Objective:To evaluate the effects of several kinds of surface treatment methods on the bond strength of zirconia prosthesis,and to provide references for improving the bond strength of zirconia prosthesis.Methods:Sixty zirconia blocks(10 mm×10 mm×2 mm) were divided into 6 groups according to the surface treatment methods:sandblasting,silica coating,Z-PRIME Plus,sandblasting+Z-PRIME Plus,sandblasting+silica coating,and silica coating+Z-PRIME Plus groups.The zirconia-resin specimens were fabricated using ScotchbondTM Universal;shear bond test was performed to detect the shear bond strength after treated with water storage(37℃) for 24 h by universal mechanical testing mechine;the fracture types were observed by stereoscopic microscope.One fracture specimen was randomly chosen from each group,and the morphology of the specimen was examined under scanning electron microscope.Results:The shear bond strength of the specimen in Z-PRIME Plus group was higher than those in the other groups(P<0.05).The adhesive failure was predominantly observed in sandblasting,silica coating,sandblasting+silica coating and silica coating+Z-PRIME Plus groups.There were 4 cases of mixed failure in Z-PRIME Plus group and there were 8 cases of mixed failure in sandblasting+Z-PRIME group.No cohesive failure was observed in all the groups.The scanning electron microscope results showed that the fracture surface occurred on the resin-zirconia interface of the specimens in sandblasting group,Z-PRIME Plus group,and sandblasting+Z-PRIME Plus group.The silica-zirconia fracture of specimens occurred in silica coating group and silica coating+Z-PRIME Plus group.The silica-resin interface fracture of specimens partially occurred in sandblasting+silica coating group.Conclusion:The application of Z-PRIME Plus can significantly improve the bond strength between zirconia and resin.

OBJECTIVE:To provide reference for further promoting the implementation ofseparation of prescribing and dis-pensingpolicy which fit China's national conditions. METHODS:Based on literature review,informant interview,and filed in-vestigation the development ofseparation of prescribing and dispensingwere compared between typical eastern and western coun-tries. Constraints ofseparation of prescribing and dispensingin China were explored,international successful experiences were summarized to inspire appropriate implementation of this policy in China. RESULTS & CONCLUSIONS:There are four con-straints in the implementation ofseparation of prescribing and dispensingin China. Firstly,the legal foundation is yet established for the professional development of pharmacists. Secondly,the medicine pricing and hospital financing systems are unreasonable. Thirdly,patients'ownership of prescriptions and right of dispensing options are monopolized by hospitals. Fourthly,safety of medi-cines use is yet ensured.Separation of prescribing and dispensingshould follow the rules of social and economic development and should be adjusted to adapt local conditions.Separation of prescribing and dispensingpolicy itself may not help to achieve the objectives of cost containment and rational use of medicines. To achieve the intended objectives,legislation of Pharmacist Law should also be accelerated to clearly define the role of pharmacist and guide the behavior of prescribers with economic levers.

Objective: To study the effect of nutrition intervention on the body composition and blood glucose in newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity. Methods: A total of 84 newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity were selected from the department of endocrinology in China-Japan Friendship Hospital from April 2015 to December 2016. Basic information and body composition of these patients were collected and measured. Also the food frequency questionnaire (FFQ) was used to investigate the dietary status in the past month, and calculate the intake of energy, three major nutrients and dietary fiber. All patients received nutrition intervention by nutritionist for three months as requested by Diabetes guidelines. After 3-month intervention, blood glucose, body composition and dietary status were examined again. Relevant indicators of patients were compared before and after the intervention. All patients were divided into three groups according to the degree of body mass index (BMI)′s change: <5%, 5%-10% and >10%. The differences of body weight, muscle, body fat rate, visceral fat index and blood glucose level among three groups were quantified. Results: There were 53 male patients with age (41.5±8.9) years and HbA1c (7.5±0.4)%, and 31 female patients with age (40.1±8.5) years with HbA1c (7.6±0.5)%. The intake of energy, carbohydrate and fat of patients were significantly decreased (P<0.05) and dietary fiber was significantly increased (P<0.05) after nutrition intervention. The body weight, muscle mass, fat mass and visceral fat index were also significantly decreased (P<0.05). The average decrease of fat was about 2.8 kg accounting for 73.7% (2.8 kg/3.8 kg) of the total weight loss. The body fat rate decreased from (31.2±3.1)% to (28.8±3.2)% (P<0.05). The fasting blood glucose and postprandial blood glucose were both decreased significantly after intervention (P<0.05). Among three BMI decreased groups, there was no significant difference in body weight and muscle mass (P>0.05), but a significant difference in body fat rate and visceral fat index (P<0.05). The body fat rate, visceral fat index, fasting blood glucose and postprandial blood glucose had more decreases with the greater amount of weight loss (P<0.05). Conclusion The three-month nutrition intervention could change the dietary habit and components of patients with type 2 diabetes mellitus by reducing the blood glucose, body fat rate and visceral fat index significantly. The degree of reduced BMI is positively related to the decrease of fasting blood glucose and postprandial blood glucose.

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.

Objective:To explore the feasibility and clinical efficacy of oblique lateral interbody fusion (OLIF) in the treatment of adjacent segment disease (ASDis).Methods:Retrospective analysis was conducted on the data of 31 patients with ASDis treated by OLIF in four medical centers from June 2015 to December 2018. There were 17 males and 14 females. The average age was (65.7±3.4) years (range, 59 to 75 years). 19 cases received single-segment fixed fusion, 11 cases received double-segment fixed fusion and 1 case received three-segment fixed fusion. Original fixed fusion site: 1 case of L 1, 2, 3 cases of L 3, 4, 11 cases of L 4, 5, 4 cases of L 5S 1, 6 cases of L 3-L 5, 5 cases of L 4-S 1, and 1 case of L 3-S 1. The time from the initial fixation and fusion to this admission was 82.5±45.5 months (rang, 24 to 180 months). ASDis occurred at the proximal end of the fixed fusion segment in 28 cases and at the distal end in 3 cases. The types of ASDis: degenerative disc disease in 11 cases, lumbar spinal stenosis in 15 cases, degenerative spondylolisthesis in 2 cases, and degenerative scoliosis in 3 cases. The location of ASDis: 6 cases of L 2, 3, 12 cases of L 3, 4, 6 cases of L 4, 5, 3 cases of L 1-L 3, 1 case of L 2-L 4, and 3 cases of L 1-L 4. At admission, 3 cases of lumbar internal fixation had been removed and 28 cases of internal fixation remained. Stand-alone OLIF was performed in 19 cases, OLIF combined with pedicle screw fixation in 8 cases, and OLIF combined with cortical screw fixation in 4 cases. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the low back pain and lumbar function before operation and at the last follow-up, and the imaging results and complications were observed. Results:All patients were followed up. The follow-up time was 23.6±9.6 months (range, 12 to 60 months). The operation time was 73.8±25.3 mins (range, 40 to 180 min), and the intraoperative blood loss was 86.2±67.4 ml (range, 20 to 310 ml). The average blood loss in each segment was 24.8 ml. During the operation, there were 1 case of segmental vein injury, 7 cases of endplate injury, 2 cases of transient iliopsoas muscle weakness, 1 case of thigh pain and numbness, and 1 case of incomplete intestinal obstruction. There was no incision necrosis and infection. The VAS score of low back pain decreased from 5.9±1.9 before operation to 1.4±0.6 at the last follow-up, with a statistically significant difference ( t=8.47, P<0.001). The ODI index recovered from 45.2%±5.7% before operation to 13.8%±4.7% at the last follow-up, with a statistically significant difference ( t=7.92, P<0.001). The height of intervertebral space increased from 8.7±1.6 mm before operation to 11.4±1.9 mm after operation and 9.9±1.8 mm at the last follow-up. There was a statistically significant difference between postoperative and preoperative height of intervertebral space ( F=4.15, P=0.007). There was a statistically significant difference between the last follow-up and postoperative height of intervertebral space ( P=0.011). During the follow-up, there were 13 cases of fusion cage subsidence, 1 case of fusion cage displacement, and no case of internal fixation loosening or fracture. The intervertebral fusion rate was 94%(29/31) and the complication rate was 42%(13/31). Conclusion:ASDis is a common complication after lumbar fixation and fusion, and requires surgical treatment. OLIF is a reliable method to treat ASDis as it has advantages of small trauma, high fusion rate and low complication rate.

Objective:To compare the clinical outcomes and complications of oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach and posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel for lumbar spinal stenosis.Methods:A retrospective study was conducted on 73 patients who underwent surgical treatment for lumbar spinal stenosis from Jun 2015 to Jun 2017, including 33 males and 40 females. The average age was 66.8±7.94 years (from 39-85 years). These diseases occured at L 3/4 in 5 patients and L 4/5 in 68 patients. Random according to the time of admission, 38 cases were treated with oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach (oblique lateral fusion group), and 35 cases with posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel (posterior fusion group). The clinical results, image data and complications were compared between the two groups. Results:All patients in both groups had operation performed smoothly. The operation time was 99±8.96 min in the oblique lateral fusion group and 96.8±9.57 min in the posterior fusion group, and there was no significant difference between the two groups. The intraoperative bleeding in the oblique lateral fusion group 80±24.72 ml was significantly less than that in the posterior fusion group 261±52.87 ml ( t=9.621, P<0.05). No incision infection occurred after surgery. The VAS score of lumbar incision 72h after operation in the oblique lateral fusion group 1.21±0.55 was significantly less than that in the posterior fusion group 1.70±0.86 ( t=3.723, P=0.028). The follow-up period lasted for 12-24 months, averagely 17.5±2.58 months. There was statistically significant difference between preoperative and postoperative in the two groups, whether it was the area of the foraminal canal or the area of the spinal canal. There wboth the foraminal area and the spinal canal area were enlarged. The intervertebral space height in the two groups recovered significantly after surgery, the difference was statistically significant. But the intervertebral space height were partly lost at the last follow-up, and there was significant difference compared with postoperative. During the follow-up, no pedicle screw loosening, displacement, rupture, or anterior and lateral displacement of cage occurred. The fusion rate was 97.1% in the posterior fusion group and 100% in the oblique lateral fusion group. There was no statistical difference between the two groups.In terms of ODI index: the posterior fusion group recovered from 48.6±6.1 preoperative to 10.2±2.2 at the last follow-up, and the oblique lateral fusion group recovered from 49.0±5.7 preoperative to 9.3±1.8 at the last follow-up. There was statistically difference between last follow-up and preoperative in the two groups. The incidence of complications in the posterior fusion group was 22.86%, and the incidence in the oblique lateral fusion group was 23.68%. There was no significant difference between the two groups. Conclusion:Both the two decompression and fusion methods have achieved good clinical results in the treatment of lumbar spinal stenosis, with the advantages of less trauma, good stability, fast recovery, and high fusion rate. Compared with posterior decompression and fusion methods, the advantages of OLIF are more obvious, such as less bleeding,lower risk of nerve injury and good indirect decompression of spinal canal. Therefore, the OLIF technique can be a better choice for surgical treatment of lumbar spinal stenosis.

Objective:To investigate the characteristics and causes of endplate injury in the oblique lateral interbody fusion for the treatment of lumbar diseases, and summarize the precaution of endplate injury.Methods:Thirty-five cases of endplate injury were observed, which were originally treated with oblique lateral interbody fusion with or without pedicle screw fixation from October 2014 to December 2017. There were 7 males and 28 females, and the age ranged from 51 to 78 years old (averagely 62.8±8.13 years). There were 2 cases of lumbar disc degeneration, 10 cases of lumbar canal stenosis, 17 cases of lumbar degenerative spondylolisthesis, 2 cases of lumbar spondylolysis with or without spondylolisthesis, and 4 cases of lumbar degenerative scoliosis. Lesion sites contained L 3,4 in 2 cases, L 4,5 in 21 cases, L 2-4 in 3 cases, L 3-5 in 4 cases, L 2-5 in 3 cases and L 1-5 in 2 cases. Preoperative bone mineral density examination revealed there were 7 cases of T>-1 SD, 24 cases of -2.5 SD

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

AIM:Using bioinformatics analysis methods to identify the hub genes involved in myocardial isch-emia-reperfusion injury(MIRI).METHODS:Firstly,the rat MIRI related dataset GSE122020,E-MEXP-2098,and E-GEOD-4105 were downloaded from the database.Secondly,differentially expressed genes(DEGs)were screened from each dataset using the linear models for microarray data(limma)package,and robust DEGs were filtered using the robust rank aggregation(RRA)method.In addition,the surrogate variable analysis(SVA)package was used to merge all datas-ets into one,and merged DEGs were screened using the limma package.The common DEGs were obtained by taking the intersection of the two channels of DEGs.Next,the protein-protein interaction(PPI)network of common DEGs was con-structed,and the hub genes were identified using the density-maximizing neighborhood component(DMNC)algorithm.The receiver operating characteristic curve(ROC)was plotted to evaluate the diagnostic performance of the hub gene.Then,the mRNA and protein expression levels of hub genes were detected in the rat MIRI model,and the literature re-view analysis was carried out on the involvement of hub genes in MIRI.Finally,the gene set enrichment analysis(GSEA)was performed on hub gene to further reveal the possible mechanism in mediating MIRI.RESULTS:A total of 143 robust DEGs and 48 merged DEGs were identified.After taking the intersection of the two,48 common DEGs were obtained.In the PPI network of common DEGs,5 hub genes were screened out,namely MYC proto-oncogene bHLH transcription fac-tor(MYC),prostaglandin-endoperoxide synthase 2(PTGS2),heme oxygenase 1(HMOX1),caspase-3(CASP3),and plasminogen activator urokinase receptor(PLAUR).The ROC results showed that the area under the curve values for all hub genes were greater than 0.8.MYC,PTGS2,CASP3,and PLAUR showed high mRNA and protein expression in rat MIRI,while there was no difference in mRNA and protein expression for HMOX1.The literature review revealed that among the 5 hub genes,only PLAUR has not been reported to be involved in MIRI.The GSEA results for PLAUR indicat-ed that its functional enrichment mainly focused on pathways such as NOD-like receptor signaling pathway,P53 signaling pathway,Toll-like receptor signaling pathway,apoptosis,and fatty acid metabolism.CONCLUSION:MYC,PTGS2,CASP3,HMOX1,and PLAUR are involved in the pathological process of MIRI.PLAUR is a potential hub gene that can mediate MIRI by regulating pathways such as NOD like receptor signaling,P53 signaling,Toll like receptor signaling,cell apoptosis,and fatty acid metabolism.The results can provide reference for further investigation into the molecular mechanisms and therapeutic targets of MIRI.

Myocardial fibrosis is featured by excessive proliferation of cardiac fibroblast and collagen deposition. There is close relationship between myocardial fibrosis and various cardiovascular disease, and it is potential risk factor for sudden death. At present the precise mechanism remains unclear.Myocardial fibrosis has been found to relate with renin-angiotensin-aldosterone system,cell factor,oxidative stress,inflamatory factor,endothelial function obstacles,Intracellular calcium ion. These factors influences the occurrence of myocardial fibrosis by the same or different pathway.