Objective To investigate mRNA expression level changes of dopamine transporter gene (DAT1) and dopamine receptor gene(DRD4) in attention deficit hyperactivity disorder(ADHD) children's peripheral blood before and after methylphenidate treatment,and to explore associations between the mRNA expression level and symptom severity,as well as methylphenidate response.Methods Forty five ADHD children by DSM-Ⅳ diagnostic criteria,aged six to fifteen years old participated in a six-week drug titration treatment of metbylphenidate.ADHD-RS-Ⅳ Home Version, WCST and VCPT were used to evaluate the ADHD clinical symptoms and cognitive functions.RNA Simple Total RNA Kit was used to extract the total RNA.After reverse transcription, the obtained c-DNA was used in the following qRT-PCR to evaluate relative mRNA expression of the candidate genges before and after medication.Results The DRD4 mRNA relative expression level after taking methylphenidate was significantly higher than that before methylphenidate treatment (0.23 ± 0.23 vs 0.16± 0.18, P =0.041).There was no significant difference between DAT1 mRNA relative expression level before (0.43 ± 0.40) and after (0.43±0.40) methylphenidate treatment.No significant difference was found on eitber basal DAT1/DRD4 mRNA expression or fold change of DAT1/DRD4 mRNA expression before and after medication between methylphenidate treatment responders and non-responders groups.There was a positively significant correlation between baseline DRD4 mRNA relative expression level and erroneous T score of CPT(r=0.424, P=0.025) , however, no other statistically significant correlation was found between basal DRD4 mRNA relative expression level and ADHD-RS-Ⅳ total score,WCST conceptual level, CPT missing T score, and CPT reaction T sco~ (all P＞0.05).There was also no statistical significant correlation between basal DAT1 mRNA relative expression level and ADHD-RS-Ⅳ total score,WCST conceptual level,and CPT T scores(all P＞0.05).Conclusion DRD4 gene function may be increased after methylphenidate treatment and play an important role in impulsivity behavior of ADHD.Therefore, DRD4 mRNA expression level might be a biomarker for ADHD diagnosis and a predicting indicator of drug efficacy.

Objective To discuss the clinical value of transesophageal echocardiography used in extracorporeal circulationcardiac valve replacement. Methods 89 patients received extracorporeal circulation cardiac valve replacement in our hospital from January 2012 to December 2014 were included in the study. Transesophageal echocardiography were performed preoperatively, intraoperation and postoperatively and the findings were compared to the result of preoperation transthoracic echocardiography exam. The measurement of aortic annulus diameter and detection rates of calcification obtained by transthoracic and transesophaged echocardiography were compared. Changes in heart function parameters before and after operation were compared. The alternations in surgery plan made after pre-operative transesophageal echocardiography exam and any relevant treatment or procedure performed according to intra-operation transesophageal echo findings were recorded. All the patients were followed up for 6 months - 40 months. Results Before extracorporeal circulation cardiac valve replacement, the aortic annulus diameter measured and detection rates of calcification by transthoracic echocardiography were smaller and lower than actual surgical pathology results ( P < 0. 05 ) . No differences in the results from transesophageal echocardiography of two-dimensional and three-dimensional examination when compared to pathological findings ( P > 0. 05 ) . Conclusions For patients receiving extracorporeal circulation cardiac valve replacement, transesophagus echocardiography examination is helpful to guide the selection of valve stent and operation methods.

Objective To explore the clinical outcome of atlantoaxial pedicle screw instrument in treatment of extension-type odontoid fracture combined with aflantoaxial subluxation. Methods From December 2002 to December 2006, seven patients with extension-type odontoid fracture combined with at-lantoaxial subluxation were reduced and fixed with atlantoaxial pedicle screw instrument of Vertex system under general anesthesia. There were five males and two females, at mean age of 39.2 years (range 21-59 years). All odontoid fractures were fresh type Aderson Ⅱ. JOA scores of spinal core function was 8.6-14.9 (average 10.7) preoperatively. The X-ray examination, CT scanning and skull traction were performed in all patients preoperatively. Results There found no severe complications such as injuries of vertebral artery, nerve root and spinal cord postoperatively. All patients obtained complete reduction and healing of the fracture and dislocation. The mean off-bed time was four days (3-6 days) after opera-tion. A follow-up for 12-36 months (average 22 months) in all patients showed that the clinical symptom was improved significantly six months postoperatively and that all screws were in proper position verified by X-ray and CT scanning. All patients obtained solid bony union on radiographs, with no loosing or breakage of instrument. The postoperative JOA scores was 13.5-16.9 (average 15.8). Conclusions Allantoaxial pedicle screw fixation has advantages of intraoperative reduction, reliable fixation and high fusion rate and can be used as an effective method for extension-type odontoid fracture combined with at-lantoaxial subluxation.

Objective To explore clinical classification and strategies for irreducible femur intertrochateric fractures.Methods A retrospective study was conducted of the 96 patients with irreducible intertrochanteric fracture who had been treated from January 2012 through December 2014 at our department.They were 47 men and 49 women,aged from 48 to 97 years (average,78.5 years).We classified the fractures according to location of fracture line and mechanism of fracture displacement into 5 types:13 cases of type Ⅰ (sagittal irreducible fracture),7 cases of type Ⅱ] (coronal irreducible fracture),72 cases of type Ⅲll (sagittal plus coronal irreducible fracture),zero of type Ⅳ (irreducible fracture involving the lesser trochanter),and 4 cases of type Ⅴ (irreducible fracture involving the greater trochanter).All the patients were managed using different techniques for closed reduction and fixation with proximal femoral nails antirotation Ⅱ.Results Of this series,limited open reduction was eventually conducted in 7.The operation time averaged 40 min;the amount of intraoperative blood loss averaged 200 mL.Fracture reduction was rated as grade Ⅰ in 78 cases and as grade Ⅱ in 18.The follow-up time averaged 16.6 months (from 12 to 24 months).All the fractures got united after an average of 5.8 months (from 3 to 9 months).The function of the affected hip was rated at the final follow-up using Harris scoring system as excellent in 79 cases and as good in 17,with an excellent to good rate of 100％.Refracture happened in one patient due to striking injury,urinary infection occurred in 2 patients and no wound infection was observed.Conclusion According to the classification and reduction strategy proposed by us,satisfactory reduction and fracture fixation can be achieved in management of irreducible intertrochanteric fractures.

Education, Dental ; Oral Medicine ; education

Objective The purpose of the study was to investigate the changes and clinical significance of matrix metalloproteinase (MMP)-1,MMP-3,tissue inhibitor of metalloproteinase (TIMP),interleukin (IL)-1,tumor necrosis factor (TNF)-α and transforming growth factor(TGF)-β in juvenile idiopathic arthritis (JIA).Methods Thirty-two JIA subjects and 28 controls (traumatic arthritis patients) were included into this study.The MMP-1,MMP-3,TIMP,IL-1,TNF-α and TGF-β level in the serum and synovia were assessed by ELISA.The WBC count,the level of CRP,ESR,RF were also detected.Independent t-test and Pearson's analysis were adopted for data analysis.Results ① The level of MMP-1,MMP-3,IL-1 and TNF-α in the serum was (158±67) ng/ml,(212±89) ng/ml,(39±19) pg/ml,(26±10) pg/ml respectively,which was significantly higher than that of the control group (all P＜0.05) ; the ratio of MMP-3/TIMP-1 (0.86±0.32) was higher in the study group than that of the control group (P＜0.05),while the value of TIMP-1,TGF-β was (248±88),(17±9) ng/ml respectively,which was lower than that of the control group (P＜0.05).The value of seral MMP-3,MMP-3/TIMP-1 was positively correlated with that of WBC,CRP,ESR in the JIA group (all P＜0.05).② The value of MMP-1,MMP-3,IL-1 and TNF-α in the synovia was (216±78) ng/nl,(766±291)ng/ml,(56±21) pg/ml,(36±14) pg/ml respectively,which was higher than that of the control group (all P＜0.05); the ratio of MMP-3/TlMP-1 (2.68±0.89) was higher than that of the control group (P＜0.05),while the value of TIMP-1,TGF-β was (286±88) ng/ml,(12±4) ng/ml respectively,which was lower than that of the control group (all P＜0.05).③ The value of MMP-1,MMP-3,TIMP-1,IL-1 and TNF-α in the synovia was higher than that in the serum (all P＜0.05),while the value of TGF-β was lower than that in the serum (P＜0.05).Conclusion The value of MMP-1,MMP-3,IL-1 and TNF-α increases both in the serum and synovia,while the value of TIMP-1 decreases.The value of TGF-β decreases,which may have protective effect on JIA.The ratio of MMP-3/TIMP-1 in the serum is positively correlated to inflammation parameters,which may be used to judge the activity of illness in JIA.

Objective To explore neurocognitive characteristics of human immunodeficiency virus (HIV)-infected patients ,and to compare the efficacy of highly active antiretroviral therapy (HAART ) among patients with different cognitive functions .Methods Cognitive function was evaluated using the Montreal cognitive assessment (MoCA) Chinese version in 118 HIV-positive patients and 62 HIV-negative controls .Among 59 patients on HAART ,CD4 + T cell count and viral load were assessed at enrollment and one-year follow-up .The mean of measurement data was compared using t test ,and enumeration data was analyzed using chi-squared or Fisher exact test when appropriate .Univariate and multivariate analysis were examined using bivariate Logistic regression models .Results Compared with control group ,HIV-infected group was characterized by higher rate of neurocognitive impairment (46 .6% vs 12 .9% , t =20 .30 ,P< 0 .05) ,and generally lower MoCA subscores for visuospatial abilities ,the clock drawing test , naming ,attention ,abstraction and delayed recall (t= - 3 .761 , - 2 .638 , - 4 .263 , - 3 .769 , - 3 .858 and- 3 .111 ,respectively ,all P< 0 .05) .Among patients on HAART ,subjects who scored < 26 showed no significant differences in viral load at three time points (pre-HAART ,post-HAART at enrollment and one-year follow-up) with those who scored ≥ 26 (t = 0 .557 ,0 .737 and - 0 .758 ,respectively ,all P >0 .05) .The former group had lower CD4 + T cell counts both at enrollment ([286 ± 127]/μL vs [363 ± 160]/μL) and one-year follow-up ([334 ± 122]/μL vs [411 ± 152]/μL) than the latter group (t= - 2 .027 and - 2 .067 ,respectively ,both P < 0 .05 ) ,while there were no obvious differences of pretreatment CD4 + T cell counts ([135 ± 77]/μL vs [155 ± 80]/μL) and HAART duration ([22 .29 ± 21 .20] months vs [18 .74 ± 16 .63] months) between these two groups (t= - 0 .968 and 0 .702 ,respectively ,both P>0 .05) .Multivariate analysis revealed that age (OR = 1 .044 ,95% CI :1 .008 - 1 .081 , P < 0 .05) and education time (OR = 0 .820 ,95% CI :0 .723 - 0 .930 , P < 0 .05 ) were independent predictors for neurocognitive impairment among HIV-infected patients . Conclusions Neurocognitive impairment is common among HIV-infected patients ,which is characterized by poor performance in multiple domains , and patients with neurocognitive impairment performed poorly in immune recovery .MoCA could be a useful screening tool of cognitive function in HIV-infected patients . Neurocognitive function has no relationship with pre- and post-treatment viral levels .

Objective To explore the clinical significance of intraoperative neuromonitoring (IONM)of recurrent laryngeal nerve (RLN) during thyroid cancer surgery.Methods 200 patients undergoing thyroid cancer surgery from Oct.2011 to May 2012 were retrospectively reviewed.The 200 patients were divided into 2 groups:100 patients in group A with IONM and 100 patients in group B without IONM.Results Group A had less RLN exposure time than group B(10.5 vs 15.3 mins,P ＜0.01).Group A had shorter operation time than group B (78.5 vs 82.3 mins).The difference had no statistical significance (P ＞ 0.05).Transient RLN palsy occurred to 5 cases in group A and 11 cases in group B(P＜0.05).Permanent RLN palsy occurred to 1 case in group A.No one in groupB had permanent RLN palsy (P ＞ 0.05).Conclusions IONM can reduce the incidence of transient RLN palsy compared with visualization alone.It is an effective procedure for identifying and protecting RLN in thyroid cancer surgery.

Objective To detect the serum levels of IL-6 and CRP in patients with acute type A aortic dissection complicated with pulmonary injury and inflammatory response. Methods From January 2007 Month to February 2016,216 patients with acute type A aortic dissection were admitted to our hospital. Among them,there were 120 male and 96 female patients,with a mean age of 52.1 years. All patients underwent cardiac ultrasound and other imaging studies. They were diagnosed and hospitalized immediately after the onset. Treatment lasted for more than 1 week. In a calm state of oxygen ,oxygenation index ≤200 preoperative lung injury is defined as positive. In this study ,according to the definition of the lung injury ,patients were divided into positive and negative lung injury groups. There were 72 positive and 144 negative cases among 216 patients. All patients were hospitalized. Every 4 hours,arterial oxygenation index is calculated. At the same time blood samples were tested for C-reactive protein(CRP)and interleukin-6(IL-6)levels. Data was analyzes by SPSS20.0 statistical software and counted byχ2 test. The results were plotted as the percentage,the measurement data with the t test,with(x ± s) to represent,evaluate serum levels of CRP and IL-6 levels with acute type A aortic dissection complicated by the relationship between lung injury. Results The differences of patients from two lung injury groups in gender,age, smoking,alcohol consumption,and other aspects of common chronic diseases were not significant(P>0.05);the difference between the pre-operative examination of several experimental studies in echocardiography were also no statistically significant(P > 0.05);two groups of patients,serum CRP positive group lung injury peak level and peak IL-6 levels were significantly higher in patients with acute lung injury negative group (P > 0.05). Further study of lung serum CRP in patients with damage to the relationship between IL-6 levels and oxygenation index found after dissection. Patient's oxygenation index decreased ,and serum C-reactive protein and interleukin-6 levels were rising rapidly ,reaching peak levels ,and then ,with the patients with inflammatory response decreased oxygenation index showed an upward trend. Conclusion Inflammatory reaction in acute type A aortic dissection plays a key role in the lung injury. In result ,patients'sicken time is prolonged ,which was closely related to serum C reactive protein(CRP),interleukin 6 levels and hypoxemia. Active anti-inflammation treatment before surgery may improve the patient's oxygenation status.

Objective:To enable the low-seniority medical personnel having the ability of disposing of difficult airway properly by mastering the knowledge of basic airway management through Airway Management Simulation Training and using all kinds of airway treatment tools.Methods:The senior medical simulation training tutors were selected, and the Airway Management Simulation Training Project Team was formed to develop the training course. Through combination of video teaching and practice of simulated teaching forms, we taught 219 trainees the airway management training course. And the feasibility and effectiveness of the course were evaluated by KE's evaluation method.Results:The course of "oriental airway simulation training" was successfully developed, and the complete course package was delivered, including bilingual airway management trainee textbook, Airway Management Simulation Training tutor manual, standardized teaching video and so on. After this simulation training, students had a good grasp of airway management skills, and more than 90.86% of the students' skills assessment resulted in more than 80 points. The overall satisfaction of the students was more than 97%, and 99% participants said that the training helped them enhance their confidence in clinical treatment, and 98% participants said that the training should be promoted among medical staff.Conclusion:The course of "oriental airway simulation training" which is made up of the combination of airway technical training, correct clinical decision-making and reality simulation, has significantly improved the airway management skills, enhanced the self-confidence of low-seniority medical staffs and improved patients' safety.