Objective To investigate the insulin sensitivity in children born small for gestational age without catch-up growth.Methods We investigated 439 outpatients in pediatric department of the Third Hospital of Peking University with diagnosis of short stature from August 2008 to August 2016.Two groups were divided based on their diagnosis as born small for gestational age group(SGA)with 218 patients and idiopathic short stature group(ISS)with 221 patients.Fasting blood-glucose,fasting insulin,fasting insulin/fasting blood-glucose,islet beta-cell function(HOMA%),homeostasis model assessment-insulin resistance(HOMA-IR)were analyzed in two groups.Results Hierarchy based on age and sex in SGA and ISS.No significant difference was observed in preadolescent boys with fasting blood-glucose(4.7±0.6 vs 4.8±0.6,P=0.678),fasting insulin(5.1±4.0 vs 4.3±4.7,P=0.345),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in preadolescent girls with fasting blood-glucose(4.5±0.5 vs 4.6±0.5,P=0.828),fasting insulin(4.7±3.5 vs 4.5±3.3,P=0.603),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in adolescent boys with fasting insulin(5.9±4.3 vs 6.0±4.5,P=0.958),fasting blood-glucose(5.0±0.8 vs 4.9±0.5,P=0.176),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in adolescent girls with fasting blood-glucose(4.9±0.6 vs 4.8±0.4,P=0.141),fasting insulin(7.5±6.4 vs 7.4±8.6,P=0.448),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.Conclusion The insulin sensitivity were in good condition in children born small for gestational age without catch-up growth.

Objective To study the features and values of ultrasound and Helical computed tomography (CT) in diagnosis of cystic renal cell carcinoma. Methods Twenty patients were preoperatively examined by B-mode ultrasound, color Doppler ultrasound and helical CT. Results All the cases were confirmed by operation and pathology,including 12 cases on the left side and 8 cases on the right side. On B-mode ultrasound images, all lesions appeared as unilocular or multilocular cyst in 5 cases, intratumoral septum in 10 cases,intratumoral nodule in 4 cases,solid-like mass in 1 case. Color blood flow was showed within tumors in 18 patients,in which 17 cases showed the arterial spectrum with a mean resistance index of 0.66. On enhanced CT scans, all the lesions appeared as the early uneven enhancement(19 cases), septal enhancement(6 cases) and mural nodular enhancement(4 cases) respectively. The accuracy of conventional ultrasound combined with color Doppler ultrasound was 85%, while the accuracy of the enhanced CT was 80%.Conclusions Conventional ultrasound combined with color Doppler ultrasound and enhanced CT plays an important role in diagnosis of cystic renal cell carcinoma.

Objective To investigate the factors associated with hyporesponsiveness to erythropoietin (EPO) in patients on maintenance peritoneal dialysis (PD) . Methods Data of 114 PD patients in our PD center were collected . Patients were divided into three groups according to weekly EPO dose: hyperresponsive, hyporesponsive and normal responsive . Various factors were compared among three groups by linear correlation and ordinal regression analysis to predict EPO resistance . Results As compared to hyperresponsive and normal responsive groups,significantly lower serum hemoglobin [(78 .11±13 .42) vs (106 .28±23 .83), (96 .31±12 .33) g/L],albumin [(33 .98±4 .78) vs (39 .72±4 .26), (35 .76±4 .88) g/L], and significantly higher serum CRP [(26 .08±21 .66) vs (5 .46±1 .75), (11 .82±5 .63) mg/L], ferritin [(371 .08±89 .38) vs (289 .39±76 .84),(323 .07±62 .46) μg/L] were found in hyporesponsive group(all P ＜ 0 .01) . Erythropoietin resistance index (ERI) was correlated with CRP and albumin . Regression analysis showed that serum albumin,CRP and ferritin were strong predictors of EPO hyporespnsiveness . Conclusions Serum albumin,CRP and ferritin are closely related to hyporesponsiveness . Malnutrition and inflammatory state contribute to EPO hyporesponsiveness .

Objective To evaluate the efficacy of dural tenting suture and epidural drainage in craniotomy. Methods In 145 cases of intracranial lesions, dural tenting suture and epidural drainage were performed to prevent epidural hematoma. Results Postoperative computed tomography (CT) showed no epidural hematoma required surgery in both groups. Conclusion Both dural tenting suture and epidural drainage are effective in preventing epidural hematoma. Hemostasis is the key step. Dural tenting suture without epidural drainage relieves psychological stress. It decreases the risk of intracranial infection and avoids some unusual complications.

Objective To evaluate the treatment effect of compound Chinese medicine on skeletal fluorosis in rats by Micro-CT.Methods Eighty-eight Wistar rats which had been weaned for two weeks were divided into four groups according to body weight [(91.1 ± 10.0)g] by the method of random number table:control group(16 mts),middle fluorine(MF)group(24 rats),high fluorine(HF) group(24 rats),and high fluoride and low calcium low protein (HF-LC-LP) group (24 rats).The amounts of fluorine of MF,HF and HF-LC-LP groups were 50,100 and 100 mg/kg,respectively.The contents of calcium and protein in HF-LC-LP group were half of MF and HF groups.Six months after treatment with fluoride,eight rats of each group were put to death with femoral artery bleeding.The rest 16 rats of each fluorosis group were divided into two groups,one was the control group and the other was fed with both fluorine and the compound Chinese medicine which simulated the actual situation of fluorosis area.Each rat of the treatment group was given the medicine 194 mg/100 g for six days every week.Daily urine samples were collected when the medicine had been used for 0,30 and 60 days.All the rats were put to death with femoral artery bleeding after the medicine had beengiven for 90 days,and limbs bones were dissected.Urine fluoride was tested by the method of fluoride ion selective electrode ; bone fluoride was tested by the method of high temperature ashing-fluoride ion selective electrode; bone mineral density(BMD),tissue mineral density(TMD),structure model index (SMI),trabecular thickness (Tb.Th),trabecular separation (Tb.Sp),anisotropy (a1/a3),trabecular connection density(Conn.D),the volume ratio of trabecular and bone tissue,the ratio of bone surface area and volume(BS/BV),and trabecular number(Tb.N) were detected by Micro-CT technology.Results The level of urinary fluoride of high fluoride and low calcium low protein treatment group [(11.01 ± 3.67)mg/L] was lower than that of its control group [(34.32 ± 9.50)mg/L,t =3.13,P ＜ 0.05] when rats were remedied with the compound Chinese medicine for 60 days.The level of bone fluoride of high fluoride treatment group[(275.38 ± 171.65)mg/kg] was lower than that of its control group[(701.67 ± 178.16)mg/kg,t =5.42,P ＜ 0.05] when rats were remedied withy the compound Chinese medicine for 90 days; bone fluoride of high fluoride and low calcium low protein treatment group[(313.26 ± 124.51)mg/kg] was lower than that of its control group[(794.66 ± 261.35)mg/kg,t =3.25,P ＜ 0.05].The differences of Tb.Th,Tb.Sp,a1/a3,Conn.D,BV/TV,BS/BV and Tb.N among groups were statistically significant(F =2.785,2.681,3.039,27.231,2.595,2.854,5.050,all P ＜ 0.05).Tb.Th[(0.04 ±0.01)mm] and Tb.Sp[(0.03 ± 0.01)mm] of middle fluorine treatment group were higher than those of their control groups[(0.02 ± 0.00),(0.02 ± 0.00)mm,all P＜ 0.05]; al/a3,Corm.D,BV/TV and Tb.N[(0.77 ±0.61),(510.91 ± 304.99)mm-3,(0.42 ± 0.06) and (13.58 ± 2.48)mm-1] were lower than those of their control groups[(1.11 ± 0.01),(2 403.69 ± 124.02)mm-3,(0.46 ± 0.03) and (18.12 ± 0.69)mm-1,all P ＜ 0.05].BV/TV(0.44 ± 0.04) of high fluoride treatment group were lower than those of their control groups(0.49 ± 0.00,P ＜ 0.05) ; Tb.Th[(0.04 ± 0.01) mm] was higher than that of its control group [(0.03 ± 0.00)mm,P ＜ 0.05].Conclusion The compound Chinese medicine may has therapeutic effect on rat skeletal fluorosis.

Objective:To explore the etiology and treatment of one case of bilateral mandibular second molar impaction with paradental cyst, and to provide a reference for its diagnosis and treatment. Methods:Root canal treatment of the left mandibular first molar of the patient was performed before operation.The left mandibular second molar of the patient was removed;the residual dental follicle, the granulation tissue and the cyst wall were stroken off under local anesthesia.The diamond ball was used to polish the wound cavity and sharp bone edge, and to mill the distal apical part of left mandibular first molar.The tissue removed during the procedure was used for the pathological examination.Results:The X-ray image showed that the bilateral mandibular second molar was impacted with the left mandibular first molar root's absorption, and there was a clear round-like density reduction zone around the second molar crown.The pathologic result was paradental cyst.Conclusion:Dental impaction complicated with paradental cyst could occur in other tooth position except for the third molar.Its diagnosis should be combined with the clinical manifestations, the pathologic manifestations and the medical imaging.Multidisciplinary consultation is in favor of its diagnosis and treatment.

Preterm birth is a major cause of perinatal mortality and long-term morbidity, chorioamnionitis (CAM) is a common cause of preterm birth and characterized by inflammation.CAM produces variety of inflammatory factors in fetal, results in structural and functional impairment, and affects the contractile function of pulmonary blood vessels, so, CAM can have impact on the morbidity of lung disease in premature, and it may even affect the long-term pulmonary function.

OBJECTIVE: To determine the efficacy of subarachnoid space protection in intracranial operation. METHODS: Data collected from 156 consecutive cranial operations, in which subarachnoid space protective technology was prophylacticly used, were analyzed. RESULTS: Fourteen patients had a postoperative fever for more than 1 week and 16 patients who required lumbar puncture to release blood contaminated cerebro-spinal fluid (CSF) or exclude meningitis. All except 3 patients were discharged as expected. No patients had symptomatic vasospasm and hydrocephalus. CONCLUSION The subarachnoid space protective technology has good effect on preventing postoperative fever and improving the outcome of patients.
Adolescent ; Adult ; Aged ; Brain Neoplasms ; surgery ; Child ; Child, Preschool ; Craniotomy ; methods ; Female ; Humans ; Infant ; Male ; Microsurgery ; methods ; Middle Aged ; Postoperative Complications ; prevention & control ; Subarachnoid Space ; physiopathology ; Vasospasm, Intracranial ; prevention & control ; Young Adult

Objective:To evaluate the level of first morning voided(FMV)urinary luteinizing hor-mone(LH)in girls with breast development,and to determine the value of FMV urine LH in the evalua-tion of central precocious puberty(CPP).Methods:From September 2018 to April 2021,among the patients who were admitted to the Department of Pediatrics of Peking University Third Hospital for"pre-cocious puberty"and underwent gonadotropin-releasing hormone(GnRH)stimulation test,a total of 108 girls were enrolled.According to CPP diagnostic criteria,they were divided into CPP group(n=45)and non-CPP group(n=63).The clinical characteristics and hormone levels of the two groups were com-pared.Receiver operating characteristic(ROC)curve was used to analyze the cut-off value of FMV uri-nary LH in the diagnosis of CPP in girls.Further analyses were done to evaluate the value of FMV urinary LH in the diagnosis of CPP using correlation analysis between urinary LH level and common clinical cha-racteristics.Results:ROC curve analysis showed that FMV urine LH level was significant for the diagno-sis of CPP.The cut-off value of FMV urine LH was 0.69 IU/L(specificity 56.9％,sensitivity 85.0％,area under curve 0.804,P＜0.001).The basic clinical characteristics without GnRH stimulation test were analyzed by binary Logistic regression analysis,indicating that the level of FMV urine LH,uterine volume,ovarian volume and advanced T-bone age had predictive significance for CPP diagnosis in girls(OR values were 2.125,1.961,1.564 and 2.672,respectively).The prediction model was established and the area under the ROC curve was 0.904,P＜0.001.The level of FMV urine LH was positively cor-related with the levels of serum LH,FSH and estrogen before GnRH stimulation test,the peak value of blood LH after GnRH stimulation test,T bone age and uterine volume,with r values of 0.462,0.373,0.242,0.360,0.373 and 0.263,respectively,and P values were＜0.001,＜0.001,0.013,＜0.001,＜0.001 and 0.007,respectively.Conclusion:FMV urine LH can provide a good indication for the diagnosis of CPP.Combining with bone age advanced level and pelvic ultrasound measurement,the pre-dictive value of FMV urine LH can be further improved for the diagnosis of CPP in girls.

Objective:To investigate the short- and long-term outcomes of fetuses with selective fetal growth restriction (sFGR).Methods:A retrospective study was conducted on monochorionic diamniotic (MCDA) twins with sFGR admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital from September 2017 to December 2019. MCDA neonates delivered during the same period without significant complications were selected as the control group. MCDA twins with sFGR were divided into type Ⅰ, Ⅱ, and Ⅲ groups and then further divided into the larger and the smaller fetus subgroups according to the birth weight. These children were followed up by telephone at 2-3 years old. Height-for-age and weight-for-age Z-scores were calculated. Ages and Stages Questionnaire-Third Edition (ASQ-3) was used to determine comprehensive development. Independent sample t-test, one-way analysis of variance, non-parameter test, and Chi-square test (or rank-sum test) were used for statistical analysis. Results:(1) A total of 116 pregnant women with sFGR (232 neonates) were enrolled in this study. There were 43, 40, and 33 mothers and 86, 80, and 66 newborns in type Ⅰ, Ⅱ, and Ⅲ groups, respectively. The control group included 31 pregnant women and 62 neonates. The gestational age at onset of sFGR was younger in the type Ⅱ and Ⅲ groups than in type Ⅰ group [(23.8±4.8) and (24.1±3.1) vs (27.0±6.1) weeks, F=5.19, P<0.05; all P<0.017 during pairwise comparisons]. (2) The incidence of sepsis and treatment abandonment/death in neonates in type Ⅱ and Ⅲ groups were higher than those in type Ⅰ and control groups [neonatal sepsis: 11.3% (9/80) and 6.1% (4/66) vs 2.3% (2/86) and 0.0% (0/62), χ2=6.30, P=0.001; death or treatment abandonment rate:13.8% (11/80) and 10.6% (7/66) vs 3.5% (3/86) and 0.0% (0/62), χ2=4.68, P=0.003; all P<0.017 during pairwise comparisons]. In cases with type Ⅱ or type Ⅲ sFGR, the risk of digestive system diseases was significantly higher in the smaller fetus group than in the larger fetus group [type Ⅱ: 46.2% (37/80) vs 38.7% (31/80), χ2=16.72; type Ⅲ: 47.0% (31/66) vs 34.8% (23/66), χ2=39.69; both P<0.001], while the rate of respiratory system diseases was lower in the smaller fetus group [type Ⅱ: 35.0% (28/80) vs 45.0% (36/80), χ2=36.85; type Ⅲ: 37.9% (25/66) vs 45.4% (30/66), χ2=12.55; both P<0.001]. The incidence of neonatal sepsis in smaller fetuses was higher than that in larger ones in type Ⅱ sFGR [7.5% (6/80) vs 3.7% (3/80), χ2=4.68, P=0.034]. The incidence of neurological complications in larger fetuses was higher than that in smaller ones in type Ⅲ sFGR [15.1% (10/66) vs 4.5% (3/66), χ2=5.72, P<0.001]. (3) In type Ⅱ group, seven neonates died (one case of cerebral hemorrhage, two cases of gastrointestinal perforation, two cases of septic shock, and two cases of necrotizing enterocolitis), and four cases withdrew the treatment. In type Ⅲ group, four neonates died (two cases of necrotizing enterocolitis, one case of gastrointestinal perforation, and one case of cerebral hemorrhage), and three cases withdrew from the treatment. (4) Totally, 71 children in type Ⅰ, 61 in type Ⅱ, and 58 in type Ⅲ group were followed up at the age of 2-3. Children with type Ⅱ or type Ⅲ sFGR lagged behind those in type Ⅰ group and control group in physical growth [ M ( P25- P75), Z-scores:－0.46 (－0.87-0.42),－0.35 (－0.62-0.71), 0.05 (－0.61-0.51), and 0.14 (－0.57-0.75); H=6.20, P=0.001]. In type Ⅱ and Ⅲ groups, the smaller fetuses lagged the larger fetuses in physical growth at 2-3 years of age. ASQ-3 scores in communication, gross motor, fine motor, problem-solving and personal-social areas were all lower in type Ⅱ and Ⅲ groups than in type Ⅰ and control groups. ASQ-3 scores in the five dimensions of the smaller fetuses in the type Ⅱ group were lower than those of the larger fetuses. In the type Ⅲ group, the smaller fetuses had lower ASQ-3 scores in communication and gross motor than the larger ones [communication ability: (42.6±18.8) vs (56.4±9.4) scores, t=19.63, P<0.001; gross motor: (45.5±19.7) vs (54.5±9.7) scores, t=12.64, P=0.003]. Conclusion:The neonatal morbidity is significantly increased in type Ⅱ and Ⅲ sFGR, and babies lagged others in height, weight, and ASQ-3 score at 2-3, which is worthy of early attention.