[Evaluation of the efficacy of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B combined with nonalcoholic fatty liver disease by high-sensitivity detection of HBV DNA levels].

Objective: To observe the efficacy of tenofovir disoproxil fumarate (TDF) antiviral therapy in patients with chronic hepatitis B (CHB) combined with nonalcoholic fatty liver disease (NAFLD), so as to provide evidence-based evidence in these special populations. Methods: Data from 91 CHB cases who received TDF 300 mg/d antiviral therapy for 96 weeks were analyzed retrospectively. Among them, 43 cases with NAFLD were included in the study group, and 48 cases without NAFLD were included in the control group. The virological and biochemical responses of the two groups of patients at 12, 24, 48, and 96 weeks were compared. Among them, 69 patients underwent highly sensitive detection of HBV DNA. The t-test and χ (2) test were performed on the data. Results: ALT normalization rate was lower in the study group (42%, 51%) at 12 and 24 weeks of treatment than that in the control group (69%, 79%), and the difference was statistically significant (P < 0.05). However, there was no statistically significant difference between the two groups at 48 and 96 weeks. HBV DNA concentration below the lower limit of detection (200 IU/ml) was lower in the study group at 12 weeks of treatment than in the control group (35% vs. 56%), and the difference was statistically significant (P < 0.05). However, there was no statistically significant difference between the two groups at 24, 48, and 96 weeks. Furthermore, HBV DNA concentration below the lower limit was significantly lower in the study group than that in the control group at 12, 24, 48, and 96 weeks of treatment when the lower limit of HBV DNA detection was set at 20IU/ml, and the difference was statistically significant (P < 0.05). The HBeAg serological negative conversion rate was gradually higher in the study group at 48 and 96 weeks of treatment than in the control group, and the difference was not statistically significant. Conclusion: TDF antiviral treatment can affect the virological and biochemical responses of NAFLD in chronic hepatitis B.

[Outcomes at discharge of preterm infants born <34 weeks' gestation].

Objective: To investigate the incidence and trend of short-term outcomes among preterm infants born <34 weeks' gestation. Methods: A secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study "reduction of infection in neonatal intensive care units (NICU) using the evidence-based practice for improving quality (REIN-EPIQ) study". This study was conducted in 25 tertiary NICU. A total of 27 192 infants with gestational age <34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled. Infants with severe congenital malformation were excluded. Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups. Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years. Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders. Results: A total of 27 192 preterm infants were enrolled with gestational age of (31.3±2.0) weeks at birth and weight of (1 617±415) g at birth. Overall, 9.5% (2 594/27 192) of infants were discharged against medical advice, and the overall mortality rate was 10.7% (2 907/27 192). Mortality for infants who received complete care was 4.7% (1 147/24 598), and mortality or any major morbidity was 26.2% (6 452/24 598). The incidences of moderate to severe bronchopulmonary dysplasia, sepsis, severe intraventricular hemorrhage or periventricular leukomalacia, proven necrotizing enterocolitis, and severe retinopathy of prematurity were 16.0% (4 342/27 192), 11.9% (3 225/27 192), 6.8% (1 641/24 206), 3.6% (939/25 762) and 1.5% (214/13 868), respectively. There was a decreasing of the overall mortality (P<0.001) during the 3 years. Also, the incidences for sepsis and severe retinopathy of prematurity both decreased (both P<0.001). However, there were no significant differences in the major morbidity in preterm infants who received complete care during the 3-year study period (P=0.230). After adjusting for confounders, infants admitted during the third study year showed significantly lower risk of overall mortality (adjust OR=0.62, 95%CI 0.55-0.69, P<0.001), mortality or major morbidity, moderate to severe bronchopulmonary dysplasia, sepsis and severe retinopathy of prematurity, compared to those admitted in the first study year (all P<0.05). Conclusions: From 2015 to 2018, the mortality and major morbidities among preterm infants in Chinese NICU decreased, but there is still space for further efforts. Further targeted quality improvement is needed to improve the overall outcome of preterm infants.

[Hierarchical clustering analysis of congenital nystagmus waveforms].

Objective: To explore the feasibility of applying machine-learning hierarchical clustering algorithm to waveform-type automatic classification and diagnosis in congenital nystagmus (CN). Methods: A retrospective case series study. A total of 90 patients (90 eyes) diagnosed with CN at Tianjin Eye Hospital from December 2018 to September 2019 were included in the study, including 67 males and 23 females, aged (12±9) years old. Eye movement waveforms were recorded with the video eye tracker in all patients. Analyses with unsupervised machine-learning hierarchical clustering algorithm were performed on the normalized eye movement waveforms. The visualized clustering results were obtained for further waveform naming. The occurrence rate of each waveform type was calculated, and the correlation between the proportion of each waveform type and the visual function of CN patients was analyzed. Independent sample t-test and Pearson correlation analysis were used for statistical analysis. Results: The 46 620 cycles of validated waveforms from the 90 CN patients were categorized into 7 types of waveforms through machine-learning hierarchical clustering algorithm, named type Ⅰ, type Ⅱ, type Ⅲ, and types Ⅳ1-4, respectively. In the 46 620 cycles of eye movement waveforms from the 90 patients with CN, there were 14 259 cycles of type Ⅰ (30.59%), 11 498 cycles of type Ⅱ (24.66%), 4 083 cycles of type Ⅲ (8.76%), 5 430 cycles of type Ⅳ1 (11.65%), 3 451 cycles of type Ⅳ2 (7.40%), 3 015 cycles of type Ⅳ3 (6.47%), 2 663 cycles of type Ⅳ4 (5.71%) and 2 221 cycles of unclassified waveforms (4.76%). The waveforms of types Ⅰ, Ⅱ and Ⅲ corresponded to the 3 basic CN eye movement waveforms (velocity-increasing jerk waveform, velocity-decreasing jerk waveform and pendular waveform) described in the textbooks, and the waveforms of types Ⅳ1-4 were complex waveforms. The proportions of patients with the 7 types of waveforms were 78.89% (71 cases), 41.11% (37 cases), 17.78% (16 cases), 20.00% (18 cases), 7.78% (7 cases), 15.56% (14 cases) and 11.11% (10 cases), respectively. According to the results of automatic classification, 38 (42.22%) CN patients presented with only one type of waveforms, and the remaining 52 (57.78%) CN patients presented with two or more types of waveforms, including 23 (25.56%) patients with 3 or more types of waveforms and 5 (5.56%) patients with 4 types of waveforms. The proportions of type Ⅰ component were significantly correlated with the patients' best corrected visual acuities (BCVAs;logarithm of the minimum angle of resolution) (r=-0.39; P<0.01), and there was no relationship between the proportions of type Ⅱ component and the patients' BCVAs (P>0.05). The BCVAs of the patients with type Ⅰ as the dominant component were better than those of the patients with type Ⅱ as the dominant component, with statistically significant difference (0.19±0.14 vs. 0.45±0.37;t=2.77; P<0.05). Conclusion: Machine-learning hierarchical clustering algorithm can be used for waveform-type automatic classification and discrimination in CN and provide an auxiliary method for the precise diagnosis and evaluation of the disease.

[Recommendations of diagnosis of autoinflammatory diseases in China].

Autoinflammatory diseases (AIDs) are a group of disorders characterized by dysfunction of innate immunity which caused by gene mutations leading to coded proteins changes, finally causing uncontrolled systemic inflammation. AIDs are a group of rare rheumatic and inflammatory diseases. Here, Chinese Rheumatology Association summarized manifestations of the main AIDs, and to standardize the methods for diagnosis of AIDs.

[The role and mechanism of human trophoblastic cell surface antigen 2 in the invasion and metastasis of ovarian cancer].

Objective: To explore the role and molecular mechanism of trophoblastic cell surface antigen 2 (Trop2) in the invasion and migration of ovarian cancer. Methods: Through the data mining of Cancer Cell Line Encyclopedia and TCGA database, the clinical significance of Trop2 expression was analyzed. Western blot was used to detect Trop2 protein expression in ovarian cancer cell lines including A3O, A1780 and SKOV3. SKOV3 cells were used to construct Trop2-short hairpin RNA (shRNA) cell model. Quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) was used to detect the SKOV3 mRNA expression in SKOV3-shRNA and SKOV3-NC cells. Cell counting kit-8 (CCK8) was used to detect the proliferation of SKOV3-shRNA cells and SKOV3-NC cells. Flow cytometry was used to detect cell cycle and apoptosis in two groups of cells. Transwell array was used to detecte the invasion and migration of SKOV3-shRNA cells and SKOV3-NC cells. Western blot was used to detect the protein expressions of AKT, p-AKT, ß-catenin, caspase3, bcl-2, E-cadherin and vimentin. Results: Trop2 mRNA highly expressed in ovarian cancer, and was related to the tumor stage and patient survival. Compared with A3O cells, Trop2 overexpressed in A1780 and SKOV3 cells (P<0.05). The relative expression levels of Trop2 mRNA in SKOV3-NC group and SKOV3-shRNA group were 1.18±0.24 and 0.42±0.08, with statistically significant difference (P<0.05). The results of CCK-8 array showed that the cell viability of SKOV3-NC group was significantly higher than that of SKOV3-shRNA group (P<0.05). The proportion of G(0)/G(1) cells in SKOV3-NC and SKOV3-shRNA groups were (38.67±4.22)% and (60.24±8.17)%, respectively. G(0)/G(1) arrest was observed in SKOV3-shRNA cells (P<0.05). The apoptosis rate of SKOV3-shRNA group was (26.32±1.81)%, significantly higher than (6.54±1.32)% of SKOV3-NC group (P<0.05). The number of migrating SKOV3 cells in the SKOV3-shRNA and SkOV3-NC groups were 1 255.83±108.44 and 1 679.71±213.92, while the number of invading cells were 242.49±52.09 and 473.54±73.11, respectively. Compared with the SKOV3-NC group, the number of migrating and invading SKOV3-shRNA group was significantly reduced (all P<0.05). The expressions of p-AKT2, Bcl-2, vimentin and ß-catenin were down-regulated, and the expressions of caspase 3 and E-cadherin were up-regulated in SKOV3-shRNA cells. There was no significant change in the total protein level of AKT. Conclusions: Trop2 expression is related to ovarian cancer stage and postoperative survival. Trop2 can promote ovarian cancer cell proliferation and metastasis by activating the AKT/ß-catenin signaling pathway and knockdown of Trop2 inhibits the progression of ovarian cancer.

[Effect of tissue inhibitor of metalloproteinase-1 and 2 siRNA on the expression of smad2/3/4 protein in hepatic stellate cells].

Objective: To study the effect of tissue inhibitor of metalloproteinases (TIMP)-1 siRNA and TIMP-2 siRNA on the expression of smad2/3/4 protein in CCl4-induced liver fibrosis rat hepatic stellate cells (HSC). Methods: Rat's liver tissues with liver fibrosis after treatment with pre-built TIMP-1siRNA and TIMP-2 siRNA were used as the research subjects. Immunohistochemistry, Western blotting and real-time PCR were used to detect the protein and corresponding mRNA expression levels on smad2/3/4. TUNEL and α-smooth muscle actin (α-SMA) positive cells were quantified by double-labeled immunofluorescence. Analysis of variance (ANOVA) was used to compare the means between multiple groups, and the SNK test was used for the pairwise comparison of means. Results: The results of immunohistochemistry showed that the protein expressions of smad2, smad3, and smad4 in the TIMP-1 siRNA group and TIMP-2 siRNA group were significantly reduced than those of the model and the negative control group (P < 0.05). In addition, Western blotting results had also shown the same trend. The protein expression of smad2, smad3, and smad4 in the TIMP-1siRNA group and TIMP-2siRNA group were significantly reduced than those of the model and the negative control group (P < 0.01). The mRNA expression of smad2, smad3, and smad4 in TIMP-1siRNA group and TIMP-2siRNA group was significantly reduced than those of the model and negative control group (P < 0.05). Immunofluorescence showed that the apoptosis of activated HSC in the TIMP-1 siRNA group(0.014 3 ± 0.002 4) and TIMP-2 siRNA group(0.010 7 ± 0.004 4) was increased than those of the model(0) and the negative control group (0.002 4 ± 0.002 4, P < 0.05). Conclusion: TIMP-1 siRNA and TIMP-2 siRNA promote the apoptosis of activated HSCs. In addition, it also has a significant inhibitory effect on the expression of smad protein.

Enhanced North Pacific deep-ocean stratification by stronger intermediate water formation during Heinrich Stadial 1.

The deglacial history of CO2 release from the deep North Pacific remains unresolved. This is due to conflicting indications about subarctic Pacific ventilation changes based on various marine proxies, especially for Heinrich Stadial 1 (HS-1) when a rapid atmospheric CO2 rise occurs. Here, we use a complex Earth System Model to investigate the deglacial North Pacific overturning and its control on ocean stratification. Our results show an enhanced intermediate-to-deep ocean stratification coeval with intensified North Pacific Intermediate Water (NPIW) formation during HS-1, compared to the Last Glacial Maximum. The stronger NPIW formation causes lower salinities and higher temperatures at intermediate depths. By lowering NPIW densities, this enlarges vertical density gradient and thus enhances intermediate-to-deep ocean stratification during HS-1. Physically, this process prevents the North Pacific deep waters from a better communication with the upper oceans, thus prolongs the existing isolation of glacial Pacific abyssal carbons during HS-1.

[Plasma exchange combined with double plasma absorption therapy improve the prognosis of acute-on-chronic liver failure].

Objective: To compare the efficacy and safety of plasma exchange (PE) combined with double plasma absorption and simple PE in the treatment of acute-on-chronic liver failure. Methods: We retrospectively analyzed 251 cases of acute-on-chronic liver failure treated with artificial liver treatment since January 2015. Changes in clinical manifestations, laboratory tests, and complications of the patients before and after different modes of treatment were compared and short-term efficacy was tracked. In accordance with different data, t-test, Pearson's chi-squared test and Fisher's exact test were used for statistical analysis. Results: The effectiveness of low-volume PE combined with double plasma molecular adsorption system (DPMAS) and equal amount of PE combined with DPMAS was significantly better than simple PE (83.7%, 84.05% and 82.15 vs 55.6%, P < 0.05) in early stage of liver failure. In late-stage of liver failure, there was no significant difference in the treatment efficiency of each group (P > 0.05). Bilirubin and bile acid levels were significantly decreased in combined treatment groups than that to simple PE group (P < 0.05). PTA and albumin improvement rate of DPMAS PE groups were significantly lower than that of simple PE group (P < 0.05). There was no statistical difference in adverse reactions between each group. Conclusion: PE combined with DPMAS improves the treatment efficiency of early hepatic failure and decrease dosage of plasma when compared with simple PE. A beforehand DPMAS treatment after PE treatment can improve the adverse effects of DPMAS on blood coagulation function and albumin levels.

[Research progress in prognostic factors of hepatitis B virus-associated end-stage liver disease].

Hepatitis B remains a worldwide health problem with a high mortality rate associated with end-stage liver diseases. The Model for End-Stage Liver Disease and Child-Pugh score is still widely used as the prognostic model for liver cirrhosis and inflammatory reaction, B-type natriuretic peptide and portal vein thrombosis are independent risk factors. Many new models have been proposed for liver failure, including a new model HINAT ACLF. HINAT ACLF is better than its preceding models and increased neutrophil-to-lymphocyte ratio is a single factor to promote thyroid hormone, cholinesterase, and antiviral treatment response in this model. HBV DNA is frequently involved in the predictive model of liver cancer, but with widespread use of antiviral drugs, the value of its long-term prognostication has gradually reduced. Therefore, liver stiffness value instead of HBV DNA shows apparent advantages in mREACH-B. ALBI has good median survival prediction value for hepatocellular carcinoma patients. Alpha-fetoprotein and staging method, which is based on tumor number and size, are still independent risk factors for liver cancer.

A suppository kit for metronomic photodynamic therapy: The elimination of rectal cancer in situ.

Metronomic photodynamic therapy (mPDT) was developed to improve tumor-specific responses through cell death by apoptosis. We developed an mPDT suppository kit including ALA and LED suppositories and analyzed its killing effect on rectal tumors in rabbits. METHODS: The ALA (10 wt%) suppository was prepared using ALA powder, type 36 semi-synthetic fatty acid glyceride, and azone. The LED suppository was constructed by encapsulating LED units and a circuit in transparent epoxy resin. VX2 cells were injected into the rectal submucosa of rabbits to establish a carcinoma model in situ. The ALA suppository was inserted into the rectal cavity for 30 min of uptake and activated for 1 h by the LED suppository at a power density of 20 mW/cm2. The mPDT process was repeated three times once a day. MRI was used to monitor tumor growth, histopathology and TUNEL staining were performed at 14 days after mPDT. RESULTS: The overall response rate was 60% in the mPDT group using the kit in which the tumor size was decreased up to about 50% at 7 days post-mPDT and almost eliminated at 14 days. HE staining showed that only 6.16% of the tumor tissue remained after mPDT treatment. TUNEL detection showed that the apoptosis rate was 18.9%. CONCLUSION: We verified the killing effect of the mPDT suppository kit on rectal tumors in rabbits based on mPDT that induced tumor cell apoptosis.

[Transforming growth factor-ß1 small interfering RNA regulates platelet-derived growth factor and phosphorylated extracellular regulated protein kinase in rats with hepatic fibrosis: an experimental study].

Objective: To investigate the impact of transforming growth factor-ß1 (TGF-ß1) silencing by small interfering RNA (siRNA) on the expression of platelet-derived growth factor-ß (PDGF-BB) and its receptor (PDGF-ßR) in rats with hepatic fibrosis. Methods: A total of 40 male Sprague-Dawley rats were randomly divided into normal control group, model group, TGF-ß1 siRNA treatment group, and negative control group. All rats except those in the normal control group were given subcutaneous injection of 40% carbon tetrachloride to establish a rat model of hepatic fibrosis. The rats in the negative control group and the TGF-ß1 siRNA treatment group were given tail vein injection of negative control plasmid or TGF-ß1 siRNA plasmid twice a week at a dose of 0.25 mg/kg, and those in the normal control group and the model group were given the injection of sterile isotonic saline twice a week. The rats were sacrificed after 12 weeks and liver tissue samples were collected. Real-time PCR, immunohistochemistry, and Western blot were used to measure the expression of PDGF-BB, PDGF-ßR, and phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) in liver tissue. A one-way analysis of variance, the q test, and the Kruskal-Wallis test were used for statistical analysis based on data type. Results: Compared with the model group and the negative control group, the TGF-ß1 siRNA treatment group had significantly inhibited mRNA and protein expression of PDGF-BB and PDGF-ßR (F = 24.785 and 22.92, P < 0.01), as well as significantly inhibited expression of p-ERK1/2 (P < 0.05). Conclusion: Targeted TGF-ß1 siRNA can effectively downregulate the expression of PDGF-BB, PDGF-ßR, and p-ERK1/2 in liver tissue and thus help to improve hepatic fibrosis.

[Value of neutrophil-lymphocyte ratio in predicting hepatitis B-related liver failure].

Objective: To investigate the value of neutrophil-lymphocyte ratio (NLR) in predicting hepatitis B-related liver failure. Methods: A total of 349 subjects were enrolled, among whom 60 were healthy persons who underwent physical examination (group A), 111 had severe chronic hepatitis B (group B), 92 had decompensated hepatitis B cirrhosis (group C), and 86 had acute-on-chronic liver failure (ACLF) (group D). Routine blood test results, liver function parameters, and coagulation parameters were collected, and NLR was calculated. According to disease progression, group B was further divided into groups B1 (with progression to ACLF) and B2 (without progression to ACLF). NLR was compared between groups, and its prognostic value was evaluated. Results: NLR was 2.22(1.76-3.05) in group A, 2.54(1.78-3.49) in group B, 3.07(1.95-5.04)in group C, and 3.41(2.01-5.15) in group D, and NLR gradually increased with the aggravation of disease condition. The univariate and multivariate regression analyses of groups B1 and B2 showed that NLR and prothrombin activity were prognostic factors for disease progression. There was a significant difference in baseline NLR between groups B1 and B2 (3.87 ± 1.54 vs 2.71 ± 1.54, P = 0.004). There was a significant increase in NLR when severe hepatitis B in 16 patients progressed to ACLF (P = 0.042). The receiver operating characteristic (ROC) curve analysis showed that the cut-off value of NLR for predicting the progression of severe hepatitis B to ACLF was 2.79, with an area under the ROC curve (AUC) of 0.739 (P = 0.002). NLR was also a reference index for judging end-stage liver disease with a cut-off value of 3.94 (AUC = 0.612, P = 0.001). Conclusion: Peripheral NLR can reflect disease progression and predict the development of liver failure.

Clinical efficacy of gamma knife and surgery treatment of mesial temporal lobe epilepsy and their effects on EF-Tumt and EF-Tsmt expression.

OBJECTIVE: To study the clinical efficacy of gamma knife and surgery treatment of mesial temporal lobe epilepsy (MTLE) and their effects on EF-Tumt and EF-Tsmt expression. PATIENTS AND METHODS: The data of 78 cases of MTLE patients treated in our hospital from April 2011 to March 2013 were retrospectively analyzed. The patients were divided into two groups according to the treatment methods: the surgery group (including 41 cases) and the gamma knife group (including 37 cases). The clinical efficacy, the occurrence and recurrence of complications were evaluated, respectively; meanwhile, the expression of the EF-Tumt protein and EF-Tsmt protein in brain tissue were analyzed. RESULTS: The difference between the efficacy rate of the two groups showed no statistical significance (χ2=0.960, p>0.05). The complication rate of the gamma knife group was significantly lower than that of the control group (χ2=6.430, p<0.05). The recurrence rate of the patients in the gamma knife group was significantly lower than that of the patients in the surgery group (p>0.05). Within the two groups, the positive expression granum of EF-Tsmt protein and EF-Tumt protein of the two groups after treatment were significantly lower than that before treatment (p<0.05). After treatment, the positive expression granum of EF-Tsmt protein of the patients in the gamma knife group was obviously more than that of the patients in the surgery group (p<0.05). The difference between the positive expression granum of EF-Tumt protein of the two groups showed no statistical significance (p>0.05). Before and after treatment within the group, the positive cell of EF-Tsmt protein and EF-Tumt protein of the two groups of patients after treatment were significantly lower than that before treatment (p<0.05). After treatment, the difference between the EF-Tsmt protein positive cell and the EF-Tumt protein positive cell of the two groups of patients showed no statistical significance (p>0.05). CONCLUSIONS: Both surgery and gamma knife could treat MTLE effectively, and the efficacy may be related to the ability to reduce the expression of EF-Tsmt protein and EF-Tumt protein in brain tissue.

[Could binocular treatment be a substitute for patching].

Amblyopia is a common eye disease with a high prevalence in clinical practice of pediatric ophthalmology and strabismus. The primary treatment strategy for amblyopia is precise correction of refractive errors and patching of the dominant eye. The application of patching has a history of more than 200 years, and now is still the most effective method for treatment of amblyopia. Similar to the principle of traditional patching, atropine penalization has been testified that it can be used as an initial treatment for amblyopia with similar therapeutic effects as patching. In the past decade, binocular treatment has been proposed as a strategy for the treatment of amblyopia. Successively, different kinds of binocular treatment methods were reported by the researchers. This article systematically reviews all these methods reported in the recent years and their therapeutic effects. Most results about the therapeutic effect of binocular treatment are from the designers of the studies themselves, but in recent 2 years the results from monocenter or multicenter randomized controlled clinical trials to compare the therapeutic effects of binocular treatment and patching were reported. We hope to help colleagues have a comprehensive and objective understanding of the research progress on binocular treatment for amblyopia and thus keep a cool head on the question of whether binocular treatment could be a substitute for patching. (Chin J Ophthalmol, 2017, 53: 885-889).

[The preliminary study of stimulus input temporal changes on the visual cortex of rats at different ages].

Objective: To observe the impact of the input temporal changes on visual cortex of rats cells and the change of the synaptic efficacy, for the study of visual developmental plasticity mechanism. Methods: Experimental research. The brain slice of ten 14d healthy Wistar rats and ten 21d healthy Wistar rats were recorded with whole cell recording technique, using single stimulation and combined stimulate model, to observe the visual cortex of rats neurons changes in synaptic activity. Change the stimulus input sequence, and observe the visual cortex of rats changes of synaptic efficacy. Using the paired t test to compare the change of excitatory postsynaptic potential (EPSC) of visual cortex. Result: The difference between single stimulation and combined stimulate about EPSC was statistically significant, which was decreased (14.3±7.4) % (n=15) in single stimulation and (53.4±17.5) % (n=20) in combined stimulation for P14 rats which were long-term depression (ts2=3.9, ts1+s2=2.2; P<0.05) , and was increased (27.5±11.4) % (n=16) in single stimulation and (34.6±10.3) % (n=10) in combined stimulation for P20 rats which were long-term potentiation (ts2=2.3, ts1+s2=3.5; P<0.05) . Rats in different development period have a specific time window for input temporal changes. Combined stimulation patterns produced by the neuron cell reaction were not just an accumulation of simple response caused by single stimulation. For P14 rats, its time window was of about ±0.5ms. However, for P20 rats, scope of time window reduced to ±0.1ms. Conclusions: Different development period of rats, change the stimulation pattern can cause the change of the visual cortex synapses reaction, and stimulate the temporal change within a specific time window to producenonlinear results. (Chin J Ophthalmol, 2016, 52: 936-940).

[Analysis on influencing factors of prognosis of patients with acute organophosphorus pesticide poisoning].

OBJECTIVE: To analyze the relationship between risk factors and prognosis of acute organophosphorus pesticide poisoning (AOPP). METHODS: The clinical data including APACHEⅡ, D-dimer, C-reactive protein, procalcitonin, lactic acid of the 67 cases of acute organophosphorus pesticide poisoning which respectively divided into survival group and death group by the outcome were collected. The independent influcing factors were got by logistic regression analysis. RESULTS: The analysis showed that APACHEⅡ, D-dimer、C-reactive protein and Procalcitonin were influencing factors to evaluate prognosis of AOPP (P<0.05) .Meanwhile, APACHEⅡ and CRP were the independent influencing factors to evaluate prognosis of AOPP (P<0.05). APACHEⅡ26was the optimum thresholds to acess the prognosis of AOPP and its Youden index was largest. CONCLUSION: APACHEⅡ and CRP played an important role in the assessment of prognosis on AOPP. When APACHEⅡwas more than 26, it suggested the patient of AOPP will have a bad prognosis.

[Significance of HBsAg quantification in guiding clinical treatment of chronic hepatitis B].

Serum hepatitis B surface antigen (HBsAg) quantification can reflect the level of HBV replication and can be used as a surrogate maker for the evaluation of infected cells. Recent studies have shown that HBsAg quantification can help to distinguish the nature history of chronic hepatitis B and predict spontaneous clearance of HBsAg and the risk of progressive liver diseases. The dynamic change in HBsAg helps to predict the therapeutic effects of interferon and nucleoside analogues and sustained virologic response, guide withdrawal, and improve and optimize the therapeutic strategy for chronic hepatitis B in clinical practice. These issues have become the hot topics in recent years. However, the cut-off values of HBsAg level in patient management and various therapeutic strategies have not been determined. This article reviews the research advances in the significance of HBsAg quantification in the natural history and optimized treatment of chronic hepatitis B.

A review of MR spectroscopy studies of pediatric bipolar disorder.

Pediatric bipolar disorder is a severe mental illness whose pathophysiology is poorly understood and for which there is an urgent need for improved diagnosis and treatment. MR spectroscopy is a neuroimaging method capable of in vivo measurement of neurochemicals relevant to bipolar disorder neurobiology. MR spectroscopy studies of adult bipolar disorder provide consistent evidence for alterations in the glutamate system and mitochondrial function. In bipolar disorder, these 2 phenomena may be linked because 85% of glucose in the brain is consumed by glutamatergic neurotransmission and the conversion of glutamate to glutamine. The purpose of this article is to review the MR spectroscopic imaging literature in pediatric bipolar disorder, at-risk samples, and severe mood dysregulation, with a focus on the published findings that are relevant to glutamatergic and mitochondrial functioning. Potential directions for future MR spectroscopy studies of the glutamate system and mitochondrial dysfunction in pediatric bipolar disorder are discussed.