Abstract Depression is a major public health issue among adolescents. The Ministry of Education of China recently proposed to integrate depression screening into students school health check among adolescents. However, there are inconsistencies regarding the strength of recommendation and implementation details of routine screening for adolescent depression across professional organizations and countries. This paper outlines the epidemiology and risk factors of adolescent depression and summarizes relevant international guidelines and recommendations. We suggest that before the national implementation of school based depression screening, key issues including scientific evidence, execution details, resource allocation and ethical considerations need to be examined in close collaboration with all stakeholders. Systematic piloting followed by rigorous evaluation will also be needed.

Objective:To investigate the effect of using extended trans-dome onlay graft(eTDOG) made of costal cartilage combined with nasal vestibule V-Y advancement flap for correction of alar retraction.Methods:Clinical data of patients diagnosed with alar retraction at Chongqing Huamei Plastic Surgery Hospital between July 2019 and October 2020 were retrospectively analyzed. The 6th or 7th right costal cartilage was harvested, cut into pieces for grafts, including a laminar trans-dome onlay graft, made from cortex part of the rib. Then a V-shaped flap was designed on the vestibular skin. At the end of the rhinoplasty, a pocket was created along the alar rim, and the eTDOG was inserted into the pocket to push down the alar rim. Nasal vestibule V-Y advancement flap provides extra soft tissue for alar retraction correction. Splints were applied to hold the eTDOG and flap in place. Assessment of therapeutic effect was made from three aspects. First of all, therapeutic satisfaction assessment, which was made based on the visual analogue scale(VAS). VAS scoring was conducted by patients and two surgeons who were not involved in surgery. Results were divided into three categories, total satisfaction with scoring 9 or 10, partly satisfaction with scoring 7 or 8, and dissatisfaction with scoring 0-6. Subsequently, the percentage of satisfaction indeed in the total number of cases was counted. Alar symmetry assessment was also included. The percentage of cases with alar symmetry in the total number of cases. Third, the ratio (a/b) of the distance between the line defined by bilateral highest points of alar retraction and the line determined by tip-defining points (a) to that between the line determined by bilateral highest points of alar retraction and the horizontal line defined by the turning point of columella lobule (b) was calculated on frontal view. The value of a and b was measured using Image J, and a/b<1 represented absence of alar retraction. The statistical analysis was performed using SPSS version 20.0. Chi-square test was used to compare the symmetry of alae pre- and post-operation. Values of a/b were expressed as Mean±SD, and was compared using t-test. SNK were used for comparison among and between groups of different types, respectively. P-value less than 0.05 considered to be statistically significant. Results:Forty-three cases were included in this study, including 5 men and 38 women, with mean age of 27.3 years (18-45 yars). Among them, medial, central and lateral type of alar retraction was comprised of 17, 22 and 4 cases, respectively. The median follow-up time was 4 months (range, 1-24 months). During the follow-up, no complications like avascular necrosis of ala, step like deformity or alar contracture were observed, so was the recurrence of alar retraction. A total of 5 complications were observed, including 4 cases of hypertrophic scar at the incision which were improved after injection of Triamcinolone and 1 case of remaining alar asymmetry which was corrected by reoperation. The VAS score of patient was 8.93±1.12, and patients with satisfaction indeed accounted for 81.4% (35/43). The mean VAS score of the two operation-non-participated surgeons was 8.93±1.04; and cases assessed to be satisfaction indeed accounted for 81.4% (70/86). The proportion of symmetric alae significantly improved from 58.1% (25/43) to 93.0% (40/43) ( P<0.01). The ratio of a/b decreased from 0.79±0.06 pre-operation to 1.00±0.04 post-operation( P<0.01). While no significance was found among groups neither pre- nor post-operation ( P>0.05). Conclusions:eTDOG made of costal cartilage combining nasal vestibule V-Y advancement flap is an effective method for correction of all types of alar retraction and improvement of alar symmetry, with high satisfaction of patients and surgeons.

Objective:To investigate the effect of using extended trans-dome onlay graft(eTDOG) made of costal cartilage combined with nasal vestibule V-Y advancement flap for correction of alar retraction.Methods:Clinical data of patients diagnosed with alar retraction at Chongqing Huamei Plastic Surgery Hospital between July 2019 and October 2020 were retrospectively analyzed. The 6th or 7th right costal cartilage was harvested, cut into pieces for grafts, including a laminar trans-dome onlay graft, made from cortex part of the rib. Then a V-shaped flap was designed on the vestibular skin. At the end of the rhinoplasty, a pocket was created along the alar rim, and the eTDOG was inserted into the pocket to push down the alar rim. Nasal vestibule V-Y advancement flap provides extra soft tissue for alar retraction correction. Splints were applied to hold the eTDOG and flap in place. Assessment of therapeutic effect was made from three aspects. First of all, therapeutic satisfaction assessment, which was made based on the visual analogue scale(VAS). VAS scoring was conducted by patients and two surgeons who were not involved in surgery. Results were divided into three categories, total satisfaction with scoring 9 or 10, partly satisfaction with scoring 7 or 8, and dissatisfaction with scoring 0-6. Subsequently, the percentage of satisfaction indeed in the total number of cases was counted. Alar symmetry assessment was also included. The percentage of cases with alar symmetry in the total number of cases. Third, the ratio (a/b) of the distance between the line defined by bilateral highest points of alar retraction and the line determined by tip-defining points (a) to that between the line determined by bilateral highest points of alar retraction and the horizontal line defined by the turning point of columella lobule (b) was calculated on frontal view. The value of a and b was measured using Image J, and a/b<1 represented absence of alar retraction. The statistical analysis was performed using SPSS version 20.0. Chi-square test was used to compare the symmetry of alae pre- and post-operation. Values of a/b were expressed as Mean±SD, and was compared using t-test. SNK were used for comparison among and between groups of different types, respectively. P-value less than 0.05 considered to be statistically significant. Results:Forty-three cases were included in this study, including 5 men and 38 women, with mean age of 27.3 years (18-45 yars). Among them, medial, central and lateral type of alar retraction was comprised of 17, 22 and 4 cases, respectively. The median follow-up time was 4 months (range, 1-24 months). During the follow-up, no complications like avascular necrosis of ala, step like deformity or alar contracture were observed, so was the recurrence of alar retraction. A total of 5 complications were observed, including 4 cases of hypertrophic scar at the incision which were improved after injection of Triamcinolone and 1 case of remaining alar asymmetry which was corrected by reoperation. The VAS score of patient was 8.93±1.12, and patients with satisfaction indeed accounted for 81.4% (35/43). The mean VAS score of the two operation-non-participated surgeons was 8.93±1.04; and cases assessed to be satisfaction indeed accounted for 81.4% (70/86). The proportion of symmetric alae significantly improved from 58.1% (25/43) to 93.0% (40/43) ( P<0.01). The ratio of a/b decreased from 0.79±0.06 pre-operation to 1.00±0.04 post-operation( P<0.01). While no significance was found among groups neither pre- nor post-operation ( P>0.05). Conclusions:eTDOG made of costal cartilage combining nasal vestibule V-Y advancement flap is an effective method for correction of all types of alar retraction and improvement of alar symmetry, with high satisfaction of patients and surgeons.

Objective To investigate the incidence of enteric pathogens causing acute gastroenteritis (AGE) among children to measure the incidence of coinfections,and to compare the clinical characteristics of those infected with one versus multiple agents.Methods A retrospective study was conducted from January 2014 to December 2014.All patients between 1 month and 14 years of age admitted to the Pediatric department with a diagnosis of AGE were eligible for enrollment.Two stool samples for each patient were tested for gastrointestinal pathogens.We summarized the clinical severity of episodes,describing the duration of diarrhea,duration and frequency of vomiting,fever.All patients underwent medical evaluation with estimation of dehydration.Results One or more etiological agents were detected in 3595 out of 4728 patients(76.0％),while we did not detect any etiological agent in 1133 (24.0％).Rotavirus was detected in 1889 (40.0％),adenovirus in 412 (8.7 ％),norovirus in 309 (6.5 ％),verotoxigenic Escherichia coli (VTEC) in 274 (5.8 ％),Salmonella spp.in 276(5.8％),Klebsiella pneumoniae in 123 (2.6％),Shigella spp.in 78 (1.6％),Staphylococcus aureus in 70 (1.5％),C.perfringens in 126(2.7％).In 1370 children out of 4728(29.0％),we found evidence of coinfection.with rotavirus and norovirus was the most common 150 (3.2％),rotavirus and C.perfringens was also common 127(2.7％).Children with coinfection had a more severe clinical presentation.The difference has statistical significance.Conclusion Rotavirus is still the most common pathogen in children with acute diarrhea,followed by NV,adenovirus,Salmonella spp.and VTEC.Rotavirus with norovirus infection was the most common.VTEC combined with three kinds of virus infection had the highest incidence.Children with multiple viral infections were more severe than those of single virus infection in the duration of vomiting and dehydration.There was no significant difference in the duration of fever and diarrhea and the frequency of diarrhea.Children infected by viruses and bacteria had a more severe clinical presentation such as fever,vomiting and diarrhea lasting for a long time,more serious diarrhea and dehydration than those with single bacteria and single virus infection.The difference has no significant difference in degree and duration of diarrhea.

BACKGROUND: Ankle fracture combined with deltoid ligament rupture and distal tibiofibular syndesmosis injury occurs occasionally. Its treatment with distal tibiofibular syndesmosis screw fixation or deltoid ligament repair remains controversial. The former appears with poor reduction, broken nails, secondary surgery and other problems.OBJECTIVE: To observe the clinical effectiveness of suture anchor repair for ankle fracture combined with deltoid ligament injury.METHODS: Twelve patients with ankle fracture combined with deltoid ligament injury were selected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2013 and December 2015. All patients were treated with open reduction, internal fixation, and anchor repair, but without distal tibiofibular syndesmosis screw fixation. The curative efficacy and joint stability were observed.RESULTS AND CONCLUSION: (1) All patients were followed-up for more than 12 months. (2) The modified Baird-Jackson scoring system showed excellent in nine cases, good in two cases, average in one case, poor in none case, and the excellent and good rate was 92%. (3) At 1 year after internal fixation, the X-ray examination showed the malleolus gap and talus slope angle of the affect side were (3.47±0.12) mm and (0.45±0.18)°, and the malleolus gap and talus slope angle of the healthy side were (3.44±0.05) mm and (0.43±0.14)°, and there was no significant difference between two sides (P > 0.05). (4) These results indicate that the suture anchor can repair the anatomy and biomechanics of deltoid ligament with stable ankle joint, and secondary surgery is unnecessary.

OBJECTIVE:To establish a method for simultaneous determination of paeoniflorin,berberine hydrochloride and ammonium glycyrrhizinate in Xiaoer huadu powder.METHODS:HPLC method was adopted.The separation was performed on Waters SunFireTM-C18 column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid (gradient elution) at the flow rate of 1.0 mL/min.The detection wavelength was set at 238 nm,and column temperature was 25 ℃.The sample size was 10 μL.RESULTS:The linear ranges of paeoniflorin,berberine hydrochloride and ammonium glycyrrhizinate were 8.808-88.08 μg/mL(r=0.999 8),1.778-17.78 μg/mL(r=0.999 6),2.533-25.33 μg/mL(r=0.999 9),respectively.LOQ were 4.404,0.889,2.533 μg/mL;LOD were 1.101,0.445,1.267 μg/mL.RSDs of precision,stability and reproducibility tests were all lower than 2％.The recoveries were 95.08％-99.61％ (RSD=1.77％,n =9),96.93％-99.94％ (RSD=0.92％,n=9),98.33％-102.05％ (RSD=1.27％,n=9).CONCLUSIONS:The method is simple,accurate and reproducible,and can be used for simultaneous determination of paeoniflorin,berberine hydrochloride and ammonium glycyrrhizinate in Xiaoer huadu powder.

[ ABSTRACT] AIM:To explore the role of SHARPIN in regulation of Rip1 in castration-resistant prostate cancer LNCaP-AI cells.METHODS:The LNCaP-AI cells were treated with TNF-α+Z-VAD ( an inhibitor of pan-caspase) to activate necroptosis, which were compared to the cells treated with TNF-α+Z-VAD+Nec-1 ( an inhibitor of Rip1 ) .A blank group and a TNF-α-treated group were set up as controls.The cell viability in each group was measured by MTS as-say.In addition, SHARPIN was knocked down by siRNA, and the inhibitory efficiency was evaluated by RT-qPCR.The expression of Rip1 at mRNA and protein levels after knocking down SHARPIN was determined by RT-qPCR and Western blot to explore the underlying mechanism of regulatory network of necroptosis in prostate cancer.RESULTS: Compared with blank control group and TNF-α-treated group, the viability of LNCaP-AI cells treated with TNF-α+Z-VAD decreased by 28%(P<0.05).After treated with TNF-α+Z-VAD+Nec-1, the LNCaP-AI cells showed no significant difference in the viability compared with blank control and TNF-α-treated groups.Taken together, necroptosis may be an important way of cell death in LNCaP-AI cells.Besides, the expression of Rip1 at protein level was up-regulated following the inhibition of SHARPIN using siRNA, indicating that down-regulation of SHARPIN enhanced necroptosis via activating Rip1 in
LNCaP-AI cells.CONCLUSION:Necroptosis is an important way of cell death .Inhibition of oncogenic factor SHARPIN enhances necroptosis via activating Rip1 in LNCaP-AI cells.

[ ABSTRACT] AIM: To investigate the SALL4 expression, proliferation and apoptosis in the LNCaP cells after transfection of SALL4 siRNA.METHODS: The expression of SALL4 at mRNA and protein levels was detected by real-time PCR and Western blotting.MTS assay, colony formation assay and flow cytometry were used to determine the prolifer-ation, colony formation ability and apoptosis of the LNCaP cells.The effect of SALL4 on the expression of Bax and Bcl-2 was analyzed by Western blotting.RESULTS:Compared with negative control group, the expression of SALL4 at mRNA and protein levels in LNCaP cells was down-regulated by transfection of SALL4 siRNA ( P<0.05 ) .The proliferation rate and colony formation ability were decreased, while apoptosis rate increased in si-SALL4 group (P<0.05).Higher expres-sion of Bax and lower expression of Bcl-2 in si-SALL4 group were observed ( P<0.05 ) .CONCLUSION:Down-regula-tion of SALL4 by siRNA not only suppresses LNCaP cell proliferation and colony formation, but also inhibits Bcl-2 expres-sion and activates Bax expression to induce apoptosis.

RNA interference (RNAi) is useful for selective gene silencing. Cytochrome P450 3A4 (CYP3A4), which metabolizes approximately 50% of drugs in clinical use, plays an important role in drug metabolism. In this study, we aimed to develop a short hairpin RNA (shRNA) to modulate CYP3A4 expression. Three new shRNAs (S1, S2 and S3) were designed to target the coding sequence (CDS) of CYP3A4, cloned into a shRNA expression vector, and tested in different cells. The mixture of three shRNAs produced optimal reduction (55%) in CYP3A4 CDS-luciferase activity in both CHL and HEK293 cells. Endogenous CYP3A4 expression in HepG2 cells was decreased about 50% at both mRNA and protein level after transfection of the mixture of three shRNAs. In contrast, CYP3A5 gene expression was not altered by the shRNAs, supporting the selectivity of CYP3A4 shRNAs. In addition, HepG2 cells transfected with CYP3A4 shRNAs were less sensitive to Ginkgolic acids, whose toxic metabolites are produced by CYP3A4. These results demonstrate that vector-based shRNAs could modulate CYP3A4 expression in cells through their actions on CYP3A4 CDS, and CYP3A4 shRNAs may be utilized to define the role of CYP3A4 in drug metabolism and toxicity.

Objective: To explore the effect of ulinastatin on anti-inflammation and pulmonary function protection with its mechanism for infants at cardiopulmonary bypass surgery. Methods: A total of 38 infants with ventricular septal defect undergoing cardiac operation were randomly divided into 2 groups. Ulinastatin group, the patients received uliastatin 20 000 U/kg,n=20 and Control group, the patients received the same volume of normal saline,n=18. The serum levels of TNF-α, IL-2, IL-l0 were examined at 4 time points: 5 min before skin incision (T1), immediate opening of aorta (T2), 4 hours after operation (T3) and 24 hours after operation (T4). The expressions of CD4+CD45+ T cells and CD4+Foxp3+ T cells were measured at T4. The respiratory index and oxygenation index at 4 time points were compared between 2 groups. Results: Compared with Control group, Ulinastatin group had the lower levels of TNF-α, IL-2 and higher level of IL-l0 at T2, T3, T4; Ulinastatin group also had the higher oxygenation index and lower respiratory index at T2, T3, T4, allP<0.05. Ulinastatin group had less expression of CD4+CD45+ T cells (35.98 ± 3.67)% than Control group (41.94 ± 4.56)% , and more expression of CD4+Foxp3+ T cells (19.65 ± 3.45)% than Control group (6.45 ± 1.47)%,P<0.05-P<0.01. Conclusion: Ulinastatin may improve the differentiation from CD4+CD45+ T cell to Foxp3+CD4+ T cell, down regulating inlfammatory response and protecting pulmonary function for infants at cardiopulmonary bypass surgery.