ObjectiveTo develop and preliminarily apply a dynamic scoring information system for critically ill patients to optimize the management system for critically ill patients. Methods? Totally 55 risk factors of three groups were selected based on Acute Physiology and Chronic Health Evaluation Scoring System, Tiss-28 Scoring System 2, critical value and expert consensus and included in the information platform, which was connected to the hospital's information and data system. A dynamic scoring system was designed and developed independently. The system consisted of two modules: alarm and clinical decision-making. An operation protocol was made by the Department of Nursing and included into the nursing management system to ensure that the system could run effectively. Data of inpatients in Tenth People's Hospital of Tongji University from October 2015 to October 2017 was selected. The disease recognition of the dynamic scoring system and the existing MEWS alarm and scoring system and the success rate of treatment in critically ill patients before and after the dynamic scoring system was introduced were compared. Results? The area under receiver operating characteristic curves (AUC-ROC) of the dynamic scoring system was 0.947(95%CI 0.930-0.964), which showed higher recognition of critical illness compared with the MEWS alarm and scoring system (P＜0.05). After the dynamic information system was introduced, the success rate of treatment in critically ill patients was 68.61%, which was higher than that before it was applied (χ2=10.046; P=0.002). Conclusions? The dynamic scoring system can accurately evaluate patients' disease and provide digital data and a list of clinical decisions for nurses, thus improving the success rate of treatment in critically ill patients and enhancing nurses' clinical decision-making ability.

At present , it is necessary to improve the national medical science knowledge , and the medical popular science bases play an important role in science popularization because of its special advantages . This study introduced the general information of base for cardiac cerebral vascular disease ( CCVD) , and set up 6 exhibition areas aimed at the characteristics of CCVD .In addition, it has received good effect by increasing the popular science activities , and using network to promote and strengthen science talents training , which also promote the development of medical science , and provide better service for people′s health.

Objective To optimize nursing work process by applying the "suspected special difficult care" information reporting and monitoring system, so as to effectively reduce the incidence of adverse nursing events and ensure patients' medical care safety. Methods Through literature review and summary analysis of the causes of adverse events in the past recent 3 years, the top 10 cases of "suspected special difficult care" were selected and implanted into the information platform. The incidence of adverse events before the implementation of "suspected special difficult care" system (April to September 2015) were compared with that after the implementation (October 2015 to March 2016). SPSS 19.0 software was used to establish a database and complete data analysis. Results There were 188 cases of nursing adverse events before the implementation of the "suspected special difficult care" system, with a incidence rate of 0.53%. After the implementation, there were 116 cases of adverse events and the incidence rate decreased to 0.30%. The difference was statistically signficant (χ2=19.77, P<0.01). At the same time, the incidence of critical cases, hospitalization duration over 30 days, difficult cases, cases of potential disputes and other difficult nursing incidents all had decreased, the differences were statisticlly significant (P<0.05). Conclusions This system can optimize the clinical nursing work flow, effectively avoid the potential risks of nursing care, so as to achieve the feedforward control of nursing adverse events and minimize the occurrence and development of adverse events.

Objective To investigate a new method for fixation of nasobiliary tube after endoscopic nasobiliary draniage ( ENBD) . Methods A total of 1 127 patients underwent ENBD were randomly divided into control ( traditional method) and experimental group ( reverse-α method) . The differences in the incidence of complications, patient self-comfort and the length of taking care of nasobiliary tube were evaluated between two groups during the period of indwelling nasobiliary tube. Results The incidence of nasal mucosa of pressure sore and dystopy of nasobiliary tube in the experimental group were 14 cases and 7 cases comparing with 31 cases and 28 cases in the control group (χ2 =7. 569,14. 071,respectively;P<0. 01). Compared with the control group, the scores of nasal comfort and average length of taking care were (3. 96 ± 0. 84) and (72. 2 ± 9. 7) s higher than those of the control group (t =8. 221, 10. 063,respectively;P <0. 05). Conclusions Patient comfort during indwelling nasobiliary tube after ENBD can be effectively improved by using ‘reverse-α method’ to fix the tube. It can also reduce the complications and improve the care efficiency.

Nonimpacted third molars (N-M3s) refer to the third molars (M3s) that completely erupt and reach the occlusal plane without rotation. Although the removal of unerupted M3s in young adults is generally approved by most dentists, the decision on removal or retention of N-M3s remains challenging as a result of unawareness of the potential harm of N-M3s. Recent studies suggested that N-M3s were associated with deteriorated effects to the health of adjacent teeth, including higher risks of caries and alveolar bone resorption. Therefore, regular monitoring and early clinical decision on N-M3s are essential to reduce the risks of adverse effects on adjacent teeth. This review is structure to give a comprehensive overview of the negative impact of N-M3s to the adjacent teeth, in order to provide rational guidelines for clinical decision-making of N-M3s.

Objective:To investigate the effects of Porphyromonas gingivalis derived outer membrane vesicles (Pg OMV) on osteoclast differentiation of macrophages and its underlying mechanisms. Methods:The morphology and the size distribution of Pg OMV were analyzed by transmission electron microscopy and nanoparticle tracing analysis, respectively. The osteoclast precursors were treated with 1, 3 and 10 mg/L Pg OMV (1, 3 and 10 mg/L OMV treatment group) or phosphate buffer solution (PBS)(control group). The formation of osteoclasts was analyzed by tartrate-resistant acid phosphase (TRAP) staining and F-actin staining and real-time quantitative PCR (RT-qPCR) were used to detect the expression of Fos and matrix metallopeptidase 9 (MMP9). Polymyxin B (PMB) was used to block lipopolysaccharide (LPS) and then Pg OMV was used to treat osteoclast precursor (PMB-OMV treatment group), and OMV treatment group was used as control. TRAP and F-actin staining were used to observe the formation of osteoclasts and actin rings. The effect of Pg OMV on the expression of Toll-like receptor (TLR) 2 and TLR4 in preosteoclasts was detected by Western blotting. The osteoclast precursors were pretreated with 10, 50, 100 and 200 μmol/L C29, an inhibitor of TLR2, and then treated with Pg OMV(OMV+10, 50, 100 and 200 μmol/L C29 treatment group) and OMV treatment group without C29 pretreatment was control. TRAP and F-actin staining were used to observe the formation of osteoclasts and actin rings. The osteoclast precursor cells were treated with OMV (OMV treatment group) and OMV incubated with PMB (PMB-OMV treatment group) and the expression of TLR2 in osteoclast precursor was detected by Western blotting.Results:Pg OMV showed classical vesicular structures, and the average particle size of Pg OMV were 179.2 nm. A large number of actin rings were observed in the 3 and 10 mg/L OMV treatment groups. The percentages of TRAP-positive osteoclast area in 3 mg/L OMV treatment group [(22.6±2.1)%] and 10 mg/L OMV treatment group [(32.0±2.3)%] were significantly increased compared with control group [(4.9±0.5)%] ( P<0.001). Compared with the control group (1.000±0.029), the mRNA relative expression of Fos in 3 mg/L OMV treatment group (1.491±0.114) and 10 mg/L OMV treatment group (1.726±0.254) was significantly increased ( P=0.013, P=0.001). Compared with the control group (1.007±0.148), the mRNA relative expression of MMP9 in the group of 10 mg/L OMV (2.232±0.097) was significantly increased ( P<0.001). Actin ring formation was less in PMB-OMV treatment groups than in OMV treatment groups. The proportion of TRAP-positive osteoclasts area [(14.8±3.8)%] in PMB-OMV treatment group was significantly lower than OMV treatment group [(31.5±6.7) %] ( P=0.004). The relative expression of TLR2 in OMV treatment group (1.359±0.134) was significantly higher than that in the control group (1.000±0.000) ( t=4.62, P=0.044). Compared with the OMV treatment group [(29.4±1.7)%], 50, 100 and 200 μmol/L C29 significantly decreased the formation of osteoclasts [(24.0±1.7)%, (18.5±2.1)%, (9.1±1.3) %] ( P=0.026, P<0.001, P<0.001). TLR2 protein expression in PMB-OMV group (0.780±0.046) was significantly lower than that in OMV group (1.000±0.000)( t=8.32, P=0.001). Conclusions:Pg OMV can promote osteoclast differentiation by carrying LPS, TLR2 plays an important role in Pg OMV mediated osteoclast differentiation.

This study investigated the perceptions and medical history of third molars (M3s) and assessed the prevalence of visible M3s (V-M3s) among 904 Chinese adults. The enrolled participants were interviewed to complete a structural questionnaire focused on sociodemographic information and their understanding of, attitudes toward, behaviors regarding, and medical history with respect to M3s. In addition, the number of V-M3s in the cohort was determined by oral examination. Logistic regression analysis was performed to explore the association between individuals' sociodemographic characteristics and their perception of M3s or the presence of V-M3s. The Chi-square test was used to compare the actions taken against symptomatic M3s and the corresponding outcomes among different groups divided according to respondents' sociodemographic factors. In total, 904 completed questionnaires were gathered and analyzed. Nearly half (43.9%) of the respondents knew nothing about M3s, and only 12.7% provided correct answers to all the questions asked. Male sex, older age, occupation involving physical labor, and no previous dental experience were active factors in unawareness of M3s. Male sex was also significantly associated with the presence of at least one V-M3 and negative behavior about symptomatic M3s. In terms of medical history, 192 participants reported having had at least one M3 extracted (438 in total), and 72.6% of the M3s were removed due to the presence of related symptoms or pathologies. In conclusion, the population investigated had a shortage of knowledge about M3s and adopted negative attitudes and actions about M3-related problems.

The positive regulation of bone-forming osteoblast activity and the negative feedback regulation of osteoclastic activity are equally important in strategies to achieve successful alveolar bone regeneration. Here, a molybdenum (Mo)-containing bioactive glass ceramic scaffold with solid-strut-packed structures (Mo-scaffold) was printed, and its ability to regulate pro-osteogenic and anti-osteoclastogenic cellular responses was evaluated in vitro and in vivo. We found that extracts derived from Mo-scaffold (Mo-extracts) strongly stimulated osteogenic differentiation of bone marrow mesenchymal stem cells and inhibited differentiation of osteoclast progenitors. The identified comodulatory effect was further demonstrated to arise from Mo ions in the Mo-extract, wherein Mo ions suppressed osteoclastic differentiation by scavenging reactive oxygen species (ROS) and inhibiting mitochondrial biogenesis in osteoclasts. Consistent with the in vitro findings, the Mo-scaffold was found to significantly promote osteoblast-mediated bone formation and inhibit osteoclast-mediated bone resorption throughout the bone healing process, leading to enhanced bone regeneration. In combination with our previous finding that Mo ions participate in material-mediated immunomodulation, this study offers the new insight that Mo ions facilitate bone repair by comodulating the balance between bone formation and resorption. Our findings suggest that Mo ions are multifunctional cellular modulators that can potentially be used in biomaterial design and bone tissue engineering.
Bone Regeneration ; Cell Differentiation ; Ions/pharmacology* ; Molybdenum/pharmacology* ; Osteoclasts ; Osteogenesis ; Printing, Three-Dimensional ; Tissue Scaffolds/chemistry*