Transalveolar technique for sinus floor elevation(TSFE)offers the advantages of minimal invasiveness,reduced postoperative reaction,and shorter operative time for vertical bone augmentation in the maxillary posterior region.The clinical data of one patient with severe deficiency of residual bone height(RBH)in the maxillary posterior region,a blood vessel visible in the lateral wall of the maxillary sinus and a visible septum at the floor of the maxillary sinus were reported,and two-stage flexible TSFE was used to improve the vertical bone height of the operated area while reducing trauma,the risk of Schneiderian membrane rupture and maxillary sinus infection,etc.,and the relevant literatures were reviewed.The patient,male,26 years old,complained of missing left maxillary posterior teeth for more than 1 year and requested restoration.The patient had 27 missing teeth,normal keratinized gingiva,full alveolar ridge,no elongation of the opposing teeth,fair width of the proximal and normal occlusal distance.The results of cone beam CT(CBCT)showed that the distance between the sinus crests at the site of the 27 teeth was about 3 mm,the width of the alveolar bone was about 12.8 mm,the bone density was normal,and there were no residual roots or other abnormalities;no cyst-like lesions were seen in the walls of the maxillary sinuses bilaterally,and separation was seen at the floor of the maxillary sinus on the left side and a blood vessel was seen in the lateral wall of the maxillary sinus.A diagnosis of Kennedy class Ⅱ maxillary tooth defects was made.After two stages of TSFE,the Schneiderian membrane was intact and the bone height of the implant area was elevated to 9.6 mm from 3 mm preoperatively after the completion of the restoration,with stable bone augmentation,good osseointegration,and restoration of normal occlusal function.For the patients with severe bone height deficiency in the maxillary posterior region,flexible two-stage TSFE should be considered,which can help to reduce the risk of maxillary sinus infection and Schneiderian membrane rupture while minimizing the damage and obtaining the ideal bone augmentation results.

The prevalence of summer endogenous fever is closely related to the climate of summer.Based on Li Dongyuan's yin-fire theory,this article proposed that summer-heat,irregular diet,excessive consumption of cold foods,poor living habits,and summer damp-heat internal invasion damaging the spleen can all lead to the generation of yin-fire,thereby causing endogenous fever.The core pathogenesis of summer endogenous fever lies in spleen deficiency with yang collapse,which results into the blockage of qi movement and the production of yin-fire.The yin-fire persists throughout the entire course of the disease.Treatment of summer endogenous fever should focus on eliminating yin-fire,primarily by addressing the spleen via boosting qi and raising yang to restore the spleen's ascending and stomach's descending functions,thereby dispersing yin-fire.Clearing heat and resolving dampness can purge yin-fire and then the spleen qi's circulation is restored.By analyzing the pathological changes of dampness accumulation into phlegm,fire-heat damaging yin and liver stagnation with kidney deficiency,the disease progression can be predicted.Correspondingly,comprehensive therapy of resolving phlegm,nourishing yin,soothing liver,and tonifying kidney can be employed to prevent further deterioration.Based on Li Dongyuan's yin-fire theory,Shengyang Yiwei Decoction(mainly composed of Astragali Radix,Pinelliae Rhizoma,Ginseng Radix et Rhizoma,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Angelicae Pubescentis Radix,Saposhnikoviae Radix,Paeoniae Radix Alba,Notopterygii Rhizoma et Radix,Citri Reticulatae Pericarpium,Poria,Bupleuri Radix,Alismatis Rhizoma,Atractylodis Macrocephalae Rhizoma,and Coptidis Rhizoma)can be used as a fundamental prescription to treat summer endogenous fever caused by yin-fire,with modifications tailored to specific clinical presentations.This theoretical exploration may provide a reference for the clinical management of summer endogenous fever.

Objective To analyze the influencing factors of postoperative subsyndromal delirium in elderly patients undergoing abdominal surgery,and to develop a nomogram risk prediction model.Methods A convenience sampling method was used to select 497 elderly patients who underwent abdominal surgery in a tertiary hospital in Sichuan Province from February to October 2022.The risk prediction model and nomograms model were constructed using Logistic regression analysis and R software.The area under the subject's working characteristic curve(AUC)and Hosmer-Lemshow test were used to evaluate the discrimination and calibration of the model.Results The results of Logistic regression showed that age(OR=1.066),functional activities(OR=1.143),patient controlled intravenous analgesia(OR=5.811),transanal drainage tube(OR=2.276)and postoperative blood transfusion(OR=4.322)were independent influences on the occurrence of postoperative subsyndromal delirium.The p-values of the prediction model in both the training and validation sets were greater than 0.05;the area under the ROC curves were 0.734 and 0.691;the model was presented in the form of nomogram.Conclusion The prediction model developed in this study has good discrimination and accuracy.It can be used to assist clinical staff in identifying patients at high risk of developing postoperative subsyndromal delirium and provide the reference for developing preventive and intervention measures.

Objective:To explore the spatial support capacity and its influence in osteogenic effect of composite biofilm based on poly(propylene carbonate)(PPC)/poly(butylene succinate)(PBS)in rabbit tibial bone defect models,and to clarify its barrier functional reliability and osteogenetic effect in vivo.Methods:The composite biofilms of PPC/PBS and PPC/PBS/collegen type Ⅰ(Col-Ⅰ)(PPC/PBS/Co)were prepared.Eighteen Japanese big-ear rabbits were selected and two bone defects were prepared on each side of the tibia of the rabbits.Six rabbits were randomly selected to place PPC/PBS composite biofilm on the bone defects,2 rabbits were executed at 2,4,8 and 12 weeks after operation,and the surface microstructures of PPC/PBS composite biofilm in the rabhit bone defect area were observed by scanning electron microscope(SEM).The experiment was divided into blank control group,PPC/PBS composite biofilm group,BME-10X collagen membrane group,and PPC/PBS/Co composite biofilm group.The above biofilms were placed on the corresponding bone defects of rabbits by operation,while no biofilm was placed in the rabbits in blank control group.Three rabbits were killed at 2,4,8 and 12 weeks after operation respectively,and the gray values of regenerated bone in the bone defect areas of the rabbits in varrous groups were detected by soft X-ray;the fluorescence intensities of regenerated bone tissue in the bone defect areas of the rabbits in various groups were observed by laser scanning confocal microscope after fluorescence labeling.The pathomorphology of regenerated bone tissue in the bone defect areas of the rabbits in various groups were observed by HE staining and modified Gomori staining,and the expression levels of bone morphogenetic protein 2(BMP-2)and osteopontin(OPN)in the regenerated bone tissue in bone defect areas of the rabbits in various groups were detected by immunohistochemical staining.Results:In general,the PPC/PBS composite biofilm was tightly covered in the bone defect area without displacement and collapse.The SEM results showed that the porous surface of PPC/PBS composite biofilm appeared micropore structure and the number of micropores was increased with the prolongation of time,while the smooth surface of biofilm basically did not form the micropore-like structure.The results of soft X-ray detection showed that the gray values of regenerated bone tissue in bone defect areas of the rabbits in various groups were increased with the prolongation of time,and the gray value of regenerated bone tissue in bone defect areas of the rabbits in PPC/PBS/Co composite biofilm group was significantly higher than those in other groups(P＜0.05).The confocal micrscope results showed that the fluorescence intensity of regenerated bone tissue in bone defect areas of the rabbits in PPC/PBS/Co composite biofilm group was similar to those in blank control group at 4,8,and 12 weeks;compared with PPC/PBS composite biofilm group and BME-10X collagen membrane group,the fluoresence intensity of regenerated bone tissue in bone defect areas of the rabbits in PPC/PB/Co composite biofilm group at 4 weeks was increased(P＜0.05),and the fluoresence intensity of regenerated bone tissue in bone defect areas of the rabbits at 8 and 12 weeks were decreased(P＜0.05).The results of HE staining and modified Gomori staining showed that compared with PPC/PBS composite biofilm group and BME-10X collagen membrane group,the new bone formed faster in PPC/PBS/Co composite biofilm group and blank control group at 2 and 4 weeks,and the lamellar bone mineralization was higher at 12 weeks.The immunohistochemical staining results showed that compared with blank control group,PPC/PBS composite biofilm group and BME-10X collagen membrane group,the expression levels of BMP-2 and OPN proteins in the regenerated bone tissue in bone defect areas of the rabbits in PPC/PBS/Co composite biofilm group at 2 and 4 weeks were increased(P＜0.05 or P＜0.01);compared with blank control group and PPC/PBS composite biofilm group,the expression levels of BMP-2 and OPN proteins in the regenerated bone tissue in bone defect areas of the rabbits in BME-10X collage membrane group were decreased(P＜0.05 or P＜0.01).Conclusion:PPC/PBS composite biofilm has excellent spatial support capacity and reliable physical barrier function.The PPC/PBS/Co composite biofilm has a good effect in guiding bone regeneration in vivo.

In this study,thermosensitive and repairable molecularly imprinted solid-phase microextraction fibers were synthesized using spiramycin as template molecule,methacrylic acid and N-isopropylacrylamide as functional monomers,ethylene glycol dimethacrylate as crosslinking agent,and silanized quartz capillary as carrier. The prepared molecularly imprinted solid-phase microextraction fibers were characterized by scanning electron microscope and nitrogen adsorption/desorption,and various parameters affecting the extraction efficiency were optimized. Due to high selectivity and sensitivity of the fibers for macrolide antibiotics,the quantitative analysis of four macrolide antibiotics in food matrix,spiramycin,tilmicosin,tylosin,and josamycin,was peroformed in combination with high performance liquid chromatography. In the range of 0.5 to 50 μg/mL,the chromatographic peak area showed a good linear relationship with the concentration. The spike recoveries of the samples at three different addition levels were between 81.8% and 119.1%;the inter-day precisions were less than 13.8% (n=6),and the intra-day precisions were less than 15.5% (n=3).

In this paper, we developed an accurate and sensitive LC-MS/MS method for the determination of amoxicillin and clavulanic acid in human plasma. A 50% aqueous acetic acid solution was used as a stabilizer, and the plasma samples were evaporated to dryness and resolved after protein precipitation on ice bathing and then were placed in an autosampler for injection. The gradient was eluted by Hedera ODS-2 column(2. 1 mm×150 mm). The aqueous phase was an aqueous solution containing 0. 2% acetic acid. The organic phase was methanol. The amoxicillin and clavulanic acid were detected under negative ion detection with electrospray ionization(ESI)in multiple reaction monitoring(MRM)mode of m/z 364. 1→223. 1 and 198. 1→135. 9 in the triple quagdrupole tandem mass spectrometer(Triple Quad TM 6500+). The concentration ranges of plasma from 20. 0 ng/mL to 5 000 ng/mL for amoxicillin and 10. 0 ng/mL to 2 500 ng/mL for clavulanic acid were good linear relationship. The accuracy deviation were ±15. 0% and precision were less than 15. 0% for the intra-assay and inter-assay. The matrix effect and recovery meeted the acceptance criteria, amoxicillin and clavulanic acid were stable under storage and processing conditions. Healthy subjects were given a test preparation of amoxicillin and clavulanate potassium granules 1 bag(125 mg/31. 25 mg/bag)and the reference preparation amoxicillin clavulanate potassium dry mix Suspension “Augmentin® ” 5 mL(125 mg/31. 25 mg/5 mL)was used to determine the plasma concentration of amoxicillin and clavulanic acid. The Phoenix WinNonlin 6. 4 software was used to estimate the pharmacokinetic parameters of non-compartmental models. The pharmacokinetic parameters of amoxicillin and clavulanic acid were statistically calculated and evaluated the bioequivalence. what′s more, we evaluated the diet on the pharmacokinetics of amoxicillin and clavulanic acid. The analytical method was rapid and sensitive, which was successfully employed in the bioequivalence study of amoxicillin(125 mg/bag)and clavulanate potassium granules(31. 25 mg/bag)for determining the concentration of amoxicillin and clavulanic acid.

OBJECTIVE:To provide reference for further promoting the rational use of antimicrobial drugs in the rural commu-nity health service stations. METHODS:4 800 prescriptions were collected from 8 community health service stations affiliated to our hospital from Jan. 1,2012 to Dec. 31,2014,the use of antimicrobial drugs in the prescriptions was statistically analyzed and the indicators were compared before and after intervention. RESULTS:The proportion of use of antimicrobial drugs in these com-munity health service stations was decreased from 52.88%in 2012 to 30.38%in 2014;the clinical diagnosis of prescription of anti-microbial drug was mainly respiratory infections;what the most used types of antibacterial drugs was cephalosporins;and the pro-portion of antimicrobial drug of irrational use was decreased from 43.50%(368/846)in 2012 to 22.84%(111/486)in 2014. CON-CLUSIONS:The combination of technique and administrative intervention is remarkable. However,the unreasonable use of antibac-terial drugs still exists. Therefore,related training should be organized,and the proportion of use of antimicrobial drugs should in-cluded in the performance appraisal to further improve the use level of antimicrobial drugs in the rural community health service sta-tions.

Objective To comprehensively evaluate the relationship between children's high iodine goiter and excessive iodine . Methods A computerized literature search was carried out to collect articles published before 2014 in electronic databases CBM , WabFang ,VIP ,CNKI ,PubMed ,EMbase ,Ovid and Cochrane Library .The study type was randomized controlled trial or quasi‐ran‐domized control trial .Literature was analyzed by RevMan5 .0 software ,then calculated and combine RR and 95% CI .Publication bi‐as of Meta analysis was evaluated by Begg's test ,Egger's test and Macaskill's test .The result stability of Meta analysis was tested by sensibility analysis .Results A total of 10 controlled before and after studies were included in our meta‐analysis .The result showed that the iodine content of 150 -300 μg/L (RR:1 .54 ;95% CI:1 .14 -2 .07);301 -600 μg/L (RR:2 .33;95% CI:1 .43 -3 .82);601-900 μg/L (RR:2 .72 :95% CI:1 .01-7 .33) and greater than 900μg/L (RR:2 .41 ;95% CI:1 .38-4 .23) would result in chil‐dren goiter .Conclusion Iodine content greater than 150 μg/L would result in children goiter .

Objective To investigate the procedures and therapeutic effects of reoperation of papillary thyroid carcinoma with lymph node metastasis.Methods The clinical data of 10 papillary thyroid carcinoma patients with lymph node metastasis received reoperation were retrospectively studied. Results Reoperation was successfully performed in 9 patients except one patient with tumor surrounding common carotid artery and brachial plexus who had partial tumor removed. Three patients had simple lymphectomy,2 had complete thyroidectomy, 2 had complete lobectomy plus ipsilateral cervical lymph node dissection and 2 had tumor resection plus cervical lymph node dissection. There were no new complications. Conclusions Papillary thyroid carcinoma has the characteristic tend to spread to spread to cervical lymph nodes. Rreoperation offers good outcome for recurrent papillary thyroid carcinoma.

Objective To discuss the possibility of mucin-1 gene(MUC1 mRNA)in mediastinal lymphnodes(MLNs)and peripheral blood as a symbol of occult metastasis in patients with non-small cell lung cancer(NSCLC).Methods By reverse transcriptase-polymerase chain reaction(RT-PCR),MUC1 mRNA in peripheral blood and in 67 MLNs from 30 patients with benign pulmonary diseases(negative control group)and in 30 MLNs which had metastasis determined by routine pathologic examination(positive control group)was detected;MUC1 mRNA in peripheral blood in 158 patients with NSCLC and in 296 MLNs proven to be tumor-free by routine histopathologic examination from 97 NSCLC patients was detected(experimental group).Results MUC1 mRNA was not identified in peripheral blood in 30 patients with benign pulmonary diseases,but 49 specimens from 158 NSCLC patients were positive(positive rate 31.0%),there was significant difference between these two groups(P0.05),but the positive rate of MUC1 mRNA in stage Ⅲ and Ⅳ NSCLC was significantly higher than that in stage Ⅰ and Ⅱ(P