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Objective To investigate changes in intestinal bacteria in chronic renal failure (CRF),their diagnostic value for CRF,and correlations between specific bacterial genera and renal function.Methods Fecal specimens were collected from 56 patients with CRF and 38 healthy controls in the Nephrology Department and Medical Examination Center of Shanxi People's Hospital between August 2017 and January 2018.High-throughput sequencing analysis of 16S rDNA V3-V4 hypervariable regions was performed for intestinal bacteria.Intestinal bacteria in CRF patients and healthy subjects were analyzed for alpha,beta diversity,species composition analysis,and differential species analysis.The diagnostic value of the presence of specific intestinal bacteria for CRF was analyzed using a receiver operating characteristic curve (ROC).Pearson's correlation analysis was used to analyze the correlation between the presence of specific genera and the estimated glomerular filtration rate (eGFR).Results The alpha and beta diversity in the CRF group was different from that in the control group (P ＜ 0.05).At the phylum level,Verrucomicrobia were significantly less abundant in the CRF group than that in the control group (0.70％ vs 3.09％,P ＜ 0.001).The abundance of Actinobacteria was significantly greater in the CRF group than that in the control group (1.48％ vs 1.14％,P=0.036).At the genus level,the abundance of Akkermansia (0.96％ vs 3.90％),Parasutterella (0.47％ vs 0.93％),and Lactobacillus (0.07％ vs 0.48％) in the CRF group was significantly less than those in the control group (all P ＜ 0.01).The abundance of Alloprevotella (0.41％ vs 0.04％) and Clostridium Ⅳ (0.6％ vs 0.1％) was significantly greater than those in the control group (all P ＜ 0.05).The diagnostic value of CRF for the area under the ROC curve (AUC) for Akkermansia was 0.753,and that for Lactobacillus diagnostic value of CRF was 0.792.The combined AUC diagnostic value of CRF for detection of Akkermansia and Lactobacillus was 0.830,with high disease prediction value.Lactobacillus abundance was positively correlated with eGFR (R=0.29,P=0.029).Conclusions The diversity and structure of intestinal bacteria are altered in patients with CRF.The abundance of Akkermansia and Lactobacillus has diagnostic value for CRF.The abundance of Lactobacillus is positively correlated with eGFR.
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Objective@#To investigate the indications and long-term outcomes of endoscopy-assisted removal of parotid gland calculi via a transoral approach.@*Methods@#From August 2005 to December 2016, 158 consecutive patients with parotid gland calculi underwent endoscopy-assisted lithectomy transorally. They included 71 males and 87 females, with an age of 5-84 years. The immediate safety and effectiveness were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical manifestations, sialography, scintigraphy and sialometry. Postoperative sialograms were categorized into 2 types: ①type Ⅰ, the main duct was normal or had ectasia and stenosis, but no persistent contrast was seen on the functional film; ②type Ⅱ, the main duct had ectasia or stenosis, with persistent contrast media on the functional film.@*Results@#Under one endoscopic procedure, the stones (or foreign bodies) were completely removed in 134 cases and almost completely removed in 10 cases, with a success rate of 91.1% (144/158). Of the 144 successful cases, the treatment options included direct basket retrieval or forceps grasping in 77 cases, basket entrapment with direct ostium incision in 36, basket capture with perio-ostium incision in 23 and perio-ostium incision in 8 cases with impacted stones. In two of the initial 14 failure cases, the stones were discharged spontaneously 3 months after operation. During 3-120 months′ follow-up (mean 36 months) of the 146 patients, one had recurrent stone, two developed ductal obturation, 16 had mild symptoms, and the remaining 127 cases were asymptomatic. Of the postoperative sialograms in 34 stone-free patients 25 were type Ⅰ, 9 were type Ⅱ. Both scintigraphy and saliva flow rate indicated an improvement of the affected gland function in some degree (P<0.05).@*Conclusions@#Transoral endoscopy-assisted removal of parotid gland calculi is a safe and effective technique. It is mainly indicated for mobile stones in the main duct or impacted stones in the anterior third of the Stensen′s duct. Sialography, scintigraphy and sialometry show postoperative improvement of gland function in most of the cases.
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Objective@#To investigate the different surgical approaches and long-term outcomes of endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct.@*Methods@#From January 2008 to March 2018, 481 consecutive patients with deep hilar and intraparenchymal calculi in the Wharton′s duct underwent endoscopy-assisted transoral removal at Deparment of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology. There were 250 males and 231 females. Their ages ranged from 9-86 years. We operated 476 patients under local anesthesia on an outpatient basis, and the remaining 5 were operated under general anesthesia. On the basis of ultrasonography, spiral CT, sialography and endoscopy, the calculi were classified into 4 types: hilum stones (located at the hilum or proximally with a distance <5 mm from the hilum), infra-hilum stones (intra-glandular stones with a distance of 5-10 mm from the hilum), intraparenchymal stones (with a distance ≥10 mm from the hilum), and multiple stones (concomitant hilum and intra-glandular stones). The treatment approaches included: hilum duct slitting, intraparenchymal duct slitting, submandibulotomy and intraductal retrieval. The success rate, immediate safety and effectiveness of different types of stones were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical symptoms and signs.@*Results@#The calculi sizes varied from 3 to 25 mm, with a mean of 7.8 mm. The calculi were located in the right submandibular gland in 259 patients, in the left submandibular gland in 219 patients and in bilateral glands in 3 patients. The calculi were successfully removed in 446 glands, with a success rate of 92.1% (446/484). The success rate varied according to the stone sites: 97.8% (363/371) for hilum stones, 64.4% (29/45) for infra-hilum stones, 4/16 for intraparenchymal stones and 96.2% (50/52) for multiple stones. The main treatment methods applied included hilum duct slitting in 347 glands, intraparenchymal duct slitting in 13, submandibulotomy in 4, intraductal retrieval in 73, and hilum duct slitting accompanied by intraductal retrieval in 9. Ductal breakage occurred in 2 glands. All patients complained of mild to moderate pain with a duration of 3-7 days. Nine had temporal lingual nerve injury. During 3-120 months′ follow-up (mean 36 months) of the total 484 glands, 1.6% (7/446) developed ranula, 1.3% (6/446) experienced obturation of the main duct and 2.0% (9/446) had recurrent stones. The remaining 95.1% (424/446) glands were symptom-free with good function.@*Conclusions@#Endoscopy-assisted transoral removal of deep hilar and intraparenchymal submandibular calculi is a safe and effective gland-preserving procedure. According to the depth, size and number of the calculi, variant surgical approaches should be attempted to maximize the success rate and to minimize the side effects.
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Objective@#To analyze the radiolographic features of ameloblastoma (AM), odontogenic keratocyst (OKC) and dentigerous cyst (DC) in the maxilla by spiral CT (SCT) and cone-beam CT (CBCT), and to provide useful information for the differential diagnosis of benign radiolucent lesions in the maxilla.@*Methods@#Clinical records, histopathological reports and SCT or CBCT imaging of 85 patients with primary maxillary AM, OKC or DC admitted to Peking University School and Hospital of Stomatology from December 2012 to May 2017 were collected. Radiographic characteristics including site, size, shape, cortex expansion, internal structure and effects on neighboring tissue were analyzed. For OKC and DC, the relationship between cysts and enveloped teeth was classified as centripetal, eccentric and adherent.@*Results@#The 85 patients included 56 males and 29 females, aged from 8 to 84 years old. Eighty-three patients had a single lesion, whereas 2 patients had bilateral cysts. In total, 87 lesions were analyzed, comprising 22 AM, 45 OKC and 20 DC. Among the 22 AM, 11 lesions were desmoplastic type, 16 were round-like in shape and 18 presented with buccal expansion. The shapes of the 45 OKC varied as round-like (n=26), oval (n=3), reniform (n=4), sinus-like (n=5), sinus+round (n=5) and irregular (n=2). Furthermore, 30 OKC presented with buccal expansion, 22 nearly filled the maxillary sinus and 26 were 'dentigerous'. The tooth-cyst relationship of the 'dentigerous' OKC was centripetal in 11, eccentric in 4 and adherent in 11. Among the 20 unicystic DC, 8 lesions were centripetal, 6 were eccentric and 6 were adherent type; 16 DC presented with buccal expansion.@*Conclusions@#Demosplastic type is common in maxillary AM. Most AM are round-like in shape and expand buccally. The shape of maxillary OKC varies greatly and maxillary sinus filling is common. More than a half of OKC appear 'dentigerous'. For DC and OKC, tooth-cyst relationship can be centripetal, eccentric and adherent.
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It is a strategic choice for a country to build top universities for innovative talents and independent innovative products.Germany,South Korea,Japan and Chinese Taiwan and Mainland are taking great measures to build top universities.In comparison with Project 985 universities under the direct administration of the Ministry of Education of China and world top universities in their environment,research,teaching and disciplines,key construction strategy including integration of distinctive resources to build top university system should be kept up,core competency cultivation,proper development environment and major features should come into being,and scientific HEIs categories should be established in building top universities in China.