Objective To find the characteristics of stress distribution on condyle during different vertical distances of edentulous jaw.Methods Three dimensional finite element models of the mandible and temporomandibular joint were established with the complete dentures in different heights by helix-CT scanned transverse sections.The stress distribution of the condyle was analyzed under load.Results The compressive stress and tensile stress coexisted on the whole condyle with the different vertical distances.The trend of distribution was consistent practically,but the stress presented a large difference on different locum.With the decrease of the vertical distance(from H-2 to H-6),the stress presented a decreasing trend but an increasing trend at H-8.Conclusion Changes in the vertical distance produce different effects of stress on edentulous jaw under the same load.

Colorectal cancer is one of the common malignant tumors and the overall prognosis is poor. The search for a more effective treatment for colorectal cancer has never stopped. The current interaction between the modulated immune system and the tumor microenvironment is a hot topic in the treatment of colorectal cancer. The achievements involve immune checkpoint inhibition, cytokine therapy, toll?like receptors and autologous cell therapy. It has been proved that these methods have mild effect on tumor loading reduction. However, significant breakthrough has been achieved with the use of checkpoint inhibitors targeting cytotoxic T lymphocyte associated antigen?4 (CTLA?4),programmed death?1 (PD?1) and programmed death receptor ligand 1 (PD?L1). Immunotherapy is promising in the treatment of patients with refractory tumors. The success of this current immunotherapy approach is largely limited to tumors with high mutation amplification, such as melanoma,renal cell carcinoma ( RCC) and non?small cell lung cancer. However,this discovery has led the development of checkpoint inhibitors in the treatment of colorectal cancer with highly mutated amplification of mismatch repair gene to a new era.

Objective To analyze reasons for unplanned return-to-theater obstetrical surgery in patients with placenta previa, and to propose a strategy for prevention.Methods Among 571 patients with placenta previa in the Department of Obstetrics, First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2015, ten cases (1.75％) who had an unplanned return-to-theater obstetrical surgery were retrospectively analyzed.Results Seven out of the ten cases returned to the theater due to severe hemorrhage after cesarean section and hysterectomy or uterine artery embolization was performed.The rest three pregnancies were terminated at mid-term with amniotic injection of rivanol, two of which developed severe infection after the induction combined with uterine artery embolization followed by cesarean section,and the other one finally had an emergent hysterectomy due to severe postpartum hemorrhage after cesarean section because of intrapartum hemorrhage.Severe postpartum hemorrhage occurred in eight out of the ten cases, with a mean volume of (4 212± 1 651) ml.Blood loss between the original and return-to-theater surgery was (2 206± 736) ml.In these eight cases, the mean volume of erythrocyte suspension transfusion was (23.7±9.0) U, and [M(min-max)] 1 845(390 3 960) ml for plasma transfusion.Platelet transfusion was performed in five cases, cryoprecipitate transfusion in eight cases, serum albumin transfusion in six cases, and fibrinogen transfusion in five cases.The interval between original and return-to-theater surgery was 2.0(0.5-19.0) h.After the return-to theater surgery, the time of antibiotic use was (9.2±2.3) d, and the duration of hospital stays was (10.6±2.5) d.No patient required further re-operation, and all were discharged without long-term sequelae.All seven neonates had a good prognosis.Conclusions Severe postpartum hemorrhage in patients after initial operation because of placenta previa is the primary indication for unplanned return-totheater surgery.Closed postoperative monitoring, early recognition and expedite return-to-theater surgery are crucial to stop bleeding and save lifes.

ObjectiveTo establish the reference value of inhibin-A in the serum of pregnant women with gestational age from 15 to 20+6 weeks in Guangdong province,and assess the efficiency of inhibin-A and quadruple test in Down syndrome screening.Methods A total of 2802 singleton pregnancies receiving triple test screening in Guangzhou Women and Children's Medical Center from March 2008 to December 2010 were included in this study.Inhibin-A was measured by automatic enzyme-linked immunosorbent chemiluminescence assay. The concentration of inhibin-A was expressed as multiples of the median (MoM),and adjusted with maternal weight and gestational age.Parameters of SURUSS were used to recalculate the risk of Down syndrome.The efficacy of single marker and combination were evaluated by receiver operating characteristic curve and the area under the curve. Results(1) In normal singleton pregnancies,the median concentration of inhibin-A was 286.60,267.10,249.10,243.40,242.30 and 256.60 pg/ml respectively for each week of gestational age from 15 to 20+6 weeks.The distribution of inhibin-A in each gestational week was relatively stable.The mean concentration [(852.83±370.04) pg/ml] and MoM (2.82) of inhibin-A in twelve pregnant mothers with Down syndrome fetuses were significantly higher than those without [(293.28±149.46) pg/ml (t=5.37,P＜0.05) and 1,respectively].(2) The detection rate was 83.3％ (10/12) by using the quadruple test including free human chorionic gonadotropin-β,alphafetoprotein,unconjugated estriol and inhibin-A at false positive rate of 5.8％; while when the detection rate of triple test including alpha-fetoprotein,free human chorionic gonadotropin-β and unconjugated estriol was 83.3％,the false positive rate was 7.7％.When the false positive rate was set to 5.0％,the area under the curve of inhibin-A,alpha-fetoprotein,free human chorionic gonadotropin-β and unconjugated estriol was 63.7％,20.5％,46.1％ and 4.8％,respectively,and the relative area under the curve of routine triple test and quadruple test was 45.5％ and 63.1％,respectively.ConclusionsInhibin-A is suggested to be the most effective marker used for secondtrimester screening,which could be used for second trimester Down syndrome screening in Chinese population combined with existing three markers.

Objective To analyze the stress distribution of the weakened root dentine restored with titanium post-core crown and fiber post-core crown by finite element method.Methods The sample was scanned by Inveon Micro-CT technology from incised margin to root apex at 21 μm interval to obtain transverse data of DICOM format.The three-dimensional finite element model was created by rebuilding the morphology of maxillary central incisor with Inveon Research Workplace as well as Mimics,Geomagic and Catia software.The model was meshed and loaded to analyze the stress distribution on the weakened dentine of root by finite element method.Results The maximum stress,shearing stress and equivalent stress of the root restored with fiber post-core crown were 60%less than the stresses of the root restored with titanium post-core crown in the experiment.The stress on various parts of the root restored with titanium post-core crown was higher than that of the root restored with fiber post-core crown.Furthermore,the stress concentration occurred mainly on the labial interface of the upper 1/3 of root. Especially when the root was restored with titanium post-core crown,the stress value reached 37 .73 MPa,which was 1.9 times that of fiber post-core crown.Conclusion The finite element analysis indicates that the fiber post-core crown is better than titanium post-core crown in avoiding stress concentration and root fracture in the restoration of weakened root of maxillary central incisors.

Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P<0.01).(2)In the patients with diabetes history,the mortality in patients whose blood glucose>10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P<0.05):while in the patients without diabetes history,the mortality began to rise as blood glucose>7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.

Objective To evaluate the diagnostic value of cerebral perfusion SPECT/CT combined with brain MRI in patients with ischemic cerebrovascular disease.Methods A total of 107 cases with ischemic cerebrovascular disease from August 2011 to August 2013 (71 males,36 females,age:33-84years) were retrospectively studied,including 31 cases with transient ischemic attack,40 cases with the first onset of cerebral infarction,36 cases with recurrent cerebral infarction.99Tcm-ECD SPECT/CT and brain MRI were performed within 7 d after attack.The interval between the two scans was within 5 d.The number of lesions and detection rate by SPECT/CT,SPECT,MRI,CT,and their combination were calculated respectively,and analyzed using x2 test.Results The detection rate was:SPECT/CT+MRI (97.20％,104/107)=SPECT+MRI (97.2％,104/107) ＞SPECT/CT (95.33％,102/107)＞SPECT (90.65％,97/107) ＞MRI (85.05％,91/107)＞CT (65.42％,70/107).No statistically significant difference was observed between the detection rate of SPECT/CT+MRI and SPECT+MRI,SPECT/CT (x2 =0.17,0.13;both P＞0.05),while there was statistically significant difference between SPECT/CT+MRI and SPECT,MRI,or CT (x2 =4.01,9.76,35.50;all P＜0.05).SPECT/CT detected more ischemic lesions located in brain gray matter and revealed crossed cerebellar diaschisis,while MRI was better for detecting small lacunar lesions in basal ganglia,brainstem and deep white matter.Conclusions SPECT/CT is valuable for the detection of ischemic cerebrovascular disease.hnproved assessment may be achieved by the combination of SPECT/CT and MRI.

Aim To investigate the effect of Tetramethylpyrazine (TMP) on the proliferation of airway smooth muscle cells (ASMCs). Methods Primary ASMCs of rats were cultured. The absorbance (A490) value of ASMCs treatment with platelet-derived growth factor (PDGF) in the presence of TMP was detected by MTTto observe the anti-proliferation of TMP. The levels of ERK1/2 and p-ERK1/2 proteins were determined by Western blot.Results In presence of the TMP with different concentrations (12.5,25,50,100 and 200 ?mol?L-1) at 6,12,24,36 and 48 hours,compared with control groups,the average inhibitory rates of cell proliferation in all groups were increased significantly (P

Objective To explore the impact of folate on MeCP2 expression and cervical cancer cells growth.Methods Cervical cancer cell lines Caski (HPV16-positive) and C33A (HPV-negative) were treated with different concentrations of folate.MTT,flow cytometry,Western blott and real-time PCR were used to detect the cells’ viability,apoptosis,the expression of MeCP2 protein and mRNA expressions respectively.Results The inhibitions of both cell growth were upgraded with the folate concentration increasing.The differences were significant between the experimental groups and the control group.With increasing of folate concentration,apoptosis ratio of C33A and Caski increased gradually (C33A:r =0.965,P ＜ 0.001; Caski:r =0.973,P ＜ 0.001) and the expression of MeCP2 protein downgraded gradually,presenting significantly negative correlations between them (C33A:r =-0.952,P ＜ 0.001; Caski:r =-0.947,P ＜ 0.001).There was significantly difference for mRNA expression in different concentration groups of Caski and C33A (C33A:F =77.041,P ＜ 0.001; Caski:F =59.885,P ＜ 0.001).In the same concentration group,the expression of MeCP2 protein and mRNA were higher in Caski than that of C33A,and the difference was significant in the concentration of 500 μg/ml group.There was a negative correlation between the expression of MeCP2 protein and cells’ apoptosis ratio (C33A:r =-0.970,P ＜ 0.001; Caski:r =-0.93,P ＜ 0.001).Conclusion Folic acid can inhibit the growth of cerical cancer cells,promote apoptosis and reduce the expression of MeCP2.The aberrant high-expression of MeCP2 can inhibit apoptosis of Caski and C33A.

Objective:A retrospective analysis was performed on clinical characteristics and deoxyguanosine kinase DGUOK gene mutations in a family with hepatocerebral mitochondrial DNA depletion syndrome (MTDPS). Methods:The clinical data, treatment process and gene detection results of a child with MTDPS in the second hospital of Hebei Medical University in April 2019 were analyzed and summarized.Results:Proband was a girl.From the first week of infantile, she suffered from recurrent hypoglycemia, hyperlactic acid, progressive cholestatic liver dysfunction, coagulopathy, difficult feeding, slow growth of body mass, microcephaly, hypotonia, and gradul intermittent binocular tremors, and eventually failed to thrive.Gene testing identified two compound heterozygous mutations c. 42-c.43insTTCA(p.F15fs129X)/c.808-1(IVS6)G>A in DGUOK gene.The former was a frame-shift mutation resulted in truncated protein and the later was a splicing mutation resulted in abnormal splicing.Each parent was a heterozygous carrier, and there were no mutations in the two sites with her elder sister. Conclusions:Both mutations were first reported worldwide. DGUOK gene mutations with MTDPS are important causes of infant liver failure.When hypoglycemia, hyperlactic acidemia and liver dysfunction occur in newborn and infant, MTDPS related gene DGUOK gene sequencing screening should be considered for early definitive diagnosis, or, when acute liver failure happen in infant and childhood, neuromuscular involvement is insufficient.