ObjectiveStudy the relationship among CaSR expression, tubulointerstitial damage,metabolic disturbance of calcium and phosphorus and microvascular density around the tubulointerstitium in children with steroid-resistant nephrotic syndrome.Methods36 cases of children with primary nephrotic syndrome were divided into hormone-sensitive group and steroid-resistant group.Semi-quantitative scores for tubulointerstitial pathological evaluation of the extent of damage, automatic biochemical analyzer for the determination of serum calcium (Ca), phosphorus (P) concentration of renal tubular epithelial CaSR expression and microvessel microvascular density around the tubulointerstitium were determined by immunohistochemical assay.ResultsMore severe the tubulointerstitial damage, lower level of serum Ca and higher level of serum P were observed [(2.26 ± 0.15) mmol/L]in children of the steroid-resistant group and the steroid-sensitive group [(1.90 + 0.12) mmol/L, P ＜ 0.05].CaSR expression (4.63 + 0.78) of renal tubular epithelial cells in the steroid- sensitive group was significantly lower than that in the steroid-resistant group (6.56 + 1.22, P ＜ 0.05), but microvascular density was significantly higher in the steroid- sensitive group(2.98 +0.35 vs 2.02 +0.24, P ＜0.05).When the tubulointerstitial damage was mild, CaSR expression (4.15 +0.58) in renal tubular epithelial cells in the steroid- sensitive group (4.26 ±0.61) was lower than the steroid-resistant group(3.12 ± 0.33; 3.01 ± 0.21), and microvascular density was higher,but the difference was not significant(P ＞0.05).In the moderate tubulointerstitial damage, CaSR expression in renal tubular epithelial cells in the steroid- sensitive group (5.35 ± 0.64) was significantly lower than the resistant group (7.37 +0.81, P ＜0.01), and microvascular density was significantly higher than the resistant group (2.81 ±0.16, 2.02 ±0.14, P ＜0.05).Compared by mild and moderate tubulointerstitial damage in children with the steroid-resistant, CaSR expression (11.46 ± 1.38) in children with severe tubulointerstitial damage was significantly increased, and microvascular density (1.15 ± 0.11) was significantly decreased (all P ＜ 0.01).ConclusionsCaSR expression was increased and microvascular density around the tubulointerstitium was decreased in children with steroid-resistant nephrotic syndrome.Dut to steroid resistance, the cytotoxic of steroid damaged the renal tubular epithelial cells, the metabolic disturbance of calcium and phosphorus and the damage of blood vessel endothelium finally resulted in severe tubulointerstitial damage.

Objective To explore the role of body fat distribution in the pathogenesis of obesity-related asthma.Methods Totally 125 patients with stable asthma were recruited and were divided into non-obese group (n =51),peripheral obesity group (n =34) and central obesity group (n =40) according to body mass index and waist circumference.The FEV1％,FVC,FEV1/FVC ratio,IL-6,and hs-CRP levels in peripheral blood,eosinophil and neutrophil percentage in induced sputum,as well as exhaled NO levels were determined,and asthma control test (ACT) scores were calculated.Both one-way analysis of variance and analysis of covariance were used for statistical analysis.Results The values of FVC in the central obesity group and the non-obese group were [3.98 (3.99) ±0.99] L and [4.51 (4.51) ±1.00] L,while the levels of IL-6 and hs-CRP in peripheral circulation and the percentage of neutrophils in induced sputum were [33.63 (33.28) ± 14.04] ng/L and [21.22 (21.33)±11.23] ng/L,[2.12 (2.15) ±0.73] mg/L and [0.92 (0.91) ±0.61] mg/L,52.58 (52.81) ± 14.14 and 45.41 (45.34) ± 12.84,respectively (all P ＜ 0.05).After adjusting for inhaled corticosteroids (ICS) doses,the ACT scores were also significantly higher in central obesity group (22.10 ± 1.68 vs.23.01 ± 1.62) (P ＜ 0.05).Only the hs-CRP level was found significantly higher in peripheral obesity group than in non-obese group [(1.54±0.68) mg/Lvs.(0.91 ±0.61) mg/L] (P＜0.05).Conclusion Central obesity may play the leading role in the pathogenesis of obesity-related asthma.

OBJECTIVETo evaluate the clinical result of alveolar vertical distraction osteogenesis for implant.

METHODS19 cases with severe vertical alveolar defects (more than 10 mm defect) underwent vertical distraction procedure before implant placement. 15 cases were male and 4 cases were female. The alveolar bone defects were caused by tumor resection in 10 cases, by trauma in 8 cases, and due to congenital defect in 1 case. The vertical defects in all cases were over 10 mm. X-ray examination were taken prior to operation and in 1 week, 2 week, 4 week, the end of active distraction and before removing distractor. Implants were placed in 17 cases after removing distractors. The prosthesis were finished 6 month later.

RESULTS11 cases out of 19 had implant prosthesis. 6 cases had implant in the jaw but waiting for the prosthesis. Altogether 65 dental implants were placed, 2 cases did not receive further implant treatment because of cost problem. The study showed that new bone formed after distraction in all 19 cases. Average gained height of new bone was 13 mm.

COMPLICATIONSUnexpected mandible fracture in 2 cases, infection in 1 case.

CONCLUSIONSAlveolar vertical distraction is a good alterative for severe alveolar defects. The distractor should be further developed and modified.

Background The management of Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) is controversial due to the early recurrence after curative hepatectomy,and many variables were related to the prognosis.The purpose of this study was to predict the tumor recurrence in early postoperative period of the patients with BCLC stage B HCC.Methods From January 2004 to January 2012,104 patients with BCLC stage B HCC underwent hepatectomy.Clinicopathological factors and follow-up data were statistically analyzed to establish a predicting scoring system.Results The overall survival rates for one,three,and five years were 69.2％,52.7％,and 42.3％,and the disease-free survival rates for one,three,and five years were 52.9％,47.3％,and 37.5％,respectively.The multiple factors analysis showed that the micro-vessel invasion,lymph nodes metastasis,multiple lesions,and the high expression of HMGB1 were independent factors (P ＜0.05).A scoring system was established to predict the early recurrence within one year after the surgery for BCLC stage B HCC,according to the analysis results with a specificity of 85.1％ and a sensitivity of 80.3％.Conclusion Variant clinicopathological factors were associated with early postoperative recurrence for BCLC stage B HCC and recurrence early after hepatectomy was more likely in patients with a higher score of the scoring system.

Objective:To analyze curative efficacy and pronosis of three-dimensional reconstruction combined with 3D printing assisted minimally invasive surgery in the treatment of hepatolithiasis.Methods:92 patients with complex hepatolithiasis treated by minimally invasive surgery in Qingdao Hospital affiliated to Shandong First Medical University from November 2018 to January 2020 were retrospectively selected. According to different surgical positioning methods, they were divided into the control group [50 cases , conventional computer tomography (CT) positioning] and the observation group (42 cases, 3D reconstruction combined with 3D printing technology). The curative effect, stone residue rate, operation related indexes, complications and recurrence rate were compared between the two groups.Results:The excellent and good rate of the observation group was higher than that of the control group (95.2% vs 80.0%), and the rate of residual stones after surgery was lower than that of the control group (4.0% vs 22.0%), with statistically significant difference (both P<0.05). Compared with the control group, the observation group had shorter operation time, less intraoperative blood loss and postoperative abdominal drainage volume, shorter postoperative abdominal drainage time and hospital stay, with statistically significant difference (all P<0.05). The incidence of postoperative complications and recurrence rate in the observation group were lower than those in the control group (11.9% vs 30.0%, 2.4% vs 18.0%), with statistically significant difference (both P<0.05). Conclusions:Three-dimensional reconstruction combined with 3D printing assisted minimally invasive surgery is effective in the treatment of complex hepatolithiasis and can reduce the recurrence rate.

Background and Purpose:Prostate cancer is one of the most common cancers and the second leading cause of cancer-related death in Europan and North American males.The incidence of prostate cancer has also been increasing during the past few decades in China.It is widely accepted that this heterogeneity,which results from the tumor progression driven largely by genomic instability(genetic and/or epigenetic alterations)of tumor cells in primary tumor,endows specific populations of tumor cells with the unique character needed for invasion,migration,and metastasis colony formation in other organs and only these subpopulations possessing thost character can survive the potentially destructive journey from the primary tumor to the sites of metastases.The purpose of the present study was to explore the genes associated with invasion and metastasis of human prostate cancer cell line PC-3M in nude mice.Methods:After PC-3M cells were inoculated into orthotopic site(prostate) in a male nude mouse for two months,tumor cells were isolated from the primary tumor and lymph node metastasis,separately.Cell invasion and adhesion ability in vitro were first compared between two cells.Then metastasis-related genes differentially expressed between them were analyzed by utilizing cDNA microarray technique.Results:The in vitro cell invasion and adhesion potential of tumor cells from lymph node metastasis was significantly higher than those from primary tumor by 2.5 fold and 1.5 fold,respectively.Metastasis-related genes differentially expressed between those two sublines were identified,all of them were up-regulated in the tumor cells from lymph node metastasis and could be categorilized: 1.genes encoding cellular matrix-degrading proteolytic enzyme including cathepsin and MMP.2.genes encoding transcription factors.3.genes related to heterotypic adhesion of tumor cells.4.genes encoding cell surface receptors.Conclusions:There are significant differences in invasion and adhesion potential between cells from primary tumor and those from lymph node metastasis.Some differentially expressed molecules might be playing pivotal roles in promoting tumor cells to migrate from primary tumors to distant metastases,which may be helpful to elucidate the possible mechanism of metastasis in prostate cancer.

Objective To explore the reasons for platform-switching abutment fracture,the treatment and prevention methods.Methods Between March 2009 and December 2014,all of the fractured platform-switching abutments were evaluated.The fracture rate of platform-switching abutments was calculated and the gender,age,implant site,implant size,abutment size,prosthetic type,loading time and crown materials were analyzed.Results A total of 2 487 platform-switching implants were placed during this period and 6 abutments were fractured.The fracture rate was 0.24％ (6/2 487).All of the 6 fractured abutments were placed in molar region.All occlusal planes were made of metal material.Five patients were male.All the fracture abutments could not be removed and the implants had to be removed and reimplanted.Conclusions Without special abutment removing instruments,it is difficult to remove the fractured platform-switching abutment.In molar region,platform-switching implant system should be carefully used.Increasing implants number and splinting crowns with porcelain occlusal planes might reduce the abutment fracture risk.

Objective:To explore the family resilience resources in parents of children with congenital pseudarthrosis of the tibia (CPT) , so as to provide a reference for formulating nursing intervention to improve their family resilience.Methods:From December 2020 to January 2021, purposive sampling was used to select 13 father or mother of children with CPT in the Department of Orthopedics of Hunan Children's Hospital as the research object. Semi-structured interviews were conducted with parents of children with CPT using the phenomenological method in qualitative research. Colaizzi 7-step method was used to organize, summarize, analyze and refine the data.Results:The family resilience resources of parents of children with CPT were reflected in three aspects, namely, personal resources, family resources and social resources.Conclusions:Family resilience interventions should make full use of their own resources when implemented in parents of children with CPT. Individualized continuous intervention should be provided by taking into account the learning ability and psychological state of the children's parents and in combination with specific needs. The intervention target should include as many family members as possible, and strengthen the establishment of a diversified support system to help parents of children with a large number of social resources.

Objective To evaluate the 10-year clinical results of implant prostheses in edentulous patients.Methods Between August 1994 and November 2009,762 implants were placed in 127 patients (162 jaws) with the mean age of (56.0 ± 10.9) years in Peking University,School and Hospital of Stomatology.Sinus lift,guide bone regeneration (GBR) and onlay graft were used according to the indications of bone defect types.Overdentures and fixed bridges were delivered.Overdentures were retained/supported by ball,magnet,telescopic crown or milled bar.Clinical evaluation included peri-implant soft tissue health status,prostheses functional status and complications.Radiographic evaluations were conducted at operation day,3 months post-operatively,right after prostheses delivery,and annually afterwards.Clinical data were collected and analyzed.Results Of the 127 patients,116 were edentulous mandible and 46 edentulous maxilla,with a mean follow-up period 109.2 months (45-228 months).Thirteen implants were lost and the 10-year implant cumulative survival rate was 97.8％ and the prostheses success rate was 100.0％.The prevalence of peri-implantitis was 3.8％ (29/762).Sixty-seven point nine percent of the patients underwent implant placement without bone graft.Sinus lift technique and guided bone regeneration technique were the most often used with 84.8％(39/46) in the upper jaws and 6.2％(10/162) in the total jaws respectively.Seventy-one percent of the cases(115/162) was overdentures.Telescopic,milled-bar,and magnetic retained/supported overdentures were the most commonly used with 34.8％(40/115),27.0％ (31/115),and 20.0％ (23/115) respectively.The implant-supported fixed prostheses included adhesive retained fixed bridges and screw retained fixed bridges with the ratio of 19.1％ and 80.9％ respectively.The prevalence of 10-year post-prosthodontic complications was 53.5％(68 cases).The most common complications were prosthetic and uperstructure complications.Conclusions The 10-year implant-retained/supported prostheses was a successful modality in edentulous cases.Sinus lift technique and guided bone regeneration technique are the most commonly used techniques with predictable clinical results.Telescopic crowns milled bar and magnet with 4-6 implants retained/supported overdenture were the most often used retention systems and telescopic crown overdenture had more advantages in terms of long-term maintenance and satisfaction.

Objective:To analyze the characteristics of child cases admitted to accidental injury and provide reliable basis for the prevention of accidental injury.Methods:The clinical data of children admitted to Hunan Children′s Hospital aged 0-18 due to accidental injuries from January 1, 2018 to December 31, 2021 were retrospectively analyzed. The type of accidental injury and characteristic factors such as prognosis, gender, age, time, and location of the child were analyzed.Results:A total of 9 049 children with accidental injury were admitted, accounting for 3.72%(9 049/33 697) of the total number of hospitalized children. The top three types of accidental injuries were falls/drop (3 695 cases), foreign bodies/suffocation (2 639 cases) and traffic accidents (1 165 cases), accounting for 82.87%(7 499/9 049). There were 8 760 cases (96.81%) of improvement and recovery, 178 cases (1.97%) of disability, and 111 cases (1.23%) of unhealed/dead. Among the accidental injuries, 5 833 cases (64.46%) were boys and 3 216 cases (35.54%) were girls, and the incidence ratio was 1.81∶1. There was significant difference between boys and girls in the composition ratio of the type of accidental injury such as falls/falls, foreign bodies/suffocation, poisoning, sharp object injury, drowning ( χ2 values were 3.90-20.56, all P<0.05). Among the accidental injuries, the children aged 1 to<3 years had higher accidental injuries than the other age groups (3 263 cases, accounting for 36.06%), and the composition ratio of accidental injuries in different age groups was different ( χ2 values were 12.98-573.97, all P<0.05). Among the accidental injuries, the accidental injuries occurred in the second quarter and the third quarter were higher than those in the other two quarters (4 892 cases, accounting for 54.06%), and the composition ratio of accidental injuries such as falls/falls, foreign bodies/suffocation, burn and scald, drowning occurred in different quarters was different ( χ2 values were 10.79-18.88, all P<0.05). In the case of accidental injuries, the family was the most likely place of accidental injury, with different types of accidental injuries occurring in different places ( χ2 values were 10.08-2 186.54, all P<0.05). Conclusions:Children′s unintentional injuries are most likely to occur in boys aged 1-<3 years, and fall/fall is the main injury type. Traffic accidents are the most important unintentional injury type leading to children′s unhealed/dead. Different injury types were related to child gender, age, quarter, and place of occurrence.Due to the differences in the occurrence mechanism and injury mode of accidental injuries in different countries and regions, and the majority of accidental injuries can be prevented, targeted preventive measures should be taken according to the characteristics of children′s accidental injuries in different regions, and a comprehensive prevention system for children′s accidental injuries should be constructed to ensure children′s safety.