Transalveolar technique for sinus floor elevation(TSFE)offers the advantages of minimal invasiveness,reduced postoperative reaction,and shorter operative time for vertical bone augmentation in the maxillary posterior region.The clinical data of one patient with severe deficiency of residual bone height(RBH)in the maxillary posterior region,a blood vessel visible in the lateral wall of the maxillary sinus and a visible septum at the floor of the maxillary sinus were reported,and two-stage flexible TSFE was used to improve the vertical bone height of the operated area while reducing trauma,the risk of Schneiderian membrane rupture and maxillary sinus infection,etc.,and the relevant literatures were reviewed.The patient,male,26 years old,complained of missing left maxillary posterior teeth for more than 1 year and requested restoration.The patient had 27 missing teeth,normal keratinized gingiva,full alveolar ridge,no elongation of the opposing teeth,fair width of the proximal and normal occlusal distance.The results of cone beam CT(CBCT)showed that the distance between the sinus crests at the site of the 27 teeth was about 3 mm,the width of the alveolar bone was about 12.8 mm,the bone density was normal,and there were no residual roots or other abnormalities;no cyst-like lesions were seen in the walls of the maxillary sinuses bilaterally,and separation was seen at the floor of the maxillary sinus on the left side and a blood vessel was seen in the lateral wall of the maxillary sinus.A diagnosis of Kennedy class Ⅱ maxillary tooth defects was made.After two stages of TSFE,the Schneiderian membrane was intact and the bone height of the implant area was elevated to 9.6 mm from 3 mm preoperatively after the completion of the restoration,with stable bone augmentation,good osseointegration,and restoration of normal occlusal function.For the patients with severe bone height deficiency in the maxillary posterior region,flexible two-stage TSFE should be considered,which can help to reduce the risk of maxillary sinus infection and Schneiderian membrane rupture while minimizing the damage and obtaining the ideal bone augmentation results.

Objective:To investigate the clinical characteristics of omphalocele, and to assess the risk factors associated with adverse outcomes.Methods:A retrospective cohort study was conducted. Clinical data of 224 patients diagnosed with omphalocele, who were hospitalized at Children′s Hospital, Zhejiang University School of Medicine from January 2013 to December 2022, were collected. Based on their discharge outcomes, the patients were classified into 2 groups: favorable outcomes and unfavorable outcomes. Chi-square test or continuity correction χ2 test or Fisher exact probability method, and Mann-Whitney U test were used for intergroup comparisons. Logistic regression analysis was performed to identify risk factors associated with adverse outcomes in omphalocele. Results:Among the 224 patients with omphalocele, 126 were male. A total of 208 patients (92.9%) had favorable outcomes, while 16 patients (7.1%) had unfavorable outcomes. In the unfavorable outcomes group, 14 patients had giant omphaloceles, while 100 patients had giant omphaloceles in the favorable outcomes group. The rates of herniation of more than two intra-abdominal organs in the hernial sac, congenital heart defects, patent ductus arteriosus, pulmonary hypertension, sepsis and infection of the hernial sac, were all higher in the unfavorable outcomes group compared to the favorable outcomes group (all P<0.05). Patients with unfavorable outcomes had longer mechanical ventilation time, duration of oxygen use, duration of parenteral nutrition, hospital stays, and higher rates of parenteral nutrition-associated cholestasis compared to those with favorable outcomes (all P<0.01). Multivariate Logistic regression analysis indicated that pulmonary hypertension ( OR=9.39, 95% CI 1.20-73.32), sepsis ( OR=8.59, 95% CI 1.32-55.86), and congenital heart defects ( OR=6.55, 95% CI 1.11-38.73) were all independent risk factors for adverse outcomes in omphalocele (all P<0.05). Conclusions:Infants with omphalocele are prone to complications such as cardiovascular malformations, infections, and pulmonary hypertension. Adverse outcomes in omphalocele are associated with pulmonary hypertension, sepsis, and congenital heart defects.

Objective:To analyze the clinical features of postnatal cytomegalovirus (pCMV) infection in very preterm infants or very low birth weight infants.Methods:This was a case-control study. A total of 50 very preterm or very low birth weight infants who were hospitalized and diagnosed with pCMV infection in the Neonatal Intensive Care Unit of Children′s Hospital, Zhejiang University School of Medicine from January 2019 to June 2024, were enrolled as the pCMV group. Meanwhile, through propensity score matching, each infant in the pCMV group was paired with a very preterm or very low birth weight infant without cytomegalovirus infection during the same period, constituting the control group, also consisting of 50 cases. Subsequently, the pCMV group was divided into a treated subgroup and an untreated subgroup according to antiviral treatment. Clinical data of all enrolled infants, including clinical features, laboratory test results, and clinical outcomes were collected. Differences in relevant parameters were analyzed using with χ2 test or continuity-corrected χ2 test or Fisher′s exact test, independent-samples t test, Mann-Whitney U test as appropriate. Logistic regression was employed to analyze the risk factors, and Spearman correlation analysis was applied for non-normal distribution data or ordinal data. Results:There were no significant differences between the pCMV group and the control group in terms of gestational age, birth weight, proportion of male infants, Apgar score at the 1 st minute and 5 th minute and days of breastfeeding during the first 3 weeks of life (all P>0.05). Compared with the control group, the duration of hospital stay and invasive mechanical ventilation were both longer in the pCMV group (both P<0.05). The risks of bronchopulmonary dysplasia, retinopathy of prematurity, and hearing impairment were all higher in the pCMV group when compared with the control group(all P<0.05). The body weight and body length of the infants in the pCMV group were both lower than those of in the control group at the corrected gestational age of 36 weeks (both P<0.05). pCMV infections were associated with the increased incidence of both necrotizing enterocolitis ( OR=11.50, 95% CI 1.94-68.30, P=0.007) and severe intraventricular hemorrhage ( OR=6.82, 95% CI 1.19-38.97, P=0.031) in very preterm infants or very low birth weight infants. In the treated group, the platelet count was significantly improved after 6-8 weeks of antiviral treatment compared with that before treatment ((245±19)×10 9/L vs. (119±14)×10 9/L, t=5.37, P<0.001). Conclusions:Very preterm infants or very low birth weight infants with postnatal cytomegalovirus infection have longer hospital stay and duration of invasive mechanical ventilation, and are highly susceptible to bronchopulmonary dysplasia, retinopathy of prematurity, hearing impairment, and growth restriction. Antiviral treatment can effectively ameliorate thrombocytopenia in these infants.

Objective To observe the clinical efficacy of Shenshuai Ⅱ Granules on patients with stage 3-4 chronic kidney disease(CKD)with spleen-kidney qi deficiency and damp-heat stasis syndrome and its effects on free fatty acid(FFA)levels.Methods A randomized double-blind clinical trial design was adopted,and 84 cases were included and randomly divided into a control group and a treatment group,with 42 cases in each group.The control group was given placebo granules,and the treatment group was given Shenshuai Ⅱ Granules,once a bag,twice a day,orally taken with warm water;the treatment for both groups lasted 3 months.Clinical efficacy and TCM syndrome efficacy of the two groups were evaluated.Renal function indicators(SCr,BUN,eGFR,24 hUP)and lipid metabolism indicators(FFA,TC,TG,LDL-C,HDL-C,LP(a),ApoA1 and ApoB)were detected and compared before and after treatment.The safety indicators of both groups were monitored.Results The total clinical effective rate of the treatment group was 83.33%(35/42),and the rate of the control group was 35.71%(13/42),with statistical significance(P<0.01);the therapeutic effect of TCM syndrome efficacy of the treatment group was 88.10%(37/42),and the rate of the control group was 40.48%(17/42),with statistical significance(P<0.01).Compared with before treatment,the levels of SCr,BUN,24-hour UP,FFA decreased in the treatment group,and eGFR increased(P<0.05,P<0.01).After treatment in the control group,SCr increased,while eGFR decreased(P<0.01).After treatment,the SCr,BUN and FFA levels in the treatment group were lower than those in the control group(P<0.01).There was no statistical significance in TC,TG,LDL-C,HDL-C,Lp(a),ApoA1 and ApoB between the two groups before and after treatment(P>0.05).No abnormal changes were observed in the safety indicators of the two groups of patients(P>0.05).Conclusion Shenshuai Ⅱ Granules integrated treatment with Western medicine can improve clinical symptoms and renal function-related indicators on patients with stage 3-4 CKD with spleen-kidney qi deficiency and damp-heat stasis syndrome,reduce serum FFA,and delay the progression of CKD.

This paper focuses on the application of health big data in cancer screening. Firstly, the sources and characteristics of health big data are introduced, then the commonly used epidemiological designs and analytical techniques in hospital-based cancer screening studies are summarized and the application scenarios of such studies are described. Finally, the challenges and future development in the application of health big data are analyzed to provide reference for the future studies.

Compared with conventional transdermal drug delivery systems, dissolving microneedles significantly enhance drug bioavailability by penetrating the stratum corneum barrier and achieving intradermal drug delivery. In order to improve the transdermal bioavailability of dexmedetomidine hydrochloride, in this study, a novel microneedle delivery system was developed for dexmedetomidine hydrochloride based on 3D printing combined with micro-molding. By systematically optimizing the microneedle geometrical parameters, array arrangement, and preparation process parameters, we determined the optimal ratio of drug-carrying matrix as 15% PVP (polyvinyl pyrrolidone) K90. The microneedles exhibited significant drug loading gradients, with mean content of (209.99±27.56) μg/patch, (405.31±30.31) μg/patch, and (621.61±34.43) μg/patch. They showed a regular pyramidal structure under SEM and handheld electron microscopy, and their mechanical strength allowed effective penetration into the stratum corneum. The surface contact angles were all < 90°, indicating excellent hydrophilicity. The microneedles dissolved completely within 10 min after skin insertion, achieving a cumulative release rate of 90% (Higuchi model, r=0.996) during 2 hours of in vitro transdermal permeation. The cytotoxicity test and hemolysis test verified good biocompatibility. Pharmacodynamic evaluation showed that the microneedle group demonstrated pain-relieving effect within 15 min, with the pain threshold at the time point of 60 min being 3 times that in the transdermal cream group. The microneedle system developed in this study not only offers an efficient drug delivery option for patients but also establishes an innovative platform for rapid percutaneous delivery of hydrophilic drugs, demonstrating significant potential in perioperative pain management.
Dexmedetomidine/pharmacokinetics* ; Printing, Three-Dimensional ; Needles ; Drug Delivery Systems/methods* ; Administration, Cutaneous ; Animals ; Microinjections/instrumentation* ; Skin Absorption ; Skin/metabolism*

In recent years,the global prevalence of myopia has remained high,seriously endangering the eye health of adolescents.A large number of studies have confirmed that orthokeratology lens can control or delay the progression of my-opia and reduce the incidence of fundus lesions in high myopia.Although the efficacy of myopia control with orthokeratolo-gy has been widely recognized,its exact mechanism of action is still unclear,and there are many hypotheses.This paper re-views the role of factors such as accommodation,defocus,choroidal thickness,high-order aberrations and biomechanics in myopia control with orthokeratology,and explores how these factors jointly affect the development of myopia.

This paper focuses on the application of health big data in cancer screening. Firstly, the sources and characteristics of health big data are introduced, then the commonly used epidemiological designs and analytical techniques in hospital-based cancer screening studies are summarized and the application scenarios of such studies are described. Finally, the challenges and future development in the application of health big data are analyzed to provide reference for the future studies.

In recent years,the global prevalence of myopia has remained high,seriously endangering the eye health of adolescents.A large number of studies have confirmed that orthokeratology lens can control or delay the progression of my-opia and reduce the incidence of fundus lesions in high myopia.Although the efficacy of myopia control with orthokeratolo-gy has been widely recognized,its exact mechanism of action is still unclear,and there are many hypotheses.This paper re-views the role of factors such as accommodation,defocus,choroidal thickness,high-order aberrations and biomechanics in myopia control with orthokeratology,and explores how these factors jointly affect the development of myopia.

Objective To observe the clinical efficacy of Shenshuai Ⅱ Granules on patients with stage 3-4 chronic kidney disease(CKD)with spleen-kidney qi deficiency and damp-heat stasis syndrome and its effects on free fatty acid(FFA)levels.Methods A randomized double-blind clinical trial design was adopted,and 84 cases were included and randomly divided into a control group and a treatment group,with 42 cases in each group.The control group was given placebo granules,and the treatment group was given Shenshuai Ⅱ Granules,once a bag,twice a day,orally taken with warm water;the treatment for both groups lasted 3 months.Clinical efficacy and TCM syndrome efficacy of the two groups were evaluated.Renal function indicators(SCr,BUN,eGFR,24 hUP)and lipid metabolism indicators(FFA,TC,TG,LDL-C,HDL-C,LP(a),ApoA1 and ApoB)were detected and compared before and after treatment.The safety indicators of both groups were monitored.Results The total clinical effective rate of the treatment group was 83.33%(35/42),and the rate of the control group was 35.71%(13/42),with statistical significance(P<0.01);the therapeutic effect of TCM syndrome efficacy of the treatment group was 88.10%(37/42),and the rate of the control group was 40.48%(17/42),with statistical significance(P<0.01).Compared with before treatment,the levels of SCr,BUN,24-hour UP,FFA decreased in the treatment group,and eGFR increased(P<0.05,P<0.01).After treatment in the control group,SCr increased,while eGFR decreased(P<0.01).After treatment,the SCr,BUN and FFA levels in the treatment group were lower than those in the control group(P<0.01).There was no statistical significance in TC,TG,LDL-C,HDL-C,Lp(a),ApoA1 and ApoB between the two groups before and after treatment(P>0.05).No abnormal changes were observed in the safety indicators of the two groups of patients(P>0.05).Conclusion Shenshuai Ⅱ Granules integrated treatment with Western medicine can improve clinical symptoms and renal function-related indicators on patients with stage 3-4 CKD with spleen-kidney qi deficiency and damp-heat stasis syndrome,reduce serum FFA,and delay the progression of CKD.