Along with the transformation of the pattern of the medicine and the development of dental medicine,more and more patients accept orthodontic treatment.The patients have higher expectations of the treatment.As a result,the abilities to make clinical communication for orthodontic postgraduates should be improved.The article discusses how to improve the orthodontic postgraduates' abilities in the hope that it will be of some help to them.

10.3969/j.issn.1007-3969.2013.05.003

OBJECTIVE:To establish a method for the separation and detection of related substances in baicalein,identify its structure and preliminarily explore the degradation mechanism. METHODS:HPLC was adopted to detect the baicalein,related impurities and forced destruction of degradation products in synthesis process:the column was ES Industries? FluoroSep-RP Phenyl with mobile phase of 0.3%formic acid-methanol-acetonitrile(gradient elution)at a flow rate of 1.0 mL/min,the detection wavelength was 275 nm,the column temperature was 10℃,and the injection volume was 10μL. LC-MS/MS was conducted to identify the related substances and conjecture degradation mechanism:the column was ES Industries? FluoroSep-RP Phenyl with mobile phase of 0.3%formic acid- methanol (gradient elution)at a flow rate of 1.0 mL/min,the detection wavelength was 275 nm,column temperature was 10℃,and the injection volume was 10μL;ion source was electrospray ion source,positive and negative ions,nebulizer pressure was 55 psi and the drying gas flow was 11 L/min,drying gas temperature was 350℃,capillary voltage was 4.0 kV,detection modes were full-scan first-order MS and selective ion full-scan second-order MS,scan ranges were m/z 100-1000 (first-order MS) and 50-500(second-order MS),ionization voltage was 80-135 eV,and the collision energy was 10-30 eV. RESULTS:The linear range of baicalein was 2.4-480μg/mL(r=0.9999);RSDs of precision,stability and reproducibility tests were lower than 2.0%;the limit of quantitation was 7.2 ng,the limit of detection was 2.4 ng. Baicalein was well separated with related substance and 3 major degradation products,the related substance was chemical synthesis precursor wood butterfly;the degradation products were 6,7-quinone derivatives and 7,8-quinone derivatives,which were isomers;oxidative degradation products were benzoic acid phenyl ester derivatives. CONCLUSIONS:The main mechanisms of alkali degradation and oxidative degradation of baicalein include pyran, reciprocal rearrangement and oxidation reaction;the established method is specific and sensitive,and can be used for the detection of related substances in baicalein.

Objective To investigate the common chromosome abnormalities in the patients with multiple myeloma and the relationships of cytogenetic abnormalities and clinical features. Methods The interphase fluorescence in situ hybridization (I-FISH) analysis method was designed to detect RB1-/13q14-and 14q32 rearrangements in 49 MM patients. The statistic value of its effect on clinical features were determined. Results FISH disclosed 14q32 translocations in 26 of the 40 (53.1%) patients. 25 out of the 49 (51.02 %) cases were found with deletion of chromosome 13q14 included del(RB1) in 9 (18.4 %) and del(13q14.3) in 18 (36.7 %). 13q14 deletion and 14q32 translocation were simultaneously observed in 18 (36.7 %) cases. Spearman correlation analysis were found associated of 14q32 rearrangement with the percentage of plasma cells in bone marrow (r=0.316, P=0.27). Conclusion The frequency of 13q14 deletion and 14q32 gene translocation in multiple myeloma are high. There is a significant correlation between the presence of 14q32 translocations and chromosome 13 abnormalities in MM patients. The percentage of 14q32 translocation in plasma cells was increased significantly. The 14q32 translocation is an independent prognostic factor.

Objective To observe the fundus lesions in the unilateral rhegmatogenous retinal detachment (RRD) eyes and contralateral eyes in non-traumatic emmetropia patients,and explore the risks of lateral eyes.Methods This is a retrospective case analysis.A total of 426 patients of unilateral RRD diagnosed by clinical examination were enrolled in this study.There were 273 males and 74 females.The average age of onset was 54.7 years.81.46％ of them (347 patients) were 51-70 years old.The average detachment time was 2.12 months.They were divided into two groups,equal or lesser than 50 years old group and more than 50 years old group.A total of 100 patients (200 eyes) with ocular surface disorders were randomly selected as control.The lattice-like degeneration,cystic degeneration and dry retinal holes were treated with prophylactic laser photocoagulation.Follow-up period was 6 to 24 months.The age,gender,proliferative vitreous retinopathy (PVR) grading,best corrected visual acuity (BCVA),distribution and quantity of retinal holes,and posterior vitreous detachment (PVD) were retrospectively analyzed.The incidence of PVD among different age groups was compared with Chi square.Results Among 426 RRD eyes,there were 239 eyes (56.10％) with PVD.Among them,there were 30 eyes with age equal or lesser than 50 years old (12.55％) and 209 eyes with age more than 50 years old (84.75％).There were 187 eyes (43.90％) without PVD,which including 38 eyes with age equal or lesser than 50 years old (20.32％) and 149 eyes with age more than 50 years old (79.68％).The incidence of PVD among different age groups was statistically significant (x2=4.72,P＜ 0.05).There were 10,254,40 and 5 eyes in class A,B,C and D of PVR,respectively;117 eyes without PVR.The retinal hole was located in superior temporal,inferior temporal,superior nasal,inferior nasal and macular in 305,91,22,4 and 4 eyes,respectively.The number of holes was 1,2,and more than 3 in 297,89 and 40 eyes,respectively.The retinal detachment range of 1,2,3 quadrants and total dissociation were 92,230,71,33 eyes,respectively.The fundus lesion was found in 47 eyes (11.03％) in the lateral eyes.There were 20 RRD eyes in class B of PVR,and 27 RRD eyes in class C of PVR.Retinal degenerated area was found.Among them,the degeneration of 41 eyes was located in the temporal retina,45 eyes involved in a quadrant.There were 16 eyes with peripheral retinal dry holes;the holes diameter was less than 1,1-2,greater than 2 optic-discs in 6,11 and 5 retinal holes.At the end of the follow-up,there were 47 eyes with almost normal visual field,16 eyes with decreased visual acuity,noeyes with retinal detachment.In the control group,4 patients (5 eyes,2.50％) had fundus lesions.Conclusion The unilateral RRD in non-traumatic emmetropia mostly occurs in elderly patients;11.03％ of patients had fundus lesions in the contralateral eyes,higher than the general population.

Objective:To summarize the echocardiographic features and outcomes in fetuses with congenital ventricular outpouching (CVO).Methods:This retrospective study enrolled ten fetuses diagnosed with CVO by fetal echocardiography in the Affiliated Hospital of Qingdao University and Qingdao Women and Children's Hospital from January 2015 to April 2022. Clinical data were analyzed, including echocardiographic features, other intracardiac and extracardiac malformations, karyotypes, and pregnancy outcomes. Data were analyzed by descriptive statistics.Results:All ten cases were single, including eight ventricular diverticula and two ventricular aneurysms. Five cases had the anomaly in the left ventricular and the other five in the right. Five cases were isolated malformations, and the other five were complicated by other intra- or extracardiac malformations. A pathogenic copy number variation was detected in one case. Three pregnancies were terminated, and one was lost to follow-up. The other six fetuses were born alive and showed no obvious clinical symptoms or abnormalities in growth and development during 3-70 months of follow-up. The right ventricular diverticulum spontaneously disappeared in one case. One case with the right ventricular aneurysm was also diagnosed with noncompaction of the left ventricular myocardium by echocardiography at six months.Conclusions:Fetal CVO presents with typical echocardiographic features and can be diagnosed prenatally. Regular follow-up during pregnancy is recommended to observe the sizes of outpouchings and the occurrence of complications in fetuses with CVO after excluding other structural and chromosomal abnormalities to avoid unnecessary termination. Attention should also be paid to postnatal follow-up.

Objective To estimate the treatment effect of a tumor necrosis factor ? alpha antagonist (etanercept) on Stevens?Johnson syndrome induced by drugs. Methods After exclusion of tuberculosis, hepatitis, severe infections and tumors, 17 patients with drug?induced Stevens?Johnson syndrome were treated with subcutaneous injections of 25 mg(initial dose, 50 mg)etanercept once every 3 days for 6 times. Meanwhile, supportive therapies and compound glycyrrhizin injections were given to counteract inflammation and protect the liver. Results All of the patients were cured. Body temperature in 15 febrile patients gradually decreased within 24- 48 hours after the first injection of etanercept, and returned to normal in 72 hours. The number of vesicles stopped increasing, and lesion color turned from bright red to dull red within 24 hours. Skin condition was evidently controlled within 72 hours, and skin appearance almost returned to normal after 2 weeks of treatment, and was completely restored after 4- 5 weeks. The recovery of mucous membrane was slower than that of skin. Serum aminotransferase levels gradually declined after the first dose of etanercept and almost returned to normal in 2-4 weeks in 14 patients. Serum levels of urea nitrogen and creatinine began to decrease after 1- 2 weeks of treatment. The serum level of tumor necrosis factor?alpha nearly dropped into or was maintained in the normal range within 3 weeks after the start of treatment. Conclusion Early usage of tumor necrosis factor?alpha antagonists at an adequate dose is beneficial to the rapid control of Stevens?Johnson syndrome.

Objective To determine whether relative abundance of epidermal growth factor receptor (EGFR) mutations in plasma predicts clinical response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced lung adenocarcinoma. Methods In this prospective study, adult patients with advanced lung adenocarcinoma were enrolled in our hospital from 1 April 2016 to 1 January 2017. EGFR mutations in tumor tissues were detected by ADx-amplification refractory mutation system (ADx-ARMS). EGFR mutations of plasma free tumor DNA were detected by ADx-ARMS and ADx-super amplification refractory mutation system (ADx-SuperARMS) at the same time. Patients with EGFR-mutant in tumor tissues and receiving EGFR-TKIs were finally enrolled. Plasma mutation-positive patients with both methods were high abundance group.Patients with positive mutations by ADx-SuperARMS but negative by ADx-ARMS were medium abundance group. Mutation-negative patients with both methods were recognized as low abundance group. The correlation between EGFR mutation abundance and clinical response to EGFR-TKIs were analyzed. Results Among 71 patients enrolled, 42 harbored EGFR mutations in plasma were detected by ADx-ARMS, while 53 were found by ADx-SuperARMS.There were 42 patients in high abundance group, 11 in medium group while the other 18 in low group. The objective response rates (ORRs) were 69.0%,7/11 and 10/18 in high, medium and low groups, respectively. The difference was significant between high and low abundances groups (P=0.006). Median progression-free survival (PFS) in high,medium and low groups were 11.0, 8.5 and 9.0 monthes, respectively (P<0.001). In patients with tumor 19-Del, the ORRs were 70.4%,5/7 and 6/11 in high,medium and low abundance groups, respectively. The median PFS of high abundance group was significantly longer than the other two groups (12.0 monthes vs 9.0, 9.0 monthes). As to subjects with L858R mutation, the ORRs were 10/15,2/4 and 3/6,respectively, with median PFS 9.6, 5.5 and 9.5 monthes. Conclusions The relative abundance of EGFR mutations in plasma predicts clinical response to EGFR-TKIs in patients with advanced lung adenocarcinoma. The higher the mutation abundance is, the better the efficacy of EGFR-TKIs is.

Objective:To develop and validate an clinical prediction model for the risk of breast cancer-related lymphedema (BCRL).Methods:Breast cancer patients who were prepared to undergo axillary lymph node dissection were propsectively enrolled, indocyanine green combined with Photodynamic Eye (PDE) was applied to reveal the arm lymphatic flow . The arm lymphatic fluorescence images were collected to calculate the proportion of arm lymph flow above and below the axilla vein. Volumetric measurements of both arms and subjective questionnaire were performed to evaluate the occurrence of lymphedema. A difference in volume between the arms >10% was defined as lymphedema. Univariate logistic regression analysis was used to analyze the relationship between each factor and BCRL. The stepwise forward method was used to include multiple factors in the logistic regression analysis to establish the prediction model.Results:Three hundred and twelve patients were enrolled. Fourty-five (14.4%) patients developed BCRL. Using the coefficients obtained from multivariate analysis, BMI ( OR 95% CI: 1.34 (1.25-1.77), P<0.05), chemotherapy ( OR 95% CI: 2.26 (1.97-2.63), P<0.05), regional lymph node radiotherapy ( OR 95% CI: 1.59 (1.05-2.41), P<0.05) and the proportion of arm lymph flow above the level of the axillary vein ( OR 95% CI: 0.70 (0.68-0.81), P<0.05) were identified as independent predictive factors for BCRL, and the following prediction equation was derived: Y=0.369×(BMI at surgery)+0.713×(taxane-based chemotherapy)+0.862×(radiotherapy)-9.058×(proportion of the arm lymph above the axillary vein)-6.859 8. The ROC curve was screened to the optimal boundary value of 0.118 6 by the Youden's index. The sensitivity, specificity, positive predictive value and negative predictive value of prediction of this model were 93.3%, 79.4%, 73.3%, 98.6%, respectively. Conclusion:With the guidance of the predictive model, particular patients who need the preservation of axillary lymphatic system can be identified, and timely intervention can be carried out.

Objective To observe the value of myocardial performance index(MPI)for evaluating fetal left ventricular(LV)function in pregnant women with obstetric antiphospholipid syndrome(OAPS).Methods Totally of 41 singleton pregnancy women with OAPS(criteria-OAPS[C-OAPS]group,n=16;non-criteria OAPS[NC-OAPS]group,n=25)and 60 healthy singleton pregnancy women(control group)were prospectively enrolled.Mitral flow E velocities/A velocities,isovolumic relaxation time(IRT),isovolumic contraction time(ICT),ejection time(ET)and MPI of fetal LV were compared among 3 groups.Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of MPI for predicting adverse pregnancy outcomes of pregnant woman.Results Significant differences of mitral flow E velocities/A velocities,IRT,ICT,ET and MPI of fetal LV were found among 3 groups(all P＜0.05).Results of pairwise comparison showed that among C-OAPS group,NC-OAPS group and control group,IRT and MPI of LV decreased,whereas E/A and ET of LV increased in order(all P＜0.05).ICT in C-OAPS group was higher than that in control group(P＜0.05).The sensitivity,specificity and area under the curve of MPI for predicting adverse pregnancy outcomes of pregnant woman with OAPS was 90.00％,64.45％and 0.798,respectively.Conclusion MPI could be used to evaluate fetal LV function in pregnant women with OAPS,also being helpful for predicting adverse pregnancy outcomes.