Identification of injury type using somatosensory and motor evoked potentials in a rat spinal cord injury model.

The spinal cord is at risk of injury during spinal surgery. If intraoperative spinal cord injury is identified early, irreversible impairment or loss of neurological function can be prevented. Different types of spinal cord injury result in damage to different spinal cord regions, which may cause different somatosensory and motor evoked potential signal responses. In this study, we examined electrophysiological and histopathological changes between contusion, distraction, and dislocation spinal cord injuries in a rat model. We found that contusion led to the most severe dorsal white matter injury and caused considerable attenuation of both somatosensory and motor evoked potentials. Dislocation resulted in loss of myelinated axons in the lateral region of the injured spinal cord along the rostrocaudal axis. The amplitude of attenuation in motor evoked potential responses caused by dislocation was greater than that caused by contusion. After distraction injury, extracellular spaces were slightly but not significantly enlarged; somatosensory evoked potential responses slightly decreased and motor evoked potential responses were lost. Correlation analysis showed that histological and electrophysiological findings were significantly correlated and related to injury type. Intraoperative monitoring of both somatosensory and motor evoked potentials has the potential to identify iatrogenic spinal cord injury type during surgery.

Autophagy-related Proteins in Genome Stability: Autophagy-Dependent and Independent Actions.

It is emerging that autophagy-related proteins regulate the adaptive response to DNA damage in maintaining genome stability at multiple pathways. Here, we discuss recent insights into how autophagy-related proteins participate in DNA damage repair processes, influence chromosomal instability, and regulate the cell cycle through autophagy-dependent and independent actions. There is increasing awareness of the importance of these pathways mediated by autophagy-related proteins to DNA damage response (DDR), and disturbances in these regulatory connections may be linked to genomic instability participated in various human diseases, such as cancer and aging.

Sodium houttuyfonate protects against cardiac injury by regulating cardiac energy metabolism in diabetic rats.

Diabetic cardiomyopathy is a diabetic complication with complicated pathophysiological changes and pathogenesis and difficult treatment. Sodium houttuyfonate is the adduct of sodium bisulfite and houttuynin, the main volatile component in Houttuynia cordata Thunb, possesses a variety of activities including multiple interventions on inhibiting ventricular remodeling. The study aims to explore effect of sodium houttuyfonate on diabetic myocardial injury and its underlying mechanisms. The diabetes model was established by intraperitoneal injection of streptozotocin at a dose of 85 mg/kg. By intragastric administration for 26 days, sodium houttuyfonate (50 and 100 mg/kg/d) reversed the abnormal serum levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol and low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio, improved the abnormal levels of serum aspartate aminotransferase and brain natriuretic peptide, reduced electrocardiogram P-R and QRS interval extension, accelerated the heart rate, decreased serum malondialdehyde content, up-regulated the myocardial energy metabolism including elevated the contents of ATP, ADP, total adenine nucleotides and phosphocreatine in myocardium, decreased AMP/ATP ratio, elevated myocardial Ca2+-Mg2+-ATPase activity, and down-regulated the mRNA expressions of AMP protein activation kinase α2 (AMPK-α2) and peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α). In a conclusion, these results suggest that sodium houttuyfonate can improve cardiac energy metabolism disorder caused by diabetes by increasing cardiac Ca2+-Mg2+-ATPase activity and regulating AMPK signaling pathway, and then attenuates cardiac injury caused by hyperglycemia. In addition, sodium houttuyfonate also has the effects of anti-oxidation and improving abnormal levels of blood lipid.

CHK2 Promotes Metabolic Stress-Induced Autophagy through ULK1 Phosphorylation.

Reactive oxygen species (ROS) act as a signaling intermediate to promote cellular adaptation to maintain homeostasis by regulating autophagy during pathophysiological stress. However, the mechanism by which ROS promotes autophagy is still largely unknown. Here, we show that the ATM/CHK2/ULK1 axis initiates autophagy to maintain cellular homeostasis by sensing ROS signaling under metabolic stress. We report that ULK1 is a physiological substrate of CHK2, and that the binding of CHK2 to ULK1 depends on the ROS signal and the phosphorylation of threonine 68 of CHK2 under metabolic stress. Further, CHK2 phosphorylates ULK1 on serine 556, and this phosphorylation is dependent on the ATM/CHK2 signaling pathway. CHK2-mediated phosphorylation of ULK1 promotes autophagic flux and inhibits apoptosis induced by metabolic stress. Taken together, these results demonstrate that the ATM/CHK2/ULK1 axis initiates an autophagic adaptive response by sensing ROS, and it protects cells from metabolic stress-induced cellular damage.

[Narrative evidence-based medicine:a strategy for evaluation of clinical efficacy of Chinese medicine].

Rich experience of clinical diagnosis and treatment has been accumulated in the developmental history of Chinese medicine, and the efficacy has been increasingly accepted by the public. However, the evaluation of clinical efficacy is currently based more on scientific evidence instead of merely the changes of patient symptoms. In Chinese medicine, the changes of major disease indicators, patient symptoms, and pathogenesis are the major criteria for the evaluation of clinical efficacy. The lack of well-accepted and uniform criteria and the uncertainty of subjective evaluation limit the development of clinical Chinese medicine. Evidence-based medicine combines clinical skills with the current best evidence. Narrative medicine, utilizing people's narratives in clinical practice, emphasizes patient feelings, willingness, and value orientation. The introduction of both evidence-based medicine and narrative medicine into the evaluation of clinical efficacy refers to the construction of the clinical efficacy evaluation system in a paradigm of participatory diagnosis and treatment. It can fully reflect the characteristics of Chinese medicine, respect the values of patients, and achieve universal clinical evidence. Therefore, it helps to improve the diagnosis and treatment, the relationship between doctors and patients, patients' life quality and decision-making awareness, and finally the new evaluation model of clinical efficacy of Chinese medicine.

Computational Medicine: Past, Present and Future.

Computational medicine is an emerging discipline that uses computer models and complex software to simulate the development and treatment of diseases. Advances in computer hardware and software technology, especially the development of algorithms and graphics processing units (GPUs), have led to the broader application of computers in the medical field. Computer vision based on mathematical biological modelling will revolutionize clinical research and diagnosis, and promote the innovative development of Chinese medicine, some biological models have begun to play a practical role in various types of research. This paper introduces the concepts and characteristics of computational medicine and then reviews the developmental history of the field, including Digital Human in Chinese medicine. Additionally, this study introduces research progress in computational medicine around the world, lists some specific clinical applications of computational medicine, discusses the key problems and limitations of the research and the development and application of computational medicine, and ultimately looks forward to the developmental prospects, especially in the field of computational Chinese medicine.

A translational study of somatosensory evoked potential time-frequency components in rats, goats, and humans.

Somatosensory evoked potentials (SEPs) have been widely used to assess neurological function in clinical practice. A good understanding of the association between SEP signals and neurological function is helpful for precise diagnosis of impairment location. Previous studies on SEPs have been reported in animal models. However, few studies have reported the relationships between SEP waveforms in animals and those in humans. In this study, we collected normal SEP waveforms and decomposed them into specific time-frequency components (TFCs). Our results showed three stable TFC distribution regions in intact goats and rats and in humans. After we induced spinal cord injury in the animal models, a greater number of small TFC distribution regions were observed in the injured goat and rat groups than in the normal group. Moreover, there were significant correlations (P < 0.05) and linear relationships between the main SEP TFCs of the human group and those of the goat and rat groups. A stable TFC distribution of SEP components was observed in the human, goat and rat groups, and the TFC distribution modes were similar between the three groups. Results in various animal models in this study could be translated to future clinical studies based on SEP TFC analysis. Human studies were approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (approval No. UM 05-312 T/975) on December 5, 2005. Rat experiments were approved by the Committee on the Use of Live Animals in Teaching and Research of Li Ka Shing Faculty of Medicine of the University of Hong Kong (approval No. CULART 2912-12) on January 28, 2013. Goat experiments were approved by the Animal Ethics Committee of Affiliated Hospital of Guangdong Medical University (approval No. GDY2002132) on March 5, 2018.

Utility of somatosensory and motor-evoked potentials in reflecting gross and fine motor functions after unilateral cervical spinal cord contusion injury.

Fine motor skills are thought to rely on the integrity of ascending sensory pathways in the spinal dorsal column as well as descending motor pathways that have a neocortical origin. However, the neurophysiological processes underlying communication between the somatosensory and motor pathways that regulate fine motor skills during spontaneous recovery after spinal cord contusion injury remain unclear. Here, we established a rat model of cervical hemicontusive injury using C5 laminectomy followed by contusional displacement of 1.2 mm (mild injury) or 2.0 mm (severe injury) to the C5 spinal cord. Electrophysiological recordings were performed on the brachial muscles up to 12 weeks after injury to investigate the mechanisms by which spinal cord pathways participate in motor function. After spinal cord contusion injury, the amplitudes of somatosensory and motor-evoked potentials were reduced, and the latencies were increased. The forelimb open field locomotion test, grooming test, rearing test and Montoya staircase test revealed improvement in functions. With increasing time after injury, the amplitudes of somatosensory and motor-evoked potentials in rats with mild spinal cord injury increased gradually, and the latencies gradually shortened. In comparison, the recovery times of somatosensory and motor-evoked potential amplitudes and latencies were longer, and the recovery of motor function was delayed in rats with severe spinal cord injury. Correlation analysis revealed that somatosensory-evoked potential and motor-evoked potential parameters were correlated with gross and fine motor function in rats with mild spinal cord contusion injury. In contrast, only somatosensory-evoked potential amplitude was correlated with fine motor skills in rats with severe spinal cord injury. Our results show that changes in both somatosensory and motor-evoked potentials can reflect the changes in gross and fine motor functions after mild spinal cord contusion injury, and that the change in somatosensory-evoked potential amplitude can also reflect the change in fine motor function after severe spinal cord contusion injury. This study was approved by the Animal Ethics Committee of Nanfang Hospital, Southern Medical University, China (approval No. NFYY-2017-67) on June 11, 2017.

Physiological CTG interpretation: the significance of baseline fetal heart rate changes after the onset of decelerations and associated perinatal outcomes.

OBJECTIVE: To determine the perinatal outcomes in fetuses with baseline fetal heart rate changes with preceding decelerations on the cardiotocography (CTG) trace, and to interpret CTG traces from the aspect of fetal physiology. MATERIALS AND METHODS: A retrospective analysis of 500 consecutive CTG traces was carried out. The presence of repetitive variable and late decelerations followed by the changes in the baseline including baseline tachycardia and abnormal baseline variability were determined. Perinatal outcomes including Apgar scores and umbilical arterial pH at birth, NNU admission, and meconium-stained amniotic fluid were analyzed. We interpreted the changes in CTG based on fetal physiology. RESULTS: When repetitive variable and late decelerations were present without tachycardia (n = 81), none of the fetuses had an Apgar score <7 at 5 minutes or an umbilical cord pH <7. After the onset of fetal tachycardia (n = 262), fetuses showed decreased Apgar scores and umbilical arterial pH(p < .01), however, there was no significant difference in the rate of abnormal 5 min Apgar score, abnormal PH and NNU admission, if the baseline variability remained normal. However, if the baseline variability was abnormal (n = 44), (either increased or reduced) after tachycardia, there was a statistically significant increase in poor perinatal outcomes. Fetuses with abnormal versus normal variability had lower Apgar scores ≤7 at 5 min (29.6 versus 0.9%, p = .000); umbilical cord arterial pH <7 at birth (29.5 versus 0%, p = .000); increased admission to the NNU (27.3 versus 3.7%, p = .000) and increased incidence of meconium-stained amniotic fluid (38.6 versus 22.5%, p = .024). These serial changes in CTG could be interpreted and predicted by the application of fetal physiology. CONCLUSIONS: There were significant differences in perinatal outcomes when fetuses were exposed to evolving intrapartum hypoxic stress culminating in an abnormal baseline fetal heart rate variability, which was preceded by repetitive decelerations, followed by an increase in the baseline heart rate. However, despite ongoing decelerations, if the baseline variability remained normal, none of the fetuses had a pH of <7. Therefore, the knowledge of fetal physiological response to evolving hypoxic stress can be reliably used to determine fetal compensation.

Effects of different mulching modes on soil nitrate concentration and grain yield of Linum usitatissimum in dry land.

To investigate soil NO3--N dynamics and yield increasing effect of mulching planting for Linum usitatissimum (oil flax) in semi-arid Loess Plateau, we examined the effects of three mul-ching modes (whole field plastic mulching and micro ridges with soil cover and bunch-seeding; whole field plastic mulching with soil cover and bunch-seeding; and straw mulching with strips) on seed yield and distribution of soil NO3--N during the main growth periods of oil flax, with the conventional planting model as control (CK) in 2015 and 2016. Results showed that the average yield under mulching modes was increased by 56.1% (2015) and 22.7% (2016). The treatment of whole field plastic mulching with soil cover and bunch-seeding had the highest grain yield. Mulching treatments significantly increased soil water content. Soil water content was increased first and then reduced in the whole growth stage of oil flax. The soil NO3--N content was gradually decreased during the oil flax growth process. In both years, NO3--N content in 0-40 cm soil depth under mul-ching treatments were increased by 3.1%-18.6% (2015) and 5.1%-16.4% (2016) at budding stage of oil flax, respectively. The whole field plastic mulching with soil cover and bunch-seeding treatment showed the larges increases across all treatments. In 2015, NO3--N accumulation in 0-100 cm soil depth between the flowering and maturity stages of oil flax were increased by 10.2%-22.2% and 8.6%-21.4%, respectively. Especially during the more rainfall period of maturity stage, NO3--N accumulation in 0-40 cm soil depth was significantly enhanced by 3.3%-4.9% than that in 40-100 cm soil depth. It indicated that more rainfall could slow down the migration of NO3--N to the lower layer under the mulching modes in the maturity stage. In 2016, high temperature and drought at late growth stages had a great influence on oil flax growth. The NO3--N accumulation in 0-100 cm soil depth at the maturity stage was increased by 6.6%-18.0%. There was significant correlation between NO3--N content and grain yield during the main growth stages of oil flax. In conclusion, the whole field plastic mulching with soil cover and bunch-seeding treatment was the most appropriate way of oil flax production in arid and semi-arid area.

Laparoscopic surgery for endometrial cancer in aged patients: Experience from a tertiary referral center in Eastern China.

OBJECTIVE: The aim of the present study was to evaluate the feasibility and safety of laparoscopic surgery for endometrial cancer in aged patients and show the experiences of laparoscopic surgery for elderly endometrial cancer patients in Eastern China. MATERIALS AND METHODS: A total of 211 patients (≥60 years) with endometrial carcinoma treated with surgery were retrospectively analyzed, including 104 patients who underwent laparoscopic surgery, and 107 who underwent laparotomy. RESULTS: The operation time was similar in both groups (192.9 vs. 185.5 min, P = 0.722). For all cases, the estimated blood loss was less in the laparoscopic group relative to that of in the open group (227.5 vs. 382.6 ml, P = 0.000). There was no difference in the complication rate between the two groups (21.2% vs. 29.0%, P = 0.191). Overall, right pelvic and periaortic lymph node dissections were similar for the laparoscopic and laparotomy groups, but the former procedure dissected more left pelvic lymph nodes than that of in laparotomy (13.3 vs. 7.2 nodes, P = 0.038). The hospital stay was shorter after laparoscopic surgery than that of after laparotomy (7 vs. 10.5 days, P = 0.000). The recurrence rate was similar in the two groups (7.7% vs. 10.3%, P = 0.511). CONCLUSIONS: Laparoscopy could be a safe alternative to laparotomy for endometrial cancer in aged patients.

New Predictive Model at 11+0 to 13+6 Gestational Weeks for Early-Onset Preeclampsia With Fetal Growth Restriction.

The aim of the present study was to determine a predictive model for early-onset preeclampsia with fetal growth restriction (FGR) to be used at 11+0 to 13+6 gestational weeks, by combining the maternal serum level of pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PLGF), placental protein 13 (PP13), soluble endoglin (sEng), mean arterial pressure (MAP), and uterine artery Doppler. This was a retrospective cohort study of 4453 pregnant women. Uterine artery Doppler examination was conducted in the first trimester. Maternal serum PAPP-A, PLGF, PP13, and sEng were measured. Mean arterial pressure was obtained. Women were classified as with/without early-onset preeclampsia, and women with preeclampsia were classified as with/without FGR. Receiver operating characteristic analysis was performed to determine the value of the model. There were 30 and 32 pregnant women with early-onset preeclampsia with and without FGR. The diagnosis rate of early-onset preeclampsia with FGR was 67.4% using the predictive model when the false positive rate was set at 5% and 73.2% when the false positive rate was 10%. The predictive model (MAP, uterine artery Doppler measurements, and serum biomarkers) had some predictive value for the early diagnosis (11+0 to 13+6 gestational weeks) of early-onset preeclampsia with FGR.

In vitro evaluation of the flexural properties of All-on-Four provisional fixed denture base resin partially reinforced with fibers.

The aim of this study was to assess the effects of partial carbon or glass fiber reinforcement on the flexural properties of All-on-Four provisional fixed denture base resin. The carbon or glass fibers were woven (3% by weight) together in three strands and twisted and tightened between the two abutments in a figure-of-"8" pattern. Four types of specimens were fabricated for the three-point loading test. The interface between the denture base resin and fibers was examined using scanning electron microscopy (SEM). Reinforcement with carbon or glass fibers between two abutments significantly increased the flexural strength and flexural modulus. SEM revealed relatively continuous contact between the fibers and acrylic resin. The addition of carbon or glass fibers between two abutments placed on All-on-Four provisional fixed denture base resin may be clinically effective in preventing All-on-Four denture fracture and can provide several advantages for clinical use.

[Clinical evaluation of "All-on-Four" provisional prostheses reinforced with carbon fibers].

OBJECTIVE: To assess the clinical effects of carbon fiber reinforcement on the "All-on-Four" provisional prostheses. METHODS: Provisional prostheses were divided into control group and carbon fiber reinforcing group according to whether carbon fiber reinforcement was used in the provisional prostheses base resin. In our study, a total of 60 patients (32 males and 28 females) with 71 provisional prostheses(28 maxilla and 43 mandible)were enrolled between April 2008 and December 2012 for control group; a total of 23 patients (13 males and 10 females) with 28 provisional prostheses (9 maxillas and 19 mandibles) were enrolled between January 2013 and March 2014 for carbon fiber reinforcing group. The information of provisional prostheses in the patients was recorded according to preoperative examination. We used the date of definitive prosthesis restoration as the cut-off point, observing whether fracture occurred on the provisional prostheses in the two groups. Additionally we observed whether fiber exposure occurred on the tissue surface of the provisional prostheses and caused mucosal irritation. The interface between the denture base resin and the fibers was examined using scanning electron microscopy (SEM). RESULTS: The age [(57.3 ± 10.1) years vs.(55.1 ± 11.4) years], gender (32 males and 28 females vs. 13 males and 10 females), maxilla and mandible distributions (28 maxillas and 43 mandibles vs. 9 maxillas and 19 mandibles), the number of extraction jaws (46 vs. 23), the average using time [(7.8 ± 1.3) months vs. (7.5 ± 1.1) months], and the opposing dentition distributions of provisional prostheses of the patients showed no significant differences between the control and reinforcing groups. There were 21(29.6%) fractures that occurred on the 71 provisional prostheses in the control group; there was no fracture that occurred on the 28 provisional prosthesesin the carbon fiber reinforcing group. The fracture rate of the carbon fiber reinforcing group was significantly lower than that of the control group (P=0.001). No carbon fiber exposure and mucosal irritation were observed from clinical examination.SEM revealed relatively continuous contact between the fiber and acrylic resin, and the resin particles adhered on the surface of the carbon fibers. CONCLUSION: The addition of carbon fibers between abutments placed on "All-on-Four" provisional fixed denture base resin may be clinically effective in preventing "All-on-Four" denture fracture and can provide several advantages for clinical use.

Effects of a restricted fetal growth environment on human kidney morphology, cell apoptosis and gene expression.

OBJECTIVE: Kidney development is key to the onset of hypertension and cardiovascular diseases in adults, and in the fetal stage will be impaired by a lack of nutrients in utero in animal models. However, few human studies have been performed. METHODS: Kidney samples from fetuses in a fetal growth restriction (FGR) environment were collected and the morphological characteristics were observed. Potentially molecular mechanisms were explored by analyzing apoptosis and kidney-development related gene expression. RESULTS: The results indicated that no malformations were observed in the kidney samples of the FGR group, but the mean kidney weight and volume were significantly decreased. Moreover, the ratio of apoptotic cells and Bax-positive cells was increased and the ratio of Bcl-2-positive cells was decreased in the FGR group, indicating potential apoptosis induction under an in utero FGR environment. Finally, aberrant expression of renin and angiotensinogen indicated potential kidney functional abnormalities in the FGR group. CONCLUSIONS: Our study suggested increased apoptosis and decreased renin and angiotensinogen expression during human kidney development in an FGR environment. The current results will be helpful to further explore the molecular mechanism of FGR and facilitate future studies of hypertension and cardiovascular diseases and the establishment of preventive methods.

[Implanting the edentulous jaws with "All-on-4" immediate reconstruction: a preliminary clinical observation].

OBJECTIVE: To evaluate the treatment outcome of the "All-on-4" immediate loading protocol via survival rate of the implants,survival rate of the prosthesis,marginal bone, postoperative complications and patient satisfaction. METHODS: In our study, 40 patients with 49 edentulous jaws (31 mandibles and 18 maxillae) were enrolled. Each jaw was restored by the shortened dental arch prosthesis supported by only 4 implants according to the All-on-4 protocol (All-on-4, Nobel Biocare AB, Goteborg, Sweden). For all the patients enrolled in the study, the loading was applied within 12 hours of surgery. The provisional prosthesis could be replaced by the final restorations within 6 to 12 months. In the present study, the survival rate of the both implants and restorations were calculated and analyzed. The radiographic evaluation of marginal bone level changes was measured. The values of the marginal bone level changes of the angled and axial implants were analyzed by the statistic software. RESULTS: In the present study, totally 196 implants were inserted, of which 13 implants failed during the whole following up periods, with 11 implants of the maxillae and 2 of the mandibles. The survival rate of the prosthesis was 95.9% (47/49). The implant survival rate of the maxillae was 85.5% (65/76)while that for the mandibles was 98.3%(118/120). The implant survival rate of the angled implants was 91.8% (90/98), while that for the straight implants was 95.0% (93/98). No significant difference in marginal bone loss was found between angled and axial implants in the 12-month evaluation according to the Wilcoxon rank sum test (P>0.05). During the follow-up period,mechanical complications as fracture of the provisional prostheses, loose of the retain screw, or crack of the artificial teeth were found in 20 prostheses. CONCLUSION: The present preliminary data of the short term observation suggest that the "All-on-4" immediate loading protocol is a viable treatment modality for the edentulous jaws. However, long term clinical random controlled trials with large samples are still needed to confirm the validity of the technique.

[Risk factors for unintentional injury among children in rural areas of Liling, Hunan Province, China].

OBJECTIVE: To evaluate the risk factors for unintentional injury among children in the rural areas of Liling, Hunan Province, China, as a basis for developing prevention and intervention measures for unintentional injury in rural children. METHODS: A total of 3 257 students, aged between 5 and 16 years from 4 middle schools and 2 primary schools in eastern and western rural areas of Liling were recruited in October 2013 by stratified sampling and cluster sampling. The general personal information and data on family backgrounds, living environment, and incidence of unintentional injury were collected from all subjects through a self-designed questionnaire. The risk factors for childhood unintentional injury were assessed by an unconditional multiple logistic regression analysis. RESULTS: Out of the 3 257 subjects, 356 (10.93%) were injured during the 12-month period prior to the study. The univariate analysis showed that unintentional injury in these subjects was related to sex, left-behind status, times of internet surfing in internet bars per week, parent companion or not, age of guardian, degree of harmony of parents' marital relationship, employment status of one or both parents as a migrant worker, storage of fireworks and firecrackers at home or not, violence in residential areas, and participation or not in violence in residential areas. The unconditional multiple logistic regression analysis showed that the major risk factors for unintentional injury in these subjects were male gender (OR=0.751, P=0.013), left-behind status (OR=1.779, P<0.001), storage of fireworks and firecrackers at home (OR=1.337, P=0.028) and violence around residential areas (OR=1.517, P<0.001). CONCLUSIONS: Risk for unintentional injury is multifactorial among children in the rural areas of Liling, Hunan. To reduce the incidence of unintentional injury in children in Liling, particular attention should be paid to boys, left-behind children, children who have home storage of fireworks and firecrackers and children who are living in areas with frequent violence.

Field distribution of epidural electrical stimulation.

Epidural electrical stimulation has been applied in clinics for many years. However, there is still a concern about possible injury to spinal nerves. This study investigated electrical field and current density distribution during direct epidural electrical stimulation. Field distribution models were theoretically deduced, while the distribution of potentials and current were analyzed. The current density presented an increase of 70-80%, with one peak value ranging from -85° to 85° between the two stimulated poles. The effect of direct epidural electrical stimulation is mainly on local tissue surrounding the electrodes, concentrated around the two stimulated positions.

The All-on-Four implant therapy protocol in the management of edentulous Chinese patients.

PURPOSE: To evaluate the outcome and special characteristics of immediate implant rehabilitation using the All-on-Four treatment concept in completely or potentially completely edentulous Chinese patients. MATERIALS AND METHODS: A convenience sample consisted of 69 consecutive patients (37 men, 32 women; mean age: 56.7 years) treated with immediate implant placement and full-arch prosthodontic provisional prostheses between April 2008 and December 2011. Of 344 implants (192 mandibular, 152 maxillary), 240 implants were placed in fresh extraction sites. The remaining 104 implants were placed in healed sites. Implants were immediately loaded with a fixed full-arch provisional prosthesis. Implant survival rate, marginal bone loss, abutment selection, complications, and subjective patient responses were recorded during follow-up. RESULTS: Implant survival rate was 96.2% at 33.7 months of mean follow-up (range: 12 to 56 months). A statistically significantly higher implant survival rate was found in the mandible (99.0% vs 92.8%) (P < .05). No significant difference existed between survival rates for implants placed in postextraction sites and healed sites (P > .05). Peri-implant marginal bone loss around upright implants and tilted implants was 0.7 ± 0.2 mm and 0.8 ± 0.4 mm, respectively. All patients reported satisfactory treatment outcomes. CONCLUSIONS: The modified All-on-Four treatment concept provides predictably favorable outcomes in completely or potentially completely edentulous patients and is well suited to the sociodemographic needs of Chinese patients. Exploratory use of a surgical guide was limited because of mouth opening, and more angulated abutments were needed in anterior upright implants of the maxilla.

[Clinical study of immediate post-extraction implant and immediate function in edentulous patients].

OBJECTIVE: To evaluate the outcomes of immediate post-extraction implant and immediate function according to All-on-4 immediate concept in edentulous patients. METHODS: The study included 46 patients with hopeless teeth. A total of 254 implants were immediately inserted after extraction and 56 fixed complete-arch all-acrylic prostheses finished and functioned on the day of extraction from June 2008 to March 2012 in Peking University School of Stomatology. At time of abutments connection, a panoramic radiograph was taken, and radiographic assessment of the marginal bone level was performed in every 6 months. Marginal bone level, integrity of the restoration, survival of the implants and degree of satisfaction of the patients were evaluated. RESULTS: A total of 254 implants were immediate loading. Thirteen implants were lost 6 - 8 weeks after immediate loading and the survival rate of 94.9% (241/254). The marginal bone absorption was (0.7 ± 0.3) mm on average. All patients were satisfied with the clinical results. CONCLUSIONS: Immediate post-extraction implant and immediate function technique can be a predictable technique. Further study is needed to determine the long-term results of the technology.