The application and studies of reduced diameter implants(RDI)are increasing recently.A case with fracture of three 3.3 mm ITI implants in maxilla was reported in this paper.Combined with the related literature,overload,mechanical complications(such as fatigue, crevice corrosion and hydrogen embrittlement)and the insufficiency of mechanical properties of RDI may lead to the fracture.

The pattern of incidence and clin ic al presentation of primary hyperparathyroidism (PHPT) collected during the past 45 years were analysed. It showed that most of PHPT patients were young or mid- aged, and female patients were somewhat more than male patients. The duration of illness was longer and symptoms were more severe. The number of post-menopausa l female patients was increased in recent ten years.

Objective To study the clinical characteristics of thyroid carcinoma in young females,in order to improve the diagnosis and treatment of this disease.Methods The clinical data of 74 consecutive young female patients with thyroid carcinoma treated in our hospital in the recent ten years were analysed.In most of the cases,there was no firm texture or fixation of the thyroid nodules to surrounding structures on physical examination before operation.Ultrasonography was performed in all patients and multiple thyroid nodules were found in 61 cases(82.43%).Thyroid scintiscans were performed in 43 cases,and thyroid nodules were found in 41 cases.The cold,cool and warm nodules were found in 14,18 and 9 cases,respectively,by scintiscans.Fine needle aspiration biopsy(FNAB) was performed in 11 cases,and in 2 cases were negative,1 case showed abnormal cell,3 cases were suspicious of carcinoma,and 5 cases were confirmed papillary carcinoma.Results Papillary carcinoma was found in 70 cases,follicular carcinoma in 3 cases and medullary carcinoma in 1 case by histological examination,and benign disease was also accompanied in most cases.Lymph node metastases was found in 28 cases(37.84%),and the rate of metastases was significantly different than that of older female patients(16.46%) at the same time.There were 2 cases who died 3 years after operation because of metastases.Conclusions The lymph node metastases were prevalent in young female patients with thyroid carcinoma.The texture and mobility of the nodules cannot be used to differentiate benign from malignant nodules.We should carefully analyze every nodule found on ultrasonography.For the solid nodules with diameter larger than 1.0cm,we suggest operation;for the non-solid nodules with diameter larger than 2.0cm,we prefer scintiscans and FNAB for diagnosis.

2.65 mmol/L with co-elevated PTH. For locating the adenoma, the specificity of B-Us was 95% and the sensitivity of MIBI was 100%. Our standard surgical procedure were bilateral exploration. We found much more tumors in inferior glands than that in superior glands. The success rate in a single exploration in benign cases was 99%. Conclusions PHPT could be diagnosed by co-elevated calcemia and PTH. B-US with 99m Tc-MIBI was the first choice for localization. Bilateral exploration is safe and effective.

Objective ToinvestigatethementaldevelopmentsituationofpreschoolchildreninTaiyuan. Methods 1174preschoolchildrenoftwourbanareasinTaiyuanwereselected.TheyweretestedwithDenverDevel-opmentScreenTest(DDST).Results Thepassingratewas94.80%in1174children.Theirindividual-social reaction ability and movement ability were good in the three groups.In the subject-touch reaction ability,the passing rate ofvertical tilt at 30°insidewas 36.36%in 4 years old group,which was higher than the other projects.In the speaking ability,the passing rates of three right in four problems with knowing preposition were 15.88% and 27. 22% in 4 and 5 years old group,which were higher than the other projects.The culture degree of the mental retar-dation children's parents were lower than those of the normal children's parents,the difference were statistically signifi-cant(χ2=4.485,P=0.034;χ2=7.577,P=0.006).Conclusion DDSTisaquicklyscreeningmethodformental retardation children,it is suggested to be used in medical and health examination for preschool children.

Through comparing problem-based learning and lecture-based learning, the PBL teaching can improve the learning interest and self-learning ability of students and also can accomplish the task of teaching better.

Objective To dynamically monitor the blood glucose in traumatic brain injury (TBI) patients within three days after admission, and to assess the impact of hyperglycemia on prognosis. Method Between 2007 and 2008, 62 TBI patients, who were admitted within 6 hours after the ineidence of injury without diahetes or severe combined injuries, were involved in this study. Blood glucose was monitored at 4 time points (instantly, 24 hours, 48 hours, and 72 hours after admission). Patients were classified into the mild, the moderate, or the se-vere TBI group according to GCS (Glasgow Coma Scale) scores, being classified into the survival or the dead group according to prognosis, or into the mile or severe hyperglycemia group depending on whether the blood glucose ex-ceeds 11.1mmol/L on admission. T tests and χ2 tests were applied to analyze the relationship among blood glucose levels, the degrees of injury, and the prognosis of studied patients. Results Patients with mild, moderate, or se-vere TBI showed hyperglycemia with different levels, and the blood glucose levels was consistent with the degree of the injury. The blood glucose of the patients in the dead group were significantly higher at all checked time points than those of the survival group, particularly instantly after admission (8.51±2.01 mmol/L vs. 11.54±2.45 mmol/L, P=0.0001, t=4.988). The mortality of patients with severe hyperglycemia was 64.71%, signifl-candy higher than that of the mild hyperglycemia group 13.95% (P=0.0002, χ2=15.46). The Intensive Care Unit Length of Stay (ICULOS) of the above two groups was 22.6 and 10.2 days,respectively (P=0.021, t= 3.216), but their hospital length of stay (HLOS) showed no statistical difference (P=0.052). Conclusions Hyperglycemia, as an early stress response to TBI, may reflect the degree of the injury. Blood glucose levels that exceed 11.1 mmol/L on admission may imply high mortality of TBI patients, so this could be used as a simple indi-cator to predict prognosis.

ObjectiveTo explore the correlation between IL-6-634C/G gene promoter polymorphism and body mass index (BMI),blood sugar (BS),25-hydroxy vitamin D (25-OH-D),and serum lipid levels by investigating in 8-12-year-old Han children in Shanxi province,China.MethodsIn Datong city of Shanxi province,214 8-12-year-old children were enrolled after obtaining informed consent from their parents.The weight and height were measured and the BMI was calculated.BS,serum lipids,and 25-OH-D were determined.IL-6-634C/G polymorphism were detected by polymerase chain reaction restricted fragment length polymorphism.The effects of genotype on BMI,BS,serum lipids,and 25-OH-D were also studied.ResultsThe genotypes of IL-6-634C/G polymorphism in 214 cases were GG ( 15％ ),GC (40％),and CC (45％).The percentages of C and G allele frequencies were 65％ and35％.The genotypes and allele frequencies showed no gender differences ( P ＞ 0.05 ).However,significantly different GG genotypes frequencies were found between overweight and obese children (38.3％) and other children ( normal weight children: 7.3％ ; thin children: 10.9％ ) (x2 =14.715,P =0.006).Multivariate logistic regression analysis showed that IL-6-634C/G polymorphisms and triglyceride were correlated with overweight and obesity (P ＜ 0.05 ).25-OH-D was not correlated with BMI (r =0.075,P =0.528),BS ( r =0.018,P =0.880 ),triglyceride ( r =- 0.097,P =0.417 ),high density lipoprotein cholesterin ( r =0.038,P =0.751 ),and low density lipoprotein cholesterin ( r =- 0.028,P =0.817 ).25-OH-D was not significantly different between overweight and obesity children.The distribution of three genotypes showed no correlation with 25-OH-D deficiency (x2 =0.622,P =0.733 ).ConclusionsIL-6-634C/G polymorphism exists in Han children in Shanxi province.IL-6 gene 634 GG genetype is a risk factor of childhood overweight and obesity,and may affect lipid metabolism.However,it has no direct impact on glucose metabolism.IL-6 gene 634C/G polymorphism and serum 25-OH-D are not relevant.IL-6 gene 634C/G polymorphism is not related to vitamin D deficiency diseases,and may be not related to bone calcium metabolism.25-OH-D is not relevant with BS and blood lipids level,and also is not associated with childhood overweight and obesity.

Objective To evaluate the value of selective intra arterial calcium stimulated venous sampling (ASVS) for the localization of pancreatic insulinoma. Methods Ten consecutive patients with clinically proved insulinoma were enrolled. Gastroduodenal artery, superior mensenteric artery, proximal and distal splenic artery were selectively cathererized for stimulating by rapid injection of 0.3g calcium gluconate. Blood was sampled through hepatic vein prior to and 30, 60, 90, 120, 150 s after stimulation for detecting insulin level. The peak insulin level after stimulation was divided by baseline level, and the highest one was named as peak ratio. The tumor was considered locating at the domain supplied by the artery of peak ratio. Results Accurate rate of ASVS was 90%, and ASVS was higher than that of B US (30%), EUS (43%), CT (70%), MRI (78%) and SAG (20%). Only 2 patients complained slight dizzy and chest distress. Conclusions ASVS has higher accuracy than conventional image studies by focusing the secreting function of insulinoma. It is suitable for some difficult cases. Injecting low dose calcium rapidly can effectively stimulate insulinoma secreting insulin. To separate the proximal splenic artery from the distal one by arteria pancreatic magna and to inject stimulator respectively is helpful for localizing the tumor in pancreas tail.

Objective To evaluate the preoperative nutritional status of patients with gastric carcinoma by using the European Nutritional Risk Screening 2002(NRS 2002)and its prediction for postoperative nutrition-related complications.Methods We prospectively evaluated the nutritional risk of 314 gastric cancer patients admitted in one center from 2004 to 2007 with NRS 2002 with China's normal body mass index(BMI),in terms of postoperative complications,mortality and hospital stay.Results NRS 2002 scoring system was applicable in 93.1% cases.Preoperatively 125 patients were of score≥3,accounting for 39.8% of this group.The postoperative complication rate(26.2%)was higher than 13.8% in those with normal preoperative nutritional scores(NRS 2002 score＜3)(P＜0.05);The odds ratio to develop a complication was 0.642 in patients with preoperative nutritional risk score(P＜0.05),and 1.596 in patients with clinicopathological stage of gastric cancer(P＜0.01).The correlation between length of hospital stay and nutritional risk was also assessed by Pearson correlation analysis.The Pearson coefficient was 0.177(P=0.002).Conclusion Preoperative nutrition score(NRS 2002)≥3 predicts higher postoperative complications and longer hospital stay.Preoperative nutritional support is necessary in patients with preoperative nutrition score(NRS 2002)≥3.