A meta-learning based method for segmentation of few-shot magnetic resonance images / 生物医学工程学杂志

When applying deep learning algorithms to magnetic resonance (MR) image segmentation, a large number of annotated images are required as data support. However, the specificity of MR images makes it difficult and costly to acquire large amounts of annotated image data. To reduce the dependence of MR image segmentation on a large amount of annotated data, this paper proposes a meta-learning U-shaped network (Meta-UNet) for few-shot MR image segmentation. Meta-UNet can use a small amount of annotated image data to complete the task of MR image segmentation and obtain good segmentation results. Meta-UNet improves U-Net by introducing dilated convolution, which can increase the receptive field of the model to improve the sensitivity to targets of different scales. We introduce the attention mechanism to improve the adaptability of the model to different scales. We introduce the meta-learning mechanism, and employ a composite loss function for well-supervised and effective bootstrapping of model training. We use the proposed Meta-UNet model to train on different segmentation tasks, and then use the trained model to evaluate on a new segmentation task, where the Meta-UNet model achieves high-precision segmentation of target images. Meta-UNet has a certain improvement in mean Dice similarity coefficient (DSC) compared with voxel morph network (VoxelMorph), data augmentation using learned transformations (DataAug) and label transfer network (LT-Net). Experiments show that the proposed method can effectively perform MR image segmentation using a small number of samples. It provides a reliable aid for clinical diagnosis and treatment.

Effects of breast milk intake ratio during hospitalization on antibiotic therapy duration in preterm infants less than 34 gestational weeks: a multicenter retrospective cohort study / 中华围产医学杂志

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d<DOT≤15.0 d), Q 3 (15.0 d<DOT≤27.0 d) and Q 4 (DOT>27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%<breast milk intake ratio≤50%), medium-ratio breastfeeding group (50%<breast milk intake ratio≤75%) and high-ratio breastfeeding group (breast milk intake ratio>75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Research progress in the role of mesenchymal stem cell sheets and their derivatives in bone defect repair / 中华创伤杂志

Bone defects are mostly caused by severe trauma, infection, tumor resection and congenital malformations, which adversely affect their health and quality of life. So far, the bone defects are mainly filled with autologous or allogeneic bone grafting, which has problems such as donor shortage, secondary bone injury and scarring. In recent years, the rise of bone tissue engineering has provided a new way for repair of bone defects, in which mesenchymal stem cell (MSC) sheets prepared by using the principle of tissue engineering can well solve the above problems of autologous or allogeneic bone grafting. With the development of preparation technology, new bone defect repair materials such as decellularized extracellular matrix (ECM) sheets and MSC/ECM clumps have been derived on the basis of MSC sheets. Therefore, the authors reviewed the preparation and the role of MSC sheets and their derivatives in bone defect repair, hoping to provide a reference for basic research and clinical treatment related to bone defect repair.

Research progress in role of astrocyte in different pathological stages of spinal cord injury / 中华创伤杂志

Spinal cord injury can be divided into primary and secondary injury. As an important process of spinal cord injury, secondary injury can be classified into acute phase, subacute phase and chronic phase according to the time and progression of the injury. Oxidative stress reaction, inflammatory reaction, tissue edema, scar formation and other pathological changes appear subsequently during the process. In the central nervous system, the astrocyte is one of the most widely distributed cell that has different shapes at different stages and plays a complex role such as anti-inflammatory or pro-inflammatory action and neuroprotective or anti-neurorestorative effect after spinal cord injury. The astrocyte has been a research focus in the field of spinal cord injury. The authors review the role and research progress of astrocyte in oxidative stress response, excitotoxicity, inflammatory response, tissue edema, scar formation, axonal regeneration and cell transformation in spinal cord injury based on the pathological changes of secondary injury, in order to provide new ideas to the related research of spinal cord injury.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants / 浙江大学学报·医学版

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Application of point-of-care cardiopulmonary ultrasound in mechanical ventilation of neonatal respiratory distress syndrome / 中华超声影像学杂志

Objective:To explore the value of point-of-care cardiopulmonary ultrasound (POCUS) in the evaluation of modifying mechanical ventilation and weaning timing of neonates with respiratory distress syndrome (RDS).Methods:A total of 82 infants with RDS received invasive mechanical ventilation in the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from January 2019 to October 2020 were enrolled.Endotracheal tube was extubated after getting in line with the clinical weaning standard. According to the results of ventilator withdrawal, infants were divided into successful group and failure group. POCUS were performed within half hour of intubation and extubation. Lung ultrasound score (LUS), left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), left ventricular eccentricity index (LVEI) and pulmonary artery systolic pressure (PASP) were recorded also with the arterial blood gas, ventilator parameters, duration of mechanical ventilation and oxygen therapy. The above indexes were compared between two groups to evaluate the predictive value of POCUS for mechanical ventilation evacuation.Results:The gestational age [(28.6±4.2)W vs (32.5±3.7)W], body weight [(1 289±790)g vs (1 969±771)g], initial ventilation PaO 2 [(41.2±8.5)mmHg vs (50.1±12.2)mmHg], LVEF of ventilator withdrawal[(62.7±3.9)% vs (66.9±3.1)%] of the failed weaning group were lower than those of successful group (all P<0.05). LUS at ventilator withdrawal[(13.7±1.0) points vs (11.1±1.6) points], PASP [(40.5±7.2)mmHg vs (32.9±6.2)mmHg] and the duration of mechanical ventilation [(5.4±4.7)d vs (3.6±2.3)d], duration of oxygen therapy [(48.5±25.0)d vs (24.5±18.5)d] were higher than those of successful group (all P<0.05). The initial LUS of mechanical ventilation was positively correlated with the duration of mechanical ventilation ( r=0.188, P<0.01), and TAPSE was negatively correlated with the duration of mechanical ventilation ( r=-0.344, P<0.01). LUS was positively correlated with X-ray grading and mean airway pressure at the initial and withdrawal time ( rs=0.790, P<0.01 and rs=0.686, P<0.01; r=0.383, P<0.01 and r=0.548, P<0.01). To assess LUS prediction of weaning failure, the area under ROC curve (AUC) was 0.922, and the combined ΔLUS (change of pre- and post-LUS ) ≤7 points and ΔPASP (change of pre- and post-PASP) ≤9.5 mmHg predicted AUC was 0.912. Prediction of AUC by using LUS combining PASP and LVEF was 0.937, Youden index was 0.736, the cut-off value was 0.185, with sensitivity 89.5% and the specificity 84.1%. LUS≥13 points, PASP≥43 mmHg and LVEF≤60% were related to weaning failure by using the Logistic regression analysis (all P<0.05). Conclusions:Bedside POCUS can effectively evaluate the application of mechanical ventilation process and predict the weaning of infants with RDS. POCUS is practical, real-time, accurate, and worthy of clinical application.

The clinical features and survival analysis of 109 patients with neuropsychiatric systemic lupus erythematosus / 中华风湿病学杂志

Objective:To investigate the clinical characteristics, prognosis, and risk factors for poor prognosis of neuropsychiatric systemic lupus erythematosus (NPSLE) .Methods:Patients who were diagnosed as NPSLE between January 2009 to January 2019 in Peking University First Hospital were included. Patients with neuro-psychiatric symptoms caused by other reasons such as infection and metabolic disorders were excluded. Patients were retrospectively followed up by telephone or medical records. Continuous variables were compared by student t test or Wilcoxon rank sum test. Quantitative variables were compared by chi-square test. Survival was analyzed by Kaplan-Meier curve. Predictive factors of prognosis was estimated by using Cox regression analysis. Results:One hundred and nine NPSLE patients were included. Thirteen (11.9%) were male and 96 (88.1%) were female with a median age of 33 years old. Central nervous system involvement was predominant (89/109, 81.7%) . The most common types were headache, cerebrovascular disease and epilepsy. Cranial neuropathy was the most common type at the initial onset of systemic lupus erythematosus (SLE) , while cerebrovascular disease was more common when SLE relapsed. Patients who demonstrated NPSLE at the initiation of SLE had shorter survival time than those who got NPSLE when SLE relapsed [ (32±26) months vs (197±79) months, t=2.834, P=0.037]. Among the 105 patients with complete followed up data, the follow up time was 118.0 (1.4, 525.7) months and 53.1 (0.4, 363.0) months from the onset of SLE and NPSLE, respectively. The mortality rate was 14.3% (15/105) . The survival rates of 1-5 years were 96.2%, 94.3%, 91.0%, 89.9% and 88.3%, respectively. The survival time was (180±138) months and (33±32) months, t=3.861 , P<0.01) from the onset of SLE and NPSLE, respectively. The major causes of death were infection, NSPLE and cardiovascular disease. Cerebrovascular disease was the independent risk factor for death [ RR=3.413, 95% CI (1.049, 11.102) , P=0.041]. Conclusion:Cranial neuropathy is the most common type at the initial onset of SLE, while cerebrovascular disease is more common when SLE relapsed. Patients who had NPSLE at the initiation of SLE have shorter survival time than those who got NPSLE when SLE relapsed. Cerebrovascular disease is the independent risk factor of death of NPSLE patients.

Application of ultrasound-guided peripherally inserted central catheter in very/extremely low birth weight infants / 中国新生儿科杂志

Objective:To study the clinical application of ultrasound-guided puncture and catheter tip positioning in peripherally inserted central catheter (PICC) among very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2019 to August 2020, VLBWI/ELBWI admitted to NICU of our hospital and received PICC were prospectively enrolled in the study. Based on the last digit of medical record number was odd or even, the infants were assigned into ultrasound group and X-ray group. In the ultrasound group, puncture and catheter tip positioning were performed at bedside guided by ultrasound, while in the X-ray group, these procedures were performed empirically. The differences of catheterization procedure duration, first-time success rate, the visibility of catheter tip, primary dislocation rate, secondary dislocation rate and complication rate were compared between the two groups using SPSS 25.0.Result:A total of 118 premature infants were enrolled, including 57 cases in ultrasound group (50 cases VLBWI and 7 cases ELBWI) and 61 cases in X-ray group (54 cases VLBWI and 7 cases ELBWI). The catheterization procedure duration [(23.2±7.1) min vs. (34.1±7.5) min], first-time success rate (93.0% vs. 65.6%), the visibility of catheter tip (96.5% vs. 83.6%), primary dislocation rate (7.0% vs. 24.6%) and complication rate (7.0% vs. 21.3%) in ultrasound group were all better than X-ray group ( P<0.05). For ELBWI, the above five indexes in the ultrasound group were better than the X-ray subgroup ( P<0.05). For VLBWI, only the catheterization procedure duration and first-time success rate were better in the ultrasound group than the X-ray group ( P<0.05). Conclusion:Ultrasound-guided PICC catheterization in VLBWI/ELBWI is convenient and accurate, which can improve success rate, reduce radiation exposure and repeated catheterization injury. Timely tracking and adjustment of the catheter under ultrasound can reduce complications after catheterization. This technique is worth popularizing among VLBWI/ELBWI.

Progress of bispecific antibodies targeting immune checkpoints in treatment of tumors / 肿瘤研究与临床

Immune checkpoint is one of the most effective research targets for tumor immunotherapy. Immune checkpoint inhibitors, mainly programmed death receptor 1 and its ligand 1, have achieved good response rates in various tumor treatments, but some tumors still have low response rates. In recent years, bispecific antibodies have developed rapidly in the field of tumor research, because they can target multiple targets and play a combined role in tumor therapy, and can effectively inhibit tumor immune escape. This article reviews the research progress and clinical status of bispecific antibodies targeting immune checkpoints.

Pseudomembranous colitis caused by antitubercular agents: a case report and review of literature / 中华老年医学杂志

Objective:To investigate the mechanism and clinical features of pseudomembranous colitis(PMC)caused by antitubercular agents for providing a reference for its clinial treatment.Methods:One PMC case was admitted to our hospital in January 2019, and the remaining 27 cases were reported at home and abroad from January 1990 to May 2020 after the application of anti-tuberculosis drugs, all of which were obtained by literature retrieval.The domestic and foreign literature on PMC caused by antitubercular agents were reviewed.The agents causing PMC, clinical characteristics and prognosis were analyzed and summarized.Results:In this paper, 28 PMC cases caused by anti-tuberculosis drugs were reviewed.The ratio of men to women was 1.0∶1.5, with a median age of 65.5 years.The 22 cases were aged 60 years and over, accounting for 78.6 percent.The onset time of PMC symptoms in 28 patients was from 6 d to 126 d after anti-tuberculosis treatment, with a median time of 32 d. All patients immediately after diagnosis of PMC stopped all anti-tuberculosis drugs, and received metronidazole or vancomycin, with a good prognosis.Seven cases relapsed after continuing anti-tuberculosis treatment.Of them, 4 cases had no recurrence only after stopping or replacing rifampicin with other drugs.Conclusions:The incidence of PMC is increased in elderly patients with long-term use of rifampicin anti-tuberculosis treatment, and it is easy to relapse.The prolonged use of rifampicin should be avoided or replaced with other anti-tubercular agents.

Study of positioning of fetal conus medullaris by detecting atlanto-axial intervertebral space with three-dimensional ultrasound / 中华超声影像学杂志

Objective:To explore the imaging rate and diagnostic rate of positioning the fetal conus medullaris by three-dimensional ultrasound method to detect atlantoaxial intervertebral space, comparing it with the traditional two-dimensional and three-dimensional ultrasound methods.Methods:Consecutively 318 singleton fetuses received routine ultrasound screening during the second trimester were enrolled from November 2017 to December 2018 in Shenzhen Luohu People′s Hospital and Shenzhen People′s Hospital. These fetuses included 276 normal cases and 42 abnormal cases. The abnormal group contained 11 cases tethered cords fetuses(tethered cords group) and 31 cases non-tethered fetuses(non-tethered group). A new ultrasound method named detecting atlanto-axial intervertebral space with three-dimensional ultrasound and traditional two-dimensional and three-dimensional ultrasound methods were used to acquire and store the images. The positions of the fetal conus medullaris were analyzed blindly and recorded by three experienced physicians using three different methods with off-line software.Results:①The χ 2 test comparing multiple sample rates was used to compare the imaging acquisition success rate of fetal conus medullaris by three ultrasound methods. The test level was adjusted to be α′=0.05/4=0.0125, the results showed that there were no statistically significant differences between the three methods in the normal group (χ 2=7.39, P=0.025) and the abnormal group (χ 2=5.32, P=0.070). ②The χ 2 test comparing multiple sample rates was used to compare the diagnostic accuracy of fetal conus medullaris position in normal group by three methods, it showed there was no significant difference in the correct rate of conus medullaris position in the normal group (χ 2=2.52, P=0.284). ③The χ 2 test comparing multiple sample rates was used to compare the diagnostic accuracy of the fetal conus medullaris in tethered cord group and non-tethered group using 3 methods, the difference was not statistically significant in tethered cord group (χ 2=1.22, P=0.543), while the difference was statistically significant in non-tethered group(χ 2=9.69, P=0.008). Conclusions:The method of detecting atlanto-axial intervertebral space with three-dimensional ultrasound has a high imaging rate and diagnostic accuracy in positioning the fetal conus medullaris. Positioning of fetal conus medullaris by detecting atlanto-axial intervertebral space with three-dimensional ultrasound is better than traditional two-dimensional and three-dimensional ultrasound in the abnormal non-tethered fetuses, which can provide more valuable information for prenatal diagnosis consultation and prenatal and postnatal care.

A preterm infant born to a mother with severe influenza A / 中华围产医学杂志

We report a case of a 2 200 g premature male baby born through cesarean section under maternal endotracheal intubation mechanical ventilation combined with extracorporeal membrane oxygenation at 34 +1 gestational weeks, while his mother was infected with influenza A in late pregnancy. Due to neonatal pneumonia, neonatal respiratory distress syndrome, prematurity, and low birth weight, the neonate was transferred to the neonatal intensive care unit for body temperature maintenance, respiratory support, maintenance of perfusion and internal environment, and nutritional management. The infant was discharged 17 days after birth and was well at six-month-old follow-up. His mother was discharged at 20 days post-delivery.

Comparative analysis of clinicopathological features in elderly patients with versus without hepatitis B virus antigen deposition in renal tissue / 中华老年医学杂志

Objective:To compare and analyze the clinicopathological data of elderly patients with versus without hepatitis B virus(HBV)antigen deposition in renal tissue, and to investigate the clinicopathological features in elderly patients with HBV associated nephritis(HBV-GN).Methods:The clinicopathological data of 33 patients with HBV-GN and 27 patients with hepatitis B and nephritis(HBV-CG)aged ≥60 years in the 90 th Hospital of the United Nations Support Force were retrospectively analyzed and statistically analyzed. Results:(1)Both the HBV-GN and HBV-CG groups were often men[26(78.8%) vs. 21(77.8%)]and had high rate of nephritic syndrome[18(54.5%) vs.15(55.6%)]. And patients in the HBV-GN group had higher incidence of hypertension than that in the HBV-CG group; (2)Membranous nephropathy(MN)was the main pathological type in both groups, and the rate of membrane proliferative glomerulonephritis(MPGN)was more found in the HBV-GN group than the HBV-CG group; (3)The proportion positive HBsAg, HBeAg and HBcAb test resultsand high viral load was significantly higher in the HBV-GN group than that in the HBV-CG group; (4)Multiple immune complex deposits were observed in the renal tissues of HBV-GN group, which was called the phenomenon of "all bright" ; (5)The pathological features in the HBV-GN group showed untypical manifestation of MN, the occasionally observed crescent formation, and the thickening of basement membrane in focal segmental glomerulosclerosis; (6)The incidence and the severity of renal tubule and interstitial lesions in HBV-GN group were significantly higher than those in HBV-CG group. Conclusions:Although there are many similarities in clinical manifestations and testing indicators between the elderly HBV-GN and HBV-CG patients, HBV-GN patients are still significantly different from HBV-CG patients in terms of serum virology and pathological changes.Therefore, we should pay attention to the serum HBV replication and renal pathological changes to provide a clinical basis for treating this kind of elderly patients.

Clinical characteristics and related factors of pneumonia in patients with aplastic anemia / 中国感染与化疗杂志

objective To analyze the clinical characteristics of pneumonia in patients with aplastic anemia for improving early prevention and clinical diagnosis. Methods A retrospective analysis was conducted for patients with aplastic anemia treated in our hosipital from June 2013 to April 2018. The clinical data of pneumonia were reviewed and analyzed in terms of radiological findings, pathogen distribution, and related risk factors. Results The clinical manifestations are atypical in patients with aplastic anemia. The imaging findings suggested that the infection was mainly bilateral pulmonary infection. The common pathogens were gram-negative bacteria such as Klebsiella pneumoniae. Disease type, agranulocytosis and low serum albumin level were independent risk factors for pneumonia in patients with aplastic anemia. Regular immunosuppressive therapy is a protective factor for pneumonia in patients with aplastic anemia. Conclusions The clinical manifestations of pneumonia are diverse in patients with aplastic anemia. The pathogens are mainly gram-negative bacteria. Empirical use of β-lactam-β-lactamase inhibitor combinations or quinolones is beneficial for controlling infection. Regular immunosuppressive therapy, recovery of hematopoietic function, nutritional support are effective measures to reduce the incidence of pneumonia in patients with aplastic anemia.

Analysis of clinical and histological features of late onset lupus nephritis / 中华老年医学杂志

Objective To compare the clinical and histological characteristics between elderly lupus nephritis (LN) patients and adult LN patients.Methods Patients diagnosed with LN from January 2011 to October 2016 at Fuzong Medical Hospital were enrolled in this retrospective study.Recruited patients were assigned into two groups according to age:the elderly-onset group (aged over 60,n=25) and the adult-onset group (aged below 60,n=50).Clinical features,laboratory manifestations,histological data and treatment responses were analyzed and compared.Results The average ages at the onset of systemic lupus erythematosus (SLE) in the elderly-onset group and the adult onset group were (62.2± 3.1)years and (33.2±10.0) years (t=18.4,P=0.000),respectively.The female to male ratio was lower in the elderly group compared with that in the adult group (1.3 ∶ 1.0 vs.5.3 ∶ 1.0,x2=6.908,P=0.009).The prevalence of hypertension in the elderly-onset group was much higher than that in the adult-onset group (x2=9.375,P=0.002).Also,elderly patients showed significantly higher serum creatinine levels (t=80.644,P=0.000) and lower rates of positive anti-dsDNA (x2 =6.304,P=0.012).Additionally,elderly onset individuals were correlated with higher scores of glomerular sclerosis (80％,x2 =14.109,P=0.000),fibrous crescents(36％,x2 =9.040,P=0.003),tubular atrophy (92％,x2=7.440,P=0.006),interstitial fibrosis (92％,x2=7.440,P=0.006) and chronicityindex (3.4±1.9,t=3.648,P 0.000),compared with the adult onset group.Conclusions There are clinical and histological differences between elderly and adult LN patients.LN in the elderly is characterized by a low female to male ratio,a low prevalence of positive anti-dsDNA,high blood pressure,severe kidney injury,and chronic lesions in renal pathology.

G protein-coupled estrogen receptor mediated neuroprotective effect and mechanism discussion in a rat model of ischemic stroke / 中国脑血管病杂志

Objective To investigate G protein-coupled estrogen receptor(GPER)mediated neuroprotective effect and mechanism in an ischemic stroke model. Methods Bilateral ovariectomy (OVX)was used to establish a castrated model of adult SPF grade female SD rats. Enzyme-linked immunosorbent assay was used to detect serum estrogen level at 4 weeks after procedure.Middle cerebral artery occlusion(MCAO)was use to prepare a stroke model.The rats were randomly divided into sham operation(n=6),MCAO(n=7),MCAO+estrogen(MCAO+E2,n=8),MCAO+agonist(MCAO+G1,n=8)and MCAO +antagonist G15(MCAO +G15,n =7)groups. The neurological severity score (NSS),2,3,5-triphenyltetrazolium chloride(TTC)staining were used to measure the volume of cerebral infarction in order to assess the effects of different interventions.Western blot was used to detect the protein expression of hypoxia inducible factor-1α(HIF-1α),c-Jun N-terminal kinase(JNK),and Caspase-3 in the ischemic penumbra. Results (1)Estrogen level:after OVX,The level of serum estrogen in rats was significantly lower than that before castration(20 ± 9 ng/L vs. 73 ± 21 ng/L,P <0. 01).(2)NSS score:the NSS score of MCAO in each group was significant higher than that in the sham operation group (P<0.01);The NSS score of the MCAO+G1 group was significantly lower than that of the MCAO group and the MCAO+G15 group(6.0 ±1.8 vs.11.9 ±2.0 and 10.0 ±2.1).The difference was statistically significant (all P<0.05).(3)Cerebral infarct volume:there was significant difference in infarcted volume between the sham operation group and all other groups(all P<0.01);Compared with the MCAO group and the MCAO+G15 group,the infarct volume of the MCAO+E2 group and MCAO+G1 group was significantly reduced(19.8 ± 4.0%,14.0 ± 2.9%)vs.29.7 ± 5.8% and 27.6 ± 3.6%).The difference was statistically significant (all P<0.05).(4)Results of Western blot:the relative optical density values of HIF-1α,JNK,and Caspase-3 of the MCAO group were higher than those of the MCAO + G1 group(all P <0.01). Conclusions GPER mediates the neuroprotective effect of estrogen in the ischemic stroke model.This protective effect is associated with the regulation of the expression levels of HIF-1α,JNK,and Caspase-3.

Application of early administration of high-dose amino acids in parenteral nutrition for low body weight infants of prematurity / 中华实用儿科临床杂志

Objective To explore the effect of early administration of high-dose amino acids in parenteral nutrition for low birth weight infants of prematurity.Methods A total of 191 prematures admitted to the First Affiliated Hospital of Nanjing Medical University from June 2015 to December 2016 were selected,and they were randomly divided into the study group (n =110) and the control group (n =81).The starting amino acid dose was 1.8-2.5 g/(kg · d)and 1.0-1.5 g/(kg · d) in the study group and the control group,respectively.Lipids,glucose,and electrolytes in parenteral nutrition were applied according to standard protocol of the guideline.And the start of enteral feeding,the recovery of birth weight,the duration of parenteral nutrition,the time before total enteral nutrition,duration of hospital stay,incidence of respiratory distress syndrome,duration of mechanical ventilation and incidence of kaliopenia were compared between the 2 groups.Results The start of enteral feeding,the recovery of birth weight,the duration of parenteral nutrition,the time before total enteral nutrition in the study group were earlier than those in the control group [(3.83 ±3.15) d vs.(5.53 ±5.63) d,(15.47±10.54) d vs.(19.47 ± 14.57) d,(16.46 ± 10.33) d vs.(21.41 ±18.00) d,(6.36 ± 4.88) d vs.(8.48 ± 9.27) d],and the differences were all statistically significant (t =2.455,2.097,2.217,2.041,P =0.016,0.038,0.029,0.043).The duration of hospital stay was shorter and the hospitalization expenses were lower in the study group than those in the control group,but the differences were not significant (all P ＞ 0.05).The incidence of respiratory distress syndrome in the study group was significantly lower than that in the control group[20.91％ (23/110 cases) vs.35.80％ (29/81 cases)],and the difference was statistically significant (x2 =5.223,P =0.022).The duration of mechanical ventilation in study group was shorter than that in control [(1.12 ± 2.62) d vs.(3.31 ± 8.13) d],and the difference was statistically significant (t =2.231,P =0.028).The incidence of kaliopenia in the study group was higher than that in the control group [30.91％ (34/110 cases)vs.17.28％ (14/81 cases)],and the difference was statistically significant (x2 =4.603,P =0.032).There were not significant differences in terms of complications of necrotizing enterocolitis,sepsis,extrauterine growth retardation,hospital infection,metabolic acidosis,hyperglycemia,glucopenia,patent ductus arteriosus and respiratory distress syndrome between 2 groups (all P ＞ 0.05).Conclusions Early administration of high-dose amino acids in parenteral nutrition for preterm infants can result in earlier enteral nutrition,shorter parenteral nutrition duration without increasing incidence of complications and hospitalization expenses.

Construction of the network course of Chinese medicine preparation analysis based on BB platform / 国际中医中药杂志

The article proposes the construction of network course of Chinese Medicine Preparation Analysis based on Black Board network teaching platform. It states the construction of teaching contents, the implementation of Case-Based Learning, the assistant of practical teaching and the formative evaluation. And it is helpful to improve the quality of classroom teaching, stimulate students self-regulated learning, expand their knowledge, improve their practical ability and innovative consciousness.

A study on the protective mechanisms of lipoxin A4 for hyperoxia-induced pulmonary epithelial cells injury in mice / 中国新生儿科杂志

Objective To study the protective mechanisms of lipoxin A 4 ( LXA4 ) for hyperoxia-induced lung injury through modulation of let-7c/TGF-β1 signal pathway in mice.Method MLE-12 cells was transfected with let-7c mimic, mimic negative control ( NC) , let-7c inhibitor and inhibitor NC.The cells were assigned into hyperoxia group , LXA4 group, let-7c over-expression group, let-7c silence group, let-7c silence+LXA4 group, and all exposed to 85% oxygen.The mRNA level of the extracellular matrixα-smooth muscle actin (α-SMA) and collagen Ⅰ( COL-Ⅰ) , and the expression of related genes in TGF-β1 signaling pathway (Smad 2, Smad 3, Smad 4, TGF-βR1, TGF-βR2) were examined using qPCR.The protein expressions in TGF-β1 signaling pathway was examined using Western blot .Result The mRNA expressions of α-SMA, COL-Ⅰ, Smad 3, Smad 4, TGF-βR1 and TGF-βR2 in LXA4 group [(24.3 ±2.1), (14.6 ±0.2), (17.0 ±0.0), (14.9 ±0.1), (20.8 ±0.1), (9.0 ±0.0) ] and let-7c over-expression group [ ( 12.2 ±0.5 ) , ( 3.0 ±0.0 ) , ( 3.1 ±0.0 ) , ( 9.6 ±0.4 ) , ( 28.5 ±0.2 ) , ( 7.6 ± 0.1)] were decreased comparing with the hyperoxia group [(51.4 ±0.5), (32.0 ±0.1), (40.6 ±0.2), (16.3 ±0.1), (89.1 ±1.1), (19.3 ±0.2)].These expressions were increased in both let-7c silence group [(87.3 ±7.0), (38.5 ±0.3), (48.0 ±0.2), (56.5 ±0.2), (126.0 ±0.9), (33.1 ±1.0)] and let-7c silence +LXA4 group [(144.5 ±12.9), (86.3 ±3.0), (91.5 ±4.7), (86.5 ±3.3), (109.0 ±4.5), (45.6 ±1.6)].The protein levels of Smad 2, Smad 3, Smad 4, p-Smad 2, p-Smad 3 and TGF-βR1 of LXA4 group and let-7c over-expression group were decreased comparing with the hyperoxia group, while p-Smad 2, p-Smad 3 of let-7c silence+LXA4 group were increased(P<0.05).Conclusion LXA4 may play a protective role through let-7c /TGF-β1 signal pathway of lung epithelial cells for hyperoxia-induced lung injury in mice .

Establishment and application of external quality assessment system for microbial morphology and detection of special drug-resistance in clinical laboratory / 临床检验杂志

Objective To investigate the establishment,operation and performance of external quality assessment(EQA) system for microbial morphology and detection of special drug-resistance in clinical laboratory,and explore the value of the developed system in clinical application.Methods The pictures of known bacteria and fungi colony,gram staining and acid-fast staining from clinical microbiology were distributed to the participating laboratories in Gansu province twice a year at regular intervals.The pictures of standard knowledge points from CLSI,such as special drug resistance were distributed simultaneously.All the participating laboratories were required to complete the interpretation for the pictures and report their resuhs in a scheduled time.Then the resuhs were summarized and analyzed as 3 modes:complete consistency,general consistency and non-consistency.Results During the 2 years when the EQA system for microbial morphology and detection of special drug-resistance were performed for 24 times,the rate of annual complete consistency increased year by year and reached to 91.3％ in 2015.Conclusion The EQA system based on the examinations of microbial morphology and CLSI standard knowledge points for clinical laboratory may supervise the staff of clinical microbiology laboratories in the hospitals at second grade or above to master the skills of morphological identification and learn CLSI knowledge points,so their professional skills of clinical microbiology could be comprehensively improved.