[Study on the diagnostic value of transient elastography, APRI and FIB-4 for liver fibrosis in children with non-alcoholic fatty liver disease].

Objective: To evaluate the diagnostic value of transient elastography, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) for liver fibrosis in children with non-alcoholic fatty liver disease (NAFLD). Methods: A retrospective study was conducted on 100 cases of nonalcoholic fatty liver disease in Hunan Children's Hospital between August 2015 to October 2020 to collect liver tissue pathological and clinical data. The receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value of liver stiffness measurement (LSM), APRI and FIB-4 in the diagnosis of different stages of liver fibrosis caused by NAFLD in children. Results: The area under the ROC curve (AUC) value of LSM, APRI and FIB-4 for diagnosing liver fibrosis (S≥1) were 0.701 [95% confidence interval (CI): 0.579 ~ 0.822, P = 0.011], 0.606 (95%CI: 0.436 ~ 0.775, P = 0.182), and 0.568 (95%CI: 0.397 ~ 0.740, P = 0.387), respectively. The best cut-off values were 6.65 kPa, 21.20, and 0.18, respectively. The AUCs value of LSM, APRI, and FIB-4 for diagnosing significant liver fibrosis (S≥ 2) were 0.660 (95% CI: 0.552 ~ 0.768, P = 0.006), 0.578 (95% CI: 0.464 ~ 0.691, P = 0.182) and 0.541 (95% CI: 0.427 ~ 0.655, P = 0.482), respectively. The best cut-off values were 7.35kpa, 24.78 and 0.22, respectively. The AUCs value of LSM, APRI and FIB-4 for the diagnosis of advanced liver fibrosis (S≥ 3) were 0.639 (95% CI: 0.446 ~ 0.832, P = 0.134), 0.613 (95% CI: 0.447 ~ 0.779, P = 0.223) and 0.587 (95% CI: 0.411 ~ 0.764, P = 0.346), respectively. The best cut-off values were 8.55kpa, 26.66 and 0.27, respectively. Conclusion: The transient elastography technique has a better diagnostic value than APRI and FIB-4 for liver fibrosis in children with NAFLD.

Structural Characterization and Immune Activity Screening of Polysaccharides With Different Molecular Weights From Astragali Radix.

Saccharides are the most abundant substance with the strongest immunological activity in Astragali Radix (AR). However, systematic structure study and immunoactivity screening of polysaccharides with different molecular weights (Mw) in AR have yet to be conducted. In this study, Astragalus polysaccharides (APSs) were divided into three fragments of different Mw values, >2,000 kDa (APS-Ⅰ), about 10 kDa (APS-Ⅱ), and about 300 Da (APS-Ⅲ), by using ultrafiltration for the first time. The structural differences of the three products were determined on the basis of monosaccharide composition, FT-IR spectrum, linkage analysis, and nuclear magnetic resonance analysis. Cellular immune activity experiments in vitro and cyclophosphamide immunosuppression animal model experiments in vivo for nonspecific and specific immunoactivity screening were applied to identify the most immunogenic fragment in APSs. Linkage analysis results showed that APS-Ⅰ, APS-Ⅱ, and APS-Ⅲ have different attachment sites of monosaccharide residues. Immune screening experiments indicated that the Mw of the APSs influenced their activity, and APS-Ⅱ had the strongest immunoenhancing activity among the products. This research may serve as a reference for further study on APSs with different structures and immune activities, and as a guidance for the quality control of APSs and the development of new APS products.

[Preliminary evaluation of endoscopic selective varices devascularization in children].

Objective: To investigate the effect of the endoscopic selective varices devascularization (ESVD) for the esophageal gastric varices bleeding (EGVB) in children. Methods: The clinical data of the patients diagnosed with EGVB and treated with ESVD from January 2018 to March 2018 were retrospectively analyzed. The effects, safety and complications of ESVD were evaluated. Results: There were five patients (including 2 males and 3 females, age ranged from 4 to 7 years) in the study. No rebleeding was found at the first follow-up on one week post operation. Three patients were treated with the endo-therapy at the twice follow-up (3 months after surgery): 2 patients had ESVD again and 1 patient had resection under endoscopy due to stenosis caused by surgical scar. After the second procedure, there was no rebleeding but one patient had abdominal pain caused by mesenteric thrombosis, cured with low molecular weight heparin. Conclusion: The ESVD for EGVB is safe and effective, but the long-term curative effect should be further studied.

Prospective feasibility study on the use of multiband mucosectomy for endoscopic resection of early squamous neoplasia in the esophagus.

BACKGROUND AND STUDY AIMS: Endoscopic resection for esophageal squamous high-grade intraepithelial neoplasia (HGIN) or intramucosal cancer (esophageal squamous cell carcinoma [ESCC]) with the endoscopic resection cap technique is technically difficult, and requires submucosal lifting and multiple snares for piecemeal resections. Multiband mucosectomy (MBM) is an easy-to-use endoscopic resection technique and may be the modality of choice in China, where ESCC is extremely prevalent. The aim of the current study was to prospectively evaluate MBM for piecemeal endoscopic resection of squamous neoplasia of the esophagus. METHODS: Patients with HGIN/ESCC and no signs of submucosal invasion or metastatic disease were included in the study. Lesions were delineated using electrocoagulation and resected using the MBM technique. Endpoints were procedure time, endoscopic radicality, complications, histology of the endoscopic resection specimens, and absence of HGIN/ESCC at the endoscopic resection scar during follow-up. RESULTS: A total of 41 patients (26 male; mean age 61 years) underwent MBM; all lesions were visible with white light endoscopy (median length 5 cm, interquartile range [IQR] 4 - 6 cm; median circumferential extent 42 %, IQR 25 - 50 %). Median procedure time was 12 minutes (IQR 8 - 24 minutes). Median number of resections was 5 (IQR 3 - 6). Endoscopic complete resection was achieved in all lesions. There was one perforation, which was treated by application of clips. No other complications were observed. The worst histology was ESCC (n = 19), HGIN (n = 17), middle grade intraepithelial neoplasia (n = 4), and normal squamous epithelium (n = 1). Endoscopic follow-up at 3 months showed HGIN at the endoscopic resection scar in two patients, which was effectively treated endoscopically, and showed normal squamous epithelium in all patients at final follow-up (median 15 months, IQR 12 - 24 months). CONCLUSION: This first prospective study on MBM for piecemeal endoscopic resection of early esophageal squamous neoplasia showed that MBM was effective for the complete removal of lesions with short procedure time, few complications, effective histological assessment of resected specimens, and durable treatment effect.

Incidence and survival of symptomatic lacunar infarction in a Beijing population: a 6-year prospective study.

BACKGROUND AND PURPOSE: The incidence of ischaemic stroke has increased or remained high in China; however, little population-based evidence is available on the incidence and survival of lacunar infarction (LAC). We examined the incidence of LAC in a northern Chinese (Beijing) population and monitored survival. METHODS: A prospective registry population-based study was conducted over a 6-year period in a general, unselected, and representative community in Beijing with approximately 100,000 long-term permanent residents. All first-ever stroke cases were registered. RESULTS: A total of 1184 patients with ischaemic stroke were identified; 36.9% (437 cases) were classified as LAC. Age-standardized incidence rates of LAC ranged from 24.0 to 51.3/100,000 with an average rate of 35.3/100,000 during study period. The incidence of LAC increased with age before 70 years. The incidence of non-LAC increased with age. There were no significant differences in crude incidence of LAC between men and women (78.4/100,000 vs. 75.4/100,000). The incidence of non-LAC was significantly higher in men than in women (155/100,000 vs. 107/100,000, P < 0.001). The 28-day case fatality proportions were significantly lower in patients with LAC (0.5%) versus non-LAC (14.9%). One year after acute stroke onset, the survival rates between LAC and non-LAC were similar. CONCLUSION: LAC is a common stroke subtype in Northern China. Men or the elderly are more likely to have non-LAC. Long-term survival following LAC is similar to non-LAC patients.

Agmatine inhibits carotid sinus baroreflex in anesthetized rats.

AIM: To study the effect of agmatine (Agm) on carotid sinus baroreflex. METHODS: The functional parameters of baroreflex were measured by perfusing the carotid sinus in anesthetized rats. RESULTS: (1) Agm 1, 5, and 10 mmol/L shifted the functional curve of carotid sinus baroreflex to the right and upwards in a concentration-dependent manner with a reduction in peak slope and a reflex decrease in mean arterial pressure, indicating that Agm exerted an inhibitory effect on the carotid baroreflex. (2) The inhibitory effect of Agm (5 mmol/L) on baroreflex was eliminated by pretreatment with idazoxan (Ida, 0.1 mmol/L), an alpha2-adrenoceptor (alpha2-AR) and imidazoline receptor (IR) antagonist, and partially blocked by yohimbine (Yoh, 15 micromol/L), a selective alpha2-AR antagonist. (3) NG-nitro-L-arginine methyl ester (L-NAME, 500 micromol/L), an NOS inhibitor, did not affect the inhibitory effect of Agm. CONCLUSION: Agm inhibits carotid baroreflex via IR and alpha2-AR.

[Agmatine inhibits the afferent activity of carotid baroreceptor in rats].

The effect of agmatine (Agm) on the carotid baroreceptor activity was examined in 24 anesthetized rats with perfused isolated carotid sinus by recording sinus nerve afferent discharges. The results are as follows. (1) By perfusing with 1 mmol/L Agm, the functional curve for the intrasinus pressure (ISP)-integral of sinus nerve activity (ISNA) relation was shifted to the right and downward with decreases in peak slope (PS) and peak integral value of carotid sinus afferent discharge (PIV). By perfusing with high concentrations of Agm (5 and 10 mmol/L), the curves were shifted to the right and downward further with marked decreases of PS and PIV. These results showed that Agm exerted an inhibitory action on the baroreceptor activity in a dose-dependent manner. (2) The Agm-induced decrease in sinus nerve afferent activity was eliminated by pretreatment with IR and alpha 2-AR blocker idazoxan (0.1 mmol/L). (3) Selective alpha 2-AR blocker yohimbine (15 mumol/L) partly abolished the inhibitory effect of Agm on baroreceptor. (4) Preperfusing with Bay K 8644 (500 nmol/L), an agonist of calcium channels, also eliminated the effect of Agm on carotid baroreceptor activity. These results indicate that Agm exerts an inhibitory action on carotid baroreceptor and such an action may be attributed to the reduction in calcium influx in carotid baroreceptor, which is mediated by IR and alpha 2-AR.

[Effect of Curcuma zedoaria (Berg.) Bosc on the myoelectric activity of uterus in rats and study of its mechanisms].

OBJECTIVE: To investigate the effect of Curcuma zedoaria on the myoelectric activity of uterus in virgin rats and study its mech anisms. METHOD: A pair of bipolar Ag-AgCl electrodes were implanted on the serosal surface of uterus in rats to observe the effect of C. zedoaria on the myoelectric activity of uterus before and after the five agonists were injected intraperitoneally. RESULT: Decoction of C. zedoaria significantly increases the spike area, the duration and the number of bursts of action potentials of the uterine smooth muscle and its effect is related dosage. Atropine and phentolamine decreased the exciting effect of C. zedoaria, whereas verapamil, diphenhydramine and indomethacin have no effect on the excitation of C. zedoaria. CONCLUSION: C. zedoaria has obvious exciting effect on the smooth muscle of uterus in rats, and its mechanisms may be associated with M-receptor and alpha-receptor.

[Role of calcium in the mechanism underlying the inhibitory effect of streptomycin on carotid sinus baroreflex in rats].

The effect of streptomycin (SM) on carotid baroreflex was examined in 23 anesthetized rats with isolated carotid sinus perfusion. The results obtained are as follows. (1) In response to perfusion with SM (200 micromol/L), the functional curve of carotid baroreflex was shifted to the right and upward with a decrease of peak slope (PS) and a reflex decrease in mean arterial pressure (RD)(P<0.01), indicating an inhibitory effect of SM on carotid sinus baroreflex. (2) By perfusing the isolated carotid sinus with high Ca(2+) solution (4 mmol/L), the inhibitory effect of SM on carotid baroreflex was partially eliminated. The functional curve of SM was shifted to the left and downward with PS increasing from 0.27+/-0.04 kPa to 0.37+/-0.02 kPa (P<0.01) and RD was enhanced from 4.32+/-0.14 kPa to 6.18+/-0.17 kPa (P<0.01). On the other hand, the threshold pressure (TP) and saturation pressure (SP) were significantly decreased from 10.29+/-0.29 kPa to 9.98+/-0.33 kPa (P<0.05) and from 27.26+/-0.42 kPa to 25.22+/-0.38 kPa (P<0.05), respectively. (3) By pretreatment with Bay K 8644 (500 nmol/L), an agonist of calcium channels, the effect of SM on carotid baroreflex was completely abolished. (4) Exposure of the carotid sinus to SM following pretreatment with charybdotoxin (ChTX,100 nmol/L), a blocker of the Ca(2+)-activated K(+) channel (KCa), still inhibited the baroreflex. These results suggest that the inhibitory action of SM on carotid baroreflex may be mediated by suppressing Ca(2+) influx.

Effects of metoclopramide on gastrointestinal myoelectric activity in rats.

AIM: To investigate the effects of metoclopramide (MCP) action on myoelectric activity in the antrum and small intestine. METHODS: Ten healthy male Wistar rats, weighing 250-350 g, were anesthetized with ketamine hydrochloride (100 mg/kg, intramuscularly). Four pairs of bipolar stainless steel electrodes 3 mm apart were implanted on the serosal surface of the antrum at one, 10 and 20 cm distal to the pylorus. Five to ten days following the operation, the gastrointestinal myoelectric activity of fasted rats after intramuscular injection of 2.5, six and 12 mg/kg MCP was recorded using a 8-channel EEG machine, and these values were quantitatively compared with the myoelectric activity after saline injection. RESULTS: In fasted rats, 2.5 mg/kg MCP increased the amplitude of spike activity (402.0 ± 138.4 µV, vs 345 ± 163.4 µV, P < 0.05) and the percentage of the slow wave-containing spike bursts (60.4% ± 22.0% vs 47.4% ± 22.5%, P < 0.01) of small intestine (1 cm distal to the pylorus), but did not affect the myoelectric activity of the antrum. Six and 12 mg/kg MCP increased the amplitude of both the slow wave (332.8 ± 200.1 µV vs 191.2 ± 143.9 µV, P < 0.01; 330.0 ± 197.1 µV vs 191.2 ± 143.9 µV, P < 0.05) and the spike activity of the antrum (180.5 ± 69.7 µV vs 121.8 ± 63.3 µV, P < 0.05; 174.5 ± 71.7 µV vs 123.8 ± 63.3 µV, P < 0.05), while in small intestine (1 cm distal to the pylorus) only the amplitude of spike activity (407.3 ± 179.0 µV vs 345.0 ± 163.4 µV, P < 0.05; 456.0 ± 145.4 µV vs 345.0 ± 163.4 µV, P < 0.05) and the percentage of the slow wave containing spike bursts (61.7% ± 26.5% vs 47.4% ± 22.5%, P < 0.01; 59.1% ± 17.3% vs 47.4% ± 22.5%, P < 0.01) was increased and the latent period significantly prolonged (2.5 ± 0.35 min vs 0.77 ± 0.18 min, P < 0.01). CONCLUSION: Different mechanisms may be involved in enhancing the myoelectric activity of the antrum and small intestine following MCP administration.

[Testing different diagnostic criteria of Behçet syndrome in Chinese patients].

In order to compare the sensitivity and specificity of different diagnostic criteria of Behçet Syndrome (BS), 98 patients with BS were collected from PUMC Hospital and China-Japan friendship Hospital in Beijing. 105 patients with other connective tissue diseases were taken as controls. Results of the study showed that the sensitivity of the diagnostic criteria of the Zhangs was 100%, O'Duffy's 78.1%, M + B's 71.9%, Japan committees (1987)72.9%, Dilsen's 87.5%, International study group A 81.3% and B 79.2%. The specificity of each of the above-mentioned criteria was 85.9%, 94.3%, 96.2%, 96.2%, 93.3%, 94.3% and 98.1% respectively. The specificity of oral ulceration could be increased to 97% only if it was found together with two other major criteria during the disease course. Ocular symptoms may be 100% specificity if found together with another major criterion. Pathergy test was found positive in 62.2% of the BS patients but rarely seen in control patients and normal subjects. Therefore, it may be considered as a specific test for BS and may well be used as one of the major diagnostic criteria. The authors are of the opinion that BS could be diagnosed only when 3 of the 5 major criteria, i.e. oral ulcer, genital ulcer, erythema nodosum, uveitis/retinitis and positive pathergy test are present, or if two each of the major and minor criteria are found.