Objective To analyze the values of anteroposterior diameter (APD) in fetal renal pelvis separation during different gestational weeks and in predicting the prognosis.Methods Totally 182 cases of fetal renal pelvis separation in the Second Affiliated Hospital of Soochow University were enrolled in this study between January 2013 and October 2015.All of them were followed up to 12 months after birth.The detecting gestational weeks of non-reversible renal hydronephrosis and values of fetal renal pelvis APD were analyzed.Results Among the 182 cases of fetal renal separation,46 cases were detected in the second trimester,136 cases were detected in the third trimester (bilateral renal pelvis separation occurred in 92 cases).During the follow-up,114 cases recovered in the fetal period and 52 cases recovered within 12 months after birth,finally,16 cases (8.8％,16/182) of them progressed to non-reversible renal hydronephrosis.Among the 16 fetus of non-reversible renal hydronephrosis,10 cases (62.5％,10/16) were detected in the second trimester,their values of APD were 7.4-11.5 mm and the average was (8.0± 1.5) mm;6 cases (37.5％,6/16) were detected in the third trimester,their values of APD were 13.6-14.8 mm and the average was (12.8±2.0) rmm.The values of APD in fetus who were detected in the second trimester were smaller than those in the fetus who detected in the third trimester and the prognosis in the fetus who were detected in the second trimester was worse than those in the fetus who were detected in the third trimester,the fetus (21.7％,10/46) who progressed to non-reversible renal hydronephrosis in the second trimester were more than the fetus (4.4％,6/136) who were detected in the third trimester.Conclusion Clinical following-up combined with the detecting gestational weeks of fetal renal pelvis separation and values of fetal renal plevis APD by prenatal ultrasound may be helpful in predicting their prognosis.

Objective To investigate the primary angle-closure glaucoma iris weeks after cutting holes cut the width of the near future, long-term effect relationship, selected after close to long-term efficacy of the forecasting methods to improve iridectomy success rate. Methods 90 cases (116 eyes) with primary angle-closure glaucoma were randomly divided into three groups:A group(the width of the iris-week cut-hole cut 1.5mm) ,30 cases 42 eyes;B group(removal of the width of the iris weeks Ceccon 2 mm) ,30 cases 40 eyes;C group(the width of the iris-week cut-lole cut 3 mm) ,30 cases 34 eyes,after over 1 month,they were followed up to observe the intraocular pressure,anterior chamber angle width of the depth, depending on the features, the iris in recent weeks, as well as cutting holes,long-term concurrency disease. Results A:recent surgery success rate of 85.79% ,long-term surgical success rate of 76. 19% ;B group of recent surgery success rate of 87.5% ,long-term surgical success rate of 82.5% ;C group of recent surgery success rate of94.11% ,long-term surgical the success rate of 88.23%, X2 test the difference was significant(P＜ 0. 05) ;3 postoperative IOP decreased in varying degrees compared with the preoperative differences were significant(P＜0.01) ;peripheral angle after deep Random mean :A group of ≥ 1/3CT,compared the difference between before and after surgery were significantly( P ＜ 0.01 ) ;B group and C group ＞ 1/2CT,2 groups were compared before and after surgery the difference was highly significant( P ＜ 0.05 ). Conclusion Iridectomy was the treatment of primary angle-closure glaucoma safe and effective method of cutting holes. The width of the iris weeks to 2～3 mmwas appropriate, beneficial to control the iris weeks before the adhesion and angle-cut hole shallow narrowing.

Purpose:To evaluate the physical dose distributions and tolerance in locally recurrent nasopharyngeal carcinoma treated with intensity modulated radiation therapy (IMRT).Methods:From June 1999 to August 2000, 10 patients with locally recurrent nasopharyngeal carcinoma proven by histology, without neck lymphoid node recurrence and distant metastasis, were treated by IMRT. The interval from the time of initial radiotherapy to recurrence ranged from 14—50(median 25) months. The initial radiotherapy in all patients were treated with external radiotherapy alone to a median dose of 69Gy/35fractions/52days. IMRT method was performed by means of the MIMiC collimator and inverse treatment planning system (NOMOS company, USA). The prescribed dose of re radiotherapy to target volume was 57Gy/19fractions/4weeks.Results:All patients, except for some patients with mild weight loss and reaction in the oral cavity during radiotherapy, tolerated this IMRT well. IMRT achieved the better immediate responses in 10 patients with complete response in 6 cases and partial response in 4 cases. Recurrence was found in two patients, lung distant metastasis in one patient. The median survival in the 10 patients was 14 months. The median planning target volume (PTV) was 95.8(60—134) cm 3. The dose distributions in the PTV were as follows: median average dose 59.65?2.47Gy, median homogeneity index (HI): 1.18(?0.06); median dose to 95% PTV ≥ 53.2 (?1.36)Gy. The median dose to the organs at risk (OAR) were as follows: spinal cord 9.46?5.23Gy; brain stem 20.24?3.55Gy; left parotid gland 18.53?5.30Gy, right parotid gland 19.68?6.21Gy; left lens 2.11?0.65Gy, right lens 2.94?0.57Gy;Chiasm12.34Gy; left optical nerve13.14 Gy, right optical nerve17.65 Gy.Conclusions:Better dose distributions treated with IMRT was achieved in the patients with locally recurrent nasopharyngeal carcinoma and the patients tolerated this radiotherapy well. [

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.

Objective:To evaluate the outcome and prognostic factors of conventional radiotherapy followed by intensity-modulated radiation therapy (IMRT) as a boost combined with chemotherapy in the treatment of high-grade gliomas (HGG). Methods:From Nov. 2004 to Nov. 2006, 112 HGG patients were treated with conventional radiotherapy followed by IMRT as a boost combined with chemotherapy. The radiotherapy regimen included first-course conventional radiotherapy and latE-course IMRT as a boost with the total radiation dosage of 57.5- 62.5Gy (27-29 fractions in 37-45 days). All the patients received chemotherapy. Sixty-three patients received temozolomidE-based chemotherapy and 49 patients received semustine plus teniposide chemotherapy. The treatment reaction was recorded. The overall survival rate and local progression-free survival rate were calculated. The prognostic factors were analyzed by using multivariate COX regression model. Results:The acute treatment toxicity was the most at grade 1 to grade 2 and no grade 4 adverse reaction was observed. Three cases had late radiation-induced brain necrosis. The overall 1-, 2-, and 3-year survival rates were 78.9%, 54.7%, and 30.8%, respectively. Multivariate analysis revealed that tumor location (P=0.001) and KPS score (P=0.011) were independent prognostic factors. The 1-, 2-, 3-year local progression-free survival rates were 63.8%, 38.9%, and 10.5%, respectively. Multivariate analysis revealed that tumor location (P=0.001), KPS score (P=0.001), and histologic type (P=0.005) were independent prognostic factors. Multivariate analysis did not reveal the significant correlation of temozolomide chemotherapy with the prognosis of the patients. Conclusion:Postoperative conventional radiotherapy followed by IMRT as a boost combined with chemotherapy has better short-term efficacy in the treatment of HGG and the adverse reaction is tolerable. KPS score, tumor location, and histologic type are important prognostic factors. Temozolomide chemotherapy is not associated with the prognosis of patients.

A subcellular proteomic method was applied to investigate the protein expression profiles of nasopharyngeal carcinoma (NPC) cell lines,CNE1 and CNE2,at various differentiation levels.Plasma membrane (PM) proteins were obtained by Percoll density grade centrifugation and subjected to twodimensional electrophoresis (2DE) followed by PDQuest software analysis.Nine proteins expressed with more than two folds difference were identified by MALDI-TOF-TOF,of which functions involved in cell differentiation,signal transduction,and metabolism.Half of these proteins,such as galectin-1 and annexin Ⅱ,were analyzed with real-time quantitative PCR or Westem blotting.We have tested a proteomic method to study differentiated NPCs at different levels and found several proteins that might be related to their biological characteristics.

Objective To study the effects of efflux pump inhibitors(CCCP and PAβN)on carbapenems in Pseudomonas aernginosa(P.aeruginosa)clinical isolates and investigate the association between the resistance to imipenem or meropenem and expression levels of efflux pumps of P.aeruginosa.Methods MICs of imipenem or meropenem combined with efflux pump inhibitors including carbonyl cyanide m-chlorophenylhydrazone(CCCP,107 strains)and Phe-Arg-β-naphthylamide(PAβN,71 strains)against imipenem-resistant strains were determined by agar dilution method,and changes of MICs were observed.For 32 strains with different resistant phenotypes to imipenem and meropenem,the mRNA expression levels of three efflux pump genes(mexA,mexD and mexF)were quantified by real time fluorescent quantitative PCR.Results The resistance rate of imipenem and meropenem didn't prove any significant difference in the presence of efflux pump inhibitors.The X2 value of imipenem combined with CCCP and PAβN were 0.338 and 0.086,respectively(P＞0.05),while that of meropenem combined with CCCP and PAβN were 1.065 and 1.458(P＞0.05).No significant in MICs of carbapenems were seen in over half of P. aeruginesa isolates. MICs of carbapenems was significantly downregulated for 4-fold or above in eight isolates. Overexpression of efflux pumps genes were present in 24 of 27 carbapenem-resistant isolates(88. 9% ). Efflux pumps genes including MexAB-OprM, MexCD-OprJ and MexEF-OprN were all overexpressed in 13 isolates,constituting 54. 2% of all carbapenem-resistant isolates. There were 3 isolates in which beth MexAB-OprM and MexCD-OprJ showed overexpression,constituting 12. 5%. Also,MexAB-OprM and MexEF-OprN overexpressed in 3 isolates. There were 2 isolates (8.3%) showing MexEF-OprN overexpression and MexAB-OprM alone. MexCD-OprJ didn't showed overexpression alone. Furthermore,the expression levels of efflux pumps genes mexA,mexD and mexF in isolates susceptible to both in imipenem and meropenem were 0. 48±0. 48,0. 48±0. 53 and 0. 30±0. 41,respectively,which were much lower than that in carbapenem-resistant ones (P＜0. 05 ). MexA gene was expressed at a higher level in meropenemresistant isolates than meropenem-susceptible ones (P＜0. 05 ). Conclusions When the concentration of CCCP and PAβN were 5 μg/ml and 20 μg/ml respectively,the efforts on the carhapenems resistance of P.aeruginosa were small Overexpression of MexAB-OprM might play an important role in meropenemresistance in P. aerugines. Overexpression of MexCD-OprJ and MexEF-OprN was associated with imipenemresistance. However,the relationship between them and meropenem-resistance need to be explored in the future.

Objective To introduce the experience of using costal cartilage in oriental secondary rhinoplasty.Methods From January 2012 to December 2016,we used costal cartilage grafts to obtain a functional and aesthetic reconstruction,in which silicone was used in 34 previous cases and e-PTFE was used in 5 cases.Results The mean duration of follow-up was 1.5 years,43 (86％) patients showed high satisfaction with the shape of nose.1 case of infection and 2 cases of costal cartilage warping occurred.1 case was somewhat dissatisfactied with outcome.There was no case of chest wall deformity and pneumothorax,but scar on the chest wall at the donor site was observed in 2 cases.Conclusions We have obtained good aesthetic results using costal cartilage grafts which could display sufficient and stable support for the scaffold of nose.We can conclude that costal cartilage is a good material in secondary rhinoplasty,and can be used to reconstruct an aesthetic nose.

Objective: To understand the prevalence of Lying Flat behaviors and its association with depressive symptoms among Chinese college students, so as to provide a scientific basis for promoting the physical and mental health development of adolescents. Methods: From July to October 2023, three universities were selected through convenient sampling from Jiangxi Province, Liaoning Province and Beijing City, respectively. Selfdesigned questionnaire links were distributed on campus to collect basic information and Lying Flat behaviors among college students, and the Patient Health Questionnaire-9 (PHQ-9) was utilized to screen for students with depressive symptoms. Finally, a total of 4 225 valid questionnaires were obtained. Chisquare was used to compare of report rates of Lying Flat behaviors across different demographic characteristics. Ordered Logistic regression analysis was used to explore the association between Lying Flat behaviors and depressive symptoms, with Z test used to assess variations in the strength of associations. Results: The reporting rates of academic, life, and social Lying Flat were 32.7%, 17.8% and 17.5%, respectively. And 6.7% of the participants were found of all three Lying Flat behaviors simultaneously.Among college students with three Lying Flat behaviors, the constituent ratios of no, mild, moderate and above depressive symptoms were 9.9%, 30.5% and 59.6%, respectively. Additionally, college students who had three Lying Flat behaviors were more likely to show mild, moderate and above depressive symptoms [OR(95%CI)=2.49(1.60-3.87), 7.69(5.01-11.79), P<0.01]. Conclusions Academic Lying Flat behavior is most prevalent among college students. Academic, life and social Lying Flat behaviors are all significantly positively correlated with depressive symptoms. Attention should be paid to the Lying Flat behaviors and college students psychological health conditions to promote their physical and mental health development.

Objective:To explore the adjunctive diagnostic value of transcranial sonography (TCS) combined with olfactory test in early Parkinson′s disease (PD) and the clinical value of both in the cognitive function of PD patients.Methods:TCS and olfactory test were performed in 157 early PD patients(PD group) and 157 healthy controls(control group) in the Second Affiliated Hospital of Soochow University from January 2018 to January 2022. The differences in clinical characteristics, TCS, and olfactory test results between the two groups were analyzed. The values of TCS, olfactory test, and their combination in diagnosing early PD were evaluated using clinical diagnosis as the gold standard. The correlations of the midbrain area, the midbrain substantia nigra hyperechoic area, and the third ventricle width in TCS examination with the cognitive score were analyzed in the PD group. According to the olfactory test scores, 157 patients with early PD were divided into two groups: 110 cases of PD with olfactory dysfunction (PD-OD) and 47 cases of PD without olfactory dysfunction (PD-NOD). The differences in clinical scores and TCS results between the two groups were compared.Results:The midbrain substantia nigra hyperechoic area, substantia nigra hyperechoic positivity rate, third ventricle width, and olfactory dysfunction rate were higher in the PD group compared to the control group, while the midbrain area and olfactory test scores were lower than those in the control group (all P<0.001). The sensitivity and the coincidence rate of TCS combined with the olfactory test for early PD diagnosis (90.0%, 77.1%) were higher than those of TCS alone (60.0%, 71.3%) and olfactory test alone (70.1%, 72.3%), but the specificity (63.7%) was lower than that of both alone (82.8% for TCS and 75.2% for olfactory test), (all P<0.001). MoCA score, visual space and executive ability, memory, attention, and language were positively correlated with the area of the midbrain ( rs=0.38, 0.32, 0.27, 0.25, 0.23; all P<0.05) and negatively correlated with the width of the third ventricle ( rs=-0.39, -0.22, -0.39, -0.22, -0.32; all P<0.05), and orientation was negatively correlated only with the width of the third ventricle ( rs=-0.24, P<0.05). The MoCA score of PD-OD group[22(18, 25)] was lower than that of PD-NOD group[24(20, 26)]( P=0.040). Conclusions:The combination of TCS and olfactory test can enhance the sensitivity and diagnostic agreement rate for early PD diagnosis, providing some auxiliary value. The cognitive function of PD patients is positively correlated with the midbrain area and negatively correlated with the width of the third ventricle. The cognitive function of PD patients with olfactory dysfunction is lower than that of PD patients without olfactory dysfunction. TCS and olfactory test may help assess cognitive function in PD patients.