Micromechanical modelling for bending behaviour of novel bioinspired alumina-based dental composites.

The clinical failure mode of dental crown ceramics involves radial cracking at the interface, driven by the surface tension generated from the flexure of the ceramic layer on the subsurface. This results in a reduced lifespan for most all-ceramic dental crowns. Therefore, investigating optimal material combinations to reduce stress concentration in dental crown materials has become crucial for future successful clinical applications. The anisotropic complex structures of natural materials, such as nacre, could potentially create suitable strong and damage-resistant materials. Their imitation of natural structural optimisation and mechanical functionality at both the macro- and micro-levels minimises weaknesses in dental crowns. This research aims to optimise cost-effective, freeze-casted bioinspired composites for the manufacture of novel, strong, and tough ceramic-based dental crowns. To this end, multilayer alumina (Al2O3) composites with four different polymer phases were tested to evaluate their bending behaviour and determine their flexural strength. A computational model was developed and validated against the experimental results. This model includes Al2O3 layers that undergo gentle compression and distribute stress, while the polymer layers act as stress relievers, undergoing plastic deformation to reduce stress concentration. Based on the experimental data and numerical modelling, it was concluded that these composites exhibit variability in mechanical properties, primarily due to differences in microstructures and their flexural strength. Furthermore, the findings suggest that bioinspired Al2O3-based composites demonstrate promising deformation and strengthening behaviour, indicating potential for application in the dental field.

Efficacy and safety of Wuhu oral liquid in treating acute soft tissue injuries: a multicenter, randomized, double-blind, double-dummy, parallel-controlled trial.

Background: Wuhu Oral Liquid (WHOL) is a modified preparation derived from the famous Wuhu Powder, which has a long history of use in treating traumatic injuries. This preparation has anti-inflammatory and analgesic properties and accelerates recovery following acute soft tissue injuries. Aims: To evaluate the efficacy and safety of WHOL in treating acute soft tissue injury associated with qi stagnation and blood stasis syndrome and to provide a basis for applying for the protection of varieties of Chinese medicine for WHOL. Methods: This study was a randomized, controlled, double-blind, multicenter clinical trial in which Fufang Shang Tong Capsule (FFSTC) was selected as the control drug. A total of 480 subjects with acute soft tissue injury associated with qi stagnation and blood stasis syndrome were randomly divided into a test and control group in a 3:1 ratio. The duration of drug treatment was 10 days. The primary outcome was Visual Analogue Scale (VAS) score for pain (including pain at rest and pain on activity). Secondary outcomes included the disappearance time of the pain at rest and on activity; the curative effect of TCM syndrome and improvement in the individual symptoms of TCM (swelling, ecchymosis, and dysfunction); and changes in C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Safety was assessed using vital signs, laboratory examinations, electrocardiograms, and physical examinations. Results: Patient compliance was satisfactory in both groups (all between 80% and 120%). After 4 days of treatment, the WHOL group was superior to the FFSTC group in decreasing the VAS scores for pain at rest (-1.88 ± 1.13 vs. -1.60 ± 0.93, p < 0.05) and on activity (-2.16 ± 1.18 vs. -1.80 ± 1.07, p < 0.05). After 7 days of treatment, the WHOL group was superior to the FFSTC group in decreasing the VAS scores for pain on activity (-3.87 ± 1.60 vs. -3.35 ± 1.30, p < 0.01) and improving swelling (cure rate: 60.4% vs. 46.2%, p < 0.05; obvious effective rate: 60.7% vs. 47.0%, p < 0.05). After 10 days of treatment, the WHOL group was superior to the FFSTC group in decreasing the levels of CRP (-0.13 ± 2.85 vs. 0.25 ± 2.09, p < 0.05) and improving the TCM syndrome (cure rate: 44.1% vs. 30.8%, p < 0.05) and swelling (cure rate: 75.6% vs. 67.5%, p < 0.01; obvious effective rate: 75.6% vs. 68.4%, p < 0.05; effective rate: 77.0% vs. 71.8%, p < 0.05). The disappearance time of pain at rest was 8 days in both groups and 9 days on activity in both groups. In addition, there was no statistical difference between the incidence of adverse events (4.5% vs. 2.6%, p > 0.05) and adverse reactions (0.3% vs. 0%, p > 0.05) between the WHOL group and the FFSTC group. No serious adverse events occurred in either group, and no subjects were withdrawn because of adverse events. Conclusion: WHOL relieves the symptoms caused by acute soft tissue injury associated with qi stagnation and blood stasis syndrome more rapidly than FFSTC, and it is effective and safe in the treatment of acute soft tissue injury. Future studies still need a larger sample size to verify its efficacy and safety. Clinical Trial Registration: https:// www.chictr.org.cn/showproj.html?proj=149531, Identifier ChiCTR2200056411.

Amphibious Polymer Materials with High Strength and Superb Toughness in Various Aquatic and Atmospheric Environments.

Herein, the fabrication of amphibious polymer materials with outstanding mechanical performances, both underwater and in the air is reported. A polyvinyl alcohol/poly(2-methoxyethylacrylate) (PVA/PMEA) composite with multiscale nanostructures is prepared by combining solvent exchange and thermal annealing strategies, which contributes to nanophase separation with rigid PVA-rich and soft PMEA-rich phases and high-density crystalline domains of PVA chains, respectively. Benefiting from the multiscale nanostructure, the PVA/PMEA hydrogel demonstrates excellent stability in harsh (such as acidic, alkaline, and saline) aqueous solutions, as well as superior mechanical behavior with a breaking strength of up to 34.8 MPa and toughness of up to 214.2 MJ m-3 . Dehydrating the PVA/PMEA hydrogel results in an extremely robust plastic with a breaking strength of 65.4 MPa and toughness of 430.9 MJ m-3 . This study provides a promising phase-structure engineering route for constructing high-performance polymer materials for complex load-bearing environments.

The clinical efficacy of Shengyu decoction in the treatment of anemia after PFNA for elderly intertrochanteric fracture: A protocol of prospective, randomized, controlled trial.

BACKGROUND: Femoral intertrochanteric fractures (ITF) occur frequently in the elderly, accounting for 45% of all hip fractures. Postoperative anemia after fracture tends to cause ischemia, hypoxia in cells, tissues and organs, increasing the rate of blood transfusion, risk of infection, disability and mortality. Meanwhile, traditional Chinese medicine is widely used in the treatment of anemia for activating blood circulation and removing blood stasis. METHODS: This study is a prospective, outcome assessor-, and data analyst-blinded randomized controlled clinical trial. The objective of this proposed study was to investigate whether Shengyu Decoction could improve the symptoms of anemia after proximal femoral nail antirotation in elderly ITF patients. After qualifying for screening, patients will be randomized into 2 groups with an allocation ratio of 1:1. Hemoglobin concentration, HBL, and HHS score are outcome measurements. The other outcomes also included time to get out of bed, discharge to home, 30-day readmission rates, and mortality. DISCUSSION: ITF is commonly occurring in senior citizens, and those who are senior in age generally suffer 1 or more basic diseases, whose nutritional status is already poor. Trauma and surgical stimulation not only aggravate the existing disease or induce corresponding cardiovascular complications, but also worsen the nutritional status, which can easily cause postoperative anemia in patients. Because of the limited clinical modalities available for the treatment of postoperative anemia after fracture surgery, and most of them have various side effects that are not easily tolerated by the elderly. Therefore, from a traditional Chinese medicine perspective, we proposed a protocol using mild Chinese herbal decoction to treat postoperative anemia in ITF.Registration number: OSF Registration number: DOI 10.17605/OSF.IO/JQ6ZF.

Fabrication and mechanical properties of biomimetic nacre-like ceramic/polymer composites for chairside CAD/CAM dental restorations.

OBJECTIVE: To fabricate and characterise a novel chairside CAD/CAM composite dental materials. These composites have a nacre-like anisotropic microstructure, consisting of highly aligned ceramic scaffolds infiltrated with polymer. METHOD: Bi-directional freeze casting of alumina ceramic suspension was used to fabricate highly aligned ceramic scaffolds that were subsequently uniaxially pressed to control the ceramic volume fraction and then infiltrated with UDMA/TEGDMA polymer. The produced composites were subjected to mechanical testing, namely three-point bending, hardness and fracture toughness tests. RESULTS: Novel biomimetic ceramic/polymer composites (BCPCs) were fabricated with nacre-like brick and mortar anisotropic microstructure. The mechanical properties were dependent on the ceramic volume fraction. The 70 vol% BCPC had sufficient flexural strength (135.08-145.77 MPa), stiffness (57.75-61.22 GPa) and hardness (3.07-3.36 GPa) and showed remarkable fracture resistance with KIC value of (2.54 MPa m1/2). SIGNIFICANT: Novel biomimetic ceramic/polymer composites show great potential as the next generation of CAD/CAM dental materials, as they closely resemble the combined mechanical properties of dentine and enamel.

Implementation of Enhanced Recovery After Surgery (ERAS) protocol for elderly patients receiving surgery for intertrochanteric fracture: a propensity score-matched analysis.

PURPOSE: Enhanced Recovery After Surgery (ERAS) is a multimodal approach to perioperative care that aims to reduce patient perioperative complications, accelerate patient recovery, and improve patient satisfaction by refining and optimizing all perioperative management processes. By comparing two groups of patients before and after the implementation of ERAS for intertrochanteric fracture (ITF) with a matching analysis of propensity score (PS), we aimed to demonstrate that the implementation of ERAS protocol shortens the length of hospital stay (LOS), reduces pain, decreases the incidence of postoperative complications, and promotes functional recovery of the joint. METHODS: We selected 2 periods of 1 year, before (n=98patients) and after ERAS implementation (n=92patients). Data were collected on patient demographics, operative and perioperative details, LOS, VAS score, Harris score, and 30-day complications. ERAS-trained nurses are engaged to support patients at each step of the pre/per/postoperative process, including completing a satisfaction survey, with the help of a mobile app. PS analyses were used for dealing with confounding bias in this retrospective observational study. RESULTS: After PS matching, the outcomes of 124 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was significantly reduced from 24.3±3.9 to 15.2±2.9 days (P<0.001). With the same preoperative VAS scores, we found that patients in the ERAS group had significantly lower postoperative VAS scores than those in the conventional group at days 3 and 7 (P<0.001), but the difference was not statistically significant at day 14. patients in the ERAS group had higher Harris scores than those in the conventional group at 1 and 3 months, but the difference was not significant at 6 months. In addition, we found that only one patient in the ERAS group developed complications, while nine patients in the conventional group developed different complications. There was no significant difference concerning the satisfaction survey. CONCLUSION: The introduction of ERAS for ITF in our institution has resulted in a significant decrease in LOS, alleviated patient pain, promoted early recovery of patient's hip function while effectively preventing complications, and obtained patient satisfaction.

The efficacy of Enhanced Recovery after Surgery (ERAS) for elderly patients with intertrochanteric fractures who received surgery: study protocol for a randomized, blinded, controlled trial.

BACKGROUND: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promotes repair of injured tissues and eliminates traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation and provide reliable evidence-based data for applying the program to clinical practice. METHODS/DESIGN: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time to get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home, and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. DISCUSSION: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway. TRIAL REGISTRATION: Registered on 12 October 2019. Trial number is ChiCTR1900026487.

[Analysis of correlation between the cervical spinal cord compression and the change of cervical intervertebral disc space, curvature of cervical vertebrae].

OBJECTIVE: To discuss the correlation between the degree of cervical spinal cord compression and gender, age, height of intervertebral space and the abnormality curvature of cervical vertebrae. The multivariable linear regression was used to build the prediction model of cervical spinal cord compression. METHODS: One hundred and twenty patients with cervical spondylosis were divided into 4 groups according to the degree of spinal cord compression. To measure the sagittal diameter of spinal cord (a) and medulla-pons junction (M) in MRI individually, and then calculate the ratio of a/M; according to the ratio to evaluate the degree of cervical spinal cord compression. In X-ray films to measure the height and angle of intervertebral space, curvature of cervical vertebrae (according to Borden's method and double line method of C2-7 Cobb angle to abtain data of curvature of cervical vertebrae). To performe linear regression and multiple linear regression to analyze the correlation above the data and build the prediction model of cervical spinal cord compression. RESULTS: (1) With the exacerbation of cervical spinal cord compression, all measured data gradually decreased; there was significant difference in the anterior height and angle of intervertebral space, the ratio of a/M between any two groups (P < 0.05). (2) The ratio of a/M showed positive corrrelation with the anterior height of intervertebral space (R = 0.296, P < 0.001) and the curvature of cervical vertebrae (are to chord distance, R = 0.241, P < 0.001), but showed negative corrrelation with the proportion of cervical spinal cord compression (R = -0.821, P < 0.001); Borden's method are to chord distance) showed positive correlation with the double line method of C2-7 Cobb angle (R = 0.840, P < 0.001). The predictive equation of the ratio of a/M by multiple linear regression was obtained, and the F = 8.959, R = 0.434, P < 0.001, in which the age, the anterior height of intervertebral space and the curvature of cervical vertebrae were risk factors of cervical spinal cord compression. CONCLUSION: The ratio of a/M can be a standard to evaluate degree of cervical spinal cord compression; the changes of the height of intervertebral disc, curvature of cervical vertebrae in X-ray films maybe have values to predict the degree of cervical spinal cord compression.