[Summary] The theory of fetal origins of adult disease (FOAD) is now widely accepted by researchers who hold the opinion that adult degenerative and metabolism diseases have close relationship with the environment of fetal development inside and outside the womb. Some studies have proved that maternal hypothyroidism can negatively affect the glucose metabolism of their offsprings. However, the whole mechanism is not clear yet. Insufficient thyroid hormone during pregnancy was proved to slow down the formation of fetal pancreatic cytoskeleton, to decrease the proinsulin gene transcription, and to modulate series of cytokines and enzymes which are related to glucose dependent insulin secretion. Thyroid hormone receptor is also considered to be partially responsible for the relation between low thyroid hormone and β cell insufficiency. However, more studies in vivo should be carried out to prove this hypothesis. Epidemiologic studies have suggested that type 2 diabetes and low birth weight can be different phenotypes of the same genotype. The definite mechanism of maternal hypothyroidism in influencing fetal β-cell function should be studied by further investigation.

Objective:To investigate influences of bicortical anchora ge on the values of natural frequency of dental implants. Methods: Using the commercial code of SolidWorks, 3-D models of a screw-shaped dental i mplant and a mandibular bone segment were generated. After the 3-D implant-bon e complex was meshed by ABAQUS software, effects of bicortical anchorage on the buccolingual and axial first-order natural frequencies of the implant were comp uted. Results:Bicortical anchorage increased the buccolingual na tural frequencies and the axial natural frequencies of the implants by a maximu m of 13.77% and 107.40% respectively. The apical anchorage depth in the cortical bone had an insignificant effect on further increase of implant stability. Conclusion:Bicortical anchorage can increase the stability of dental implants, especially in the axial direction.

Objective To discuss the application of allowable total error (Tea) and allowable imprecision derived from biological variation in routine chemistry external quality assessment ( EQA) and internal quality control (IQC) and set up quality specifications of routine chemistry in our country.Methods Data of test items including K,Na,CI,Ca,P,Glu,Urea,UA,Cre,Alb,TP,TC,TG,AST,ALT,Tbil,ALP,AMY,CK,LDH,Fe,Mg,Cu,Zn and GGT was collected and evaluated by a nationwide EQA.At the same time the coefficients of variation (CVs) of these test items during the month were acquired from the IQC reports of each laboratory and then the results were analyzed.Results Percent of pass was different in these test items based on Tea derived from biological variation in EQA results.Except for items of CI,Mg,Cu and Zn,about 80％ of participant laboratories could achieve the minimum performance of biological variation.About 80％ of participant laboratories could achieve the desired performance of biological variation for K,P,Glu,Urea,UA,Cre,TC,TG,ALT,AST,Tbil,AMY,CK,LDH,Fe and GGT.About 80％ of participant laboratories could achieve the optimum performance of biological variation for Urea,UA,TC,TG,ALT,AST,Tbil,C K,and GGT.And the IQC results showed that acceptable percents of different items based on three allowable imprecision were different.More than 80％ of participant laboratories could achieve the minimum allowable imprecision for K,P,Glu,Urea,UA,TC,TG,ALT,AST,Tbil,AMY,CK,LDH,Dbil,Fe,GGT,the desirable imprecision for P,Urea,UA,TG,ALT,AST,Tbil,CK,Dbil,Fe,GGT and the optimum imprecision for TG,ALT,CK,Dbil,Fe.Conclusions The quality specifications derived from biological variation can be as evaluation criteria for EQA and IQC in order to know the detection ability of each laboratory more completely and objectively,set up quality specifications derived from allowable total error and allowable imprecision in routine chemistry and to provide basis for mutual recognition of routine chemistry test results.

Objective To investigate the exercise performance in maintenance dialysis patients,and analyze its correlative factors.Methods Maintenance dialysis patients admitted in Tongji Hospital of Shanghai from December 2014 to March 2015 were enrolled,with their baseline data and biochemical measurement being collected.The anthropometric indexes including arm circumference,triceps skinfold,waist circumference and hip circumference were detected.The exercise activity was assessed by hand grip test,timed up and go test (3mTUG) and five times sit-to-stand test (FTSST).Patients were divided into fast group (3mTUG≤12 s) and slow group (3mTUG ＞ 12 s).Univariate and multivariable analyses were used to evaluate the factors influencing exercise performance in maintenance dialysis.Results There were 121 patients enrolled:62 on peritoneal dialysis and 59 on hemodialysis,76 men and 45 women.Patients' average age was (61.6± 13.0) years and median dialysis age was 31.7(12.3,69.0) months.There was no statistical difference between fast group (n=80) and slow group (n=41) in gender,dialysis method,dialysis age,body mass index (BMI),arm muscle area (AMA),waist-hip ratio (WHR),hemoglobin (Hb) and total cholesterol (TC).Patients in fast group were younger,had higher serum albumin,prealbumin,serum phosphate and iPTH,and less prevalence of diabetes than those in slow group.In exercise activity,patients in fast group had better performance in handgrip,3mTUG and FTSST (all P ＜ 0.05).Univariate analysis showed that,handgrip was correlated with sex (male),AMA,BMI,age,diabetes,serum phosphorus and TC;scores in FTSST was correlated with age,BMI,diabetes,WHR,dialysis method,dialysis age,prealbumin and serum phosphorus;scores in 3mTUG was correlated with age,diabetes,WHR,dialysis method and dialysis age,prealbumin,serum phosphorus and iPTH (all P ＜ 0.05).Multiple stepwise regression analysis showed that sex (male),age,AMA and diabetes were independently correlated with handgrip in dialysis patients (all P ＜ 0.05);age,dialysis method,BMI and diabetes were independently correlated with scores in FTSST (all P ＜ 0.05);age,dialysis method,diabetes and WHR were independently correlated with scores in 3mTUG (all P ＜ 0.05).Conclusions The exercise performances of patients on maintenance dialysis are impaired.Age and diabetes are independent factor associated with the exercise performances of patients on maintenance dialysis.AMA is independently associated with upper limb movement,and dialysis method,BMI and WHR are independent factors associated with lower limb movement in dialysis patients.

Thyroid diseases during pregnancy are highlighted in recent decade by both endocrinologists and gynaecologists.Hyper-and hypothyroidism accompanied with pregnancy may cause side effects on maternal and fetal health,increase the incidence of obstetric complications and impair the development of the fetal nervous system.It is widely accepted that subclinical thyroid dysfunction such as subclinical hypothyroidism,hypothyroxinemia,and thyroid autoimmunity may result in adverse obstetric outcomes.A very crucial work is going on to set up trimester special reference of thyroid function in each clinical laboratory.

China ; Haplopappus ; Humans ; Phytotherapy ; Sesquiterpenes

Objective To investigate the relationships between the levels of plasma soluble CD40 ligand (sCD40L),fetuin-A and pregnancy-associated plasma protein A (PAPP-A) and carotid plaque in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled in the study.Carotid arteries were assessed by using carotid artery ultrasound.The patients were divided into either a carotid artery plaque group or a non-carotid artery plaque group according to the assessment results.The former were further divided into a stable plaque sub-group and an unstable plaque sub-group according the nature of plaque.Enzyme-linked immunosorbent assay was used to detect the levels of plasma sCD40L,fetuin-A and PAPP-A.The demography,previous history,complications,laboratory tests and plasma inflammatory biomarkers between the carotid artery plaque group and the non-carotid artery plaque group and between the stable plaque subgroup and the unstable plaque subgroup were compared.Multivariate logistic regression analysis was used to investigate the relationship between plasma inflammatory biomarkers and carotid plaques.Results A total of 200 patients with acute ischemic stroke were included.Among them,78 were females and 122 were males (aged 33 to 87 years,mean 60.1 ± 10.3 years); 139 patients were in the carotid artery plaque group and 61 were in the non-plaque group; 43 were in the stable plaque subgroup and 96 were in the unstable plaque subgoup.The mean age of the carotid artery plaque subgroup was significantly greater than that in the non-plaque subgroup (63.2 ± 8.7 years vs.50.3 ± 9.5 years; t ＝ 10.179,P =0.000),the constituent ratios of men (68.3％ vs.44.3％;x2＝ 10.336,P＝ 0.001),hypertension (71.2 vs.54.1％;x2=5.540,P=0.019),diabetes (46.8％ vs.29.5％ ;x2 =5.199,P =0.023),and hyperlipidemia (78.4％ vs.37.7％ ;x2 =31.31,P =0.000)in patients of carotid plaque group were significantly higher than those of the non-carotid plaque group.The levels of total cholesterol (5.7 ± 1.1 mmol/L vs.5.3 ± 1.0 mmol/L; t =2.433,P =0.016),low-density lipoprotein cholesterol (4.5 ± 1.0 mmol/L vs.4.1 ±0.9 mmol/L; t =2.683,P =0.008),fasting glucose (7.5 ±2.5 mmol/Lvs.6.4±2.1 mmol/L; t=3.002,P＝0.003),sCD40L (151.4 ± 55.8 pg/mlvs.102.8 ±65.9 pg/ml; t =5.360,P=0.000),fctuin-A (390.1 ± 80.6 μg/ml v.s.352.9 ± 98.6 μg/ml; t =2.591,P =0.011),and PAPP-A (11.49 ±4.67 mIU/L vs.8.46 ± 3.99 mIU/L; t =4.409,P =0.000) were significantly higher than those of the non-carotid plaque group.Multivariate logistic regression analysis showed that hyperlipidemia (odds ratio [OR] 6.582,95％ confidence interval [CI] 2.321-18.662; P =0.000),sCD40L (OR6.372,95％ CI 2.174-18.670;P=0.010),and fetuin-A (OR 4.101,95％ CI 1.012-16.619; P=0.048) were the independent predictors for carotid artery plaques in patients with acute ischemic stroke.The mean age of the stable plaque subgroup was significantly lower than that of the unstable plaque subgroup (59.6 ± 9.3 years vs.64.1 ± 7.2 years; t =3.231,P =0.002).The constituent ratio in patients with hypertension was significantly lower than that of the unstable plaque subgroup (55.8％ vs.78.1％ ; x2 =7.213,P =0.007).The levels of total cholesterol (5.4 ±0.9 mmol/L vs.6.0 ± 1.1 mmol/L; t =3.136,P =0.002),low-density lipoprotein cholesterol (4.0 ± 1.2 mmol/L vs.5.7 ± 1.0 mmol/L; t =8.696,P =0.000),fasting glucose (7.1 ± 2.3 mmol/L vs,7.9 ± 1.9 mmol/L; t =2.147,P =0.034),sCD40L (135.3 ±74.3 pg/ml vs.176.5 ±64.5 pg/ml; t =3.319,P ＝0.001),and PAPP-A (10.96 ± 5.02 mIU/L vs.13.98 ±4.63 mIU/L; t =3.463,P =0.001) were significantly lower than those of the unstable plaque subgroup,while the level of high-density lipoprotein cholesterol was significantly higher than that of the unstable plaque subgroup (1.2 ± 0.2 mmol/L vs.1.1 ± 0.3 mmol/L; t =2.314,P=0.022).Multivariate logistic regression analysis showed that HDL-C (OR 0.234,95％ CI0.060-0.906; P =0.022) was an independent protective factor for unstable plaques,while sCD40L (OR 5.290,95％ CI 1.613-17.351; P =0.029) and PAPP-A (OR4.125,95％ CI 1.281-13.283; P =0.021) were the independent predictors for unstable plaques.Conclusions The levels of sCD40L,PAPP-A,and fetuin-A were associated with the existence and stability of carotid artery plaque.The increased plasma sCD40L and fetuin-A were the independent predictors for carotid artery plaques in patients with acute ischemic stroke,and the increased levels of plasma sCD40L and PAPP-A were the independent predictors for carotid artery plaque instability in patients with acute ischemic stroke.

Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.

Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease (IBD) patients with comorbid autoimmune disease (AD) and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn's disease (CD)+AD group (n=16),CD group (n=26),ulcerative colitis (UC)+AD group (n=38) and UC group (n=48).Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups (all P＞0.05).The most common concomitant AD of IBD was rheumatoid arthritis (20.4％,11/54) and ankylosing spondylitis (13.0％,7/54).The proportion of mild active patients of CD+ AD group was lower than that of CD group (2/16 vs 53.8％ (14/26),x2 =7.180,P=0.007),while the proportion of severe active patients was significantly higher that of CD group (6/16 vs 0,x2 =8.519,P=0.004).There was no statistically significant difference in moderate active patients between the two groups (P=0.808).Main type of patients of UC+ AD group (76.3 ％,29/38) and UC group (68.8 ％,33/48) were moderate active patients.There was no statistically significant difference in disease stage and location (all P＞0.05).The incidence of extraintestinal manifestations of IBD+AD group (55.6 ％,30/ 54) was significantly higher than that of IBD group (9.5 ％,7/74,x2 =32.279,P＜0.01),and the main manifestation was arthritis (37.0％ (20/54) vs 5.4％ (4/74),x2=20.504,P＜0.01).The rate of glucocorticoid and immunosuppressant application in IBD+AD group was higher than that of IBD group (40.7％ (22/54) vs 17.6％(13/74),x2 =8.438,P=0.004;20.4％(11/54) vs 0,x2=14.000,P＜ 0.01).Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.

Objective To research the visualization of congenital heart disease by three-dimensional echocardiographic(3DE) virtual endoscopy(VE) system. Methods Datasets.from 10 healthy children and 22 patients with congenital heart disease were collected (10 patients with atrial septal defects, 6 patients with ventricular septal defects and 6 patients with tetralogy of Fallot). 3DE heart models were reconstructed by virtual reality computing techniques and visualization in scientific computing techniques. The VE system was programmed under the C++ 6.0 language condition,the visualization toolkit (VTK) platform was employed to carry out the graphics and visualization utilities. The virtual eye can move along the navigation paths in the heart by manual camera movements. Results The VE can provide special information in aspects of intracardiac anatomy, The visible heart models show precisely complex anatomy structure and spatial relationships. 3DE intracardiac endoscopic imaging can thus be visualized and navigated successfully by the VE system. Conclusions 3DE VE is a new system for the visualization of congenital heart disease.