Objective:To establish a fluid dynamics model of upper airway before and after surgery and explore the changes of three-dimensional fluid dynamics in patients with micrognathia.Methods:A patient with micrognathia and severe obstructive sleep apnea-hypopnea syndrome(OSAHS)accepted CT scan before and six months after mandibular advancement operation.Computation-al fluid dynamics model was built on the base of CT scan by Mimics 1 0.01 and ANSYS ICEMCFD1 4.0.The internal flow of upper respiratory tract was simulated by ANSYS-FLUENT 1 4.0 and the results were analyzed by Tecplot.Results:Fluid dynamics model of upper airway was constructed before and after the surgery respectively.The volume of the upper airway of the patient increased from 37.284 cm3 to 44.498 cm3;the most narrow area of upper airway was located in the lower bound of pharyngopalatiae,and it was augmented from 1 .1 35 cm2 to 2.297 cm2;the minimum pressure was decreased from1 01 308 Pa to 1 01 272 Pa;the maximum air velocity increased from 3.476 m/s to 4.978 m/s.Conclusion:Mandibular advancement may correct the occlusal deformity,ex-panse the upper respiratory tract,decrease the negative pressure and maintain the patency of the airflow in the treatment of patients with micrognathia and OSAHS.

Objective:To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).Methods:In this study,461 patients with type 2 diabetes who received PCNL in Peking Uni-versity People’s Hospital from June 2006 to December 2015 were reviewed.There were 281 males and 180 females with an average age of 57 years were included,of whom,137 were diagnosed with SIRS after PCNL.The demographic data,clinical features,and test results were compared between the patients with SIRS and without SIRS,trying to identify the correlation between their clinical characters and the occur-rence of SIRS.Results:The SIRS was significantly correlated with the patients’preoperative white blood cell counting (×109 /L)[7.76 (4.00 -17.96)vs.6.31 (2.00 -17.40),P <0.001 ],preopera-tional blood glucose level (mmol /L)[7.30 (3.08 -19.90)vs.6.40 (3.42 -16.78),P <0.001], operative time (min)[75 (20 -270)vs.60 (20 -200),P <0.001 ],length of stay (d)[12 (2 -46)vs.11 (3 -29),P =0.019],staghorn stones [38.8% (33 /85)vs.27.7% (104 /376),P =0.042],and preoperational urinary tract infection [36.8% (50 /136)vs.26.6% (81 /304),P =0.032].There was no significant correlation between the SIRS and the patients’age,body mass index, preoperative hemoglobin level,preoperative serum creatinine,and transfusion.In multivariate analysis, abnormal preoperative white blood cell counting (OR =3.194,95% CI:1.531 -6.666,P =0.002), operative time longer than 60 min (OR =1.635,95% CI:1.088 -2.456,P =0.018),and preopera-tional blood glucose level higher than normal 7.1 mmol /L were significantly correlated with the presence of SIRS.Conclusion:The high level of preoperational blood glucose,abnormal preoperative white blood cell counting,and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Objective: To evaluate the effects of percutaneous nephrolithotomy (PNL) in the treatment of medullary sponge kidney with calculi. Methods: A total of 77 patients (91 renal units) of medullary sponge kidney with calculi (MSK group) and 77 patients (77 renal units) with common kidney stone (control group) received PNL at Department of Urology in Peking University People′s Hospital from September 2006 to February 2016 were analyzed retrospectively. The MSK group included 33 males and 44 females with a mean age of (42.1±13.2) years, the mean stone burden was (3.9±1.8) cm. The control group included 36 males and 41 females with a mean age of (45.3±13.0) years, the mean stone burden was (3.6±1.5) cm. The numbers of tracts, the time of operation, the drop of hemoglobin, the change of creatine, the time of hospitalization, the stone free rate and major complications were compared between the two groups. The measurement data and numeration data were compared with t test and χ² test. Results: There were no significant differences in sex, age, preoperative urinary tract infection, stone type, and stone burden between the two groups (all P>0.05). The proportion of bilateral renal calculus in MSK group was higher (18.2% vs. 0, χ²=15.400, P=0.000). There were 159 percutaneous channels were established in MSK group while 90 percutaneous channels were established in control group. Compared with the control group, the operation time ((88.1±37.5) minutes vs. (68.5±30.1) minutes, t=3.543, P=0.000) and hospitalization time ((15.1±8.3) days vs. (10.1±3.6) days, t=4.816, P=0.000) were longer, the creatinine level increased ((101.2±62.6) μmol/L vs. (71.3±23.6) μmol/L, t=3.777, P=0.000), the rate of stone free decreased (27.5% vs. 83.1%, χ²=51.840, P=0.000) and the rate of complications increased (29.9% vs. 11.7%, χ²=8.114, P=0.004) in MSK group. There was no statistically difference in hemoglobin drop ((12.5±13.2) g/L vs. (13.0±10.9) g/L, t=-0.260, P=0.795). Conclusions Using PNL for patients of MSK with calculi has a lower stone free rate and a higher complications. It is an effective method for patients of MSK with large and complex calculi.

Objective:To explore the association of molecular subtypes with local recurrence, distant metastasis and prognosis in breast cancer patients undergoing adjuvant therapy after modified radical mastectomy as well as its significance.Methods:The clinical data of 108 patients with breast cancer undergoing adjuvant therapy after modified radical operation in the First Affiliated Hospital of Xi'an Jiaotong University from March 2002 to March 2012 were retrospectively analyzed. According to the expressions of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2), patients with breast cancer were divided into 4 molecular subtypes, including Luminal A, Luminal B, HER2-positive and triple-negative. The relationship between clinicopathological factors and molecular subtypes was analyzed, and the local recurrence rate and distant metastasis rate of breast cancer patients with various molecular subtypes were compared. Kaplan-Meier method and log-rank test were used to make single factor analysis of survival. Cox proportional hazard model was used to make multi-factor survival analysis.Results:Among 108 patients, 41 cases were Luminal A, 40 cases were Luminal B, 17 cases were HER2-positive and 10 cases were triple-negative. The differences in compositions of patients with age, tumor size, pathological type, lymph node metastasis, American Joint Committee on Cancer (AJCC) staging, vascular tumor thrombus, resection margin, and chemotherapy cycle number among groups with 4 molecular subtypes were not statistically significant (all P > 0.05), while the difference in compositions of patients receiving endocrine therapy was statistically significant ( P < 0.01). The local recurrence rate of patients with Luminal A, Luminal B, HER2 positive and triple-negative was 14.6% (6/41),15.0% (6/40), 11.8% (2/17), 10.0% (1/10), respectively, and the difference was not statistically significant ( P > 0.05). The distant metastasis rate of patients with HER2-positive and triple-negative was 35.3% (6/17) and 40% (4/10), respectively, which was higher than that of patients with Luminal A [24.4% (10/41)] and Luminal B [22.5% (9/40)], but there was no statistically significant difference among the four types ( P > 0.05). Kaplan-Meier analysis showed there was no statistical difference in progression-free survival of patients with Luminal A, Luminal B, HER2-positive and triple-negative ( P > 0.05), while there was a statistical difference in the overall survival (OS) ( P = 0.047), and the OS of triple-negative patients was the worst, meanwhile AJCC staging, lymph node metastasis and endocrine therapy were associated with the OS (all P < 0.05). Multi-factor Cox proportional hazard model analysis showed that lymph node metastasis ( OR = 4.481, 95% CI 1.377-14.580, P = 0.013) and endocrine therapy ( OR = 0.165, 95% CI 0.034-0.800, P = 0.025) were independent prognostic factors affecting OS. Conclusions:There is no statistically significant difference in local recurrence rate for breast cancer patients with different molecular types undergoing adjuvant therapy after modified radical mastectomy. Breast cancer patients with Luminal have better OS, while those with triple-negative have the worst OS. Molecular subtypes may have an important significance for the treatment choice and prognosis judgement of breast cancer.

Objective This study was to assess the efficacy of corneal collagen cross-linking treatment on fungal keratitis.Methods Eighty SPF male C57BL/6 mice aged 6-8 weeks were selected for the experiment.Fusarium solani infected model was established on the left eyes of all 80 mice.Forty mice were distributed randomly into sham operation group,model control group,scraped epithelium group and corneal collagen cross-linking (CXL)group (treated with epithelium scraped and CXL).Three days after modeling,the levels of the corncal disease sevcrity were scored by slit lamp microscopy.The fungal activity was confirmed by plate counts.The left 40 mice were divided randomly into sham operation group,model control group,scraped epithelium group and CXL group (treated with epithelium scraped and CXL).In 1 day and 2,3,4,5,6,7,14 days after modeling,the corneas were examined under the slit lamp microscope.The corneal pathological examination of each group were conducted with hematoxylin and eosin staining at postoperative 14 days.The animal feeding and use was in accordance with the standards set by the ARVO,and the experiment was approved by the Ethic Committee for Experimental Animal of Henan Eye Institute.Results The colony-forming units (CFUs) of fungal solutions in culture significantly decreased with CXL treatment (F =11.97,P =0.00).The Pearson correlation analysis of CFU and clinical scores in CXL group showed that inflammatory cells infiltration was positively correlated with corneal disease severity (r =0.723,P =0.043).Corneal inflammatory score was significantly lower in the CXL group in various time points,with a significant differences among the groups and time points (Fgroup =34.44,P=0.00;Ftime =17.49,P=0.00).Corneal lesion and the depth of ulceration in scraped epithelium group and CXL group were remarkably lower than that in the model control group (all at P ＜ 0.05).Histopathology revealed that the degree of corneal collagen fibers destruction and the ratio of inflammatory cells infiltration in scraped epithelium group (59.33％) and CXL group (11.29％) were much lower than that in the model control group (73.65％).Conclusions CXL can inhibit the fungal activity effectively in the cornea of mice,and reduce the fungal induced keratitis reaction.

OBJECTIVETo investigate the mandibular incisive canal (MIC) with cone-beam computed tomography (CBCT).

METHODSFifty adults were selected and CBCT was taken. The CBCT data were reconstructed to evaluate the visibility, shape, diameter, length of the MIC and its relationship with mandible.

RESULTSMIC could be identified in 100% (100/100) of CBCT with good clarity in 71% (71/100). The diameters (horizontal diameter versus vertical diameter) of MIC became smaller from origin to end (left origin of MIC was 2.17 mm×2.22 mm, left end was 0.82 mm×0.92 mm; right origin of MIC was 2.14 mm×2.08 mm, right end was 0.87 mm×0.86 mm). The left and right mean length of MIC was 17.84 mm and 17.73 mm respectively. In bucca-lingual direction, MIC was close to buccal cortical border, and in vertical direction, MIC was close to lower margin of mandible. The distance from MIC to apex of root was shortest in canine.

CONCLUSIONSCBCT can identify MIC with high visibility and prominent clarity. In the interforaminal region of mandible, MIC was close to buccal and lower margin of mandible.

HMG-CoA reductase (HMGCR) protein is usually upregulated after statin (HMGCR inhibitor) treatment, which inevitably diminishes its therapeutic efficacy, provoking the need for higher doses associated with adverse effects. The proteolysis targeting chimera (PROTAC) technology has recently emerged as a powerful approach for inducing protein degradation. Nonetheless, due to their bifunctional nature, developing orally bioavailable PROTACs remains a great challenge. Herein, we identified a powerful HMGCR-targeted PROTAC (