Objective:To analyze and the smile line of Zhuang-Chinese youths.Methods:1 00 Zhuang volunteers aged 1 8-25 years were recruited for this study.The faces were individually registered by digital videography.The length and thickness of upper lips and mandibular incisor crown height appearance at rest,smile and laugh were recorded.Statistical analysis was performed using Mann-Whitney-U Test and non-parametric analysis.Results:The upper lip in men was longer than that in women at rest(P<0.05 ).The upper lip length increased and thickness decreased at smile and laugh in all subjects,in men was longer and thicker than in women(P<0.05),but there was no significant difference of upper lip thickness at rest between sexes(P<0.05).The mandibular anterior teeth,gingival papilla of all subjects were appeared at smile and laugh,there was no significant difference between sexes(P<0.05). Gingiva appearance at smile was in less than 1 0%of the subjects.39%subjects had high smile line,46%had average smile line and 1 5% had low smile line.Conclusion:Most of the Zhuang youths have moderate smile line,less high smile line and least low smile line.

Objective　To assess the roles of the soft contact lens(SCL) in the treatment of bullous keratopathy.Methods　Seventeen cases with bullous keratopathy wore SCL continuously and disposed it each month. All cases were followed up to observe whether the clinical symptoms were relieved and complications appear.Results　 Seventeen cases were followed up for 2 to 22 months. The results suggested that the clinical symptoms were relieved significantly without complications.Conclusion　SCL can relieve the clinical symptoms and improve the life quality of patients with bullous keratopathy significantly.

Objective To explore the clinical significance of the precision evaluation of computed tomography angiography and color Doppler image formation technology to the condition of the vascular system in the donor site.Methods From January,2014 to December,2014,CTA and color Doppler were used to examine conditions of the first dorsal metatarsal artery's courser and the size of original caliber in 25 patients with thumb or finger defected.Also the distance between skin and the first dorsal metatarsal artery.The accurate positions and adjacent relations of vessels in donor site were precisely marked and then the vessel original caliber was measured.Results All the first dorsal metatarsal arteries of 25 cases can be appeared clearly in CTA and color Doppler.Blood vessels line and filling results were completely consistent in intraoperative findings.The difference of the vessel original average caliber was statistically significant (P ＜ 0.05) (1.20 ± 0.25 mm,1.41 ± 0.15 mm and 1.3 ±0.2 mm in Doppler,CTA and operation,respectively) while the distance was not significant (P ＞ 0.05)(9.20 ±3.06 mm,10.32 ± 2.76 mm and 0.2 ± 2.6 mm in Doppler,CTA and operation,respectively) All the 25 transplanted toes were survived.Conclusion CTA combined color Doppler image formation technology in thumb or finger reconstruction can objectively reflect the real situation of the vessels in donor sites,and the structural characteristics and classification of anatomy for individualized,and has important clinical value in preoperative foot blood supply assessment.

Objective To investigate the early diagnostic value and prognostic significance of serum presepsin in patients with sepsis.Methods A prospective observational study of 80 patients from ICU was carried out between January 2014 and June 2015.According to sepsis criteria,the cases were divided into sepsis group (n =50)and noninfectious systemic inflammation syndrome group (SIRS group,n =30), and another 25 healthy volunteers were collected as control group.Meanwhile,sepsis group was further divided into survival and death subgroups according to 28-day mortality.The dynamic changes of serum presepsin,procalcitonin (PCT),soluble myeloid cells expressing triggering receptor-1 (sTREM-1 ),C-reactive protein (CRP),interleukin 6 (IL-6)were monitored on the 1st,3rd and 7th day after admission. Results (1)The serum presepsin level of sepsis group was higher than SIRS group and control group on the 1st day,and the difference was statistically significant [912.0 (563.5,1514.8)pg/mL vs.462.0 (334.0,556.0)pg/mL vs.120.0 (70.2,320.1)pg/mL,P <0.05];(2)The area under the ROC curve (AUC)of presepsin for the sepsis diagnosis was greater than PCT,sTREM-1,CRP,IL-6.As cut-off point set at 672.5 pg/mL,presepsin measurements showed a sensitivity of 80%,specificity of 96.7%, combination of presepsin,PCT and sTREM-1 could offer better diagnostic confirmation;(3)The level of serum presepsin,PCT and sTREM-1 in death group were higher than those in survival group.The levels of serum presepsin,PCT,sTREM-1 and IL-6 in survival group gradually decreased to normal level following the therapy,but the levels of above markers in death group didn’t decrease significantly;(4)The AUC of presepsin in prognosis of sepsis prediction was greater than that of PCT,sTREM-1,and combination of the above three markers could offer better prognostic value.Conclusions Serum presepsin provided superior diagnostic and prognostic accuracy to PCT and sTREM-1,and the combination of presepsin,PCT and sTREM-1 can offer the reliable guide for sepsis diagnosis and death risk prediction.

This study investigated the effect of cadmium on the telomerase activity, the expression of TERT, c-myc and p53 and the apoptosis of rat hepatocytes. The rats were administrated 5, 10 and 20 μmol/kg cadmium chloride intraperitoneally and sacrificed 48 h after the initial treatment. The telomerase activity of the rat hepatocytes was measured by the telomeric repeat amplification protocol (TRAP), and apoptosis was detected by flow cytometry. The mRNA expressions of TERT, c-myc and p53 were measured by reverse transcription-polymerase chain reaction (RT-PCR). C-myc and P53 proteins were determined by immunochemistry. The results showed that cadmium chloride increased the hepatocellular telomerase activity in a dose-dependant manner and induced the apoptosis of hepatocytes significantly. The value of relative coefficient between the telomerase activity and the apoptosis rate was 0.9398. RT-PCR revealed that specific bands corresponding to the TERT mRNA, c-myc mRNA, and p53 mRNA were displayed at 185, 342 and 538 bp respectively. Cadmium chloride could substantially increase the mRNA expressions of TERT, c-myc and p53 in rat hepatocytes, as compared with control. Moreover, cadmium chloride at the doses of 5, 10 and 20 μmol/kg could increase the content of P53 protein in rat hepatocytes obviously, but only that at the doses of 10 and 20 μmol/kg substantially promoted the c-myc protein level in rat hepatocytes. Our study herein suggested that cadmium may contribute to the carcinogenesis by activating telomerase, and overexpressing the mRNAs of TERT, c-myc and p53, and causing apoptosis of normal cells.

Objective To investigate the treatment of septic shock(SS) from upper urinary obstruction(UUO). Methods Continuous veno-venous haemofiltration(CVVH) combined with surgical method was applied to 42 SS patients from UUO. Their general conditions, liver and kidney functions, APACHE Ⅱ, therapeutic intervention scorisystem(TISS), multiple organ dysfunction syndrome (MODS), complication rate and main outcomes were analysed comparing with traditional therapies groups(n=30). Results Compared with those traditional therapies, the APACHEⅡ , MODS and TISS score decreased (P＜0.05). Thirty-seven out of 42 patients survived and the survival rate was 88.0% during ICU. Conclusion CVVH combined with surgical methods may effectively decrease the incidence of complications and mortality of SS from UUO, and the mechanism may be related to the remove of mediators of inflammation.

Objective To evaluate the effect of different fluid resuscitation strategies on the cardiac function in patients with septic shock.Methods Forty-eight patients met diagnostic criteria of septic shock were enrolled prospectively between January 2014 and April 2015.Patients were divided into conservative late fluid management (CLFM) group (n =20) and liberal late fluid management (LLFM) group (n=28) after achieving early goal-directed therapy within 24 h.Haemodynamic parameters,mRNA levels in Toll-like receptor 4 (TLR4) signal pathway and serum levels of myocardial damage markers were compared.Student t-test was used to compare means between two groups.Quantitative data that were not normally distributed were compared by Mann-Whitney U test.Qualitative data were compared using x2 test.Multivariable Logistic regression analysis was used to identify the independent predictors for prognosis.Results The cardiac function index (CFI) in CLFM group were (5.01± 1.41)/min and (5.39±1.48)/min on day 3 and day 7,respectively,and the cardiac index (CI) were (3.43±0.50) and (3.73±0.76) mL · min-1 · m-2 on day 3 and day 7,respectively.The CFI and CI in LLFM group were (4.28±1.22)/min,(4.22±1.63)/min and (3.31±1.24),(3.09±1.14) mL · min-1 · m-2 respectively on day 3 and day 7.The differences between two groups were statistically significant on day 7 (t=2.546,2.185,both P＜0.05).TheTLR4 mRNAlevelswere3.0±1.1 inCLFM group compared to 4.8±1.4in LLFM group on day 3 (t=4.786,P＜0.01) and 1.6±0.5 compared to 4.0±1.1 on day 7 (t=9.089,P＜0.01).Nuclear factor (NF)-κB mRNA levels were 3.5±1.1 inCLFM group compared to 6.8±1.5 in LLFM group on day 3 (t=8.354,P＜0.01) and 2.4±0.5 compared to 5.7±0.9 (t=14.820,P＜0.01) on day 7.The levels of serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β in CLFM group were lower than those in LLFM group on day 3 and day 7 (all P＜0.01).Multivariable Logistic regression analysis showed that fluid balance (OR =1.236,95 ％ CI:0.78-1.692,P =0.033),CFI (OR=3.263,95％CI:1.136-7.936,P=0.027) and acute physiology and chronic health evaluation Ⅱ (OR=2.064,95％CI:1.248-2.898,P=0.003) were the independent predictors for 28-day mortality.Conclusions CLFM may inhibit the product of myocardial depressant factors TNF-α and IL-1β through attenuating TLR4/NF-κB signal pathway activation and thus to improve myocardial function and decrease mortality.

Objective:To understand the present situation of the construction of standardized asthma clinic for children in China, to explore the problems existing in the process of construction, and to promote the healthy development of standardized clinic construction.Methods:The process and current situation of the construction of standar-dized asthma clinics for children in China were reviewed and investigated, and the practical significance of the China Children′s Asthma Action Plan (CCAAP) in the construction of standardized asthma clinics for children was explored.Results:(1)By December 2020, 1 289 standardized asthma clinics for children and 135 regional demonstration centers had been built; 56 training sessions had been held, with a total of 2 560 doctors and 650 nurses trained, covering 2 560 hospitals across the country; and 4 518 patient education sessions were held.Online publicity covers a total of 1 million person-times, with an annual average of 1.33 million patients.(2)CCAAP improved the quality control level of standardized asthma clinic and promoted the standardized management of children.Conclusions:Through process optimization, professional evaluation, individual health education and real-time disease monitoring, standardized asthma clinic for children with asthma can effectively enhance asthma management awareness of children and their parents, improve disease awareness, and promote better control of asthma.It is an effective management model of asthma in children at present, and it is worthy of clinical promotion.CCAAP plays a good role in the construction of standardized outpatient clinic for asthma in children.The construction of standardized asthma clinic for children in China has achieved remarkable results, and the development trend is good in the future.

This study investigated the effect of cadmium on the telomerase activity, the expression of TERT, c-myc and p53 and the apoptosis of rat hepatocytes. The rats were administrated 5, 10 and 20 μmol/kg cadmium chloride intraperitoneally and sacrificed 48 h after the initial treatment. The telomerase activity of the rat hepatocytes was measured by the telomeric repeat amplification protocol (TRAP), and apoptosis was detected by flow cytometry. The mRNA expressions of TERT, c-myc and p53 were measured by reverse transcription-polymerase chain reaction (RT-PCR). C-myc and P53 proteins were determined by immunochemistry. The results showed that cadmium chloride increased the hepatocellular telomerase activity in a dose-dependant manner and induced the apoptosis of hepatocytes significantly. The value of relative coefficient between the telomerase activity and the apoptosis rate was 0.9398. RT-PCR revealed that specific bands corresponding to the TERT mRNA, c-myc mRNA, and p53 mRNA were displayed at 185, 342 and 538 bp respectively. Cadmium chloride could substantially increase the mRNA expressions of TERT, c-myc and p53 in rat hepatocytes, as compared with control. Moreover, cadmium chloride at the doses of 5, 10 and 20 μmol/kg could increase the content of P53 protein in rat hepatocytes obviously, but only that at the doses of 10 and 20 μmol/kg substantially promoted the c-myc protein level in rat hepatocytes. Our study herein suggested that cadmium may contribute to the carcinogenesis by activating telomerase, and overexpressing the mRNAs of TERT, c-myc and p53, and causing apoptosis of normal cells.
Animals ; Apoptosis ; drug effects ; Cadmium ; toxicity ; Hepatocytes ; drug effects ; metabolism ; pathology ; Male ; Proto-Oncogene Proteins c-myc ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Telomerase ; genetics ; metabolism ; Tumor Suppressor Protein p53 ; genetics ; metabolism

Hierarchical diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the homogenization of basic medical services. The medical alliance is an important service mode and service system of hierarchical diagnosis and treatment, whose role is to perfect the up-down linkage and meet the patient′s medical needs. Informatization construction is an important starting point to promote the services of the medical alliance. In order to solve the problem of connectivity, the medical alliance needs to establish a regional referral platform and realize the integrated service of all medical institutions. Renji Hospital, Shanghai Jiaotong University School of Medicine, has built a blockchain based referral system for hierarchical diagnosis and treatment, incorporating the S2B2C mode concept, and using the traceability, tamper proof and distributed accounting features of blockchain technology, realized independent storage of data in hospitals, realized real-time information sharing and interconnection, and provided a feasible solution for medical alliance management.