BACKGROUND: BACKGROUND: Studies have found that surface treatment agents containing 10-methacryloyloxy decyl dihydrogen phosphate may be chemical y bonded to the oxide on the surface of zirconia, thereby notably improving the bonding performance of zirconia. OBJECTIVE: To study the effects of Mondbond N and Single bond Universal Adhesive on microtensile bond strength between zirconia and composite resin. METHODS: Sixty pieces of zirconia were randomized into three groups: in group 1, conventional Bis-GMA resin cement was used to bond zironia and composite resin; in group 2, conventional Bis-GMA resin cement was used to bond zironia and composite resin fol owing Mondbond N treatment; in group 3, conventional Bis-GMA resin cement was used to bond zironia and composite resin fol owing surface treatment with Single Bond Universal Adhesive containing 10-methacryloyloxy decyl dihydrogen phosphate. Microtensile bond strength and microstructure on the bonding interface were compared among three groups. RESULTS AND CONCLUSION: (1) Microtensile bond strength was significantly higher in the groups 2, 3 than group 1 (P < 0.05), and there was no difference between the two former groups. (2) Scanning electron microscope observation of the bonding interface: before microtensile test, there were more fissures on the bonding interface of group 1; in the group 2, there were a few fissures on the bonding interface that was relatively even; in the group 3, the bonding interface was smooth and continuous with few fissures. After microtensile, cohesive failure and bonding interface failure were mainly seen in the three groups, but there was no simple interface failure in the groups 2 and 3. These findings indicate that Monobond N and Single Bond Universal Adhesive can both improve the bonding strength of zirconia with composite resin.

ObjectiveTo evaluate term efficacy of focal cryoablation for localized single lesion prostate cancer and the protection of erectile function.MethodsFrom June 2008 to December 2009, 12 patients with localized single lesion prostate cancer were treated with focal cryoablation. All diagnoses were confirmed by transrectal ultrasound-guided prostatic biopsy. The mean Gleason score was ≤ 7; three cases had a Gleason score of 5, five cases a score of 6, and four cases a score of 7. The average preoperative value of PSA was 9.7 ng/ml ( 4.2 - 14.9 ng/ml ). The PSA level was obtained every three months for the first year and then every six months thereafter. Patients with a PSA nadir greater than 1.0 ng/ml or if the PSA nadir increased more than 2 ng/ml underwent repeat biopsy to exclude tumor recurrence.ResultsThe mean operative time was (82 ±26) minutes. The mean postoperative hospital stay was (5 ± 2) days. After catheter removal, all 12 cases had good continence and 10 had erectile function before surgery. Of the 10 patients, eight had erectile function after surgery. The follow - up ranged from 12 to 30 months ( mean 23 ).The lowest average serum PSA nadir was 2.2 ng/ml, nine patients had a minimum PSA nadir of less than 1.0 ng/ml and three had a minimum PSA nadir of more than 1.0 ng/ml. Four patients underwent repeat biopsy after abnormal PSA, and prostate cancer was detected in the contralateral gland in one patient.ConclusionsUltrasound-guided transperineal focal cryoablation is a safe and effective treatment with few complications for localized single lesion prostate cancer. Additional studies with longer follow-up are necessary for long-term efficacy.

Colorectal cancer (CRC) is one of the most common malignancies in the world.Methylene tetrahydrofolate reductase (MTHFR) is a key enzyme of folate metabolism process.In recent years,many studies indicate that MTHFR polymorphisms are significantly associated with the morbidity,response to chemotherapy and prognosis of CRC,but conclusions are inconsistent and remain to be further confirmed.

Objective:To evaluate the value of the crescent sign for predicting the invasiveness of lung adenocarcinoma presenting as pure ground-glass nodule (pGGN).Methods:The clinical, pathological and imaging data of 316 patients (320 pGGNs) confirmed lung adenocarcinoma by surgery and pathology from July 2013 to June 2018 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. All pGGNs were divided into preinvasive group (148 pGGNs) and invasive group (172 pGGNs) according to histopathology. Logistic regression analysis was used to determine the risk factors for invasiveness of pGGN, and the ROC curve analysis was performed on each risk factor.Results:Crescent sign was found in 24 cases (16.2%) in the preinvasive group and 49 (28.5%) in the invasive group, and the difference between the two groups was statistically significant (χ2=6.804 ,P=0.009).There were statistically significant differences in patient′s age, lesion size, shape, lobulation sign, and vascular stretch sign between the two groups ( P<0.05). The ROC curve showed that with the lesion size 10.5 mm as the optimal cut off value, the sensitivity for differential diagnosis of preinvasive and invasive lesions was 65.7%, the specificity was 61.5%, and the area under the curve was 0.666. Logistic regression analysis showed that maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch were independent risk factors of invasiveness of pGGN, and the OR value (95%CI) were 3.192 (1.981-5.144), 3.672 (1.545-8.725), 1.972 (1.104-3.521), and 2.026 (1.087-3.777), respectively. A logistic model was established based on the above four independent risk factors, and the area under curve was 0.711 (95%CI 0.655-0.768). Conclusion:Crescent sign can effectively reflect the invasiveness of pGGN. Maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch sign are independent risk factors of invasiveness of pGGN.

Consensus ; Hirschsprung Disease ; diagnosis ; Humans

Objective:To develop a UPLC method for the simultaneous determination of 5 components in Guilong Kechuanning tablets including paeoniflorin, berberine hydrochloride, alkaloid, cinnamic acid and cinnamaldehyde. Methods:An ACQUITY UPLC BEH C18(2.1 mm ×100 mm,1.7 μm)chromatographic column was used;the mobile phase was acetonitrile(A)–0.1% formic acid solution (B) with gradient elution (0-10 min, 85% A;10-13 min, 10% A;13-15 min, 85% A) at a flow rate of 0. 4 ml·min-1, the detection wavelengths were:0-1. 8 min, 230 nm;1. 8-6. 0 min, 345 nm;6. 0-9. 0 min, 285 nm;9. 0-12. 0 min, 345 nm, and the column temperature was 30℃. Results:The linear range of paeoniflorin, berberine hydrochloride, alkaloid, cinnamic acid and cinna-maldehyde was 0. 060-1. 202 μg(r=0. 9999),0. 100-2. 010 μg(r=0. 9999),0. 040-0. 794 μg(r=0. 9994),0. 015-0. 302 μg(r=0.9999) and 0.042-0.850 μg(r =0.9999), the average recovery (n = 6) was 99.63%,99.26%,100.17%,98.80% and 100. 26%, and the RSDs were 0. 39%,0. 97%,0. 73%,1. 00% and 0. 71%, respectively. Conclusion:The method is simple, accu-rate and reproducible. It can be used for the quality control of Guilong Kechuanning tablets.

Objective To evallhte factors affecting blood loss during mini-percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal lithotripsy(MPCNL). Methods 1156MPCNL procedures in 885 patients from July 2002 to October 2006 were reviewed. Various patientrelated and intraoperative factors were assessed for association with total blood loss using multivariate regression analysis. ResuIts The average hemoglobin drop was(14.2+8.3)g/L.The overall blood transfusion rate was 1.5%. Approximately 0.6%of patients required angiography embolization to control intractable bleeding. Multivariate regression analysis showed that the occurrence ot operative complications(6=0.496,P＜0.001),size of the tract(b=0.405,P＜0.001),mature nephrostomy tract(6=0.377,P＜0.001),multiple tracts(6=0.326,P=0.005),size of stone(b=0.210,P=0.015),operative time(6=0.139,P=0.027),renal parenehymal thickness(b=0.128,P=0.035),prior stone intervention(b=-0.121,P=0.038),diabetes(b=0.110,P=0.051),and bacteriuria(b=-0.095,P=0.058)were significant predictors of blood loss.Factors such as age,sex,side,obesity,hypertension,renal function,operating surgeon,anaesthesia,calix of puncture,number of attempts to successful puncture,urine from puncture needle may not affect the blood loss. Concluslons Maneuvers that may reduce blood loss include reducing the operative time,decreasing the occurrence of intraoperative complications, reducing the tract size and tract number, and staging the procedure.Staging the procedure of MPCNL is a judicious decision in case of a large stone burden,intraoperative complications,multiple-tract,lager tract or diabetes.

Objective:To develop a UPLC method for the simultaneous determination of 5 components in Guilong Kechuanning tablets including paeoniflorin, berberine hydrochloride, alkaloid, cinnamic acid and cinnamaldehyde. Methods:An ACQUITY UPLC BEH C18(2.1 mm ×100 mm,1.7 μm)chromatographic column was used;the mobile phase was acetonitrile(A)–0.1% formic acid solution (B) with gradient elution (0-10 min, 85% A;10-13 min, 10% A;13-15 min, 85% A) at a flow rate of 0. 4 ml·min-1, the detection wavelengths were:0-1. 8 min, 230 nm;1. 8-6. 0 min, 345 nm;6. 0-9. 0 min, 285 nm;9. 0-12. 0 min, 345 nm, and the column temperature was 30℃. Results:The linear range of paeoniflorin, berberine hydrochloride, alkaloid, cinnamic acid and cinna-maldehyde was 0. 060-1. 202 μg(r=0. 9999),0. 100-2. 010 μg(r=0. 9999),0. 040-0. 794 μg(r=0. 9994),0. 015-0. 302 μg(r=0.9999) and 0.042-0.850 μg(r =0.9999), the average recovery (n = 6) was 99.63%,99.26%,100.17%,98.80% and 100. 26%, and the RSDs were 0. 39%,0. 97%,0. 73%,1. 00% and 0. 71%, respectively. Conclusion:The method is simple, accu-rate and reproducible. It can be used for the quality control of Guilong Kechuanning tablets.

Objective:To study the prognostic risk factors of Enterobacteriaceae bloodstream infection in patients with sepsis.Methods:The medical records of patients with sepsis caused by Enterobacteriaceae bloodstream infection in our hospital from June 2017 to May 2019 were screened. The gender, age, admission department, basic disease, infection site, etiology examination and treatment plan were recorded in detail. The survival and death groups were divided according to the patient's survival status. The ratio of C-reactive protein (CRP) to serum prealbumin (PA) was recorded within 24 h after admission. The acute physiological and chronic health scores (APACHEⅡ score) and Pitt bacteremia score (PBS score) were calculated within 24 h, and based on the results of blood culture drug sensitivity test to analyze whether the initial experience treatment was appropriate. Logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients, and the receiver operating characteristic curve (ROC curve) was drawn to predict the occurrence of poor prognosis in patients with sepsis.Results:Logistic regression analysis showed that CRP ( OR=1.021, P<0.01), CRP/PA ( OR=34.638, P<0.01), extended-spectrum β-lactamase production ( OR=0.244, P<0.01), inappropriate empirical antibacterial treatment ( OR=0.156, P<0.01), APACHE Ⅱ score ( OR=1.436, P<0.01), and PBS score ( OR=8.622, P<0.01) were risk factors affecting patient's prognosis. Multivariate regression analysis showed that CRP/PA ( OR=25.420, P<0.05), inappropriate empirical treatment ( OR=0.077, P<0.05), APACHEⅡ score ( OR=1.476, P<0.01), PBS score ( OR=12.042, P<0.01) were independent risk factors for death in patients with sepsis ( P<0.05). The higher the CRP/PA level, PBS score and APACHEⅡ score, the worse the prognosis. When CRP/PA ≥0.89, PBS score ≥3.5, APACHEⅡ score ≥17.5, the patient's risk of death increased significantly. In addition, inappropriate empirical treatment was also a key factor in patients with poor prognosis. Conclusions:CRP/PA, PBS score, APACHE Ⅱ score, and inappropriate empiricaltreatment are independent risk factors affecting the prognosis of patients with enterobacter hemorrhagic infection with sepsis. The PBS score and APACHEⅡ score can better predict the poor prognosis and risk of death. Compared with APACHEⅡscore, the former is simpler and practical and can be widely used.

Bezlotoxumab is a human monoclonal antibody that can bind to C. difficile toxin B and neutralize its effects. In October 2016, bezlotoxumab was approved by the food and drug administration(FDA) to reduce the recurrence of Clostridium difficile infection (CDI) in the patients aged equal or above 18 years who are receiving antibacterial therapy. This paper introduced the pharmacology, pharmacokinetics,clinical studies,adverse reactions,interactions and medication attentions of bezlotoxumab.