Objective To quantitate coronary tortuosity and provide favorable conditions for understanding the hemodynamic effects caused by coronary tortuosity.Methods We obtained all images from 72 patients who received coronary computed tomo-graphy scanning.After image post-processing,we extracted the medial axis of three main coronary vessel and analysed its coordi-nates on three dimensions.Then we calculated the tortuosity coefficient of coronary artery.Results Tortuosity coefficient was 6.66±7.54 in anterior descending,13.43±12.85 in left circumflex,and 1 7.61 ±7.67 in right coronary artery.We had proved its validity by the changes in morphology with simulated shapes.Conclusion We proposed a new method for quantitating coronary tor-tuosity,by computed tomography coronary imaging.The measurement results would not be affected by projection plane,vessel length or other artificial factors.

Objective To investigate the clinical manifestation, inherited pattern and the related factor of Hunting?ton disease families. Method The clinical data from 12 HD families was collected from 2013-2014. Patients received the genetic test and neurological evaluation including motor, cognitive and problem of behavior. Results There were 12 patients having the IT15 gene dynamic mutations, including 1 Juvenile Huntington disease patient and 3 pre-symptomat?ic mutant gene carriers. The average CAG repeats of these patients was between the range of 40 to 60, and the average on?set age ranged from 13 to 54 year-old. Positive family history and genetic anticipation could be observed. Patients pre?sented with different clinical manifestations at the early stage while had typical chorea movements, declined cognitive and psychiatric symptoms at the late stage of the illness. Conclusions There are typical triad symptoms in the late stage but not in the early stage nor pre-symptom stage illness. Clinical manifestation and the neuroimaging are both of great ref?erence value, and the genetic test is essential for final diagnosis.

Objective To evaluate the efficacy of bronchial blocker outside the endotracheal tube for one-lung ventilation (OLV) in pediatric patients. Methods Thirty-eight American Society of Anesthe-siologists physical status ⅠorⅡ patients of both sexes, aged 4-8 yr, weighing 14. 0-28. 6 kg, scheduled for elective thoracic surgery under general anesthesia, were enrolled in this study. The size of tracheal tube was selected according to the endotracheal diameter at the level of clavicle and sternum on chest X-ray. Af-ter anesthesia induction, the distal end of the bronchial blocker was bent toward the target bronchus with a videolaryngoscope and then inserted until resistance was felt, and the preselected tracheal tube was inserted with a videolaryngoscope at a depth of (age∕2+12) cm. The position of the bronchial blocker was adjusted using a bronchofiberscope so that the upper edge of the blue cuff was 0. 5-1. 0 cm below the carina. The heart rate, mean arterial pressure, SpO2and airway pressure were recorded, arterial blood gas analysis was performed, and PaCO2and PaO2were recorded immediately before OLV (T1), at 30 min after OLV (T2) and at the end of OLV (T3). The intubation time, success rate of intubation at first attempt, displacement of bronchial blocker and occurrence of postoperative laryngeal pain and hoarseness were recorded. The pul-monary collapse was evaluated according to the standard described by Campos.Results Compared with the baseline at T1, PaO2was significantly decreased and airway pressure was increased at T2,3(P＜0. 05), and no significant change was found in heart rate, mean arterial pressure, PaCO2or SpO2at T2,3( P＞0. 05). The average intubation time was (185±38) s. The success rate of intubation at first attempt, rate of bronchial blocker displacement, excellent and good rates of pulmonary collapse and incidence of laryngeal pain and hoarseness were 95%, 16%, 100% and 11%, respectively. Conclusion Bronchial blocker outside the endotracheal tube can be effectively used for OLV in pediatric patients.

Objective To investigate the predictive value of D-dimer for early neurological deteriora- tion (END) in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Department of Neurology, the Second People ' s Hospital of Shenzhen between January 2015 and December 2017 were enrolled retrospectively. END was defined as an increase ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score or an increase ≥1 in the motor function score within 7 days after admission compared with the baseline score. Demographics, baseline clinical data, and primary treatment options during hospitalization were compared between the END group and the non-END groups. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of D-dimer for END. Results A total of 625 patients were enrolled in the study, including 40 in the END group (including 3 deaths) and 585 in the non-END group. The mean hospital stay, international normalized ratio, D-dimer, uric acid, NIHSS score and modified Rankin Scale (mRS) score at admission, and the proportion of patients with complete anterior circulation infarction, large atherosclerotic stroke, and pulmonary infection were significantly higher than those in the non-END group (all P < 0. 05). There was no significant difference in the proportion of patients receiving thrombolysis, antiplatelet,anticoagulation, and statins between the two groups. ROC curve analysis showed that the area under the curve of D-dimer predicting END was 0. 810 (95％ confidence interval [CI] 0. 736-0. 884; P < 0. 001); the optimal cut-off value was 2. 35 mg/L, and the sensitivity and specificity were 54. 74％ and 96. 13％ respectively. Multivariate logistic regression analysis showed that large atherosclerotic stroke (odds ratio [OR] 1. 115, 95％ CI 1. 005-1. 390; P = 0. 003 ), D-dimer ≥2. 35 mg/L (OR 1. 055,95％ CI 1. 012-1. 150; P = 0. 001 ), NIHSS score at admission (OR 1. 191, 95％ CI 1. 006-1. 410; P <0. 001), mRS score > 1 at admission (OR 1. 755, 95％ CI 1. 139-3. 656; P = 0. 037 ), and pulmonary infection (OR 2. 598, 95％ CI 1. 132-3. 081; P = 0. 012) were the independent risk factors for END in patients with acute ischemic stroke. Conclusion D-dimer ≥2. 35 mg/L at admission has higher predictive value for END in patients with acute ischemic stroke.

BACKGROUND:Computer-assisted implant surgery can improve implantation accuracy,but the use of implant template in the posterior tooth area is limited for patients with small opening and small interocclusal distance.Therefore,the digital guide has been improved. OBJECTIVE:To study the effect of modified implant template on the accuracy of assisted implantation in missing second molars. METHODS:From July 2020 to July 2023,40 patients who received digital guide plate implantation or free hand implantation to repair missing second molars were selected from First Affiliated Hospital of Guangzhou Medical University.According to the coin toss method,patients were randomly divided into a trial group(n=22;modified digital guide assisted implantation)and a control group(n=18;free hand implantation).The data of neck deviation,tip deviation,depth deviation,and angle deviation were compared between groups for preoperative and postoperative cone beam CT overlap analysis.One week after the operation,the patients'satisfaction with the operation was assessed by visual analog scale score. RESULTS AND CONCLUSION:(1)The trial group included 25 implants(12 in the upper jaw and 13 in the lower jaw);the control group included 23 implants(8 in the upper jaw and 15 in the lower jaw).The neck deviation,tip deviation,depth deviation,and angle deviation of the trial group were all smaller than those of the control group(P<0.05,P<0.001).There was no significant difference in accuracy between the maxillary and mandibular implant site in the trial group(P>0.05).(2)There was no significant difference in satisfaction with the operation between the two groups(P>0.05).(3)The results showed that improving the digital guide plate for assisted implantation for missing second molar can improve surgical accuracy and is suitable for patients with small opening and small interocclusal distance in the posterior tooth area.

Objective To study the pathological changes of the sudden death cases due to the dysplasia of the cardiac conduction system. Methods Using the newly established pathological sampling method by our research team, 26 hearts of unidentified sudden deaths excluding trauma, poisoning and diseases were collected and observed optically with H&E staining, Masson staining and immunohistochemical staining. Results Among the 26 cases, there were dysplasia in the cardiac conduction system,structural abnormalities, tissue or structure shift, fibrous cushion in the sinoatrial node and 9 cases have 2~3 abnormalities at the same time. Among the age groups from 16 to 30, 21 cases (80.8%) showed dysplasia of the cardiac conduction system. Conclusion The dysplasia of the cardiac conduction system may be one of the predominant reasons for the sudden death in young adults.

Objective:To master the 2018 annual oral operation skills assessment of dental standardized residency training trainees, to explore the weak links in the process of the dental residency training, and to provide data support and scientific basis for improving the teaching of clinical skills for dental residency training in the future.Methods:The results of 2018 annual oral operating skills examination of dental standardized residency training trainees in the Affiliated Stomatological Hospital of Nanchang University were collected, the data were sorted by excel and analyzed statistically by SPSS 22.0, and independent sample t test was performed for univariate analysis. Results:The tooth preparation expert results and the scores of cavity preparation expert process in Batch 2017 were higher than those in Batch 2016 [(23.72±2.13) scores vs. (25.82±1.53) scores], and the cavity preparation results of Batch 2017 [(21.08±3.13) scores] were lower than those of Batch 2016 [(23.36±2.32) scores]. The scores of social trainees in the process of tooth preparation [(24.59±2.03) points] were lower than those of the professional postgraduates [(26.29±1.64) points], and the results were all statistically significant ( P<0.05). The three lowest scores of each item in different grades and status types were almost the same. Conclusion:Different grades and different status categories have different scores in different operation items and different score indicators, which suggests that the dental standardized residency training should focus on the weak items and the indicators with lowest scores of each item, so as to make up the shortage and improve the quality of standardized residency training.

Background and purpose:Chimeric antigen receptor T(CAR-T)cell therapy has shown remarkable efficacy in treating hematological and lymphatic system tumors,but its effectiveness in solid tumors is relatively poor,which is partly attributed to target selection.For Ewing sarcoma(ES),CD99 can be a potential target for CAR-T cells.However,due to T cells'endogenous expression of CD99 protein,CAR-T cells targeting CD99 face limitations in their expansion capacity in vitro.This study aimed to identify the optimal conditions for preparing CD99 CAR-T cells by incorporating CD99 knockdown short hairpin RNA(shRNA),optimizing the multiplicity of infection(MOI)for lentiviral transduction,and screening for the best culture medium and container for CAR-T cell expansion.Methods:shRNA sequences were screened to enhance the expansion capacity of CD99 CAR-T cells.Different MOI,culture media,and containers were used to assess CAR-T cell transduction efficiency,cell viability,proliferation capacity,specific killing ability,and interferon-γ(IFN-γ)release levels under various conditions,in order to identify the optimal cell preparation conditions.Results:The expansion level of KO-CD99 CAR-T cells obtained through shRNA knockdown was significantly higher than that of CD99 CAR-T cells[(16.40±0.40)vs(6.33±1.53),P<0.01].The optimal expansion effect was observed when the transduction MOI was between 0.25 and 1.0,and OptiVitro was used as the culture medium.CAR-T cells cultured in ventilated flasks exhibited significantly higher expansion rates compared to cells cultured in bags[MOI=0.25:(50.23±3.32)vs(13.02±4.82);MOI=0.50:(49.96±0.83)vs(18.25±2.88);MOI=1.00:(48.27±5.08)vs(13.16±6.26);P<0.01],with better cell phenotype and higher specific killing ability.Conclusion:KO-CD99 CAR-T cells obtained through shRNA technology can achieve stable expansion.Based on the optimization of expansion conditions,KO-CD99 CAR-T cells exhibit superior expansion capacity and a higher proportion of memory T cells when the MOI is between 0.25 and 1.00,OptiVitro is used as the culture medium,and ventilated flasks are used as the culture container.These findings lay a solid foundation for further clinical trials of CD99 CAR-T cell therapy for ES.

OBJECTIVETo determine the efficacy and safety of telbivudine for blocking intrauterine transmission of hepatitis B virus (HBV) in pregnant women with high-load HBV DNA.

METHODSWomen in general good health and pragnant were enrolled for study between the ages of 20 to 40 year-old, with a diagnosis of HBV infection with high-load HBV DNA level (≥1*10(6) IU/ml). According to each participant's willingness, the women were divided into a telbivudine treatment group (82 women) and an untreated control group (75 women). The telbivudine treatment was initiated at gestation week 26 as oral dosing of 600 mg/d and continued until 1 month after the birth.Women in the control group had not gotten any antiviral drug treatment. All of the women delivered by cesarean section, and all of the neonates were administered the standard passive immunization therapy, which consisted of a hepatitis B immunoglobulin (200 IU) injection given within 12 hours of birth and an injection of hepatitis B vaccine (20 µg) at birth and at postnatal month 1 and 6. None of the mother's performed breastfeeding.

RESULTSThe telbivudine-treated women showed a significant decrease in HBV DNA levels prior to delivery, as well as significantly decreased prenatal HBV DNA levels (>2 logl0). Efficiency of the telbivudine treatment was 100%. Immediately prior to delivery, 16 (19.5%) of the women in the telbivudine treatment group showed negative HBV DNA status, as opposed to the untreated control group in which no women showed negative status. The telbivudine treatment group had no case of maternal or fetal adverse reaction or of congenital malformation.

CONCLUSIONUse of telbivudine antiviral therapy during late pregnancy in women with high-load HBV DNA can significantly reduce level of HBV DNA in maternal peripheral blood, block HBV intrauterine transmission, and provide good short-term efficacy, with good tolerability and safety.

Adult ; Antiviral Agents ; DNA, Viral ; Female ; Hepatitis B Vaccines ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Immunoglobulins ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Mothers ; Pregnancy ; Pregnancy Complications, Infectious ; Thymidine ; analogs & derivatives ; Young Adult

OBJECTIVE：To study the ef fects of Gegen qinlian decoction （GGQLD）on blood lipid and blood glucose of hyperlipidemia（HLP）model rats ，and to explore its mechanism from the perspective of intestinal flora. METHODS ：Totally 48 rats were randomly divided into blank control group （n＝8）and modeling group （n＝40）. For consecutive 5 weeks，model group was given high-lipid diet to induce HLP model ；blank control group was given routine diet. After modeling ，30 modeling rats were randomly divided into model group ，simvastatin group （positive control ，10 mg/kg），GGQLD high-dose ，medium-dose and low-dose groups （14.85，4.95，1.65 g/kg，by crude drug ），with 6 rats in each group. Blank control group and model group were given constant volume of normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day，for consecutive 11 weeks. At the same time ，each group was continuously given corresponding diet. After the last medication ， body mass and body length of rats were determined ，and Lee ’s index was calculated. Serum levels of TG ，TC，HDL-C，LDL-C and fasting blood glucose （FBG）were determined in rats. DNA of rat caecum content was extracted for 16S rRNA V 3-V4 region sequencing. The Two-part model was used to analyze the correlation between intestinal flora with lipids and blood glucose. RESULTS：After 11 weeks of administration ，compared with blank control group ，the body mass ，body length ，Lee’s index ， serum levels of TC ，TG，HDL-C and FBG of model group were increased significantly （P＜0.05 or P＜0.01），while the level of HDL-C was decreased significantly （P＜0.05）. Compared with model group ，body mass and Lee ’s index and serum levels of TG ， FBG of rats in GGQLD high-dose group ，and serum levels of TC ，TG in GGQLD medium-dose group ，as well as serum level of TG of rats in GGQLD low-dose group was decreased significantly （P＜0.05 or P＜0.01）. Correlation analysis with intestinal flora showed that TC and TG shared 3 operational taxonomic units （OTU），including OTU 559，OTU701 and OTU 135（OTU135 was also shared with FBG ），which were all positively correlated with the level of TC ，TG and FBG （P＜0.01）. The three OTU were annotated as Tyzzerella of Spirillaceae ，Anaerotruncus of Verrucaceae and Peptoclostridium of Streptococcidae ，respectively. High-dose and low-dose GGQLD had a down-regulating effect on Tyzzerella and Anaerotruncus（P＜0.05 or P＜0.01），while had up-regulating effect on Peptoclostridium（P＜0.01）. CONCLUSIONS ：High-dose GGQLD （14.85 g/kg）can effectively reduce the body mass and blood lipid of HLP model rats ，and can prevent the abnormal increase of blood glucose of model rats. The mechanism may be associated with that the reduction of intestinal flora （Tyzzerella，Anaerotruncus）content.