Objective To analyze the ability of micro-implant nails placed in different locations in the posterior re-gion to improve the hard and soft tissues of the labiodental region in patients with gummy smiles to provide a reference for clinicians.Methods This study was reviewed and approved by the Ethics Committee,and informed consent was ob-tained from the patients.Thirty young female patients with anterior tooth protrusions and gummy smiles were included in the retrospective study;18 patients had micro-implant nails implanted between the premolars(group A),and 12 pa-tients had implant nails placed between the roots of the premolar and the molar and an intraoperatively placed rocking-chair archwire(group B).The preoperative and postoperative distances from the incisal end of the upper mesial incisors to the lower point of the upper lip(U1-Stms),the vertical distance from the incisal end of the upper mesial incisors to the palatal plane(U1-PP),the vertical distance from the point of the alveolar ridge to the palatal plane(Spr-PP),the dis-tance from the incisal end of the upper mesial incisors to the point of the alveolar margin(U1-Spr),and the vertical dis-tance from the point of the proximal middle buccal cusp of the maxillary first molar to the palatal plane of the maxillary first molar(U6-PP)were measured in the cephalometric lateral radiographs of the two groups;additionally,the amount of hard and soft tissues of the upper anterior region exposedduring smiling and the maximum amount of gingiva exposed during smiling were assessed from the smile photograph.Results After correction,the lip-dentition relationship im-proved significantly in both groups,with an average reduction of 2.6 mm in U1-Stms,2.4 mm in U1-PP,1.4 mm in Spr-PP,and 0.9 mm in U1-Spr in Group A.In group B,the U1-Stms was reduced by an average of 2.3 mm,the U1-PPs by an average of 1.6 mm,the Spr-PPs by 1.4 mm,and the U1-Spr by 0.2 mm.The difference between pre-and postoperative U6-PP in both groups was not significant(P＞0.05).Group A had greater ?U1-PP and ?U1-Spr changes than group B(P＜0.05).There was no difference between the two groups in terms of ?U1-Stms or ?Spr-PP(P＞0.05).The amount of soft and hard tissue exposed and maximum amount of gingiva exposed in the upper anterior region of the smile were reduced in 30 patients postoperatively,with group A having anaverage reduction of 70.19%of the preoperative amount of soft and hard tissue exposed in the upper anterior region and an average reduction of 24.12%of the preoperative max-imum amount of gingiva exposed,and group B having an average reduction of 76.12%of the preoperative amount of hard and soft tissue exposed in the upper anterior region and an average reduction of 31.88%of the preoperative maxi-mum gingiva exposed after the operation.The difference in the ratio between the two groups was not statistically sig-nificant(P＞0.05).Conclusion For patients with proptosis and gummy smiles,placing micro-implant nails between the roots of maxillary premolars can effectively lead to retraction and intrusion of anterior teeth to improve the lip-denti-tion relationship and improve gummy smile,and placing micro-implant nails between the roots of the maxillary second premolar and the first molar together with the use of rocking chair arches can also achieve a good therapeutic effect.

Objective To investigate the clinical efficacy of disc repositioning surgery combined with orthodontic treatment in patients with temporomandibular disorder and facial asymmetry.Methods One patient who underwent disc repositioning surgery combined with orthodontic treatment for temporomandibular joint disorder and facial asymme-try was reported.Preoperatively,the patient had a skewed shape of the opening,mild pressure pain in the right preauric-ular region with left mandibular deviation,and a mismatch between the width of the upper and lower dental arches.In the arthrosurgery department,bilateral temporomandibular disc replacement and anchorage were performed through a transauricular incision,and an auxiliary splint was worn to stabilize the jaw position for 6 months.In the orthopedic de-partment,maxillary skeletal expansion was used in combination with the multiloop edgewise archwire technique to re-construct the occlusion after 16 months of orthodontic treatment.Results The deviation was corrected by wearing an occlusal splint for six months after joint repositioning and anchoring;moreover,the pain symptoms disappeared,and the cone beam CT examination showed that the bilateral temporomandibular joint space was uniformly enlarged,the lower alveolar ridge midline deviated to the right,the posterior regions of the teeth were bilaterally inverted,and the anterior region and the posterior region of the left side were open.The orthodontic treatment matched the width of the upper and lower dental arches and established the cuspal molar neutrality relationship and the normal overjet coverage of the ante-rior teeth;additionally,the mandibular position was not obviously skewed.A review of the results of the related litera-ture shows that abnormal occlusal relationships,such as mismatched arch width and skewed occlusal plane,can cause adaptive mandibular deviation,which can lead to the occurrence of TMD.Temporomandibular joint disc anchorage with splint treatment can effectively improve maxillofacial deformity in young TMD patients.After the establishment of a sta-ble,physiologically functional disc-condylar relationship,orthodontic treatment is required to remove the interfering fac-tors to rebuild the occlusion,and long-term postoperative review and follow-up are needed.Conclusion In patients with TMD and mandibular accommodative deviation due to occlusal anomalies,establishing a normal disc-condylar rela-tionship and eliminating occlusal interference through disc repositioning surgery combined with orthodontic treatment can effectively improve facial shape and establish a stable jaw position.

Objective:To understand the current situation and influencing factors of exercise intention among patients after percutaneous coronary artery stent implantation (CASI) , so as to promote patients to actively participate in exercise.Methods:Using the convenient sampling method, 165 patients with CASI who revisited in the cardiology department of a Class Ⅲ Grade A hospital in Shandong Province from May to August 2020 were selected as the research objects. General information questionnaire, Exercise Intention Scale, Exercise Self-efficacy Scale and Exercise Social Support Scale were used for investigation.Results:In this study, 165 questionnaires were distributed and 154 valid questionnaires were returned, with an effective recovery rate of 93.33%. The score of Exercise Intention Scale for 154 patients after CASI was (12.46±4.05) . The results of multiple linear regression analysis showed that age, moderate-intensity activity in the past week, classification of cardiac function, exercise self-efficacy and exercise social support were influencing factors of exercise intention among patients after CASI ( P<0.05) , which explained 47.6% of the total variation. Conclusions:The exercise intention of patients after CASI needs to be further improved and there are many factors that affect exercise intention of patients. Family members of patients and medical staff should provide more exercise support to improve their exercise self-efficacy.

Objective:To explore the predictive value of complement and coagulation indicators in sepsis related acute kidney injury (AKI).Methods:Clinical data of 217 patients with sepsis admitted to the Department of Internal Medicine and Intensive Care Unit of Affiliated Hospital of Jiangnan University from January 2018 to June 2019 were retrospectively analyzed. All patients were divided into sepsis with AKI group and without AKI group. Laboratory indicators of all patients were collected, including complement C 3, complement C 4, activated partial thrombin time (APTT), prothrombin time (PT), international normalized ratio (INR), D-dimer, procalcitonin(PCT), etc. logistic regression analysis was used to explore the risk factors of sepsis related AKI. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of independent risk factors. Results:Among 217 patients, 120 patients developed sepsis related AKI and 97 patients didn′t. PCT, lactic acid, PT, APTT, INR and D-dimer in AKI patients were significantly higher than those without AKI ( P<0.01). Complement C 3 and complement C 4 were significantly lower in AKI group ( P<0.01). Multivariate logistic regression analysis suggested that blood pressure<90/60 mmHg (1 mmHg=0.133 kPa)( OR=3.705, 95% CI 1.536-8.934, P=0.004), increased lactic acid ( OR=1.479, 95% CI 1.089-2.008, P=0.012), decreased complement C 3 ( OR=0.027, 95% CI 0.005-0.152, P<0.001) and prolonged APTT ( OR=1.090, 95% CI 1.047-1.137, P<0.001)were independent risk factors predicting AKI. The area under the ROC curve (AUC) of these multivariates were 0.741 (95% CI 0.675-0.807), 0.798 (95% CI 0.732-0.864), 0.712 (95% CI 0.643-0.781) and 0.716 (95% CI 0.648-0.783) respectively. The relevant sensitivity was 57.5%, 80.8%, 87.5%, 59.2%, and the specificity was 90.7%, 75.3%, 51.5%, 77.3%, respectively. The AUC of the combined four indicators was 0.880 (95 %CI 0.835-0.926) with the sensitivity 75.0% and the specificity 90.7%. Conclusion:The low level of complement C 3 and prolonged APTT predict sepsis related AKI, and the predictive value can be enhanced if hypotension and hyperlactacidemia are added.

Objective To explore the influence of peer support on blood glucose management of type 2 diabetic patients.Methods From April 2017 to December 2017,the study subjects were selected according to the inclusion criteria from all type 2 diabetes patients who admitted in the Fourth People′s Hosipital of Ningbo.The patients in bed 1-9 were assigned into observation group,and patients in bed 10-20 were assigned into control group.All beds were assigned randomly from a random number generator.Standard diabetes education was provided to both two groups,while peer support was added to the experimental group.The average hospitalization costs and length of hospital stay were compared between the two groups using t-test.Results The average hospitalization cost of the observation group was(6218.48 ±1432.75)yuan,which of the control group was(6913.32 ±1426.34)yuan,the average hospitalization time of the observation group was(6.49 ±1.91)d,which of the control group was(7.41 ±1.99)d,the differences between the two groups were significant(t=-4.480,-4.347,all P<0.01).Conclusion Application of peer support to the glucose management in patients with type 2 diabetes can effectively enhance education effect and reduce hospitalization cost and length of hospital stay.

Objective To apply the Plan -Do -Check -Act ( PDCA ) cycle in glucose management in inpatients with diabetes , in order to decrease the incidence of hypoglycemia and related complications .Methods 517 inpatients with diabetes were divided into 4 groups according to the quarter ,the monthly incidence rates of hypo-glycemia were collected.The association of monthly incidence of hypoglycemia with age (≥65 years),longer diabetic history (≥5 years),lower C-peptide (<0.370nmol/L),receiving combined regimen (basal insulin plus 3 doses of pre-prandial short-acting insulin ) were analyzed .PDCA cycle was applied for hypoglycemia detection and etiolo-gy control in order to achieve quality improvement via effective glucose control measures .Theχ2 test was used to ana-lyze the incidence of the hypoglycemia in each group .The hypoglycemic incidence based on different characteristics , were also compared with the overall hypoglycemic incidences of all patients .Results The incidence of hypoglycemia was significantly reduced with the application of PDCA cycle in inpatients with diabetes ,from 44.09％ in the first quarter to 13.04％ in the fourth quarter (χ2 =32.815,P<0.001).The annual hypoglycemic incidence rate was 26.89％.The patients with low C-peptide or receiving combined regimen had significantly higher incidence rate of hypoglycemia (53.57％and 31.88％) as compared to general inpatients with diabetes (χ2 =35.721,7.105,all P<0.05).Conclusion The application of PDCA cycle can effectively decrease the incidence of hypoglycemia ,and it can be a great asset for management of inpatients with diabetes .

Objective To study the application of walking combined with Buerger exercise in the treatment of grade 0 diabetic foot.Methods Eighty patients with grade 0 diabetic foot were randomly divided into observation group and control group.The control group was trained by walking exercise .The observation group was trained by walking combined with Buerger exercise through 12 months of training.The changes of self-sensory symptoms,ABI and DAWV were observed.Results The self-sensory symptoms of the two groups were significantly decreased (observation group: markedly effective 15 cases,effective 19 cases;control group: markedly effective 5 cases,effective 23 cases).The effective rate of the observation group was higher than that of the control group (85% vs.70%,χ2 =7.831,P <0.05).The ABI ratio of the two groups were higher than those before treatment ,and the ABI ratio of the observation group was higher than that of the control group [(0.889 ±0.113) vs.(0.842 ±0.124),t =1.772 P <0.05].The ratio of DAWV in the observation group was higher than that in the control group [(6.772 ±0.435)cm/s vs.(6.543 ±0.552)cm/s,t =2.061,P <0.05].Conclusion Walking combined with Buerger exercise can improve the blood flow velocity and blood flow of the collateral circulation of the lower limbs of patients with grade 0 diabetic foot,and improve the self-sensory symptoms of peripheral neuropathy .

Objective To explore the relationship between homocysteine (Hcy)expression and diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM).Methods 100 cases with T2DM were selected,they were divided into observation group(diabetic early nephropathy,n =50)and matched group(simple diabetes,n =50),50 healthy people were involved as control group.Hcy,BUN and Cre were detected and compared among groups. Results Hcy level in 3 groups showed a increased trend,there were significant differences among groups (F =145.007,P <0.01).Hcy level of the control group was (8.19 ±0.92)μmol/L,which was significantly lower than that in the observation group and matched group[(9.63 ±1.15)μmol/L (P <0.01)and (11.94 ±1.24)mmol/L (P <0.01)].There were no significant differences of levels of BUN and Cre among the groups (F =0.66,P >0.05),the comparison between groups also had no statistical significance (P =0.936,0.097,all P >0.05 ). Conclusion Hcy may participate in the process of early type 2 diabetic nephropathy,can be used as important reference index of diagnosis of early diabetic nephropathy.

Objective To compare the effects of pulse high-volume hemofiltration (PHVHF) and continuous veno-venous hemofiltration (CVVH) on severe acute panceatitis (SAP). Method From January 2005 to December 2009, a total of 38 patients with SAP were randomly(random number) divided into PHVHF group ( n = 18)and CVVH group ( n = 20). After hemofiltration for 72 hours, clinical symptoms, APACHE Ⅱ score, biochemical changes and mortality were observed. The levels of TNF-α, IL-6, and IL-10 in plasma were assayed by using ELISA before and after treatment. The doses of dopamine used in shock patients were also observed. Measurement data were expressed in(-x) ± s, and t-test was used for comparison between two groups. Results In both groups ,symptoms were markedly improved after treatment. The APACHE Ⅱ score, serum amylase, creatinine, and white blood cell count were decreased ( P ＜ 0.05). Besides, hypoxemia and acidosis were corrected, and the PHVHF group was superior to the CVVH group especially in heart rate, breathing and APACHE Ⅱ score ( P ＜ 0. 05).The levels of TNF-α, IL-6 and IL-10 decreased in both groups ( P ＜ 0.05), and the PHVHF group was superior to the CVVH group ( P ＜ 0. 01 ). The doses of dopamine used in shock patients also decreased in both groups ( P ＜0. 01 ), and they decreased more in PHVHF group than in CVVH group ( P ＜ 0.05). The mortality was 11.1%in PHVHF group and 25 % in CVVH group. Conclusions PHVHF is obviously superior to CVVH in the treatment of SAP, and can serve as an important adjuvant therapy for SAP, stabilizing the hemodynamics and reducing the levels of pro-inflammatory factors and mortality.

Objective To analyze the related factors of urinary tract infection with diabetes. Methods Ret-rospective studies were conducted in 350 diabetes cases who were in hospital from 2008.01.01 to 2008.12.31 in en-docrine department of our hospital. Results The primary pathogen was Gram-negative bacteria(84.9%),The major one was Eachefichia coil (59.7%), the followed one was Enterococcus faecalis (11.2%). The Bacillus cloacae、Staphylococcus epidemidis、Klebsiella pneumoniae、Bacillus aerogenes、Bacillus proteus、Blastomyces albicans also were the pathogens which caused the urinary tract infection. The influence of infection:the higher was the incidence of female patients;The older was the diabetes patients,the higher was the incidence of urinary tract infection;The longer course of diabetes,the higher was the incidence of urinary tract infection; Complicated by the ketosis patients were higher in the incidence of urinary tract infection;The hyperglycosemia patients were higher than the multisystem pa-tients;the patients with nervous bladder were higher than the patients without. Conclusion Diabetes patients who suffered from urinary tract infection are more in old lady,long course、hyperglycosemia and with urgent or chronicity complication.