BACKGROUND:Amount of debris extruded apicaly is an important indicator to evaluate the effect of root canal preparation instrument. Studies have shown that debris extruded apicaly can cause post-treatment pain, and thus, reducing the amount of debris extruded apicaly can decrease the incidence of post-treatment pain. OBJECTIVE:To compare the root canal cleanness and the amount of apicaly extruded debris during root canal preparation with Self-adjusting files, ProTaper Next and ProTaper Universal. METHODS:Forty-five premolars with single canal were divided into three groups randomly, and then prepared by Self-adjusting files, ProTaper Next and ProTaper Universal, respectively. Debris extruded apicaly was colected, dried and weighed. Then roots were longitudinaly sectioned and observed under scanning electronic microscope to evaluate the cleanness of the root canal. RESULTS AND CONCLUSION:The amount of apicaly extruded debris in the ProTaper Universal group was significantly higher than that in the Self-adjusting files group and ProTaper Next group (P < 0.05), but there were no statisticaly significant differences between the groups of Self-adjusting files and ProTaper Next in apicaly extruded debris (P > 0.05). Scores on debris and smear layer were lower in the group of Self-adjusting files than the groups of ProTaper Next and ProTaper Universal (P < 0.05), but there was no difference between the latter two groups (P > 0.05). These findings indicate that the Self-adjusting files and ProTaper Next can extrude less debris beyond the apical foramen, which may decrease the incidence of post-treatment pain. Cleaning ability of Self-adjusting files is better than ProTaper Next and ProTaper Universal.

BACKGROUND:Currently, the nickel-titanium file has no uniform international standards for clinical use, and several nickel-titanium systems have unique designs in terms of cross-sectional shape, taper change,
composition number, central steel volume, and cutting edge angle, so there are some differences in cleanup
capability, security, and cutting efficiency. ProTaper Next is developed based on the ProTaper Universal, and its composition number, blade cross-sectional shape, contact point with the root canal wal and the tip tapers are al improved.
OBJECTIVE:To compare the shaping ability between ProTaper Next and ProTaper Universal Ni-Ti rotary endodontic instruments by preparing the simulated root canals.
METHODS: Two groups of resin blocks were prepared by ProTaper Next and ProTaper Universal respectively. Preparation time and incidence of canal aberration and instruments failure were recorded. After preparation, the images taken before and after preparation were superimposed and analyzed by software Adobe Photoshop v7.0. We measured the amount of resin removed at the inner and outer canal wals. The centering ability was also assessed.
RESULTS AND CONCLUSION:There was no difference in the incidence of canal aberration. ProTaper Next was faster than ProTaper Universal to prepare canals (P < 0.05). Both instruments caused apical transportation. 
ProTaper Universal F2 removed more materials than ProTaper Next X2 at the inner canal wals (P < 0.05). ProTaper Next showed better centering ability than ProTaper Universal in most levels (P < 0.05). Two instruments showed good performance in preparation but both created some apical transportation. However, the ProTaper Next was better in maintaining the original form of curved canal with safety and higher efficiency.

OBJECTIVE:To observe clinical efficacy and safety of paclitaxel or 5-fluorouracil combined with nadaplatin in the treatment of advanced nasopharyngeal carcinoma(NPC). METHODS:42 patients with advanced NPC were randomly divided into observation group and control group(n=21). 2 groups of patients were treated with radiotherapy. Observation group received che-motherapy of paclitaxel(135 mg/m2,d1)and nedaplatin(80 mg/m2,d 2-4);control group received chemotherapy of 5-fluoroura-cil(500 mg/m2,d1-5)and nedaplatin(80 mg/m2,d1-3);a treatment course lasted for 3 weeks,and both groups received 2 courses of treatment. Clinical efficacy, survival rate and ADR were observed in 2 groups. RESULTS:The overall response rate was 95.2%in observation group and 90.5% in control group,with no significant difference between 2 groups (P>0.05). The 3-year overall survival rate and progression-free survival rate were 81.0% and 71.4% in observation group and 76.2% and 66.6% in control group,with no significant difference(P>0.05). The incidence of nausea and vomiting in observation group were lower than in con-trol group,while the incidence of oral mucosa inflammation was higher than control group,with statistical significance(P<0.05). CONCLUSIONS:The chemoradiotherapy of paclitaxel or 5-fluorouracil combined with nadaplatin have similar therapeutic efficacy for advanced NPC. ADR by chemoradiotherapy should be monitored closely and treated timely.

BACKGROUND:The role of minocycline hydrochloride in adjuvant therapy of chronic periodontitis and
periodontal abscess has been widely reported, but detailed study of minocycline hydrochloride for combined periodontal-endodontic lesions is rare at present.
OBJECTIVE:To investigate the effect of minocycline hydrochloride in the treatment of combined periodontal-endodontic lesions.
METHODS:A total of 68 teeth with combined periodontal-endodontic lesions were treated with periodontal mechanical treatment and root canal therapy. According to the patient’s wiling, 68 patients were divided into experimental group (n=24; local injection of minocycline hydrochloride after periodontal mechanical treatment), positive control group (n=24; local injection of iodine glycerol after periodontal mechanical treatment), and
negative control group (n=20; no injection after periodontal mechanical treatment). These three groups were reviewed 1 month after periodontal mechanical treatment, and the differences before and after treatment were compared, including periodontal probing depth, attachment loss and gingival bleeding index.
RESULTS AND CONCLUSION: Probing depth, attachment loss and gingival bleeding index in three groups were significantly improved after 1 month of periodontal mechanical treatment (P< 0.05); both probing depth and
sulcus bleeding index in experimental group and positive control group were better than that of the negative
control group (P < 0.05), and probing depth and sulcus bleeding index in experimental group were better than that
of positive control group (P < 0.05). Experimental findings indicate that, in the clinical treatment of combined
periodontal-endodontic lesions, in addition to periodontal mechanical treatment and root canal therapy, local application of minocycline hydrochloride can effectively reduce the depth of periodontal pocket, improve gingival inflammatory
conditions and consolidate curative effect.

Objective To investigate the feasibility of gene delivery to the ischemic myocardium of rabbits by ultrasound-mediated destruction of microbubbles. Methods A ligation model of left circumflex branch coronary artery was established in 48 rabbits. Three days after ligation, the mixture of gene and microbubbles was infused into the vein of rabbits with or without simultaneous ultrasound. Additional controls included ultrasound of microbubbles that did not contain gene, gene alone, gene plus ultrasound,and blank control. Rabbits were killed after two weeks and examined for the expression of vascular endothelial growth factor(VEGF). Results The hearts of five rabbits that underwent ultrasound-mediated destruction of microbubbles containing gene showed VEGF expression in ischemic myocardium.None of the control animals showed VEGF expression. Conclusions Ultrasound-mediated destruction of microbubbles is a promising method for the delivery of bioactive agents to the heart.

Objective To summarize the clinical experiences and efficacy of laparoscopic total extraperitoneal repair(TEP) for inguinal hernia.Methods From April 2004 to August 2006,294 TEP operations was performed on 269 patients with inguinal hernia by using laparoscopy under epidural or general anesthesia.Among the patients,175 had indirect hernia,40 direct hernias,25 bilateral hernias,and 29 recurrent hernias.Results The operation was completed without converting to open surgeries in all the cases.The mean operation time was(63.1?37.5) min,blood loss(12.3 ?8.2) ml,and hospital stay(3.7 ?1.4) d.Of the patients,24 had peritoneal tearing(8.2%,24/269),4 had groin hematoma(2.4%,4/269),and 2 had foreign body sensation(0.7%,2/269).The patients were followed up for 6-12 months(median,9 months),the recurrence rate was 1.0%(3/294). Conclusion Laparoscopic TEP is safe and effective for patients with inguinal hernia.

Objective To observe the effect of RNA interference binding immunoglobulin protein (BiP) on expression of bone markers and keytranscription factors in osteoblast exposed to fluoride.Methods MC3T3-E1 cells were used as osteoblast model in vitro.The cell viability was test with cell counting Kit-8 after cells were administrated with varying concentrations of fluoride [0.0 (control),0.1,1.0,2.0,4.0,8.0,16.0,20.0,32.0 and 64.0 mg/L] for different duration.Cells transfected with small interfering RNA (siRNA) BiP were exposed to fluoride (2.0,8.0 and 20.0 mg/L) for 2 days.Real-time PCR and Western blotting technique were used to determine the gene and protein levels of BiP.Meantime,the mRNA expression of bone markers and key transcription factors was investigated by real-time PCR.Results The difference of all viability in fluoride-dose groups was statistically significant exposed for 1,3,7 and 14 days (F =46.7,118.6,214.6,325.6,all P ＜ 0.05).Expression of BiP significantly increased in cells exposed to 20.0 mg/L compared to that of control (11.22 ± 3.25 vs.7.94 ± 1.31,P ＜ 0.05).The expression of alkaline phosphatase (ALP) elevated in cells exposed to 2.0 mg/L of fluoride (12.81 ± 3.62 vs.6.86 ± 2.13,P ＜ 0.01);conversely,it significantly reduced in cells exposed to 20.0 mg/L of fluoride (0.89 ± 0.17 vs.6.87 ± 2.14,P ＜ 0.01).Cells transfected with siRNA BiP significantly decreased the ALP expression in cells exposed to fluoride compared to that of cells only exposed to the same concentration of fluorine (12.81 ± 3.62 vs.7.43 ± 2.06;5.92 ± 2.38 vs.3.96 ± 0.21,all P ＜ 0.05).Cells transfected with siRNA BiP and administrated with 2.0 mg/L significantly reduced the osteocalcin expression (4.29 ± 0.99 vs.1.29 ± 0.86,P ＜ 0.01).Similarly,expression of runt-related transcription factor 2 (Runx2) significantly increased in cells exposed to 2.0 mg/L.However,expression of Runx2 significantly decreased in cells transfected with siRNA BiP and administrated with fluoride.Cells transfected with siRNA BiP significantly decreased the Runx2 expression in cells exposed to 2.0 mg/L and 20.0 mg/L compared to that of cells only exposed to the same concentration of fluorine (1.13 ± 0.22 vs.6.61 ± 0.48;0.02 ± 0.02 vs.1.50 ± 0.38,all P ＜ 0.01).As the downstream of Runx2,the expression of osterix in cells treated with different concentrations of fluoride was similar to that of Runx2.Conclusion BiP is not directly involved in the process of osteoblast differentiation induced by fluoride;instead,it affects the expression of bone markers and key transcription factors in osteoblast exposed to fluoride.

Objective To evaluate the safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction. Methods A total of 108 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2011 to May 2014 were enrolled. The clinical suc-cess rates and the complications were reviewed. Results The clinical success rates were 92.59%(100/108). Abdomi-nal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 16.67% (18/108), 7.41% (8/108), 6.48% (7/108), respectively. The abdominal pain in most patients was self-reliev-ing except for 6 patients with perforation of colon. Patients with perforation were cured by emergency surgery. The 7 patients developing bleeding recovered themselves. Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study. As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effec-tive and safe for malignant colorectal obstruction.

Objective To investigate the clinical value of nutritional risk screening 2002(NRS2002)and malnutritional universal screening tools(MUST)in the preoperative nutrition risk evaluation of patients with gastric cancer.Methods The preoperative nutritional risk of 3 14 patients who had been admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2004 to December 2007 was assessed by subjective global assessment(SGA),NRS 2002 and M UST,and the influence of nutritional risk on the incidence of postoperative complications and hospital stay was investigated.All data were analyzed by Wilcoxon test,Kappa test and Logistics regression analysis.Results Compared with SGA,the sensitivity,specificity,positive predicting value and negative predicting value were 86.7%,74.2%,86.9% and 73.8% for NRS2002,and were 73.1%,70.6%,74.8% and 68.7% for MUST.Compared with MUST,NRS2002 had a higher consistency with SGA(K_(NRS2002)=0.601,K_(MUST)=0.436).Logistic regression analysis revealed that patients with higher MUST or NRS2002 score had higher incidence of postoperative complications and longer hospital stay.In the aspect of hospital stay,the relative risk of MUST was 2.517,which was lower than 3.426 of NRS2002.The relative risk of MUST was 0.529,which was lower than 0.642 of NRS2002 in the aspect of incidence of postoperative complications.Conclusions NRS2002 and MUST are suitable for preoperative nutritional risk screening of patients with gastric cancer,and the score of NRS2002 or MUST is associated with the incidence of postoperative complications and length of hospital stay.However,NRS2002 is more accurate than MUST in the reflection of nutritional risk of patients with gastric cancer.

Objective To investigate whether the presence of sepsis associated encephalopathy (SAE) would predict nosocomial coma (NC) and poor outcome in patients with supratentorial intracerebral hemorrhage (SICH). Methods A retrospective cohort study was conducted. The adult acute SICH patients with or without coma admitted to intensive care unit (ICU) of Shuyang People' Hospital Affiliated to Xuzhou Medical University from December 2012 to December 2015 were enrolled. Brain computed tomography (CT) scans were analyzed and the patients were divided into pre-hospital coma (PC) and NC groups. The clinical data and the incidence of SAE of patients in two groups were compared, and the 30-day prognosis was followed up. Univariate and Cox regression analyses were performed to analyze whether SAE would predict NC and poor outcome in patients with SICH. Results A total of 330 patients with acute SICH and coma were enrolled, excluding 60 cases of infratentorial cerebral hemorrhage, 3 cases of primary intraventricular hemorrhage, and 6 cases of unknown volume hematoma. Finally, 261 patients were included, with 111 patients of NC events, and 150 patients of PC events. 69 (62.2%) SAE in SICH with NC and 33 (22.2%) SAE in SICH with PC was diagnosed, and the incidence of SAE between two groups was statistically significant (P < 0.01). Compared with PC group, SICH patients in the NC group had lower incidence of hypertension (81.1% vs. 96.0%), longer time from onset to NC [days: 2.3 (23.9) vs. 0 (0.5)] and length of ICU stay [days: 5.0 (34.0) vs. 3.0 (12.0)], higher initial Glasgow coma score (GCS, 10.2±1.5 vs. 6.6±1.6) and sequential organ failure assessment (SOFA) score [4.0 (6.0) vs. 3.0 (3.0)], lower initial National Institutes of Health Stroke Scale (NIHSS) score (19.4±6.6 vs. 30.2±6.8), as well as more frequent sepsis (78.4% vs. 38.0%), vegetative state (24.3% vs. 14.0%), acute respiratory failure (24.3% vs. 10.0%), pneumonia (37.8% vs. 24.0%), septic shock (8.1% vs. 0), acute liver failure (5.4% vs. 0), hypernatremia (8.1% vs. 0), CT indicating that more frequent vasogenic edema (64.9% vs. 16.0%) and white matter lesion (13.5% vs. 2.0%), and less mannitol usage (94.6% vs. 100.0%), and less brain midline shift (32.4% vs. 68.0%) and hematoma enlargement (8.1% vs. 30.0%), less hematoma volume (mL: 28.0±18.8 vs. 38.3±24.4) in CT, and higher 30-day mortality (54.1% vs. 26.0%) with statistical differences (all P < 0.05). It was shown by Cox regression analyses that SAE [hazard ratio (HR) = 3.5, 95% confidence interval (95%CI) = 1.346-6.765, P = 0.000] and SOFA score (HR = 1.8, 95%CI = 1.073-1.756, P = 0.008) were independent risk factors of death of SICH patients with NC, and hematoma enlargement was independent risk factor of death of SICH patients with PC (HR = 3.0, 95%CI = 1.313-5.814, P = 0.000). Conclusion SAE is the independent factor of inducing NC event and poor prognosis in SICH patients.