Objective : To classify the furcation involvement (FI) of endodontically treated mandibular first permanent molars based on cone beam computed tomography (CBCT), provide reference for individualized treatment of FI. Methods: CBCT images of the FI of 164 endodontically treated mandibular first permanent molars from 163 patients in Nanjing Stomatological Hospital, Medical School of Nanjing University were collected retrospectively. On the CBCT images, the shape and extent of periapical and periodontitis bone resorption, the thickness of residual dentin in the pulp floor and root canal wall, and the periodontal bone resorption of the complete dentition were evaluated. The FI was classified into periodontal, periapical, perforated and mixed types. Results: Among the 164 FIs of endodontically treated mandibular first permanent molars, the periapical type was the most common (41.5%), followed by the mixed type (26.2%), perforated type (18.3%), and periodontal type (14.0%). Among the 68 periapical-type FIs of endodontically treated mandibular first permanent molars, 48.5% were proper root canal filling, 44.1% were insufficient filling and 7.4% were overfilling. Among the 43 mixed-type FIs, the periodontal mixed periapical type was the most common (72.1%). Conclusion Detailed evaluation and classification of furcation involvement could be performed using CBCT images; therefore, the study has guiding significance for clinical treatment.

Objective: To analyze the expression and clinical prognostic significance of nuclear Dbf2-related kinase 1 ( NDR1 ) in hepatocellular carcinoma ，and to investigate the biological function and regulatory mechanism of NDR1 in hepatocellular carcinoma cells． Methods: ENCORI database was used to analyze the correlation of NDR1 and c-Myc．Cycloheximide ( CHX) experiment analyzed the relationship between NDR1 and c-Myc protein stability．The expression levels of NDR1 in liver cancer tissues and normal tissues and its relationship with the survival rate of liver cancer patients were analyzed using the ENCORI database．MYC-NDR1 eukaryotic expression vector was constructed，transfected with hepatocellular carcinoma HepG2 cells，and its expression was verified by protein immuno blotting (Western blot) ; cell proliferation and migration ability were detected by CCK-8 assay，cell clone formation assay and scratch assay，respectively．The correlation between NDR1 and c-Myc expression was analyzed using the ENCORI database，and the relationship between NDR1 and c-Myc protein was investigated using a protein synthesis inhibitor CHX dosing assay. Results: The results of the ENCORI database showed that the expression of NDR1 in liver cancer tissues was higher than that in normal tissues and the overall survival rate of patients with high NDR1 expression was lower than that of patients with low NDR1 expression，and the difference was statistically significant (P＜0. 001) ．The results of the CCK-8 assay showed that the MYC-NDR1 group grew faster than the empty vector group (P＜0. 001) ．The clone formation assay showed that the number of clones in the MYC-NDR1 group was higher than that in the empty vector group (P＜0. 001) ．The cell scratch assay showed that the mean migration distance in the MYC-NDR1 group was greater than that in the empty vector group (P＜0. 001) ．ENCORI database analysis showed that NDR1 correlated with c-Myc expression (R = 0. 184，P＜0. 001) ; CHX dosing assay showed that the reduction of c-Myc protein in the MYC-NDR1 group was lower than that in the empty vector group during the same time． Conclusion NDR1 is highly expressed in hepatocellular carcinoma tissues，closely correlated with poor prognosis of hepatocellular carcinoma patients ，and positively correlated with the expression of c-Myc gene. The study successfully constructes MYC-NDR1 eukaryotic expression vector ，and the expression product MYC- NDR1 can increase the stability of c-Myc protein and promote the proliferation and migration of human hepatocellu- lar carcinoma cells.

Objective:To investigate the clinical characteristics and changing trends of primary liver cancer in Yunnan province from 2005 to 2014, in order to provide theoretical basis for the prevention and treatment of liver cancer in this region.Methods:A retrospective survey was used to select inpatient cases of liver cancer who were initially diagnosed and treated in our hospital from 2005 to 2014 with simple random sampling. Patients socio-demographic and clinicopathological characteristics were extracted by a unified and standardized questionnaire, and the data were statistically analyzed.Results:A total of 1000 cases with liver cancer were included, aged (53.2±11.2) years, with a male-to-female ratio of 5.99/1.00. There was no significant change in the gender and age composition ratio of patients in the past 10 years. The proportion of patients with lower education level (primary or junior high school) were increased from 21.8% to 23.4%, and the proportion of patients with relatively higher education level were decreased from 58% to 38.2% ( P<0.001). Smokers and non-smokers patients were decreased and increased from 58.8% to 44.4%, and 41.2% to 55.6% ( P<0.001). The proportion of drinker patients were decreased from 46.4% to 35.2%. The proportion of patients with advanced liver cancer (stage C and D) were increased, while the proportion of patients with stage A and B showed a downward trend ( P<0.001). The proportion of HBsAg-positive patients showed an upward trend, that is, rising from 69% in 2005 to 82% in 2014 ( P=0.043). The proportion of HBeAg-positive patients showed a steady trend ( P=0.008). The use rate of ultrasound examination in patients with liver cancer were decreased from 91.0% to 58.0% ( P=0.001), while the use rate of computed tomography (CT), MRI, and PET/CT examinations were increased from 81.0% to 84.0% ( P=0.05), 0 to 22% ( P<0.001), and 0 to 3% ( P=0.026) between 2005 to 2014. The proportion of surgical patients were increased ( P=0.005), but the proportion of interventional patients did not change significantly ( P=0.590). Surgery and interventional therapy were the most common treatment methods, and the proportion of patients treated with surgery over the past 10 years showed an upward trend ( P=0.005), while the proportion of interventional therapy remained at a high level with no significant change ( P=0.590). Conclusion:In Yunnan province, the incidence of liver cancer increases with age, and the proportion of male with liver cancer is almost six times that of women. Moreover, the low positive rate of alpha-fetoprotein levels and advanced clinical stage in this region are presently the main challenges against the liver cancer prevention and treatment. The application scope of CT, magnetic resonance imaging, PET-CT and other examination methods has gradually expanded, but the treatment methods are still mainly surgery and interventional therapy.

Objective:To investigate the etiology of necrotizing pneumonia (NP) in children and the clinical characteristics of NP caused by different pathogens in China.Methods:A retrospective, case-control study was performed in children with NP who were admitted to 13 hospitals in China from January 2008 to December 2019. The demographic and clinical information, laboratory data, etiological and radiological findings were analyzed. The data were divided into three groups based on the following years: 2008-2011, 2012-2015 and 2016-2019, and the distribution characteristics of the pathogens in different period were compared. Meanwhile, the pathogens of pediatric NP in the southern and northern China were compared. And the clinical characteristics of the Mycoplasma pneumoniae (MP) NP and the bacterial NP were also compared. T-test or Mann-Whitney nonparametric test was used for comparison of numerical variables, and χ 2 test was used for categorical variables. Results:A total of 494 children with NP were enrolled, the median ages were 4.7 (0.1-15.3) years, including 272 boys and 222 girls. Among these patients, pathogens were identified in 347 cases and the pathogen was unclear in the remaining 147 cases. The main pathogens were MP (238 cases), Streptococcus pneumoniae (SP) (61 cases), Staphylococcus aureus (SA) (51 cases), Pseudomonas aeruginosa (13 cases), Haemophilus influenzae (10 cases), adenovirus (10 cases), and influenza virus A (7 cases), respectively. MP was the most common pathogen in all three periods and the proportion increased yearly. The proportion of MP in 2016-2019 was significantly higher than that in 2012-2015 (52.1% (197/378) vs. 36.8% (32/87), χ 2= 6.654, P=0.010), while there was no significant difference in the proportion of MP in 2012-2015 and that in 2008-2011 (36.8% (32/87) vs. 31.0% (9/29), χ2=0.314, P=0.575).Regarding the regional distribution, 342 cases were in the southern China and 152 in the northern China. Also, MP was the most common pathogen in both regions, but the proportion of MP was higher and the proportion of SP was lower in the north than those in the south (60.5% (92/152) vs. 42.7% (146/342), χ 2=13.409, P<0.010; 7.9% (12/152) vs. 14.3% (49/342), χ 2= 4.023, P=0.045). Comparing the clinical characteristics of different pathogens, we found that fever and cough were the common symptoms in both single MP and single bacterial groups, but chest pain was more common (17.0% (34/200) vs. 6.1% (6/98), χ 2=6.697, P=0.010) while shortness of breath and wheezing were less common in MP group (16.0% (32/200) vs. 60.2% (59/98), χ 2=60.688, P<0.01; 4.5% (9/200) vs. 21.4% (21/98), χ 2=20.819, P<0.01, respectively). The white blood cell count, C-reactive protein and procalcitonin in the bacterial group were significantly higher than those in the MP group (14.7 (1.0-67.1)×10 9/L vs. 10.5 (2.5-32.2)×10 9/L, 122.5 (0.5-277.3) mg/L vs. 51.4 (0.5-200.0) g/L, 2.13 (0.05-100.00) μg/L vs. 0.24 (0.01-18.85) μg/L, Z=-3.719, -5.901 and -7.765, all P<0.01). Conclusions:The prevalence of pediatric NP in China shows an increasing trend during the past years. MP, SP and SA are the main pathogens of NP, and the most common clinical symptoms are fever and cough. The WBC count, C-reactive protein and procalcitonin in bacterial NP are significantly higher than those caused by MP.

BACKGROUND: Lung cancer is the most common neoplasmas with a poor prognosis and a low 5-year survival rate. Early screening is an important measure for the prevention and treatment of lung cancer. At present, different countries have issued corresponding lung cancer screening guidelines, but China still lacks guidelines based on Chinese population research. Therefore, the National Cancer Center launched a Multi-center Cancer Screening Program in Urban China. This study analyzed the evaluation of lung cancer risk assessment model and screening effect in urban China of Yunnan, so as to explore the evaluation model of high-risk lung cancer population suitable for China's national conditions and develop lung cancer screening guidelines for Chinese. METHODS: A questionnaire survey and lung cancer risk assessment were conducted on 165,337 people in 36 street offices in 4 main urban areas of Kunming, Yunnan Province, using cluster sampling method from January 2015 to December 2019. People with high-risk of lung cancer conducted low-dose computed tomography (LDCT) screening of chest. What's more, all participants were followed up by active or passive follow-up. RESULTS: There were 264 patients were diagnosed lung cancer by pathology, and the overall incidence of lung cancer was 0.16% (264/165,337). The high-risk group (0.31%, 116/37,914) was higher than the non-high-risk group (0.12%, 148/127,423), and the difference was statistically significant (P<0.001). The incidence of lung cancer in the high-risk group was higher than the non-high-risk group among the male, female, and lower 50-year-old or more than 50-year-old subgroups, with statistical differences (P<0.001), but there was no statistical difference in the group without LDCT screening (P=0.73). The sensitivity of the lung cancer high-risk population assessment model was 43.94% (116/264) and the specificity was 77.10% (127,275/165,073). The early diagnosis rate of the screening group was 72.97% (54/74), which was significantly higher than that of the non-screening group [28.48% (43/151)]. CONCLUSIONS The lung cancer high-risk population assessment model of National Key Public Health Program: Cancer Screening Program in Urban China can detect high-risk populations and improve the early diagnosis rate of lung cancer effectively.

Objective: To investigate the change and association of glioma-associated oncogene homolog 1 (Gli1) and β-catenin on bone formation in rats with chronic fluorosis which were inhibited by cyclopamine (Cycl). Methods: Forty-eight Sprague-Dawley rats were evenly divided to four groups, including control, F, F+Cycl and F+DMSO groups. The control group were fed with tap water (NaF<1 ppm). The F, F+Cycl and F+DMSO groups were exposed to NaF (50 ppm) in drinking water as the chronic fluorosis model. Then the rats in F+Cycl or F+DMSO groups were injected by Cycl or DMSO after 6 months, respectively. Urine fluoride concentration was detected using fluorine ion selective electrode. The enzyme-linked immunosorbent assay (ELISA) was used to detect bone alkaline phosphatase (BALP). Bone tissues were stained with hematoxylin-eosin. The mRNA and protein expression of Gli1 and β-catenin in bone tissue were detected using real-time PCR, immunohistochemistry and Western blot. Results: Compared with the controls, the urine fluoride concentration and the width and volume of bone trabeculae were increased in the F, F+Cycl and F+DMSO groups, but no statistical difference among the 3 fluorosis groups. The concentration of BALP was increased in the F group and decreased in F+Cycl group (P<0.05). The expression of Gli1 and β-catenin mRNA and protein was higher in the F and F+Cycl groups than controls, but lower in the F+Cycl group than in the F group. There was positive correlation between the expression of Gli1 and β-catenin (r=0.476, P<0.05). The expression of Gli1 and β-catenin was also associated with BALP concentration and volume of bone trabeculae, respectively (r₁=0.457, r₂=0.466, r₃=0.581, r₄=0.554, respectively, P<0.05 for all). Conclusions The expression of Gli1 can be inhibited by Cycl. It may be involved in the bone formation of rats with chronic fluorosis. It may also affect the expression of β-catenin, which is an osteogenesis factor.

Objective:To investigate the expression changes of Hedgehog related factors (Ihh, Shh and Smo) in bone of rats with chronic fluorosis, and the significance.Methods:Thirty-six healthy SD rats were divided to three groups with the method of random digits table by body weight (100 - 120 g), 12 rats in each group, half male and half female. The rats of control were fed with tap water (NaF < 1 mg/L), and the experimental rats were exposed to NaF (low dose fluoride group: 5 mg/L, high dose fluoride group: 50 mg/L) added to the drinking water to establish the chronic fluorosis model. After the rats were raised for six months, 24-hour urine samples were collected and the femoral metaphysis of the rats was taken. Urine fluoride and bone fluoride were detected by fluorin ion selective electrode method. Bone tissues were stained with hematoxylin-eosin and observed under light microscope. The content of bone alkalinephosphatase (BALP) in rats' serum was detected by enzyme-linked immunosorbent assay (ELISA). The expressions of Ihh, Shh and Smo mRNA and protein in bone were detected by Real-time PCR and immunohistochemistry (IHC).Results:The contents of urine fluoride, bone fluoride and serum BALP were increased gradually in the control, low and high doses fluoride groups [urine fluoride: (1.37 ± 0.44), (5.96 ± 0.56), (7.60 ± 0.61) mg/L; bone fluoride: (306.04 ± 12.58), (652.91 ± 51.83), (1 094.11 ± 126.34) mg/kg; BALP: (27.78 ± 4.09), (46.59 ± 5.75), (57.45 ± 3.99) U/L, P < 0.05]. It could observed that bone sclerosis by light microscope in low and high doses fluoride groups. The expressions of Ihh, Shh and Smo mRNA in high dose fluoride group (1.39 ± 0.36, 0.56 ± 0.23, 0.40 ± 0.15) were higher than those of the control and low dose fluoride groups (0.73 ± 0.19, 0.92 ± 0.34; 0.19 ± 0.04, 0.36 ± 0.16; 0.14 ± 0.04, 0.24 ± 0.13; P < 0.05). The expression of Shh mRNA in low dose fluoride group was higher than that of the control group ( P < 0.05). The expressions of Ihh and Smo protein in high dose fluoride group (138.89 ± 3.72, 149.29 ± 7.63) were higher than those of the control and the low dose fluoride groups (127.39 ± 2.69, 134.81 ± 3.53; 129.64 ± 12.62, 139.07 ± 9.30), and the low dose fluoride group were higher than those of the control group ( P < 0.05). The expression of Shh protein in high dose fluoride group (141.26 ± 7.49) was higher than that of the control group (130.96 ± 11.10, P < 0.05). Conclusion:The expression of Hedgehog signaling pathway related factors in bone of rats with chronic fluorosis is changed, which indicates that bone formation can be affected by activation of Hedgehog signaling pathway induced by fluoride.

Objective:To evaluate the effect of two kinds of anterior maxillary segmental osteotomies on nasal morphology.Methods:30 patients with bimaxillary protrusion were included at from Tianjin Stomatological Hospital Between January 2015 and December 2017. There were 8 males and 22 females aged from 19 to 32 years old, the patients were randomly divided into the traditional operation group and modified operation group according to the order of treatment. 20 patients underwent traditional anterior maxillary osteotomy while 10 patients underwent modified osteotomy. Pre- and post-operative 1-year CBCT data of 30 patients were imported in Proplan CMF software, to reconstruct the 3D model of the nose and select characteristic landmarks. Three locating planes and 3D point measurement system were established, Relevant indices consisted of nasolabial angle, upper and lower nasolabial angle, nasal tip angle, nasal tip inclination, nasal columella inclination, nasal height, depth of nasal tip, vertical nasal tip position, nasal alar base width, inner canthic diameter, nasal columella height, bilateral nasal axis angle, nostril area and the comparison between two groups were conducted using paired-samples t test, the effect of two surgical methods on nasal morphology were evaluated. Results:There were statistically significant differences between the nasolabial angle, nasal columella inclination, nasal height, nasal alar base width between preoperative group(113.74°±9.42°, 120.06°±7.73°)and postoperative group (121.93°±4.05°, 129.86°±7.63°), whereas no significant difference among nasal tip angle, nasal tip inclination, vertical nasal tip position, nasal columella height, bilateral nasal axis angle and nostril area in traditional operative group. However, in the modified operation group, there were statistically significant differences in the nasolabial angle, vertical nasal tip position between preoperative group [110.75°±1.67°and(11.87±1.39) mm] and postoperative group [122.42°±6.95° and(11.16±1.02) mm], whereas no significant difference among other measurement items.Conclusions:Compared with the traditional osteotomies, the modified method has little influence on the nasal morphology after operation, meanwhile achieve good surgical result. However, the modified surgical method has its own indications, flexible application can obtain the best surgical result and patient satisfaction.

Objective:Using a combination of 2D and 3D methods to evaluate the difference of lip changes between two maxillary anterior segmental osteotomy methods.Methods:30 patients who visited the Department of Orthognathic Surgery of Tianjin Stomatological Hospital from January 2015 to January 2017 with maxillary protrusion [8 males and 22 females, aged (25.0 ± 0.6) years old] were divided into two groups. One group was treated with cupar maxillary anterior segmental osteotomy. One group underwent modified method. 4 osseous tissue measurements, 8 soft tissue measurements and 7 lip measurements were collected in three-dimensional model, lateral cephalometric radiographs and frontal photos at one week before surgery and one year after surgery to observe the difference between the two groups in the lip area and calculate the retreat ratio of upper incisor to upper lip.Results:The wounds of all 30 patients were healed in one stage without infection and bone necrosis. There was no recurrence of the bone protrusion at 1 year after the operation. After treatment, the bone relationship was normal and the dental arch and occlusal curve were normal. The occlusion relationship and the lip-tooth relationship were good. The shape of the lower third of the face was significantly improved, and the relationship between nose, lips and chin was coordinated. The change of the horizontal position of the lip and the position of the neck of upper incisor tooth (UJ) had a significant positive correlation. In traditional group R= 0.768 and in modified group R= 0.771. The sella-nasion-A point decreased and the nasolabial angle increased in both groups. The difference was statistically significant before and after surgery ( P<0.05). The amount of retraction of the neck point and incision point of the upper incisor and the amount of retraction of the upper lip were significantly reduced. The difference before and after surgery was statistically significant ( P<0.05). There was an increase in the thickness of the upper lip before and after surgery, a decrease in the distance between the upper and lower lip, and a decrease in the distance between the upper incisor and the upper lip. The differences were statistically significant ( P<0.05) compared with those before surgery. The increase of upper lip height in the modified group was statistically significant ( P<0.05), but not in the traditional group. Upper lip height showed a statistically significant increase in the modified procedure group. The retreat ratios of the point Pro of incisor and the upper lip were 1.19∶1 and 0.81∶1 in traditional group and modified group. In frontal view, it was observed that the midline lip thickness became more significantly smaller although the limited change amount and the upper lip line tended to be M-type. Conclusions:These two surgical procedures have obvious effects on maxillary protrusion deformity. The change of the horizontal position of the lip and the position of the neck of upper incisor tooth (UJ) had a significant positive correlation. The lip height increased in modified group compared to traditional group.

Objective:To evaluate the effect of two kinds of anterior maxillary segmental osteotomies on nasal morphology.Methods:30 patients with bimaxillary protrusion were included at from Tianjin Stomatological Hospital Between January 2015 and December 2017. There were 8 males and 22 females aged from 19 to 32 years old, the patients were randomly divided into the traditional operation group and modified operation group according to the order of treatment. 20 patients underwent traditional anterior maxillary osteotomy while 10 patients underwent modified osteotomy. Pre- and post-operative 1-year CBCT data of 30 patients were imported in Proplan CMF software, to reconstruct the 3D model of the nose and select characteristic landmarks. Three locating planes and 3D point measurement system were established, Relevant indices consisted of nasolabial angle, upper and lower nasolabial angle, nasal tip angle, nasal tip inclination, nasal columella inclination, nasal height, depth of nasal tip, vertical nasal tip position, nasal alar base width, inner canthic diameter, nasal columella height, bilateral nasal axis angle, nostril area and the comparison between two groups were conducted using paired-samples t test, the effect of two surgical methods on nasal morphology were evaluated. Results:There were statistically significant differences between the nasolabial angle, nasal columella inclination, nasal height, nasal alar base width between preoperative group(113.74°±9.42°, 120.06°±7.73°)and postoperative group (121.93°±4.05°, 129.86°±7.63°), whereas no significant difference among nasal tip angle, nasal tip inclination, vertical nasal tip position, nasal columella height, bilateral nasal axis angle and nostril area in traditional operative group. However, in the modified operation group, there were statistically significant differences in the nasolabial angle, vertical nasal tip position between preoperative group [110.75°±1.67°and(11.87±1.39) mm] and postoperative group [122.42°±6.95° and(11.16±1.02) mm], whereas no significant difference among other measurement items.Conclusions:Compared with the traditional osteotomies, the modified method has little influence on the nasal morphology after operation, meanwhile achieve good surgical result. However, the modified surgical method has its own indications, flexible application can obtain the best surgical result and patient satisfaction.