Objective:To investigate the effects of recombinant human growth hormone on bone metabolism, insulin-like growth factor-1 (IGF-1) and vitamin D3 in dwarfism children at different ages.Methods:Sixty children with dwarfism who received treatment in Shaoxing Women's and Children's Health Care Hospital from January 2018 to January 2019 were included in this study. They were divided into group A (age at 4-9 years, n = 32) and group B (age at >9-13 years, n = 28) according to different ages. Two groups of children were treated with recombinant human growth hormone for 6 months. Total effective rate in two groups was recorded. Before and after treatment, bone metabolism index, serum IGF-1 and 25-hydroxyvitamin D3 levels were measured in each group. Results:Total effective rate in the group A was significantly higher than that in the group B [90.62% (29/32) vs. 67.85% (19/28), χ2 = 4.838, P < 0.05]. Before treatment, there were no significant differences in serum levels of calcium, phosphorus, zinc, IGF-1 and 25 hydroxyvitamin D3 between groups A and B (all P > 0.05). After treatment, serum levels of calcium, phosphorus, zinc, IGF-1 and 25 hydroxyvitamin D3 in the group A were (1.99 ± 0.53) mmol/L, (1.76 ± 0.14 ) mmol/L, (88.97 ± 6.89) μmol/L, (325.57 ± 15.29) ng/L, (89.47 ± 15.58) ng/L, respectively,which were significantly higher than those in the group B [(1.71 ± 0.55) mmol/L, (1.65 ± 0.15) mmol/L, (85.22 ± 6.76) μmol/L, (312.29 ± 13.88) ng/L, (80.11 ± 15.31) ng/L, t = 2.005, 2.936, 2.121, 3.502, 2.340, all P < 0.05]. Conclusion:Recombinant human growth hormone has better curative effect on dwarfism in children at 4-9 years old than in children at 9-13 years old, and it can effectively improve bone metabolism, IGF-1, vitamin D3 and other indicators.

Objectives This study was conducted to detect and analyze the presence of plasmidmediated quinolone resistance (PMQR) determinants [qnr,aac-(6′)-Ib-cr and qepA] among clinical isolates of Citrobacter freundii strains isolated from patients in Anhui,China,and to understand the susceptibility of PMQR positive strains to commonly used antimicrobial agents.Methods During the year 2009,31 Citrobacter strains were collected from the First Affiliated Hospital of Anhui Medical University.Polymerase chain reaction (PCR) was used to detect PMQR genes.Amplicons were purified,sequenced and compared with data from the GenBank.Conjugation experiments were conducted to determine whether the qnr-carrying plasmids were self-transferable.The susceptibility of the positive isolates and transconjugants were tested by agar dilution method according to Clinical and Laboratory Standards Institute (CLSI) guidelines.The minimum inhibitory concentrations (MIC) of ciprofloxacin and levofloxacin were determined by E-test strips.Results Among the 31 Citrobacter strains,the qnr genes were detected in 8 isolates (25.8％),among which,6 carried qnrB.Aac-(6′)-Ib-cr and qepA were not identified in these isolates.The qnr genes were transferred from four clinical isolates to their transconjugants.Sequence analysis identified one novel qnrB variant (qnrB24).The resistant rate of qnr-positive clinical isolates to quinolone was 87.5 ％.Most of them were also resistant to various other antibiotics,including cefotaxime (75.0 ％),amikacin (7.5 ％),ceftazidime (62.5 ％),cefapime (37.5 ％),and gentamycin (87.5 ％).All qnr positive strains were susceptible to imipenem.MIC of all transconjugants showed reduced susceptibility to fluoroquinolones,with MIC increased by 10-23 folds.Conclusions Our study shows that qnr gene has occurred in Citrobacter freundii isolates from Anhui Province,China.QnrB is most prevalent in these isolates.Most qnr positive isolates are resistant to commonly used antimicrobial agents.

Objective To explore the CT appearance of thoracic lymphonodus in AIDS patients with immune reconstitution in-flammatory syndrome(IRIS)after highly active antiretroviral therapy (HAART).Methods The data of thoracic CT in 24 AIDS pa-tients after HAART with enlarged thoracic lymphonodus in IRIS were collected,and the chest CT appearance was analyzed.Results Of the 24 cases of AIDS patients with IRIS after HAART,1 9 cases were complicated with pulmonary tuberculosis,which includ-ed 5 cases with cervical tuberculous lymphadenitis,3 cases were co-infected with bacterium and fungi,1 case was infected by penicil-lium marneffei,1 case by pneumocystis carinii.The enlarged thoracic lymphonodus were primarily located in 4R region(20/24), secondly in 2R region(1 1/24)and 4L region(1 1/24),in which the density was uniform or non-uniform,edge clear or unclear,some parts of lymphonodus were fused together but not calcified.The minor axis of enlarged lymphonodus was 1 1.0-25.0 mm except X region,enhanced uniformly in 2 cases.Obstructive pneumonia and pulmonary consolidation were found in 2 cases with enlarged lym-phonodus,which were located in 10R region.Pleural effusion was found in 13 cases with greatest depth of about 22 mm,pericardial effusion was found in 5 cases with greatest depth of about 24 mm.Conclusion The enlarged thoracic lymphonodus in AIDS patients with IRIS affer HAART are mainly involved in the region of 4R,2R and 4L,with or without pleural effusion and pericardial effusion.

Objective To investigate the expression level of antisense non-coding RNA in the INK4 locus (ANRIL) in hepatocellular carcinoma (HCC) tissues and to evaluate its relation to clinicopathological features and prognosis of HCC.Methods Quantitative real-time polymerase chain reaction (qRT-PCR) method was used to detect the expression of ANRIL in HCC tissues and adiacent tissues (n =90) and to analyze its relationship with clinicopathological data.Kaplan-Meier curves and multivariate Cox proportional models were used to study the impact on clinical outcome.Small interfering RNA (siRNA) was used to silence ANRIL and to explore the effects of reduced ANRIL expression on cell growth and metastasis.Results ANRIL expression in HCC tissues was significantly higher than in the adjacent non-tumor tissues (t =13.083,P ＜ 0.05).The expression of ANRIL was remarkably associated with the histologic grade (x2 =40.724,P ＜ 0.05) and TNM stage (x2 =43.245,P ＜ 0.05).The mean survival time of the patients with high ANRIL was 18.2 months (95％ CI:14.9-21.5 months),shorter than 39.4 months (95％ CI:35.5-43.4 months) in low expression (x2 =47.590,P ＜0.05).Multivariate analysis suggested that high ANRIL expression was an independent predictor of poor prognosis (HR =2.143,95％ CI:1.083-4.243,P ＜ 0.05).Decreased expression of ANRIL could suppress the cell proliferation,migration and invasion of HCC cells.Conclusion Positive ANRIL expression is negatively correlated with the prognosis of HCC patients.

Objective To investigate influence of amlodipine /atorvastatin on atherosclerosis in the elderly with hypertension and hyperlipidemia.Methods Totally 108 cases with hypertension and hyperlipidemia in our hospital were randomly divided into control group and observation group (n =54 each).The control group received conventional antihypertensive treatment such as diuretics,angiotensin-converting enzyme inhibitors,calcium antagonists; the observation group received amlodipine and atorvastatin combination tablet as add-on therapy to the above drugs for 6 months.The blood lipid level and carotid artery ultrasound detection results were observed and compared between the two groups after treatment.Results The levels of TC[(4.23 ± 0.79)mmol/L vs.( 5.32 ±1.23)mmol/L],TG[(1.53±0.35) mmol/L vs.(5.32± 1.23) mmol/L],LDL-C [(3.19 ± 0.59)mmol/L vs.(4.07±0.79)mmo1/L]were decreased,while HDL-C [(1.53±0.95)mmol/L vs.(1.32±0.83)mmol/L]were increased in observation group after treatment as compared to control group (all P ＜0.05).After carotid artery ultrasonography,the LN[( 1.61± 0.76) scores vs.( 2.24 ± 0.89) scores ] and IMT [(0.76 ± 0.22)mm vs.(0.98 ± 0.28)mm] levels were lower in observation group after treatment than in control group (P＜0.05).Conclusions Amlodipine/atorvastatin combination can reduce blood lipids and alleviate atherosclerosis.It is suitable for elderly patients with hypertension and hyperlipidemia.

Objective To explore the surgical intervention outcomes of necrotizing enterocolitis (NEC)pa-tients with different extent of the disease.Methods The data of 25 pediatric patients with NEC who were treated with surgical intervention in Shanghai Children′s Hospital from December 201 1 to December 201 5 were retrospectively ana-lyzed.According to the extent of the disease,the patients were divided into 3 groups:focal disease(F),multisegmental disease(M),and pan -involvement(P).The information including operation style,survival rate and time for close osto-my was analyzed.Results There were 1 1 cases with F,8 cases with M,and 6 cases with P.All patients received lapa-rotomy surgery,colostomy,or peritoneal drainage.There were 1 2 patients with very low birth weight,7 patients with low birth weight,6 patients with normal birth weight in this study.There were 1 7 cases with gastrointestinal perforation (9 cases with pneumoperitoneum,8 cases without pneumoperitoneum),8 cases without digestive tract perforation (4 cases without pneumoperitoneum,4 cases with enterostenosis after conservative treatment).In this study,close ostomy was commonly conducted 3 -6 months after the operation,except for 3 cases who received 2 or more times of operation.The survival rate in F group was 1 00.0%(1 1 /1 1 cases),higher than those in the Mgroup with 62.5%(5 /8 cases)and P group with 1 6.7%(1 /6 cases)(χ2 =4.898,1 0.31 2,all P <0.05).However,there was no difference between Mgroup and P group (χ2 =1 .367,P >0.05).Conclusions The extent of disease is correlated to the outcomes of surgical in-tervention,as F had a better outcome than Mand P.Low birth weight is a risk factor for NEC.Protecting the edge of the bowel is a key factor to ensure the survival and improve the quality of life of NEC patients.Close ostomy should be con-sidered when the patients are in a stable condition (liver function and intestinal function recovery,good nutrition condi-tion,etc),and under special circumstances to conduct early or delayed closure of fistula.

Objective To enhance awareness of the dangerous of multiple magnets ingestion in children and to explore the optimal treatment of it.Methods The clinical data of 3 cases with multiple magnet ingestion were retrospectively studied based on literature review.Results Ingestion of multiple magnets (range:2-5 magnets) magnets occurred in 3 cases.Age ranged from 1 to 8 years old.Magnet sources included:2 from children's family,1 from their kindergarten.All patients had several bowel perforations(range:2-4).One case was completed by laparoscopic,1 case was converted to open suegery after laparoscopy,1 case was done by open surgery.All cases got complete recovery after surgical treatment,and no complications occurred by follow-up.Conclusions Ingestion of multiple magnets may show minimal initial physical manifestations at beginning but may result in significant complications later.Two or more magnets separated from each other along the gastrointestinal tract can attract each other across bowel walls,with may result in pressure necrosis,bowel perforation,and fistulas formation and even death.Early surgical consultation with an aggressive surgical approach is recommended.Family and society should be aware of the dangers of magnet ingestion.

Objective:To study the anatomical correlation between dental arch and the volume of upper airway in patients with obstruc-tive sleep apnea hypoventilation syndrome(OSAHS). Methods: Dental arch architecture and upper airway volume were measured by cone beam CT(CBCT) in the subjects with OSAHS(n=22) and without OSAHS(n=19). The correlation between dental arch and the supper airway volume in OSAHS patients was analyzed. Results:The length of the upper dental arch and the height of palate in OSAHS patients were larger than those of the controls(All, P<0. 05). Cross-sectional area of nasopharynx and retropalatal and the total volume of upper airway were negatively correlated with the palatal height and upper dental arch length(P<0. 05), while positively correlated with upper dental arch of molar regions(P<0. 05). Conclusion:The abnormal shape of upper dental arch is related to the airway vol-ume of nasopharynx and retropalatal region in patients with OSAHS.

Objective To explore the clinical results of total ankle replacements with the Scandinavian Total Ankle Replacement (STAR) prosthesis for end-stage ankle arthritis.Methods Data of 73 cases with end-stage ankle arthritis who received Scandinavian total ankle replacement from January 2005 to May 2013 were retrospectively analyzed.They were 34 males and 39 females,with an average age of 59.6 years old (range,37-76 years old),average body mass index (BMI) of 25.3 kg/m2 (range,21.8-28.0 kg/m2).All patients were classified into stage-3 arthritis according to Morrey-Wiedeman.Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) were used to evaluate the function of foot and ankle.Patients with a hindfoot deformity below 10° were compared with those who above 10°;and patients above 55 years old were compared with those who below it.Results 5 replacement failed (2 liner ruptured and received replacement;2 metal components displaced,1 received TTC fusion and the other underwent revision with inferior tibiofibular joint fusion,the last patient suffered from deep infection and received the STAR removal and secondary fusion) in 73,and the rest were followed up for 12 to 110 months (average,55.2 months).59 patients were satisfied with or without reservations.The satisfaction rate was 80.8％ (59/73).The pre-op values of AOFAS,Kofoed,VAS and range of motion (ROM) were 46.6±3.5,43.0±4.7,8.7±0.7,34.4°±7.1° and the post-op values were 86.6±4.3,82.6±4.6,3.0±1.0,45.1°±8.2° respectively,and all were significantly improved compared with before.The AOFAS,AOFAS Function and ROM values of patients below 55 years old were 86.1±3.8,47.0±2.7,45.7°±7.0°,and the same values of patients above 55 were 86.7±4.6,46.8±3.1,44.9°±8.8°.The AOFAS,AOFAS Function and ROM values of patients with above 10° coronal deformity were 86.1±4.7,47.0±2.7,43.0°±7.7°,and the same values of patients below 10° were 86.8±4.2,46.8±3.1,46.1°±8.2°.There was no difference between the groups.Conclusion The STAR is the preferable surgical treatment option in patients with end-stage ankle arthritis,showing high reliability and effectivity in pain relieving and function improvement.

Objective To explore the feasibility and assess the efficacy of posterior paraspinal muscle gap approach in the treatment of thoracic and lumbar spinal tuberculosis.Methods From June 2009 to June 2013,a total of 29 patients were analyzed retrospectively.There were 2 patients of tuberculosis T8,9,6 of T9,10,8 of L1,2,10 of L2,3,and 3 of L4,5.The patients included 12cases of male,17 cases of female; the age ranged from 28 to 53 years,with a mean of 40.78 years.Nine patients had preoperative kyphosis deformity,and Cobb angle ranged from 19° to 39° (mean,29.67°).Two patients complained with paraplegia with Frankel grade C.All patients had preoperative standardized oral isoniazid,rifampicin,pyrazinamide border,ethambutol,glucuronolactone for 2-4 weeks.All patients underwent one-stage posterior paraspinal muscle gap approach fixation,rectification,debridement and autograft bone fusion.The clinical effects were observed by the time and blood loss in operation,blood loss after operation; the score of visual analogue scale (VAS) one week after operation and the last follow-up,the time erythrocyte sedimentation rate (ESR) drop to normal after operation,the change of cobb angle,the improvement of the neurological symptom,the situation of the bone fusion.Results Operation time was 3-4 h,with an average of 3.3 h; operative blood loss was 300-600 ml,with an average of 434 ml.Drainage volumn was 250-450 ml after surgery with an average of 340 ml.All patients were followed up for 6 to 36 months with an average of 16.56 months.There was no recurrence,sinus formation or internal fixation failure,and all patients obtained successful bony fusion.The mean time ESR drop to normal range after operation was 4.22 months.One patient of the two with Frankel grade C pre-operation turn to grade D,the other grade E.The Cobb angle was 10.33° (9°-12°) immediately after operation,and 12.22° (11°-14°) at the final follow-up.Conclusion Posterior paraspinal muscle gap approach surgeries is feasible and effective in the treatment of thoracic and lumbar spinal tuberculosis.