Radiofrequency ablation for infants with incessant ventricular tachycardia and heart failure / 中国小儿急救医学

Objective:To investigate the effect of radiofrequency ablation on infants with incessant ventricular tachycardia(IIVT) and heart failure.Methods:Twenty-eight infants with IIVT combined with heart failure admitted to Beijing Children′s Hospital of Capital Medical University from January 2006 to December 2021 were selected, including 16 boys and 12 girls; 26 cases were treated with radiofrequency ablation.The characteristics of IIVT and heart failure and the results of radiofrequency ablation were analyzed.Results:The average age of the first diagnosis of 28 infants was 13.9 months old, and all of them had heart failure.Eleven infants had cardiogenic shock, three infants had cardiogenic syncope, two infants had respiratory failure for respiratory support, and one infant died.Color Doppler echocardiography showed that the left ventricular diameter increased and/or left ventricular systolic function decreased.Anti-heart failure treatment was effective in 27 cases(96.4%), electrical cardioversion in five cases, effective in three cases, and anti-arrhythmic drugs were effective in 17 cases(60.7%). Twenty-six cases(92.9%, 26/28) were treated with radiofrequency ablation, with immediate success in 23 cases(88.5%, 23/26) and effective in three cases(11.5%, 3/26). During the follow-up period for 3 to 36 months, cardiac function returned to normal in 25 cases(96.2%, 25/26) and recurred in three cases(11.5%, 3/26 cases), which were cured after radiofrequency ablation again.Temporary complications of atrioventricular block occurred in one case(3.8%, 1/26). In 26 cases of surgical children, 15 cases were measured by X-ray two-dimensional mapping and 11 cases were measured by three-dimensional mapping.The cumulative X-ray exposure was 87.0(51.5, 151.5) mGy and 1.2(0, 15.9) mGy, respectively, and the dose area product was 39.8(19.2, 427.8) μGy/m 2 and 2.8(0, 44.3) μGy/m 2.The cumulative X ray exposure and the dose area product were significantly reduced under the three-dimensional mapping method( P<0.001). Conclusion:The infants with IIVT combined with heart failure are prone to serious complications, and the effects of cardioversion and anti-arrhythmic drugs are limited.Radiofrequency ablation should be performed as soon as possible after heart failure is controlled.The application of three-dimensional mapping technology in surgery can significantly reduce ionizing radiation.

Analysis of 15 cases of bronchial-pulmonary artery fistula / 中华儿科杂志

Objective: To summarize the clinical characteristics of bronchial-pulmonary artery fistula and evaluate the effect of interventional closure of bronchial-pulmonary artery fistula. Methods: A retrospective case study was conducted. Fifteen children with hemoptysis who were diagnosed with bronchial-pulmonary artery fistula in Beijing Children's Hospital, Capital Medical University from January 2018 to March 2022 were selected. Their clinical symptoms and chest-enhanced CT findings were recorded. The children who failed to improve after anti-infection and hemostasis treatment were treated with transcatheter embolization through microparticles under digital subtraction angiography (DSA). The efficacy and post-operation recurrence were evaluated. Results: There were 15 children, including 9 males and 6 females, aged 9.8 (3.7, 12.1) years, weighing 35 (16, 55) kg. There was hemoptysis of varying degrees before surgery. Only 2 children had decreased hemoglobin. Chest enhanced CT showed that their bronchial arteries were thickened and tortuous, including 11 cases of single vessel disease and 4 cases of multivessel disease; 11 children had varying degrees of pneumonia and 4 children had atelectasis. Except for one case effectively treated with medical therapy, the remaining 14 cases were all treated with transcatheter interventional closure with embolic microparticles, among whom 12 had their fistula completely blocked with a single operation and the other 2 children underwent multiple operations because of too many fistulas. One child had extensive bronchial-pulmonary artery fistula which failed to be blocked completely even after multiple operations. Among the remaining 13 children, only 2 patients whose fistula was considered to be completely closed had recurrence presenting with hemoptysis at 3 months and 2 years after the operation, and no hemoptysis was found after the second closure. All children were discharged without chest pain, spinal cord paraplegia, or other serious complications. Fourteen children were followed up for 1.4 (0.9,2.9) years, among whom one still has intermittent mild hemoptysis due to incomplete closure and the rest had a satisfactory outcome. Conclusions: Hemoptysis is the first symptom of bronchial-pulmonary artery fistula. For children with failed medical treatment, transcatheter closure with an embolic pellet is effective, safe and feasible, with a low recurrence rate.

Dosimetric comparison of hippocampal avoidance wholebrain radiotherapy with flattening filter and flattening filter-free modes / 中国辐射卫生

@#<b>Objective</b> To compare the dosimetric differences of volumetric modulated arc therapy (VMAT) with flattening filter(FF) and flattening filter-free(FFF) modes in hippocampal avoidance whole brain radiotherapy. <b>Methods</b> We included 15 patients with hippocampal-sparing whole brain radiotherapy, and designed two radiotherapy plans of FF-VMAT and FFF-VMAT for each patient. On the premise of meeting clinical dose requirements, the two plans’ dosimetry, total number of monitor units, and beam-on time were compared. <b>Results</b> There were no significant differences in the target coverage, conformity index, and dose gradient of the FF-VMAT and FFF-VMAT plans (<i>P</i> > 0.05). The <i>D</i>_max, <i>D</i>_100%, and <i>D</i>_meanto the hippocampal tissue were significantly lower with FFF-VMAT [(15.13 ± 0.38) Gy, (7.12 ± 0.34) Gy, and (9.76 ± 0.43) Gy, respectively)] than with FF-VMAT (16.46 ± 0.56) Gy, (7.72 ± 0.28) Gy, and (10.54 ± 0.48) Gy, respectively)] (<i>P</i> < 0.05). The <i>D</i>_maxto the left and right lenses and the <i>D</i>_meanto the left and right eyeballs with FFF-VMAT were (7.26 ± 0.43) Gy, (6.29 ± 1.13) Gy, (11.01 ± 0.94) Gy, and (9.78 ± 1.13) Gy, respectively, which were significantly lower than FF-VMAT’s corresponding doses of (8.09 ± 0.66) Gy, (7.80 ± 0.74) Gy, (11.38 ± 1.09) Gy, and (11.05 ± 0.90) Gy, respectively (<i>P</i> < 0.05). The doses to other organs at risk including the optic nerve and optic chiasm were all controlled within the safe dosage ranges, with no significant differences between the two plans (<i>P</i> > 0.05). The FFF-VMAT plan had a significantly greater number of monitor units and a significantly shorter beam-on time than the FF-VMAT plan (<i>P</i> < 0.05). <b>Conclusion</b> Both FF-VMAT and FFF-VMAT can meet the clinical requirements, with FFF-VMAT having better hippocampus and lens protection, shorter beam-on time, and higher treatment efficiency.

Study on event-related potential P300 in patients with chronic insomnia combined with anxiety and depression / 中华行为医学与脑科学杂志

Objective:To explore the clinical significance of event-related potential P300 in the diagnosis and treatment of cognitive function in patients with chronic insomnia combined with anxiety and depression.Methods:Sixty patients with chronic insomnia complicated with anxiety and depression treated in Wuhan First Hospital from October 2020 to March 2021 were selected as the observation group, and 60 healthy volunteers were selected as the control group in the same period.Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were used to evaluate the anxiety and depression status of patients.Mini mental state examination (MMSE) and Montreal cognitive assessment scale (MoCA) were used to evaluate the cognitive function of the subjects.All subjects were tested for P300 event-related potential, and the latency and amplitude of P300 event-related potential were recorded.SPSS 25.0 software was used for statistical analysis.Independent sample t-test was used for comparison between groups.Pearson correlation analysis was used to analyze the correlation between cognitive function and P300 event-related potential. Results:The scores of HAMA ((16.65±5.10), (9.30±4.42)) and HAMD ((18.07±3.97), (8.48±3.21)) in the observation group were higher than those in the control group ( t=8.438, 14.545, both P<0.05), and the MoCA score (22.35±4.25) was lower than that(25.65±2.29) in the control group ( t=-5.291, P<0.05). In the eight dimensions of MoCA, the scores of visual space and executive ability ((3.38±1.46), (4.63±0.69)), naming ((2.37±0.78), (2.65±0.48)), language ((2.17±0.96), (2.53±0.81)) and delayed recall ((2.58±1.45), (4.17±0.85))in the observation group were lower than those in the control group ( t=-5.991, -2.394, -2.259, -7.292, all P<0.05). Compared with the control group, the latencies of P300 (N1, N2, P3) in the observation group were significantly prolonged ( t=3.281, 4.342, 4.492, all P<0.01). The latencies of P300 (N1, N2, P3) were positively correlated with HAMD score ( r=0.242, 0.301, 0.311, all P<0.05). The latencies of P300 (N2, P3) were positively correlated with HAMA score ( r=0.205, 0.207, both P<0.05). The latencies of P300 (N2, P3) were negatively correlated with the delayed recall score of MoCA ( r=-0.197, -0.236, both P<0.05). Conclusion:There are different degrees of cognitive impairment in patients with chronic insomnia combined with anxiety and depression.P300 in patients with chronic insomnia combined with anxiety and depression shows prolonged latency.P300 latency is related to depression, anxiety and cognition in patients with chronic insomnia combined with anxiety and depression.Event-related potential P300 may be used as a neurophysiological objective evaluation tool for cognitive impairment in patients with chronic insomnia combined with anxiety and depression.

Progress on treatment of tachyarrhythmia in infants / 中国小儿急救医学

Infant tachycardia is a critical disease, mainly with supraventricular tachycardia and ventricular tachycardia.The treatment of tachycardia in infant is quite different from that of older children, and there is no relevant guidelines at present.Drug therapy in the acute stage of supraventricular tachycardia and atrial fluttery is mainly intravenous adenosine injection.Digoxin is widely used in neonates.Propranolol is the first choice for prophylactic treatment, and landilolol is in the development stage.Ventricular tachycardia can be spontaneously subsided, the treatment is dominated by intravenous lidocaine.For non-drug therapy, heart cardioerter is the emergency treatment for serious rapid arrhythmia.Radiofrequency ablation is used in infants with more severe conditions and where the onset of tachycardia can not be controlled.Bury cardioverter-defibrillator is effective in preventing infant ion channel disease complicated with malignant ventricular tachycardia induced sudden cardiac death.Subcutaneous implantion of a defibrillator may be superior to intravenous implantation in infants and young children.

Unsupervised deep learning for identifying the O 6-carboxymethyl guanine by nanopore sequencing / 生物医学工程学杂志

O 6-carboxymethyl guanine(O 6-CMG) is a highly mutagenic alkylation product of DNA that causes gastrointestinal cancer in organisms. Existing studies used mutant Mycobacterium smegmatis porin A (MspA) nanopore assisted by Phi29 DNA polymerase to localize it. Recently, machine learning technology has been widely used in the analysis of nanopore sequencing data. But the machine learning always need a large number of data labels that have brought extra work burden to researchers, which greatly affects its practicability. Accordingly, this paper proposes a nano-Unsupervised-Deep-Learning method (nano-UDL) based on an unsupervised clustering algorithm to identify methylation events in nanopore data automatically. Specially, nano-UDL first uses the deep AutoEncoder to extract features from the nanopore dataset and then applies the MeanShift clustering algorithm to classify data. Besides, nano-UDL can extract the optimal features for clustering by joint optimizing the clustering loss and reconstruction loss. Experimental results demonstrate that nano-UDL has relatively accurate recognition accuracy on the O 6-CMG dataset and can accurately identify all sequence segments containing O 6-CMG. In order to further verify the robustness of nano-UDL, hyperparameter sensitivity verification and ablation experiments were carried out in this paper. Using machine learning to analyze nanopore data can effectively reduce the additional cost of manual data analysis, which is significant for many biological studies, including genome sequencing.

The effect of aquaporin 4 regulated by microRNA-320a on a cell model of Alzheimer′s disease / 中华物理医学与康复杂志

Objective:To explore the effect of aquaporin 4 (AQP4) regulated by miR-320a on a cell model of Alzheimer′s disease.Methods:A rat adrenal pheochromocytoma cell line (PC12) was induced into neurons using nerve growth factor (NGF). The morphology of the PC12 cells and the neurons was observed, and ubiquitin carboxy terminal hydrolase L1 (Uch-L1) and neurofilament protein (NFP) were detected. Levels of microtubule-associated protein (MAP2) and AQP4 target genes were related to the mRNA expression of NFP to determine the neuron-inducing effect. The neurons were then randomly divided into a control group (given no treatment), an miR-320a mimic transfection group (cultured by adding 50nmol/L miR-320a as a mimic agent), an miR-320a inhibitor group (cultured by adding 50nmol/L miR-320a as an inhibitor), an Aβ treatment group (cultured by adding Aβ), an Aβ+ miR-320a mimic group (cultured by adding both 50nmol/L miR-320a and Aβ), and an Aβ+ miR-320a inhibitor group (also cultured by adding Aβ, but with 50nmol/L miR-320a as an inhibitor). Cell activity was measured by the CCK8 method. Reverse-transcription polymerase chain reactions were used to detect the relative expression of the target gene miR-320a, AQP4, B-cell bcl2-associated X (Bax), and B-cell bcl-2 (Bcl-2) mRNA. Western blotting was employed to detect the relative expression of AQP4, Bax and Bcl-2 proteins.Results:After PC12 was induced by 50μg/L NGF, the expression of Uch-L1 genes in the induced neuron was significantly down-regulated compared with the PC12. The expressions of NFP, MAP2 and AQP4 genes were significantly up-regulated, and the relative expressions of MAP2 and AQP4 proteins increased significantly. Compared with the control group, the apoptosis and cell activity of neurons in the treatment group increased, the mRNA and protein expressions of miR-320a, AQP4, bcl-2, AQP4 and Bcl-2 decreased significantly, and the mRNA and protein expressions of Bax increased significantly. Compared with the Aβ-treated group, the cell activity of the Aβ+ Mir-320a mimic group increased significantly, the mRNA and protein expressions of miR-320a, AQP4 and Bcl-2 increased significantly, and the mRNA and protein expressions of Bax decreased significantly. Compared with the Aβ+ miR-320a mimic group, the cell activity of the Aβ+ miR-320a inhibitor group decreased significantly, the mRNA and protein expressions of miR-320a, AQP4 and Bcl-2 decreased significantly, and the mRNA and protein expressions of Bax increased significantly.Conclusion:miR-320a can up-regulate AQP4 expression in a cell model of Alzheimer′s disease, reduce apoptosis and increase the cell survival rate.

Research on vascular leakage of 6% hydroxyethyl starch 130/0.4 doing acute hemodilution in orthopedic patients / 中国综合临床

Objective:To explore the incidence of vascular leakage after acute hemodilution in patients with traumatic orthopedics by using 6% hydroxyethyl starch 130/0.4 (HES).Methods:Using prospective cohort study method, 48 orthopedic trauma patients in in Yantaishan Hospital from June 2018 to December 2018 were selected as the subjects of observation.The American Society of anesthesiologists (ASA) grade was divided into grade I-III.According to the degree of trauma, they were divided into two groups: general orthopedic patients group (24 cases) and severe trauma orthopedic patients group (24 cases). According to the formula of blood volume, the blood volume of the patients in the two groups was calculated.After intubation, 10% of the blood volume of HES was infused intravenously at the rate of 0.5 ml/(kg·min) for acute hemodilution.Plasma colloidal osmolality and hemoglobin were measured immediately before acute hemodilution (T0), 15 minutes (T1) and 30 minutes (T2) after acute hemodilution.The concentrations of HES in T1 and T2 plasma were measured.The urine volume from the beginning of infusion to 30 minutes after the end of infusion was saved.The urine volume and hes concentration were measured to calculate the urine hes content.Results:The amount of HES input was the same in the general orthopedic patients group and the severe trauma orthopedic patients group, which were (7.71±0.3) ml/kg and (7.70±0.2) ml/kg, and the expansion ratio was about 100%.Compared with T0, plasma colloid osmotic pressure at T1 and T2 were (27.9±1.5) mmHg(1 mmHg=0.133 kPa)) and (27.7±1.5) mmHg in the general traumatic orthopedics patients, which was higher than T0((26.5±1.5) mmHg, P<0.05). There was no significant difference of COP at T1 and T2 ((27.0±1.6) mmHg and(26.9±1.5) mmHg) compared with T0((26.3±1.7) mmHg, P>0.05) in the severe trauma orthopedic patients). The concentration of plasma HES in the severe trauma orthopedic patients ((6.8±0.6) g/L and (5.8±0.5) g/L) was lower than in the general traumatic orthopedics patients ((7.7±0.5) g/L and (7.1±0.5) g/L, t=5.660 and 6.755, all P<0.05) at T1 and T2.There was no significant difference of the urine HES content ((29.0±3.5 ) mg vs.(28.4±3.3) mg, t=0.61, P>0.05 )between the two groups after infusion. Conclusion:The ratio of acute hemodilution and volume expansion of HES was the same in the two groups.The changes of plasma colloid osmotic pressure and HES concentration were lower in patients with severe trauma orthopedics, and there was more obvious extravascular leakage in patients with severe trauma orthopedics.

The effect of preprcelecoxib on postoperative analgesia after total knee arthroplasty in patients with Kashin-Beck disease / 中华地方病学杂志

Objective:To study the analgesic effect of preprcelecoxib on total knee arthroplasty in patients with Kashin-Beck disease(KBD).Methods:Eighty-four patients with severe knee joint KBD who underwent total knee arthroplasty in our hospital from January 2017 to January 2019 were selected as the subject of study. The patients were randomly divided into control group ( n = 42) and observation group ( n = 42). The control group was not treated with any analgesia before operation. The observation group was given preemptive analgesia with preprcelecoxib, and patients were injected intravenously with 40 mg preprcelecoxib 30 min before anesthesia induction. The visual analogue score (VAS) score and number of pressing patient-controlled induce analgesia (PCIA) 30 min, 2 h, 4 h and 12 h after operation were compared between two groups. The Hospital for Special Surgery (HSS) score and stress response index [norepinephrine (NE), blood glucose (BG) and cortisol(Cor)] were compared between two groups before operation and 12 and 24 h after operation. And the incidence of adverse drug incidence was also compared between the two groups. Results:The VAS score of the two groups increased at first and then decreased. There was no significant difference in VAS scores between the two groups 30 min after operation ( P > 0.05). But 2, 4 and 12 h after operation, the VAS score in the observation group [(5.75 ± 0.27), (4.02 ± 0.85), (2.04 ± 0.23) points] were significantly lower than those in the control group [(7.34 ± 0.35), (5.96 ± 0.90), (3.89 ± 0.27) points, P < 0.05]. The HSS score increased over time between the two groups, but without significant difference before operation ( P > 0.05). And 12 and 24 h after operation, the HSS scores in the observation group [(53.19 ± 6.53), (75.18 ± 4.63) points] were significantly higher than those in the control group [(46.29 ± 6.37), (60.38 ± 5.29) points, P < 0.05]. The level of stress response index of the two groups increased with time. And 12 and 24 h after operation, the levels of NE [(325.94 ± 25.67), (397.63 ± 27.55) ng/L], BG [(5.38 ± 0.52), (5.41 ± 0.54) nmol/L] and Cor [(241.94 ± 14.18), (253.82 ± 14.65) mg/L] in the observation group were significantly lower than those in the control group [(387.28 ± 26.92), (437.84 ± 28.96) ng/L, (5.79 ± 0.43), (6.54 ± 0.52) nmol/L, (275.39 ± 13.72), (289.63 ± 13.95) mg/L, P < 0.05]. The number of PCIA pressing 24 h after operation in both groups was significantly higher than that 12 h after operation. The number of PCIA (4.62 ± 0.84, 8.38 ± 0.41) in the observation group was significantly lower than that in the control group (8.26 ± 0.65, 12.48 ± 0.73) 12 and 24 h after operation ( P < 0.05). The incidence of adverse reactions (19.05%, 8/42) in the observation group was significantly lower than that in the control group (52.38%, 22/42, P < 0.05). Conclusions:Preprcelecoxib can significantly reduce postoperative pain, reduce the expression of stress index, improve knee motion in a short period of time, reduce the number of pressing (PCIA) and the incidence of adverse drug reactions in patients with severe KBD of knee joint.

Clinical study of transcatheter closure of atrial septal defect in children guided by echocardiography / 中华实用儿科临床杂志

Objective:To study the method and clinical effect of transcatheter closure of children′s secondary atrial septal defect (ASD) by femoral vein under the guidance of echocardiography.Methods:A total of 306 children (137 males and 169 females) with secondary ASD undergoing transcatheter closure surgery in the Department of Car-diology of Beijing Children′s Hospital from January 2017 to October 2019 were enrolled.The age of the patients was 2.1-15.0 years old [(6.18±2.45) years old], and the weight was 10-63 kg [(23.05±9.97) kg]. Among 306 children, 259 cases had single central ASD, with the defect diameter of 5-25 mm; 47 cases had ethmoid ASD, and the shunting range was measured to be 11-31 mm by echocardiography.Patients had normal cardiac function, and no other cardiac malformations were found.Eighteen children are complicated with other system malformations, including funnel chest in 5 children, chicken chest in 4 children, scoliosis in 4 children, epilepsy in 2 children, and Down′s syndrome in 3 children.In addition, there were 8 children with ASD and arrhythmia.Specifically, 3 cases were complicated by preexcitation syndrome, 3 cases by ventricular premature beat and 2 cases by supraventricular tachycardia.Three patients with ventricular premature beat, 1 patient with supraventricular tachycardia and 1 patient with preexcitation syndrome had indications of radiofrequency ablation.All the operations were performed in the same time with ASD occlusion via femoral vein under basic anesthesia.ASD occlusion was guided by transthoracic or transesophageal echocardiography.Results:Of all 306 cases enrolled, ASD occlusion was successfully performed in 301 cases under the guidance of echocardiography, but it failed in 5 cases due to the large ultrasonic defect during the operation.For these 5 patients, the occluder was successfully released by the method of left superior pulmonary vein under X-ray.The operation time (from the beginning of anesthesia to the sheath extubation) was 17-45 min, with an average of (21.25±8.84) min.The occluder model was 10-30 mm.The operation process was smooth, and there were no serious complications during and after the operation.Conclusions:ASD transcatheter closure by femoral vein puncture under the guidance of echocardiography is safe and feasible operation for children with ASD.It is minimally invasive and causes no radiation injury.

Mechanisms of electroacupuncture underlying treatment of osteoporosis based on HDAC2-mediated osteoblast differentiation pathway / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) on expression of histone deacetylase 2 (HDAC2), histone H3, bone formation related genes and proteins in osteoporosis rats, so as to reveal its mechanisms underlying improvement of osteoporosis. METHODS: Female SD rats were randomly divided into 4 groups: sham operation, model, EA and medication (n＝ 10 rats in each group). The osteoporosis model was established by castration. EA (2 Hz, 1 mA) was applied to bilateral "Shenshu" (BL23) and "Pishu" (BL20) for 10 min, once every other day for 8 weeks. Rats of the medication group received subcutaneous injection of 17 β-estradiol (100 µg/kg, 20 µg/mL). The bone quality and quantity including the cortical bone mineral density (CBMD), trabecular bone mineral density (TBMD), ratio of bone volume /total volume (BV /TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb. Sp), trabecular bone pattern factor (Tb.Pf), and structure model index (SMI) of the right thigh-bone were detected by using a micro-computed tomography. Serum alkaline phosphatase (ALP) and estrogen 2 (E2) contents were assayed by using colorimetry and ELISA, expression levels of HDAC2, histone H3 and Runx2 in the thigh-bone were detected using Western blot, and that of Runx2 mRNA was detected using quantitative real-time PCR, separately. The co-expression of Ac-histone H3/Runx2 and Runx2/ALP was observed by using immunofluorescence histochemical staining. RESULTS: After modeling, the levels of TBMD, BV/TV, Tb.Th, and Tb.N, serum E2 and ALP, and expression of Runx2 protein and mRNA, Ac-histone and ALP proteins were significantly lower (P0.05). The effects of EA were significantly superior to 17 β-estradiol in down-regulating the expression of HDAC2 and histone H3 proteins and in up-regulating expression of Ac-histone H3 protein (P<0.01，P<0.05)．. CONCLUSION: EA treatment can increase bone density, increase bone mass and trabecular bone, and promote trabecular bone rod-like changes in plate shape in osteoporosis rats, which is related to its effect in up-regulating the expression of Ac-histone H3 protein, and down-regulating the expression of bone formation-related proteins.

Expression of Costimulatory Molecule Tim3 on NK Cells and Its Subsets in Patients with Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the expression of costimulatory molecule Tim3 and its subsets on NK cells in patients with acute myeloid leukemia.@*METHODS@#30 patients with acute myeloid leukemia treated in our hospital from August 2016 to August 2018 were randomly selected as the AML group, and 30 healthy persons in our hospital during the same period were randomly selected as the control group. The expression levels of CD56@*RESULTS@#The expression levels of CD56@*CONCLUSION@#The expression of costimulatory molecule Tim3 in NK cells and its subsets of patients with acute myeloid leukemia is down-regulated.

Analysis on clinical features of 106 type 2 diabetic patients complicated with insulin autoimmune syndrome / 中华内分泌代谢杂志

Objective:To analyze the clinical features of type 2 diabetic patients with insulin autoimmune syndrome after treatment with exogenous insulin.Methods:A total of 106 patients with type 2 diabetes diagnosed with exogenous insulin-related insulin autoimmune syndrome (EIAS) were included from September 2017 to March 2019 in the Department of Endocrinology, Zhongshan Hospital, Fudan University. The clinical data, physical examination, and laboratory examination results of patients were collected.Results:Of the 106 patients, 84 (79.24%) used premixed human insulin or premixed insulin analogs, and 18 patients (16.98%) presented recurrent hypoglycemia. The arginine stimulation test showed that the median value of the baseline insulin was 73.40 (23.07-146.75) μU/ml, and the median ratio of 4 minute insulin to 0 minute insulin was 1.27 (1.03-1.85), with the mean of the ratio 1.72±1.47. The ratio of baseline insulin (μU/ml) to C-peptide (ng/ml) was 44.60 (14.92-87.93), with an average of 81.92±130.93. Taking the two-fold upper limit of fasting insulin reference value (49.8 μU/ml) as the cut-off point, the subjects were divided into insulin accumulation group (baseline insulin≥49.8 μU/ml) and insulin non-accumulation group (baseline insulin <49.8 μU/ml). Among the 66 patients in the insulin accumulation group, 14 patients had hypoglycemia (21.21%) and 4 patients in the insulin non-accumulation group presented hypoglycemia (10%). The ratio of 4 minute insulin to baseline insulin, ratio of baseline insulin to C-peptide, blood glucose level standard deviation (SDBG) and maximum blood glucose fluctuation amplitude (LAGE) in the insulin accumulation group were significantly higher than those in the insulin non-accumulation group (all P<0.05). Among 66 patients in the insulin accumulation group, 36 patients changed the type of insulin preparafion (insulin treatment group), 30 patients were changed from insulin to oral hypoglycemic agents (oral medication group). After treatment, both SDBG and LAGE in the two groups were significantly lower than before treatment ( P<0.05). Conclusions:With the aggravation of exogenous insulin accumulation, the fluctuation of blood glucose and the proportion of hypoglycemia were significantly increased. There was a characteristic change in islet function in patients with insulin autoimmune syndrome. After arginine stimulation, there was no significant peak of insulin secretion, showing a " high-level" curve. The baseline insulin/C-peptide ratio was significantly increased. The prognosis of EIAS patients is good after timely diagnosis and adjustment of treatment.

Correlation between bracing treatment and depression severity in adolescent idiopathic scoliosis / 第二军医大学学报

Objective To evaluate the mental health status of patients with adolescent idiopathic scoliosis (AIS) after bracing treatment, and to observe the severity of depressive symptoms and analyze the influencing factors. Methods We collected the general data and imaging data of AIS patients who underwent bracing treatment in the outpatient clinic of Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2015. The data included age, gender, body mass index, coronal main curve Cobb angle at the initial treatment and the last follow-up, and duration of bracing treatment. The Center for Epidemiological Studies depression scale for children (CES-DC) and the strengths and difficulties questionnaire (SDQ) were used to assess the severity of depression and the mental health status before bracing treatment and at the last follow-up. Multivariate linear regression model was used to analyze the factors influencing the severity of depression during the bracing treatment. Results A total of 112 patients (16 males and 96 females) were enrolled in our study. We found that the CES-DC score was significantly higher at the last follow-up than that at the beginning (38.4±3.0 vs 26.1±4.2); the scores of the emotional problems (7.7±1.5 vs 5.3±2.2) and peer problems (7.6±1.4 vs 5.0±1.6) in the SDQ were significantly increased and the score of the prosocial behavior was significantly decreased (2.7±0.5 vs 4.2±0.3) at the last follow-up (t＝25.22, －27.22, 9.54 and 12.94; all P0.01). Multivariate linear regression analysis suggested that the depression severity of AIS patients was positively correlated with the pre-treatment coronal main curve Cobb angle, duration of bracing treatment, and pre-treatment SDQ emotional symptom and peer problem scores (all P0.05), but were negatively correlated with the score of the prosocial behavioral subscale of SDQ. Conclusion The mental health status of patients with AIS is changed after bracing treatment, with increased severity of depression. Active psychological intervention shall be given to patients with large pre-treatment coronal main curve Cobb angle, longer treatment time of bracing, and higher pre-treatment SDQ’s emotional symptom scores and peer problem scores, which may improve the post-treatment quality of life of patients.

Breeding and variety characteristics of a new variety of Fritillaria thunbergii "Zhebei 3" / 中国中药杂志

A new variety "Zhebei 3(Zhejiao Pharmaceutical 2018002)" was selected and bred from multi seeded Fritillaria thunbergii mutants by systematic breeding method. From 2012 to 2016, the traits assessment, disease resistance appraisal, plot ratios and regional trials of the variety were continuously carried out. The results showed that "Zhebei 3" emerged early and had late seedlings. The average growth period was about 100 days, which was 6 days and 12 days higher than the "Zhebei 1" and "Zhebei 2". The average yield was 5 095.5 kg·hm~(-2), which was 14.42% and 17.71% higher than of the control respectively. The average proliferation rate of bulbs was 261.2%, which was 37.46% and 31.58% higher than that of the control, respectively. The propagation coefficient of bulbs was about 1∶2.6, and the total amount of peimine and peiminine was 0.172 2%, which was 4.49% and 29.47% higher than the control, respectively. The identification of disease resistance showed that it was resistance to bulb stem(soft) rot, better than the control. "Zhebei 3" has stable characters, high yield, good quality, strong disease resistance, and moderate propagation coefficient which is suitable for planting in Zhejiang province.

Immunomodulatory drugs in type 1 diabetes mellitus: current status and future prospects / 中国医师杂志

The pathophysiological nature of type 1 diabetes mellitus (T1DM) as an autoimmune disease provides the basis for immunotherapy.As an important therapeutic approach,immunomodulatory drugs are promising in the protection of pancreatic β-cells by effecting at various stages of autoimmune progression.In this review,we summarize the recent advances of immunomodulatory drugs in the prevention and treatment of T1DM and propose future directions.

Chemical genomics reveals inhibition of breast cancer lung metastasis by Ponatinib via c-Jun

Metastasis is the leading cause of human cancer deaths. Unfortunately, no approved drugs are available for anti-metastatic treatment. In our study, high-throughput sequencing-based high-throughput screening (HTS) and a breast cancer lung metastasis (BCLM)-associated gene signature were combined to discover anti-metastatic drugs. After screening of thousands of compounds, we identified Ponatinib as a BCLM inhibitor. Ponatinib significantly inhibited the migration and mammosphere formation of breast cancer cells in vitro and blocked BCLM in multiple mouse models. Mechanistically, Ponatinib represses the expression of BCLM-associated genes mainly through the ERK/c-Jun signaling pathway by inhibiting the transcription of JUN and accelerating the degradation of c-Jun protein. Notably, JUN expression levels were positively correlated with BCLM-associated gene expression and lung metastases in breast cancer patients. Collectively, we established a novel approach for the discovery of anti-metastatic drugs, identified Ponatinib as a new drug to inhibit BCLM and revealed c-Jun as a crucial factor and potential drug target for BCLM. Our study may facilitate the therapeutic treatment of BCLM as well as other metastases.

Establishment of quality standards for Xiangsu Weitong capsule / 药学实践杂志

Objective To establish the quality standard for Xiangsu Weitong capsule.Methods Radixet rhizoma glycyr-rhizae,rhizoma corydalis,poria,rhizoma cyperi were identified by TLC and the contents of baicalin were determined by RP-HPLC.Chromatography conditions were Welchrom C18(4.6 mm×250 mm,5 μm)column.The mobile phase was acetonitrile-0.1% phosphoric acid(40:60).UV detection wavelength was set at 280 nm and the column temperature was 30 ℃ with the flow rate of 1.0 ml/min.Results The method of TLC had good resolution with clear spots and negative control showed no in-terference.The good linearity was obtained within the range of 1-80 μg/ml(r=0.999 9)for Tetrahydropalmatine hydrochloride and the average recovery was 99.1%(RSD= 1.28%,n= 6).Conclusion The method was simple,accurate and sensitive which could be applied in the quality control of Xiangsu Weitong capsule.

Observation on the clinical curative effect of edaravone combined with ginkgo diterpene lactone on acute cerebral infarction / 药学实践杂志

Objective To analyze the effect of edaravone combined with ginkgo diterpene lactone in treatment of acute cerebral infarction (ACI) and discuss the better clinical treatment to ACI .Methods 100 cases of ACI and who accepted treat-ments in our hospital were selected as the research objects in January 2014 to January 2015 .50 patients as observation group were given the treatment of edaravone and ginkgo diterpene lactone at the same time ,while other 50 patients as control group were merely given the treatment of ginkgo diterpene lactone .At the same time ,both groups were given treatment of conven-tional therapy .The total neurological function ,effective rate ,adverse reactions ,and the treatment satisfaction of both groups before and after the treatment were observed .Results There were no significant different of NIHSS score of two groups before treatment (P>0 .05) .After treatment ,NIHSS score of the observation group was significantly lower than the control group (P<0 .05) .The total effective rate of observation group was 90％ ,which was significantly higher than the control group (66％ ,P<0 .05) .The main adverse reactions were rash ,nausea ,dizziness of two groups ,and there were no significant differ-ent of adverse reactions rate of two groups through the treatment (P>0 .05) .The treatment of patients with satisfaction rate of observation group was 94％ ,which was significantly higher than control group (84％ , P< 0.05) .Conclusion Edaravone combined with ginkgo diterpene lactone had a good effect on improving nerve function of ACI patients ,which could improve the treatment of patients with satisfaction ,high security ,and could be recommended in clinical .

Association between the elderly frequent attender to the emergency department and 30-day mortality: A retrospective study over 10 years / 世界急诊医学杂志（英文）

BACKGROUND:To determine if elderly frequent attenders are associated with increased 30-day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality. METHODS:Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student t-test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender. RESULTS:1.381 million attendance records were analyzed. Elderly patients accounted for 25.5％ of all attendances, of which 31.3％ are frequent attenders. Their 30-day mortality rate increased from 4.0％ in the first visit, to 8.8％ in the third visit, peaking at 10.2％ in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year. CONCLUSION:Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.