锁定螺钉不同头部角度对钉板系统力学性能的影响

目的探究锁定螺钉的头部角度以及锁定次数对钉板系统力学性能的影响,为医生在临床手术过程中选用适当锁定螺钉和把控锁定次数提供理论依据。方法选用具有不同头部角度的锁定螺钉与同种接骨板配合,并进行不同次数的锁定,通过悬臂弯曲试验,比较各组试件力学性能的差异。结果头部角度不同的锁定螺钉与锁定加压接骨板配合后的失效载荷与抗弯刚度存在显著性差异(P<0.05),锁紧程度最佳的钉板系统的力学性能最优;钉板配合进行3次锁定与进行1次锁定之间显著性差异不明显(P>0.05);不同头部角度锁定螺钉在不同锁定次数情况下的螺钉失效形式存在差异,锁定螺钉失效形式与其头部角度以及锁定次数正相关。结论头部角度不同的锁定螺钉与锁定加压接骨板配合后力学性能的差异性不容忽视,医生在临床过程中选用锁紧程度最佳的锁定螺钉与锁定加压接骨板,并选用合适扭矩的限力扳手酌情进行多次锁定,避免螺钉松动影响患者康复。     

Comparison of the success rate of a bioactive dentin substitute with those of other root restoration materials in pulpotomy of primary teeth: Systematic review and meta-analysis

BackgroundSeveral root canal restoration materials can be used after pulpotomy in primary teeth; however, it is unclear which is the most successful. The authors’ aim in this systematic review and meta-analysis was to compare the radiographic and clinical failure rates of a calcium silicate-based bioactive material (Biodentine, Septodont) with those of other root restoration materials such as mineral trioxide aggregate (MTA), formocresol, and ferric sulfate.Types of Studies ReviewedOn the basis of the determined study strategy, the authors performed a comprehensive search of the MEDLINE, Web of Science, Embase, and Cochrane Central Register of Controlled Trials online databases. The authors considered only randomized controlled trials. In the included studies, the authors compared the clinical and radiographic failure rates at different follow-up times of the pulpotomy of primary teeth with extensive caries treated by using Biodentine and other root restoration materials.ResultsAll of the included studies had an unknown or high risk of bias. On the basis of the Grading of Recommendations Assessment, Development and Evaluation scale, the quality of evidence for the comparison of MTA and Biodentine was moderate. Biodentine had a statically significantly higher radiographic failure rate than did MTA at 6 and at 9 through 12 months after pulpotomy. The authors found no substantial differences between the clinical failure rates of Biodentine and MTA and the radiographic or clinical failure rates of Biodentine and formocresol or of Biodentine and ferric sulfate.Conclusions and Practical ImplicationsMTA has a significantly lower radiographic failure rate than does Biodentine but no difference in clinical failure rates. On the basis of this result, the dentist can weigh the advantages and disadvantages of using Biodentine, MTA, ferric sulfate, and formocresol and can make a more informed decision about using the proper root restoration material.     

Protective effect of rapamycin against acrylamide-induced hepatotoxicity: The associations between autophagy,apoptosis, and necroptosis

Acrylamide (ACRL) was demonstrated to induce hepatotoxicity and programmed cell death (PCD). Rapamycin (RAPA)-induced autophagy had been reported to limit the progression of hepatocellular injury in experimental models. This research was designed to study two death pathways involved in ACRL-induced hepatotoxicity and the modulating effect of RAPA on the resulting hepatic injury. Thirty-six adult male rats were divided into three groups: control group, ACRL-treated group (20 mg kg/day), and the last group co-treated with ACRL plus RAPA (0.5 mg kg/day). Drugs were administered for 21 days via oral gavage. Blood samples were collected to assess alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Livers were dissected; parts were used for detection of superoxide dismutase (SOD) and malondialdehyde (MDA) tissue levels. Other parts were processed for hematoxylin and eosin, Masson's trichrome staining, immunostaining for microtubule-associated proteins 1A/1B light chain 3B (LC3), ubiquitin-binding protein (p62), caspase-3, and receptor-interacting protein kinase 1 (RIPK1). ACRL induced a significant elevation in ALT, AST, MDA levels, and reduction in the SOD level. ACRL also induced hepatocellular injury, fibrosis, and defective autophagy indicated by elevation of LC3 and p62 and increased p62/LC3 ratio. Moreover, it increased the apoptotic (caspase-3) and necroptotic (RIPK1) markers expression. RAPA significantly reduced liver enzymes, oxidative stress, fibrosis, and improved liver histology. Moreover, RAPA decreased p62/LC3 ratio indicated enhanced autophagy, and significantly reduced caspase-3 and RIPK1 expression. In conclusion, RAPA maintained autophagic activity which may save the hepatocytes from PCD and enhance cell viability.     

Identification of Dyslipidemic Patients Attending Primary Care Clinics Using Electronic Medical Record (EMR) Data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Database

The objective of this study was to define the optimal algorithm to identify patients with dyslipidemia using electronic medical records (EMRs). EMRs of patients attending primary care clinics in St. John’s, Newfoundland and Labrador (NL), Canada during 2009–2010, were studied to determine the best algorithm for identification of dyslipidemia. Six algorithms containing three components, dyslipidemia ICD coding, lipid lowering medication use, and abnormal laboratory lipid levels, were tested against a gold standard, defined as the existence of any of the three criteria. Linear discriminate analysis, and bootstrapping were performed following sensitivity/specificity testing and receiver’s operating curve analysis. Two validating datasets, NL records of 2011–2014, and Canada-wide records of 2010–2012, were used to replicate the results. Relative to the gold standard, combining laboratory data together with lipid lowering medication consumption yielded the highest sensitivity (99.6%), NPV (98.1%), Kappa agreement (0.98), and area under the curve (AUC, 0.998). The linear discriminant analysis for this combination resulted in an error rate of 0.15 and an Eigenvalue of 1.99, and the bootstrapping led to AUC: 0.998, 95% confidence interval: 0.997–0.999, Kappa: 0.99. This algorithm in the first validating dataset yielded a sensitivity of 97%, Negative Predictive Value (NPV) = 83%, Kappa = 0.88, and AUC = 0.98. These figures for the second validating data set were 98%, 93%, 0.95, and 0.99, respectively. Combining laboratory data with lipid lowering medication consumption within the EMR is the best algorithm for detecting dyslipidemia. These results can generate standardized information systems for dyslipidemia and other chronic disease investigations using EMRs.