Objective To analyze the relationship between insulin resistance (IR) and left ventricular hypertrophy ( LVH ) in patients with early chronic kidney disease ( CKD ). Methods Homeostatic model method was used for detecting insulin resistance index (Homa-IR) in 108 patients with early CKD and 25 normal healthy cases, and the other clinical data such as Hb, creatinine clearance rate (Ccr) , parathyroid hormone (PTH) , ambulatory blood pressure monitoring ( ABPM ) data, including day average systolic blood pressure (dSBP), day average diastolic blood pressure (dDBP), night average systolic blood pressure ( nSBP) , night average diastolic blood pressure ( nDBP) , 24-hour mean systolic blood pressure (mSBP), 24-hour mean diastolic blood pressure (mDBP), decline in the percentage of diastolic blood pressure at night (nDPD) and decline in the percentage of systolic blood pressure at night (nDPS) were also measured. Echocardiography was used for measuring LVH relevant data, and left ventricular mass index (LVMI) was calculated. Then, the relationship between LVH and IR and other clinical data were analyzed retrospectively. Results IR existed in early CKD patients. With the decline of Ccr, both the value of Homa-IR and the incidence of IR increased significantly (both P < 0. 05). LVH existed in early CKD patients and with the decline of Ccr, both LVMI value and the incidence of LVH increased significantly (both P <0. 01). Compared with the non-IR group, the IR group had higher LVMI value (P<0. 05) and higher incidence of LVH (P<0. 01). Compared with the non-LVH group, the LVH group had higher levels of Fins, 2hPG, Homa-IR (all P <0. 05), and higher incidence of IR (P <0. 01). The LVH group had significant lower levels of Ccr, Hb and nDPD (all P <0. 05) , higher levels of dSBP, dDBP, nSBP, nDBP, mSBP, mDBP and PTH (all P<0.05) than the non-LVH group. LVMI had significant positive correlations with 2hPG, Fins, Homa-IR, dSBP, nSBP, mSBP and PTH (r = 0.255, 0.373, 0.376,0.222,0.199,0.225,0.221,0.246, respectively; all P<0.05), but significant negative correlations with Hb and Ccr (r = -0.588,-0.313, respectively; both P<0.01). Multi-factor regression analysis showed that Hb, Homa-IR, and Ccr entered the regression equation (y = 167. 106 - 0. 755x_1 + 0. 250x_2 +0.322x_3, y = LVMI; 167. 106 = constant, t = 12. 138, P =0.000; x_1 =Hb, t= -6.800, P = 0. 000; x_2 = Homa-IR, t = 3. 229, P = 0. 002; x_3 = Ccr, t = 2. 898, P = 0. 005). Conclusion IR existed in early CKD patients and become more severe with the decline of renal function. IR had a significant correlation with LVH, and it may be an important risk factor for the development of LVH. Besides, both anemia and decline of renal function are also associated with LVH.

Objective To study the effects of insulin resistance on the occurance of hypertension in uremia. Methods With use of the oral glucose tolerance test (OGTT) and the insulin release test (IRT) , insulin glycoregulatory activity, including insulin sensitivity index (ISI) , glucose uptake rate (M) and the total areas under the glucose and insulin curves during OGTTs (AUCG, AUCINS) were investigated in 29 hypertensive (CRF-H) and 21 normotensive (CRF-NH) urernic patients and 12 healthy controls (C), and their plasma renin activity (PRA), angiotensin Ⅱ (AT Ⅱ) levels were investigated too. Results (1) Uremic patients had significantly higher blood glucose and serum insulin levels after glucose load, much higher AUCG and AUCINS values and significantly lower ISI and M values than the controls, compared with the CRF-NH patients, CRF-H patients had significantly higher blood glucose levels at 30', 60', 120', and higher serum insulin levels at 120' during OGTTS, significantly higher AUCG and AUCINS values, significantly lower ISI and M values and significantly increased incidences of insulin resistance and glucose intolerance; (2) Insulin resistant patients had more frequency and severe hypertension than the non-insulin resistant ones; simple regression showed that arterial blood pressure (SBP, DBF, MBP) had significant negative correlation with ISI and M, significant positive correlation with AUCG and AUCINS; (3) The levels of PRA, ATⅡbetween two CRT groups were not different; (4) Multiple linear regression showed that AUCG and AUCINS had significant positive correlation with MBP independent of age、 sex、 obesity、 the degree of real failure and plasma renin-angiotensin activity. Conclusion Insulin resistance 、 hyperinsulinemia and glucose intolerance or hyperglycemia may be one of the important mechanisms of uremic hypertension.

BACKGROUND: Orthodontic tooth movement is dependent on reconstruction of periodontium. Osteoclastic bone resorption is the first step of tooth movement. The present study hotspots focus on signal transduction pathway regarding osteoclast differentiation and functional development under stress and on the relationship between periodontal ligament cells and osteoclasts. OBJECTIVE: To set up a simple method to in vitro culture human osteoclast-like cells and to observe the effects of bone resorption-stimulating factors on differentiation, proliferation, and function of osteoclast-like cells, DESIGN, TIME AND STTING: A cytological in vitro controUod observation was performed at the Central Laboratory,Stomatology Hospital, Xi'an Jiaotong University between October 2007 and May 2008. MATERIALS: Umbilical cord blood was sourced from the healthy puerperae who had not suffered from high-risk pregnancy. Freshly prepared fetal femur provided by Laboratory Animal Center, Xi'an Jiaotong University and were used for preparation of bone flaps at 100-200 μm thickness. 1α ,25-(OH)2D3, macrophage colony-stimulating factor (M-CSF), prostaglandin E2 were purchased from Sigma Company, USA.METHODS: Under aseptic condition, umbilical cord blood was collected. Following Ficoll solution separation and centrifugation, supematant was discarded. Umbilical cord blood-derived mononuclear cells were suspended with o -modified minimal essential medium (α-MEM) solution and then inoculated into a 24-well culture plate, in which, coverslips and femoral slices were pre-placed, at a density of 1×109/L, 1.0 mL per well. Five groups were set, blank control, 108 mol/L 1α ,25-(OH)2D3, 10-7 mol/L 1α ,25-(OH)2D3, macrophage colony stimulating factor (M-CSF), and 1α ,25-(OH)2D3+prostaglandin E2 (PGE2). Each group was cultured for 7 days. MAIN OUTCOME MEASURES: Cellular growth morphology was observed under an inverted microscope; osteoclast-like celt formation was examined by tartrate-resistant acid phosphatase (TRAP) staining; and osteoclastic Howship's lacuna was detected by toluidine blue staining. Any cell with TRAP-positive staining and more than two nuclei was considered osteoclast-like cell and counted. RESULTS: After 3 days of culture, cells from the blank control group did not exhibit apparent changes in morphology and quantity. In the remaining groups, mononuclear cells appeared with confluent tendency. After 7 days of culture, a small number of osteoclast- like cells with 2-3 nuclei were found in the blank control group; a great many of multinucleated osteoclast- like cells with 3-20 nuclei were present in the remaining groups. Through the use of optical microscope, osteoclast-like cells could be found for the presence of red cytoplasm, bright yellow nuclei, and TRAP-positive staining in each inducing factor-treated group, in particular in the 108 mol/L 1α ,25-(OH)2D3 group, which displayed osteoclast- like cells exhibiting 14 nuclei, strong TRAP-positive staining, and a relatively big cell body. But no osteoclastic Howship's lacuna was found in any group. Compared to the blank control group, the numbers of osteoclast-like cells were greater in each inducing factor-treated group (F = 9.78, P < 0.01). There was no significant difference in the numbers of osteoclast-like cells between the 108 mol/L 1α ,25-(OH)2D3 and the 10-7 mol/L 1 a ,25-(OH)2D3 groups (P0.05). The M-CSF group and the 1α ,25-(OH)2D3+PGE2 group exhibited significantly less numbers of osteoclast-like cells than the 108 mol/L 1α ,25-(OH)2D3 group (F= 7.46, P< 0.01). CONCLUSION: After in vitro culture of 1α ,25-(OH)2D3, M-CSF, and PGE2, umbilical cord blood-derived mononuclear cells can differentiate into TRAP-positive multinucleated osteoclast-like cells, the 10-8 mol/L 1α ,25-(OH)2D3 being the most effective.

Objective To evaluate the characteristics of brachyfacial types in adolescents with class Ⅱ~1 division 1 malocclusions by comparing with normal patterns.Methods 32 parameters were evaluated in pretreatment lateral cephalograms of 60 brachyfacial type adolescents,including 30 boys and 30 girls,aged from 11 to 13 years,with class Ⅱ~1 division 1 malocclusions(distal moral relationship,ANB＞5°,Go-Gn-SN＞28°).Results There was a remarkable increase in SNA,ANB,upper incisor inclination (U1-NA),U1-L1/N-Me and Me-L1/N-Me,so was lip protrusion of soft tissue facial profile(NB-Pg'-Ls);the lower sulcus depth(Si-Pg'-Ls)and the lower lip thickness(Li-L1).Mandibular plane(Go-Gn-SN),OP-MP,OP-FH,U1-L1,anterior lower facial height(ANS-Me),anterior lower facial height/anterior facial height(ANS-Me/N-Me),anterior lower facial height/posterior lower facial height (ALFH/PLFH)and mandibular length(B'-J')were significantly decreased.Conslusions Brachyfacial type in adolescents with class Ⅱ'division 1 malocclusions is characterized by decreased anterior lower facial height,increased posterior lower facial height,clockwise rotation of the palatal plane,anticlockwise rotation of the occlusion plane and mandibular plane,deepen overbite,soft tissue protrusive profiles with upper lip protrusion,crimpled lower lip and retracted chin.

OBJECTIVEIn order to minimize lead pollution and to protect the identified individuals with high blood lead level from lead contamination, an epidemiological study was carried on children living around the village and township-owned lead industries in Tianying town.

METHODSEnvironmental monitoring: lead levels in air, soil, drinking water and crops were measured. Biological monitoring: 959 children aged 5 - 12 years were selected from villages where the lead smelters located near the residential areas and the battery disassembling was done in some families. The control children (207 pupils) were from other villages without lead exposure. Blood lead, ZnPP and teeth lead were determined. Height, weight and head circle of children and IQ scores were measured.

RESULTSThe environment was seriously polluted. The average lead concentrations in air and soils were 8.5 times and 10 times of the MACs (national health standard) respectively. Eighty-five per cent the air samples with lead concentrations higher than the national health standard. Local crops and wheat at farmers' home were also contaminated by lead dust, with. Lead content being 24 times higher than the standard. The mean blood lead and ZnPP levels of children lived in the polluted areas were 496 microgram/L and 9.41 microgram/g Hb respectively. The lead exposure caused adverse effects on children's IQ and physical development.

CONCLUSIONIt is necessary to remove and reduce currently active sources of lead pollution in the community and to increase public awareness of potential health effects of lead exposure.

Air Pollutants ; analysis ; Child ; Child Development ; drug effects ; Child, Preschool ; China ; Crops, Agricultural ; chemistry ; Environmental Monitoring ; methods ; Environmental Pollution ; adverse effects ; analysis ; Female ; Health Status ; Humans ; Industrial Waste ; adverse effects ; analysis ; Lead ; adverse effects ; blood ; Male ; Soil Pollutants ; analysis ; Suburban Health ; standards ; Urban Health ; standards

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

Objective To analyze the role of telehealth?based dialysis registration systems in real?time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3％) were male.The average rate age was (60.5 ± 13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2％and 47.5％, respectively. After 28 months follow?up, the detection rate of Hb increased from 54.2％ to 73.6％ (P<0.001), the target rate of Hb increased from 47.5％ to 56.1％ (P<0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth?based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long?term way. The telehealth?based dialysis registration system, as an improved mode of dialysis registration is a promising way for long?term management of renal anemia in dialysis patients.