Virtual medical education has been used in the preclinical training of dentistry. The study aimed to evaluate the effectiveness of orthodontic bracket bonding training using the haptic-enhanced virtual reality simulation system. Twenty-six orthodontic postgraduates were recruited to attend the preclinical training using the virtual training system, consisting of the Virtual Learning Network Platform (VLNP) and the Virtual Simulation Training and Evaluation System (VSTES). Students were asked to perform the online training on VLNP within one week and the offline section on VSTES once each week for 6 consecutive weeks. Students’ training outcomes were assessed using the 3D scanning data of the fixed bracket position before and after the training. Students were asked to provide feedback through a survey to identify their perceived benefits or drawbacks of this system. Student’s t-tests or Wilcoxon signed-rank tests were used to compare differences in the outcomes, including the total score and each tooth score, between the pre- and post-training and among each online or offline virtual training session. The level of significance was P < 0.05. The final online test scores of ‘etching’, ‘rinsing’, ‘positioning bracket position’, and total items in the online interactive virtual practicing using VLNP were 3–17

Background: This study aimed to evaluate the effectiveness of integrating digital technology into cephalometric measurement teaching. Methods: In total, 94 undergraduates of stomatology were recruited and randomly allocated to two groups. According to the cross-over design, both groups completed cephalometric measurements by the traditional hand-drawn method and digital technology (the Dolphin software) in different order. In the traditional hand-drawn method, students depicted the outline of the craniofacial anatomical structures on sulfuric transfer paper first, then marked the measurement points and completed the measurement of line spacings and angles; by digital technology, they marked the points in the software and adjust the automatically generated outlines of the structures to obtain the results. Two professional orthodontists were invited as instructors and their measurements were set as standards. An online questionnaire was also used to investigate students' attitudes toward digital technology being used in the cephalometric teaching process. Results: There were significant differences of students' measurements ( P 1-SNA<0.01, P 1-SNB=0.01 and P 1-L1-NB (mm)<0.01; SNA: sella-nasion-subspinale angle, SNB: sella-nasion-supramental angle, L1-NB (mm): the distance from the lower central incisor tip to the nasion-supramental plane) between the traditional method and digital technology. Besides, the results of most items by digital technology were closer to the standards than those by the traditional method, including five items with statistical significance ( P 2-SNB<0.05, P 2-L1-NB (mm)<0.01, P 2-FMA<0.05, P 2-FMIA<0.05, P 2-IMPA<0.01), while three items were the opposite ( P 2-SNA<0.05, P 2-ANB (mm)<0.01, P 2-NA-PA<0.01). The questionnaire showed more students preferred digital technology (33%) as a better teaching method than the traditional method (2%) and 72% of participants thought they had mastered 50-80% of cephalometric knowledge after the course. Conclusions: This study demonstrated effectiveness and acceptance of the course applying digital technology during the cephalometric teaching process.

Background: This study aimed to evaluate the effectiveness of integrating digital technology into cephalometric measurement teaching. Methods: In total, 94 undergraduates of stomatology were recruited and randomly allocated to two groups. According to the cross-over design, both groups completed cephalometric measurements by the traditional hand-drawn method and digital technology (the Dolphin software) in different order. In the traditional hand-drawn method, students depicted the outline of the craniofacial anatomical structures on sulfuric transfer paper first, then marked the measurement points and completed the measurement of line spacings and angles; by digital technology, they marked the points in the software and adjust the automatically generated outlines of the structures to obtain the results. Two professional orthodontists were invited as instructors and their measurements were set as standards. An online questionnaire was also used to investigate students' attitudes toward digital technology being used in the cephalometric teaching process. Results: There were significant differences of students’ measurements (P1-SNA<0.01, P1-SNB=0.01 and P1-L1-NB (mm)<0.01; SNA: sella-nasion-subspinale angle, SNB: sella-nasion-supramental angle, L1-NB (mm): the distance from the lower central incisor tip to the nasion-supramental plane) between the traditional method and digital technology. Besides, the results of most items by digital technology were closer to the standards than those by the traditional method, including five items with statistical significance (P2-SNB<0.05, P2-L1-NB (mm)<0.01, P2-FMA<0.05, P2-FMIA<0.05, P2-IMPA<0.01), while three items were the opposite (P2-SNA<0.05, P2-ANB (mm)<0.01, P2-NA-PA<0.01). The questionnaire showed more students preferred digital technology (33%) as a better teaching method than the traditional method (2%) and 72% of participants thought they had mastered 50-80% of cephalometric knowledge after the course. Conclusions: This study demonstrated effectiveness and acceptance of the course applying digital technology during the cephalometric teaching process.

INTRODUCTION:Human umbilical cord mesenchymal stem cells (UCMSCs) play an important role in repairing the damaged endometrium of intrauterine adhesion (IUA). Meanwhile, exosomes released by UCMSCs can mediate intercellular communication by delivering miRNAs. It has been shown that miR-543 level was reduced in IUA tissues. However, the role of miR-543 in the progression of IUA remains largely unknown. Therefore, we investigated the role of UCMSCs-derived exosomal miR-543 in IUA. METHODS:In this study, human endometrial epithelial cells (hEECs) were treated with TGF-β1 for mimicking endometrial fibrosis in vitro. In addition, the IUA-like mouse model in vivo was established by a dual damage method of curettage and LPS infection. RESULTS:The level of miR-543 was markedly reduced in hEECs exposed to TGF-β1 and in endometrium tissues of IUA mice. Additionally, miR-543 could be transferred from UCMSCs to hEECs via exosomes. Meanwhile, exosomal miR-543-derived from UCMSCs significantly reduced the expressions of N-cadherin, α-SMA, fibronectin 1 and elevated the expression of E-cadherin in TGF-β1-treated hEECs. Furthermore, UCMSCs-derived exosomal miR-543 attenuated IUA-induced endometrial fibrosis in vivo, as shown by the decreased N-cadherin, α-SMA and fibronectin 1 protein expressions. DISCUSSION:Collectively, UCMSCs-derived exosomal miR-543 was able to prevent endometrial fibrosis both in vitro and in vivo via downregulating N-cadherin. These results may provide an insight into the clinical treatment for IUA.

Qixue Shuangbu Prescription (QSP) has been widely applied in the treatment of chronic heart failure (CHF). Previous clinical studies have found that the efficacy of processed QSP was significantly enhanced in the treatment of CHF. We have identified and analyzed the nonvolatile components before and after processing of QSP, and predicted the mechanism of synergistic effect after processing in the treatment of CHF. However, the synergistic mechanism of processed QSP caused by the difference of volatile components was still unclear. In this study, we developed a method of needle trap device coupled with gas chromatography-triple quadrupole mass spectrometry to elucidate the difference of volatile components between crude and processed QSP. The established method has been used to identify 104 volatile compounds in crude and processed QSP. The results of multivariate data showed 38 differential compounds were screened as potential markers, which would further explain the mechanism of processing synergistic effect of processed QSP. This study successfully developed the method to elucidate its processing mechanism based on the difference of volatile compositions between crude and processed QSP for the first time, and it would provide a novel analytical strategy for the impacts of different processing methods on main volatile compounds in traditional Chinese medicine.

Abstract Background: Periodontal ligament (PDL) is a dense fibrous connective tissue connecting tooth to its alveolar socket. As the most abundant cells in the PDL, PDL fibroblasts possess osteoblastic phenotypes and are mechanoresponsive to various mechanical stimuli including vibration. Recent studies show that low magnitude (0.2-0.5 g) high frequency (30-120 Hz) vibrations (LMHFV) could increase the mass and density of alveolar bone as well as restrain the atrophy of alveolar bone after tooth extraction. However, the cellular and molecular mechanisms of these anabolic actions of mechanical vibration are largely unknown. To study the effects of mechanical vibration on the osteogenic differentiation of human periodontal ligament cells (hPDLCs) and its regulation on osteoclast formation, hPDLCs were subjected to sinusoidal LMHFV (0.3 g) at various frequencies (30, 60, 90 Hz). Methods and Results: Our results show that LMHFV enhanced osteogenic differentiation of hPDLCs most significantly at 60 Hz. Induction with the conditioned medium (CM) from the vibrated hPDLCs significantly inhibited osteoclastic formation. Mechanistically, LMHFV significantly induced potentiation of Wnt/β-catenin signaling, in parallel with the up-regulated expressions of osteogenic marker genes RUNX2, OPN and BSP which were enhanced by LiCl. LiCl treatment also enhanced the LMHFV-induced up-regulation of osteoprotegerin (OPG)/nuclear factor-κ b ligand (RANKL) ratio. Conclusions: LMHFV (0.3 g, 60 Hz) could maximally promote osteogenic differentiation of hPDLCs via potentiation of Wnt/β-catenin signaling and regulate its downstream OPG/RANKL axis towards inhibiting osteoclastogenesis.

Objective To investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic spinal compression fracture(OSCF)in elderly patients. Methods From February 2017 to June 2018,a total of 77 elderly patients who met the inclusion and exclusion criteria were included in this study.Grip strength of dominant hand was measured by an electronic grip dynamometer with cut-off values of 27 kg for males and 16 kg for females.The cross-sectional area of the pedicle level muscle of the 12th thoracic vertebra(T12)was measured by chest CT.The skeletal muscle index(SMI)was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height.The SMI cut-off value used to diagnose sarcopenia was 42.6 cm2/m2for males and 30.6 cm2/m2 for females.Sarcopenia is confirmed when both grip strength and SMI are below the cut-off values.The patients with OSCF all received PKP.The patients in the sarcopenia and non-sarcopenia groups were compared in terms of age,gender,body weight,operation duration,the amount of bleeding,time to ambulation,hospital stay,visual analogue scale(VAS)before and 1 month after operation,Oswestry disability index(ODI)1 month after operation as well as the incidence of refracture within 1 year after operation. Results Gender,body weight,operation duration,the amount of bleeding and the preoperative VAS score showed no significant difference between the two groups(χ2=3.563,P=0.059;t=0.406,P=0.686;t=1.119,P=0.267;t=-0.166,P=0.868;z=-1.076,P=0.282).The patients in the sarcopenia group showed longer time to ambulation,longer hospital stay,higher VAS score and ODI 1 month after operation than those in the non-sarcopenia group(t=3.938,P<0.001;t=5.655,P<0.001;z=-4.562,P<0.001;z=-5.222,P<0.001).There was no significant difference in the incidence of refracture within 1 year after operation between the two groups(χ2=0.596,P=0.440).Linear regression results showed that age did not affect the hospital stay,rehabilitation duration,VAS score or ODI(P=0.519,P=0.870,P=0.332,P=0.126),whereas sarcopenia had significant effects(P<0.001,P=0.001,P<0.001,P<0.001). Conclusions Sarcopenia with OSCF has poorer limb function recovery.Reasonable rehabilitation exercise and dietary therapy are necessary for patients with sarcopenia.

Although genetic variants in autophagy pathway genes were associated with the risk of oral cancers and early development in embryos, their associations with non-syndromic cleft lip with or without cleft palate (NSCL/P) risk remained unclear. A two-stage case-control study (2,027 NSCL/P cases and 1,843 controls) was performed to investigate the associations between single nucleotide polymorphisms (SNPs) in 23 autophagy pathway genes and NSCL/P susceptibility. The logistic regression model was used to calculate effects of SNPs on NSCL/P susceptibility. Gene-based analysis was performed via the sequence kernel association test (SKAT) and multi-marker analysis of genomic annotation (MAGMA) methods. Expression quantitative trait loci (eQTL) analysis was conducted using NSCL/P lip tissue samples. Gene expression during embryonic development was evaluated using RNA-Seq. Functional roles were explored by luciferase activity assay, cell apoptosis, proliferation, and cycle in vitro. Rs2301104 in HIF1A was significantly associated with NSCL/P susceptibility in the combined analysis (OR: 1.29, 95% CI: 1.09-1.29, P = 3.39 × 10-03), and showed strong evidence of association heterogeneity (P = 9.06 × 10-03) with obvious association in the female (OR: 1.80; 95% CI: 1.32-2.45; P = 1.79 × 10-04). The G allele of rs2301104 was associated with enhanced transcription activity and high expression of HIF1A compared with that of C allele. Moreover, rs2301104 exhibited an eQTL effect for HIF1A with its GC/CC genotypes associated with decreased HIF1A expression compared with those with GG genotypes (P = 3.1 × 10-2). Knockdown of HIF1A induced cell apoptosis and inhibited cell proliferation in human embryonic palate mesenchyme (HEPM) and human oral epithelium cells (HOEC). This study demonstrated that rs2301104 in autophagy pathway gene HIF1A was associated with susceptibility of NSCL/P.

Background Postoperative delirium is common in older patients after spinal surgery. Many reports investigating the risk factors for delirium after spinal surgery have been published recently. Methods A literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, and Springer databases from inception to February 2019. Relevant studies involving patients with delirium who underwent spinal surgery were included if the studies contained data about blood transfusion or other related factors, such as haemoglobin, haematocrit, and blood loss levels. The Newcastle–Ottawa Scale was used for the study-quality evaluation. The pooled odds ratios or (standard) mean differences of the individual risk factors were estimated using the Mantel–Haenszel or inverse-variance methods. Results Fifteen observational studies met the inclusion criteria; the studies included a total of 583,290 patients (5431 patients with delirium and 577,859 patients without delirium). In addition to an advanced age, the results of the meta-analyses showed that living in an institution, diabetes, cerebral vascular diseases, pulmonary diseases, opioid use, length of surgery, intraoperative blood loss, blood transfusions, intraoperative infusion, preoperative albumin, postoperative albumin, preoperative haematocrit, postoperative haematocrit, preoperative haemoglobin, postoperative haemoglobin, preoperative sodium, postoperative sodium, Mini-Mental State Examination score, inability to ambulate, depression, number of medications, and treatment with multiple drugs (> three types) were significantly associated with delirium. Conclusion The above-mentioned risk factors can be used to identify high-risk patients, and the appropriate prophylaxis strategies should be implemented to prevent delirium after spinal surgery.

PURPOSE:To investigate the effect of buccolingual inclination and width of molars and their alveolar ridge height in skeletal Class III patients with width discrepancy by camouflaged treatment using cone-beam CT (CBCT). METHODS:Sixteen adult patients (5 males, 11 females) with mild to moderate skeletal Class III were treated with camouflaged method in the Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University from 2014 to 2015. CBCT scans were performed before and after treatment. Dicom data were calibrated and reconstructed using the software Simplant 16.0. Fifty-nine landmarks and two reference planes were located and measured in three coordinated dimensions. The data was processed using SPSS 17.0 software package. RESULTS:The buccolingual inclination of the maxillary first and second molars were increased, while the mandibular ones were decreased significantly after treatment (P＜0.05). The inter-molar width was increased in the upper arch while decreased in the lower arch. The buccal alveolar ridge height of maxillary molars was decreased significantly (P＜0.05). No significant difference of alveolar ridge height was found in the lingual side of maxillary molars or either side of mandibular molars. CONCLUSIONS:Camouflaged treatment deteriorated the transverse compensation in skeletal Class Ⅲ patients with width discrepancy, accompanied with maxillary buccal alveolar bone resorption. When camouflaged treatment is planned, the potential of molar compensation in transverse dimension should be clearly defined. Appropriate pre-adjusted appliance or surgery-assisted expansion should be considered to avoid periodontal risks.

OBJECTIVE:Clinical trials comparing the efficacy of different interventions for endometriosis are limited and controversial. The aim of the present study is to perform a network meta-analysis on the efficacy of various interventions for endometriosis. METHODS:We searched PubMed and Ovid EMBASE through 1 June, 2018, for trials reporting the pain score and 1-year pregnancy rate of patients including at least one pair of direct control group. The mean difference of pain score, odds ratio of 1-year pregnancy rate, and their associated 95% credible intervals (CrI) were used to describe efficacy. The surface under the cumulative ranking curve (SUCRA) was calculated to illustrate the rank probability of various treatments for different outcomes, on the basis of network meta-analysis. RESULTS:Our meta-analysis enrolled six studies for the evaluation of reducing pain and 10 studies for the 1-year pregnancy rate. All involved trials were sufficiently powered with a low risk of bias. Expectant management (EM), progesterone (PR), and gonadotropin-releasing hormone (GnRH)-agonist (GN) were significantly effective to reduce pain when compared with the placebo; EM ranked the highest on the SUCRA curve. For the 1-year pregnancy rate, no significant difference between the interventions was evident. Ablation ranked the highest with a SUCRA value of 0.6328. The rank of EM was acceptable with a SUCRA value of 0.4452. Our experimental results need to be verified by more high-quality randomized controlled trial articles. CONCLUSION:Limited available evidence showed that EM, PR, and GN were significantly effective to reduce pain when compared with the placebo. Due to a lack of convincing evidence favoring surgery or medication, we recommend considering EM.

BACKGROUND:Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery.METHODS:Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I test. Both Begg and Egger tests were used to assess potential publication bias.RESULTS:We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion (P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome (P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents (P <.05).CONCLUSION:In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.

The purpose of the study was to extract, separate, purify and character Scutellaria baicalensis Georgi polysaccharides, and to further explore the potential mechanism on colitis. Scutellaria baicalensis Georgi was extracted with water and precipitated with alcohol. The obtained crude polysaccharide was fractionated sequentially by DEAE-52 ion exchange column and Sephadex G-100 gel colum. Then, we obtain the purified fraction, named SP1-1. SP1-1 (4.56 × 105 Da) was mainly composed of mannose, ribose, glucuronic acid, glucose, xylose and arabinose with molar ratios of 2.14:3.61:1:2.86:5.98:36.39. FI-TR indicated SP1-1 had the characteristic absorption of polysaccharides with a pyranoid ring. SEM displayed honeycomb structure. Oral administration of SP1-1 significantly decreased disease activity index, ameliorated dextran sulfate sodium-induced colonic pathological damage, and reduced myeloperoxidase activity. Additionally, SP1-1 markedly suppressed the proinflammatory cytokines level, including IL-1β, IL-18 and TNF-α, in the serum and colon of DSS-induced mice and THP-1-derived macrophages. Furthermore, a decreased CD11b+ macrophage infiltration in colons and inactivation of caspase-1 in peritoneal macrophages were detected in SP1-1-treated mice. The mechanisms responsible for these effects of SP1-1 were attributed to its inhibition on NF-κB signaling and NLRP3 inflammasome activation. These findings support SP1-1 as a novel drug candidate in the treatment of colitis.

OBJECTIVENon-syndromic tooth agenesis (NSTA) may share common genetic factors with non-syndromic cleft lip with or without cleft palate (NSCL/P). Single-nucleotide polymorphisms (SNPs) were associated with individual's susceptibility to these anomalies. We selected five NSCL/P-associated SNPs from our previous genome-wide association study (GWAS) to test for the associations with NSTA.MATERIALS AND METHODSA total of 677 NSTA cases and 1,144 healthy controls were recruited in this case-control study. Five genome-wide NSCL/P-associated SNPs (rs2235371, rs7078160, rs8049367, rs4791774, and rs13041247) were genotyped by TaqMan platform and evaluated for the associations with NSTA using plink software.RESULTSNo significant associations between these SNPs and risk of NSTA were observed in the overall analysis and subgroup analysis with the number of missing teeth. However, in the subgroup analysis by tooth position, rs8049367 was nominally associated with mandibular premolar agenesis (Dominant model: ORdom  = 0.66, 95% CIdom  = 0.47-0.93, pdom  = 0.016; Heterozygote model: ORhet  = 0.60, 95% CIhet  = 0.41-0.88, Phet  = 0.008). Rs4791774 showed a nominal association with congenitally missing maxillary canine (Dominant model: ORdom  = 0.53, 95% CIdom  = 0.28-0.98, pdom  = 0.041; Heterozygote model: ORhet  = 0.50, 95% CIhet  = 0.26-0.97, Phet  = 0.041) and premolar (Additive model: OR = 0.59, 95% CI = 0.36-0.96, p = 0.035).CONCLUSIONThis study showed that NSCL/P susceptible loci rs8049367 and rs4791774 were probably associated with the risk of NSTA.

The aim of this study was to examine the buccolingual inclination and intermolar arch width of first molars related to sagittal and vertical discrepancies in the Chinese population. Cone-beam computed tomography (CBCT) data and medical records of 236 patients were analyzed with respect to gender, developmental stage, sagittal classification, and vertical growth pattern. Independent samples t-test, analysis of variance with post-hoc test, and regression analysis were performed. The study showed (1) no statistical significance among various developmental stages. (2) males' intermolar distances were wider than females' in both arches, while no gender difference was found in the angular measurements. (3) maxillary first molars were the most buccally inclined (P < 0.000) in skeletal Class III subjects, while the mandibular ones were the most buccally compensated (P < 0.001) in skeletal Class II subjects. The skeletal Class III showed the widest intermolar distances with significant difference. (4) varying compensations among the different growth patterns, which showed the most buccal inclinations in the maxilla (P < 0.002) and the most lingual inclinations in the mandible (P < 0.000) for subjects in the high angle group. This study demonstrated that (1) sagittal skeletal discrepancy can affect both the buccolingual inclination and the intermolar width of the first molars and (2) vertical skeletal discrepancy can affect buccolingual inclination of the first molars. These should be taken into consideration to avoid clinical complications when planning and treating different skeletal malocclusions.