Objective To explore the effect of combined application of Pathfile in the VDW-Mtwo nickel titanium file in the elderly narrow canals.Methods 35 teeth with 101 root canals were divided into the two groups by drawing lots.In group A,root canals were prepared with VDW-Mtwo and Pathfile.In group B,root canals were prepared with VDW-Mtwo.All root canals were filled with continuous wave thermoplasticized gutta-percha technique.The operating time for each root canal,the number of broken instruments and postoperative pain were recorded.The efficacy of reparation was analyzed with radiography.Results The root canal preparation time of group A was (5.14 ± 1.25) min,which was significantly shorter than (6.82 ± 1.76) min of group B (t =5.539,P ＜ 0.05) ; The difference was not statistically significant in step formation and just fill rate between the two groups (P =1.00,1.74) ; The instrument intact of group A was 100.00％,which was significantly higher than 79.17％ of group B (x2 =4.279,P =0.039) ;The difference was not statistically significant in pain after operation between the two groups (P =0.20).Conclusion For narrow root canals preparation in the elderly treated with Mtwo and Pathfile would be shorten the preparation time and reduce broken instruments.

Objective To investigate technique and clinical effect of total en bloc spondylectomy for thoracic and lumbar chondrosarcoma.Methods From January 2010 to March 2012,6 patients with thoracic or lumbar chondrosarcoma underwent total en bloc spondylectomy.There were 4 males and 2 females,aged from 25 to 54 years (average,38 years).The tumor ranged from T3 to L3; 1 located in T3 and T4,1 in T7,1in T11,1 in L1,1 in L2 and 1 in L3.According to Tomita surgical classification system,there was 1 case of type 2,1 case of type 4,3 cases of type 5 and 1 case of type 6.One patient underwent tumor resection through single posterior approach,while the other 5 patients underwent anterior dissection and posterior resection of tumor.All spines were reconstructed by posterior fixation with pedicle screws and anterior interbody fusion with titanium mesh cages or artificial vertebrae.Results The average amount of blood loss was 3200 ml (range,2100 to 6300 ml).The duration of operation ranged from 3.5 to 12 hours (average,5.5hours).Two patients obtained wide resection,3 obtained marginal resection,and 1 had intralesional margin.The complications included 2 cases of cerebrospinal leak,1 case of pleural effusion and 1 case of pulmonary infection.There was no wound infection and death during peroperative period.All patients were followed up for 6 to 32 months (average,19 months).The neurological function improved from preoperative Frankel C to postoperative Frankel E in 2 cases.All patients obtained bone union 6 to 12 months (average,8 months) after operation.At final follow-up,all patients could walk without aid,and there was no recurrence.Conclusion The total en bloc spondylectomy is an effective method for thoracolumbar chondrosarcoma,which could provide a satisfied tumor control and neurological function improvement.

Objective To investigate the morbidity and related factors for osteoporosis in postmenopausal patients with type 2 diabetes mellitus (T2DM).Methods The bone mineral density (BMD) at lumbar vertebrae(L1-4), left femoral neck, femoral trochanter and total hip were measured by dual energy X-ray absorptiometry (DEXA) in 79 postmenopansal patients with T2DM.The patients were divided into two groups: osteoporosis group and non-osteoporosis group.The correlations between BMD and age, course of disease, menopausal age, menopausal duration and body mass index (BMI) were analyzed by multivariate regression analysis.Results There were significantly statistical differences in age, BMI, interleukin 6 (IL-6), osteocalcin and menopause duration between two groups.Linear correlation analysis showed IL-6 was positively correlated with osteoporosis (r=0.260, P=0.020) and glycosylated hemoglobin (GHbAlc) (r=0.259, P=0.023) Logistic regression analysis showed that the morbidity of osteoporosis had an independent positive correlation with age, but an independent negative correlation with BMI.Conclusions In postmenopausal patients with T2DM, age and low BMI are independent risk factors for osteoporosis.

Objective:To explore the effect of endoplasmic reticulum stressed (ER) on colorectal cancer (CRC) cell proliferation and invasion via ATG5-mediated autophagy pathway and the underlying mechanism.Methods:We performed bioinformatics analysis to identify the expression level of PERK, ATF6 and ATG5 in CRC tissues and adjacent tissues and the correlation between PERK and ATG5 expression in CRC tissues.The expression level of PERK in CRC cell lines was examined by qRT-PCR assay. Cell proliferation was quantified by CCK-8.The invasion of the cells was detected by Transwell.Western blot assay was performed to verify the levels of protein. The levels of autophagy were examined by electron microscopy.Results:PERK and ATF6 expression in CRC tissues was higher than that in the adjacent tissues and PERK expression was higher in CRC cells than intestinal mucosal cells. Expression level of PERK in CRC cell lines HCT116,SW480,HT29,LoVo and colonic mucosa cell lines FHC was 1.51±0.04,3.12±0.05,2.19±0.04,2.38±0.06 and 0.98±0.04 ( P<0.001) .The increased expression of PERK promoted CRC cell proliferation and invasion. PERK expression levels was positively associated with ATG5 expression levels ( r=0.52, P<0.001) and overexpression of PERK accelerated the protein expression of ATG5 (1.00±0.04,3.53±0.07, t=74.61, P<0.001) . ATG5 was highly expressed in CRC tissues. Overexpression of ATG5 could promote proliferation,invasion and accelerate autophagy of CRC cells (the number of autophagosomes in the blank control group,the negative control group and ATG5-Overexpression group was 4.33±1.53, 4.00±1.00, 9.67±2.52, and t=3.14,3.62, P=0.035,0.022, respectively) .ATG5 promoted colorectal cancer cell proliferation and invasion through autophagy pathway. Conclusion:ER stressed-CRC cells could promote CRC cell proliferation and invasion through ATG5-mediated autophagy pathway.

Although the flu vaccine is the most effective strategy for preventing influenza currently,the population incidence and mortality of influenza present an unstable trend.Due to the rapid variability of influenza virus,the conventional flu vaccine components and dominant lineage are not matching;more importantly,trivalent influenza vaccine (T IV) contains only A/H3N2,A/H1N1 and B/Victoria lineage,which does not match the B/Yamagata lineage that have prevailed in recent years.Quadrivalent influenza vaccine (QIV) adds the B/Yamagata lineage,and it has been used abroad for susceptible populations.Compared with TIV,QIV provides better protection for susceptible populations and is considered to have better public health benefits.This article reviews the history of development and current status,the safety,immunogenicity,efficacy of prevention and control and cost-effectiveness of QIV,to provide reference for the promotion and implementation of influenza vaccination.

Objective:To evaluate the detection accuracy of hepatitis B virus (HBV) serological markers among grassroots medical institutions in the demonstration areas of infectious diseases.Methods:A fixed sampling method was used among the followed-up hepatitis B cohort in general population of six infectious disease demonstration areas nationwide. Blood samples of chosen objects were collected, in which HBsAg and anti-HBs were tested by grassroots medical institutions and were also parallely tested by the third-party platform. The test results were compared between the two groups. Statistical analyses were conducted by SAS 9.4 software.Results:A total of 5 756 and 5 263 samples of HBsAg and anti-HBs were successfully tested, respectively. Comparing the results of HBsAg and anti-HBs from grassroots medical institutions with the results from the third platform, the agreement of HBsAg and anti-HBs was 97.13% and 77.33%, respectively. The Kappa value was 0.56 (95% CI 0.50-0.62) for HBsAg and 0.54 (95% CI 0.52-0.56) for anti-HBs, respectively; and the McNemar tests indicated the difference between the results (all P<0.01). There were also significant differences in agreement of testing results with the third platformin among different regions ( P<0.05 or <0.01). The Kappa values indicated that Jiangsu province and Guangdong province had high accordance rates of HBsAg (0.87 and 0.81, respectively), and Gansu province and Guangdong province had high accordance rates of anti-HBs (Both were 0.74). Regarding the results from the third platform as the standard, the sensitivity of HBsAg testing in grassroots medical institutions was moderate (40.51%) and the specificity was well (99.96%). The sensitivity of anti-HBs testing was substantial (73.18%) and the specificity was well (84.31%). Guangdong province (Youden index: 0.69) and Jiangsu province (Youden index: 0.80) had high identification ability for HBsAg, and for indicator of anti-HBs, Gansu province (Youden index: 0.78) and Guangdong province (Youden index: 0.76) had high identification ability. Conclusion:There are certain differences in results of HBV serological markers tests between the grassroots medical institutions in the demonstration areas of infectious diseases and the third platform. Current testing strategies in grassroots medical institutions are suitable for identifying people without hepatitis B infection, while it is necessary to pay attention to the situation of potential false negative error.