Objective To evaluate the ability of contrast-enhanced ultrasound (CEUS) as a prognostic indicator of renal function in chronic kidney disease (CKD) patients.Methods A total of 122 patients with CKD were collected,and patients with allergies to sulfur hexafluoride,pregnancy,cardiopulmonary insufficiency,urinary calculus and tumour were excluded.These patients were divided into estimated glomerular filtration rate [eGFR,ml·min1· (1.73 m2)-1] ≥60 group,eGFR 30-59 group and eGFR ＜ 30 group.CEUS was performed after an intravenous bolus injection of 1.5 ml SonoVue (BR1;Bracco Milan,Italy).Time-intensity curves (TICs) and quantitative indexes were created using QLAB quantification software.Followed up for 2 years,and patients with eGFR dropped 50％,double serum creatinine and end-stage renal disease (ESRD) were regarded as having kidney failure events.Risk factors related to kidney survival were investigated using a multivariate Cox regression model.Results One hundred patients were enrolled in the study,with 78％ patients in CKD 1-2 stages,16％ in CKD 3 stage and 6％ in CKD 4-5 stages.Patients were followed for a mean period of 14.1 months,ten (10％) patients exhibited composite kidney failure events.Among 3 groups,significant differences in the left kidney length derived peak intensity (DPI) were noted (P=0.014,P=0.010).Multivariate Cox regression analysis revealed that the DPI was an independent factor of progression of kidney disease.Multiple linear regression showed that age,basic eGFR,peak intensity were associated with eGFR decline rate.Patients with DPI ＜ 12.27 db were less to recover from kidney disease progression as compared with patients with DPI≥ 12.27 db (P=0.008).The area under the curve (AUC) for DPI was 0.778(95％ CI 0.612-0.944,P＜ 0.05),with a sensitivity of 64％ and a specificity of 88％.Conclusions The DPI might be the most valuable CEUS parameter for the evaluation of renal function.The DPI could serve as an independent predictor of the long-term prognosis of CKD patients.

Objective To investigate the current status of semen testing in the hospitals without assisted reproductive technology in Hu-nan Province,propose improvement strategies to enhance the diagnosis of male infertility and promote reproductive health services in these hospitals.Methods Questionnaire surveys and on-site investigations were conducted to examine the semen testing status in 67 hospitals without assisted reproductive technology in Hunan Province.The existing problems were summarized,and improvement strate-gies were suggested.Results Among the 67 hospitals,59.7％(40/67)performed semen testing.Of these,45％(18/40)possessed dedicated personnel,60％(24/40)possessed staff received relevant training,and 22.5％(9/40)held certificates.Only 30％(12/40)conducted sperm morphology testing,among them 20％(8/40)able to stain and interpret following WHO standards.The hospitals of 37.5％(15/40)used computer-assisted sperm analysis(CASA)systems,and 22.5％(9/40)were equipped with phase-contrast microscopes.30％(12/40)had dedicated examination areas,and 32.5％(13/40)had independent ejaculation rooms,17.5％(7/40)used disposable slides to observe sperm concentration.In 2022,the hospitals of 57.5％(23/40)had an average daily sample volume＜1.The hospital of 67.5％(27/40)performed standard operating procedures,40％(16/40)followed the WHO 5th la-boratory manual for routine testing,15％(6/40)conducted internal quality control,and 12.5％(5/40)participated in external quali-ty assessment(EQA).Another 55％(22/40)wished to participate in EQA.Conclusion The semen testing capacity in the hospitals,in which assisted reproductive technology is not yet carried out currently,urgently requiring multifaceted improvements.The proposed strategies include emphasizing semen testing,establishing reproductive medicine consortia for comprehensive support,establishing a provincial quality control center for EQA,founding a professional committee for a learning platform,offering training to enhance staff expertise,and including the pre-pregnancy semen testing in public health programs.

China has entered the task stage of comprehensive medical insurance payment reform, but there are problems restricting the development of innovative medical technology in the reform of diagnosis-related groups(DRG) payment system. The author introduced the international definition and scope of innovative medical technology, and summarized the preconditions and payment policy of short-term payment of innovative medical technology under the DRG payment system; And put forward suggestions in line with China′s actual situation, including clarifying the definition of innovative medical technology, setting access conditions for additional payment or actual payment, setting up special transition funds for high-value innovative drugs, clarifying the payment amount of innovative medical technology, and formulating payment strategies for innovative medical technology.

Objective To explore the influence of diabetic complications simulated experience education on blood glucose control and self-behavior management in elderly patients with type 2 diabetes mellitus.Methods A total of 150 elderly patients with type 2 diabetes mellitus were selected according to the diabetic diagnostic criteria by WHO from November 2015 to April 2016.They were randomly divided into intervention group (75 cases, diabetic complications simulated experience education , one-to-one education mode) and control group (75 cases, conventional education for diabetic complications , one-to-one education mode).The differences in fasting blood glucose , 2 hours′postprandial glucose, glycosylated hemoglobin (HbA1c), and self-management behavior were compared before and one month after intervention .Results There were no difference in general situation , every glucose index , the score of diabetes management self efficacy ( Chinese version Diabetes Management Self-Efficacy Scale, C-DMSES), and the score of self-management behavior (Summary of Diabetes Self-Care Activities, SDSCA) between two groups before intervention (P>0.05).After intervention, fasting blood glucose, 2 hours′postprandial glucose, and HbA1c were (6.51 ±1.93) mmol/L,(11.08 ± 5.02)mmol/L,(7.52 ±3.01)% in intervention group, which were lower than (7.31 ±1.80) mmol/L, (12.81 ±5.46) mmol/L,(8.84 ±2.52)%in control group (P<0.05).The scores of C-DMSES and SDSCA in intervention group were higher than those in control group ( P <0.01 ).Conclusions The diabetic complications simulated experience education is better than conventional health education in blood glucose control and self-behavior management in elderly patients with type 2 diabetes mellitus .

Objective? To explore the effects of interpregancy interval (IPI) on pregnancy outcomes in multiparas with vaginal delivery and to provide a scientific reference for preconception counseling and clinical guidance for women who planned to bear another child. Methods? All the multiparas who labored via vaginal delivery in Peking University Third Hospital between January and December 2016 were selected in this retrospective analysis. The multiparas were divided into three groups based on their IPI. The IPI of the first group was 0-35 months (n=134); The IPI of the second group was 36-71 months (n=274); and the IPI of the third group was≥72 months(n=256). The relationship between IPI and pregnancy complications, comorbidities, labor time, hemorrhage and perinatal outcome was analyzed. SPSS 22.0 was used for statistical analysis. Results? Premature rupture of membranes (PROM) was found in 18 multiparas in the first group, 37 in the second group and 58 in the third group; uterine fibroid was found in 7 multiparas in the first group, 17 in the second group and 31 in the third group; there was statistically significant difference in PROM and the incidence rate of uterine fibroid between the groups with different IPI (χ2=9.379,8.143;P＜0.05); when confounding factors such as the mothers' age were adjusted, the risk of PROM and uterine fibroid continued to rise since the 72nd month of IPI (OR=1.888,2.519;P＜0.05). Conclusions? Longer IPI is associated with the increase in the risk of PROM and uterine fibroid. Pre-pregnancy and pregnancy education should be enhanced to ensure maternal and child health according to the characteristics of multiparas with longer IPI.

OBJECTIVETo investigate the associations of occupational, educational and residential factors with the outcomes of in vitro fertilization -embryo transfer (IVF-ET).

METHODSA retrospective analysis was conducted among 3998 patients undergoing the first treatment with IVF-ET and 3064 perinatal infants in our center between January, 2010 and June, 2014. The relation of the patients' occupation, educational background, and residence registry with IVF-ET outcomes was analyzed.

RESULTSThe risk of abortion in the first trimester was significantly higher in female patients engaged in agriculture (OR=4.319, P=0.047). Occupation and educational background of the patients and their spouse were related with the incidence of ectopic pregnancy following IVF-ET. The total incidence rate of perinatal birth defects was 2.1% in this cohort, and was the highest in Shenzhen (5.5%) but this difference was not statistically significant (P>0.05).

CONCLUSIONThe patients' occupation and educational background are related with the outcomes of IVF-ET, suggesting the importance of health education and prenatal examination.

Abortion, Spontaneous ; Educational Status ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Incidence ; Infant ; Occupations ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Residence Characteristics ; Retrospective Studies

Objective To mimic oral squamous cell carcinoma(OSCC) cell hypoxia by using chemical agent CoCl2 and to investigate its biological behaviour.Methods Oral squamous cell carcinoma cell lines HSC-3 and SCC-4 were exposed to different concentration of CoCl2.HSC-3 and SCC-4 cells were treated with 50,100,150,200 μ mol/L CoCl2.Expression of hypoxia inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF) and B-cell lymphoma-2(BCL-2) were measured by real time polymerase chain reaction(PCR) and Western blotting in both mRNA and protein level.Cell proliferation,cell apoptosis and cell cycle were detected to analyze its biological behaviour.Both wound healing and Transwell assay were applied to test the ability of cell igration.Results The result showed that after treatment of 150 μ mol/L CoCl22 for 24 h,mRNA level of HIF-1α,VEGF and Bcl-2 was increased by 6.00±0.20,5.40±0.40,5.40±0.30 (SCC-4); 5.60±0.30,5.20±0.60,5.80±0.40(HSC-3).OSCC cells treated with 150 μmol/L CoCl2 for 24 h were collected.Compared with control group,the growth rate of cells was significantly decreased,P value was less than 0.05 (when HSC-3,SCC-4 cultured for 2 and 3 days).The apoptosis of OSCC cells was increased when treated with 150 μmol/L CoCl2 for 24 h:HSC-3 2.25％(control group) and 5.82％(treatment group); SCC-4 2.58％(control group) and 10.27％ (treatment group).The migration ablility of OSCC cells was decreased when using 150 μmol/L CoCl2 for 24 h.The migration area ratio was(31.5±2.3) ％(HSC-3),(29.1± 1.5) ％ (SCC-4) in control group and(18.3± 1.9) ％ (HSC-3),(13.2±0.8)％ (SCC-4) in treatment group(P＜0.05).Conclusions The hypoxic cell model of OSCC could be induced by CoCl2.The expression level of hypoxic markers was up regulated significantly and the cells biological behaviour changed including decreased cell proliferation,increased apoptosis and decreased migration.

Objective: To evaluate the clinical effect of a digital whole-process surgical guide for immediate implantation in the molar area. Methods : Twenty-six patients with molar extraction plans were accepted for preoperative CBCT and model construction. Computer software was used to design the ideal three-dimensional position of the implant. The control group of 13 patients underwent immediate implantation with a free hand operation, whereas the experimental group of 13 patients underwent preparation and implant insertion under the guidance of a surgical guide. Bone grafting was performed, and a good initial stability was achieved. After 5 to 6 months, osseointegration was achieved, and the final restoration was delivered. After surgery, the accuracy of the three-dimensional position of the implants was measured, and at the 6 month return visit, the modified Plaque Index (mPLI), modified Sulcular Bleeding Index (mSBI) and probing depth (PD) were measured. Results : In the control group and experimental group, the vertical errors at the top of the implants were 1.246 ± 0.072 mm and 0.628 ± 0.046 mm (t = 26.078, P < 0.001), respectively, and the horizontal errors were 1.563 ± 0.086 mm and 0.546 ± 0.056 mm (t = 35.813, P < 0.001), respectively; and the vertical errors at the root of the implants were 1.352 ± 0.042 mm and 0.532 ± 0.030 mm (t = 57.021, P < 0.001), respectively, and the horizontal errors were 1.645 ± 0.076 mm and 0.625 ± 0.072 mm (t = 35.086, P < 0.001), respectively. For the experimental group, the mPLI value was 0.923 ± 0.760, the mSBI value was 0.846 ± 0.689, and the PD value was 3.460 ± 0.713 mm, which were significantly lower than those of the control group. For the control group, the mPLI value was 1.769 ± 0.927 (t = 2.546, P = 0.018), the mSBI value was 1.692 ± 0.947 (t = 22.605, P = 0.016) and the PD value was (4.579 ± 0.475) mm (t = 4.709, P < 0.001). Conclusion A digital surgical guide plate can increase the precision of immediate implantation and the peri-implant health in the molar area.

Objective To investigate the influence of different end shapes of esophageal stents on the mechanical behavior of the stent-esophagus system. Methods Through finite element simulation, the mechanical behavior of the coupling system between braided esophageal stents with different end shapes (straight-tube-shaped, cup-spherical-shaped, double-trumpet-shaped) and the esophageal cavity was analyzed. The influences of bare stents and covered stents with three different end shapes on stress distributions in the inner wall of the esophagus and on dilatation of the esophageal stenosis zone were compared. Results The reduction in stenosis rate caused by the bare stent was larger than that of the covered stent. Moreover, the equivalent stress and the contact stress caused by the bare stent were much larger than those of the covered stent. Different end shapes had a significant influence on the stress occurring in the healthy esophageal zone. Stress concentration occurred in the zones where the esophagus contacted the central part of the cup-shaped end and the edge of the double-trumpet-shaped end. The braided esophageal stents with three different end shapes all had good apposition.Conclusions Different end shapes of stents cause different stress states in the esophagus. A larger stress involves a higher probability of occurrence of esophageal tissue hyperplasia, but a smaller possibility of stent migration. Therefore, understanding the effect of the end shapes on stent performance can provide important theoretical references for optimization design of the braided stent and its clinical selection.

Purpose To investigate the clinicopathological features,diagnosis and differential diagnosis of the primordial odontogenic tumour(POT).Methods Clinical data of 4 cases of jawbone POT were collected.Imaging examination,HE,and immunohistochemical EnVision two-step staining was used to an-alyze their clinical and pathological characteristics,and relevant literatures were reviewed.Results The age arranged from 5 years to 21 years.2 cases were male and 2 case were female.There were 2 cases in maxilla and 2 cases in mandible.The clinical presentation was a slow growing painless mass.Cut sur-face of the tumor was appeared grayish yellow and grayish white,the tumor involved the crown of an unerupted tooth.The tumour consisted of a proliferation of spindled and stellate cells in myx-oid stroma.Surfaced by cuboidal to columnar epithelium forming papillary structures and invaginations.Calcification was observed in 2 cases.Conclusion POT is a rare benign mixed odontogen-ic tumor that is more common in children and adolescents.Mas-tering its characteristic histological morphology can make a cor-rect diagnosis.Local complete resection of the tumor has a good prognosis.