Objective:To investigate the predictive value of Doppler ultrasonography combined with cytokeratin fragment 19 (Cyfra21-1) and soluble interleukin-2 receptor (sIL-2R) in cervical lymph node metastasis of thyroid micropapillary carcinoma.Methods:102 patients with minimal papillary carcinoma of thyroid confirmed by surgery and pathology admitted to Ultrasound Department, Shanxi Cancer Hospital from Aug. 2020 to Aug. 2023 were selected and treated with thyroidectomy plus central region and at least one cervical lymph node dissection. Among them, There were 24 cases in the LLNM group and 78 cases in the non-LLNM group.Results:There were significant differences in age, shape, nodular and capsule contact area, tumor shape aspect ratio > 1, blood flow, microcalcification, serum Cyfra21-1 and serum sIL-2R levels between the two groups (Cyfra21-1: P<0.001, sIL-2R: P=0.001). Logistic regression analysis showed that age ≥50 years old ( OR=0.443, 95% CI: 0.217-0.904), microcalcification ( OR=2.787, 95% CI: 1.491-5.208), Cyfra21-1>3.3ng/ml ( OR=3.117, 95% CI: 1.404-6.922) and sIL-2R > 110.45pmol/L ( OR=3.408, 95% CI: 1.473-7.884) were independent risk factors for cervical lymph node metastasis in PTMC patients ( P < 0.05). The ROC curve results showed that the area under the curve of cervical lymph node metastasis predicted by Doppler ultrasound combined with Cyfra21-1 and sIL-2R was 0.82, and the sensitivity and specificity were 83.67% and 70.56%, respectively. Conclusions:The calcification features of Doppler ultrasound and the elevation of serum Cyfra21-1 and sIL-2R are closely related to cervical lymph node metastasis of thyroid micropapillary carcinoma. The combination of Doppler ultrasound with serum Cyfra21-1 and sIL-2R has important reference value in predicting cervical lymph node metastasis.

ObjectiveTo compare the short-term effectiveness of the three different manipulations for atlantoaxial joint disorders and their effects on surface electromyography of sternocleidomastoid muscle. MethodsNinty patients with atlantoaxial joint disorders were randomly divided into the tendon relaxing manipulation group， the tendon relaxing plus rehabilitation manipulation group， and the conventional manipulation group， with 30 cases in each group， and each group of patients received the corresponding manipulation treatment for 2 weeks. The changes of visual analogue score （VAS） of occipital neck pain， evaluation scale for cervical vertigo （ESCV）， and averaged electromyography （AEMG） of surface electromyography of bilateral sternocleidomastoid muscles before and after the treatment were observed， and the clinical effectiveness and safety of the patients were compared among groups. ResultsThe VAS scores of patients in each group decreased， and the ESCV scores increased after treatment （P＜0.01）， and the tendon relaxing manipulation group and the tendon relaxing plus rehabilitation manipulation group were significantly better than the conventional manipulation group （P＜0.01）. The AEMG of the bilateral sternocleidomastoid muscles of the three groups increased after treatment （P＜0.01）； when compared among the three groups， the AEMG of the bilateral sternocleidomastoid muscles of the tendon relaxing plus rehabilitation manipulation group was higher than that of the tendon relaxing manipulation group， and the tendon relaxing manipulation group was higher than that of the conventional manipulation group （P＜0.05 or P＜0.01）. The cure and markedly effective rates of the tendon relaxing manipulation group， the tendon relaxing plus rehabilitation manipulation group， and the conventional manipulation group were 56.67%， 86.67%， and 36.67% respectively， showing statistically difference （K=10.21， P＜0.01）. ConclusionThe tendon relaxing manipulation and tendon relaxing plus rehabilitation manipulation can effectively improve the symptoms of vertigo， headache， and neck pain for patients with atlantoaxial joint disorders， and can improve the contraction function of sternocleidomastoid muscle， whose effectiveness are better than that of conventional manipulation.

The dental operative microscope has been widely employed in the field of dentistry, particularly in endodontics and operative dentistry, resulting in significant advancements in the effectiveness of root canal therapy, endodontic surgery, and dental restoration. However, the improper use of this microscope continues to be common in clinical settings, primarily due to operators' insufficient understanding and proficiency in both the features and established operating procedures of this equipment. In October 2019, Professor Jingping Liang, Vice Chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, organized a consensus meeting with Chinese experts in endodontics and operative dentistry. The objective of this meeting was to establish a standard operation procedure for the dental operative microscope. Subsequently, a consensus was reached and officially issued. Over the span of about four years, the content of this consensus has been further developed and improved through practical experience.
Humans ; Dentistry, Operative ; Consensus ; Endodontics ; Root Canal Therapy ; Dental Care

OBJECTIVE: To explore the genetic basis for a child with clinically suspected 3-methylcrotonyl-coenzyme A carboxylase deficiency (MCCD). METHODS: Genomic DNA was extracted from peripheral blood samples of the proband and her parents. Whole exome sequencing was used to screen pathogenic variant in the proband. Suspected variant was verified by Sanger sequencing. Impact of the variant on the structure and function of protein product was analyzed by using bioinformatic software. RESULTS: Sanger sequencing showed that the proband has carried homozygous missense c.1342G>A (p.Gly448Ala) variant of the MCCC2 gene, for which her mother was a heterozygous carrier. The same variant was not detected in her father. The variant was predicted to be pathogenic by PolyPhen-2 and Mutation Taster software, and the site was highly conserved among various species. Based on the American College of Medical Genetics and Genomics standards and guidelines, the c.1342G>A (p.Gly448Ala) variant of MCCC2 gene was predicted to be likely pathogenic(PM2+PP2-PP5). CONCLUSION The homozygous missense variant of the MCCC2 gene c.1342G>A (p.Gly448Ala) probably underlay the molecular pathogenesis of the proband. Genetic testing has confirmed the clinical diagnosis.
Carbon-Carbon Ligases/genetics* ; Child ; Female ; Humans ; Male ; Mutation, Missense/genetics* ; Pedigree ; Urea Cycle Disorders, Inborn/genetics*

Objective:To investigate the role of autophagy mediated by mTOR signaling pathway in the inhibition of osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) induced by cadmium.Methods:HBMSCs were divided into 0, 2.5 or 5.0 μmol/L groups according to the exposure dose of cadmium chloride (CdCl 2), and each group was treated for 1 day, 4 days and (or) 7 days. The ALP activity and mRNA and protein expression levels of osteogenesis markers (ALP, RUNX2 and OSTERIX), autophagy-related proteins (LC3 and Beclin-1) and mTOR signaling pathway related proteins (mTOR, p-mTOR and p-p70S6K) expression, alkaline phosphatase staining and alizarin red staining were detected. MHY 1485 was selected as the signaling pathway activator. The control group, CdCl 2 group (5.0 μmol/L), MHY 1485 group and CdCl 2+MHY 1485 combined treatment group were set. After 7 days of treatment, the expression levels of autophagy related proteins and mTOR signaling pathway related proteins of hBMSCs in each group were detected. Results:There was no significant difference in ALP activity between 0, 2.5 and 5.0 μmol/L groups on day 1 and 4 ( P>0.05); On day 7, compared with the 0 μmol/L group, the ALP activity, expression of osteogenic markers (ALP, RUNX2, OSTERIX) and mTOR signaling pathway related proteins (mTOR, p-mTOR, p-p70S6K) expression decreased in the 2.5 and 5.0 μmol/L group ( P<0.05). Compared with the 0 μmol/L group, the staining of the 2.5 and 5.0 μmol/L groups became lighter, and the formation of ALP and mineralized nodules was reduced. Compared with the CdCl 2 group, the autophagy related protein expression in the CdCl 2+MHY 1485 combined treatment group decreased, and the mTOR signaling pathway related protein expression increased. The difference was statistically significant ( P<0.05). Conclusion:The inhibition of osteogenic differentiation of hBMSCs by cadmium may be related to autophagy mediated by mTOR signaling pathway.

Objective:To investigate the role of autophagy mediated by mTOR signaling pathway in the inhibition of osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) induced by cadmium.Methods:HBMSCs were divided into 0, 2.5 or 5.0 μmol/L groups according to the exposure dose of cadmium chloride (CdCl 2), and each group was treated for 1 day, 4 days and (or) 7 days. The ALP activity and mRNA and protein expression levels of osteogenesis markers (ALP, RUNX2 and OSTERIX), autophagy-related proteins (LC3 and Beclin-1) and mTOR signaling pathway related proteins (mTOR, p-mTOR and p-p70S6K) expression, alkaline phosphatase staining and alizarin red staining were detected. MHY 1485 was selected as the signaling pathway activator. The control group, CdCl 2 group (5.0 μmol/L), MHY 1485 group and CdCl 2+MHY 1485 combined treatment group were set. After 7 days of treatment, the expression levels of autophagy related proteins and mTOR signaling pathway related proteins of hBMSCs in each group were detected. Results:There was no significant difference in ALP activity between 0, 2.5 and 5.0 μmol/L groups on day 1 and 4 ( P>0.05); On day 7, compared with the 0 μmol/L group, the ALP activity, expression of osteogenic markers (ALP, RUNX2, OSTERIX) and mTOR signaling pathway related proteins (mTOR, p-mTOR, p-p70S6K) expression decreased in the 2.5 and 5.0 μmol/L group ( P<0.05). Compared with the 0 μmol/L group, the staining of the 2.5 and 5.0 μmol/L groups became lighter, and the formation of ALP and mineralized nodules was reduced. Compared with the CdCl 2 group, the autophagy related protein expression in the CdCl 2+MHY 1485 combined treatment group decreased, and the mTOR signaling pathway related protein expression increased. The difference was statistically significant ( P<0.05). Conclusion:The inhibition of osteogenic differentiation of hBMSCs by cadmium may be related to autophagy mediated by mTOR signaling pathway.

Objective:To discuss how to make the surgical strategy for tibial tubercle fracture associated with bicondylar tibial plateau fracture.Methods:Data of thirty-five patients of tibial tubercle fractures associated with bicondylar tibial plateau fractures who were treated from October 2014 to May 2018 were retrospectively analyzed. There were 26 males and 9 females with an average age of 37.6 years (range, 21-68 years). According to Schatzker classification in tibial plateau fracture, 16 cases were type V and 19 cases were type VI. According to the integrity of tibial tubercle fracture and cortical bone of the proximal tibia in bicondylar tibial plateau fracture, they were divided into four types: type A, tibial tubercle fracture fragment and cortical bone of the proximal tibia are both complete; type B, tibial tubercle fracture fragment is complete but cortical bone of the proximal tibia is comminuted; type C, tibial tubercle fracture fragment is comminuted but cortical bone of the proximal tibia is complete; type D, both of them are comminuted. The surgical approaches and fixation methods of all the tibial tubercle fractures were according to the four different types. There were 22 cases with type A and B that were treated via an anterolateral and a medial incision, 13 cases with type C and D were treated via an anterior midline and a medial incision. There were 4 cases belonging to type A fixed with lag screws singly, 18 cases with type B fixed with 1/4 tubular plates, 7 cases with type C and 6 cases with type D fixed by 1/4 tubular plates combined with lag screws.Results:Thirty-five patients were followed up for 16.8 months (range, 12-24 months). All fractures healed with an average time of 4.7 months (range, 3-6 months). Loss of reduction didn’t occur in 34 cases except one. According to Rasmussen radiographic evaluation, the average score was 14.1 (range, 10-18) and clinical outcomes were rated with excellent in 11 cases, good in 19, fair in 5. The excellent and good rate was 85.7% (30/35) . The mean Hospital for Special Surgery (HSS) scores of all cases were 86.8 (range, 64-98) and the functional scores were excellent in 22 cases, good in 10 cases and fair in 3 cases with the excellent and good rate of 91.4% (32/35) . Surgical complications included fat liquefaction in 2 cases, superficial wound infection in 1, loosening of implant in 1and traumatic arthritis in 1.Conclusion:This kind of tibial tubercle fracture associated with bicondylar tibial plateau fracture is rare and special. Therefore, the preoperative plan should be made by considering the morphological features of the tibial tubercle fragments and the cortical bone of the proximal tibia. The middle longitude approach is the best way to expose tibial tubercle fragments which should be fixed with 1/4 tubularplate and/or lag screws.

Objective: To explore the clinical features and treatment strategies of tibial plateau fractures sustained with hyperextension varus. Methods: Data of 11 patients of tibial plateau fractures with hyperextension varus treated from January 2008 to November 2017 were retrospectively analyzed. There were 7 males and 4 females with an average age of 41.2 years old (range, 25-67 years). Injuries were caused by falling down in 7 cases, traffic accident in 3 cases, and falling from height in 1 case, respectively. On the basis of Luo's three columns classification in tibial plateau, there were 9 cases of medial column fracture and 2 cases of medial combined with posterior column fracture. Six cases were concomitant with fibular head fracture and 2 cases with the injury of common peroneal nerve. Preoperative magnetic resonance imaging showed that there were anterior cruciate ligament injury in 3 cases, posterior cruciate ligament injury in 4 cases, medial meniscus injury in 5 cases, lateral meniscus injury in 3 cases, medial collateral ligament injury in 6 cases, iliotibial band injury in 2 cases and posterolateral complex injury of the knee joint in 9 cases, respectively. All tibial plateau fractures were treated firstly by open reduction and internal fixation via medial approach of the knee. The medial meniscuses and collateral ligaments were explored, in which of them there were 2 medial meniscuses with the marginal tear been sutured simultaneously. Then the knee joints which were still unstable after the examination of stable tests in 6 cases with posterolateral complex injuries were repaired surgically via lateral approach. Fibular head fractures were fixed with anchor nails or cannulated screws in 6 cases. The ruptured posterior cruciate ligaments in 2 cases were reconstructed with autologous tendon transplantation under endoscopy. Results: All the patients were followed up for an average period of 16.2 months (range, 12-22 months). All fractures were healed in 10-20 weeks with an average time of 16.5 weeks. The range of extension of the affected knee joint in all patients was 0° and the average flexion was 135° (range, 120°-145°) one year after surgery. The average flexion of affected knee in 4 cases which were only treated with the tibial plateau fracture without the mild ligament injuries was 137° (range, 132°-145°) and the average flexion of affected knee in 7 cases who were treated with tibial plateau fracture and severe posterolateral complex included posterior cruciate ligaments completely broken with reconstruction was 132° (range, 120°-140°). According to Rasmussen radiographic evaluation, the average score of all patients was 16.3 (range, 14 to 18) and clinical outcomes were rated with excellent in 10 cases and good in 1. The excellent and good rate was 100% (11/11). The mean of the hospital for special surgery (HSS) score was 86.7 (range, 79-96) and the functional scores were excellent in 9 cases, good in 2 cases thus the excellent and good rate was 100% (11/11). Both varus stress test 30° and dial test were positive in one case considered for the ligament laxity postoperatively who didn’t accept further treatment and the stabilization tests were negative in the other 10 cases. There were no intraoperative complications in all patients such as neurovascular injury. No incision infection, failure of the implants and fracture nonunion occurred postoperatively. Traumatic arthritis of the affected knee occurred one year after surgery in 1 case who had no obvious pain after treated with oral medicine. Conclusion The hyperextension varus injuries of the knee are rare clinically. The posterolateral complex should be evaluated thoroughly for this injury pattern. If it's necessary, the posterolateral structures must be repaired surgically after the tibial plateau fractures are fixed.

Objective To investigate the clinical effect of donor kidneys in rhabdomyolysis(RM) combined with acute kidney injury(AKI).Methods A retrospective analysis was made on the clinical data of 10 donors with RM and 14 cases of renal transplantation from March 2017 to May 2018.Results AKI was caused by RM in 10 donors.Before harvesting the donor kidneys,blood creatine kinase (CK) level was (14 005.19 ± 11 894.27) U/L in 10 donors,plasma myoglobin level was ＞3 000 μg/L in 7 cases,and that was (2 288 ± 680) μg/L in 3 cases.LDH level was 883 ± 453 IU/L and serum creatinine (Cr) value was (216.55 ± 125) μmol/L.6 donors received continuous renal replacement therapy.Six patients with delayed renal function recovery (DGF) were treated with CRRT.The duration of GDF was 3-20 days,with an average of 10 ± 6.6 days.All the patients were followed up for 3-15 months.The glomerular filtration rate was (40.19 ± 19.55) ml·min· 1.73 m-2 and (55.01 ± 15.94) ml · min· 1.73 m-2 at 1st and 3rd month after operation,respectively.Conclusion The incidence of DGF in donor kidneys with RM and AKI is high,and the short-term effect is satisfactory.The long-term effect needs to be further observed.

Objective To explore the guiding significance of posterior tibial plateau partition for the selection of surgical approach in treatment for posterior column fracture.Methods From June 2008 to May 2015,46 patients with posterior column fractures of tibial plateaus treated were retrospectively analyzed.There were 31 males and 15 females with an average age of 35.1±12.8 years old (range,19-62 years).Nineteen patients were left side and twenty-seven patients were right side.Injury was caused by traffic accident in 27 cases,falling from bicycle in 12 cases and falling from height in 7 cases.On the basis of the posterior condyle with anatomical structure in tibia1 plateau,the posterior column was divided into four parts.All fractures were treated via the optimal approach based on the location of them.The posteromedial approach was used with fractures in zone 1 and 2,posterolateral approach used in zone 3,lateral approach via the fibular head osteotomy was used in zone 4 and combined approaches were used in multiple zones.All the fractures involved the posterior column were treated by anatomical reduction and fixation with plates and screws under direct vision.Results All the patients were followed up with an average of 15.5±3.7 months (range from 12 to 24 months).The healing time of all patients was 11-18 weeks,with an average time of 14.6±2.3 weeks.According to Rasmussen radiographic evaluation,the average score was 15.1 (range from 11 to 18) and clinical outcomes were rated with "excellent" in 17 cases,"good" in 24 cases,"fair" in 5 cases.The excellent and good rate was 89.1％ (41/46).The mean HSS (the Hospital for Special Surgery) score of all patients at 12 months operatively were 86.7±8.6 (range from 67 to 98) and the functional scores were excellent in 25 cases,good in 17 cases and fair in 4 cases with the excellent and good rate was 91.3％ (42/46).The average range of motion in affected knee was 118°±13.7° (range from 0° to 135°) in 17 cases via posterolateral approach,123°±15.6° (range from 0° to 135°) in 18 cases via posteromedial approach,115°±16.7° (range from 0° to 130°) in 18 cases via combined posteromedial and posterolateral approaches and 124°±7.4° (range from 0° to 130°) in 4 cases via the fibular head osteotomy lateral approach.Complications included fat liquefaction in 1 case,anterior tibial artery spasm in 1 case and traumatic arthritis in 1 case.Conclusion The partition of posterior tibial plateau can be used to guide the surgical approach to the posterior column simply and accurately.For the fractures of isolated posterior column and posterior column mainly involved,the partition has a certain guiding significance.