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<b>Objective</b> To evaluate the safety, effectiveness and feasibility of robotic-assisted kidney transplantation (RAKT). <b>Methods</b> Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. <b>Results</b> All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (<i>P</i>=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both <i>P</i>>0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (<i>P</i>>0.05). <b>Conclusions</b> Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation.

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BACKGROUND@#Tissue engineering is increasingly viewed as a promising avenue for functional cartilage reconstruction.However, chondrocyte dedifferentiation during in vitro culture remains an obstacle for clinical translation of tissue engineered cartilage. Re-differentiated induction have been employed to induce dedifferentiated chondrocytes back to their original phenotype. Regrettably, these strategies have been proven to be only moderately effective. @*METHODS@#To explore underlying mechanism, RNA transcriptome sequencing was conducted on primary chondrocytes (P0), dedifferentiated chondrocytes (P5), and redifferentiated chondrocytes (redifferentiation-induction of P5, P5.R). Based on multiple bioinformatics analysis, LGR5 was identified as a target gene. Subsequently, stable cell lines with LGR5 knocking-down and overexpression were established using P0 chondrocytes. The phenotypic changes in P1 and P5 chondrocytes with either LGR5 knockdown or overexpression were assessed to ascertain the potential influence of LGR5 dysregulation on chondrocyte phenotypes. Regulatory mechanism was then investigated using bioinformatic analysis, protein–protein docking, immunofluorescence co-localization and immunoprecipitation. @*RESULTS@#The current study found that dysregulation of LGR5 can significantly impact the dedifferentiated phenotypes of chondrocytes (P5). Upregulation of LGR5 appears to activate the PI3K/AKT signal via increasing the phosphorylation levels of AKT (p-AKT1). Moreover, the increase of p-AKT1 may stabilize b-catenin and enhance the intensity of Wnt/b-catenin signal, and help to restore the dedifferentated phenotype of chondrocytes. @*CONCLUSION@#LGR5 can modulate the phenotypes of chondrocytes in P5 passage through PI3K/AKT signaling pathway.

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Objective:To compare the clinical effects of two methods for the treatment of ankle fracture involving lower tibiofibular syndesmosis with triangular ligament injury.Methods:From January 2019 to November 2022, the data of patients with Weber B and C-type ankle fractures involving lower tibiofibular syndesmosis with triangular ligament injury in Tangshan Second Hospital were analyzed. The patients were divided into observation group (45 cases) and control group (39 cases) according to the principle of comparability between the groups of gender, age, injury cause and injury site, Both the treatment of lower tibiofibular syndesmosis and triangular ligament injury with loop steel plate and the treatment of lower tibiofibular syndesmosis injury with loop steel plate, as well as the full layer repair of triangular ligament with wire anchor nail, were used for treatment. Record and compare the fracture healing time, surgical time, surgical cost, American Orthopedic Foot and Ankle Society (AOFAS) score, Visual Analogue Scale (VAS) score, Tibiofibular Clear Space (TFCS) score Medial clear space (MCS), etc.Results:The fracture healing time in the observation group was (4.36±1.26) months, while the fracture healing time in the control group was (4.08±1.35) months. There was no statistically significant difference between the two groups (t=0.978, P=0.331). The observation group had a surgical time of (85.72±14.54) minutes, while the control group had a surgical time of (109.76±14.02); Observation group surgery cost (37 048±2 299.53) Font: ( t=0.978 p=0.331) Delete ( t=7.706 p<0.001) Delete: yuan, control group surgery cost (39 040.22±2 306.02); The differences between the two groups were statistically significant (t-values were 7.71 and 3.95, respectively, P<0.001). The AOFAS score of the observation group was (81.18±3.77) points, while the AOFAS score of the control group was (81.26±3.91) points; The VAS score of the observation group was 0.90±0.38 points, while the VAS score of the control group was 0.87±0.39 points. There was no statistically significant difference between the two groups ( t=0.09, P=0.926; t=0.39, P=0.698). The observation group had a MCS of (3.46±0.25) mm, while the control group had a MCS of (3.53±0.26) mm; The observation group had TFCS (3.49±0.24) mm, while the control group had TFCS (3.47±0.26) mm. There was no statistically significant difference between the two groups ( t=1.24, P=0.217; t=0.21, P=0.833). Conclusions:Although the patients with ankle fracture involving lower tibiofibular syndesmosis and triangular ligament injury can obtain satisfactory clinical results only by using the looped steel plate or the looped steel plate combined with the cable anchor, the application of the looped steel plate alone can reduce the treatment cost of patients, reduce the difficulty of surgery, and reduce the risk of iatrogenic injury of patients.

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Buruli ulcer (BU), caused by

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BackgroundThick-section CT scanners are more affordable for the developing countries. Considering the widely spread COVID-19, it is of great benefit to develop an automated and accurate system for quantification of COVID-19 associated lung abnormalities using thick-section chest CT images. PurposeTo develop a fully automated AI system to quantitatively assess the disease severity and disease progression using thick-section chest CT images. Materials and MethodsIn this retrospective study, a deep learning based system was developed to automatically segment and quantify the COVID-19 infected lung regions on thick-section chest CT images. 531 thick-section CT scans from 204 patients diagnosed with COVID-19 were collected from one appointed COVID-19 hospital from 23 January 2020 to 12 February 2020. The lung abnormalities were first segmented by a deep learning model. To assess the disease severity (non-severe or severe) and the progression, two imaging bio-markers were automatically computed, i.e., the portion of infection (POI) and the average infection HU (iHU). The performance of lung abnormality segmentation was examined using Dice coefficient, while the assessment of disease severity and the disease progression were evaluated using the area under the receiver operating characteristic curve (AUC) and the Cohens kappa statistic, respectively. ResultsDice coefficient between the segmentation of the AI system and the manual delineations of two experienced radiologists for the COVID-19 infected lung abnormalities were 0.74{+/-}0.28 and 0.76{+/-}0.29, respectively, which were close to the inter-observer agreement, i.e., 0.79{+/-}0.25. The computed two imaging bio-markers can distinguish between the severe and non-severe stages with an AUC of 0.9680 (p-value< 0.001). Very good agreement ({kappa} = 0.8220) between the AI system and the radiologists were achieved on evaluating the changes of infection volumes. ConclusionsA deep learning based AI system built on the thick-section CT imaging can accurately quantify the COVID-19 associated lung abnormalities, assess the disease severity and its progressions. Key ResultsA deep learning based AI system was able to accurately segment the infected lung regions by COVID-19 using the thick-section CT scans (Dice coefficient [≥] 0.74). The computed imaging bio-markers were able to distinguish between the non-severe and severe COVID-19 stages (area under the receiver operating characteristic curve 0.968). The infection volume changes computed by the AI system was able to assess the COVID-19 progression (Cohens kappa 0.8220). Summary StatementA deep learning based AI system built on the thick-section CT imaging can accurately quantify the COVID-19 infected lung regions, assess patients disease severity and their disease progressions.

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Objective@#To investigate the quantitative relationship between liver fat content and bone mineral density (BMD) in middle-aged and elderly people.@*Methods@#Totally 184 middle-aged and elderly community residents were recruited from March to June 2016, including 68 males and 116 females. MRI mDIXON-Quant and quantitative CT (QCT) examinations were performed to determine the content of liver fat and L1-L3 vertebral BMD. The subjects were divided into four groups according to the quartiles of liver fat content, and the baseline characteristics and other variables of different groups were were identified by using one-way analysis of Variance. The relationship between liver fat content and lumbar vertebral BMD was assessed with Spearman correlation and partial correlation analysis.@*Result@#Subjects with higher hepatic fat content had lower spine BMD and higher body mass index (BMI), waist circumference. Liver fat content was negatively correlated with BMD (r=-0.203, P=0.003). After age and body weight were controlled, the negative correlation between liver fat content and BMD was still significant (r=-0.291, P<0.001), in males (r=-0.283, P=0.021) and in females (r=-0.210, P=0.025).@*Conclusion@#Liver fat content is negatively correlated with lumbar vertebral BMD in middle-aged and elderly people.

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This paper reviews the clinical research on the treatment of chronic prostatitis with traditional Chinese medicine in recent years. It is believed that the core of the etiology and pathogenesis of this disease lies in the deficiency of spleen and kidney, dampness heat, phlegm turbid and blood stasis toxin. If the disease lasts for a long time, the spleen and kidney become to the deficiency from excess. The internal treatment of traditional Chinese medicine includes syndrome differentiation, disease differentiation or single prescription, while the external treatment mainly includes herbal bathing, enema, anal administration and acupuncture. Traditional Chinese medicine has advantages in the treatment of this disease. We should continue to study the the mechanism of traditional Chinese medicine for this disease, standardize the syndrome differentiation and treatment and outocmes evaluation, and carry out research on famous prescriptions on prostatitis.

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Objective:To understand the situation and distribution of fluoride in rural centralized water supply in Inner Mongolia Autonomous Region (Inner Mongolia for short), and provide a reference for adjustment of prevention and control measures.Methods:From 2014 to 2018, 836, 947, 1 033, 1 068, 1 099 rural centralized water supply monitoring sites were designated in 77 banners (counties, districts) separately in Inner Mongolia, and factory water and tip water samples were collected during plentiful phase and exhausted phase every year, respectively, and fluoride content was tested. Descriptive analysis was done according to time, water period (plentiful phase and exhausted phase), water sample type (factory water and tip water), water treatment method (conventional treatment, sedimentation and filtration, only disinfection and untreated), area distribution [eastern region (Hulunbuir, Xing'an League, Tongliao and Chifeng), central region (Hohhot, Baotou, Ulanqab and Xilinhot) and western region (Ordos, Bayannur and Alashan)], and the results were analyzed visually by ArcMAP 10.2.Results:From 2014 to 2018, 3 251, 3 671, 4 058, 4 087 and 4 395 water samples were collected, the medians fluoride were 0.69, 0.70, 0.69, 0.64 and 0.66 mg/L, and the annual compliance rates of fluoride were 80.31% (2 611/3 251), 81.83% (3 004/3 671), 83.14% (3 374/4 058), 85.91% (3 511/4 087) and 84.57% (3 717/4 395). The difference of compliance rate of fluoride in rural centralized water supply in different years was statistically significant (χ 2=51.748, P < 0.01), and the compliance rate of fluoride showed an increasing trend with the years (χ 2=41.140, P < 0.01). The compliance rates of fluoride in plentiful phase and exhausted phase were 83.36% (8 128/9 750) and 83.29% (8 089/9 712), respectively, and the difference was not significant statistically (χ 2=0.020, P > 0.05). As for water sample type, the compliance rates of fluoride in factory water and tip water were 83.55% (6 583/7 879) and 83.17% (9 628/11 576), and the difference was not significant statistically (χ 2=0.485, P > 0.05). The difference of compliance rate of fluoride in different water treatment methods was statistically significant (χ 2=192.014, P < 0.01). The compliance rates of fluoride in water with conventional treatment and only disinfection were higher [95.51% (404/423) and 94.44% (986/1 044)]; and the untreated water had the lowest compliance rate of fluoride [81.75% (13 073/15 991)]. There was a statistically significant difference in compliance rates of fluoride in the eastern, central and western regions (χ 2=629.256, P < 0.01), with the eastern region had the highest compliance rate of 89.17% (7 337/8 228); the central region had the lowest compliance rate of 74.67% (5 391/7 220). The visualization results showed that the compliance rate of fluoride was obviously low in the central region north of Yin Mountains and west of Greater Higgnan Mountains. Conclusions:From 2014 to 2018, the compliance rates of fluoride in rural centralized water supply increase year by year, and some achievements have been made in fluorine reduction and water improvement project in Inner Mongolia. However, there are still some rural areas with low level of water fluoride compliance rates which mainly distribute in the central region of Inner Mongolia in the north of Yin Mountains and west of Greater Higgnan Mountains. The current focus of prevention and control should be shifted from "general control" to "precise fluorine control". In the future, it is necessary to implement treatment projects in key areas of fluorine pollution from the aspects of policy implementation and technological innovation to ensure the drinking water safety of local rural residents.

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Objective:To investigate the status of depression and physiological, psychological and social factors among people with type 2 diabetes(T2DM), as well as the mediating effects of illness perception and diabetes distress on glycemic control and depression.Methods:A total of 511 patients with type 2 diabetes were recruited and investigated using general demographic questionnaire, self-rating depression scale(SDS), brief illness perception questionnaire(BIPQ) and diabetes distress scale(DDS). Body mass index (BMI) and hemoglobin a1c (HbA1c) were detected in laboratory.Results:The mean score of SDS was (57.48±9.94). The distribution of depression condition were 138(27.0%)without depression, 179(35%)with mild depression, 174(34.1%)with moderate depression and 20(3.9%)with severe depression.SDS score was significantly positively correlated with poor glycemic control ( r=0.157, P<0.01), illness perception( r=0.359, P<0.01) and four dimensions of diabetes distress( r=0.177-0.354, P<0.01). Partially mediating effect of illness perception( B=0.216, 95% CI=0.112-0.372) was found in glycemic control and depression, the proportion of effect was 25.9%.The chain mediating effect ( B=0.086, 95% CI=0.042-0.149) of illness perception and diabetes distress was also found between glycemic control and depression, whose indirect effect size was 10.3%. Conclusion:Glycemic control is significantly related with depression.Illness perception and diabetes distress are partly mediating the effect between glycemic control and depression.

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Objective:Traumatic heterotopic ossification is the formation of extra-skeletal bone within soft tissues or joints after trauma. Injury factors induce many types of precursor cells to participate in this process. Many cytokines such as bone morphogenetic proteins, hypoxia inducible factor 1-α, inflammation factors and fibrin, can influence this process. Formation of heterotopic ossification often leads to the limitation of limb function and pain. However, prevention and treatment of heterotopic ossification often lead to bone nonunion and high recurrence rate. To find a treatment that can inhibit the formation of heterotopic ossification without affecting fracture healing has become a concern of clinicians. It is necessary to explore the formation mechanism of heterotopic ossification and find effective and safe methods. The authors document the cellular and molecular mechanisms involved in formation of traumatic heterotopic ossification for better understanding the factors affecting the formation of heterotopic ossification so as to provide references for new treatment methods.

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Objective:To investigate the quantitative relationship between liver fat content and bone mineral density (BMD) in middle-aged and elderly people.Methods:Totally 184 middle-aged and elderly community residents were recruited from March to June 2016, including 68 males and 116 females. MRI mDIXON-Quant and quantitative CT (QCT) examinations were performed to determine the content of liver fat and L1-L3 vertebral BMD. The subjects were divided into four groups according to the quartiles of liver fat content, and the baseline characteristics and other variables of different groups were were identified by using one-way analysis of Variance. The relationship between liver fat content and lumbar vertebral BMD was assessed with Spearman correlation and partial correlation analysis.Result:Subjects with higher hepatic fat content had lower spine BMD and higher body mass index (BMI), waist circumference. Liver fat content was negatively correlated with BMD ( r=-0.203, P=0.003). After age and body weight were controlled, the negative correlation between liver fat content and BMD was still significant ( r=-0.291, P<0.001), in males ( r=-0.283, P=0.021) and in females ( r=-0.210, P=0.025). Conclusion:Liver fat content is negatively correlated with lumbar vertebral BMD in middle-aged and elderly people.

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Objective To analyze the acoustic features of patients with Parkinson's disease (PD),and to explore the correlation between the acoustic features and the severity and course of disease.Methods Fifty-two patients with PD from the Tongji Hospital Affiliated to Tongji Medical University and the Ninth People's Hospital Affiliated to the Medical College of Shanghai Jiaotong University from August to December 2015 were enrolled into this study.Thirty-two age-matched healthy people served as control group.PD patients were tested with Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr (H-Y) staging.And all the patients were tested with Mini-Mental State Examiantion (MMSE) and Voice Handicap Index (VHI).The voice samples of all subjects were collected and the frequency perturbation (jitter),amplitude perturbation (shimmer),and harmonic-to-noise ratio (NHR) were analyzed using a vocal assessment.Fundamental frequency (F0),standard deviation of fundamental frequency (SDF0) and formant ratio (F2i/F2u) were analyzed using a real-time speech measuring instrument.The acoustic parameters of the two groups were compared and the correlation between the parameters of the patients and the disease and course of disease was analyzed.Results Subjective assessment using VHI showed a total of 24 VHI abnormalities (46％) in the PD group,including 13 males (54％),11 females (46％).No VHI abnormalities were found in the control group.Among the parameters analyzed by objective acoustic method,compared with the control group (female/a/1.43(1.19,1.92),/i/3.39(1.49,9.85),/u/1.46(1.23,3.85);male/a/1.06(0.92,1.89),/u/1.30(1.07,1.64)),the SDF0 of the three vowels of the female patients in the PD group (/a/2.99(1.81,4.12),Z=5.429,P＜0.01;/i/10.89(5.47,22.20),Z=8.487,P＜0.01;/u/5.16(3.75,7.80),Z=7.138,P＜0.01) and /a/ and /u/ of the male patients in the PD group (/a/2.16(1.73,2.94),Z=4.858,P=0.002;/u/3.70(2.41,5.43),Z=7.664,P＜0.01) were significantly increased,and the F2i/F2u in the PD group (male 1.96±0.84,female 1.81± 1.14) was lower than that in the control group (male 3.48±0.70,female 4.14± 1.08),and the difference was statistically significant (t=-6.669,-6.844,P＜0.01).There were no statistically significant differences in frequency perturbation,amplitude perturbation,harmonic noise ratio and fundamental frequency.Only the fundamental frequency standard deviation of the sound parameters used in the study was correlated with the disease course of PD patients.After the severity of the disease was assessed by H-Y staging,the frequency perturbation (jitter),amplitude perturbation (shimmer) in the middle and late stage patients were higher than those in the early stage patients,and the difference of frequency perturbation in the three vowels was statistically significant,and the difference of amplitude perturbation in the vowels/i/and/u/was statistically significant.No correlation was found between the acoustic parameters and UPDRS score.Conclusions Consonance disorders are common in PD patients,and the changes in acoustic parameters are mainly manifested as the increase in the SDF0 and the decrease in the F2i/F2u.Acoustic parameters can be used as an effective indicator to evaluate the condition and course of PD patients,and further language tasks need to be added to clarify.

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Objective To explore the characteristics of trunk muscle activity in persons with Parkinson's disease (PD) in search of better treatments for abnormal posture.Methods Ninety persons with PD of different severity and 8 normal controls were studied using surface electromyography (sEMG).A sixteen-lead sEMG instrument was used to collect sEMG amplitudes from the bilateral thoracic erector spinae,lumbar erector spinae,external oblique and rectus abdominis muscles when the subjects were lying,standing and walking.Results Compared with the control group,a significant increase was observed in the sEMG amplitude of the lumbar erector spinal muscle [(18.56±14.57) μV] and rectus abdominis muscles [(24.00±18.80)μV] of the PD group when lying.Significant relative increases in (P＜0.05),of the external oblique muscles were observed [(27.87± 11.49)μV] when standing (P＜0.05),and in the thoracic erector spinae muscle [(58.74±29.69)μV] and external oblique muscles [(59.01± 25.20) μV] increased when walking (P＜0.05).Compared with the control group,the sEMG activity of the external oblique muscles was significantly elevated in PD patients at Hoehn and Yahr stage 1 to 1.5 when walking.One or more of the trunk muscle groups showed significantly greater activity in the PD patients in Hoehn and Yahr stage 2 or 3 in all three positions.Conclusions The sEMG activities of the extensor and flexor muscles increase simultaneously in PD patients.More trunk muscles are involved in PD patients with higher H-Y grades.These findings provide a neurophysiological basis for the customizaton of rehabilitation therapy for patients with Parkinson's disease and for the precise selection of muscles for botulinum toxin injection.

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Objective@#To investigate the translucency parameters (TP) and the color parameters of computer-aided design and computer-aided manufacturing (CAD/CAM) materials for veneer restorations in order to guide clinical practice.@*Methods@#Eleven groups of CAD/CAM materials (A2 shade) were included in this study: IPS e.max CAD HT/LT, IPS Empress CAD HT/LT, LavaTM Ultimate HT/LT, VITA SUPRINITY HT/T, VITA ENAMIC HT/T, VITABLOCS Mark Ⅱ, and were named as Group A, B, C, D, E, F, G, H, I, J, K. Each material was designed and milled to disk-shaped specimens (10.0 mm×8.0 mm×0.7 mm) (n=6). The specimens were polished with silicon carbide paper and the thickness of specimens were adjusted into (0.60±0.03) mm. The color parameters of specimens were individually measured with the colorimeter against black and white ceramic tiles background to obtain the TP values. The color parameters of the specimens against the composite resin background were also measured and the color differences (ΔE values) between specimens and the A2 shade tab were calculated.@*Results@#One-way ANOVA showed that the translucency parameters of the 11 groups of materials were statistically significant (F=253.69, P<0.05). The ΔE values of CAD/CAM material groups ranged from 1.78 to 4.12 (ΔE values<5.5).@*Conclusions@#The microstructure of CAD/CAM materials and the types of material translucency influence the optical properties. The CAD/CAM materials in this experiment have achieved color matching with the A2 shade tab.

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Objective@#To discuss the clinical results of three-stage functional ear reconstruction for microtia with congenital aural stenosis (CAS).@*Methods@#From September 2007 to June 2017, 53 cases of microtia with CAS underwent all three-stage functional ear reconstruction, and 445 cases of microtia underwent two stage ear reconstruction without meatoplasty at the same periods. First-stage of three-stage functional ear reconstruction: it was similar to Nagata technique. The crus of helix could not be too long, since we needed the space for the next meatoplasty. Second-stage: it was a modified meatoplasty with endoaural-conchal incision, in which two local rotation flaps and a transposition split-thickness scalp flap were used to widen the stenotic external auditory canal (EAC) and reconstructed the tympanic membrane. Third-stage: it was a modified technique for firm elevation of the reconstructed auricle by using the retro-auricular fascial flap wrapping a porous polyethylene (Medpor) wedge or stored cartilage as the strut. If the patient showed EAC cholesteatoma or infection, we could do the meatoplasty at the first stage. If the patient had completed ear reconstruction, meatoplasty could be done at the third stage.@*Results@#53 cases underwent all three-stage functional ear reconstruction. There were 41 cases (77.4%) obtaining serviceable hearing. The complication rate of meatoplasty was 1.89% and the complication rate of ear reconstruction was 5.66%. Among the 445 cases of microtia treated with two stage ear reconstruction without meatoplasty, the complication rate of ear reconstruction was 9.43%. There was no significant difference between the two groups (P>0.05).@*Conclusions@#Our novel three-stage functional ear reconstruction is a feasible strategy for microtia with CAS. The patients can obtain satisfactory auricle and serviceable hearing. The results are stable and can improve the life quality in both aesthetics and hearing function.

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Objective The aim of the study was to evaluate the hearing performance of a new transcutaneous bone conduction hearing aid.Methods One hundred and nine patients with conductive or mix hearing loss and eleven patients with single sided sensorineural hearing loss from four tertiary referral centers were tested under unaided and aided conditions with the sound processors on testbands.Free field test was performed to obtain the hearing thresholds and speech recognition thresholds in quiet.Adverse events were also documented by a self-reported questionnaire.Results ①Conductive or mixed hearing loss patients:for aged≥6 yrs subgroup,the bone conduction PTA average of aided sides was 18.55±8.99 dB HL.For aged<6 yrs subgroup, the bone conduction ABR hearing threshold average was 18.33±8.36 dB HL.②Statistically significant improvements in free field hearing thresholds were seen when compared aided hearing with unaided outcomes.The average PTA (pure tone average in free field) was measured at 32.21±10.00, 37.33±14.15, and 34.38±10.76 dB HL respectively in conductive or mixed hearing loss aged≥6 yrs subgroup;aged<6 yrs subgroup and SSD subgroup.③In aided situations;speech recognition thresholds in quiet were significantly better compared to unaided situation in patients aged≥6yrs.④None of patients presented adverse events related to the devices.Conclusion The Sophono bone conduction hearing aid has satisfactory hearing performance and can be considered an alternative device for patients with conductive or mix hearing loss or with SSD.

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Objective To analyze the efficacy and tolerance of methotrexate(MTX)in remission maintenance of Crohn′s disease (CD).Methods From June 2012 to August 2015 ,49 CD patients who received MTX as mainly treatment medication to maintain remission were enrolled.The pre-medication history,efficacy,dosage and side effects of MTX were analyzed.The effects of inducing strategy on disease recurrence were analyzed.Chi-square test and t test were used for statistical analysis.Results Among the 49 patients,34 (69.4%)received steroids for remission inducing,nine (18.4%)received infliximab for remission inducing and six (12.2%)achieved remission after operation.In the 44 patients treated with azathioprine (AZA)before,the median treatment time was one month and the dosage for withdrawal of AZA was (42.0 ± 14.8)mg/d.The most common reason was leucopenia (81 .8%, 36/44).Till the time point of follow-up,46 of the 49 CD patients still took MTX orally with a median treatment time of 16 months,and the weekly dosage was (12.7 ±2.0)mg.Thirty-one cases (67.4%) achieved clinical stability,while 15 cases (32.6%)underwent clinical recurrence.The median Crohn′s disease activity index (CDAI)was 123.5 ± 66.6.The weekly dosage of clinical stability group was (12.5 ±2.1)mg,and that of clinical recurrence group was (13.0 ±1 .7 )mg,there was no statistically significant difference between the two groups (t =0.802,P =0.426 ).The recurrence rate of steroids-induced remission group was 41 .2% (14/34 ),which was higher than that of infliximab and surgery-induced remission group (1/15),and the differnce was statistically significant (χ2 =5 .177,P =0.023 ). The common side effects were gastrointestinal reaction (26.5 %, 13/49 ), impaired liver function (20.4%,10/49)and leukopenia (12.2%,6/49).Only three cases could not tolerate the side effects and underwent medication withdrawal.Conclusions As a second-line immunosuppressant for maintanence remission in CD,MTX is effective and well-tolerated in patients.So it can be an important option during the long course of CD.

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OBJECTIVE: To investigate the validity and feasibility of consecutive three-stage surgical technique of combining auricle reconstruction with external auditory canal atresia reconstruction in patients with congenital microtia-atresia, and to assess the post-surgery results by cosmetic and hearing aspects. METHODS: From Sep. 2007 to Jun. 2011, all 74 patients (79 ears) with congenital microtia-atresia treated in our department were enrolled in this study. They consecutively accepted the following three-stage surgical technique: The first stage was Brent' s technique as follows, rib cartilage graft harvest, framework fabrication, and implantation. The second stage combined transfer of the lobule with meatoplasty and tympanoplasty. The third stage was the elevation of the reconstructed auricle. Both the cosmetic and functional hearing results were recorded at follow-ups. RESULTS: Among these patients, 60 patients (78.5%), 62 ears, acquired extremely satisfactory cosmetic results; 10 patients (16.5%), 13 ears, acquired acceptable cosmetic results; while the remaining 4 patients (5.1%) acquired unsatisfactory cosmetic results. However, the height of elevation of the newly performed auricle framework was not enough due to the existence of newly formed external ear canal. Regarding the hearing results, there were 69 ears with followup audiograms. An air-bone gap (ABG) improvement of 12.5 dB was achieved. The air-conduction hearing threshold improved (10.9 ± 8.2) dBHL, 37 ears (53.6%) achieved serviceable hearing after surgery, with ABG less than 30 dB. There were multiple complications occurred after surgery with the incidence of 49.4% (39/79). CONCLUSIONS: The combined three-stage surgical microtia and canal atresia reconstruction technique is a viable choice for some suitable patients with microtia-atresia. However, the incidence of complication after meatoplasty is very high and the hearing restoration is not good enough, which need further investigation for the better results.

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Objective To study the effects of Liensinine on apoptosis of 5637 cells, and its mechanism thereof. Meth?ods CCK-8 method and the colony formation test were used to detect cell viabilities, and then inhibition rates were calcu?lated. Flow cytometry was used to detect the effects of Liensinine on apoptosis of 5637 cells. Western blot assay was used to detect Caspase-7 protein expression. Results CCK-8 assay and colony formation test indicated that Liensinine inhibited the cell proliferation significantly. Results of flow cytometry indicated that Liensinine induced early apoptosis of 5637 cells. Western blot assay showed that Liensinine improved the expression of Caspase-7 and enhanced the activation of Caspase-7 in 5637 cells. Conclusion Liensinine could inhibit the proliferation of 5637 cells, induce early apoptosis, which may be re?lated with the enhanced expression of Caspase-7 and its activation.