Objective: To investigate the long-term effects of GnRHa treatment on final height gain, gonadal function, and body mass index(BMI) in children with central precocious puberty(CPP) or early and fast puberty(EFP), and to explore the influencing factors of height gain and early predictors. Methods: Fifty patients with CPP and 44 patients with EFP who were treated with GnRHa for more than 2 years were enrolled(80 females and 14 males). Body height, bone age, BMI, gonads hormone, uterus and ovarian volumes(female), testicular volume(male), and other parameters before and after treatment were measured. Results: (1)For girls: GnRHa plus GH treatment gained more final height compared with GnRHa treatment [(10.69±5.73) cm vs (7.42±5.76) cm, P<0.05]. Height lost >5cm at the initial treatment benefited much more for the final height compared with height lost<5cm [(10.65±3.32) cm vs (6.51±3.40) cm, P<0.01]. The proportion of overweight/obesity decreased when reaching the final height compared with the initial treatment and stopping the treatment. Serum LH level, uterine and ovarian volume were significantly decreased after stopping treatment compared with before treatment, and increased half a year to 1 year after stopping treatment.100% of girls had menarche and 95% reached the regular cycle 3 years after stopping treatment.(2)For boys: GnRHa plus GH treatment and GnRHa treatment gained height by(8.78±5.2) and(7.99±4.82) cm, respectively. Serum LH level and testicular volume were significantly decreased after stopping treatment as compared with those before treatment, and increased for half a year to 1 year after stopping treatment. Conclusion GnRHa treatment can significantly improve the final height for girls with CPP and EFP. The patients with more height lost could gain more height, which can be used as a predictor of height gain.

Objective: To analyze the risk factors of frequent gout flare, and to evaluate its susceptibility to identify patients with≥2 acute attacks per year. Methods: A total of 579 of cases gout patients with no history of taking urate lowering treatment (ULT) in recent 12 months were enrolled. The patients were divided into frequent group (gout episodes≥twice per year) and non-frequent group(gout attacksResults: There were significant differences in involvement of upper limb joints, tophi, combining hypertension and renal stone between two groups. The two groups had no statistical differences in family history, gender, history of smoking and drinking, ratios of regular exercise, and combining diabetes, hepatic insufficiency, hypertriglyceridemia, hypercholesterolemia, and overweight/obesity. There was significant differences in the number of joints involved, the history of disease duration, the level of SUA and TG[(4.66±2.54) vs (2.77±1.64), (6.68±5.11) vs (5.14±3.89) years, (525.82±132.11) vs (489.33±139.81) μmol/L, (2.51±1.94) vs (2.05±1.22) mmol/L, P<0.05 or P<0.01]; There were no statistical differences in age of onset, SBP, DBP, age of initial diagnosis, fasting blood glucose, TC, creatinine, glomerular filtration rate, AST, ALT, body mass index, waist circumference, and waist-to-hip ratio. Logistic regression analysis indicated that a large number of joints involved and higher serum uric acid level were risk factors of frequent gout attacks. The ROC curve showed that the number of joints involved had qualified performance in identifying patients with frequent gout attacks. When the number of joints involved was >2, and the sensitivity, specificity, positive predictive value and negative predictive value were 77.8%, 43.3%, 85.6%, and 56.6%, respectively, and the difference was significant. Conclusion Higher SUA and a larger number of joints involved associate independently with frequent gout attacks. The number of joints involved at initial diagnosis>2, which can predict the frequent flare, and start ULT as earlier as possible. Patients with joints involved at initial diagnosis>2 are at greater risk of frequent gout flare.

Objective: To investigate the risk factors for susceptibility of abnormal liver function in patients with gout. Methods: A total of 5 044 cases of male gout patients in remission were selected and divided into normal liver function group with 3 693 patients and abnormal liver function group with 1 351 patients. The clinical information was collected and relevant biochemical indices were detected. Serum uric acid(SUA) was divided into quartiles, and its associations with elevated ALT were evaluated. Results: There were significant differences in the history of drinking, family history, combining with hyperlipidemia, fatty liver, and coronary heart disease between the abnormal liver function group and normal function group(P<0.05 or P<0.01). There were significant statistical differences in age, disease duration, body mass index, waist circumference, diastolic blood pressure, serum cholesterol and triglyceride, uric acid, and creatinine clearance rate between 2 groups(P<0.01), while without significant difference in history of smoking, regular exercise, combining hypertension and diabetes, the means of systolic blood pressure, and fasting blood glucose(all P>0.05). Further logistic regression analysis indicated that body mass, waist circumference, combining fatty liver, higher SUA level, higher cholesterol and triglyceride were risk factors of the early onset of abnormal liver function. ALT and the proportion of abnormal liver function were increased with the increase of UA. After adjustment for BMI, TG, TC and fatty liver, the ALT level and the proportion of abnormal liver function decreased significantly while still showed an upward trend. Conclusion Patients with obesity, high level of uric acid, high blood lipids and fatty liver were more likely to develop abnormal liver function, SUA was independently associated with elevated ALT.

Objective: To screen gene mutation information of gout pedigree through whole genome sequencing and to carry out preliminary analysis. Methods: One typical gout pedigree was selected as the study subjects. The clinical data and the peripheral blood samples were collected and constructed charts of the pedigree. DNAs were extracted from peripheral blood and analyzed by the whole genome sequencing, and by the software analysis and comparison, screening out the pathogenic genes and related mutations. Then the verifications were conducted in the family members and the controls. Bioinformatics software was applied to predict the effect of mutation on gene expression. Results: Based on the sequencing results, advanced informational analysis was performed to screen out the mutations 1040-8 A> G near the 5 ′end near the exon 8 of the PLAA gene. The results showed that all the gout patients in the family had 1040 -8 A> G sites, and none of the mutants were found in the non-gout group and 200 controls; bioinformatics analysis suggested that the mutation could affect PLAA gene expression, but not affecting PLAA mRNA structure. Conclusion PLAA gene 1040-8 A> G mutation is separated from patients in the gout pedigree, and the newly discovered PLAA gene may act as a gout pathogenic gene.

Objective:To investigate the effect of concentrated growth factor (CGF) on proliferation and differentiation in Beagle adipose-derived stem cells (ADSCs).Methods:ADSCs were isolated from adipose tissue of healthy Beagles and cultured.The multidirectional differentiation potential of ADSCs was identified.The ADSCs were assigned to a CGF group and a control group.The rate of proliferation was analyzed by CCK-8 assay.The osteogenic differentiation capability was detected by ALP staining after the osteoinduction.Bone formationrelated gene expression was detected by RT-PCR.Results:CGF promoted the proliferation of ADSCs in vitro.ADSCs in the CGF group showed higher level of ALP activity than that in the control group (P＜0.05).CGF stimulated the expression of the genes associated with osteogenesis,such as Col-I and Runx2.Conclusion:CGF can promote the proliferation and osteogenic differentiation in ADSCs in vitro.

Objective To evaluate the effect of individualized rehabilitation extended nursing on activities of daily living (ADL) in children with cerebral palsy. Methods A total of 156 cases of non-operative children with severe disorder of cerebral palsy from January to December 2017 in Sichuan 81 Rehabilitation Center, of 101 males and 55 females, aged 2-7 years with weighting 9 to 21 kg, were divided into 2 groups according to the time sequence, of which 70 cases of January to June 2017 before extension nursing as control group and 86 cases of July to December 2017 after extension nursing as observation group. The control group was received routine nursing according to the ADL rating scale, and the observation group was adopted the extended nursing method, according to the ADL rating scale to evaluate and judge the barrier grade, and chosen the suitable measures for rehabilitation nursing according to the individualized principle.The rehabilitation assessment was carried out before extended nursing (W0), the second week after extended nursing (W2), fourth week (W4), sixth week (W6), eighth week (W8), tenth week (W10), and twelfth week (W12) respectively. Results There was no significant difference in gender, age, weight and ADL scores at the time point of W0between the two groups (P>0.05). The ADL scores of the two groups were increased with the treatment time, and the increase of the observation group was greater than that of the control group. Compared with the control group, the ADL scores of the observation group were increased significantly at the time of W4to W12(P<0.01).After 12 weeks of treatment, there were 25 cases of mild disorders (29% ), 46 cases of moderate disorder (53.5% ) and 15 cases of severe disorder (17.5% ) in the observation group, and 3 cases of mild disorders (4.3% ), 38 cases of moderate disorder (54.3% ) and 29 cases of severe disorder (41.4% ) in the control group, and the observation group was obviously better than that of the control group (χ2＝21.083,P＜0.01). Conclusion Individualized rehabilitation extended nursing can improve ADL in children with cerebral palsy.

Objective Obesity is one of the risk factors for gout.The aim of the present study was to evaluate clinical characteristics of gout patients with different BMI.Methods A total of 5 104 patients with gout were enrolled and divided into three groups according to the BMI.The clinical information was collected and relevant biochemical indices were detected.SPSS software was applied for the statistical analyses.Results There were significant differences in the ratios of gender,regular exercise,hypertension,tophus,renal insufficiency,hyperlipidemia,impaired glucose metabolism,liver dysfunction among the three groups (all P＜0.01).The onset age in overweight [45(36,55) years] and obese subjects [40(31,50)years] were earlier than that of the normal weight subjects [50 (38,61) years].Moreover,waist circumstances [103(99,108) cm and 94 (90,98) cm vs 87 (82,91) cm],systolic pressure [130 (120,145) mmHg (1 mmHg =0.133 kPa) and 130 (120,140) mmHg vs 128 (115,140) mmHg],diastolic pressure [90 (80,100) mmHg and 85 (80,92) mmHg vs 80 (79,90) mmHg],fasting blood glucose [5.77 (5.30,6.44) mmol/L and 5.65 (5.19,6.26) mmol/L vs 5.55 (5.10,6.15) mmol/L],TG [2.10 (1.46,3.04) mmol/L and1.88 (1.35,2.78) mmol/L vs 1.52 (1.07,2.39) mmol/L],TC [5.20 (4.55,5.93) mmol/L and 5.07 (4.46,5.75) mmol/L vs 4.95 (4.27,5.65) mmol/L],serum uric acid [483(418,552) μmol/L and461(395,524) μmol/L vs440 (368,517) μmol/L],ALT [30 (21,46) U/L and25 (18,36) U/L vs 21 (14,29) U/L],AST [21(17,28) U/L and 20 (17,26) U/L vs 20 (6,25) U/L],the number of joints involved [2 (1,3) joints and 2 (1,2) joints vs 1 (1,2) joints] in the overweight and obese groups were higher than those in the normal weight group (all P ＜ 0.01).There were no statistical differences in family history,involvement of upper limb joints,kidney stones and coronary heart disease among the three groups (all P ＞ 0.05).Conclusions Obesity is associated with an earlier age of gout onset.With the increase of BMI,the blood pressures,glucose,lipid,serum uric acid,liver transaminase levels and the number of involved joints increased gradually.Cautions should be taken in treating patients with different BMI.

Objective To discuss the risk factors for susceptibility of subcutaneous tophi with an aim to provide clinical evidence for the prevention and treatment of tophi.Methods A total of 5 321 cases of gout patients whose course of disease was less than 10 years were selected and divided into two groups according to whether a subcutaneous tophus was present. The clinical information was collected and relevant biochemical indices were detected.Results There were significant differences in the ratios of regular exercise, involvement of upper limb joints, combining renal insufficiency, kidney stone and coronary heart disease between the tophus group and the non-tophus group(P<0.05 or P<0.01). There were significant statistical differences in age, disease duration, body mass index, systolic blood pressure, diastolic blood pressure, serum uric acid, serum creatinine, creatinine clearance rate, the number of joints involved between the two groups[(51.80±14.58 vs 48.45±14.45)year,(5.61±3.20 vs 3.28±3.06)year,(26.50±3.39 vs 27.05±3.45)kg/m2,(138±20 vs 133±18)mmHg, 1 mmHg=0.133 kPa,(89±13 vs 87±12)mmHg,(486.66±121.96 vs 460.02±119.10) μmol/L,(112.11±62.97 vs 104.43±46.28) μmol/L, (86.46±37.99 vs 93.00±40.11 )ml/min,(2.89±1.86 vs 1.76±1.22) joints, all P<0.01]. There were no statistical differences in family history, gender, history of smoking and drinking, the means of waistline, fasting blood glucose, triglyceride, and total cholesterol between the two groups(all P>0.05). Further logistic regression analysis indicated that disease duration, a large number of joints involved, the involvement of upper limb joints, combining kidney stones, higher serum uric acid level, and higher diastolic pressure were risk factors of the early onset of subcutaneous tophi, while regular exercise and body mass index were protective factors.Conclusion Patients with long duration, high serum level of uric acid, a large number of joints involved, upper limb joint involved, kidney stones, and hypertension were more likely to develop subcutaneous tophi. These risk factors should be intervened actively in clinic.

Objective To explore the interventional treatment method for complex and refractory lymphatic malformation in children.Methods The clinical data of 78 cases with complex and refractory lymphatic malformation during January 2013 to January 2016 in our department were retrospectively analyzed.The lesions involved the neck in 28 cases,maxillofacial regions in 19 cases,the chest and armpit in 8 cases,the limb in 7 cases,the pelvic cavity and retroperitoneal space in 6 cases,the superior mediastinum in 3 cases,the hypogloeeis in 3 cases and scrotum or perineum region in 4 cases.All the children underwent ultrasound or MRI imaging studies preoperatively.The interventional procedures included:(1) Percutaneous puncture of the LM for sclerotherapy.The lesions were punctured with 20 G needle under the guidance of DSA or ultrasound and the correct positions were confirmed with angiography.The liquid of the lesions was extracted as far as possible.The dosage of sclerosing agents was adjusted according to the size of lesion.The dose of Laurolacrogol injection was 1/10—1/5 of the amount of the liquid in the lesions and the maximum of Laurolacrogol foam was ≤8 ml(20 mg).The dose of Pingyangmycin was ≤ 8 mg.(2) The drainage catheter placement and sclerotherapy.Percutaneous catheter drainage under ultrasound guidance or by surgery was conducted.The liquid in the lesions was drained by retaining the catheter for 1-4 weeks,and sclerotherapy was applied for several sessions during this period.(3) Treatment for one time a week,2 times a session.The interval of every two sessions was 4 weeks.The sclerosing agents included:Laurolacrogol Injection or Pingyangmycin for the lesions with high tension,Laurolacrogol foam for the lesions with low tension,Pingyangmycin for the microcystic lesions.Statistical analysis was conducted using SPSS20.0 software.Results A total of 208 sessions of sclerotherapy for 78 LM patients were performed and average session was (3.0±0.8).Nine patients used Lauromacrogol foam,23 patients used Lauromacrogol Injection,39 patients used pingyangmycin,while combined treatment was conducted in 7 patients.Laurolacrogol injection was used in 20 cases,Pingyangmycin in 29 cases and combination therapy in 5 cases for the high tension lesions in the neck,maxillofacial,chest and armpit.The low tension lesions of pelvic cavity and retroperitoneal space in 6 cases and of superior mediastinum in 3 cases were placed with draining catheters,and treated with sclerotherapy with Laurolacrogol foam.Three cases with hypogloeeis LM was neonates,who were treated with Laurolacrogol injection.The lesions on the limb and scrotum or perineum region were almost microcystic,were treated with Pingyangmycin in 9 cases and with combination therapy in 2 cases.The total curative rate was 97.4％ (76/78),total effective rate was 100％ (78/78).Imaging examinations showed that the cavities were closed or only a small amount of residual sclerotic lesions were present.Clinical examinations showed that the surface masses almost disappeared.The follow up period was 6 months to 2 years.There were no serious complication and adverse reactions occurred.Conclusions Interventional treatment is a safe,effective,and minimally invasive treatment for the complex and refractory lymphatic malformation.In order to receive the best treatment effect,we should use targeted therapy for different region and type of LM.

According to the onset age, a total of 5 674 outpatients with gout admitted in the affiliated hospital of Qingdao University from January 2011 to January 2016 were divided into youth group (≤44 years, n=3 058), middle age group (45~64 years, n=2 101), and elderly group (≥65 years, n=515).Their clinical and biochemical characteristics were analyzed.The results showed that the proportion of gout in the males in three groups was higher than that in the females.The proportions of gout in male youth, middle age, and elderly groups were 98.1%, 93.4%, and 83.1%, respectively.The proportion of gout in females increased with age.The proportion of gout family history in youth group was higher than that in middle age and elderly groups(P<0.05).The proportions of hypertension and impaired fasting glucose(IFG) in elderly group were higher than those in youth and middle age groups (P<0.05), with lower proportions of hypertriglyceride and obesity (P<0.05).The levels of systolic blood pressure, blood urea nitrogen, creatinine in elderly group were increased compared with youth and middle age groups (P<0.05) while the levels of uric acid and triglyceride were decreased (P<0.05), with higher ratio of renal dysfunction (P<0.05).There were no differences in tophus and kidney calculi among three groups (P>0.05).The distributions of the onset joint among three groups revealed statistical difference(P<0.05), but the first plantar toe joint was mostly involved in each group.These results suggest that the clinical characteristics of patients with gout at different onset ages are not identical, should be treated differently.