Giant adenoma of the gallbladder misdiagnosed as gallbladder carcinoma： A case report / 临床肝胆病杂志

One patient with gallbladder mass had transient jaundice and was diagnosed with gallbladder carcinoma by abdominal ultrasonography， contrast-enhanced CT， MRCP， and PET-CT. Surgical exploration showed enlarged gallbladder and a mass in the neck of the gallbladder pressing against the hilum of the liver， with no manifestation of tumor invasion， and there were no signs of liver metastasis. Only cholecystectomy was performed for the patient. The pathological diagnosis was tubular adenoma of the gallbladder without carcinogenesis. This case is characterized by a large gallbladder tumor， without marginal infiltration on imaging or malignant transformation based on pathology.

Hypoglycemic activities of flowers of Xanthoceras sorbifolia and identification of anti-oxidant components by off-line UPLC-QTOF-MS/MS-free radical scavenging detection / 中草药·英文版

OBJECTIVE@#To identify phytochemical constituents present in the extract of flowers of Xanthoceras sorbifolia and evaluate their anti-oxidant and anti-hyperglycemic capacities.@*METHODS@#The AlCl3 colorimetric method and Prussian Blue assay were used to determine the contents of total flavonoids and total phenolic acids in extraction layers, and the bioactive layers was screened through anti - oxidative activity in vitro. The Waters ACQUITY UPLC system and a Waters ACQUITY UPLC BEH C18 column (2.0 mm × 150 mm, 5 μm) were used to identify the ingredients. And anti-oxidative ingredients were screened by off-line UPLC-QTOF-MS/MS-free radical scavenging. The ameliorative role of it was further evaluated in a high-fat, streptozotocin-induced type 2 diabetic rat model and the study was carried out on NADPH oxidase (PDB ID: 2CDU) by molecular docking.@*RESULTS@#Combined with the results of activity screening in vitro, the anti - oxidative part was identified as the ethyl acetate layer. A total of 24 chemical constituents were identified by liquid chromatography-mass spectrometry in the ethyl acetate layer and 13 main anti-oxidative active constituents were preliminarily screened out through off-line UPLC-QTOF-MS/MS-free radical scavenging. In vivo experiments showed that flowers of X. sorbifolia could significantly reduce the blood glucose level of diabetic mice and alleviate liver cell damage. Based on the results of docking analysis related to the identified phytocompounds and oxidase which involved in type 2 diabetes, quercetin 3-O-rutinoside, kaempferol-3-O-rhamnoside, isorhamnetin-3-O-glucoside, and isoquercitrin showed a better inhibitory profile.@*CONCLUSION@#The ethyl acetate layer was rich in flavonoids and phenolic acids and had significant anti-oxidant activity, which could prevent hyperglycemia. This observed activity profile suggested X. sorbifolia flowers as a promising new source of tea to develop alternative natural anti-diabetic products with a high safety margin.

Insights into the catalytic and regulatory mechanisms of dihydroflavonol 4-reductase, a key enzyme of anthocyanin synthesis in Zanthoxylum bungeanum.

Accumulation of anthocyanins largely determines the fruit color, and dihydroflavonol 4-reductase (DFR) is a key enzyme involved in the formation of anthocyanins. However, the catalytic and regulatory mechanisms of DFR are unclear. In this study, the gene encoding DFR from Zanthoxylum bungeanum Maxim. was cloned and ZbDFR was analyzed in detail. The ZbDFR accepted dihydrokaempferol, dihydroquercetin and dihydromyricetin as substrates. Flavonols such as myricetin, quercetin and kaempferol significantly inhibited the activity of ZbDFR, while quercitrin and isoquercitrin slightly increased the activity. Quercetin was a competitive inhibitor at low concentrations, and it had a combined effect of competitive and noncompetitive inhibition at high concentrations, which was consistent with ZbDFR having two inhibitor binding sites. In addition, the content of different types of flavonoids in Z. bungeanum peel at green, semi-red and red stage was analyzed, and the in vivo results could be explained by the regulation of ZbDFR activity in vitro. Site-directed mutagenesis combined with enzyme activity experiments showed that Ser128, Tyr163, Phe164 and Lys167 are the key catalytic amino acid residues. The Ser128, Tyr163 and Lys167 were crucial for the hydrogen transfer reaction, and mutation of these amino acids resulted in the loss of all or most of the activity. Phe164 was found to be important for the regulation of ZbDFR by flavonols. Accordingly, ZbDFR is a node at which flavonoids regulate the synthesis of anthocyanins and proanthocyanins.

Imaging analysis and clinical follow-up of Ewing sarcoma of bone / 中国医师进修杂志

Objective:To analyze and summarize the imaging characteristics and clinical follow-up results of Ewing sarcoma of bone.Methods:The imaging data of 23 patients with Ewing sarcoma confirmed by pathology who treatment in Drum Tower Hospital Affiliated to Nanjing University School of Medicine from May 2010 to October 2021 were retrospectively analyzed, and clinical follow-up was performed.Results:Of the 23 patients with Ewing sarcoma of the bone in this group, a total of 18 patients had follow-up results and 5 cases were lost to follow-up. Of the 18 cases, 6 cases died and 12 cases survived. The main cause of death was lung metastasis. There were 27 lesions in total, femoral diaphysis was the most common site of the disease; bone structure destruction and soft tissue mass shadows could be seen in the images of each lesion. Periosteal reaction could be seen in most of the lesions (92.59%, 25/27). There were certain differences in signs of bone destruction and periosteal reaction between different bone types.Conclusions:The imaging of Ewing sarcoma of bone mainly manifests various types of bone destruction, soft tissue masses and periosteal reactions. Ewing sarcoma of bone is mainly bone marrow metastasis and lung metastasis, and lung metastasis is the main cause of death.

Association of Alexithymia With Positive Symptoms in Chinese Chronic Schizophrenia Patients With and Without Obesity

Objective@#A growing body of research suggests the presence of alexithymia (a form of social cognitive impairment) in patients with schizophrenia (SCZ), which may be related to their psychopathological symptoms. Patients with SCZ exhibit high rates of obesity. Interestingly, studies of the general population have found that alexithymia acts a pivotal role in the development and maintenance of obesity. However, little is known regarding the relationship between obesity, alexithymia, and clinical symptoms in SCZ patients. The study was aim to explore the relationship between obesity, alexithymia, and clinical symptoms in SCZ patients. @*Methods@#Demographic and clinical data were collected from 507 patients with chronic SCZ. Their symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS), and alexithymia was assessed with the Toronto Alexithymia Scale (TAS). @*Results@#Compare with nonobese SCZ patients, obese SCZ patients scored higher on PANSS positive symptoms, TAS total score, difficulty identifying feelings, and difficulty describing feelings (all p<0.05). Correlation analysis revealed a significant association between difficulty identifying feelings and positive symptoms in SCZ patients. Further correlation analysis showed that this association was only present in obese SCZ patients (p<0.05). @*Conclusion@#Obesity may moderate the association between alexithymia and positive symptoms in chronic SCZ patients.

Advances in in vitro induction of hepatocyte-like cells and the application of small-molecule compounds in inducing hepatocyte-like cells / 临床肝胆病杂志

The induction of hepatocyte-like cells (HLCs) in vitro is one of the effective ways to obtain a large number of useful hepatocyte, and these HLCs can be used in disease modeling, drug design, and toxicological evaluation. At present, the induction of HLCs in vitro is mainly achieved by introducing exogenous transcription factors, cytokines or small-molecule compounds. Since small-molecule compounds have the advantages of structural diversity, controllable time and dose, and convenient and safe operation, scientists are devoted to screening out the small-molecule compounds to replace exogenous transcription factors and cytokines, and such compounds have a promising application prospect in the field of regenerative medicine. This article reviews the studies on the in vitro induction of HLCs from pluripotent stem cells and other adult stem cells and summarizes the application of small-molecule compounds in the in vitro induction of HLCs, in order to provide ideas and references for the in vitro induction of HLCs.

Case report: Successful treatment of acute generalized pustular psoriasis of puerperium with secukinumab.

Generalized pustular psoriasis (GPP) is a rare and severe form of psoriasis presenting with erythematous, aseptic pustules. Common systemic symptoms include fever and myalgias. The presentation of GPP resembles acute generalized exanthematous pustulosis (AGEP). However, the treatment of these two pathologies differs. While AGEP is self-limiting and treated with topical corticosteroids and constrain of systemic steroids. GPP treatment avoids corticosteroid, choosing acitretin, methotrexate, and cyclosporine as first-line agents. In this case report, a 27-year-old female with a medical history of AGEP presented to the hospital with extensive erythema and pustules. Complete blood count acute phase reactant analysis revealed an elevated white blood cell count and C-reactive protein (CRP). Two histopathological examinations revealed psoriatic hyperplasia of the epidermis with keratosis, along with Kogoj and Munro micro abscesses above the spina layer. Lymphocytic and neutrophilic infiltrate was present in the superficial derma layer along with vasodilation. The patient was diagnosed with GPP according to pathological and clinical criteria. Treatment was initiated with secukinumab because of the patient's failure to respond to systemic treatment with Acitretin, methotrexate, and cyclosporin. Following 2 weeks of therapy with 300 mg of secukinumab, the pustular lesions had resolved. This study indicates the potential efficacy of secukinumab as an effective therapy that can rapidly improve the clinical symptoms of GPP.

Comparative analysisof Saponins in different medicinal parts of Panax Ginseng / 国际中医中药杂志

Objective:To analyze the differences of Saponins in different parts of Panax ginseng, which couldprovide reference for a comprehensive quality evaluation.Methods:UFLC- Triple-TOF-MS/MS was used to analyze the Saponins in Ginseng Radix et Rhizoma, Ginseng Folium and Ginseng Flos,The analysis was carried out on a SynergiTM Hydro-RP 100A column, Gradient elution of water (containing 0.1% formic acid) (A)-acetonitrile (B). Principal component analysis (PCA) was used to analyze the grouping of samples, and partial least squares regression (PLS-DA) was used to classify the samples to find the differences of chemical components in different medicinal parts of Panax ginseng. Significant differences in saponins and its rules were found by multivariate statistical analysis.Results:PCA indicated that there was remarkable difference in saponins of Ginseng Radix et Rhizoma, Ginseng Folium and Ginseng Flos, ten different components were found by PLS-DA. Conclusion:There exists obvious differences of different medicinal parts of Panax Ginseng which could provide foundation for the further research and rathional use of Panax ginseng.

Impact of General Factors on Glioma Immunotherapy

Glioma remains the most common malignant tumor in the brain and is also the most difficult to treat. Immunotherapy achieving long-lasting tumor remission in multiple cancer types has received considerable attention due to its potential to improve the treatment outcomes of patients with glioma. However, clinical trials have not yet demonstrated major improvements in prognoses, which might be attributable to the extrinsic components and intrinsic mechanisms involved in the tumor microenvironment and immune system. It is particularly noteworthy that there is emerging evidence that current routine treatment modalities and the physical and psychological characteristics of patients have different impacts on the efficacy of glioma immunotherapy. This article addresses how these factors interact with the host immune system and tumor microenvironment, and highlights their potential roles in glioma immunotherapy, with the ultimate goal of developing better immunotherapybased personalized medicine strategies.

Predicting Vertical Ground Reaction Force during Treadmill Running Using Principal Component Analysis and Wavelet Neural Network / 医用生物力学

Objective To establish the method of predicting the vertical ground reaction force (vGRF) during treadmill running based on principal component analysis and wavelet neural network (PCA-WNN). Methods Nine rearfoot strikers were selected and participated in running experiment on an instrumented treadmill at the speed of 12, 14 and 16 km/h. The kinematics data and vGRF were collected using infrared motion capture system and dynamometer treadmill. A three-layer neural network framework was constructed, in which the activation function of the hidden layers was the Morlet function. Velocities of mass center of the thigh, shank and foot as well as joint angles of the hip, knee and ankle were input into the WNN model. The prediction accuracy of the model was evaluated by the coefficient of multiple correlation (CMC) and error. The consistencies between predicted and measured peak GRF were analyzed by Bland-Altman method. Results The CMC between the predicted and measured GRF at different speeds were all greater than 0.99; the root mean square error (RMSE) between the predicted and measured vGRF was 0.18-0.28 BW; and the normalized root mean square error (NRMSE) was 6.20%-8.42%; the NRMSE between the predicted and measured impact forces and propulsive forces were all smaller than 15%. Bland-Altman results showed that the predicted peak errors of propulsive force at 12 km/h and that of impact force and propulsive force at 14 km/h were within the 95% agreement interval. Conclusions The PCA-WNN model constructed in this study can accurately predict the vGRF during treadmill running. The results provide a new method to obtain kinetic data and perform real-time monitoring on a treadmill, which is of great significance for studying running injuries and rehabilitation treatment.

Analysis of the results of chromosomal trisomies 21, 18 and 13 screening among 40 628 women by non-invasive prenatal testing / 中华医学遗传学杂志

OBJECTIVE@#To assess the clinical value of non-invasive prenatal testing (NIPT) for the screening of trisomy and copy number variations (CNVs) of chromosomes 21, 18 and 13.@*METHODS@#From January 2015 to December 2019, 40 628 pregnant women underwent NIPT testing using high-throughput sequencing and bioinformatics analysis to test the cell-free fetal DNA in maternal plasma. High-risk pregnant women underwent invasive prenatal diagnosis, while low-risk ones were followed up by telephone.@*RESULTS@#The three most common indications included intermediate risk of serological screening, high risk of serological screening and advanced maternal age. Among all pregnant women, 257 cases were detected as trisomy 21, 18 and 13 (170, 49 and 38 cases, respectively). 227 cases chose invasive prenatal diagnosis, with respectively 122, 28 and 10 cases confirmed. The positive predictive value (PPV) was 81.33% (122/150), 65.12% (28/43), 29.41% (10/34), respectively. Two false negative cases of trisomy 18 were found during follow-up. Meanwhile, NIPT has detected 46 cases (15, 16 and 15 cases, respectively) CNVs on chromosomes 21, 18 and 13, among which 37 cases underwent invasive prenatal diagnosis. There were 5, 3 and 5 positive cases, which yielded a PPV of 41.67% (5/12), 25%(3/12) and 33.33%(5/15), respectively. Two other chromosome CNVs were accidentally discovered among the false positive samples.@*CONCLUSION@#The incidence of chromosomal abnormalities in the serological screening high-risk group was 52.02%, which was significantly higher than other groups. NIPT has a high sensitivity and specificity for the screening of trisomies 21, 18 and 13, while its accuracy for detecting CNVs of chromosomes 21, 18 and 13 needs to be improved. As a screening method, NIPT has a great clinical value, though there are still limitations of false positive and false negative results.Comprehensive pre- and post-test genetic counseling should be provided to the patients.

Epidemiological characteristics and risk factors of bronchial asthma combined with recurrent respiratory tract infection in children in Hebei District of Tianjin / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics and risk factors of bronchial asthma (BA) complicated with recurrent respiratory tract infection (RRTI) in children in Hebei District, Tianjin City, and to provide a reference for the prevention and treatment of children with BA complicated with RRTI. Methods The stratified cluster sampling method was adopted to randomly select 428 children with BA hospitalized in Hebei District of Tianjin as the study subjects. The routine deep sputum culture and etiological examination were carried out. The children with RRTI were included in the experimental group (n=84), and the children without RRTI (n=344) were included in the control group. A self-designed questionnaire was used to investigate gender, age, smoking proportion of family members, use of antibiotics 3 times or more a year, and family history of allergy. The risk factors of BA combined with RRTI were analyzed by logistic regression. Results RRTI occurred in 84 of 428 children with BA, and the incidence rate was 19.63% (84/428). The proportion of BA complicated with RRTI in children aged 6 months to 2 years was higher than that in other age groups (χ2=6.213, P0.05). The proportion of family smoking, the use of antibiotics 3 times or more a year, and the proportion of family allergy history in the experimental group were significantly higher than those in the control group (P<0.05). Logistic regression analysis showed that family smoking, antibiotic use 3 times or more a year and family history of allergy were independent risk factors for BA complicated with RRTI (P<0.05). Conclusion The incidence of BA complicated with RRTI in children in Hebei District, Tianjin City is high, and the age of high incidence is 6 months to 2 years old. The proportion of family smoking, the use of antibiotics three times or more a year, and the proportion of family allergy history are the high-risk factors for the occurrence of BA complicated with RRTI in children in Hebei District, Tianjin City.

Effects of LncRNASNHG6 regulating miR-26a/EZH2 on proliferation, apoptosis and chemosensitivity of prostate cancer stem cells / 中华内分泌外科杂志

Objective:To investigate the effects and its mechanism of long non-coding RNA (LncRNA) small nucleolar RNA host gene 6 (SNHG6) on proliferation, apoptosis and chemosensitivity of prostate cancer stem cells.Methods:CD44 + CD24 - tumor stem cells and non-CD44 + CD24 - cells were selected from prostate cancer cell PC-3 by flow separation technology, and the expression level of SNHG6 and microRNA (miR) -26a were detected by real-time fluorescence quantitative PCR. Cell proliferation was detected by 5-bromodeoxyuridine (Br-dU) , the apoptosis was detected by flow cytometry, the chemosensitivity of cells to cisplatin was detected by methyl thiazolyl tetrazolium (MTT) , and Western blot was used to detect the protein expressions of proliferating cell nuclear antigen (Ki-67) , B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X protein (Bax) ; moreover, the target relationships of SNHG6, miR-26a and zeste enhancer of zeste homolog 2 (EZH2) were detected by double luciferase reporter gene assay, and Western blot was used to detect the effect of miR-26a analog on EZH2 protein expression. Results:Compared with non-CD44 + CD24 - cells, the expression level of SNHG6 in CD44 + CD24 - cells was significantly higher ( P<0.05) ; compared with NC-siRNA group [ (1.00±0.06) %, (96.85±6.48) %, (0.72±0.06) %, (0.43±0.03) %, (5.32±0.15) %, (0.35±0.03) %], SNHG6 expression level (0.25±0.03) , cell proliferation activity [ (75.36±5.1) %], Ki67 (0.38±0.03) and Bcl-2 protein (0.21±0.02) expression levels in SNHG6-siRNA group were significantly lower, while miR-26a expression level, apoptosis rate [ (13.83±2.36) %] and Bax protein (0.48±0.03) expression level were significantly higher, and the sensitivity of the cells to cisplatin was significantly higher ( P<0.05) ; in addition, miR-26a was the target gene of SNHG6, EZH2 was the target gene of miR-26a, and miR-26a analog could reduce the expression level of EZH2 protein. Conclusions:SNHG6 is up-regulated in prostate cancer stem cells. Interfering SNHG6 expression can inhibit the proliferation of cancer stem cells, promote apoptosis, and enhance the sensitivity of cancer stem cells to cisplatin. The mechanism may be related to the targeting regulation of miR-26a/EZH2 axis.

Analysis of the SARS-CoV-2 specific antibodies and immune function of COVID-19 patients one year after discharge / 中国胸心血管外科临床杂志

@#Objective    To summarize the results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibody, total antibody and cellular immune function of COVID-19 convalescent patients one year after discharge, and to analyze the correlation between the SARS-CoV-2 antibody and the indexes of immune function. Methods    A total of 41 confirmed COVID-19 patients discharged from Chengdu Public Health Clinical Medical Center from January to April 2020 and followed up one year after discharge were included in the study as the research group, including 18 males and 23 females with an average age of 47.83±12.95 years. The results of SARS-CoV-2 IgG, total antibody and immune function indexes one year after discharge were collected in order to discuss the correlation of SARS-CoV-2 and cellular immune function. A total of 40 healthy employees of the hospital vaccinated against COVID-19 were randomly selected as the vaccine group, including 10 males and 30 females with an average age of 43.90±6.86 years. The SARS-CoV-2 antibodies between the two groups were compared. Results    CD8+T cell count was higher and CD4+T/CD8+T was lower in male patients than those in female patients (all P<0.05). The IgG and total antibodies in patients with re-detectable positive RNA test were both higher than those in patients without re-detectable positive RNA test, but the differences were not statistically significant (P=0.158, 0.060). The positive rate of SARS-CoV-2 IgG in the research group was 80.5% (33/41). SARS-CoV-2 IgG was positively correlated with total antibody (P<0.001). There was a positive correlation between CD4+T cell count and SARS-CoV-2 IgG (r=0.455, P=0.003). The positive rate of SARS-CoV-2 IgG, SARS-CoV-2 IgG amount and total antibody amount in the research group were significantly higher than those in the vaccine group (all P<0.001). Conclusion    SARS-CoV-2 IgG of most COVID-19 patients one year after discharge is positive, and their SARS-CoV-2 total antibody is significantly higher than people vaccinated against COVID-19, which suggests that patients infected with SARS-CoV-2 can obtain lasting protection, but the protection may be gradually weaken over time. The degree of antibody attenuation in patients with re-detectable positive RNA test may be weaker. In the convalescence stage, the dynamics of SARS-CoV-2 IgG may be closely related to cellular immune function.

Investigation on iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde / 公共卫生与预防医学

Objective To investigate the iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde. Methods A total of 136 early pregnancy women who had lived in Chengde were randomly selected in this study from January 2018 to March 2020. A questionnaire survey was conducted. The iodized salt, urine and blood samples of the pregnant women were collected to analyze the salt iodine concentration, serum iodine, urinary iodine, serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Results In 2018 and 2019, the iodized salt coverage rates were 96.97% and 98.57%, the non-iodized salt rates were 3.03% and 1.43%, the iodized salt qualification rates were 95.45% and 97.14%, and the qualified iodized salt consumption rates were 93.94% and 92.86%, respectively. In addition, the median of iodized salt consumption was 22.20 mg/kg and 25.51 mg/kg, in 2018 and 2019, respectively. There was a statistically significant difference in the median urine iodine from 2018 to 2019 among women in early pregnancy (P0.05). Conclusion After the implementation of a new standard of iodized salt in Chengde, the iodine nutritional status of early pregnant women in 2019 was significantly improved, but there was still a small amount of insufficient iodine intake. The incidence of thyroid diseases in early pregnant women with abnormal iodine intake was higher than that in early pregnant women with appropriate iodine intake.

Sensitivity analysis of biomechanical effect in vertebral body of two different augmenters.

BACKGROUND: Transvertebral Bone Graft and Augmentation (TBGA) has achieved good clinical effects in the treatment of osteoporotic vertebral compression fractures (OVCFs). This study aimed to investigate the postoperatively biomechanical effects of TBGA and compare the biomechanical sensitivity of two different augmenters: a cylindrical enhancement device (CED) and bone cement. METHODS: Finite element models of the spine segment T11-L3 were created, including one model based on normal segment and the other three with L1 augmentation for pathological conditions. Three treatments were simulated including CED implant treatment A, CED implant treatment B, and bone cement treatment. The stress distribution and maximum displacement of the four models under different treatments were analyzed. A method of linear fitting of dummy variables was used to analyze the sensitivity of biomechanical parameters to the degree of osteoporosis (DO) and load. FINDINGS: The reduction of stress with increasing DO in augmented and adjacent vertebral bodies under bone cement augmentation was less than that under CED augmentation. The stress of augmented vertebral body and the adjacent vertebral body was most sensitive to extension and rotation loading conditions. As DO increasing, the bone cement augmentation significantly increased the stress level on the upper and lower endplates. INTERPRETATION: When the degree of osteoporosis increased, CED outperforms bone cement in terms of the stress reduction in augmented vertebral and adjacent vertebral, which could be beneficial for avoiding re-fracture. Using TBGA to treat OVCFs, especially with Plan B method, the condition of the pathological spine is closer to the original status in terms of the sensitivity to stress and the spinal range of motion. The TBGA treatment is sensitive to lateral bending and torsion, therefore patients should be advised to avoid high-risk motions like lateral bending and rotation.

[Diffusion-weighted imaging hyperintensity is reversible in large middle cerebral artery infarction following thrombectomy:a case report].

Diffusion-weighted imaging (DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging (MRI) and angiography (MRA) revealed occlusion of his right middle cerebral artery (MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 mL at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 mL. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI, suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.

[Mismatch of ASPECTS based on arterial spin labeling and diffusion-weighted imaging as an indicator for mechanical thrombectomy in patients with wake-up stroke].

OBJECTIVE: To retrospectively analyze the outcomes of wake-up stroke (WUS) patients with occlusion of large vessel occlusion (LVO), who were selected for mechanical thrombectomy according to the mismatch of Alberta Stroke Program Early CT Score (ASPECTS) based on arterial spin labeling (ASL) and diffusion-weighted image (DWI) on admission magnetic resonance (MR) scans. METHODS: Twelve consecutive WUS patients with acute LVO of the anterior circulation undergoing MR scans with ASL and DWI prior to thrombectomy were retrospectively evaluated. The mismatch of ASPECTS was defined as the difference between ASL-ASPECTS and DWI-ASPECTS, and a higher score indicates a greater mismatch. RESULTS: The procedures led to successful reperfusion in all the cases (Thrombolysis in Cerebral Infarction Grade 2b-3). Eleven patients (91.7%) had significantly decreased National Institute of Health Stroke scale (NIHSS) score at discharge.AmRS score of ≤2 at 90 days was achieved in 8 of the 12 patients (66.7%). CONCLUSIONS: The mismatch between ASPECTS assessed based on ASL and DWI can detect a true mismatch in patients with acute LVO of the anterior circulation, and can be used for rapid screening of patients eligible for thrombectomy.

Multivariate analysis of immune effect of hepatitis B vaccination in post-liver transplantation children aged under 5 years old / 国际外科学杂志

Objective@#To investigate the effect of hepatitis B vaccine immune response after liver transplantation in children under 5 years old and assess the necessity of multiple vaccination.@*Methods@#A retrospective collection of children who had liver transplantation from February 2014 to December 2018 in the same liver transplantation group in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University were analyzed. In accordance with the requirements of the doctor, 170 children under 5 years old injected with over 4 doses were enrolled, including 75 males and 95 females, aged from 4 months to 5 years old. After every dose of vaccination, the blood were collected to detect hepatitis B following regular review in liver transplantation clinic, observe the effect of HBsAb (hepatitis B surface antibody) after postoperative hepatitis B vaccination.Count data were represented by cases and percentage (%), and comparison between groups were analyzed by chi-square test.@*Results@#After the first course of treatment, in total children under 5 years old who completed the first course of treatment, 121 cases got successful immune responses(HBsAb≥100 IU/L) and 49 cases got the responses failure (HBsAb<100 IU/L). After the second course of treatment, 29 cases got successful immune responses, and only 20 cases finally failed to response (HBsAb<10 IU/L)to 8 injections namely two courses. The factors affecting the immune effect of hepatitis B vaccination were not related to gender, primary disease, liver feeding mode, and postoperative vaccination time, and were related to age, place of residence, and preoperative level of HBsAb titer (100 IU/L). The immune responses rate of children averagly aged over 2 years old was significantly higher than that of children under 1 year old after the first course of postoperative vaccination. Children with preoperative hepatitis B vaccination and >100 IU/L anti-HBs titer had a higher immune response rate after the first course of postoperative vaccination (84.72%), and the immune response rate of children with anti-HBs titers <100 IU/L after the first course of hepatitis B vaccine was slightly lower(60.71%).@*Conclusions@#Most post-liver transplantation children can obtain protective antibodies to prevent re-infection of hepatitis B virus by inoculation with hepatitis B vaccine. Multiple inoculation can effectively induce hepatitis B antibody production and improve immune response level economically. The hepatitis B vaccination proved to be indispensable and is one of the current methods promoted and applied to post-liver transplantation.

Multivariate analysis of immune effect of hepatitis B vaccination in post-liver transplantation children aged under 5 years old / 国际外科学杂志

Objective To investigate the effect of hepatitis B vaccine immune response after liver transplantation in children under 5 years old and assess the necessity of multiple vaccination.Methods A retrospective collection of children who had liver transplantation from February 2014 to December 2018 in the same liver transplantation group in the Department of General Surgery,Beijing Friendship Hospital,Capital Medical University were analyzed.In accordance with the requirements of the doctor,170 children under 5 years old injected with over 4 doses were enrolled,including 75 males and 95 females,aged from 4 months to 5 years old.After every dose of vaccination,the blood were collected to detect hepatitis B following regular review in liver transplantation clinic,observe the effect of HBsAb (hepatitis B surface antibody) after postoperative hepatitis B vaccination.Count data were represented by cases and percentage (％),and comparison between groups were analyzed by chi-square test.Results After the first course of treatment,in total children under 5 years old who completed the first course of treatment,121 cases got successful immune responses (HBsAb ≥ 100 IU/L) and 49 cases got the responses failure (HBsAb ＜ 100 IU/L).After the second course of treatment,29 cases got successful immune responses,and only 20 cases finally failed to response (HBsAb ＜ 10 IU/L) to 8 injections namely two courses.The factors affecting the immune effect of hepatitis B vaccination were not related to gender,primary disease,liver feeding mode,and postoperative vaccination time,and were related to age,place of residence,and preoperative level of HBsAb titer (100 IU/L).The immune responses rate of children averagly aged over 2 years old was significantly higher than that of children under 1 year old after the first course of postoperative vaccination.Children with preoperative hepatitis B vaccination and ＞ 100 IU/L anti-HBs titer had a higher immune response rate after the first course of postoperative vaccination (84.72％),and the immune response rate of children with anti-HBs titers ＜ 100 IU/L after the first course of hepatitis B vaccine was slightly lower(60.71％).Conclusions Most post-liver transplantation children can obtain protective antibodies to prevent re-infection of hepatitis B virus by inoculation with hepatitis B vaccine.Multiple inoculation can effectively induce hepatitis B antibody production and improve immune response level economically.The hepatitis B vaccination proved to be indispensable and is one of the current methods promoted and applied to post-liver transplantation.