Mechanism of Tumor T Cell Exhaustion from Perspective of ''Sanjiao-Yingwei'' Qi Transformation Malfunction / 中国实验方剂学杂志

In order to promote the innovative application of Sanjiao theory and Yingwei theory， this paper tries to apply the ''Sanjiao-Yingwei'' Qi transformation theory to the treatment of tumor diseases， integrating it with T cell exhaustion mechanism to elaborate on its scientific connotation and using network pharmacology and bioinformatics to elucidate the correlation between the anti-tumor mechanism of ''Sanjiao-Yingwei'' Qi transformation and T cell exhaustion. The ''Sanjiao-Yingwei'' Qi transformation function is closely related to the immunometabolic ability of the human body， and the ''Sanjiao-Yingwei'' Qi transformation system constitutes the immunometabolic exchange system within and outside the cellular environment. Cancer toxicity is generated by the fuzzy Sanjiao Qi， and the long-term fuzzy Sanjiao Qi is the primary factor leading to T cell exhaustion， which is related to the long-term activation of T cell receptors by the high tumor antigen load in the tumor microenvironment. Qi transformation malfunction of the Sanjiao produces phlegm and collects stasis， which contributes to T cell exhaustion and is correlated with nutrient deprivation， lipid accumulation， and high lactate levels in the immunosuppressed tumor microenvironment， as well as with the release of transforming growth factor-β and upregulated expression of programmed death receptor-1 by tumor-associated fibroblasts and platelets in the tumor microenvironment. Ying and Wei damage due to Sanjiao Qi transformation malfunction is similar to the abnormal manifestations such as progressive loss of exhausted T cell effector function and disturbance of cellular energy metabolism. Guizhi decoction， Shengming decoction， and Wendan decoction can correct T cell exhaustion and exert anti-tumor effects through multi-target and multi-pathways by regulating ''Sanjiao-Yingwei'' Qi transformation， and hypoxia inducible factor-1α （HIF-1α） may be one of the main pathways to correct T cell exhaustion. It was found that HIF-1α may be one of the important prognostic indicators in common tumors by bioinformatics. The use of the ''Sanjiao-Yingwei'' Qi transformation method may play an important part in improving the prognosis of tumor patients in clinical practice.

Aurantii Fructus Immaturus， Atractylodis Macrocephalae Rhizoma， and Their Combination Treat Colonic Motility Disorders in Rats with Slow Transit Constipation via PINK1/Parkin Signaling Pathway-mediated Mitophagy / 中国实验方剂学杂志

ObjectiveTo observe the effects of Aurantii Fructus Immaturus， Atractylodis Macrocephalae Rhizoma， and their combination on slow transit constipation via PTEN-induced putative kinase 1 （PINK1）/Parkin pathway-mediated mitophagy. MethodFifty-six male SD rats were randomly assigned into normal group， model group， natural recovery group， Aurantii Fructus Immaturus group， Atractylodis Macrocephalae Rhizoma group， Aurantii Fructus Immaturus combined with Atractylodis Macrocephalae Rhizoma group， and mosapride group， with 8 rats in each group. Slow transit constipation model was established by gavage with loperamide （3 mg·kg-1·d-1） for 14 days in other groups except the normal group. After successful modeling， except that the model group was continuously induced by loperamide， the normal group and the natural recovery group were administrated with 0.9% normal saline by gavage， and the rats in the Aurantii Fructus Immaturus （1.35 g·kg-1·d-1） group， the Atractylodis Macrocephalae Rhizoma （2.7 g·kg-1·d-1） group， the Aurantii Fructus Immaturus combined with Atractylodis Macrocephalae Rhizoma （4.05 g·kg-1·d-1） group， and the mosapride （1.56 mg·kg-1·d-1） group were administrated with corresponding drugs by gavage for 7 days. The amount of feces， fecal water content， and intestinal propulsion rate of rats were determined. The pathological changes of the colon were evaluated by hematoxylin-eosin （HE） staining and Alcian blue-periodic acid-Schiff （AB-PAS） staining. The activity of respiratory chain complex and the ultrastructure of the colon tissue were determined by ultraviolet spectrophotometry and observed by transmission electron microscopy， respectively. Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was employed to determine the mRNA levels of PINK1， Parkin， and p62， and Western blot to determine the protein levels of microtubule-associated protein 1 light chain 3 （LC3）， PINK1， and Parkin. ResultCompared with the normal group， the model group and the natural recovery group showed decreases in the amount of feces， fecal water content， intestinal propulsion rate （P<0.05，P<0.01）， and activities of mitochondrial respiratory chain complexes Ⅱ， Ⅲ， and Ⅳ in the colon tissue （P<0.05，P<0.01）. Further， the mRNA levels of PINK1 and Parkin and the protein levels of PINK1， Parkin， and LC3 were up-regulated （P<0.01） and the mRNA level of p62 was down-regulated in the model group （P<0.05） and the natural recovery group. Compared with the model group and the natural recovery group， the Aurantii Fructus Immaturus combined with Atractylodis Macrocephalae Rhizoma group showed increased amount of feces， fecal water content， intestinal propulsion rate， and activities of mitochondrial respiratory chain complexes Ⅱ， Ⅲ， and Ⅳ （P<0.05，P<0.01）. Moreover， the combination meliorated the degree of mitochondrial swelling in the colon tissue， down-regulated the mRNA levels of PINK1 and Parkin and the protein levels of PINK1， Parkin， and LC3 （P<0.05，P<0.01）， and up-regulated the mRNA level of p62 （P<0.05）. ConclusionAurantii Fructus Immaturus and Atractylodis Macrocephalae Rhizoma， and their combination may remedy the colonic motility disorders in rats with slow transit constipation by blocking PINK1/Parkin signaling pathway to inhibit the excessive mitophagy in interstitial cells of Cajal in the colon tissue.

Efficacy and safety of trimethoprim/sulfamethoxazole combined with caspofungin for the treatment of acquired immunodeficiency syndrome patients with moderate to severe pneumocystis pneumonia / 中华传染病杂志

Objective:To assess the efficacy and safety of trimethoprim/sulfamethoxazole (TMP/SMZ) combined with caspofungin for the treatment of acquired immunodeficiency syndrome (AIDS)patients with moderate to severe pneumocystis pneumonia (PCP) requiring mechanical ventilation.Methods:The clinical data of AIDS patients who admitted to Chongqing Public Health Medical Center from March 1, 2019 to March 1, 2021 with moderate to severe PCP requiring mechanical ventilation were retrospectively analyzed. Clinical characteristics and outcomes were compared between two groups receiving either combination therapy with TMP/SMZ and caspofungin (combination therapy group) or TMP/SMZ monotherapy (monotherapy group). The patients were divided into two subgroups according to the baseline arterial partial pressure of oxygen (PaO 2), patients with arterial PaO 2≥50 mmHg (1 mmHg=0.133 kPa) and PaO 2 <50 mmHg. The clinical efficacies of combination therapy and monotherapy in each subgroup were further compared. Chi-square and Fisher exact test were used for statistical analysis. The three-month survival was estimated by the Kaplan-Meier method, and the three-month survival rates were compared by Log-rank method. Results:A total of 83 patients were enrolled, including 23 in the monotherapy group and 60 in the combination therapy group. There was no significant difference in all-cause hospital mortalities between these two groups (34.8%(8/23) vs 23.3%(14/60), χ2=1.12, P=0.290). Kaplan-Meier survival curves indicated no significant difference in the three-month survival rates between the two groups ( χ2=0.51, P=0.477). There ware no significant differences observed in the positive clinical response rates and the mechanical ventilation rates after seven days of anti-PCP treatment between the two groups ( χ2=0.02 and 0.01, respectively, both P>0.05). In the 52 patients with PaO 2≥50 mmHg, no significant difference in all-cause hospital mortalities was observed between the monotherapy group and the combination therapy group (2/13 vs 25.6%(10/39), χ2=0.14, P=0.704). There was no statistical significance in the three-month survival rates between the two groups ( χ2=0.69, P=0.407). No significant difference was observed either in the clinical positive response rates or the mechanical ventilation rates after seven days of anti-PCP treatment between the two group( χ2=1.02 and 0.69, respectively, both P>0.05). In the 31 patients with PaO 2<50 mmHg, the all-cause hospital mortality in the combination therapy group was 19.0%(4/21), while six of the 10 patients in the monotherapy group died, and the difference was statistically significant (Fisher exact test, P=0.040). The three-month survival rate in the combination therapy group was significantly higher than that in the monotherapy group ( χ2=4.09, P=0.043). There were no significant differences in clinical positive response rate and the mechanical ventilation rate after seven days of anti-PCP treatment between the two group (Fisher exact test, both P>0.05). The overall adverse event rate in the monotherapy group was 87.0%(20/23), with an incidence of 56.5%(13/23) for both electrolyte disturbances and bone marrow suppression. The above incidences in the combination therapy group were 78.3%(47/60), 35.0%(21/60) and 53.3%(32/60), respectively, and all differences were not statistically significant ( χ2=0.34, 3.18 and 0.07, respectively, all P>0.05). Conclusions:The efficacy of combination therapy with TMP/SMZ and caspofungin is comparable to that of TMP/SMZ monotherapy in AIDS patients with moderate to severe PCP requiring mechanical ventilation. However, in AIDS patients with PCP requiring mechanical ventilation with the baseline PaO 2<50 mmHg, the efficacy of combination therapy is statistically superior to that of TMP/SMZ monotherapy. Combination therapy does not increase the risk of adverse events.

Feasibility of a Clinical-Radiomics Model to Predict the Outcomes of Acute Ischemic Stroke

Objective@#To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. @*Materials and Methods@#Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. @*Results@#Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825–0.910) in the training cohort and 0.890 (0.844–0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. @*Conclusion@#The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.

HIV antibody screening and confirmative tests of voluntary blood donors in a hospital in Beijing: A retrospective analysis / 中国输血杂志

【Objective】 To retrospectively analyze the epidemiological characteristics and regularity of HIV among voluntary blood donors in our hospital, so as to provide help for the formulation of effective coping strategies for voluntary blood donation, reduce the incidence of blood transmitted diseases, and improve blood safety. 【Methods】 HIV infection and population characteristics of voluntary blood donors in our hospital from January 2010 to December 2019 were statistically analyzed. 【Results】 A total of 330 000 blood donations occurred during 2010 to 2019, and 1 024 HIV-infected blood donors were screened out, with a positive rate of 0.31%. The detection rate was the highest in 2016, with 158 cases infected(158/35 889, 0.44%), followed by 151 in 2015(151/37 586, 0.40%), and 42 in 2010(42/20 824, 0.20%). The difference was statistically significant (χ2=88.754, P<0.001). Among the 1 024 HIV-infected patients, 876 were males and 148 females, with a gender ratio close to 6∶1. The majority were aged between 18~35 years old, accounting for 86.13%. 【Conclusion】 The HIV infection rate among voluntary blood donors had been increasing year by year in recent years. Major blood centers should strengthen the health information before blood donation, carry out HIV screening strictly, select blood donors appropriately, establish a stable blood donation team, so as to reduce the discarding rate of blood.

Progress of Epstein-Barr virus and lymphoma transformation / 白血病·淋巴瘤

Epstein-Barr virus (EBV) is one of the most common human herpesviruses, presenting a latent infection in more than 95% of healthy adults. EBV can regulate the differentiation, proliferation and colony formation of infected lymphocytes by coding viral proteins, and it is associated with Burkitt lymphoma, NK/T cell lymphoma, Hodgkin lymphoma, and vascular immunoblastic lymphoma. This article reviews the research progress of EBV in lymphoma transformation.

Dynamic observation and antibiotic susceptibility analysis of biofilm of Staphylococcus aureus isolated from clinical specimens / 中华检验医学杂志

Objective To analyze the correlation between antibiotic susceptibility andbiofilm formation of Staphylococcus aureus. Methods According to Standardized Operational Guidance for Clinical Microbiological Testing, fifty-eight non-repetitive pathogenic Staphylococcus aureus isolates were collected from blood, urine, sputum and purulent secretions of inpatients in the Laboratory Department of the First Affiliated Hospital of Guangxi Medical University in January 2018. The antibiotics susceptibility of strains was characterized by disk diffusion method and VITEK-2.96-hole culture. The biofilm formation ability was detected bythe crystal violet assay and Congo redplate methods.The in vitro dynamic forming process of S.aureus′sbiofilm was analyzed by crystal violet staining combined with bacterial culture in 96 wells.Besides, the rate differences of drug resistance between biofilm producers and non-producers was performed by Chi-square test. The diameter of bacteriostasis zone of biofilm producers and non-producers was compared by t test. The drug resistance among strains with different biofilm formation ability was analyzed withnonparametric rank sum test. Results The positive ratio of biofilm producing S. aureus was higher in MRSA (68.42％) than in MSSA(20.00％)(χ2=12.304,P=0.001. Antibiotic resistance rates of biofilm producers were higher than non-producers.The resistance rates of biofilm positive strains to oxacillin and clindamycin were 73.33％ and 53.33％, respectively. The antibiotic resistance of the strain was higher along with the biofilm forming ability was increasing. (χ2=9.099, P=0.008). Depths of the S. aureus′s biofilm on the 96-well plates increased significantly over time and reached biofilm maturation after 72 hours′ incubation. Light microscopic observation revealed that the mature biofilm was compact and growing with many layers. Conclusions For the clinical isolates of S. aureus, the antibiotic resistance of biofilm producers is significantly higher than non-producers. Strains with stronger biofilm forming ability had higher antibiotics resistance. Depths of the S. aureus′s biofilm on the 96-well plates increased significantly over time and reached biofilm maturation after 72 hours′incubation.

Pathogenic genes and adipogenic differentiation transcription factor PPARγ associated with congenital lipodystrophic diabetes / 中华医学遗传学杂志

Congenital lipodystrophic diabetes (CLD) is a rare genetic disease characterized by generalized or topical subcutaneous fat loss combined with various metabolic disorders such as insulin resistance, dyslipidemia, and impaired glucose tolerance. Recent studies have discovered genes underlying the disease. Mutations of such genes are associated with adipogenic anomaly, especially regulational function of peroxisome proliferators-activated receptor γ (γPPAR) for lipid. This paper has provided a review for the main clinical symptoms, classification, pathogenic genes, molecular mechanism and the relationship between PPARγ and fat loss.

Research progress of lipoprotein lipase gene mutation in patients with hypertriglyceridemia / 中华检验医学杂志

Hypertriglyceridemia is a syndrome characterized by abnormal triglyceride synthesis or degradation. High triglycerides is an independent risk factor for cardiovascular disease. Some study found that in addition to lifestyle, such as nutrition and their own activities, the genetic factors also determine the concentration of plasma triglycerides. Lipoprotein lipase is a rate-limiting enzyme for triglyceride degradation, which plays an important role in lipid metabolism, insulin resistance, and adipocyte differentiation. In recent years, family analysis and genome-wide association analysis (GWAS) have identified genes associated with hypertriglyceridemia, including the LPL gene, which mutates to reduce lipoprotein esterase activity and affect its protein content, resulting in hypertriglyceridemia. This paper reviewed the LPL gene structure, function, expression regulation, commonly used detection method and the relationship between LPL gene mutation and hypertriglyceridemia.

Intra-abdominal infection due to gram-negative bacilli:an analysis of 478 cases / 中国感染与化疗杂志

Objective To investigate the epidemiological and etiological characteristics of gram-negative bacilli (GNB) isolated from patients with intra-abdominal infection (IAI). Methods The patients with abdominal infection were identified retrospectively during the period from 2011 to 2015. The clinical and microbiological data were analyzed by WHONET 5.6 and SPSS 20.0. Results A total of 478 cases of IAI [hospital-acquired (HA) 290 cases, community-acquired (CA) 188 cases] were included in this analysis. CA-IAI patients at low risk were associated with significantly better outcome, and lower acute physiology and chronic health evaluation (APACHE) Ⅱ score and sequential organ failure assessment (SOFA) score than the CA-IAI and HA-IAI patients at high risk. The most common gram-negative bacillus isolated from intra-abdominal infections was E. coli and K. pneumoniae. The prevalence of ESBLs-producing E. coli and K. pneumoniae isolates was 75.8％ and 35.8％, respectively. The E. coli isolates remained highly susceptible to amikacin, piperacillin-tazobactam, and carbapenems during the 5-year period, while the K. pneumoniae isolates showed poorer susceptibility to ampicillin-sulbactam. Conclusions The prevalence of ESBLs-producing GNB is increasing in the patients with IAI. Such isolates were resistant to commonly used antimicrobial agents, but generally susceptible to carbapenems. It is important to strengthen the monitoring of antimicrobial resistance in IAIs, and choose antimicrobial therapy rationally based on the results of antimicrobial susceptibility test.

Epidemiological and clinical infection features of heterogeneous vancomycin-intermediate Staphylococcus aureus / 中国感染与化疗杂志

Objective To investigate the prevalence and clinical characteristics of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) in the First Affiliated Hospital of Chongqing Medical University. Methods Clinical isolates of S. aureus were collected from the hospital during the period from 2012 to 2015 and were tested for susceptibility to vancomycin using agar dilution method. The results were interpreted according to CLSI 2016 breakpoints. VISA and hVISA strains were screened out by population analysis profile-area under the curve (PAP-AUC). E-test was carried out to determine the MIC of VISA. The clinical data of the patients infected with S. aureus were reviewed retrospectively. Results A total of 105 patients were included in this analysis. And 105 strains of S. aureus were isolated from these patients, including methicillin-resistant S. aureus (MRSA) strains (58.1％, 61/105). PAP-AUC identified 19 (18.1％) hVISA strains and 10 (9.5％) VISA strains. Overall, 52 of the 105 patients were nosocomial infections and 53 community infections. The prevalence of MRSA was 69.2％ (36/52) in nosocomial infections, higher than that in community infections (47.2％, 25/53) (P＜0.05). The prevalence of hVISA in community infections (20.8％, 11/53) did not show significant difference from that in nosocomial infections (15.4％, 8/52) (P＞0.05). The clinical outcome (P＞0.05) and length of hospital stay (P＞0.05) did not show significant difference between hVISA and non-hVISA infections, or between VISA and non-VISA infections. Conclusions The prevalence of hVISA is high in this hospital, which does not show difference between S. aureus nosocomial infection and community infection, or between MRSA and MSSA. The length of hospital stay of hVISA infection is not significantly longer than that of nonhVISA infection. The clinical outcome of hVISA infection does not show difference from that of non-hVISA infection. Larger sample size is required to better understand the prevalence and clinical features of hVISA.

Atlas-based deep gray matter and white matter analysis in Alzheimer's disease：diffusion ;abnormality and correlation with cognitive function / 中华放射学杂志

Objective To identify the diffusion alterations of deep gray matter(GM) and white matter (WM) among Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy people by atlas?based analysis (ABA), and to investigate the respective relationship with cognitive function. Methods Twenty?one AD patients (AD group), 8 MCI patients (MCI group) and 15 normal controls (control group) were performed by conventional MRI and diffusion tensor imaging (DTI). The raw data of DTI was processed by using DTI studio software to generate the fractional anisotropy (FA) images. Then ABA was used to quantify the FA value in 58 deep GM and WM structures. The differences of FA value among three groups were compared by using one way ANOVA, with a post?hoc analysis. In AD and MCI groups, the partial correlation was further investigated between mini?mental state examination (MMSE) score and FA value in the brain regions that have significant differences between AD and MCI group or between MCI and control group. Results Compared with control group, AD patients showed wide?spread FA decrease in most deep GM and WM regions (corrected P0.05). Conclusion Based on ABA, this study found the diffusion changes not only in the WM but also the deep GM in AD patients, but only WM diffusion disruptions in MCI group. The decreased FA value in the right SCC appeared early, but had no correlation with the cognitive impairment. The FA value in the hypothalamus, the fornix, the SLF and the cingulum decreased with the disease progression, and correlated positively with the cognition decline.

Association between mothers' body mass index before pregnancy or weight gain during pregnancy and autism in children / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the relationship between mothers' body mass index (BMI) before pregnancy or weight gain during pregnancy and autism in children.</p><p><b>METHODS</b>From 2013 to 2014, the 181 children with autism and 181 healthy children matched by sex and age from same area were included in this study. According to mothers' BMI before pregnancy, the selected cases were divided into 3 groups: low, normal and high group. Then 3 groups were divided into 3 subgroups based on mother' s weight gain during pregnancy: low, normal and high group, according to the recommendations of Institute of Medicine. Logistic regression analysis and χ(2) test were conducted with SPSS 18.0 software to analysis the relationship between mothers' BMI before pregnancy or weight gain during pregnancy and autism in children.</p><p><b>RESULTS</b>The age and sex distributions of case group and control group were consistent (χ(2)=0.434, P>0.05). The mothers' BMI before pregnancy of case group was higher than that of control group (χ(2)=9.580, P<0.05) ,which was (21.28±3.80) kg/m(2) for case group and (19.87±2.83) kg/m(2) for control group. The proportion of cases in high BMI group (10.5%) was much higher than that in control group (2.8%) . The risk of children with autism in high BMI group was 3.7 times higher than that in normal BMI group (OR=3.71, 95% CI: 1.34-10.24). In normal BMI group, the proportion of mothers who had excessive weight gain during pregnancy was higher in case group (44.1%) than in control group (33.9%). In high BMI group, the proportion of mothers who had excessive weight gain was higher in case group (52.6%) than in control group (20.0%) . In normal BMI group (χ(2) =8.690, P<0.05) and high BMI group (χ(2)=4.775, P<0.05), the weight gain during pregnancy was associated with autism in children. Logistic regression analysis showed that mothers' BMI before pregnancy (unadjusted OR=1.89, 95% CI: 1.26-2.85, adjusted OR=1.52, 95% CI: 1.19-2.27) and weight gain during pregnancy were the risk factors for autism in children (unadjusted OR=1.63, 95% CI: 1.08-1.25, adjusted OR=1.64, 95% CI: 1.21-2.21).</p><p><b>CONCLUSION</b>Overweight or obesity before pregnancy and excessive weight gain during pregnancy were associated with autism in children, suggesting that women who plan to be pregnant should pay attention to body weight control.</p>

Association between guardian's first notice of autism symptom of children and time to seek medical care / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the symptoms of autism of children that caused the first notice of guardian, related risk factors and the influence on the time to seek medical care.</p><p><b>METHODS</b>The children with autism aged <5 years were selected from autism rehabilitation centers in Wuhan, Changsha, Haikou, Liuzhou and Changsha between September 2012 and April 2014, and their guardians were retrospectively surveyed by using questionnaire. SPSS 13.0 software was used for statistical analysis.</p><p><b>RESULTS</b>A total of 415 children with autism were included in the study. Including 355 boys (85.54%) and 60 girls (14.46%), the sex ratio was 5.9 : 1. The most common concern of guardian were: language dysplasia (20.72%); ignoring of people or lack of interaction with others (18.55%); repeat and weird action pattern (14.94%). The age when the first symptom occurred, which causing guardians' concern, ranged from 8 months to 28 months, the time when guardian began to concern varied with symptom (χ² =46.64, P<0.000 1). Guardian's educational level, guardian's contact time with the children, guardian's intimate degree with the children, the age of guardian, family type and tie had no statistical association with the fist autism symptom that caused guardian's concern. The age of the children at first medical care seeking ranged from 10.5 months to 33 months, the time of the first medical care seeking varied with symptom (χ² =46.10, P<0.000 1). Up to 90.74% of the guardians delayed the medical care seeking of the children with autism, but the symptom specific differences in medical care delay had no statistical significance (χ² =9.46, P=0.579 6).</p><p><b>CONCLUSION</b>The symptom of the children with autism causing guardian's first notice were mainly verbal communication barrier, social interaction barrier and restricted interests and behaviors. Guardian's educational level and intimate degree with children had no correlation with the symptom which caused guardian's first notice. The time when guardian began to concern and the time for children's medical care varied with guardian's first notice.</p>

Two-dimensional Multiple-echo Recalled Gradient Echo Sequence at Flexion Position in the Diagnosis of Hirayama Disease / 中国医学影像学杂志

Purpose To evaluate the diagnostic value of two-dimensional multiple-echo recalled gradient echo (2D MERGE) with flexural position in the hirayama disease. Materials and Methods Conventional MRI and axial MERGE images (7 cases) were analyzed and the anteroposterior diameter was measured at C6 vertebral body, and the structure of spinal, extramedullary and subdural space and extradural space were compared. Results The anteroposterior diameter was (5.7±0.6) cm and (4.7±0.5) cm in the neutral position and flexural position (t=-2.95, P<0.05). The“butterfly”shape of spinal grey matter could not be detected in the 4 cases on MERGE with flexural position, which could not demonstrated on the conventional MR images. 2D MERGE was not sensitive for the CSF flow artefacts and the contrast between spinal and surrounding structures was improved. However, the vascular images could not displayed on 2D MERGE images. Conclusion 2D MERGE sequence is better than T1WI and T2WI on sagittal view and T2WI on axial view in the pathological changes of hirayama disease except flow-empty vein sign, thus it has an important role in diagnosing hirayama disease.

Comparison and analysis of in vitro cytotoxocity of different shengmai injections / 中国中药杂志

<p><b>OBJECTIVE</b>To compare the cytotoxic response with respect to different Shengmai injections manufactured by different manufacturers and to find the main reasons that cause the differences.</p><p><b>METHOD</b>L929 cells were cultured with various Shengmai injections which were incubated into serum-supplemented minimum essential medium at different doses. The cellular morphology was observed by phase contrast inverted microscopy and proliferation of the cells was examined using mitochondrial function methyl thiazolyl tetrazolium (MTT) assay. Relative growth rate (RGR) was calculated. Moreover, cytotoxicity was evaluated.</p><p><b>RESULT</b>For Shengmai injections manufactured by 8 manufacturers, cytotoxicity was high, Class 4. The EC value of sample A was high than other samples. This result indicated that sample A is much more toxic than other samples. For the excipients of Shengmai injections, when the concentration of tween 80 is 0.5% of composition of drug products, cytotoxicity was classified as 3-4; while the concentration of tween 80 is 0.062 5% of composition of drug products, the cellular toxicity was classified as 1 (no cellular toxic response). The content of tween 80 of shengmai injection is different during different factories; some of it is higher than 0.5%.</p><p><b>CONCLUSION</b>Cytotoxic results of these various injections were significantly different because of different manufacturers of drug substance and manufacturing process. As an excipient of injection, it showed cytotoxicity when the concentration is higher than 0.062 5%. The content of tween-80 and the degree of cytotoxicity in different Shengmai injections may have a positive correlation.</p>

Investigation on positive correlation of increased brain iron deposition with cognitive impairment in Alzheimer disease by using quantitative MR R2' mapping / 华中科技大学学报（医学）（英德文版）

Brain iron deposition has been proposed to play an important role in the pathophysiology of Alzheimer disease (AD). The aim of this study was to investigate the correlation of brain iron accumulation with the severity of cognitive impairment in patients with AD by using quantitative MR relaxation rate R2' measurements. Fifteen patients with AD, 15 age- and sex-matched healthy controls, and 30 healthy volunteers underwent 1.5T MR multi-echo T2 mapping and T2* mapping for the measurement of transverse relaxation rate R2' (R2'=R2*-R2). We statistically analyzed the R2' and iron concentrations of bilateral hippocampus (HP), parietal cortex (PC), frontal white matter (FWM), putamen (PU), caudate nucleus (CN), thalamus (TH), red nucleus (RN), substantia nigra (SN), and dentate nucleus (DN) of the cerebellum for the correlation with the severity of dementia. Two-tailed t-test, Student-Newman-Keuls test (ANOVA) and linear correlation test were used for statistical analysis. In 30 healthy volunteers, the R2' values of bilateral SN, RN, PU, CN, globus pallidus (GP), TH, and FWM were measured. The correlation with the postmortem iron concentration in normal adults was analyzed in order to establish a formula on the relationship between regional R2' and brain iron concentration. The iron concentration of regions of interest (ROI) in AD patients and controls was calculated by this formula and its correlation with the severity of AD was analyzed. Regional R2' was positively correlated with regional brain iron concentration in normal adults (r=0.977, P<0.01). Iron concentrations in bilateral HP, PC, PU, CN, and DN of patients with AD were significantly higher than those of the controls (P<0.05); Moreover, the brain iron concentrations, especially in parietal cortex and hippocampus at the early stage of AD, were positively correlated with the severity of patients' cognitive impairment (P<0.05). The higher the R2' and iron concentrations were, the more severe the cognitive impairment was. Regional R2' and iron concentration in parietal cortex and hippocampus were positively correlated with the severity of AD patients' cognitive impairment, indicating that it may be used as a biomarker to evaluate the progression of AD.

Improvement of sleep and anxiety in patients of major depression with fluoxetine combined with small dose of olanzapine / 中国组织工程研究

BACKGROUND: Major depression is a subtype of depression. Application of thymoleptics alone has bad effect. It has shown from relevant studies abroad that application of fluoxetine combined with atypical antipsychotic drugs maybe an effective treating strategy.OBJECTIVE: To observe the curative effects of fluoxetine combined with olanzapine and the time of its taking effect.DESIGN: Comparative study of open clinical test with completely random sampling for the first visit outpatients SETTING: A psychological consulting clinic in a hospital of a Military Medical College of Chinese PLA.PARTICIPANTS: Totally 140 patients visiting psychological counseling outpatient clinic in the hospital were collected from January 2004 to August 2004. Inclusion criteria: According to the diagnostic criterion of depression of CCMD-3, patients with total scores of 17 items in Hamilton depression rating scale≥28and age ≥18 years old .EXclusion criteria;①slight to middle edgree of depression(Hamt≤27);②secondary depression;③convalesscent period of schizophrenia and other affective disorder caused by psychosis;④severe of unstable body diseases ,including diseases of liver,kidney,cardiae vessel,respiration,gastro-intestine,endocrine,nervous system,innune system or hematological system,cet.⑤drug or alcohol addict;⑥women in pregnancy and lactation. Totally 110 patients accorded with the inclusive criteria. Among them, there were 40 males and 70 females with the course of disease for 4 months to 5 years, aged 18 to 63 with the average (37 ± 12) years old. They all took part in the trial voluntarily. According to the date of admittance, they were divided into odd-numbered date alprazolam group in which there were 55 patients with 21 males and 34 females and double date olanzapine group in which there were 55 patients with 19 males and 36 females.METHODS: The patients were divided into 2 groups according to the date of admittance. Odd-numbered date group was alprazolam group. 0.4 mg alprazolam was given every noon and before sleep and 20 mg fluoxetine was given at a draught after breakfast every day. Even-numbered date group was olanzapine group. 2.5 mg olanzapine was given before sleep every day and 20mg fluoxetine was given at a draught after breakfast every day. The course of treatment was 6 weeks. HAMD and HAMA scores of taken were evaluated respectively before and at the end of 1st, 2nd, 4th and 6th week. Reducing score rate was used to decide effective time. Lost rate was presented as percentage. And improvement of sleep factor and somatization factor in HAMD were observed before therapy and at every observing time period after therapy.MAIN OUTCOME MEASURES: Terminus index: Comparison of HAMD,HAMA score in the two groups before therapy and at the 1st, 2nd, 4th and 6th weekend after therapy. Scores of sleep factor and anxiety somatization factor of HAMD at every observing time period in the two groups. Substitution index: lost rate in the two groups. Reducing score rate at every observing time period in the two groups.RESULTS: Lost rate in olanzapine group was significantly lower than that in alprazolam group ( P ＜ 0.05) and the effect was taken at 1 week after therapy(excellence rate 67% ) . But, scores of HAMD and HAMA at every observing time period in olanzapine group were significant lower than those in alprazolam group( P ＜ 0.01) and sleep factor and somatization factor at every observing time period improved more significantly than those of alprazolam group( P ＜ 0. 01).CONCLUSION: Small amount of olanzapine combined with fluoxetine used to treat major depression of the patients can improve sleep and anxiety body symptoms rapidly and then elevate their living quality significantly.

Intrinsic personality traits in patients with generalized anxiety disorder / 中国组织工程研究

BACKGROUND: According to Eysenck's theory of personality, trait level belongs tolow-grade personality, which can better reflect characteristics of individual habitual behavior reaction.OBJECTIVE: To explore the correspondent relationship between generalized anxiety patient and internal personality trait through adopting Cattell's 16 Personality Factor Questionnaire (16PFQ) and Zung's Self-rating Anxiety Scale (SAS) to test generalized anxiety patients.DESIGN: A transectional sampling survey and data was compared with that of health adult norms.SETTING: Counseling clinic of out-patient in the Southwest Hospital of the Third Military Medical University of Chinese PLA.PARTICIPANTS: Totally 100 patients with generalized anxiety disorders who visited the clinical counseling clinic of out-patient in the Southwest Hospital, Third Military Medical University of Chinese PLA for the first time from August 2003 to March 2004 were included, including 40 men and 60 women.METHODS: Catell's 16PFQ was tested with Psychometric Toolbox Standard Edition V2.3 developed by the Insight Group of Peking University.The patients filled out the forms independently after the method being explained clearly by professional staff members. These 16 personality factors included warmth (reserved vs. warm; Factor A), reasoning (concrete vs.abstract; Factor B), emotional stability (reactive vs. emotionally stable;Factor C), dominance (deferential vs. dominant; Factor E), liveliness (serious vs. lively; Factor F), rule-consciousness (expedient vs. rule-conscious;Factor G), social boldness (shy vs. socially bold; Factor H), sensitivity (utilitarian vs. sensitive; Factor I), vigilance (trusting vs. vigilant; Factor L),abstractedness (grounded vs. abstracted; Factor M), privateness (forthright vs. private; Factor N), apprehension (self-assured vs. apprehensive; Factor O), openness to change (traditional vs. open to change; Factor Q1), self-reliance (group-oriented vs. self-reliant; Factor Q2), perfectionism (tolerates disorder vs. perfectionistic; Factor Q3), tension (relaxed vs. tense; Factor Q4). Standard score of each observed index was measured automatically by computer measuring system. The standard score in Zung's SAS was (65.31±7.90).MAIN OUTCOME MEASURES: Comparison of standard scores in Cattell's 16PF between anxiety group and health adult norms.tell's 16PFQ for patients with generalized anxiety disorders: Scores in A,I, L, M, O, Q4 factor of anxiety patients were higher than that of health adult norms (6.19±1.69, 5.49±1.75;6.63±1.46, 5.53±1.84;5.84±1.52,5.47 ± 1.78; 6.22 ± 1.54,5.42 ± 1.61; 8.32 ±1.54,5.48 ±1.81; 8.10 ±1.27,5.60±1.99,(t=-2.03 to -13.15, P＜ 0.05-0.01)) while scores in B, C, E, F, G H,Q1, Q2, Q3 were significantly lower (5.22±1.46, 5.93±1.97;3.48±1.68,5.51±1.75;4.86±1.60, 5.53±1.83;5.01±2.22, 5.50±1.89;4.42±1.60,5.54 ±1.66 ;4.58±1.66, 5.56±1.84 ;4.64±1.29, 5.50±1.72 ;4.73±1.80, 5.50±1.72;and F had a significantly negative correlation with scores in Zung's SAS (r=-0.273,P ＜ 0.01 ;r=-0.217,P ＜ 0.05;r=-0.217,P ＜ 0.05) while factor Q4 had a significantly positive correlation(r=0.248 ,P ＜ 0.05).CONCLUSION: The development of anxiety with high scores in C, E, F and Q4 correlates with self-personality trait. These 4 personality traits may be susceptible factors in the development of anxiety disorder and may also affect its severity.

The randomized placebo-controlled trial on fluoxetine combined with olanzapine in treating major depression / 第三军医大学学报

Objective To evaluate the efficacy and effective time of low dosage of olanzapine combined with fluoxetine in treatment of major depression. Methods A total of 53 patients who suffered from major depression diagnosed according to CCMD-3 and the score of Hamilton rating scale for depression (HAMD) over 28, were randomly divided into 2 groups: alprazolam group (0.4 mg alprazolam, 2/d and 20 mg fluoxetine, 1/d), olanzapine group (2.5 mg olanzapine, 1/d, and 20 mg fluoxetine, 1/d). The treatment period lasted six weeks and the subjects were evaluated by using HAMD and HAMA at week 1, 2, 4, 6. The effective time was estimated by decreasing rate of the scale of HAMD and the amelioration of sleep disturbance and anxiety/somatization in HAMD were observed before and during the treatment. Results The therapeutic effects in olanzapine group at week 1 were observed with the apparent rate of 67%. The scores of HAMD and HAMA in olanzapine group were obviously lower than those in alprazolam group at each time point. The sleep disturbance and anxiety/somatization of the patients in olanzapine group improved significantly as compared with those in alprazolam group. Conclusion Fluoxetine combined with olanzapine is a fast and effective method to treat major depression.