BACKGROUND:Socket-shield technique can effectively maintain labial soft and hard tissues,but the incidence of postoperative complications such as exposure and displacement of root shield is relatively high.It is speculated that the root shield may be exposed and displaced due to excessive load after long-term function of dental implants. OBJECTIVE:Through three-dimensional finite element analysis,we aim to study the influence of varying root shield thicknesses on the stress distribution,equivalent stress peaks,and displacement in the root shield,periodontal ligaments,implant,and surrounding alveolar bone under normal occlusal loading.We also attempt to analyze the correlation between the thickness of the root shield and occurrence of mechanical events such as root shield exposure,displacement,and fracture. METHODS:Cone-beam CT data of a patient who met the indication standard of socket-shield technique for maxillary central incisor were retrieved from database.Reverse engineering techniques were used to build models of the maxillary bone and root shield,while forward engineering was used to create models for the implant components based on their parameters.Models depicting various root shield thicknesses(0.5,1.0,1.5,and 2.0 mm)were created using Solidworks 2022 software.ANSYS Workbench 2021 software was then used to simulate and analyze the effects of varying root shield thicknesses on stress distribution,equivalent stress peaks,and displacement of the root shields,periodontal ligaments,implants,and surrounding alveolar bone under normal occlusion. RESULTS AND CONCLUSION:(1)In all root shield models,the stress was concentrated on the palatal cervical side,both sides of the edges and the lower edge of the labial side.As the thickness of the root shield increased,the equivalent stress peak and displacement showed a decreasing trend.The 0.5 mm thickness model produced a stress concentration of 176.20 MPa,which exceeded the yield strength(150 MPa)of tooth tissue.(2)The periodontal ligament stress in each group was concentrated in the neck margin and upper region.With the increase of root shield thickness,the equivalent stress peak and displacement of periodontal ligament showed a decreasing trend.(3)Implant stress in all models was concentrated in the neck of the implant and the joint of the implant-repair abutment,and the labial side was more concentrated than the palatal side.With the increase of root shield thickness,the equivalent stress peak of the implant in the model showed an increasing trend.(4)In each group of models,stress of cortical bone concentrated around the neck of the implant and the periphery of the root shield,and the labial side was more concentrated than the palatal side.With the increase of the thickness of the root shield,the equivalent stress peak around the root shield decreased;the peak value of the equivalent stress of the bone around the neck of the implant showed an increasing trend.In the model,the stress of cancellous bone was mainly concentrated around the neck of the lip of the implant,the top of the thread,the root tip and the lower margin of the root shield,and the labial side was more concentrated than the palatal side.With the increase of the thickness of the root shield,the peak value of the equivalent stress of the bone around the root shield in the model showed a decreasing trend.The minimum principal stress of cortical bone in each group of models was concentrated around the neck of the implant,exhibiting a fan-shaped distribution.As the thickness of the root shield increased,the minimum principal stress of cortical bone showed an increasing trend.(5)These results indicate that different thicknesses of the root shield have different biomechanical effects.The root shield with a thickness of 0.5 mm is easy to fracture.For patients with sufficient bone width,the root shield with a thickness of 2.0 mm is an option to reduce the risk of complications such as root shield exposure,fracture,and displacement.Meanwhile,it should be taken into account to protect the periodontal ligament in the preparation process,and rounding treatments ought to be carried out on both sides and the lower edge of the root shield.

ObjectiveTo investigate the expression level of lysophosphatidyllecithin acyltransferase 4 （LPCAT4） in pancreatic cancer and its effect on the proliferation of pancreatic cancer cells. MethodsIn this study， the differentially expressed genes of patients with KRAS mutant and wild-type pancreatic cancer were analyzed by online database LinkedOmics. The LPCAT4 expression in pancreatic cancer tissues was analyzed online by the University of Alabama at Birmingham Cancer Data Analysis （UALCAN）， Sangerbox and gene expression profile interaction analysis 2 （GEPIA2）. Kaplan-Meier Plotter database was used to explore the correlation between LPCAT4 and the prognosis of patients with pancreatic cancer. The expression of LPCAT4 in human pancreatic cancer cells were detected by quantitative real-time PCR and Western blot analysis. LPCAT4 was knocked down in the high-expressing SW1990 cell line and overexpressed in the low-expressing MIA PaCa-2 cell line. The effects of LPCAT4 expression on cell proliferation were assessed using CCK-8 and EdU assays. STRING and GEPIA2 databases were used to obtain LPCAT4 binding and coexpressed genes in tumors， which were then analyzed by GO and KEGG. ResultsAnalysis of the LinkedOmics online database revealed a significant upregulation of LPCAT4 in patients with KRAS mutant pancreatic cancer compared to patients with KRAS wild-type pancreatic cancer. The online analysis of GEPIA2， UALCAN and Sangerbox 3.0 showed that the expression of LPCAT4 was higher in pancreatic cancer than in normal tissues. Analysis of the Kaplan-Meier Plotter database revealed that high LPCAT4 expression was associated with poorer prognosis in pancreatic cancer patients.Western blot and qPCR results showed that expression of LPCAT4 in pancreatic cancer cell lines was significantly higher than in normal pancreatic ductal epithelial cells. Knockdown of LPCAT4 in SW1990 cells inhibited proliferation， while overexpression in MIA PaCa-2 cells promoted proliferation. Enrichment analysis indicated that LPCAT4 was closely related to sulfur metabolism. ConclusionsLPCAT4 is highly expressed in pancreatic cancer and is associated with poor prognosis of patients. It plays a significant regulatory role in the proliferation of pancreatic cancer cells， with its expression level closely correlated with cell proliferation capacity. These findings reveal the critical role of LPCAT4 in the malignant progression of pancreatic cancer and provide important evidence for its potential as a therapeutic target.

Objective:To examine the therapeutic effects and molecular mechanisms of nuclear receptor NR4A1 in alleviating postoperative ileus (POI) in a rat model.Methods:Twenty-four Sprague-Dawley rats were randomly(random number) divided into four groups ( n=6/group): sham-operated control, POI model, POI model + NR4A1 stimultior (Cytosporone B, 13 mg/kg), and POI model + NR4A1 antagonist (DIM-C-pPhCO2Me, 2 mg/kg). After 24 hours, intestinal tissues and serum were collected for analysis. We assessed: (1) histopathological changes, (2) intestinal motility via propulsion rate, (3) NR4A1 expression by immunohistochemistry, (4) epithelial apoptosis via TUNEL assay, (5) inflammatory cytokines (IL-6, IL-4) by ELISA, (6) tight junction protein (occludin) by Western blot, and (7) p38MAPK/NF-κB pathway activation through combined western blot and immunofluorescence analyses. Results:Compared with sham controls, POI model rats showed (all P<0.05): significantly reduced NR4A1 expression, severe mucosal damage, increased inflammatory infiltration, elevated epithelial apoptosis, decreased occludin expression, impaired intestinal motility, upregulated pro-inflammatory cytokines (IL-6, IL-4), and activated p38MAPK/NF-κB signaling. NR4A1 activation with Cytosporone B significantly reversed these pathological changes (all P<0.05), while NR4A1 inhibition exacerbated them. Conclusions:NR4A1 activation attenuates POI by suppressing p38MAPK/NF-κB-mediated inflammation and preserving intestinal barrier function, suggesting its potential as a therapeutic target for postoperative ileus.

Objectives:To investigate the incidence,relative risk factors and treatment strategies of rod breakage after correction and internal fixation of adult spinal deformity(ASD).Methods:The clinical data of ASD patients treated with posterior corrective operation and internal fixation in the Department of Orthopedics of Xinqiao Hospital between January 2015 and December 2019 were analyzed retrospectively.A total of 79 patients aged 45-75 years(62.1±7.7 years)were included.The follow-up period was 24-59 months(30.6±9.2 months).According to whether the rod was broken during the follow-up period,the patients were divided into rod fracture group(RF group)and rod non-fracture group(NRF group).The sex,age,body mass index(BMI),bone mineral density(BMD)T value,complications and follow-up time of the two groups were recorded.The sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracic kyphosis(TK),lumbar lordosis(LL),LL-TK value,PI-LL value,and coronal Cobb angle were measured before and after operation.The operation-related information of the two groups was collected,including operative time,intraoperative blood loss,the number of fixed fusion segments,whether three-column osteotomy,whether the lower fixed ver-tebrae involved the sacrum or pelvis,and whether there was interbody fusion.The position,time and revision operation of the broken rod in the RF group were recorded.The data of the two groups were compared and analyzed by Spearman test,and the positive parameters were further analyzed by multivariate logistic regres-sion to find potential risk factors for rod fractures.Odds ratio(OR)and 95％confidence interval(CI)were cal-culated.Results:Among the 79 patients,rod fracture occurred in 14 patients(17.7％),with bilateral fracture in 11 cases and unilateral fractures in 3 cases.The time of rod fracture occurred at 6-31 months after oper-ation(averaged 16 months),which occurred at the early stage after operation(within 24 months)in 10 patients(71.4％)and at 24 months after operation in 4 patients(28.6％).The rod fracture occurred at the osteotomy site in 11 cases and at T10-12 level in 3 cases.Spearman test showed that younger age(P=0.038),more lev-els of fusion(P＜0.001),3-column osteotomy(P＜0.001)and bigger preoperative SV A(P＜0.00 1)were correlated with rod breakage.Multivariate logistic regression analysis showed that more levels of fusion(P=0.037,OR=2.043,95％CI=1.046-3.992),3-column osteotomy(P=0.044,OR=0.113,95％CI=0.014-0.941),and bigger preop-erative SVA(P=0.006,OR=1.1 19,95％CI=1.032-1.212)were the risk factors of rod breakage after corrective surgery for ASD patients.11 patients(78.6％)underwent revision surgery because of intractable low back pain or progression of spinal deformities,and were replaced the broken rods through posterior primary incision ap-proach,combined with satellite rod technique;And meanwhile,out of which,5 patients underwent one-stage retroperitoneal approach for anterior iliac bone graft fusion and received satisfactory results during follow-up.Conclusions:The incidence of rod breakage after correction and internal fixation in ASD patients is high.More levels of fusion,3-column osteotomy,and greater preoperative SVA were significantly associated with rod fracture.The"Multi-rod technique"and anterior bone graft fusion technique can be used in the revision operation of rod fracture.

Liver failure （LF） is a great trouble to the majority of patients due to its severe onset， many complications， difficult treatment， poor prognosis and other characteristics. This disease is liver injury caused by infection， hepatotoxic substances， autoimmunity， circulation disorders and other factors. It is a group of common clinical symptoms mainly manifested by coagulation disorders， jaundice， hepatic encephalopathy， ascites， and so on. In traditional Chinese medicine， it falls under the categories of "tympanites"， "jaundice" and other diseases. At present， the research progress of Western medicine in the treatment of LF is slow， and its clinical application effect is still not ideal. In contrast， traditional Chinese medicine has a long history in the treatment of this disease， with over thousands of years of clinical practice and verification. It is characterized by exact efficacy and fewer side effects. The pathological mechanism of LF is extremely complex， involves a variety of signaling pathways， and is mainly related to inflammation， oxidative stress， liver fibrosis， cell apoptosis and other processes. In recent years， many studies have shown that traditional Chinese medicine can intervene in the occurrence and development of LF by mediating relevant signaling pathways in vivo， but there is still a lack of relevant summary. Therefore， this review summarized several signaling pathways related to the intervention of traditional Chinese medicine in LF by referring to and sorting out relevant literature worldwide， including nuclear factor kappa B （NF-κB）， mitogen-activated protein kinase （MAPK）， phosphatidylin-ositol-3-kinase/protein kinase B （PI3K/Akt）， transforming growth factor-β/ drosophila mothers against decapentaplegic proteins （TGF-β/Smads）， and nuclear factor erythroid 2-related factor 2/heme oxygenase-1 （Nrf2/HO-1）， and elaborated the specific mechanism of their intervention in LF. This paper aims to provide practical and effective pathways and corresponding mechanisms for the treatment of LF by traditional Chinese medicine， and to provide new ideas and a theoretical basis for the clinical treatment of LF and further scientific research.

Objective:To explore the effects of Undaria pinnatifida polysaccharides(UPPs)on depressive-like behavior,neurotransmitter content,oxidative stress,and the hypothalamus-pituitary-adrenal(HPA)axis in rats treated with chronic unpredictable mild stress(CUMS).Methods:A rat model of depression was prepared using the CUMS method,and rats were treated with normal saline(NS)or different doses of UPPs by gavage.The general condition of the rats was observed,and depressive-like behavior was detected by the open field test(OFT),sucrose preference test(SPT),and forced swimming test(FST).The activity or levels of 5-hydroxytryptamine(5-HT),dopamine(DA)and norepinephrine(NE),malondialdehyde(MDA),superoxide disidase(SOD)and catalase(CAT),adrenocorticotrop-ic hormore(ACTH),corticosterone(CORT)in the hippocampus or serum of rats were detected using commercial kits.Western Blot was used to detect the expression level of hippocampal glucocorticoid receptor(GR)protein,and hema-toxylin-eosin(HE)staining was used to observe the tissue structure of hippocampus of rats.Results:The depressive-like behavior of rats in the UPPs medium and high dose groups was significantly improved(P＜0.05).In the UPPs high dose group,the contents of 5-HT,DA,and NE in the hippocampus of rats increased(P＜0.05),while the con-tents of MDA in both serum and hippocampus decreased(P＜0.05),and the activities of SOD and CAT increased(P＜0.05).The contents of ACTH and CORT in serum decreased(P＜0.05).In the UPPs medium dose group,the levels of hippocampal MDA and CAT,as well as serum SOD,ACTH,and CORT were improved(P＜0.05).The expression level of GR protein in the hippocampus increased(P＜0.05),and the pathological changes in the hipp-ocampal dentate gyrus were significantly improved.Conclusion:UPPs can alleviate depressive-like behavior in CUMS rats,and its mechanism may be related to increasing the content of monoamine neurotransmitters in the hippocampus,reducing oxidative stress damage,and HPA axis hyperfunction.

Objective:To explore the reoperation rate and risk factors of adjacent segment disease (ASDis) in patients with lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF).Methods:The clinical data of 460 patients who underwent TLIF for lumbar degenerative diseases in our hospital from January 2011 to December 2013 were retrospectively analyzed. There were 204 males and 256 females with an age of 54.6±12.6 years (range, 20-85 years). Divided into ASDis group and None ASDis (N-ASDis) group according to the occurrence of ASDis and received surgical treatment. The age of ASDis group was 57.9±12.2 years, with 14 males and 12 females, while the age of N-ASDis group was 54.4±12.5 years, with 188 males and 246 females. Count the reoperation rate of ASDis. Compare the age, body mass index (BMI), comorbidities, surgery-related parameters, length of stay, imaging parameters before and after surgery between the two groups, and use univariate analysis and logistic regression analysis to explore risk factors for ASDis.Results:Among 460 patients who underwent TLIF due to lumbar degenerative diseases, 26 patients developed ASDis and received surgical treatment, the reoperation rate was about 5.7%. Among them, the reoperation rate of ASDis with above Pfirrmann grade III in the adjacent intervertebral disc was about 53.1% (17/32). The average onset time of adjacent segment disease was 76.3±25.0 months (range, 30-111 months). Univariate analysis showed that BMI ( t=3.86, P<0.001), history of hypertension (χ 2=5.30, P=0.021), preoperative adjacent vertebral disc degeneration (χ 2=85.90, P<0.001), preoperative adjacent spinal canal stenosis (χ 2=25.35, P<0.001), and preoperative intervertebral space height of adjacent segments ( t=4.33, P<0.001) were statistically different among patients with or without ASDis. Incorporating the above indicators into the logistic regression model, the analysis results showed that body mass index (BMI) >24.9 kg/m 2 and preoperative adjacent intervertebral disc degeneration ≥III degree were risk factors for ASDis after TLIF. Conclusion:The reoperation rate of ASDis after TLIF in patients with lumbar degenerative disease is about 5.7%. BMI>24.9 kg/m 2 and preoperative adjacent intervertebral disc degeneration ≥III degree are risk factors for ASDis and received surgical treatment after TLIF.

Through the expert questionnaire (Delphi Indagate) to form Traditional Chinese Medicine (TCM) Healthy Lifestyle Guiding Principles.We conducted two rounds of surveys of TCM experts in the field of preventive health care on the basis of previous literature research.This study was aimed to form the framework in order to entry to the TCM Healthy Life-style Guiding Principles.The results showed that the positive coefficient of experts in two rounds of investigation were 84.31％ and 100％,respectively.The authoritative decree were both more than 0.7.The expert opinion score mean median was 9.21 and 9.085.Median mean values were 7.965 and 7.925.The median scores of full marks were higher than 65.12％ and 66.67％.The minimum coefficients of variation were 0.11 and 0.10.It was concluded that in the investigation and study,the enthusiasm of the experts,professional standards and credibility were high.Expert opinion is more concentrated.Expert opinion is well coordinated and gradually converges through two rounds of surveys.Through the Delphi indagate,the basic framework and items of TCM guiding principles of healthy lifestyle were established,which laid the foundation for further standardizing the guiding principles of TCM in healthy lifestyle.

To summarize status quo of clinical application of needleless connectors, to compare effects of different types of airtight connectors in transfusion, their influence on catheter-related blood stream infections and their replacement time, and to summarize disinfecting and nursing methods, so as to provide reference for nurses in choosing best disinfecting method to prevent catheter-related blood stream infections (CRBSI), to improve nursing quality, and to reduce the patients' risk of nosocomial infection.

Objective:To study microwave-assisted extraction technique of flavonoids from Ophiopogon japonicus. Methods:The effect of the parameters,i.e.ratio of solid to liquid,microwave treatment time,microwave power and volume ratio of ethanol on extraction amount of flavonoid were analyzed by single factor experiment.Results:Optimum processing data were determined as follows:90.0% ethanol as extracting solvent,stock ratio 1:14(g/ml) ,microwave extracting for 4 minutes at the power of MED. The extraction rate was 39.7% higher than that of non-microwave's.Conclusion:Extraction of flavonoids by microwave from Ophiopogon japonicus is an eficient method.