Objective To explore application value of blood flow ratio indexes in the diagnosis of Hashimoto's thyroiditis(HT) with different thyroid functions.Methods One hundred and four patients who were diagnosed clinically as HT were enrolled in the study.The patients were classified into three groups according to thyroid functions:the hyperthyroidism group,the hypothyroidism group and the euthyroidism group.Thirty-two volunteers with normal thyroid functions were enrolled as control group.All the cases were examined with ultrasound and five blood flow ratio indexes were calculated automatically.Their differences in the four groups were compared.Results ①Among the five blood flow ratio indexes,three indexes(mean ratio,maxratio and minratio) had significant differences between each two groups(P ＜ 0.001),the other two indexes didn't have any differences among the four groups.②Two receiver operating characteristic (ROC) curves on meanratio were drew:a)HT with hyperthyroidism and HT with euthyroidism;b) HT with euthyroidism and HT with hypothyroidism.The cutoff value as a result of the ROC analysis of HT with hyperthyroidism and HT with euthyroidism was 0.235 with the maxim of specificity and sensitivity.The cutoff value of HT with euthyroidism and HT with hypothyroidism was 0.113 with the maxim of specificity and sensitivity.Both Bland-Altamn scatter diagrams and high intraclass correlation coefficient(ICC) showed that blood flow ratio indexes have high repeatability.Conclusions Blood flow ratio indexes are promising quantitative indexes in reflecting the vascularity of thyroid parenchyma,and they are helpful in the differential diagnosis of HT with different thyroid functions.

Objective To explore the method of isolation, identification and in vitro differentiation of islet stem cells in neonatal rat. Methods The whole pancreata of neonatal rats were digested with collagenase, then,under the (condition) of pH 7.4～7.6,the digested tissue fragments were cultured with serum and serum-free RPMI 1640 (( bFGF), EGF, N2).The whole formation process of new islet cell-like cell masses was examined.The insulin (release) test was used to detect islet function. The expression of nestin was tested by immunocytochemistry. Results The nestin positive cells can be found within 36 h of culture of the digested pancreatic fragments.After addition of bFGF,ECF,N2,nestin positive cells proliferated fast and formed new islets-like cell masses after 18～24 d, and (insulin)ssion could be confirmed. Conclusions The nestin positive cells of pancreatic cells possess the character of islet stem cells, and can form islet like cell masses through culture in vitro.

Objective To evaluate the application of preserved urethral plate urethroplasty to treat urethral fistula after hypospadias repair. Methods Two hundred and twenty-four cases with u-rethral fistula after hypospadias repair were treated by preserved urethral plate urethroplasty from 2001 to 2006.Follow-up data were reviewed and analyzed.All of these cases had big(>1 cm)ure-thral fistula.One hundred and two failed hypospadias cases were repaired by tubularized incised plateurethroplasty(Snodgrass).The patients were 2-16 years old and mean age was 3.7 years old.In thesame time period,86 failed hypospadias cases were repaired by Duplay urethroplasty.The children were 2-14 years old and mean age was 3.5 years old.Twenty failed hypospadias cases were repaircd by Onlay island flap urethroplasty and another 1 6 failed hypospadias cases were repaired by Flip-Flap urethroplasty. Results Fistulas were successfully repaired in 86(84.3%)cases out of 102 tubular-ized incised plate urethroplasty procedure.There were 1 3 urethral fistulas and 3 urethral strictures.Seventy-five(87.2%)cases were successful out of 86 Duplay procedure.There were 9 urethral fistulas and 2 urethral strictures.There was no significant difference between these tWO groups of results(P>0.05).Nineteen cases were successful out of 20 Onlay urethroplasty procedures and there was only l urethral fistula.Fourteen cases were successful out of 1 6 Flip-Flap procedures and there was onlv 2 u-rethral fistulas. Conclusions Surgical procedure for urethral fistula repair should be chosen accord-ing to the condition of penis.Tubularized incised plate urethroplasty can get same satisfactory result comparing with Duplay method for failed hypospadias repair.More Snodgrass should be used to assure the cosmetic penis.

Objective To discuss the management of urethral duplication in children. Methods The clinical data of 1 8 children(all are males)with urethral duplication were retrospectivelv ana-lyzed. All the 18 patients were sagittal plane included epispadias in 6,hyposPadias in 4 and Y type in the remaining 8. In 6 cases with epispadias,3 patients underwent excision of the accessorv dorsal ure-thra,3 patients without operation.Urethroplasty was necessary in the patient with a duplicated hypo-spadiac urethra. Of 8 patients with Y-type urethral duplication,7 patients underwent 2 stage repair including displacement of the urethra from the anal canal to the perineum at stage 1 and subsequent urethral reconstruction at stage 2.The ventral urethra which was hypospadias had been excised in the other one. Results All the patients were followed-up. Good cosmetic and functional resuIts were a-chieved in the 3 boys who underwent excision of the accessory dorsal urethra.In the hypospadiac du-plication,2 patients could void spontaneously through a normally positioned granular meatus.One boy presented with urethral stenosis after operated. One boy had a vesicostomy for neuropathic bladder. In Y-type urethral duplications,only 1 patient was successful after 2-stage urethroplasty,3 patients de- veloped urethra stricture or fistula,3 boys need the 2-stage operation,the other 0ne who underwent excision of the ventral urethra could void spontaneously. Conclusions Urethral duplication is a rare congenital anomaly.The clinical presentation varies because of the different anatomical Datterns of this abnormality. Commonly the ventral urethra is most functional and maintained after surgical correc-tion.Surgical management should be individual and depend on the anatomical configuration of the du-plicated urethras.

Objective To investigate the diagnosis,treatment and prognosis of nephroblastomatosis (Nbm) combined with Wilms'tumor (WT). Methods Clinical data of six patients treated for WT combined with Nbm in Beijing Children's Hospital from 2006 to 2010 were reviewed retrospectively.The patients'ages ranged from five to 14 months.Two of the patients were female and four were male.The WTs were left-sided in four cases and right-sided in two cases.The Nbms were ipsilateral with WT in three cases,contralateral in two cases and bilateral in one case. The Nbms were single In three cases and multiple in three cases.WTs were all single and the maximum diameter was 3,4,8,10,11,and 12 cm respectively.Two paitents underwent nephrectomy.Nephron sparing surgery and upper and lower pole nodule biopsy was conducted in two cases,Nephrectomy and contralateral nephron sparing surgery was conducted in an additional two cases.Adjuvant chemotherapy included vincristine,actinomycin and doxorubicin. Results One patient had tumor recurrence 33 months after a 15 month regimen of postoperative chemotherapy. One patient had tumor recurrence and died after nephron sparing surgery 5 months after a 11 month regimen of chemotherapy.Four patients underwent 6 months of chemotherapy,and it was 9,12,and 21 months respectively after stop of chemotherapy.Another patient was still in chemotherapy. Conclusions Nbm is a pre-neoplastic proliferative process with high risk of developing WT.Chemotherapy may reduce the rate of Nbm malignancy.If Nbm is malignant or chemotherapy is invalid,nephron sparing surgery is recommended.

Objective To discuss the management of the congenital vesicoureteral junction obstruction (UVJO). Methods A retrospective cohort study was performed of patients who underwent ureteral reimplantation due to UVJO between 2003 and 2008. Of the 73 patients with 83 ureters (male 49 and female 24, age range 8 months to 13 years, median 41 months). Forty-one cases were on the left, 22 were on the right and 10 were bilateral obstruction. The most common presenting symptoms were intermittent abdominal pain and urinary infection. All patients were evaluated preoperatively by ultrasound, voiding cystourethrogram, intravenous pyelogram and diagnosed as UVJO. Reimplantation was done by the Cohen technique in all patients. Results Follow-up of 46 patients ranged 0.5-3.5 years postoperatively, including ultrasound, voiding cystourethrogram, intravenous pyelogram. Hydronephrosis improve in 41 patients, had no change in 5 ureters. Conclusions Symptomatic children or advanced hydroureteronephrosis are definite indication for surgical treatment of UVJO patients. Surgical management could be effective for most of patients.

Objective To evaluate the long-term functional results, complications and patient's satisfaction level in patients performed augmented enterocystoplasty and continent urinary diversion using the appendix. Methods From 1999 to 2005, there were 22 children (12 males and 10 females) underwent augmented enterocystoplasty and continent urinary diversion using the appendix. Surgical results were reviewed retrospectively. There were 11 eases with bladder and urethra dysfunction attributed to neurogenic bladder, 2 cases with complex genitourinary malformation associated with an imperforated anus, 2 cases with exstrophy-epispadias complex, 2 cases with posterior urethral valves, 3 cases with failed urethrovaginal fistula repair and 2 epispadias cases with post failure of Young-Dees- Leadbetter bladder neck reconstruction. Upper urinary tract dilatation and hydroureteronephrosis were found in 17 eases (28 units), including grade Ⅱ-Ⅴ vesicoureteral reflux in 15 children (24 units). Simultaneous procedures included ureteral reimplantation in 15 cases and bladder neck closure in 14 cases. The appendix was used as the catheterizable conduit placed in the right lower abdomen and clean intermittent catheterization was performed in all patients. Outcomes were assessed by urodynamic study, IVU, ultrasound, voiding cystourethrography, BUN, Cr and electrolyte test. Results Mean follow-up was 3.6 years, ranging from 1.5-6 years. Complications included stomal stenosis requiring dilatation in 2 cases and leakage in 2 cases without bladder neck closure and 1 case required surgical revision. All patients achieved excellent stomal continence. No metabolic acidosis and bladder stone was noted. Upper urinary tract impairment had not worsened in all patients. Conclusion Augmented enterocystoplasty and continent urinary diversion using the appendix are associated with high continence, compliance and satisfaction rate and a low complication rate in the treatment of pediatric patients with disorders related to bladder and urethral dysfunction.

OBJECTIVETo study the roles of type II 11β-hydroxysteroid dehydrogenase (11β-HSD2) and it's signaling factors in the lung tissue in pathogenesis of persistent pulmonary hypertension (PPH) in neonatal rats.

METHODSSix Sprague-Dawley rats on the 19th day of pregnancy were randomly divided into PPH and control groups (n=3 each). The PPH group was intraperitoneally injected with indomethacin (0.5 mg/kg) twice daily and exposed in 12% oxygen for three days, in order to prepare a fetal rat model of PPH. The control group was intraperitoneally injected with an equal volume of normal saline and exposed to air. Neonatal rats were born by caesarean section from both groups on the 22nd day of pregnancy. In each group, 15 neonatal rats were randomly selected and sacrificed. 11β-HSD2 expression in the lung tissue of neonatal rats were observed by Confocal laser technology, and serum cortisol levels and prostacyclin, renin, angiotensin and aldosterone in the lung tissue of both groups were measured using ELISA.

RESULTS11β-HSD2 protein was widely expressed in the lung tissue of the control and PPH groups. The levels of 11β-HSD2 and prostacyclin in the lung tissue were lower in the PPH group than in the control group, while serum cortisol levels and renin, angiotensin and aldosterone in the lung tissue were higher in the PPH group than in the control group (P<0.05).

CONCLUSIONS11β-HSD2 and it's signaling factors play roles in pathogenesis of PPH in neonatal rats.

11-beta-Hydroxysteroid Dehydrogenase Type 2 ; analysis ; physiology ; Animals ; Animals, Newborn ; Female ; Hypertension, Pulmonary ; enzymology ; etiology ; Male ; Rats ; Rats, Sprague-Dawley ; Signal Transduction

OBJECTIVE: To assess the accuracy of anterior tooth movement using clear aligners in integrated three-dimensional digital models. METHODS: Cone-beam computed tomography was performed before and after treatment with clear aligners in 32 patients. Plaster casts were laser-scanned for virtual setup and aligner fabrication. Differences in predicted and achieved root and crown positions of anterior teeth were compared on superimposed maxillofacial digital images and virtual models and analyzed by Student's t-test. RESULTS: The mean discrepancies in maxillary and mandibular crown positions were 0.376 +/- 0.041 mm and 0.398 +/- 0.037 mm, respectively. Maxillary and mandibular root positions differed by 2.062 +/- 0.128 mm and 1.941 +/- 0.154 mm, respectively. CONCLUSIONS: Crowns but not roots of anterior teeth can be moved to designated positions using clear aligners, because these appliances cause tooth movement by tilting motion.
Casts, Surgical ; Cone-Beam Computed Tomography ; Crowns ; Humans ; Tooth Movement* ; Tooth*

Objective To analyse the clinical effect and safety of Alimta (Pemetrexed) combined with cisplatin treatment (PP) on elderly patients with non small cell lung cancer (NSCLC).Methods We retrospectively analyzed the clinical data of 40 cases of NSCLC patients treated with Pemetrexed combined with cisplatin for first-line chemotherapy,and 24 cases of them continually received single Pemetrexed for maintenance treatment (PP + C).Then we compared the results with 35 patients in the non-Pemetrexed regimen (control group) and 26 patients with best supportive care (BSC) in the same period.The adverse reactions and short-term efficacy [response rate (RR),disease control rate (DCR)] were evaluated.Time to progression (TTP),median survival time (MST),one-year and three-year survival rates and follow-up overall survival (OS) were calculated.Results Among 40 patients with Pemetrexed regimen,2 patients had complete remission (CR),and the RR was 47.8％,which was better than 42.8％ (P =0.026) in the control group.The main adverse reactions of pemetrexed regimen were myelosuppression,fatigue,nausea and vomiting,but all were tolerated and no treatment-related death occurred.24 patients received single Pemetrexed maintenance therapy.The MST of the PP + C group was superior to the other groups (P =0.03,P ≤0.05);the median OS of the PP + C group,the control group,and the BSC group reached 13.2,10.4 months and 8.6 months,respectively (P ≤ 0.001).Conclusions For elderly patients with advanced NSCLC,especially adenocarcinoma,the combination of Pemetrexed and cisplatin is a better treatment option.It is convenient to administer and has less toxicity and adverse reactions related to chemotherapy.Patients with better PS score after first-line treatment can obtain longer survival period after maintenance treatment.