Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Finite element method (FEM) is a method to decompose a large complex problem into several small problems to solve it. With this method, multiple small elements can be used to simulate the real physical system, which greatly promotes the development of biomechanics. Biomechanics has always been a hot research direction in spine surgery, and the finite element method is also widely used in spine biomechanics. It can simulate the healthy spine on the computer and study the stress of normal spine in various states, so as to provide help for the study of basic stress of spine.It can simulate the spinal column of pathological changes and degenerative changes, and study its stress in various scenarios, so as to provide direction for the treatment of diseases. Different surgical methods can be simulated to study the stress of the spine and internal fixation after different surgical methods, so as to select the best surgical method for patients; At the same time, it can also simulate different implants and study the stress of different implants in vivo and in vitro, so as to provide guidance for the selection of intraoperative implants and the upgrading and optimization of implants.This paper mainly discusses the application and progress of finite element method in spine surgery, and provides more references for the future study of spine biomechanics and clinical treatment of spine surgery.

Objective:To explore the association between vitamin A, E and recurrent respiratory tract infections (RRTIs) in children.Methods:1 853 children with RRTIs and 2 695 health children were separately selected as cases and controls. Propensity score matching (PSM) analysis were conducted to reducing confounding bias between groups. Blood samples were collected to measure serum levels of vitamins A and E by high performance liquid chromatographie (HPLC). Paired logistic regression was used to determine odds ratios ( OR) and 95% confidence intervals ( CI) to evaluate the association of RRTIs with the serum levels of vitamin A and E. Results:After propensity score estimation and 1∶1 matching, the study cohort included 1 507 cases with RRTIs and 1 507 health children as controls. The main characteristics between the two groups were all not significantly different after matching ( P>0.05). The average levels of vitamin A in two groups were different ( P<0.05). Paired logistic regression analysis showed that greater serum levels of vitamin A had a lower risk of RRTIs ( OR=0.46, 95% CI: 0.22-0.98), similarly, deficiency of vitamin A would also increase the risk of RRTIs ( OR=1.18, 95% CI: 1.00-1.38). The statistical difference was not found between VitE and RRTIs ( P>0.05). Conclusions:The serum levels of vitamin E didn′t have a statistically significant association with RRTIs. However, we observed an obvious association between vitamin A and RRTIs. Hence vitamin A clinical monitoring and supplementation are vital for preventing and treating RRTIs.

Objective To evaluate the performance of Xpert C. difficile multiplex real-time PCR assay for diagnosis of Clostridium difficile infections in Chinese hospital settings. Methods This study was performed in Huashan Hospital, Ruijin Hospital, Beijing Hospital, Nanfang Hospital and Sir Run Run Shaw Hospital using a standard study protocol. Unique unformed stools from patients with acute hospital-acquired diarrhea were simultaneously analyzed by toxigenic anaerobic cultures and the Xpert C. difficile assay. All specimens displaying discordant results between the Xpert assay and toxigenic culture were sent for Sanger tcdB gene sequencing. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), total concordance rate, and 95％ confidence interval (CI) were calculated before and after resolution of discordant results using SAS 9.3. Results A total of 745 stool specimens were collected and 46 were excluded due to failure of C. difficile recovery. The remaining 699 specimens were included. Compared to the results of toxigenic culture, the sensitivity, specificity, PPV, and NPV of Xpert C. difficile assay were 94.1％ (144/153)(95％CI:89.1％-97.3％), 93.2％ (509/546)(95％CI:96.7％-99.2％), 79.6％ (144/181)(95％CI:72.9％-85.2％)and 98.3％ (509 / 518) (95％CI: 96.7％-99.2％), respectively. Both methods had a Kappa of 0.819. Xpert C. difficile assay showed sensitivity of 98.4％(62/63) (95％ CI: 90.3％-99.9％) and specificity of 93.2％(509/546) (95％ CI: 90.8％-95.2％) for toxin A-negative toxin B-positive strains. After the discordant results resolved by tcdB gene sequencing, PCR assay provided better performance with high sensitivity, specificity, positive predictive value, and negative predictive value [98.8％ (171 / 173), 98.1％ (516 / 526), 94.5％ (171/181) and 99.6％ (516/518), respectively]. Conclusions Compared to the results of toxigenic culture, the sensitivity, specificity and NPV of Xpert C. difficile assay were 94.1％ (144/153) and 93.2％(509/546), respectively. With the results available within 1 h, Xpert C. difficile assay provides prompt and precise laboratory diagnosis in Chinese clinical settings.

BACKGROUND: Polylactic acid copolymer bone scaffold has excellent biodegradability, and it is easy to be shaped and can promote the formation and growth of bone tissue and blood vessel.OBJECTIVE: To observe the effects of adipose-derived stem cells(ADSCs)/poly(lactic-co-glycolic acid) (PLGA) complex on the biomechanical properties after fracture healing in osteoporotic bone.METHODS: Sixty Sprague-Dawley rats were randomly divided into four groups: blank control group received no treatment; the bilateral tibial fracture model was made after 3 months of bilateral ovarian resection in model group; the bilateral tibial fracture model was made and ADSCs were implanted into the bone after 3 months of bilateral ovarian resection in cell therapy group; the bilateral tibial fracture model was made and the PLGA/ADSCs complex was implanted after 3 months of bilateral ovarian resection in combined treatment group.The bone mineral density, callus thickness, biomechanical parameters and the microstructure of the trabecular bone were detected.RESULTS AND CONCLUSION: (1) The bone density: The bone density of the model group was significantly lower than that of the blank control group (P < 0.05); the bone mineral density of the cell therapy group and the combined treatment group was higher than that of the model group (P < 0.05), but lower than that of the control group (P < 0.05); and the bone mineral density of the combination treatment group was higher than that of the cell therapy group (P < 0.05). (2)Thickness of the callus: The thickness of the callus in the cell therapy group and combined treatment group was higher than that of the model group and blank control group (P < 0.05); moreover, the thickness of the callus in the combined treatment group was higher than that of the cell therapy group (P < 0.05). (3) Biomechanical test: The failure load, stress and shear strength, elastic modulus were decreased in the model group compared with the blank control group (P < 0.05), while the shear strain increased (P < 0.05). Compared with the model group, the failure load, ultimate stress, shear strength, elastic modulus were increased in the cell therapy group and combined treatment group (P < 0.05), and the shear strain was decreased (P < 0.05). Moreover, the combined treatment group showed more changes in these biomechanical parameters (P < 0.05). (4) The trabecular bone microstructure: The model group presented with trabecular derangement, spacing increases, and even fracture and lacuna. After ADSCs or ADSCs/PLGA transplantation,the trabecular bones increased in number, thickness, and spacing, and the number of lacunae reduced. In conclusion,ADSCs combined with PLGA in the treatment of osteoporotic fracture can significantly improve the biomechanical parameters of bone tissue after healing.

Objective To explore the diagnostic value of full-field digital mammography (FFDM) combined with digital breast tomosynthesis (DBT) in breast diseases.Methods 506 patients receiving mammary gland molybdenum target inspection from January 1, 2014 to December 31, 2014 were selected.The images from FFDM and DBT were analyzed, respectively.The breast imaging reports and pathological results were compared to investigate the sensitivity, specificity and accuracy of FFDM, DBT alone and combined use of DBT and FFDM.Results The results of preoperative mammography in the 506 women (bilateral breast) were as follows: FFDM combined with DBT detected 202 benign cases (39.9%) and 304 malignant cases (60.1%);FFDM alone detected 194 benign cases (38.3%) and 312 malignant cases (61.7%);DBT alone detected 187 benign cases (37.0%) and 319 malignant cases (63.0%).Pathologically, 214 benign cases (42.3%) were detected and 292 malignant cases (57.7%).In terms of the sensitivity, specificity and accuracy, The combined use of DBT combined with FFDM was the best, followed by FFDM alone and DBT alone.Conclusion The sensitivity, specificity and accuracy of FFDM combined with DBT for diagnosis are better than those of FFDM alone or DBT alone.

BACKGROUND: SSh as a Hedgehog signal protein can promote bone development, growth and remodeling.OBJECTIVE: To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) combined with Shh modified nano-hydroxyapatite/collagen (nHAC) in the repair of femoral defects in rats.METHODS: Forty-eight Sprague-Dawley rats were randomly divided into four groups, and the model of femoral defects was established in these rats. At 14 days after modeling, experimental group was implanted with the BMSCs/Shh modified nHAC, scaffold group was implanted with simple nHAC, cell scaffold group was implanted with BMSCs/nHAC,and blank control group was without any implantation. At 3, 6, 9, 12 weeks after repair, X-ray examination, bone density measurement and bone biopsy in bone defect area were performed.RESULTS AND CONCLUSION: (1) X-ray examination: The Lane-Sandhu X-ray score and bone mineral density value in the experimental group at different time points after operation were significantly higher than those in the other three groups (P < 0.05). (2) Hematoxylin-eosin staining: 12 weeks after repair, a small amount of bone tissues but no bone marrow formed in the scaffold group; a small amount of bone tissues with absence of bone marrow formed in the cell scaffold group, and the residual scaffold was visible; in the experimental group, the scaffold was completely absorbed,and mature bone and medullary cavity formed with presence of bone marrow. (3) Scanning electron microscope observation: 12 weeks after repair, irregular arrangement of bone fibers and a large number of bone fossae were observed in the scaffold group; the cell scaffold group showed a large number of osteoblasts, but bone fibers still arranged irregularly; in the presence of the Haversian system, a large number of regularly arranged bone trabeculae were detective in the experimental group. These results elucidate that the Shh modified nHAC/BMSCs complex can promote the repair of bone defects.

Objective To investigate antimicrobial resistance among Streptococcus pneumoniae clinically isolated from 14 teaching hospitals located at different areas in China in 2005-2008 and to give logical guidance for clinical empirical therapy.Methods A total of 1 317 non-repetitive S.pneumoniae isolates in 14 teaching hospitals from 2005-2008 were collected and sent to the central lab for reidentification and susceptibility testing, including 271 isolates collected in 2005, 391 isolates collected in 2006, 363 isolates collected in 2007 and 292 isolates collected in 2008. Most of the isolates were from community-acquired respiratory tract infections, which were isolated from outpatient or emergency department patients with respiratory tract infections or those patients with respiratory tract infections within ≤48 hours hospitalization.The districts where the organisms were isolated include North China, Northeast China, South China, Central and Northwest China and East China.The patients included adults, teenagers and children.The minimum inhibitory concentrations (MICs) or inhibitory zone diameter of 17 antimicrobial agents were determined by Etest method, agar dilution method or disk diffusion method.WHONET5.5 software was used to analyze susceptibility rate, intermediate rate, resistance rate, MIC50 and MIC90.Results Linezolid (100%) and fluoroquinolones (95.2%-99.7%) showed excellent activities against S.pneumoniae.Among β-lactams, amoxicillin-clavulanic acid remained high activities (73.8%-92.1%),followed by penicillin, ceftriaxone and cefepime with year-over-year decrease in activities.The activities of three second-generation cephalosporins were low (36.3%-38.4% in 2008).The activities of erythromycin, azithromycin, clindamycin, trimethoprim/sulfamethoxazole and tetracycline against S.pneumoniae were poor and decreased year over year.The incidence of penicillin non-susceptible S.pneumoniae (PNSP) was increasing especially for PISP (from 4.4% in 2005 to 20.2% in 2008).The incidence of PNSP in North China was low (6.0%), while this value were high in central China and East China (30.1% and 38.7%, separately).The incidence of PNSP in adults (15.7%) was obviously lower than that in children(≤5 years:33.0%) and teenagers (6-17 years:38.2%).Conclusions linezolid and fluoroquinolones showed excellent in vitro activity against S.pneumoniae, followed by penicillin and cephalosporins with year-over-year decrease of activity. Clinicians should pay more attention when using those antimicrobial agents with poor activity against S.pneumoniae, which include macrolides, clindamycin, trimethoprim/sulfamethoxazole and tetracycline.

Objective: To study the effect of enalapril on inducible atrial fibrillation(AF) in old rats. Methods: Old male Wistar rats were randomly divided into control group(n = 12) and experimental group(n = 13). Rats in control group were fed routinely. Rats were fed with enalapril besides normal diet in experimental group for three months. Rats were then anesthetized, thoracotomy was performed and pericardium was opened to expose heart. Right atrium effective refractory period(ERP) was measured. Sinus conduction time (SCT) and sinus recovery time (SRT) were measured for evaluating sinus function. Interatrial conduction time(IACT) and atrium response to burst pacing were evaluated in vivo. Plasma angiotensinⅡ level and atrial tissue angiotensinⅡ level were determined by radioimmunoassay. Sections were cut from the tissue of atrium and stained with Masson trichrome. The ratio of the area occupied by interstitial to the total area was measured. Results: Contrast to control group,IACT and SRT were shorter in experimental group(P ＜ 0.01 and P ＜ 0.05 respectively). AF were induced in 9 rats in control group and 4 rats in experimental group(P ＜ 0.05). AngiotensinⅡconcentration was significantly decreased in right and left atrium tissues of experimental group compared with that in control group(P ＜ 0.01). A significant decrease in interstitial atrial fibrosis was presented in experimental group compared with that of control group(P ＜ 0.01). Conclusion: Inducible atrial fibrillation rate was decreased in old rats after treatment with enalapril. This effect maybe resulted from the inhibited local atrium renin-angiotensin system and improved sinus node function by enalapril.

Objective To evaluate the influences of susceptibility interpretation of Escherichia coli,Klebsiella pneumonia and Proteus mirabilis in China mainland according to the old and new ceftazidime,cefotaxime and ceftriaxone breakpoints in CLSI M100-S20 and CLSI M100-S19. Methods First, We analyzed the antibacterial susceptibility results of the three bacteria by agar dilution method in the SEANIR surveillance item, which were collected from 15 national hospitals between the year of 2005 and 2007 and excluded the AmpC enzyme positive isolates according to the PGR-DNA sequencing method and/or the antibacterial susceptibility phenotype. ESBL phenotype was confirmed by the CLSI phenotypic confirmatory test. Antibacterial susceptibility of the total 2733 Escherichia coli, Klebsiella pneumonia, Proteus mirabilis isolates was retrospectively analyzed by WHONET 5. 4 software according to the breakpoints of the CLSI M100-S19 (S19) and CLSI M100-S20 (S20). Second, 207 isolates of Peking Union Medical College Hospital with the results of both agar dilution method and disk diffusion method were performed by recurrent analysis. Then we observed the inter-method agreement through the scatter diagram according to the breakpoints of S19 and S20. Results First, as to the ESBL positive Escherichia coli, Klebsiella pneumonia and Proteus mirabili.s, the resistant rate of cefotaxime increased from 65.2% , 55.5%, 14. 6% under S19 (64 μg/ml) to 99. 7%, 96. 2% , 93. 8% under S20 (4 μg/ml). The susceptibility rates decreased from 6. 0%, 11.5%, 33.3% under S19 (8 μg/ml) to 0%, 0. 2%, 0% under S20 ( 1 μg/ml). Ceftriaxone had the same trend as cefotaxime. Though ceftazidime was more active than cefotaxime and ceftriaxone, as to the ESBL positive Escherichia coli and Klebsiella pneumonia, the resistant rates slightly increased from 30. 3%,43. 2% under S19 (32 μg/ml) to42.0%, 56. 0% under S20 (16 μg/ml). The susceptibility rates slightly decreased from 58. 1%, 44. 1% under S19 (8 μg/ml) to 44. 7%, 28.0% under S20 (4 μg/ml). Second,as to the ESBL negative Escherichia coli, Klebsiella pneumonia and Proteus mirabilis, all the susceptibility rates of ceftazidime, cefotaxime and ceftriaxone were between 99. 2%-100. 0%, the resistant rate were between 0%-0. 4%. Third, the S20 MIC breakpoints had a good correspondence with the ESBL phenotype.Fourth, according to the recurrent analysis of MIC testing and disk dilution method, r value was 0. 67,0. 79, 0. 77 for ceftazidime, cefotaxime and ceftriaxone, respectively, and all P value were under 0. 01. The intermethod rates of S19 and S20 were both acceptable. Conclusions If the cefotaxime and ceftriaxone S20 new breakpoints were used, the concordance of antibacterial susceptibility results and ESBL phenotype would increase greatly. The clinician could select proper antibiotics according to the antibacterial susceptibility results and clinical symptoms. It is no longer necessary to edit results for cephalosporins, aztreonam, or penicillins from susceptible to resistant. However, until laboratories implement the new interpretive criteria,ESBL testing should be performed as described in Supplemental Table 2A-S1. The relationship between the new breakpoints of ceftazidime and clinical outcomes need to be further evaluated.