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This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
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BACKGROUND@#Despite the progress in perinatal-neonatal medicine, complications of extremely preterm infants continue to constitute the major adverse outcomes in neonatal intensive care unit. Human umbilical cord Wharton’s Jellyderived mesenchymal stem cells (HUMSCs) may offer new hope for the treatment of intractable neonatal disorders. This study will explore the functional differences of HUMSCs between extremely preterm and term infants. @*METHODS@#UMSCs from 5 extremely preterm infants(weeks of gestation: 22+5 w,24+4 w,25+3 w,26 w,28 w) and 2 term infants(39 w,39+2 w) were isolated, and mesenchymal markers, pluripotent genes, proliferation rate were analyzed.HUVECs were injured by treated with LPS and repaired by co-cultured with HUMSCs of different gestational ages. @*RESULTS@#All HUMSCs showed fibroblast-like adherence to plastic and positively expressed surface marker of CD105,CD73 and CD90, but did not expressed CD45,CD34,CD14,CD79a and HLA-DR; HUMSCs in extremely preterm exhibited significant increase in proliferation as evidenced by CCK8, pluripotency markers OCT-4 tested by RT-PCR also showed increase. Above all, in LPS induced co-cultured inflame systerm, HUMSCs in extremely preterm were more capable to promote wound healing and tube formation in HUVEC cultures, they promoted TGFb1 expression and inhibited IL6 expression. @*CONCLUSIONS@#Our results suggest that HUMSCs from extremely preterm infants may be more suitable as candidates in cell therapy for the preterm infants.
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Acute lymphoblastic leukemia (ALL) accounts for 75%-85% of the cases of childhood leukemia. As a result of the progress made in diagnosis and treatment, an event-free survival rate of 70%–80% has been reported in our country. Consequently, research should focus on long-term physical function and quality of life of childhood ALL survivors. In the past 20 years, cancer rehabilitation has achieved rapid development in European and American countries, but gaps remain in clinical practice and academic research of rehabilitation for childhood leukemia. Specifically, rehabilitation for childhood leukemia in our country lags behind, compared with that in Western developed countries. In this commentary, we describe a relatively comprehensive childhood ALL survivorship care quality framework to improve patients' long-term quality of life.
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Chuanxiong Chatiaosan was first recorded in Taiping Huimin Heji Jufang, which was made up of 8 herbs, including Chuanxiong Rhizoma, Menthae Haplocalycis Herba, Asari Radix et Rhizoma, Schizonepetae Herba, Saposhnikoviae Radix, Angelicae Dahuricae Radix, Notopterygii Rhizoma et Radix and Glycyrrhizae Radix et Rhizoma. This prescription mainly contains a variety of alkaloids, flavonoids, phenylpropanoids, volatile oils and other compounds, which play the biological activity of promoting blood circulation and relieving pain. Modern pharmacological studies have confirmed that Chuanxiong Chatiaosan can reduce blood viscosity, improve cerebral circulation, and has central analgesic effect to treat migraine effectively. However, the mechanism for treating migraine of this prescription is still unclear. The author elaborated the research status of Chuanxiong Chatiaosan from four aspects, including quality control method, chemical composition, preparation technology and pharmacological research, hoping to provide references for rational clinical application and explanation of pharmacological mechanism of this prescription.
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Objective To explore the clinical value of magnetic resonance imaging( MRI) in the diagnosis and classification of perianal abscess and anal fistula.Methods Eighty patients with suspected perianal abscess and anal fistula were selected in Yuyao People＇s Hospital from May 2016 to December 2017.They were divided into general examination group and MRI group by random number table,with 40 cases in each group. The general examination group underwent ultrasound examination,and the MRI group underwent MRI examination.The detection rate of MRI examination for various types of perianal abscess and anal fistula was analyzed based on the results of operation. Results In the general examination group, the diagnostic accuracy of anal fistula supervisor, anal fistula internal orifice,perianal abscess and anal fistula branch were 65.0% (26/40),70.0% (28/40),57.5% (23/40) and 52.5% (21/40),respectively,which in the MRI group were 92.5% (37/40),77.5% (31/40),87.5% (35/40) and 95.0% (38/40),respectively.There were statistically significant differences in diagnostic accuracy of anal fistula supervisor, perianal abscess and anal fistula branch between the two groups ( χ2 =9.054,7.116,8.865, all P <0.05). The effective rate of operation in the MRI group was 67.5% (27/40),which was significantly higher than that in the general examination group [67.5% (27/40)],the difference was statistically significant(χ2 =9.935,P<0.01). Conclusion Using MRI to diagnose perianal abscess and anal fistula can accurately judge the number,involvement range,specific location and surrounding structure of the abscess and anal fistula,and has important value for clinical treatment and prognosis.
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Objective: Based on the color space technology of CIE-LAB,the color of vinegar-processed Corydalis Rhizoma decoction pieces was digitized,combining with the contents of 10 major alkaloids in the decoction pieces,to discuss the correlation between the color and contents of main ingredients of vinegar-processed Corydalis Rhizoma decoction pieces,and investigate the intrinsic quality difference in the decoction pieces with different color. Method: The precision colorimeter was used to determine the color parameters of vinegar-processed Corydalis Rhizoma decoction pieces;HPLC was employed to determine contents of main chemical components in the decoction pieces,which was performed on Agilent ZORBAX SB-C18 column(4.6 mm×250 mm,5 μm) with mobile phase of acetonitrile(A)-0.1% potassium dihydrogen phosphate aqueous solution(B) for gradient elution(0-10 min,5%-22%A;10-30 min,22%-25%A;30-50 min,25%-60%A;50-70 min,60%-95%A),detection wavelength of 280 nm,column temperature at 30℃ and flow rate of 1.0 mL·min-1. Result: The quality of vinegar-processed Corydalis Rhizoma decoction pieces with different color was in line with the requirement of the 2015 edition of Chinese Pharmacopoeia,but there were differences in the intrinsic quality between the decoction pieces.The total content of chemical components in the samples showed a positive correlation with the a*(green-red axis) and total chromatic aberration value(ΔE) in the CIE-LAB color space, and it was significantly negative correlated with L*(lightness) and b*(blue-yellow axis).In the 10 tested components,except for D-tetrahydrojatrorrhizine and tetrahydrocoptisine,contents of protopine and other 6 components were positively correlated with color,and only the content of corydaline was negatively correlated with color. Conclusion: Color analysis technology can objectively quantify the color of the decoction pieces,and can achieve a quick evaluation of quality of the decoction pieces by analyzing correlation between the color and the contents of main active ingredients.
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Bupleuri Radix is a traditional Chinese medicine commonly used in clinical practice, which has the effects of relieving fever, relieving liver and depression, and promoting Yangqi. At present, the varieties of Bupleuri Radix are relatively chaotic, and the processing in the production areas is relatively extensive. In the processing of Bupleuri Radix, the processed products contained in the 2015 edition of Chinese Pharmacopoeia are raw products and vinegar-processed products. In addition, the specifications on Chinese medicine processing in various provinces and cities contain many processing methods, such as stir-frying with wine, stir-frying with honey, processed with turtle blood, etc. However, there are great differences in processing specifications among provinces and cities, and the processing methods lack clear process parameters, so the quality of Bupleuri Radix decoction pieces produced on these basis is uneven, which affects the clinical application of the decoction pieces. By consulting ancient books and relevant literature, the authors conduct textual research on the varieties of Bupleuri Radix, and systematically summarized the processing methods and processing methods in the producing area, so as to provide reference for the establishment of processing technology specifications and quality standards of Bupleuri Radix decoction pieces.
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Ischemic stroke is one of the diseases that seriously threaten human health. It is characterized by the high morbidity, disability rate and mortality, and has been lacking effective treatment. Its occurrence is related to metabolic disorder, calcium overload, free radical injury, inflammatory reaction, etc. Gardeniae Fructus not only has antipyretic, analgesic, hepatoprotective and cholagogic effects, but also has protective effects against ischemic brain injury. At present, there are more studies about the main components of Gardeniae Fructus against ischemic brain injury, but the mechanism is unclear. In this paper, the mechanism of the main active ingredients from Gardeniae Fructus in the treatment of cerebral ischemia injury in recent years was reviewed, and the effective component monomer and the whole were analyzed, so as to provide a basis for the prevention and treatment of ischemic brain injury of Gardeniae Fructus decoction pieces, and provide a reference for further research and application of this decoction pieces.
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Objective@#To establish the functional models based on various shapes of bone defects in isolated cleft palate patients and to classify the bone defects of the cleft palate cases using different functional curves.@*Methods@#Tracking back from January 2018 to December 2018, 143 patients with cleft palate (Veau Ⅰ & Ⅱ) treated in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, were included (age of 7 months to 25 years, average age 1.6 years, median age 1.0 year, the male to female ratio was 0.57∶1).The pre-operative (CT) data sets were reconstructed into a three dimensional model to produce a direct image of the cleft palate. According to the shapes of the bone defect, cleft palate cases were divided into three types, i.e."儿" shape, inverted "V" shape and inverted "U" shape, and then the cases were assessed and reviewed by five examiners independently. Using Microsoft Excel software, the curves of the bone defect were placed in the coordinate system for mathematical modeling, including exponential function (y=aebx), linear function (y=ax+b) and logarithm function (y=alnx+b). The function of the maximum fit R2 value was used as the final fit curve. Statistical analysis was performed in four aspects: ① The reliability and feasibility of the curve fitting of the functions; ② The calculation of the composition ratio of the types of bone defect; ③Analyzing the correspondence between the subjective judgment results and fitting function curves; ④ The R2 values of three types of functional curves homologous to different morphological types, and the data were tested by variance analysis and P values were shown.@*Results@#Among the 143 patients with cleft palate, the "儿" shaped defect accounted for 18% (26/143), the inverted "V" shaped defect accounted for 31% (44/143), and the inverted "U" shaped defect accounted for 51% (73/143). The coincidence rate of the "儿" shaped defect with the exponential function (y=aebx) was 96%, the coincidence rate of the inverted "V" shaped defect with the linear function (y=ax+b) was 82%, and the coincidence rate of the inverted "U" shaped defect with the logarithmic function (y=alnx+b) was 93%. The differences in R2 values amongst the three groups were statistically significant (P<0.05).@*Conclusions@#The shapes of bone defects of the incomplete cleft palate can be described by functional curve models which include exponential, linear and logarithmic functions and can be used to classify and lay the foundation for digital classification of cleft lip and palate cases.
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Objective It is crucial to restore and fix the position of nasal septum which elaborates supportive function in rhinoplasty for secondary nose deformity of cleft lip and palate patients.The aim of this study was to explore the fixation technique with absorbable material in rhinoplasty for correction cleft lip nose deformity.Methods Nineteen cases with unilateral cleft lip/with or without palate cleft were included in this study.Absorbable screw was used to fix the implanted and re-positioned grafted cartilage septum which was shaped into strip with anterior nasal spine.Results Full success was achieved for all of 19 cases with internal fixation technique to re-position nasal septum to correct nasal deformity.There was no complications occurred.Conclusions Internal fixation technique with absorbable material could be used to correct secondary nasal deformity in cleft lip and palate patients and fixed re-positioned grafted cartilage septum can apply a strong support to ala nasi cartilage in cleft site.
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Objective To investigate the clinical features,pathogenesis,diagnosis and treatment of neonatal cerebral infarction(NCI)in order to have a further understanding of its clinical features,to enhance therapeutic effica﹣cy and to improve prognosis. Methods The clinical history,head magnetic resonance imaging( MRI)+ diffusion Weighted imaging(DWI)data and folloW－up results of 39 neonates With NCI admitted into the Department of Neonato﹣logy,Gaozhou People＇s Hospital and the Second Affiliated Hospital of Shantou University Medical College from January 2013 to March 2018 Were retrospectively analyzed. Results All the 39 children Were diagnosed as NCI by MRI +DWI,among Which 30 cases(76. 92%)Were full－term infants,and 9 cases(23. 08%)Were premature infants,in Which 61. 54%(24／39 cases)Were males,and 17 cases(43. 59%)Were performed With emergency cesarean section because of umbilical cord around neck,intrauterine distress or maternal pregnancy hypertension respectively. TWenty－five patients(64. 10%)had the history of perinatal hypoxia. The presentation of MRI shoWed 32 cases(82. 10%)of ischemic cerebral infarction and 7 cases(17. 90%)of hemorrhagic cerebral infarction,While middle cerebral artery and its branches Were more susceptible to NCI With a left hemisphere predominance. Sixteen patients(41. 03%)developed convulsions. TWo patients died of purulent meningoencephalitis associated With NCI. One patient gave up treatment in the neonatal period and died 2 days after discharge. One patient died of cerebral palsy and pneumonia at the age of 11 months. Nine cases(31. 03%)developed cerebral palsy,and 2 patients developed speech disturbance so they could not express complex sentences. Conclusions Perinatal hypoxia and emergency cesarean section may be closely related to the incidence of NCI. NCI resulting from purulent meningoencephalitis is more severe and has a Worse prognosis. Considering the facts that NCI usually does not have specific clinical manifestations in the early stage,MRI +DWI,as the gold standard for the diagnosis of NCI,could be performed to facilitate early diagnosis and intervention.
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In this experiment,the gradation analysis method was used to evaluate the quality of different pieces of Gardeniae Fructus through the extraction rate difference and the difference analysis of the main components in the extract. In this experiment cold-dip and hot-dip methods were used to compare the yield of Gardeniae Fructus extract and the content of chemical constituents with water,25%,50%,75% and 95% ethanol fractions. By weighted calculation,the optimal extraction method of Gardeniae Fructus was determined,and this was verified by practical application. RESULTS:: showed that for the water-soluble extract,cold dip method was better than the hot dip method; and for alcohol-soluble extract,75% ethanol under cold dip method was best. The verification results showed that water-soluble extracts under cold dip methods could be used to significantly distinguish the raw Gardeniae Fructus( GF) and processed( stir-baked) GF( GFP) collected from the market. Meanwhile,this method could be also used to distinguish the same batch of GF,GFP and carbonized GF( GFC) with significant differences,respectively( P<0. 05). Ethanol-soluble extract can be used to clearly distinguish GFP and GFC pieces in the same batch( P<0. 05). The results of content determination showed that the variation coefficient of components in GF processed products was higher than that in extracts,and the content of hydroxygeniposide was the most significant component between GF and its processed products. It is suggested that the method of water-soluble extract of GF and the determination of the content of gardoside should be combined together to evaluate the quality of GF and its heat processed products.
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Drugs, Chinese Herbal , Fruit , Chemistry , Gardenia , Chemistry , Plant ExtractsABSTRACT
Commercially available japonica rice and indica rice with different trade names were collected,and then based on the method of rice stir-frying,their many indexes were evaluated,for example the physical and chemical properties such as appearance color,grain type,broken kernel ratio,length-width ratio,1 000-grain weight,specific heat capacity,moisture content,amylose content,and protein content. The discriminant function analysis was used to determine the effective factors affecting the quality of rice as excipients. The results showed that two types of rice could be distinguished by rice color parameter a*,grain parameter circularity,1 000-grain weight and amylose content. These four effective factors can be used as the quality evaluation indexes for fried rice as excipients.Protein is one of the main components of rice,and its content affects the quality of rice. There is a significant difference in the protein content between japonica rice and indica rice. Therefore,protein content should be used as one of the evaluation indexes for rice quality. After comprehensive consideration,it is suggested that the red-green value a*shall not be less than 0. 50; the circularity not less than 53. 0,the 1 000-grain weight not less than 16. 0 g,the amylose content not less than 12. 0% and the protein content not less than4. 0% in the japonica rice; the red-green value a*shall not be lower than-1. 0,the circularity not less than 41. 0,the 1 000-grain weight not less than 13. 0 g,the amylose content not less than 9. 0% and the protein content not less than 3. 5% in the indica rice. In this study,the quality evaluation standards for rice as excipients( japonica rice,indica rice) were supplemented and improved,laying foundation for the development of quality standards for rice as excipients with the rice stir-frying method.
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Amylose , Cooking , Excipients , Food Quality , Hot Temperature , Oryza , ChemistryABSTRACT
Anemia of neonate,especially in premature infants,is a common phenomenon in newborns and has attracted more and more attention in the academic world.There are various reasons for anemia.Besides the common pathophysiological basis such as iron deficiency and erythropoietin deficiency,blood group incompatibility,hemolysis and iatrogenic blood loss are also important factors leading to anemia of neonates.Preventive measures for neonatal ane-mia include delayed ligation of the umbilical cord,the application of erythropoietin and the effective reduction of iatro-genic blood loss.At present,blood transfusion is still one of the main treatments for neonatal anemia.However,there are still controversies about transfusion indications as well as it′s short-term and long-term side effects.
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The qualitative analysis method of ultra performance liquid chromatography tandem quadrupole time of flight mass spectrometry (UPLC-Q-TOF-MS/MS) was established for the chemical constituents in Sanhuang tablets. Waters ACQUITY BEH C₁₈ (2.1 mm×100 mm, 1.7 μm) column was used with 0.1% formic acid solution (A)-0.1% formic acid acetonitrile (B) as the mobile phase for gradient elution. The flow rate was 0.2 mL•min⁻¹; the sample volume was 1 μL and the column temperature was 30 ℃. The high-resolution quadrupole time-flight mass spectrometry was used as detector with electrospray ion source in both positive and negative models, and the dry gas temperature was 325 ℃. Based on the analysis of mass spectrometry and literature reports, 38 compounds were confirmed, including 1 alkaloid, 1 dianthrone compound, 6 tannins, 7 anthraquinone glycosides, 6 anthraquinones and 17 flavonoids. Liquid chromatography-mass spectrometry method is simple, reliable and rapid to identify the chemical compositions of Sanhuang tablets, and it is helpful to reveal its chemical constituents and pharmacodynamic substances.
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BACKGROUND: Human umbilical cord mesenchymal stem cells (HUMSCs) can differentiate into insulin-producing cellsafter induced by chemical drugs or co-culture methods, but insulin secretion is extremely low. Therefore, to inducemature pancreatic beta cell differentiation from stem cells by adenovirus transfection of specific genes involved in thedevelopment of pancreas is a research hotspot in recent years.OBJECTIVE: To study the differentiation potential of HUMSCs into insulin-producing cells after transfection withmusculoaponeurotic fibrosarcoma oncogene homologue A (MafA).METHODS: Ad-MafA-EGFP was transferred into passage 3 HUMSCs. After 7 days of induction, changes of cellmorphology were observed by inverted phase contrast microscope. Expression of pancreatic cell-specific genes(glucagon, PDX1, Nkx2.2) was detected by PCR technique.RESULTS AND CONCLUSION: After Ad-MafA-EGFP transfection, no significant morphological changes were observedin the HUMSCs under inverted phase contrast microscope. It was confirmed by fluorescence microscope thatAd-MafA-EGFP was transferred into the HUMSCs. After induction, the expression of human pancreatic precursorcell-related genes, including glucagon, PDX1 and Nkx2.2, was increased as detected by PCR. To conclude, thesefindings could provide experimental evidence for further differentiation and maturation of pancreatic β cells fromHUMSCs.
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Some of the clinical manifestation of primary immunodeficiency disease in children is similar with that of hematological system diseases in children.It would result into the change of one or multiple lines of blood cells, which would lead to infection or malignant tumors.To strengthen the awareness of the hematologic manifestations of immunodeficiency diseases will be beneficial for doctors in the diagnosis of diseases,judgment of complication and prog-nosis.
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Objective:To evaluate the surgical corrective results of maxillary hypoplasia in patients with cleft lip and palate withtranspalatal modified Le Fort Ⅰ osteotomy.Methods:In the study,1 1 patients (4 women,and 7 men)with maxillary hypoplasia secondary to cleft lip and palate underwent transpalatal modified Le Fort Ⅰ osteotomy at Peking University School of Stomatology from Jan.201 2 to Dec.201 3, with the mean age of 21 years (from 1 8 to 27 years),Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty were performed simultaneously in 9 of them for better appearance and functional occlu-sion.Lateral cephalometric radiographs were taken and traced before surgery,immediately after surgery and 6 months after surgery.The position of subspinale (A)on horizontal direction,the angle of sella-na-sion-subsipmale (SNA)and the angle of sella-nasion-supramental (SNB)were collected and analyzed to evaluate the results.Results:All the patients were uneventful with transpalatal modified Le Fort Ⅰosteotomy.All of them had a better profile and a satisfactory occlusionafter operation.The position of A was moved forward (6.6 ±1 .1 )mm on average in horizontal direction when surgery was completed,and maintained (6.0 ±1 .2)mm on average 6 months after surgery.The average of SNA was 75.9°±2.8° before surgery,81 .6°±8.6°immediately after surgery,and maintained 81 .0°±2.6°6 months after sur-gery.The average of SNB was 82.6°±3.7°before surgery,78.0°±2.4°immediately after surgery,and maintained 78.5°±2.4°6 months after surgery.Conclusion:The maxillary hypoplasia in cleft lip and palate patients can be successfully corrected with transpalatal modified Le Fort Ⅰ osteotomy and the func-tional occlusion can be achieved simultaneously.The effect of deformity correction was satisfactory. Transpalatal modified Le Fort Ⅰ osteotomy can move maxilla more sufficiently,especially applicable for the patient with severe palatal scars preoperatively.
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To elucidate the key issues in the development and innovation of traditional Chinese medicine processing discipline and Chinese herbal pieces industry Chinese herbal pieces industry. According to the author's accumulated experience over years and demand of the development of the Chinese herbal pieces industry, the key issues in the development and innovation on the Chinese herbal pieces industry were summarized. According to the author, the traditional Chinese medicine processing discipline shall focus on a application basis research. The development of this discipline should be closely related to the development of Chinese herbal pieces. The traditional Chinese medicine processing discipline can be improved and its results can be transformed only if this discipline were correlated with the Chinese herbal pieces industry, matched with the development of the Chinese herbal pieces industry, and solved the problems in the development on the Chinese herbal pieces industry. The development of traditional Chinese medicine processing discipline and the Chinese herbal pieces industry also requires scientific researchers to make constant innovations, realize the specialty of the researches, and innovate based on inheritance.
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<p><b>Objective</b>To investigate the influence of cellphone electromagnetic radiation (CER) on the testicular ultrastructure and the apoptosis of spermatogenic cells in male rats.atability, feasibility, applicability, and controllability in the construction of experimental animal models, we compared the major anatomic features of the penis of 20 adult beagle dogs with those of 10 adult men. Using microsurgical techniques, we performed cross-transplantation of the penis in the 20 (10 pairs) beagle dogs and observed the survival rate of the transplanted penises by FK506+MMF+MP immune induction. We compared the relevant indexes with those of the 10 cases of microsurgical replantation of the amputated penis.</p><p><b>METHODS</b>Thirty adult male SD rats were equally randomized into a 2 h CER, a 4 h CER, and a normal control group, the former two groups exposed to 30 days of 900 MHz CER for 2 and 4 hours a day, respectively, while the latter left untreated. Then the changes in the ultrastructure of the testis tissue were observed under the transmission electron microscope and the apoptosis of the spermatogenic cells was determined by TUNEL.</p><p><b>RESULTS</b>Compared with the normal controls, the rats of the 2 h CER group showed swollen basement membrane of seminiferous tubules, separated tight junction of Sertoli cells, increased cell intervals, apparent vacuoles and medullization in some mitochondria, and increased apoptosis of spermatogenic cells, mainly the apoptosis of primary spermatocytes (P<0.05 ). In comparison with the 2 h CER group, the animals of the 4 h CER group exhibited swollen basement membrane of seminiferous tubules, more separated tight junction of Sertoli cells, wider cell intervals, incomplete membrane of spermatogonial cells, fragments of cytoplasm, nuclear pyknosis and notch, slight dilation of perinuclear space, abnormalities of intracellular mitochondria with vacuoles, fuzzy structure, and fusion or disappearance of some cristae, and increased damage of mitochondria and apoptosis of spermatogenic cells, including the apoptosis of spermatogonial cells, primary spermatocytes, and secondary spermatocytes (P<0.05 ).</p><p><b>CONCLUSIONS</b>CER can damage the testicular ultrastructure and increase the apoptosis of spermatogenic cells of the male rat in a time-dependent manner, and the apoptosis of spermatogenic cells may be associated with the damage to mitochondria.</p>