.Down-regulation of IGF-1R causes chondrocyte apoptosis,and it may play an important role in KBD chondrocyte apoptosis.

Construction and application of information system of nursing quality management based on PDCA vision field / 中国实用护理杂志

Objective To design and apply the nursing quality management system of our hospital in order to strengthen nursing informationization construction, and improve management efficiency of nursing quality. Methods Based on the original design of nursing management system, the quality management system which take nursing as the main part was researched and developed by us and applied to the clinical. Our nursing management department combined PDCA cycle with our nursing quality management, and developed nursing unit quality evaluation criteria, each ward were checked by evaluating group of nursing quality management, the analysis and corrective measures should be asked to put forward. Results From July to December in 2016, nursing accidents, pressure ulcer, tumbling, pipe slippage, medication, errors and all adverse events incidence compared with 2015 year dropped 60.00％(0.03/0.05), 43.33％ (0.13/0.30), 50.00％ (0.04/0.08), 40.00％ (0.04/0.10), 33.33％ (0.01/0.03),43.85％(0.25/0.57), and all adverse events in 2016 compared to the period of 2015 had statistically difference (χ2=7.266, P<0.05), and the problem rectification rate was significantly higher than before(χ2=-3.212--2.637,P<0.05). Conclusion The construction and application of nursing quality management system realized the informationization and resource sharing of nursing quality management, it will help the quality of management to upgrade continuously and improve the efficiency of nursing quality management.

Application of fracture liaison service model in patients with osteoporotic vertebral compression fractures / 中华创伤杂志

Objective To investigate the effects of fracture liaison service(FLS)model on the medication compliance of patients,quality of life,pain and re-fracture rate in patients with osteoporotic vertebral compression fracture(OVCF).Methods A prospective case control study was conducted to analyze the clinical data of 117 OVCF patients admitted to Department of Pain of Guizhou Provincial People's Hospital from January 2017 to September 2017.According to the random table method,patients were divided into control group(58 patients)and intervention group(59 patients).Routine nursing was adopted in the control group,and fracture liaison service mode was adopted in the intervention group on the basis of the control group until 3 months after discharge.Morisky scale was used to compare the medication compliance of patients on admission,at discharge,1 month,and 3 months after discharge,and SF-36 was used to evaluate the quality of life.The SF-36 scale contained eight dimensions including physiological function,physiological performance,physical pain,overall health,varsity,social function,emotional function and mental health.Visual analogue scale(VAS)was used to evaluate the pain of patients.The re fracture rates of the two groups were compared.Results There were no significant differences between the two groups concerning gender,age,history of diabetes,history of hormone use,number of vertebral fractures,fracture site and cause of injury(P＞0.05).In the intervention group,the medication compliance scores of patients in the first and third months after discharge were(5.5±2.0)points and(6.3±1.8)points,which were higher than those in the control group [(3.5 ±2.2)points and(3.3± 1.8)points](P＜0.05).Within each group,there were significant differences among the medication compliance scores at the different time points of evaluation(on admission,at discharge,1 month,and 3 months after discharge).The scores of the eight dimensions of the SF-36 scale in the intervention group were higher than those in the control group at 1 st and 3rd months after discharge(P＜0.05).Within each group,there were significant differences among the SF-36 scores at the different time points of evaluation.The pain scores of the intervention group at discharge and 1st and 3rd months after discharge were(3.1±1.7)points,(1.8±1.3)points,(1.4±1.3)points,all lower than those in the control group [(5.2±1.7)points,(3.6±1.6)points,(2.7±1.8)points](P＜0.05).Within each group,there were significant differences among the pain scores at the different time points of evaluation.At 1 st and 3rd months after discharge,the re-fracture rates of the intervention group were both 2％,and the those of the control group were 3％and 9％,respectively,showing no significant difference between the two groups(P＞0.05).Conclusion The FI.S model can effectively alleviate the pain of OVCF patients,improve the medication compliance and quality of life of patients after discharge,but it cannot reduce the short-term re fracture rate after discharge.

Long Non-Coding RNA Expression Profile in Vascular Endothelial Cells before and after Infected by Dengue Virus Type Ι / 中山大学学报(医学科学版)

@#【Objective】 To use high- throughout sequencing technologies for examining differentially expressed long non-coding RNA（lncRNA）in human umbilical vein endothelial cell（HUVEC）infected by dengue virus type Ι（DENV-1）， to analyze and explore the potential molecular mechanisms of HUVEC dysfunction or damage.【Methods】After 24 hours of DENV-1 infection，RNA samples were extracted from control groups and viral groups. Sequencing and the differentially expressed lncRNAs were screened ，and then GO and KEGG enrichment analysis were conducted and a co- expression network map was constructed.【Results】In contrast to the control group，there were 2 623 lncRNA expressed differently， among which 1 441 were up-regulated，while 1 182 were down-regulated. It was found that the differentially expressed lncRNA and the predicted corresponding target genes were mainly distributed in the regions of biological processes of antigen presentation，interferon synthesis，apoptosis and cell adhesion. 【Conclusion】After HUVEC were infected with DENV-1，lncRNA expression profile changes significantly，which is closely related to the occurrence and development of dengue hemorrhagic fever/dengue shock syndrome（DHF/DSS）.

Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013—Evidence from Two Provinces in South of China / 华中科技大学学报（医学）（英德文版）

Along with the development of society and the rapid economic growth in the past decades,hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China.This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID),including 3229 people in Hubei province and 2628 people in Guangdong province.One-way ANOVA was used to compare the total medical expense,out-of-pocket (OOP)expense and hospital stay between variables.A multiple linear regression analysis was done to identify possible risk factors of total medical expense.The results showed that the average total medical expense per capita was 5709.89 yuan,and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province,respectively.The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuanin 2013.There were no significant differences in medical expenses between different genders of hypertensive patients (P＞0.05).People of different ages,provinces,medical insurances and medical institution levels showed significant differences in medical expenses.The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region.Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances.And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.

Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013—Evidence from Two Provinces in South of China / 华中科技大学学报（医学）（英德文版）

Along with the development of society and the rapid economic growth in the past decades,hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China.This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID),including 3229 people in Hubei province and 2628 people in Guangdong province.One-way ANOVA was used to compare the total medical expense,out-of-pocket (OOP)expense and hospital stay between variables.A multiple linear regression analysis was done to identify possible risk factors of total medical expense.The results showed that the average total medical expense per capita was 5709.89 yuan,and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province,respectively.The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuanin 2013.There were no significant differences in medical expenses between different genders of hypertensive patients (P＞0.05).People of different ages,provinces,medical insurances and medical institution levels showed significant differences in medical expenses.The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region.Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances.And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.

Exploration of the Construction of Medical Alliance Under Public and Private Partnership / 中国医院管理

The medical alliance is an important carrier for the construction of hierarchical medical treatment system.In the study,the medical alliance under public and private partnership is explored and analyzed,the necessity of private medical institutions participating in the medical alliance construction is expounded.The feasibility of the construction of medical alliance under public and private partnership is illustrated from three aspects,such as policy,theory and practice.Based on the policy background and market environment of China,challenges of the construction of public and private partnership is analyzed,and the corresponding suggestions are proposed to provide ideas for the long-term development of medical alliance in China.

Feasibility Analysis and Path Choice of the Corporate Governance of Medical Alliance in China / 中国医院管理

The medical alliance,as a new exploration of the joint structure of medical institutions at present,can promote the sinking of quality medical resources and promote the integration of medical resources in the region.Medical governance is one of the most important way for medical reform in China.In the paper,the path choice of the corporate governance of medical alliance is explored,and the corresponding policy suggestions are proposed.