Bone age, the most commonly used and effective indicator for understanding children's growth and development, plays an important role in the diagnosis and efficacy evaluation of various growth and development disorders. Clinically, X-rays of the left hand and wrist are mostly taken for bone age assessment, but there is a certain radiation risk. Ultrasound can clearly display the epiphysis and secondary ossification center, and conveniently perform multi-site scanning and dynamic measurement without radiation. In recent years, great progress has been made in the research and clinical application of ultrasound in bone age assessment. This article, by reviewing the latest literature, discusses the value of musculoskeletal ultrasound and quantitative ultrasound in bone age assessment, raises the problems in the study of ultrasound assessment of bone age, and suggests direction for improvement.

Preliminary exploration of using ultrasound to quantitatively evaluate the development of epiphyseal cartilage and analyze its correlation with bone age, based on the ultrasound findings of the long bone joint end.

To research on area ossification ratio (AOR), a novel parameter for quantitatively assessing adolescent bone age by conventional ultrasonography, and evaluate the correlation between AOR and radiographic bone age.

Different degrees of visual function impairment is the main reason for first visit of children with optic pathway glioma; it seriously affects the quality of life of children. Early diagnosis, timely treatment, maximum preservation or restoration of the children's vision function, and improvement of quality of life of children are major challenges. This article reviews the recent advance in visual function assessments for children with optic pathway glioma, aiming to provide some references for early clinical objective assessment of visual function impairment and clear diagnosis.

Objective:To develop a deep transfer learning method for the differential diagnosis of osteonecrosis of the femoral head (ONFH) with other common hip diseases using anteroposterior hip radiographs.Methods:Patients suffering from ONFH, DDH, and other hip diseases including primary hip osteoarthritis, non-infectious inflammatory hip disease, and femoral neck fracture treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to December 2020 were enrolled in the study. A clinical data set containing anteroposterior hip radiographs of the eligible patients was created. Data augmentation by rotating and flipping images was performed to enlarge the data set, then the data set was divided equally into a training data set and a testing data set. The ResNet-152, a deep neural network model, was used in the study, but the original Batch Normalization was replaced with Transferable Normalization to construct a novel deep transfer learning model. The model was trained to distinguish ONFH and DDH from other common hip diseases using anteroposterior hip radiographs on the training data set and its classification performance was evaluated on the testing data set.Results:The clinical data set was comprised of anteroposterior hip radiographs of 1024 hips, including 542 with ONFH, 296 with DDH, and 186 with other common hip diseases (56 hips with primary osteoarthritis, 85 hips with non-infectious inflammatory osteoarthritis, 45 hips with femoral neck fracture). After data augmentation, the size of the data set multiplied to 6144. The model was trained 100 050 times in each task. Accuracy was used as the representative parameter to evaluate the performance of the model. In the binary classification task to identify ONFH, the best accuracy was 95.80%. As for the multi-classification task for classification of ONFH and DDH from other hip diseases, the best accuracy was 91.40%. The plateau of the model was observed in each task after 50 000 times of training. The mean accuracy in plateaus was 95.35% (95% CI: 95.33%, 95.37%), and 90.85% (95% CI: 90.82%, 90.87%), respectively. Conclusion:The present study proves the encouraging performance of a deep transfer learning method for the first-visit classification of ONFH, DDH, and other hip diseases using the convenient and economical anteroposterior hip radiographs.

Objective: To propose the concept of a novel regional control and prevention (RCP) system for the outbreak of COVID-19 infectious disease, design an emergency epidemic prevention information system based on the existing network architecture and information system in the region, and a remote intelligent medical consultation and remote office platform, research and develop the technology of risk assessment and early warning for people in the region, and improve the regions’prevention and control ability facing emergency of major infectious diseases. Methods: Taking colleges, affiliated (teaching) hospitals, and cloud applications as typical RCP regional units, the existing local area network interaction methods between the cloud and universities and affiliated (teaching) hospitals are established to realize remote work in the network environment, remote medical imaging, psychological and ethical consultation and interaction; applying multi-agent propagation model based on complex network, combining Global Positioning System (GPS), Radio Frequency Identification (RFID), and electronic fence technology, to realize the risk classification and early warning of units and personnel in the area. Results: In the RCP, a system architecture combining campus network, affiliated (teaching) hospital intranet, and the Internet is used. Dynamic connection is made using distributed technology and cloud storage. The data buffer mechanism of the intermediary database in the network realized telemedicine consultation and telecommuting. Relying on the platform, multi-agent propagation model based on complex network and cellular automaton model are used to realize the score and early warning of population exposure risk in the region by using GPS, RFID and electronic fence technology. Conclusions In the epidemic phase of major infectious diseases, the construction of RCP can improve the response speed of wartime epidemic prevention, provide reasonable data-based warnings and risk ratings, and reduce the exposure risk of susceptible people. The design and development of RCP is a systematic project that needs to combine regional structural and functional characteristics, and the foundation of the early informatization work in the region and the level of the emergency development team determine the development progress, maintenance, and actual application effects. It is recommended to establish a peacetime and wartime combined RCP mode and incorporate it into the government's disease control system to improve the national and regional level of prevention and control of major infectious diseases.

Objective To analyze the mutations of causal genes in 5 children with primary distal renal tubular acidosis (dRTA),and explore their association of genotype and phenotype,so as to raise the awareness of the disease.Methods The whole exome sequencing was used to identify mutations in these 5 children from 5 families.Results A total of 4 different mutations of ATP6V0A4 gene were found in 2 dRTA children,including a novel heterozygous intron mutation (c.639 + 1G＞ A),a reported heterozygous nonsense variant (c.580C ＞T,p.Arg194*) and 2 novel heterozygous duplications (c.1504dupT,p.Tyr502Leufs*22;c.2351dupT,p.Phe785Ilefs*28).Two novel heterozygous missense mutations of ATP6V 1B 1 gene (c.409C ＞ T,p.Pro 137Ser;c.904C ＞ T,p.Arg302Trp) were identified in the third child,and a heterozygous missense mutation of SLC4A1 gene (c.1765C ＞ A,p.Arg589Ser) previously reported was found in the fourth child.No mutation of the dRTA-related causal genes was found in the fifth child.Furthermore,the mutations of causal genes in each of the first three children were compound heterozygous,which were consistent with the autosomal recessive inheritance pattern,and the variant from the fourth child was de novo.Conclusions The present study has found 7 mutations,including 5 novel variants,which enriches the human gene mutation database (HGMD) and contributes to a better understanding of the disease mechanisms.

Objective To investigate the effect of dexmedetomidine on perioperative cardiac function in patients with mild cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer. Methods Sixty patients scheduled with laparoscopic radical resection of rectal cancer with mild heart failure were selected, with New York Heart Association (NYHA) cardiac function gradingⅠtoⅡ, American Association of Anesthesiologists (ASA) grading Ⅱ to Ⅲ, and age from 63 to 72 years. The patients were divided into dexmedetomidine group (group D) and control group (group C) according to the random digits table method with 30 cases each. At the beginning of induction, the patients in group D were given intravenous infusion a loading dose of dexmedetomidine at 0.5 μg/kg for more than 10 min. Then continuous intravenous infusion of dexmedetomidine was given at 0.3 μg/(kg·h) for 60 min. The patients in group C were given 0.9% sodium chloride with the same method. The small vessel resistance (SVR), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), cardiac output (CO) and myocardial working index (Tei index) before induction (T0) and after administration of 20 min (T1), 40 min (T2), 60 min (T3) were measured by color Doppler ultrasound, and the heart rate (HR) and mean arterial pressure (MAP) were recorded at the same times. The time from the end of operation to extubation and incidences of agitation during recovery period were recorded. Results The T1to T3SVR in group D were significantly lower than those of T0: (883 ± 30), (827 ± 36) and (804 ± 38) dyn·s·cm-5vs. (1 075 ± 37) dyn·s·cm-5, and there were statistical differences (P＜0.05); compared with those in group C, the T1 to T3 SVR in group D were significantly lower, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in CO between T1to T3 and T0(P＞0.05); compared with those in group D, the T1 to T3 CO in group C were significantly lower: (3.4 ± 0.6) L/min vs. (4.4 ± 1.0) L/min, (3.2 ± 0.7) L/min vs. (4.3 ± 0.8) L/min and (3.3 ± 0.9) L/min vs. (4.4 ± 0.9) L/min, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in LVEF between T1to T3 and T0(P＞0.05); compared with those in group D, the T1to T2 LVEF in group C were significantly lower, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in Tei index between T1 to T3 and T0(P＞0.05); compared with group D, the T1 to T2 Tei index in group C were significantly higher, and there were statistical differences (P＜0.05). There were no statistical differences in LVEDV after intra-group and inter-group comparison (P＞0.05). In group D, the T1 to T3 HR were significantly lower than T0: (68.1 ± 12.8), (67.3 ± 11.9) and (65.4 ± 11.7) times/min vs. (88.2 ± 15.1) times/min, and there were statistical differences (P＜0.05); compared with those in group C, the T1 to T3 HR in group were significantly slower. In group D, the T1 MAP significantly increased, significantly higher than those in T0 and in group C (P＜0.05). There was no statistical difference in the time from the end of operation to extubation between 2 groups (P＞0.05). The incidence of agitation during recovery period in group D was significantly lower than that in group C. Conclusions Dexmedetomidine can effectively promote the perioperative cardiac function recovery in patients with cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer, suggesting that it has a certain myocardial protection effect.

PURPOSE: Accumulating evidence has shown that dysregulation of microRNA-191 (miR-191) is closely associated with tumorigenesis and progression in a wide range of cancers. This study aimed to explore the potential role of miR-191 in esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: miR-191 expression was assessed in 93 ESCC tissue specimens by real-time polymerase chain reaction, and survival analysis was performed via Kaplan-Meier and Cox regression analyses. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide, plate colony-forming, BrdU, and Transwell assays were conducted to observe the effect of miR-191 on ESCC proliferation and invasion. Luciferase reporter and western blot assays were taken to identify target genes of miR-191. RESULTS: miR-191 was overexpressed in 93 cases of ESCC, compared with adjacent normal tissues, and miR-191 expression was significantly related to differentiation, depth of invasion, TNM stage, lymph node metastasis, and distant metastasis of tumor. Kaplan-Meier and Cox regression analyses demonstrated that overexpression of miR-191 was an independent and significant predictor of ESCC prognosis. Both gain-of-function and loss-of-function experiments showed that miR-191 promoted ESCC cell proliferation and invasion activities in vitro. Early growth response 1 (EGR1), a tumor suppressor, was predicted as a direct target of miR-191. Luciferase reporter and western blot assays proved that miR-191 reduced EGR1 expression by directly binding its 3' untranslated region. Moreover, EGR1 knockdown by siRNA enhanced ESCC cell growth and invasion. CONCLUSION: Our findings provide specific biological roles of miR-191 in ESCC survival and progression. Targeting the novel miR-191/EGR1 axis represents a potential new therapeutic way to block ESCC development.
3' Untranslated Regions ; Blotting, Western ; Bromodeoxyuridine ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Cell Proliferation ; Epithelial Cells* ; In Vitro Techniques ; Luciferases ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Real-Time Polymerase Chain Reaction ; RNA, Small Interfering

Objective To explore the impact of different anesthesia methods and anesthesia-related factors in initial bladder cancer patients with partial cystectomy, and to provide a reference for clinical anesthesia choice and the questions that should be concerned. Methods Ambispective cohort study was performed in consecutive case of illness with initial occurrence bladder cancer patients treatedwith partial cystectomy from 2009 to 2012. A historical cohort was from January 5, 2009 to January 4, 2011. A prospective cohort was from January 5, 2011 to December 31, 2011. Follow-up was terminated in December 31, 2012. All cases were followed up to one full year after surgery. The 402 cases who were diagnosed of initial occurrence bladder cancer and partial cystectomy patients, according to different anesthesia method, were divided into general anesthesia group and intraspinal anesthesia group. Postoperative recurrence was determined within 1 year of follow-up. Multivariate analysis was carried out based on univariate analysis to analyze the causal connection factors for one year recurrence in initial occurrence bladder cancer patients with partial cystectomy. Variables included gender, age, blood type, smoking history, drinking history , number of tumors, tumor size, pathologic TNM stage, anesthesia method, duration of anesthesia, postoperative visual analog scale (VAS) score at 12 h, tumor-associated factor Ki67, P53, CK20, VEGF (whether two or more positive). Tumor recurrence was considered the dependent variable (outcome). Univariate analysis used χ2 or rank sum test, and multivariate analysis used Logistic regression model fitting analysis and the maximum likelihood method. SPSS 16.0 software package was used for data analysis and processing. Results Four hundred and two patients were followed up and got a result of 396 cases (98.51％). Two hundred and eleven cases showed recurrence within one year (53.28％). Univariate analysis showed that age, smoking history, drinking history, duration of anesthesia, pathologic stage, postoperative VAS scores at 12 h less than 3 scores, blood type, tumor-associated factor Ki67, P53, CK20, VEGF (two or more positive) were associated with one year recurrence in initial occurrence bladder cancer patients (P < 0.01) with partial cystectomy, while the difference of two anesthesia methods was not shown (P>0.05). Multivariate Logistic regression model analysis showed that the following factors were associated with postoperative recurrence within a year in initial occurrence bladder cancer patients with partial cystectomy: age (RR = 0.371, 95％ CI 0.183-0.752), drinking history (RR=0.348, 95％CI 0.161-0.752), postoperative VAS scores at 12 h less than 3 scores (RR=0.023, 95％CI 0.011-0.050), duration of anesthesia (RR=3.042, 95％CI 1.495-6.192), and tumor-associated factor Ki67, P53, CK20, VEGF of two or more positive(RR=8.676, 95％CI 4.018-18.733). Among these, duration of anesthesia and tumor-associated factors Ki67, P53, CK20, VEGF of two or more positive were risk factors, and drinking history, age, and postoperative VAS scores at 12 h less than 3 scores were protection factors. Conclusions The impact of general anesthesia and intraspinal anesthesia on one year recurrence in initial occurrence bladder cancer patients with partial cystectomy is not statistically significant. Duration of anesthesia depends on the part of the surgical time which is associated with the postoperative recurrence within a year. Postoperative analgesic perfect (VAS score at 12 h less than 3 scores) is the protective factor. Age and drinking history are also the protective factors for one year recurrence in initial occurrence bladder cancer patients of partial cystectomy.