BACKGROUND: Twin-block appliance has been confirmed to efficiently change hard tissue and the profile of soft tissue.Whether a linear relationship exists between soft tissue and hard tissue changes remains unclear.OBJECTIVE: To evaluate the face convexity changes of soft and hard tissues after Twin-block appliance therapy and compare with controls.METHODS: Thirty-one class Ⅱ division 1 malocclusion subjects with hand-wrist radiographs in FG-G stage were selected.Among the 31 patients,17 received Twin-block appliance therapy,serving as experimental group,and the remaining 14 subjects abandoned treatment,serving as control group.Cephalometric radiographs of each included subject were taken prior to and after treatment or observation.Face convexity of soft and hard tissues,as well as the face convexity changes,was compared between the experimental and control groups.Linear regression equation was employed to analyze the linear association between soft-and hard-tissue changes.Regression equations of experimental and control groups were compared.RESULTS AND CONCLUSION: Prior to and after Twin-block appliance therapy,a significant correlation existed between the position changes of superior and inferior alveolar sockets relative to the nose and mandible,and the position changes of upper and lower lip pits relative to the nose and mandible,i.e.,there was a linear correlation between A-E change and Ss-E change,and between B-E change and Si-E change.The largest Pearson's correlation coefficient(0.839)appeared between Si-E change and B-E change,indicating the best correlativity between these two changes.Statistical analysis revealed that the linear equations of face convexity changes of soft and hard tissues after Twin-block appliance therapy were Si-E=0.745 B-E,Ss-E=0.276 A-E.These linear equations would be helpful to explain mandible growth and face convexity change after Twin-block appliance therapy and predict the prognosis of face convexity change.

PBL teaching module is the developing trend of medical education reform in China.By studying the advanced foreign experiences and modern methods,teachers and students should change the perceptions and roles to adapt to the PBL teaching style in order to propel the reform of the medical education.

To improve the quality of clinical teaching in burn surgery,79 students of Grade 2005 were randomly divided to problem-based learning(PBL)group and lecture-based learning(LBL) group.The teaching quality of two teaching methods were compared.The results showed that the average score,the score of teaching effectiveness appraisal targets in PBL group were sig-nificant higher than that in LBL group.This indicated that the teaching effectiveness of PBL was better than that of LBL,PBL should be applied in clinical teaching in burn surgery.

Objective To produce the experimental pig model of obstructive sleep apnea hypopnea syndrome(OSAHS) through raising pigs in the lower pressure container in order to study the effect of low pressure on morphology of upper respiratory soft tissue in pig.Methods The pigs were living in a container of low pressure for 6 months to make up the pig models of OSAHS.When the symptoms like OSAHS appearing and the pharyngeal respiratory pressure changing like the characteristics of OSAHS,the pigs were scanned by CT and compared with controls.Results The pharyngeal rear wall and soft palate in model pigs were thickened(0.94 cm?0.16 cm and 1.06 cm?0.23 cm respectively),while in control groups were(0.60 cm?0.11 cm and 0.59 cm?0.13 cm respectively).The cross-sectional area of upper airway in anterior,middle and rear parts were(1.49?0.12) cm2,(1.37?0.32) cm2 and(1.00?0.21) cm2 respectively,the narrowest part was in rear area,and in control groups were(1.30?0.14) cm2,(1.57?0.32) cm2 and(2.48?0.42) cm2 respectively.Conclusion The lower pressure condition can be used to produce animal experimental model of OSAHS,the low pressure is the important factor to cause OSAHS.

BACKGROUND:Twin block appliance has been shown to effectively promote mandibular bone growth of Class Ⅱ malocclusion patients and improve lateral appearance of mandibular retrusion.The other improvement of Twin block appliance on hard-soft tissues remains unclear.OBJECTIVE:To assess the hard-soft tissue changes following Twinblock appliance treatment.METHODS:Atotal of 48 adolescent patients,30 males and 18 females,aged 11.6 years (range 9.58-12.37) with Class Ⅱ malocclusion were selected from Department of Orthodontics,Affiliated Stomatology Hospital of Hebei Medical University.Of them,27 were treated with Twinblock appliance as the treatment group,and 21 adolescent patients without treatments were selected as the control group.Cephalonetric analysis was used to compare the changes before and after treatment.RESULTS AND CONCLUSLON:Comparative analysis showed that Twinblock could effectively adjust or improve the effect of the natural growth,reduced upper lip convexity and mentolabial furrow angle.Moreover,Twinblock inhibited facial vertical distance reduction and facial convexity increase to decrease the potential differences between maxillary and mandibular bones in sagittal plance.Results show that Twinblock could effectively improve the profile of soft-tissues of Class Ⅱ malocclusion cases,

Objective To study the baseline level of fraction anisotropy (FA) and the normal value of apparent diffusion coefficient (ADC) in deep white matter of preterm and its application.Methods From Oct.2010 to Dec.2013,in Department of Neonatology,Jiangsu Province Hospital,magnetic resonance imaging (MRI) (T1,T2) and diffusion tensor imaging (DTI) were done on 13 preterm infants of less than 37 weeks of corrected gestational age (CA),42 preterm infants of term-matched age,and 15 term infants.ADC and FA were measured in genu and splenium of corpus callosum (CC),anterior limb and posterior limb of internal capsule (IC).Results 1.The ADC values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were higher than those in term-matched infants and in term infants.The ADC values in the 6 regions in term-matched infants and in term infants were significantly different with those in CA ＜ 37 weeks infant(F =5.559,5.775,21.948,19.462,30.586,15.452,all P ＜ 0.01).The differences of ADC values between CA ＜ 37 weeks infants and term-matched infants,between CA ＜37 weeks infants and term infants were significant(all P ＜0.05),except that in CC between CA ＜ 37 weeks infants and term-matched infants.2 The FA values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were lower than those in term-matched infants and in term infants.The FA values in the 6 regions in term-matched infants and in term infants were significantly different from those in CA ＜ 37 weeks infants (F =9.835,7.500,4.811,11.430,8.674,12.666,all P ＜ 0.01).The differences of FA values between CA ＜ 37 weeks infants and term-matched infants (P ＜ 0.05),between CA ＜ 37 weeks infants and term infants were significant (all P ＜ 0.05).Conclusions The baseline values of FA and ADC in different deep white matters were obtained.As corrected gestational age of preterm babies' increased,FA values in brain white matter increased,while ADC values decreased.The myelination in most white matter of preterm infants at matched term can catch up with that of term infants.The diagnostic value of ADC and FA needs to be studied further.

Objective To evaluate the relative efficacy of different dosages of Calf Pulmonary Surfactant (Calsurf) administration in premature infants with established respiratory distress syndrome (NRDS).Methods Four neonatal intensive care units in Jiangsu province were enrolled.Premature infants,birth weight ＜ 2 500 g,with NRDS,received 70 mg/kg (61 cases)or 100 mg/kg (69 cases)Calsurf.Clinical and respiratory parameters were recorded.The primary outcome measures were blood gas analysis of 1 h,12 h and 36 h after administration,the need for oxygenation and ventilatory requirements and the adverse events of NRDS.Results Arterial oxygen tension[pa (O2)] results in a significant improvement(80.27-±36.81) mmHg,(73.03 ±24.94) mmHg and (72.35 ± 24.72) mmHg at 1 h,12 h and 24 h in higher dose group(P ＜ 0.05),(67.95 ± 23.79) mmHg,(72.35 ± 24.72) mmHg in 24 h,as compared with the lower dose group at the same time [(67.07 ± 19.94) mmHg,(62.93 ± 21.71) mmHg,(67.95 ±-23.79) mmHg] (P ＞ 0.05).Inspired oxygen (FiO2) and pa (O2) decreased after administration in two groups and the duration of FiO2 decline lasted to 48 h (all P ＜ 0.05).The oxygen index (OI) was improved after Calsurf administration,especially in the infants who received 100 mg/kg of Calsurf with 6.1 ± 2.8,5.6 ± 3.3,5.5 ± 3.5,5.8 ± 4.5,5.3 ± 3.1 in 1 h,12 h,24 h,36 h,48 h,respectively(P ＜ 0.01).The arterial-to-alveolar oxygen tension ratio (a/APO2) of 100 mg/kg group was reduced significantly in 1 h,12 h,24 h,36 h,48 h with 0.39 ±0.22,0.42 ±0.20,0.45 ± 0.22,0.44 ± 0.22,0.46 ± 0.21 as compared with 0.27 ± 0.18 which was at the time point before administration (P ＜ 0.01).Although not statistically significant,the mean time of duration of mechanical ventilation and oxygen inhalation of higher dose group were decreased as compared to the lower dose group [(94.54 ± 113.44) h vs (109.27 ± 124.87) h (P＞0.05) and (259.10 ±280.45) vs (372.31 ±398.08) h(P ＞0.05)].There were no significant differences in the rates of other adverse events such as pneumonia,pneumothorax,intracranial hemorrhage,patent ductus arteriosus (PDA),pneumorrhagia,necrotizing enterocolitis,septicemia between two groups (P ＞ 0.05).Conclusions Calsurf given to preterm infants with NRDS at a dose of 100 mg/kg resulted in a higher Pa (O2),a/APO2,better OI and lower FiO2 as compared with those receiving 70 mg/kg.The need for mechanical ventilation and oxygen supplement were reduced with higher-dose administration.Large dose of Calsurf did not increase the risk of complications as mentioned above.

Objective:To investigate the safety and early and mid-term efficacy of upper sternal mini-incision with debranching technique in B aortic dissection involving the arch.Methods:18 patients with B aortic dissection involving the arch who were admitted into our center from November 2017 to January 2019 were enrolled, to evaluate the intraoperative and postoperative conditions, including special intraoperative treatment, time of operation、poseoperative drainage、time of use ventilators, time of staying in ICU, complications etc, 12-24 months follow-up were performed after operation.Results:No death occurred, 1 case with acute renal failure, 1 case with type I endoleak, 1 case with paraplegia occurred during hospitalization, 1 patient with sudden vomiting of blood 30 days after discharge from hospital who was found aortoesophageal fistula, underwent emergency surgery to replace thoracic aortic and repair esophageal fistula, all of them were cured and discharged, the rate of complication was 22.2%(4/18). none of the other patients had any phenomena such as agnail、distal rupture、twisted or displaced of the stents、ischemic of coronary artery、cerebrovascular accident, etc.Conclusion:The result of upper sternal mini-incision with debranching technique in B aortic dissection involving the arch is satisfied, the early and mid-term survival rate is significantly improved, the patient's prognosis are improved.

Objective:To explore the establishment and assessment of the depression model of adult SD rats induced by early maternal infant separation stress combined with adult chronic unpredictable mild stress(CUMS), and to observe the behavior and synaptic protein expression of SD rats.Methods:Twenty-four male rats were randomly divided into three groups: control group (CON group), chronic unpredictable stress group (CUMS group), maternal infant separation combined with chronic unpredictable stress group (MS + CUMS group). The depression model of rats in cums group was established by CUMS, and the depression model of rats in MS + CUMS group was established by maternal infant separation + CUMS. The depression model was evaluated by body mass and appearance observation, sugar water preference experiment, open field test and forced swimming test.Synapse-associated proteins (PSD-95 and synaptophysin (Syn)) of the hippocampus were assayed using Western blot. Syn protein expression was measured by immunohistochemistry.Results:After modeling, compared with CON group, the rats in CUMS group and MS + CUMS group had significantly lower body mass((126.43±3.88) g, (91.04±3.85) g, (69.89±6.67) g; t=5.03, 8.03, both P<0.01), significantly lower sugar water preference((94.21±0.56)%, (79.30±1.13)%, (72.73±1.82)%; t=8.24, 11.87, both P<0.01) and significantly increased immobility time((3.50±0.84)s, (13.59±2.40)s, (15.70±2.97)s; t=3.16, 3.82, both P<0.01). Among them, the body mass and sugar water preference of MS + CUMS group were lower than those of CUMS group ( t=3.00, 3.63; both P<0.01). (2)The center time of the rats in MS+ CUMS group markedly reduced compared with that of CON group((21.41±4.65) s, (8.96±2.37) s; t=2.66, P<0.05). (3)In the immunohistochemistry experiment, compared with the CON group, the percentage of Syn positive area in hippocampus of rats in CUMS group and MS+ CUMS group decreased significantly ((24.42±0.76)%, (14.00±0.95)%, (10.38±1.38)%; t=6.93, 9.33, P<0.01). (4)The results of Western blot showed that compared with CON group, both the expression of PSD-95 ((1.18±0.02), (0.74±0.06), (0.52±0.05), t=6.29, 9.31; both P<0.05) and Syn ((1.12±0.08), (0.95±0.06), (0.90±0.07); t=3.10, 4.04; both P<0.05) in hippocampus of rats in CUMS group and MS+ CUMS group were significantly decreased.And compared with the CUMS group, the expression of PSD-95 in MS+ CUMS group was lower( t=0.93, P<0.05). Conclusion:The method of MS combined with CUMS can effectively induce depression like behavior and decrease the expression of synaptic plasticity related protein of hippocampus in rats.

Objective To evaluate the role of multi-disciplinary team (MDT) in improving the diagnosis and treatment of human herpes virus-6B (HHV-6B) encephalitis after liver transplantation. Methods MDT consultation was delivered for one rare case of HHV-6B encephalitis after liver transplantation to establish an effective individualized treatment regime. Results On the 16 d after liver transplantation, the patient developed headache, and suddenly presented with unresponsiveness, unconsciousness, coma complicated with involuntary limb twitching on the 18 d. Blood ammonia level was increased. Brain CT scan showed cerebral ischemic changes. Electroencephalography prompted the epileptic seizure. After MDT consultation, the possibility of nervous system infection after liver transplantation was considered, and medication therapy was given to control the epileptic seizure. Cerebrospinal fluid examination via lumbar puncture hinted increased intracranial pressure. Real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) of the cerebrospinal fluid demonstrated that the patient was tested positive for HHV-6B nucleic acid, which confirmed the diagnosis of HHV-6B encephalitis. The immunosuppressant regime was adjusted, intravenous ganciclovir was given for antiviral treatment, and active interventions were delivered to prevent and treat relevant complications. Epileptic seizure disappeared after 4 d, and neurological symptoms were significantly alleviated after 2 weeks. After 4-week antiviral treatment, the patient was tested negative for virology testing, and the neurological function was restored to normal. Conclusions HHV-6B encephalitis rarely occurs after adult liver transplantation, which is primarily associated with the virus reactivation after use of immunosuppressant. MDT pattern may be employed to deepen the understanding of the patient's condition, formulate more effective individualized treatment regime, and enhance the clinical efficacy and safety.