Objeetive To explore routine magnetic resonance imaging characteristics of newborn bilirubin encephalopathy(NBE).Methods MRI features and clinical data of 17 patients with Newbern bilirubin encephalopathy were retrospectively analyzed, globus pallidus (GP)and subthalamic signal intensity was evaluated.The increase of GP signal intensity and serum total bilirubin peak value were analyzed using pearson correlation analysis.Serum total bilimbin peak value between patients with high signal in the subthalamic nuclei on T1 WI and patients without high signal in the subthalamic nuclei were compared statistically.Results The main MRI presentation in the NBE group Was abnormally increased signal intensity in the GP on T1 WI,which was not apparent on T2 WI One patient showed abnormal high signal intensity in the postemmedial part of GP.Nine patients had high signal in the subthalamic nuclei on T1 WI and normal signal on T2 WI Four patients showed hiigh signal in the brainstem with sparing of dorsal pontine.The increase in value of GP signal intensity was 249.0-423.8 in 12 patients and their serum total bilirubin peak values were 366.0-983.3μmol/L A positive correlation Was found between increase of GP signal intensity and serum total bilirubin peak value.The serum total bilirubin level of abnormal subthalamic group and normal subthalamic group were 660.7±192.4 μmol/L and 513.3±107.5μmol/L respectively.The difference between the two groups was not statistically significant(t=1.914,P＞0.05).Conclusion The routine MRI has some characteristics and is useful in the diagnosis of newborn bilirubin encephalopathy.

Objective To provide a reliable differential diagnosis among the progressive supranuclear palsy ( PSP), striatonigral degeneration ( SND ) and Parkinson disease ( PD ) . Methods Conventional MRI data in clinically proved PSP(8 cases), SND(9 cases), PI)( 12 cases)and 12 normal controls were retrospectively analyzed. Midbrain area, pons area, ports diameter and middle eerebellar peduncles width were measured. The ratio of pons area over midbrain area (pons area/midbrain area) was calculated in all patients and normal controls. Then one way ANOVA and a Kruskal-Wallis H test were used for statistical analysis. Results Midbrain area of the PSP group [ (85. 8±12. 0) mm2 ] was the smallest, and there was statistically significant difference ( P < 0. 05 ) comparing with the SND group [ ( 133.2± 8. 4) nun2 ], PD group[ ( 133. 5±10. 8) mm2 ] and the control group [ ( 135.9±7.5 ) mm2 ]. There was no overlapping in the distribution of midbrain area between the PSP group(66.0-98. 2 mm2 ) and SND, PD and normal groups( 116. 2-142. 1, 110. 8-146. 2 and 121.7-145.8 mm2 ). The pons area-midbrain area ratio (P/M) of the PSP group (5.9±0. 8) was the largest in four groups, and there was statistically significant difference ( P < 0. 05 ) comparing with the SN D group ( 2. 9±0. 5 ), PD group ( 3.8±0. 3 ) and the control group (3. 8±0. 3 ). There was no overlapping in the distribution of P/M between the PSP group(5.0-7.2) and SND,PD and normal groups(2. 2-3.5, 3. 3-4. 6 and 3. 2-4. 2). SND group had the smallest P/M, pens area, pons diameter and middle cerebellar peduncles width [ 2.9±0. 5, ( 384. 8±62. 6) mm2 , ( 18. 6±2. 0) nun and( 12. 9±2. 4) mm ] in all groups, and significant difference ( P < 0. 05 ) was found comparing with the PSP group[5.9±0. 8, (500.1±21.8)mm2, (22. 7±1.7)mm and( 16. 3±1. 1) nun],PD group[3.8±0.3, (500.2±25.8)mm2, (23.7±1.0)mm and(16.8±1. 1)mm]and the control group [3. 8±0. 3, ( 508. 8±20. 6 ) mm2, ( 23.2±1.2) nun and ( 16. 4±0. 9 ) mm]. But the PD group and control group had no statistically significant difference in the midbrain area, pans area, pons diameter, P/M and middle cerebellar peduncles width ( P > 0. 05 ). Conclusion MRI measurements helps in the differential diagnosis among PSP, SND and PD.

Objective To evaluate the apparant diffusion coefficient (ADC) values of cerebellar and the middle cerebellar peduncles in the differential diagnosis of multiple system atrophy (MSA) and Parkinson disease (PD). Methods Conventional MRI and DWI were performed in 18 clinically proved MSA patients with 7 cases of early cases (early-stage MSA group), 19 PD patients (PD group) and 18 agematched normal controls (the control group). DWI was performed using a single shot-spin echo-echo planar imaging sequences, and ADC values were measured in the ROIs (0. 16 cm2) of the bilateral cerebellum, the middle cerebellar peduncles and cerebral white matter. Then one way ANOVA test was used for statistical analysis. Results Of the 18 MSA patients, 11 had MR abnormalities, 8 had hot-cross bun sign in the pens on T2-weighted images, 11 patients had pontine, cerebellar and medulla oblongata atrophy, 10 patients had atrophy of the middle cerebellar peduncles, 2 patients had hyperintense rim of the putamen and putaminal atrophy on T2-weighted images. The ADC values in the middle cerebellar peduncles were significantly increased in the MSA group[ (0. 98 ±0. 07) × 103 mm2/s] and early-stnge MSA group [ (0. 95 ±0. 05) ×103 mm2/s] as compared to PD group [ (0. 77 ±0. 04) × 103 mm2/s] and control group[ (0. 78 ±0. 04) ×103 mm2/s]. There was statistical significant difference among them (F = 91.049,55. 301, P ＜ 0.01 ).There was no overlap in the distribution of ADC values of the middle cerebellar peduncles among the MSA group [ (0.86-1.13 ) × 103 mm2/s ], early-stage MSA group [ (0. 86-1.02 ) × 103 mm2/s ] and PD group [ (0. 68-0. 84) × 103 mm2/s] and the control group [ (0. 69-0. 82) × 103 mm2/s]. The ADC values in the cerebellum were significantly increased in the MSA group[ (0. 95 ±0. 09) × 103 mm2/s] and early-stage MSA group [ (0. 92 ±0. 07) × 103 mm2/s] as compared to PD group [ (0. 78 ±0. 05) × 103 mm2/s] and control group[ (0. 79 ± 0. 05 ) × 103 mm2/s ]. Statistically significant difference was found among them (F =39. 274,18. 623 ,P ＜0. 01 ). There was overlap in the distribution of ADC values of the cerebellum [ MSAgroup(0. 80-1.10) × 103 mm2/s,early stage MSA group (0. 80-0. 99) × 103 mm2/s,PD group(0. 72-0. 90) × 103 mm2/s,control group (0. 71-0. 87) × 103 mm2/s]. There was no significant difference among the ADC values of MSA group, MSA group(early stages) and PD group and the control group in the cerebral white matter( P ＞ 0. 05 ). Conclusions ADC values in the cerebellum and the middle cerebellar peduncles have very important significance in differential diagnosis between MSA and PD.

Objective To evaluate the clinical outcomes of severely resorbed edentulous mandibles with tilted implants and fixed prostheses. Methods Ten patients with severely resorbed edentulous mandibles were en-rolled. Each patient received 4 implants,two posteriors placed tilted implants. Immediate loading of tilted implants were applied in all cases using a fixed provisional prosthesis. All patients were finalized 3-4 months with fixed pros-theses. Results 40/40 implants with initial torque(>35N.cm)were followed 1-1.5 years presenting 100%surviv-al. Conclusion The method of using tilted implants and fixed prostheses in the cases of severely resorbed edentu-lous mandibles can achieve an ideal short-term and medium-term effects.

OBJECTIVETo assess the effect and safety of periodontal therapy in relieving the symptoms and clinical signs of rheumatoid arthritis (RA).

METHODSThe electronic search was conducted in Medline (OVID, 1950-2010 Sep), EMBASE (1984-2010 Sep), CENTRAL (2010, Issue 3), CBM (1978-2010 Sep) and the Chinese journals on stomatology were hand-searched. Clinical randomized controlled trials as well as clinical controlled trials were selected regarding the targeted issue. Two investigators evaluated the reporting quality and risk of bias of those included trials in accordance with CONSORT statement and Cochrane risk of bias assessment tools, and collected data of included studies in duplicate. Revman 5.0.23 was applied for Meta-analysis.

RESULTSFour trials met the inclusion criteria and a total of 150 patients were enrolled in the trials, one had low risk of bias and others had moderate risk of bias. Meta-analysis showed that pure periodontal therapy could not decrease disease activity score in 28 joints (DAS28) (P=0.06), and there was no statistically significant difference between periodontal therapy with anti-tumor necrosis factor-alpha (TNF-alpha) medication and pure anti-TNF-alpha medication (P=0.24). But the subgroup analysis showed that a significantly decreased DAS28 was achieved by periodontal therapy (P=0.03), and the interventions provided a remarkable effect on alleviating clinical signs and erythrocyte sedimentation rate of RA (P<0.05). Results of the symptoms relief differed from the studies. No adverse events were reported.

CONCLUSIONThe evidence available currently indicates that periodontal therapy may play a positive role in remitting the clinical signs and periodontal status of RA except the relief of the symptoms.

Objective To compare the clinical outcomes of dilator-kyphoplasty (DKP) and balloonkyphoplasty (BKP) in treatment of osteoporotic vertebral compression fractures. Methods From May 2007 to March 2009, 23 cases with 26 vertebrae were treated with DKP, while 29 cases with 29 vertebrae were treated with BKP procedures. The operating time, bleeding volume and injecting volume of cement were recorded during operation. The distribution of cement, the restoration of vertebral height and Cobb angle were observed. The patients' visual analogue scales (VAS) score and Oswestry disability index (ODI) score were evaluated after operation. Results There were no differences in operative time, bleeding volume of every vertebrae and cement injected volume between these two groups (P＞0.05). The vertebral height, Cobb angle, VAS and ODI scores were significantly improved than those of pre-operation in these two groups (P＜0.05). The height of the anterior vertebrae and Cobb angle in DKP groups were restored significantly than those in BKP groups (P＜ 0.05). There were 1 case (1 vertebra, 3.8%) underwent cement leakage in DKP groups and 5 cases (5 vertebrae, 17.2%) in BKP groups. Conclusion DKP and BKP were effective in the treatment of osteoporotic vertebral compression fractures. The height of the anterior vertebrae and Cobb angle in DKP groups were restored significantly than those in BKP groups.

Objective: To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure. Methods: A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m². The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized. Results: All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

Objective To compare the effect of laparoscopy-assisted gastrectomy (LAG) and open D2 radical gastrectomy (OG) for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 117 patients who underwent D2 radical gastrectomy at the Guangdong General Hospital from January 2014 to December 2014 were collected.Of 117 patients,60 undergoing LAG and 57 undergoing OG were respectively allocated into the LAG group and OG group.Total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were performed according to the location of the tumor.The perigastric lymph nodes dissection was performed according to the Japanese " Gastric cancer treatment protocol" (the 14th edition).Eligible patients received the adjuvant chemotherapy of XELOX regimen according to the Guideline published by National Comprehensive Cancer Network (NCCN).Observation indicators:(1) comparison of intra-and postoperative recovery between groups;(2) stratified analysis of number of lymph node dissected;(3) relationship among surgical method,number of lymph node dissected and postoperative complication;(4) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy,tumor-free survival and tumor recurrence or metastasis up to December 2016.Measurement data with normal distribution were represented as (x)± s and comparison between groups was analyzed using the independent-sample t test.Count data were analyzed using the chi-square test or Fisher exact probability.The relationship between number of lymph node dissected and postoperative complication was done using the Logistic regression model.Results (1) Comparison of intra-and post-operative recovery between groups:all the patients completed the operation successfully.Volume of intraoperative blood loss,time to postoperative anal exsufflation and duration of postoperative hospital stay were (113±36) mL,(4.3±2.1) days,(9.7±2.9) days in the LAG group and (209 ± 77) mL,(5.3 ± 2.2) days,(11.2 ± 3.9) days in the OG group,respectively,with statistically significant differences between groups (t =6.850,-2.604,-2.405,P＜0.05).Number of lymph node dissected,numbers of patients with overall complication,incisional infection,intestinal obstruction,digestive tract fistula,intra-abdominal bleeding,cardiovascular accident,pulmonary infection,urinary tract infection and death within postoperative 30 days were respectively 31±7,6,1,0,4,0,0,1,0,0 in the LAG group and 34±6,12,0,1,2,2,1,4,1,1 in the OG group,with no statistically significant difference between groups (t=0.177,x2=2.743,0.126,0.563,0.837,P＞0.05).All the patients with complications received symptomatic treatment,1 patient with abdominal bleeding in the OG group died and other patients recovered smoothly.(2) Stratified analysis of number of lymph node dissected:number of lymph node dissected in patients with total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were 35±8,29±5,27±4 in the LAG group and 34± 5,34±6,29±6 in the OG group,respectively,with no statistically significant difference between groups (t =0.846,1.052,0.934,P＞0.05).Number of lymph node dissected in patients with stage Ⅰ,Ⅱ and Ⅲ of TNM staging were respectively 31±5,32±9,31±6 in the LAG group and 34±7,32±4,35±6 in the OG group,with no statistically significant difference between groups (t =0.494,1.657,0.136,P＞0.05).(3) Relationship among surgical method,number of lymph node dissected and postoperative complication:surgical method (LAG and OG) and number of lymph node dissected were used as the independent variable and postoperative complication between groups was used as the dependent variable,the Logistic regression model showed that surgical method and number of lymph node dissected were not related factors affecting the postoperative complication (OR =1.062,2.049,95％ confidence interval:0.998-1.140,0.695-6.042,P＞0.05).(4) Follow-up and survival:108 of 117 patients (54 in each group) were followed up for 2-35 months,with a median time of 28 months.During the follow-up,numbers of patients undergoing postoperative adjuvant chemotherapy,with tumor-free survival and with tumor recurrence were 45,43,10 in the LAG group and 42,42,10 in the OG group,respectively,with no statistically significant difference in the tumor-free survival and tumor recurrence between groups (x2 =0.055,0.002,P＞0.05).Conclusion Laparoscopy-assisted D2 radical gastrectomy is safe and feasible,which equivalent to clinical effect of open radical gastrectomy,meanwhile,it also can reduce volume of intraoperative blood loss and duration of postoperative hospital stay,and accelerate recovery of postoperative gastrointestinal function.

Objective To explore the effects of both folic acid,p16 protein expression and their interaction on progression of cervical cancerization.Methods Participants were pathologically diagnosed new cases,including 80 women with normal cervical (NC),55 patients with low-grade cervical intraepithelial neoplasia (CIN Ⅰ),55 patients with high-grade cervical intraepithelial neoplasia (CIN Ⅱ/Ⅲ) and 64 patients with cervical squamous cell carcinoma (SCC).Serum folate levels were detected by microbiological assay method while p16 protein expression levels were measured by Western-blot.In vitro,cervical cancer cell lines C33A (HPV negative) and Caski (HPV16 positive) were treated with different concentrations of folate.Proliferation and apoptosis of cells and the levels of p16 protein expression were measured in groups with different folic acid concentrations.Results Results showed that the levels of serum folate were (5.96± 3.93) ng/ml,(5.08±3.43) ng/ml,(3.92 ± 2.59) ng/ml and (3.18 ± 2.71) ng/ml,and the levels ofpl6 protein were 0.80 ± 0.32,1.33 ± 0.52,1.91 ± 0.77,and 2.09 ± 0.72 in the group of NC,CIN Ⅰ,CIN Ⅱ/Ⅲ and SCC,respectively.However,the levels of serum folate decreased (trend X2 =32.71,P＜ 0.001) and p 16 protein expression increased (trend x2=56.06,P＜0.001) gradually along with the severity of cervix lesions.An additive interaction was seen between serum folate deficiency and high expression of p l 6 protein in the CIN Ⅰ,CIN n/Ⅲ and SCC group.Results in vitro showed that,with the increase of folate concentration,the inhibition rate of cell proliferation (C33A:r=0.928,P=0.003;Caski:r=0.962,P=0.001) and the rate on cell apoptosis (C33A:r=0.984,P＜0.001;Caski:r=0.986,P＜0.001) all increased but the levels of p16 protein expression (C33A:r=-0.817,P=0.025;Caski:r=-0.871,P=0.011) reduced.The proliferation inhibition rate (C33A:r=-0.935,P=0.002;Caski:r=-0.963,P=0.001) and apoptosis rate of cells (C33A:r=-0.844,P=0.017;Caski:r=-0.898,P=0.006) were negatively correlated with the levels of p16 protein expression.Conclusions Our findings indicated that both serum folate deficiency and high expression of p16 protein could increase the risk of cervical cancer and cervix precancerous lesion,and there was an additive interaction between them.Our findings suggested that folic acid supplementation could reverse the abnormal expression of p16 protein,and effectively promote apoptosis and inhibit proliferation in cervical carcinoma cells.

Objective To investigate the correlation between the expression of (epidermal growth factor receptor-2,HER-2) and clinicopathological features and survival of colorectal cancer.Methods From Jan 2005 to Dec 2015,all colorectal cancer cases were enrolled that the expression levels of HER-2 were detected in Guangdong Provincial People's Hospital.Clinicopathological features of the tumors and survival of the patients were analyzed.Results A total of 1 463 cases were collected in 10 years,including 711 cases (48.6％) of HER-2 (-),470 cases (32.1％) of HER-2 (+),249 cases (17％) of HER-2 (+ +),and 33 cases (2.3％) of HER-2 (+ + +).Correlation analysis shows that the expression levels of HER-2 were significantly correlated with tumor differentiation and the depth of tumor invasion(T stage),but not correlated with gender,age,tumor location,N stage,M stage,TNM stage and overall survival,and disease-free survival.Conclusion The expression of HER-2 may be related to tumor differentiation and growth infiltration,but it cannot be used as a predictor of prognosis in patients with colorectal cancer.