International Committee for Monitoring Assisted Reproductive Technology world report: assisted reproductive technology, 2015 and 2016.

OBJECTIVE: To report utilization, effectiveness, and safety of assisted reproductive technologies in 2015 and 2016. DESIGN: Retrospective, cross-sectional survey of 3103 assisted reproductive technology clinics in 74 countries in 2015 and 3249 clinics in 79 countries in 2016 that submitted cycle and pregnancy outcome data through national and regional registries. SUBJECTS: Patients undergoing assisted reproductive technology procedures. EXPOSURE: Assisted reproductive technology. MAIN OUTCOME MEASURES: Outcomes on country, regional, and global levels. RESULTS: Reported for 2015: 2,358,239 cycles with 548,652 babies born; for 2016: 2,807,963 cycles with 647,188 babies born. Estimated in 2015, ≥2,683,677 cycles resulted in >675,134 babies; in 2016, ≥3,100,448 cycles resulted in ≥723,026 babies. Reported cycles represent approximately 80% of global utilization. In 2015 and 2016, 27.6% and 27.8%, respectively, of women undergoing fresh autologous cycles were age ≥40 years. Frozen-thawed embryo transfer cycles accounted for 47.0% and 51.9%, respectively, of all embryo transfers in 2015 and 2016. Oocyte donation cycles accounted for 6.7% and 7.1% of all embryo transfers in 2015 and 2016. Intracytoplasmic sperm injection was performed in 57.7% and 56.4% of autologous aspiration cycles in 2015 and 2016, respectively. The cumulative delivery rate per aspiration cycle for fresh and frozen-thawed embryo transfer was 32.4% in 2015 and 33.1% in 2016, respectively. The average number of transferred embryos was 1.70 in 2015 and 1.69 in 2016. The proportion of single embryo transfers in fresh autologous cycles increased from 42.1% in 2015 to 44.0% in 2016. The twin delivery rate decreased from 16.0% in 2015 to 14.7% in 2016, and the triplet rate decreased from 0.6% in 2015 to 0.4% in 2016. The proportion of single embryo transfers in frozen-thawed embryo transfer autologous cycles was 62.2% in 2015 and 64.2% in 2016, with twin and triplet rates of 10.1% and 0.3% in 2015 and 10.0% and 0.2% in 2016, respectively. CONCLUSION: Utilization of assisted reproductive technology and births per cycle increased from 2015 to 2016 while multiple births were reduced . Increasing proportion of frozen-thawed embryo transfer cycles, continuing wide variation in use of intracytoplasmic sperm injection, and increase in single embryo transfer rates are reported.

Citrate Improves Biomimetic Mineralization Induced by Polyelectrolyte-Cation Complexes Using PAsp-Ca&Mg Complexes.

Magnesium ions are highly enriched in early stage of biological mineralization of hard tissues. Paradoxically, hydroxyapatite (HAp) crystallization is inhibited significantly by high concentration of magnesium ions. The mechanism to regulate magnesium-doped biomimetic mineralization of collagen fibrils has never been fully elucidated. Herein, it is revealed that citrate can bioinspire the magnesium-stabilized mineral precursors to generate magnesium-doped biomimetic mineralization as follows: Citrate can enhance the electronegativity of collagen fibrils by its absorption to fibrils via hydrogen bonds. Afterward, electronegative collagen fibrils can attract highly concentrated electropositive polyaspartic acid-Ca&Mg (PAsp-Ca&Mg) complexes followed by phosphate solution via strong electrostatic attraction. Meanwhile, citrate adsorbed in/on fibrils can eliminate mineralization inhibitory effects of magnesium ions by breaking hydration layer surrounding magnesium ions and thus reduce dehydration energy barrier for rapid fulfillment of biomimetic mineralization. The remineralized demineralized dentin with magnesium-doped HAp possesses antibacterial ability, and the mineralization mediums possess excellent biocompatibility via cytotoxicity and oral mucosa irritation tests. This strategy shall shed light on cationic ions-doped biomimetic mineralization with antibacterial ability via modifying collagen fibrils and eliminating mineralization inhibitory effects of some cationic ions, as well as can excite attention to the neglected multiple regulations of small biomolecules, such as citrate, during biomineralization process.

Engineering of Bacillus thuringiensis Cry2Ab toxin for improved insecticidal activity.

Bacillus thuringiensis Cry2Ab toxin was a widely used bioinsecticide to control lepidopteran pests all over the world. In the present study, engineering of Bacillus thuringiensis Cry2Ab toxin was performed for improved insecticidal activity using site-specific saturation mutation. Variants L183I were screened with lower LC50 (0.129 µg/cm2) against P. xylostella when compared to wild-type Cry2Ab (0.267 µg/cm2). To investigate the molecular mechanism behind the enhanced activity of variant L183I, the activation, oligomerization and pore-formation activities of L183I were evaluated, using wild-type Cry2Ab as a control. The results demonstrated that the proteolytic activation of L183I was the same as that of wild-type Cry2Ab. However, variant L183I displayed higher oligomerization and pore-formation activities, which was consistence with its increased insecticidal activity. The current study demonstrated that the insecticidal activity of Cry2Ab toxin could be assessed using oligomerization and pore-formation activities, and the screened variant L183I with improved activity might contribute to Cry2Ab toxin's future application.

[Synergistic Benefits of Pollution and Carbon Reduction from Air Pollution Control in Hebei Province from 2013 to 2020].

Recently, China has been facing the dual challenges of air pollution control and carbon emission reduction. Pollution and carbon reduction have become a breakthrough point for green socio-economic transformation. Air pollutant and CO2 emission inventories provide a tool for monitoring pollution and carbon reduction; however, there have been some problems in previous studies, including incomplete species coverage, different source classifications, and narrow time scales. Based on the unified emission source classification system and estimation method, an emission inventory was developed for Hebei Province from 2013 to 2020, and the emission trends, structure change, driving force, synergistic benefits, and spatial distribution were analyzed. Hebei Province achieved a balance during the study period in socio-economic development and anthropogenic emission control. SO2 emissions decreased rapidly during the "Ten Atmospheric Measures" period. VOCs and NH3 emissions reduction were more significant during the "Blue Sky Defense War" period. The decrease rates of NOx and PM2.5 emissions were relatively stable, and CO2 emissions increased slightly. The coal-fired treatment effectively reduced the air pollutant and CO2 emissions and strengthening the emission standards for key industries reduced SO2, NOx, and PM2.5 emissions; however, the VOCs emission control requires improvement. Power and residential sources achieved co-reduction of air pollutants and CO2 and reducing residential coal optimized the energy structure, thereby leading to greater synergistic benefits in the residential source. The key pollution and carbon reduction areas in Hebei Province were Shijiazhuang, Tangshan, Handan, Baoding, and Langfang. The methods and conclusions in this study can provide technical and decision-making references for regional pollution and carbon reduction efforts.

Stability is essential for insecticidal activity of Vip3Aa toxin against Spodoptera exigua.

Vegetative insecticidal proteins 3A (Vip3A) were important insecticidal proteins for control of lepidopteran pests. Previous study demonstrated that Vip3Aa and Vip3Ad showed significant difference in insecticidal activities against Spodoptera exigua, while the molecular mechanism remained ambiguous. Here we demonstrated that the difference in insecticidal activities between Vip3Aa and Vip3Ad might be caused by the difference in stability of Vip3Aa and Vip3Ad in S. exigua midgut protease. Vip3Aa was quite stable while Vip3Ad could be further degraded. Molecular dynamics simulation revealed that Vip3Aa was more stable than Vip3Ad, with smaller RMSD and RMSF value. Amino acid sequence alignment indicated that three were three extra prolines (P591, P605 and P779) located on Vip3Aa. We further identified that residue P591 played a crucial role on stability and insecticidal activity of Vip3Aa. Taken together, our study demonstrated that the stability was essential for the insecticidal activity of Vip3A toxins, which might provide new insight into the action mode of Vip3A toxins and contribute to the design Vip3A variants with improved stability and insecticidal activity.

Minimum residual root dentin thickness of mandibular premolars restored with a post: A finite element analysis study.

STATEMENT OF PROBLEM: Thin root dentin after post space preparation will increase the risk of root fracture. However, the minimum residual root dentin thickness to be preserved after post space preparation is unclear. PURPOSE: The purpose of this finite element analysis (FEA) study was to measure the residual root dentin thicknesses and analyze the stress distributions of post-restored mandibular premolars. MATERIAL AND METHODS: The cone beam computed tomography (CBCT) data of 90 first and second mandibular premolars from Chinese participants (44 men, 46 women; aged between 20 and 79 years) were analyzed. Cross-sections 5 to 9 mm from the radiologic apex were used to measure the buccolingual and mesiodistal root diameters. The probability that the residual thickness of the buccolingual and mesiodistal root walls would be no less than 0.5, 0.6, 0.7, 0.8, 0.9, and 1 mm after post space preparation with a #2 Peeso reamer was calculated. Six 3-dimensional finite element models of cast post-restored mandibular premolars with 0.5, 0.6, 0.7, 0.8, 0.9, and 1 mm mesial and distal root dentin thicknesses were established. A static force of 100 N was applied to the buccal cusp tip at 45, 60, 75, and 90 degrees to the long axis of the tooth, and the maximum tensile stress and von Mises stress were analyzed. The Bonferroni post hoc test (αcorrected=.003) was used for multiple comparisons. RESULTS: The buccolingual root diameter of mandibular premolars was wider than the mesiodistal root diameter. The probabilities that the mesiodistal residual root dentin thickness of mandibular first and second premolars at 5 mm from the apex would be no less than 1 mm after post space preparation with a #2 Peeso reamer were only 10% and 28%, respectively. The maximum tensile stress was at a minimum when the mesial and distal residual root dentin thickness was 0.6 mm in the external cervical dentin adjacent to the crestal bone and 1 mm in the apical dentin corresponding to the apex of the post. The maximum tensile stress of the mandibular premolar model with 0.6-mm mesial and distal residual root dentin thicknesses was lower than that with 0.9 mm and 1.0 mm thicknesses (Pcorrected<.001). CONCLUSIONS: Short posts or smaller instruments for post space preparation are recommended to obtain a 1-mm residual root dentin thickness in the mesiodistal direction of mandibular premolars. If a 1-mm thickness cannot be preserved, a minimum residual root dentin thickness of 0.6 to 0.9 mm in the mesiodistal direction should be retained.

The role of nursing care in the type 2 diabetes treatment associated with chronic liver diseases.

OBJECTIVE: Diabetes is the fifth leading cause of death in the People's Republic of China. The aim of the article is to compare the effects of nursing care on the laboratory findings and ultrasound results of diabetic patients with chronic liver diseases (CLD) who were treated with antiglycemic drugs. METHODS: Diabetic were patients treated with metformin hydrochloride in combination with gliclazide, pioglitazone hydrochloride, sitagliptin, exenatide or liraglutide. Non-alcoholic fatty liver disease (NAFLD) was evaluated by abdominal ultrasound, and fibrosis stages were evaluated at baseline and 8 months. All the patients were equally divided into two groups depending on the therapeutic approach. RESULTS: The first group of patients additionally received nursing care, and the second group adhered to the prescribed therapy on their own. In total 90 patients, or 55.6%, had NAFLD at baseline, and its course was dependent upon changes in the weight (P = 0.009) and waist circumference (P = 0.012). The proportions of patients who demonstrated an ultrasonographic improvement in the control group were: 24 (56.8%) with gliclazide, 15 (41.3%) with pioglitazone hydrochloride, 28 (66.1%) with sitagliptin, 16 (79%) with exenatide and 15 (66.7%) with liraglutide (P = 0.2). For the group that received nursing care an ultrasonographic improvement was in: 29 (68.16%) with gliclazide, 18 (49.56%) with pioglitazone hydrochloride, 33 (79.32%) with sitagliptin, 19 (94.8%) with exenatide and 21 80.04% with liraglutide (P = 0.2). CONCLUSIONS: Outcomes from the type 2 diabetes treatment paralleling of CLD were presented. Treatment of type 2 diabetes with pioglitazone hydrochloride, gliclazide, sitagliptin, liraglutide and exenatide was proven effective.

Effect of an extrafibrillar dentin demineralization strategy on the durability of the resin-dentin bond.

OBJECTIVES: This study aimed to evaluate the potential of the extrafibrillar dentin demineralization strategy on the long-term dentin bond strength of an etch-and-rinse adhesive. METHODS: A water-soluble glycol chitosan-EDTA (GCE), a chelating conditioner, was synthesized and subjected to size-exclusion dialysis to obtain molecules >40 kDa. The conjugation of EDTA to glycol chitosan was analyzed by Fourier transform infrared (FTIR) spectroscopy. Mid-coronal dentin surfaces of 80 teeth were either acid-etched with 35% phosphoric acid or conditioned with 25 mg/mL GCE (n = 40) and thoroughly water-sprayed before applying the etch-and-rinse adhesive Adper Single Bond Plus and placing Z250 composite resin (3 M Oral Care; St Paul, MN, USA). Resin-bonded specimens were prepared into beams with a cross-sectional area of about 0.9 mm2 vertically through the resin-dentin interfaces before the microtensile bond strengths (MTBS) were determined immediately or after 3, 6, or 12 months of water storage. The resin-dentin interfaces were analyzed using transmission electron microscopy (TEM). The MTBS data were analyzed using two-way ANOVA followed by the LSD post-hoc multiple comparisons (P < 0.05). RESULTS: FTIR spectra showed that EDTA was successfully conjugated to glycol chitosan. The phosphoric acid-etching group and GCE-conditioning group showed similar bond strength values after 24 h of water storage. The bond strength of the phosphoric acid-etching group after 12-month water aging was significantly reduced from 51.61 ± 3.30 MPa to 38.57 ± 4.81 MPa, while the bond strength of the GCE-conditioning group was not significantly reduced from 50.28 ± 3.62 MPa to 46.40 ± 4.71 MPa.The degradation of the hybrid layer could be detected in the phosphoric acid-etching group after 12 months of water aging, but not in the GCE-conditioning group. CONCLUSION: The extrafibrillar dentin demineralization strategy using GCE conditioner could defy the hybrid layer degradation of the dentin bond after 12 months of water aging and enhance the dentin bond durability of the etch-and-rinse adhesive Adper Single Bond Plus.

Metabolomics based protective effect of Amygdalus mongolica on pulmonary fibrosis in rats / 药学学报

This study used pharmacology combined with metabolomics to explore the effect of Amygdalus mongolica total extract on bleomycin induced pulmonary fibrosis in rats. The rat model of pulmonary fibrosis was established by intratracheal injection of bleomycin and treated with the total extract of Amygdalus mongolica. The pathological changes of lung tissue were evaluated by hematoxylin and eosin (HE) and Masson staining, the contents of superoxide dismutase (SOD) and malondialdehyde (MDA) in lung tissue were detected, and transforming growth factor β1 (TGF-β1), Smad family member 3 (Smad3), α-smooth muscle actin (α-SMA) pathway index expression in lung tissue was detected by fluorescence quantitative PCR. UPLC-Q-TOF/MS was used to study serum metabolomics to explore the changing patterns of biomarkers and the metabolic pathways affected by them. The results showed that compared with the model group, the medium (1.5 g·kg-1) and high (3.0 g·kg-1) doses of Amygdalus mongolica total extract could significantly reduce the lung index, significantly increase the activity of SOD in serum and lung tissue, reduce the degree of alveolar inflammation and pulmonary fibrosis, and reduce MDA in serum and lung tissue, and significantly reduce TGF-β1, Smad3, α-SMA mRNA expression in lung tissue. Serum metabolomics profile analysis identified 25 significantly different metabolites, the Amygdalus mongolica total extract can participate in linoleic acid metabolism, glycerophospholipid metabolism and alpha-linolenic acid metabolism by reducing five key biomarkers: lysoPE(0∶0/22∶5(4Z,7Z,10Z,13Z,16Z)), lysoPC(20∶0/0∶0), PC(20∶5(5Z,8Z,11Z,14Z,17Z)/15∶0), 12,13-dihydroxy-9-octadecenoic acid (12,13-DHOME), 9,10-dihydroxy-12-octadecenoic acid (9,10-DHOME) to affect pulmonary fibrosis. This study preliminarily revealed the action mechanism of Amygdalus mongolica total extract against pulmonary fibrosis in rats, and provided a reference basis for the clinical application of Amygdalus mongolica. The animal experiments were approved by the Medical Ethics Committee of Baotou Medical College (No.20170315).

Separated root tip formation associated with a fractured tubercle of dens evaginatus: A case report.

BACKGROUND: Several previous studies have reported an unusual root formation in which a fractured apical fragment of an immature root continued to develop independent of the main root after trauma to an immature tooth. To date, there have been only rare reports of the continuing apical formation of the fractured root associated with dens evaginatus (DE). This paper presents a case of a separated root tip formation associated with a fractured tubercle of DE. CASE SUMMARY: An 11-year-old boy was referred for gingival sinus on the buccal side of the right mandibular second premolar (tooth # 45). Clinically, tooth # 45 was free of caries, but there was a sign of a fractured tubercle of DE on the occlusal surface. Radiography showed that the root canal of tooth # 45 was widely radiolucent. A separated root apex was found apically under the main root and was nearly completely formed with an apical orifice at the apical tip. Tooth # 45 was diagnosed as tubular fracture of DE with chronic apical periodontitis. A revascularization technique was recommended to treat the tooth. At 3-mo and 1-yr follow-up, the patient remained asymptomatic. Periapical radiography revealed that the separated root tip distally drifted with closure of the apex. However, the root length and thickness of the main root did not increased. CONCLUSION: Clinicians should be aware that even if tubercle of DE is fractured in an immature tooth, the root tip may be separated from the main root and completely formed.

Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture: A case report and review of the literature.

BACKGROUND: The success rate of conservative endodontic management for root fracture varies greatly based on different methods used. It has been rarely reported that calcium silicate-based materials are applied in root fracture treatment. CASE SUMMARY: A 38-year-old male patient presented with spontaneous pain from the upper left anterior teeth for 1 wk. The spontaneous pain was subsequently relieved, but pain on mastication persisted for 3 d. The patient had a dental trauma from a boxing match 15 years ago. Cone beam computed tomography showed that the maxillary left central incisor had oblique fracture lines and a radiolucent lesion around the fracture line. The tooth was diagnosed with an oblique root fracture with no healing and symptomatic apical periodontitis. In the following conservative endodontic management, the coronal and apical fragments of the canal both were chemo-mechanically prepared and obturated using a single cone gutta-percha with iRoot SP (Innovative BioCreamix Inc, Vancouver, Canada), a new calcium silicate-based bioceramic root canal sealer. At follow-ups at 1, 6, 12, and 24 mo, the patient was asymptomatic and the radiolucency around the fracture line was healing radiographically. CONCLUSION: Conservative root canal treatment is an alternative treatment in some cases of oblique root fracture with no healing. The application of bioceramic sealers and single core obturation techniques may also be essential to obtain an excellent outcome.

Surgical and Non-Surgical Treatment for 3-Part and 4-Part Fractures of the Proximal Humerus: A Systematic Review of Overlapping Meta-Analyses.

This systematic review of overlapping meta-analyses was conducted to propose a principle to make decisions for comparing clinical safety and efficacy of surgical and non-surgical treatment for displaced 3-part and 4-part fractures of the proximal humerus. Three electronic databases (PubMed, EMBASE, and the Cochrane Library) were systematically searched to retrieve available published systematic reviews and meta-analyses comparing surgical versus non-surgical treatment for displaced 3-part and 4-part fractures of the proximal humerus. Ten meta-analyses were identified for this investigation. Based on the application of selection with the Jadad algorithm, a meta-analysis including 6 randomized clinical trials was selected for this systematic review, which demonstrated the best available evidence that no statistically significant differences were found in the Constant score, health-related quality of life, and mortality between surgical and non-surgical treatments for displaced 3-part and 4-part fractures of the proximal humerus; however, surgical treatment was associated with a significant increase in the incidence of reoperation. This systematic review of  overlapping meta-analyses reveals that although surgical treatment is more advantageous than and superior to non-surgical treatment for displaced 3-part and 4-part fractures of the proximal humerus, the former leads to a higher incidence of postoperative complications.

Clinical study of Yangsheng-Yishen decoction combined with irbesartan in the treatment of early diabetic nephropathy / 国际中医中药杂志

Objective To evaluate the efficacy of Yangsheng-Yishen decoction combined with irbesartan in the treatment of early diabetic nephropathy (DN).Methods A total of 95 patients with early DN who met the inclusion criteria were randomly divided into control group (47 cases) and treatment group (48 cases).The control group was treated with irbesartan,while the treatment group was given Yangsheng-Yishen decoction on the basis of the control group.The two groups were treated for 6 months.The FBG,HbAlc,urinary albumin excretion rate (UAER),Scr,TG,TC,LDL-C and HDL-C were detected by automatic biochemical analyzer.The level of vascular endothelial growth factor (VEGF),platelet derived growth factor (PDGF),tumor necrosis TNF-α and transforming growth TGF-β were measured by elisa assay,and the clinical efficacy was evaluated.Results After treatment,the levels of FBG,HbAlc,UAER and SCr in the treatment group was significantly lower than those in the control group (t=3.886,4.056,9.346,8.806,all P＜0.01).After treatment,the serum TG,TC and LDL-C of the treatment group were significantly lower than those of the control group (t=8.294,12.800,6.153,all P＜0.001),and HDL-C was significantly higher than that of the control group (t=4.293,P＜0.01).The levels of serum VEGF,PDGF,TNF-α and TGF-β in the treatment group was significantly lower than those in the control group (t=13.585,11.613,10.774,10.490 respectively,all P＜0.01).Conclusions The Yangsheng-Yishen decoction combined with irbesartan can reduce blood sugar,blood lipid and urinary protein level in early DN patients,improve renal function.

Defying ageing: An expectation for dentine bonding with universal adhesives?

OBJECTIVES: The present study evaluated the long-term dentine bonding effectiveness of five universal adhesives in etch-and-rinse or self-etch mode after 12 months of water-ageing. METHODS: The adhesives evaluated included All-Bond Universal, Clearfil Universal Bond, Futurabond U Prime&Bond Elect and Scotchbond Universal. Microtensile bond strength and transmission electron microscopy of the resin-dentine interfaces created in human coronal dentine were examined after 24h or 12 months. RESULTS: Microtensile bond strength were significantly affected by bonding strategy (etch-and-rinse vs self-etch) and ageing (24h vs 12 months). All subgroups showed significantly decreased bond strength after ageing except for Prime&Bond Elect and Scotchbond Universal used in self-etch mode. All five adhesives employed in etch-and-rinse mode exhibited ultrastructural features characteristic of collagen degradation and resin hydrolysis. A previously-unobserved inside-out collagen degradation pattern was identified in hybrid layers created by 10-MDP containing adhesives (All-Bond Universal, Scotchbond Universal and Clearfil Universal Bond) in the etch-and-rinse mode, producing partially degraded collagen fibrils with intact periphery and a hollow core. In the self-etch mode, all adhesives except for Prime&Bond Elect exhibited degradation of the collagen fibrils along the thin hybrid layers. The three 10-MDP containing universal adhesives did not protect surface collagen fibrils from degradation when bonding was performed in the self-etch mode. CONCLUSIONS: Despite the adjunctive conclusion that bonds created by universal adhesives in the self-etch bonding mode are more resistant to decline in bond strength when compared with those bonds created using the etch-and-rinse mode, bonds created by universal adhesives are generally incapable of defying ageing.

Predictors of childbirth fear among pregnant Chinese women: A cross-sectional questionnaire survey.

OBJECTIVE: to examine childbirth fear and identify its predictors among pregnant Chinese women. DESIGN AND SETTING: a cross-sectional descriptive questionnaire survey was conducted in a regional teaching hospital in Guangzhou, China, between October and November 2013. PARTICIPANTS: 353 pregnant Chinese women who were at least 18 years old, with a singleton fetus, in the third trimester of pregnancy, not at high risk for complications of pregnancy, and not having had a previous caesarean section. MEASUREMENTS: a social-demographic data sheet; the Chinese version of the Childbirth Attitude Questionnaire and the Spielberger׳s State-Trait Anxiety Inventory; and the short form of 32-item Chinese Childbirth Self-Efficacy Inventory. FINDINGS: the pregnant Chinese women reported moderate levels of childbirth fear. The pregnant Chinese women who were younger, with lower educational level, not satisfied with their husbands׳ support, and with previous experience of miscarriage reported higher level of childbirth fear. Pregnant women׳s childbirth self-efficacy, state anxiety and trait anxiety were correlated with childbirth fear. The best-fit regression analysis revealed four variables that explained 28% of variance in childbirth fear: trait anxiety, state anxiety, age and previous experience of miscarriage. CONCLUSION: this study highlighted the connection between childbirth fear, state and trait anxiety, childbirth self-efficacy, age, education and previous miscarriage among pregnant Chinese women. IMPLICATIONS FOR PRACTICE: the CAQ was an appropriate method to measure childbirth fear in pregnant Chinese women. The health-care professionals should be sensitive toward issues that could affect levels of childbirth fear in pregnant Chinese women, including age, education and previous miscarriage.

FXR agonist GW4064 alleviates endotoxin-induced hepatic inflammation by repressing macrophage activation.

AIM: To examine the effect of farnesoid X receptor (FXR) activation by GW4064 on endotoxin-induced hepatic inflammation in nonalcoholic fatty liver disease (NAFLD) and the underlying mechanism. METHODS: Six-week-old male C57BL/6 mice were fed a normal diet or a high-fat (HF) diet for 8 wk. HF diet-fed mice were intraperitoneally injected with GW4064 (30 mg/kg) or DMSO (vehicle) once daily for a week and then sacrificed after lipopolysaccharide (LPS, 50 µg/mouse) administration. Hepatic inflammation, levels of the macrophage marker F4/80, and apoptosis were measured at the end of the study. Additionally, the expression of proinflammatory genes involved in NAFLD (interleukin-6, interleukin-1ß, interferon-γ, MCP-1) were analyzed by real-time PCR in the murine macrophage cell line RAW 264.7 cultured with or without GW4064 (2 µmol/L) before treatment with LPS. RESULTS: In patients with NAFLD, the expression of FXR was detected by immunohistochemical staining and the relation between FXR expression and NAFLD activity score (NAS) was analyzed. Activation of FXR by GW4064 alleviated hepatic inflammation induced by endotoxin in a murine NAFLD model fed an HF diet as reflected by reduced serum levels of aspartate aminotransferase and alanine aminotransferase. Apoptosis and proinflammatory cytokine levels in liver tissues were also reduced by GW4064, and GW4064 could reduce induction of proinflammatory cytokines by LPS in vitro. FXR levels were reduced in patients with non-alcoholic steatohepatitis compared with healthy controls and were negatively correlated with NAS. CONCLUSION: FXR activation attenuates LPS-induced hepatic inflammation in murine NAFLD by reducing expression of proinflammatory cytokines in macrophages.

Improvement of enamel bond strengths for conventional and resin-modified glass ionomers: acid-etching vs. conditioning.

OBJECTIVE: This study deals with the effect of phosphoric acid etching and conditioning on enamel micro-tensile bond strengths (µTBSs) of conventional and resin-modified glass ionomer cements (GICs/RMGICs). METHODS: Forty-eight bovine incisors were prepared into rectangular blocks. Highly-polished labial enamel surfaces were either acid-etched, conditioned with liquids of cements, or not further treated (control). Subsequently, two matching pre-treated enamel surfaces were cemented together with one of four cements [two GICs: Fuji I (GC), Ketac Cem Easymix (3M ESPE); two RMGICs: Fuji Plus (GC), RelyX Luting (3M ESPE)] in preparation for µTBS tests. Pre-treated enamel surfaces and cement-enamel interfaces were analyzed by scanning electron microscopy (SEM). RESULTS: Phosphoric acid etching significantly increased the enamel µTBS of GICs/RMGICs. Conditioning with the liquids of the cements produced significantly weaker or equivalent enamel µTBS compared to the control. Regardless of etching, RMGICs yielded stronger enamel µTBS than GICs. A visible hybrid layer was found at certain enamel-cement interfaces of the etched enamels. CONCLUSIONS: Phosphoric acid etching significantly increased the enamel µTBSs of GICs/RMGICs. Phosphoric acid etching should be recommended to etch the enamel margins before the cementation of the prostheses such as inlays and onlays, using GICs/RMGICs to improve the bond strengths. RMGICs provided stronger enamel bond strength than GICs and conditioning did not increase enamel bond strength.

Endoscopic papillary balloon intermittent dilatation and endoscopic sphincterotomy for bile duct stones.

AIM: To compare the effectiveness and safety of endoscopic papillary balloon intermittent dilatation (EPBID) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones. METHODS: From March 2011 to May 2012, endoscopic retrograde cholangiopancreatography was performed in 560 patients, 262 with common bile duct stones. A total of 206 patients with common bile duct stones were enrolled in the study and randomized to receive either EPBID with a 10-12 mm dilated balloon or EST (103 patients in each group). For both groups a conventional reticular basket or balloon was used to remove the stones. After the procedure, routine endoscopic nasobiliary drainage was performed. RESULTS: First-time stone removal was successfully performed in 94 patients in the EPBID group (91.3%) and 75 patients in the EST group (72.8%). There was no statistically significant difference in terms of operation time between the two groups. The overall incidence of early complications in the EPBID and EST groups was 2.9% and 13.6%, respectively, with no deaths reported during the course of the study and follow-up. Multiple regression analysis showed that the success rate of stone removal was associated with stone removal method [odds ratio (OR): 5.35; 95%CI: 2.24-12.77; P = 0.00], the transverse diameter of the stone (OR: 2.63; 95%CI: 1.19-5.80; P = 0.02) and the presence or absence of diverticulum (OR: 2.35; 95%CI: 1.03-5.37; P = 0.04). Postoperative pancreatitis was associated with the EST method of stone removal (OR: 5.00; 95%CI: 1.23-20.28; P = 0.02) and whether or not pancreatography was performed (OR: 0.10; 95%CI: 0.03-0.35; P = 0.00). CONCLUSION: The EPBID group had a higher success rate of stone removal with a lower incidence of pancreatitis compared with the EST group.

Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability.

Sacral fractures with both transverse and bilateral vertical fracture components are by definition multiplanar fractures, and often present with spinopelvic instability and cauda equina deficits. The treatment is challenging. Between 2006 and 2009, we treated nine such patients at our trauma centre. There were six men and three women, with a mean age of 32.2 years. Preoperative neurologic deficits were noted in seven patients; four patients had complete cauda equina paralysis, and three patients had incomplete cauda equina syndrome. All patients were treated using lumbopelvic instrumented fixation without other devices for their multiplanar sacral fractures. Six patients who had neurological deficits and sacral canal compression underwent decompression laminectomy. The mean postoperative follow-up time was 21.7 months (range, 14-32 months). All fractures went on to union without loss of reduction or hardware failure. The mean Gibbons score improved from 3.5 preoperatively to 2.3 postoperatively among the patients who underwent decompression laminectomy. Eight out of nine patients had fair or better results based on radiographic criteria and the Majeed pelvic fracture outcome score. Our experience suggests lumbopelvic fixation can be used for the treatment of multiplanar sacral fractures with spinopelvic instability with a low rate of complications. Neurologic improvement can be expected, but whether surgical decompression results in substantially better neurologic recovery than conservative treatment remains uncertain.