OBJECTIVE:To observe the clinical efficacy and safety of Calcitriol soft capsules combined with Telmisartan tab-lets in the treatment of early diabetic nephropathy(DN),and the effect on the levels of inflammatory factors. METHODS:Totally 110 patients with early DN were randomly divided into observation group and control group. The control group was orally given Telmisartan tablets with the initial dose of 40 mg,qd,and the maximum dose was 80 mg,qd;the observation group was orally giv-en Calcitriol soft capsules 0.25μg based on the treatment of control group,qd. The course was 1 month. The clinical data was com-pared,including the clinical efficacy and 24 h urinary protein,serum creatinine(Scr),urinary albumin excretion rate(UAER),se-rum C reactive protein (CRP),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) before and after treatment. The adverse reactions were observed. RESULTS:After treatment,the total effective rate in observation group was significantly higher than con-trol group,with significant difference (P<0.05);the 24 h urinary protein,Scr,UAER,and levels of CRP,TNF-α and IL-6 in observation group were significantly lower than control group and before treatment,with significant differences(P<0.01 or P<0.05). There were no obvious adverse reactions in 2 groups. CONCLUSIONS:Calcitriol soft capsules combined with Telmisartan tablets has better efficacy than only Telmisartan tablets in the treatment of DN,and can more effectively improve the levels of CR, TNF-αand IL-6,which is helpful to delay progression of patients.

OBJECTIVETo investigate the shaping effects of three nickel-titanium rotary instruments on preparing curved canals in posterior teeth.

METHODS64 curved mesial canals of extracted lower molars, embedded in the Branmante models, were randomly assigned to four groups: (1) Flexofile; (2) LightSpeed; (3) ProFile; (4) Qantec SC. Apical preparation was carried out till size 30. The area of dentine removal, least remaining dentine thickness and transportation of canal center were measured.

RESULTSFlexofile resulted in more dentine removal and canal center transportation than LightSpeed and ProFile (P < 0.05) at the apical and mid-root levels. In the mid-root sections, Flexofile left the thinnest dental wall in the distal aspect; 87% of the canal centers in the Flexofile group were transported in a distal direction as compared with one third in other groups.

CONCLUSIONSLightSpeed and ProFile exhibited better shaping ability than Flexofile in preparing curved canals.

Dental Alloys ; Dental Instruments ; standards ; Humans ; Molar ; Nickel ; Root Canal Preparation ; instrumentation ; Titanium

BACKGROUNDVon Hippel-Lindau (VHL) disease is a hereditary tumor disorder caused by mutations or deletions of the VHL gene. Few studies have documented the clinical phenotype and genetic basis of the occurrence of VHL disease in China. This study armed to present clinical and genetic analyses of VHL within a five-generation VHL family from Northwestern China, and summarize the VHL mutations and clinical characteristics of Chinese families with VHL according to previous studies.

METHODSAn epidemiological investigation of family members was done to collect the general information. A retrospective study of clinical VHL cases was launched to collect the relative clinical data. Genetic linkage and haplotype analysis were used to make sure the linkage of VHL to disease in this family. The VHL gene screening was performed by directly analyzing DNA sequence output. At last, we summarized the VHL gene mutation in China by the literature review.

RESULTSA five-generation North-western Chinese family afflicted with VHL disease was traced in this research. The family consisted of 38 living family members, of whom nine were affected. The individuals afflicted with VHL exhibited multi-organ tumors that included pheochromocytomas (8), central nervous system hemangioblastomas (3), pancreatic endocrine tumors (2), pancreatic cysts (3), renal cysts (4), and paragangliomas (2). A linkage analysis resulted in a high maximal LOD score of 8.26 (theta = 0.0) for the marker D3S1263, which is in the same chromosome region as VHL. Sequence analysis resulted in the identification of a functional C>T transition mutation (c. 499 C>T, p.R167W) located in exon 3 of the 167 th codon of VHL. All affected individuals shared this mutation, whereas the unaffected family members and an additional 100 unrelated healthy individuals did not. To date, 49 mutations have been associated with this disease in Chinese populations. The most frequent VHL mutations in China are p.S65 W, p.N78 S, p.R161Q and p.R167 W.

CONCLUSIONSThe results supported the notion that the genomic sequence that corresponds to the 167 th residue of VHL is a mutational hotspot. Further research is needed to clarify the molecular role of VHL in the development of organ-specific tumors.

Adolescent ; Adult ; Asian Continental Ancestry Group ; China ; Female ; Haplotypes ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Pedigree ; Retrospective Studies ; Von Hippel-Lindau Tumor Suppressor Protein ; genetics ; Young Adult ; von Hippel-Lindau Disease ; diagnosis ; genetics

Objective:To assess the diagnostic value of whole-lesion intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) in differentiating benign and malignant thyroid nodules based on turbo spin echo (TSE) sequence.Methods:Totally 57 patients with thyroid nodules diagnosed by pathology were prospectively collected at the Affiliated Lianyungang Hospital of Xuzhou Medical University from March 2019 to December 2019. A total of 62 nodules were included for analysis, including 27 benign nodules and 35 malignant nodules. All patients underwent routine MRI scan and IVIM-DWI based on TSE sequence before surgery. The regions of interest were drawn along the edge of the lesion on multiple consecutive slices to cover the entire nodule, and the apparent diffusion coefficient (ADC), diffusivity (D), pseudo-diffusivity (D *) and quantitation of perfusion fraction (f) values were measured, and the mean value of the multilayer measurement was recorded for further analysis. The differences of the parameters between benign and malignant thyroid nodules were analyzed using independent samples ttest (normal distribution) and Mann-Whitney U test (non-normal distribution). The diagnostic efficacy of parameters with statistical significance was evaluated using the receiver operating characteristics (ROC) curve. Results:The ADC, D and D *values in the malignant nodules were lower than those in benign nodules, the differences were statistically significant ( t=3.821, P=0.001; t=2.034, P=0.046).There were no statistical differences of D * and f values ( t=-1.170, P=0.247; Z=-0.559, P=0.577).The optimal cut-off values of ADC and D were 1.90×10 -3mm 2/s and 1.10×10 -3mm 2/s, with both sensitivity of 81.5%, specificity of 73.5% and 61.8%, respectively. The area under ROC curve of ADC and D were 0.782 and 0.688, and the statistical difference was found ( Z=2.098, P=0.040). Conclusion:The whole-lesion IVIM parameters (ADC and D) based on the TSE sequence provide imaging features for preoperative differentiation of benign and malignant nodules of the thyroid gland.

Objective:To explore high-resolution MRI (HR-MRI) characteristics in patients with ischemic stroke caused by vertebral artery dissection.Methods:A total of 47 patients with suspected vertebral artery dissection in the First People′s Hospital of Lianyungang, Kangda College, Nanjing Medical University from June 2015 to June 2020 were consecutively enrolled. All patients underwent routine MRI before HR-MRI, and three-dimensional arterial spin labeling (3D-ASL) was performed in those with negative MR. Patients with posterior circulation infarction on MRI and ischemic hypoperfusion on 3D-ASL were included in the ischemic stroke group, while patients with negative plain MRI and normal 3D-ASL were included in the normal group. The clinical characteristics and HR-MRI imaging characteristics between the two groups were compared using t-test or χ 2 test, while the correlations of quantitative data or ranked data were analyzed by Pearson or Spearman test. Results:There were 27 patients in the ischemic stroke group and 20 patients in the normal group, and there were no significant differences in clinical characteristics such as gender, age, site of onset, history of hypertension, hyperlipidemia, and history of diabetes between the two groups ( P>0.05). Basilar artery lateral deviation classification (χ2 =7.013, P=0.030), basilar lateral bend angle (140°±19° vs. 137°±15°, t=2.231, P<0.026), minimum bending angle of vertebral basilar artery (131°±27° vs. 90°±13°, t=42.630, P<0.001), the minimum bending angle of vertebrobasilar artery ≤ 90° distribution (3 cases vs. 21 cases, χ2=15.240, P<0.001) and effective lumen index (0.33±0.10 vs. 0.17±0.09, t=35.934, P<0.001) of normal group and ischemic stroke group showed statistically significant differences. Among them, the minimum bending angle of the vertebrobasilar artery was negatively correlated with posterior circulation ischemic hypoperfusion ( r=-0.621, P<0.001), and the effective lumen index was negatively correlated with posterior circulation ischemic stroke ( r =-0.713, P<0.001). However, the location of the dissection, the distribution of hematoma, the shape of the lumen and the enhancement type were not statistically significant between the normal group and ischemic stroke group ( P>0.05). Conclusion:HR-MRI shows that the lateral deviation of the basilar artery of grade 3, the minimum bending angle of the vertebrobasilar artery less than 90°, and small effective lumen index are related to posterior circulation stroke caused by vertebral artery dissection, which may help for the proper formulation of clinical treatment plan.

ObjectiveTo determine the pathogens and drug resistance in patients with bacterial diarrhea in Lishui City of Zhejiang Province from 2015 to 2019， and provide scientific evidence for prevention and treatment of bacterial diarrhea. MethodFecal specimens were collected from patients with diarrhea in the People’s Hospital of Lishui City from 2015 to 2019. Bacteria were identified by time-of-flight mass spectrometer and serum agglutination reaction. Drug sensitivity in the suspected bacteria was identified by VITEK 2 Compact system. ResultsA total of 2 937 fecal samples were tested from 2015 to 2019， of which 191 were positive for bacteria. The prevalence was 6.65% in male and 6.32% in female. It was highest in the age group 21‒30 years old， followed by the group 51‒60 years old. Summer was the season with the highest prevalence of bacteria. Furthermore，the bacterial species included salmonella （3.98%）， Vibrio parahaemolyticus （1.43%）， aeromonas （0.48%）， shigella （0.37%） and other bacteria （3.66%）. Salmonella had high resistance to cefuroxime and amikacin. Vibrio parahaemolyticus and shigella had high resistance to ampicillin. Aeromonas had high resistance to ampicillin and ampicillin/sulbactam. ConclusionPrevalence of bacteria differs by gender， age and seasons in patients with bacterial diarrhea in Lishui from 2015 to 2019. Salmonella is the principal pathogen in bacterial diarrhea. Additionally， multiple drug resistance is commonly identified. Therefore， it warrants strengthening the pathogenic surveillance on bacteria and drug resistance in bacterial diarrhea.