Therapeutic Window of Intravenous Immunoglobulin (IVIG) and its correlation with IVIG-resistant in Kawasaki Disease: a retrospective study

Abstract Objective: To investigate the optimal timing of initial intravenous immunoglobulin (IVIG) treatment in Kawasaki disease (KD) patients. Methods: KD patients were classified as the early group (day 1-4), conventional group (day 5-7), conventional group (day 8-10), and late group (after day 10). Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analyses and receiver operating characteristic (ROC) curve analysis. Results: There were no significant differences in IVIG resistance among the 4 groups (p = 0.335). The sensitivity analysis also confirmed no difference in the IVIG resistance between those who started the initial IVIG ≤ day 7 of illness and those who received IVIG >day 7 of illness (p = 0.761). In addition, patients who received IVIG administration more than 7 days from the onset had a higher proportion of coronary artery abnormalities (p = 0.034) and longer length of hospitalization (p = 0.033) than those who started IVIG administration less than 7 days. The optimal cut-off value of initial IVIG administration time for predicting IVIG resistance was >7 days, with a sensitivity of 75.25% and specificity of 82.41%. Conclusions: IVIG therapy within 7 days of illness is found to be more effective for reducing the risk of coronary artery abnormalities than those who received IVIG >day 7 of illness. IVIG treatment within the 7 days of illness seems to be the optimal therapeutic window of IVIG. However, further prospective studies with long-term follow-up are required.

The ratio of hamstring to quadriceps peak torque predicts balance and walking quality among hemiplegic stroke survivors / 中华物理医学与康复杂志

Objective:To seek any correlation of the ratio of knee flexor to knee extensor peak torque (H/Q) with the balance and walking ability of hemiplegic stroke survivors.Methods:Thirty stroke survivors with hemiplegia had the H/Q value of their knees measured at angular velocities of 60°/sec and 120°/sec using an isokinetic muscle strength test. Their motor control ability was assessed using the Pro-Kin balance test system, while their balance and walking were assessed using the Berg balance scale (BBS), the stand-to-walk timing test (TUGT) and the 10m walk test (10MWT). Any correlation was sought between the H/Q value of the affected knee, the test results, stability limits and offset index.Results:The average H/Q values of the affected knee joint at 60°/sec and 120°/sec were significantly lower than those of healthy joints. They were positively correlated with BBS scores and stability limits, and negatively correlated with TUGT and 10MWT times and with the offset indices.Conclusion:The H/Q value of the affected knee of a stroke survivor with hemiplegia predicts balance and walking ability. It may be a useful clinical indicator for evaluating their motor functioning.

Research progress of anticoagulation therapy during pregnancy after mechanical valve replacement / 医学研究生学报

Artificial heart valve has been used for more than 50 years, which mechanical valve has significant clinical effect in the treatment of valvular disease and has been widely used in cardiac-disease patients. After mechanical valve replacement, some female patients in childbearing age still have a family planning. Meanwhile, anticoagulants must be taken for lifelong to prevent thrombosis and thromboembolism. However, pregnancy is a special physiological preocess and anticoagulant therapy has a certain risk to both mothers and infants. Because the blood during pregnancy is in a hypercoagulable state, anticoagulant therapy has its particularity for pregnant patients after cardiac mechanical valve replacement. In addition, some anticoagulant drugs can affect fetal development. As a result, there is a lack of ideal and consistent anticoagulation scheme at present. In this paper, we review the related studies of anticoagulant drugs and anticoagulant therapy during pregnancy after mechanical valve replacement.

AngⅡ/AT1R pathway leads to down-regulation of endothelial nitric oxide synthase phosphorylation / 中国病理生理杂志

AIM:To investigate the mechanism of angiotensinⅡ(AngⅡ)/angiotensinⅡ type 1 receptor (AT1R)pathway activating protein phosphatase 2A(PP2A)which leads to down-regulation endothelial nitric oxide syn-thase(eNOS)phosphorylation level in mesenteric arteries of rats.METHODS: METHODS: The mesenteric arteries of adult male SD rats(weighing 160~180 g;n=90)were isolated under aseptic conditions.Firstly,to determine the effect of angiotensinⅡdown-regulated eNOS(Ser1177)phosphorylation level,the mesenteric arteries were randomly divided into normal control(control)group and AngⅡgroup.The mesenteric arteries in AngⅡgroup were incubated with AngⅡat 1×10 -7mol/L,1×10 -6mol/L and 1×10 -5mol/L for 6 h,12 h and 24 h,respectively.Secondly,to investigate the mo-lecular mechanism by which angiotensinⅡ activated PP2A leading to down-regulation eNOS(Ser1177)phosphorylation level,the mesenteric arteries were randomly divided into control group, AngⅡ group and candesartan(CAN; a specific AT1R blocker)+AngⅡgroup.The mesenteric arteries were pretreated with 1×10 -5mol /L CAN for 1 h,then incubated with 1×10 -7mol/L AngⅡfor 12 h in CAN+AngⅡgroup.The protein levels of eNOS,p-eNOS(Ser1177),PP2Ac,p-PP2Ac(Tyr307)and protein phosphatase 2A inhibitor 2(IPP2A2 )in the arteries were determined by Western blot.The ac-tivity of PP2A in the arteries was detected by PP2A activity kit.RESULTS:Compared with the control group,the protein level of p-eNOS(Ser1177)in the mesenteric arteries was decreased after incubated with AngⅡfor 6 h,12 h and 24 h(P<0.05).The decreasing tendency of p-eNOS(Ser1177)showed concentration-dependently,especially in 12 h and 24 h groups.The expression of eNOS protein showed no significant difference in each group.Compared with the control group, the mesenteric arteries of the rats were incubated with AngⅡ at 1×10-7mol/L for 12 h in vitro, the protein levels of p-eNOS(Ser1177)were down-regulated(P<0.05); pretreatment with CAN significantly increased the protein level of p-eNOS(Ser1177)(P<0.05);the protein levels of eNOS showed no significant difference in each group.Compared with the control group,the protein levels of p-PP2Ac(Tyr307)and IPP2A2 were decreased after the mesenteric arteries were trea-ted with AngⅡat 1×10 -7mol/L for 12 h(P<0.05).Candesartan pretreatment restored the protein levels of p-PP2Ac (Tyr307)and IPP2A2 (P<0.05),however the expression of PP2Ac protein showed no significant difference in each group. Compared with the control group,the activity of PP2A was increased in the mesenteric arteries incubated with AngⅡat 1× 10-7mol/L for 12 h(P<0.05).Candesarten pretreatment inhibited the activity of PP 2A significantly(P<0.05).CON-CLUSION:AngⅡincreases PP2A activity via AT1R pathway,thus leading to down-regulation eNOS(Ser1177)phospho-rylation level in mesenteric arteries.The molecular mechanism of PP2A activation may be associated with decreasing the protein levels of p-PP2Ac(Tyr307)and IPP2A2.

Role of regulatory T cell in clinical outcome of traumatic brain injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traumatic brain injury (TBI) is a life-threatening disease worldwide. Regulatory T cells (Treg cells) were involved in the immunological system in central nervous system. It is defined as a subpopulation of CD4 + cells that express CD25 and transcription factor forkhead box P3. The level of circulating Treg cells increases in a variety of pathologic conditions. The purpose of this study was to uncover the role of circulating Treg cells in TBI.</p><p><b>METHODS</b>A clinical study was conducted in two neurosurgical intensive care units of Tianjin Medical University General Hospital and Second Hospital of Tianjin Medical University (Tianjin, China). Forty patients and 30 healthy controls were recruited from August 2013 to November 2013. Circulating Treg cells was detected on the follow-up period of 1, 4, 7, 14, and 21 days after TBI. Blood sample (1 ml) was withdrawn in the morning and processed within 2 h.</p><p><b>RESULTS</b>There was no significant difference in the level of circulating Treg cells between TBI patients and normal controls during follow-up. TBI patients exhibited higher circulating Treg level than normal controls on the 1 st day after TBI. Treg level was decreased on the 4 th day, climbed up on the 7 th day and peaked on 14 th day after TBI. Treg cells declined to the normal level on 21 th day after TBI. The level of circulating Treg cells was significantly higher in survival TBI patients when compared to nonsurvival TBI patients. TBI patients with improved conditions exhibited significantly higher circulating Treg level when compared to those with deteriorated conditions. The circulating Treg level was correlated with neurologic recovery after TBI. A better neural recovery and lower hospital mortality were found in TBI patients with circulating Treg cells more than 4.91% in total CD4 + mononuclear cells as compared to those with circulating Treg cells less than 4.91% in total CD4 + mononuclear cells in the first 14 days.</p><p><b>CONCLUSIONS</b>The level of circulating Treg cells is positively correlated with clinical outcome of TBI. The level of Treg cells predicts the progress for TBI patients and may be a target in TBI treatment.</p>

Effect of Bortezomib on Proliferation, Apoptosis and SHP-2 Gene Expression of Lymphoma Cells / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the effects of Bortezomib on proliferation, apoptosis and SHP-2 gene expression of lymphoma Jurkat cells and Raji cells.</p><p><b>METHODS</b>Methylthiazoly tetrazolium assay (MTT) was used to observe the proliferation of Jurkat cells and Raji cells treated with bortezomib in different doses. Cell apoptosis was detected by morphological examination and flow cytometry. The level of SHP-2 mRNA expression before and after the treatment with bortezomib was measured by RT-PCR.</p><p><b>RESULTS</b>Bortezomib could inhibit the proliferation of Jurkat and Raji cells and induce their apoptosis with time-and dose-dependent manner. After treatment with 5-100 nmol/L bortezomib, the expression of SHP-2 in Jurkat cells and Raji cells was upregulated.</p><p><b>CONCLUSION</b>Bortezomib can inhibit the proliferation and induc the apoptosis of Jurkat and Raji cells obviously, upregulate the expression of SHP-2 mRNA, suggesting that the SHP-2 may participate in regulation of bortezomib induced apoptosis of Jurkat cells and Raji cells.</p>

Effect of computer-assisted cognitive training on cognitive function and functional independence of stroke patients / 实用医学杂志

Objective To investigate the computer-assisted cognitive training (CACT) on cognitive function and functional independence of stroke patients. Methods Sixty patients were randomly divided into 2 groups: the CACT group and the control group. All patients received routine training. Patients in the CACT group received computer-assisted cognitive training additionally. Before and after the CACT, the cognitive function and functional independence of patients were assessed by MMSE, MoCA and FIM assays. Results Before the CACT, no significant differences in the scores of MMSE, MoCA and FIM were found between the two groups (P > 0.05). After the CACT, scores of MMSE, MoCA and FIM were improved in both groups, especially in the CACT group, with statistical differences (P < 0.05). Conclusions CACT can help improve the cognitive function and functional independence in stroke patients.

Resting state functional magnetic resonance imaging of the hippocampus after ischemic stroke / 中华物理医学与康复杂志

Objective To observe the functional connectivity (FC) pattern linking the hippocampus with the rest of the brain in ischemic stroke patients with cognitive dysfunction,especially the default mode network (DMN).Methods Resting-state functional connectivity magnetic resonance imaging (fMRI) was performed on 15 ischemic stroke patients with cognitive dysfunction (the patient group) and 10 normal elderly controls.The bilateral hippocampus was the region of interest.Correlation analyses yielded a mapping of cerebral functional connectivity activation for both groups.Results Compared with the healthy controls,the patient group showed weakened functional connectivity between the hippocampus and other regions including the cingulate gyrus,the superior,middle and inferior frontal lobes,the inferior parietal lobule and the superior temporal gyrus.But there was enhanced functional connectivity with the cerebellar posterior lobe,the occipital lobe,the medial temporal lobe,the precuneus and the calcarine.The results were significantly different between the two groups.Conclusion The functional connectivity pattern of the hippocampus is impaired in stroke patients with cognitive dysfunction.Reduced functional connectivity between brain regions may be one cause of cognitive dysfunction after stroke,and enhanced functional connectivity may be an appropriate compensatory mechanism.

Traumatic brain injury impairs synaptic plasticity in hippocampus in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traumatic brain injury (TBI) often causes cognitive deficits and remote symptomatic epilepsy. Hippocampal regional excitability is associated with the cognitive function. However, little is known about injury-induced neuronal loss and subsequent alterations of hippocampal regional excitability. The present study was designed to determine whether TBI may impair the cellular circuit in the hippocampus.</p><p><b>METHODS</b>Forty male Wistar rats were randomized into control (n = 20) and TBI groups (n = 20). Long-term potentiation, extracellular input/output curves, and hippocampal parvalbumin-immunoreactive and cholecystokinin-immunoreactive interneurons were compared between the two groups.</p><p><b>RESULTS</b>TBI resulted in a significantly increased excitability in the dentate gyrus (DG), but a significantly decreased excitability in the cornu ammonis 1 (CA1) area. Using design-based stereological injury procedures, we induced interneuronal loss in the DG and CA3 subregions in the hippocampus, but not in the CA1 area.</p><p><b>CONCLUSIONS</b>TBI leads to the impairment of hippocampus synaptic plasticity due to the changing of interneuronal interaction. The injury-induced disruption of synaptic efficacy within the hippocampal circuit may underlie the observed cognitive deficits and symptomatic epilepsy.</p>

Circulating endothelial progenitor cells in traumatic brain injury: an emerging therapeutic target? / 中华创伤杂志(英文版)

Traumatic brain injury (TBI) is a major cause of mortality and morbidity in the world. Recent clinical investigations and basic researches suggest that strategies to improve angiogenesis following TBI may provide promising opportunities to improve clinical outcomes and brain functional recovery. More and more evidences show that circulating endothelial progenitor cells (EPCs), which have been identified in the peripheral blood, may play an important role in the pathologic and physiological angiogenesis in adults. Moreover, impressive data demonstrate that EPCs are mobilized from bone marrow to blood circulation in response to traumatic or inflammatory stimulations. In this review, we discussed the role of EPCs in the repair of brain injury and the possible therapeutic implication for functional recovery of TBI in the future.

Preliminary analysis on the gene expression profiles of medulloblastomas by use of cDNA array / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the molecular genesis of medulloblastomas with cDNA array.</p><p><b>METHODS</b>Four samples of medulloblastomas and 1 sample of normal brain tissue were collected freshly. After total RNA extraction, the (32)P targeted cDNA probes were converted and then hybridized with Atlas Human Cancer Array 1.2. The gene expression profiles were acquired through autoradiography. The discrepancy between the tumor and the normal brain tissue was analyzed with Atlas Image 1.01a.</p><p><b>RESULTS</b>In comparison with the genes in the normal brain tissue, 6 down-regulated and 35 up-regulated genes in the medulloblastomas were revealed by means of the microarrays and autoradiography, and were verified by reverse transcriptase-PCR. The regulatory trends of most differential expression genes were in compliance with the biological features of this tumor.</p><p><b>CONCLUSION</b>Medulloblastomas are diseases involving multiple genes with some molecular pathological mechanisms different from the astrocytic gliomas. There are complex interrelationships between these genes, which need to be further researched.</p>

Preliminary study on the gene expression profiles of ependymomas with cDNA array / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the differential gene expression of ependymomas.</p><p><b>METHODS</b>Four fresh samples of ependymomas and 1 of normal brain tissue were collected during operation. The extracted total RNAs were converted as (32)P tagged cDNA probes, which were then hybridized with the Atlas Human Cancer Array, producing the array based hybridization maps following the protocol provided with the kit. A set of special software was applied to the analysis and RT-PCR was performed to test the result.</p><p><b>RESULT</b>In comparison with the normal brain tissue, there were 31 upregulated gene and 1 downregulated gene in ependymomas, most of which were firstly found to be differentially expressed in this kind of tumor.</p><p><b>CONCLUSION</b>The discrepancy of gene expression profiles between ependymomas and normal brain tissues is highly put through and effectively detected with cDNA array, which provides new information for the further research on the molecular mechanisms of this lesion.</p>