Pediatric reference intervals for plasma and whole blood procalcitonin of in China: a multicenter research / 中华检验医学杂志

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

One case of mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency and literature review / 中国基层医药

Objective:To summarize the clinical phenotype and genetic characteristics of one child patient with mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency (mHS) caused by HMGCS2 gene mutation. Methods:One child patient with mHS who received treatment in Chongqing University Three Gorges Hospital on April 10, 2020 was included in this patient. The child was hospitalized due to cough, shortness of breath and deep coma. After admission, gas chromatography-mass spectrometry of the blood and urine samples and high-throughput whole genome sequencing were performed. The pedigree of the child with gene mutation was analyzed. The child was diagnosed with mHS. Related publications published by June, 2020 were searched in Wanfang database, Chinese Journal Full Text Database, PubMed and HGMD databases using search terms "mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency", "HMGCS2" "mHS deficiency". Forty-three papers addressing mHS deficiency were retrieved. The clinical phenotype and genotypes of the child with HMGCS2 mutation were summarized. Results:As of June 2020, there were 44 children with mHS deficiency, including the child reported in this study. These children consisted of 15 males, 11 females and 18 unknown genders. Among these children, 29 were aged 0-24 months, 4 were aged > 24 months, 6 had no symptoms, and 5 were of unknown age of disease onset. The first symptoms of most children were fever, cough, acute gastroenteritis, and coma. Twenty-seven children had hypoglycemia, 21 children had metabolic acidosis, 15 children developed hepatomegaly, 16 children had increased FFA/D-3-HB, and 10 children were tested 4-hydroxy-6-methyl-2-pyrone positive. The child included in this study had hepatomegaly, elevated alanine aminotransferase and metabolic acidosis. Gas chromatography-mass spectrometry results showed that a variety of metabolites were increased. Tandem mass spectrometry results showed that C40 level was elevated, and long-chain carnitine contents were increased. High-throughput whole genome sequencing results revealed that there were two heterozygous mutations in HMGCS2 gene, (NM_0055) c.559+1G > A; c. 758 T > C heterozygous mutation. Sanger sequencing and parental origin analysis showed that the mutations in this child were from parents. The two gene mutations in this child were new mutations, which have not been reported in China and countries outside China. According to the criteria and guidelines for interpretation of ACMG sequence variation, the variation was determined to be pathogenic. Conclusion:When a child has hypoketotic hypoglycemia and/or metabolic acidosis, increased FFA/D-3-HB and acetylcarnitine levels, mHS deficiency should be considered. HMGCS2 gene examination can help diagnose mHS deficiency.

Clinical application of dense fine spot anti-nuclear antibody in children with autoimmune diseases / 中华实用儿科临床杂志

Objective:To analyze the differences of the clinical characteristics and laboratory indexes in children with positive dense fine spot (DFS) type anti-nuclear antibody, and thereby to explore the value of positive DFS in the diagnosis of immunological diseases.Methods:Among 9 613 cases who were routinely tested for antinuclear antibody (ANA) from August 2017 to February 2020, there were 197 cases with DFS positive, who were subjected to a retrospective analysis.These patients were divided into the autoimmune diseases (AID) group (39 cases) and the non-AID group (158 cases) according to clinical diagnosis.Healthy children in the same physical examination were used as healthy control group (40 cases). T test was applied to analyze the differences of humoral immunity markers between AID and non-AID groups.What′s more, DFS positive patients in different clinical departments, initial symptom and the part of body were further compared. Results:Among 9 613 children tested for autoantibodies, 2 654 (27.61%) were ANA positive, with the highest detection rate of the spotted type and 197 DFS positive cases, accoun-ting for 7.42% of ANA positive children; 97 DFS positive male patients accounted for 8.20% (97/1 183 case) of ANA positive male patients, 100 DFS positive female patients accounted for 6.80% (100/1 471 cases) of ANA positive female patients, and there was no significant difference in the positive rate.The departments with high positive ANA detection included the nephrology department (27.88%) and the rheumatology department (24.83%). The departments with a higher ANA positive rate in DFS positive children included the gastroenterology department (13.25%) and the infectious department (11.76%). Among the children with DFS antibody positive, 39 cases had AID, among which 38 cases had organ-specific AID, and juvenile idiopathic arthritis (JIA) had the highest detection rate in 13 cases.The diseases with a high DFS positive rate in 158 non-AID cases included allergic purpura (46 cases). Serum immunoglobulin (IgG) level in the AID group was significantly lower than this in the non-AID group, serum IgM and C 4 levels in AID children were significantly lower than those in the non-AID group and healthy control group, and the serum IgA level of DFS positive group was significantly higher than that of children in the healthy control group.All children with DFS antibody positive had no specific autoantibodies. Conclusions:DFS antibody positive is important for the diagnosis of systemic AID in children.The combined detection with the DFS, other autoimmunity antibody index, humoral immune function index contributes to the early differential diagnosis of autoimmune diseases in children.

Evaluation of the performance of systems for whole blood C-reactive protein detection: a multi-center study / 中华检验医学杂志

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.

Machine learning empowering laboratory medicine / 中华检验医学杂志

Traditional data storage strategy has not capacity to meet analytical needs of medical big data possessing with mixed structure and high-dimensional features. Machine learning based on algorithms that generate models in the data is becoming an innovative source of intelligent data analysis technology in computer simulation of human learning. This paper gives an introduction to the development of machine learning and its current background of medical big data. Emphases are placed on applications of machine learning in the medical image recognition, automated validation for test reports, Chinese medical language processing and computer-aided diagnosis. The opportunities and challenges to the development of laboratory medicine which taken from machine learning worth focusing.(Chin J Lab Med, 2018, 41: 627-630)

Neural stem cell transplantation effects on neuronal apoptosis, differentiation and neurobehavior changes in rats with cerebral ischemia / 中国组织工程研究

BACKGROUND:In recent years, neural stem cell transplantation has become a research hotspot in the treatment of brain injuries, such as cerebral ischemia, but the mechanism has not been fully elucidated.OBJECTIVE:To study the effect of neural stem cell transplantation on neuronal apoptosis and differentiation and neurobehaviors in cerebral ischemia rats.METHODS:Ninety Sprague-Dawley rats with cerebral ischemia were randomized into model group, phosphate buffer solution (PBS) group and neural stem cell group (n=30 per group). Another 30 rats were selected as sham operation group with vascular exposure but with no occlusion under anesthesia. Thirty normal 30 rats acted as controls with no treatment. Thereafter, neurological deficit scores, cerebral infarction volume, the number of apoptotic nerve cells,BrdU/NeuN and BrdU/GFAP expression were detected at 3, 7, 14 days after modeling.RESULTS AND CONCLUSION:On the 7th day and 14th day after modeling, the neurological deficit scores, cerebral infarct volume and the number of apoptotic nerve cells in the neural stem cell group were significantly lower than those in the model group and PBS group (P 0.05). On the 3rd day, 7th day and 14th day after modeling, the neurological deficit scores and the number of apoptotic nerve cells in the control group and sham operation group were significantly lower than those in the model group, PBS group and neural stem cell group (P 0.05); on the 7th day and 14th day after modeling, the BrdU/NeuN positive cell count in the neural stem cell group was significantly higher than that in the model group and PBS group (P 0.05). On the 3rd day, 7th day and 14th day after modeling, BrdU/GFAP positive cell count in the neural stem cell group was significantly lower than that in the model group and PBS group (P 0.05). In summary, neural stem cell transplantation for cerebral ischemia contributes to the neuronal differentiation of endogenous neural stem cells in the subventricular zone of the lateral ventricles, reduce neuronal apoptosis, and ease ischemic damage to the rat neurological function.

Delay in Diagnosis of Spontaneous Dual Arteriovenous Fistulas : Correlative Factors and Influence on Outcome / 中山大学学报(医学科学版)

[Objective] To study the factors relative to the delayed diagnosis of spontaneous dual arteriovenous fistulas (DAVF) and its influence on the prognosis.[Methods] We included 102 continuous patients diagnosed DAVF in the First Affiliated Hospital of Sun Yat-sen University,and analyzed the correlative factors and impact on outcome of diagnostic delay.Outcome was whether symptoms were non-improvement,improvement or restoration at discharge.[Results] Median delay from onset to diagnosis was 3 months (interquartile range,1 to 6).Compared with patients diagnosed carlier(diagnose time≤3 months),patients diagnosed later (diagnose time ＞ 3 months) had a lower frequency of headache (P =0.012),ptosis (P =0.035) and parenchymal lesions (P =0.001),a higher frequency of conjunctival congestion (P =0.004),tinnitus (P =0.021),visual dysfunction (P ＜ 0.001),isolated visual dysfunction (P =0.007) and delayed imaging scan (P ＜ 0.001),a higher frequency of endovascular treatment,and a lower frequency of improvement or restoration at discharge (P =0.033),in which patients with visual dysfunction had a lower frequency of improvement or restoration than those without visual dysfunction (P =0.023).Compared to those with visual dysfunction and other symptoms,patients with isolated visual dysfunction had a higher frequency of onset with paroxysmal blurring or blinding (P ＜ 0.001),two eyes involved (P ＜ 0.001) and more severe visual loss (P =0.057),a higher frequency of draining into transversesigmoid sinus (P ＜ 0.001) instead of cavernous sinus (P ＜ 0.001),and suffered intracranial hypertension all (median intracranial pressure,405 mmH2O;interquartile range,370 ～ 512 mmH2O).However,no statistically significant differences were found in the frequency of improvement or restoration at discharge between two groups (P =0.739).[Conclusion] Diagnostic delay was considerable in this cohort and was associated with outcome,especially in patients with visual dysfunction.

Anterior circulation and posterior circulation ischemic stroke in young adults: a comparison of risk factors, etiologies, imaging features, and long-term outcomes / 国际脑血管病杂志

Objective To investigate the differences of risk factors,imaging features,etiologies,and long-term outcomes in young adults with anterior and posterior circulation ischemic stroke.Methods Consecutive young patients (15-45 years) with ischemic stroke were divided into an anterior circulation group and a posterior circulation group.They were followed up regularly for a long term,and the endpoint events included stroke,cardiovascular events,and death.Results A total of 289 patients were enrolled in the study,including 220 males.Their mean age was 38.0 ±6.5 years.There were 213 patients (73.7％) in the anterior circulation group and 76 (26.3％) in the posterior circulation group.In terms of risk factors,valvular heart disease was more common in the anterior circulation group (6.6％ vs.0.0％;Fisher's exact test,P =0.025),while hypertension (51.3％ vs.36.6％;x2 =5.021,P=0.025) and prodromic infection (6.6％ vs.1.4％;Fisher's exact test,P =0.018) were more common in the posterior circulation group.In the etiologies of stroke,large-artery atherosclerosis was more common in the anterior circulation group (32.4％ vs.13.2％;x2 =10.435,P =0.001),while small vessel occlusion (26.3％ vs.15.5％;x2 =4.381,P =0.036) and arterial dissection (19.7％ vs.9.9％;x2 =5.012,P =0.025) were more common in the posterior circulation group.There was no significant difference in the incidence of 5-year cumulative end-point events between the anterior circulation group and the posterior circulation group (20.2％ vs.18.5％;log-rank test P =0.614).Multivariate Cox proportional hazards regression analysis showed that after adjusting for age and gender,the independent predictors of end-point events in the posterior circulatory group included hypercholesterolemia (hazard ratio [HR] 3.622,95％ confidence interval [CI] 1.216-17.766;P =0.030),old infarction (HR 6.045,95％ CI 1.602-29.580;P =0.016),and CE (HR 8.256,95％ CI 1.398-27.302;P=0.029).Conclusion There were significant differences in the risk factors,etiologies,and influencing factors of long-term outcome between the anterior circulation and posterior circulation in Chinese young patients with ischemic stroke,suggesting that the different diagnosis and treatment strategies should be adopted for the two types of patients.

Systemic lupus erythematosus combined with antiphospholipid syndrome and cerebral thrombosis in a child: a case report and literature review / 临床儿科杂志

Objective To explore the clinical features of systemic lupus erythematosus (SLE) combined with antiphospholipid syndrome (APS) and cerebral thrombosis in a child. Method The clinical data of SLE combined with APS and cerebral thrombosis in a child was retrospectively analyzed, and the related literature was reviewed. Results This was a 12-year-old boy. The disease onset with recurrent fever, confusion and rash in cheek. He had anemia and thrombocytopenia, and positive antinuclear antibody (ANA) and anticardiolipin antibody (aCL). Magnetic resonance imaging showed multiple cerebral infarction. The diagnosis of SLE combined with APS and cerebral thrombosis was clearly made. Methylprednisolone, cyclophosphamide, warfarin, meropenem and acyclovir were used for the treatment. At the same time, the patient also received intravenous immunoglobulin. Conclusion SLE combined with APS and cerebral thrombosis in children was usually in a severe condition, the prognosis of which can be effectively improve by early diagnosis and reasonable treatment.

Risk and predictors of stroke recurrence of patients with symptomatic intracranial internal carotid artery stenosis:long-term follow-up results / 国际脑血管病杂志

Objective To investigate the risk and predictors of stroke recurrence in patients with symptomatic intracranial internal carotid artery(IICA)stenosis.Methods Consecutive patients with first-ever ischemic stroke or transient ischemic attack (TIA) caused by IICA atherosclerotic stenosis were enrolled prospectively. The patients were regularly followed up to assess stroke recurrence. Results A total of 70 patients were enrolled, 49 patients were males, and the mean age was 68.2 ± 12.3 years. The mean follow-up time was 34 ± 17 months (median, 33 months). Twenty-seven patients (38.6%) experienced recurrent events during the follow-up period (5 TIAs and 22 ischemic strokes);92.6% of recurrent events occurred in the original symptomatic stenotic IICA territory. Internal watershed infarction in patients with recurrent stroke was more common than those without stroke recurrence(74.1% vs. 44.2%,P=0.025). Kaplan-Meier survival analysis showed that the risks of stroke recurrence at 1,3 and 5 years were 26.8%, 42.5%, and 46.9%, respectively in patients with symptomatic IICA stenosis. Multivariate Cox proportional risk regression analysis showed that the predictors for stroke recurrence in patients with symptomatic IICA stenosis included diabetes (hazard risk [HR] 3.68,95% confidence interval[CI] 1.43-9.46; P=0.007), combined asymptomatic intracranial artery occlusive disease(HR 2.95,95% CI 1.16-7.50;P=0.023),and internal watershed infarction (HR 4.50, 95% CI 1.43-14.17; P=0.010) after adjusting for sex, age and traditional vascular risk factors. Conclusions The risk of long-term stroke recurrence in patients with symptomatic IICA stenosis is still high under the current drug treatment. Diabetes, combined asymptomatic intracranial arterial occlusive disease, and internal watershed infarction are closely associated with stroke recurrence.

Clinical,imaging features and long-term outcomes in isolated anterior cerebral artery territory infarction:comparison of atherosclerotic stroke and non-atherosclerotic stroke / 国际脑血管病杂志

Objective To investigate clinical, imaging features, and long-term outcomes in patients with isolated anterior cerebral artery (ACA) territory infarction due to ACA atherosclerosis, and compare with isolated ACA territory infarction due to other etiologies. Methods The consecutive patients with acute isolated ACA territory infarction confirmed by diffusion-weighted imaging were enrolled prospectively. According to their stroke etiology, they were divided into ACA atherosclerotic stroke and non-ACA atherosclerotic stroke. The infarction patterns were classified as single infarction including perforating artery infarction (PAI), small branch infarction (SBI) and cortical branch infarction(CBI), and multiple infarctions (a combination of PAI,SBI or CBI).The clinical,imaging features and long-term outcomes were compared between the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group. Results A total of 86 patients (47 males) were enrolled, ages ranging from 39 to 88 years (mean 67.5 ± 12.5 years). There were 56 patients in the ACA atherosclerotic stroke group, and 30 patients in the non-ACA atherosclerotic stroke group (12 carotid atherosclerosis, 6 cardioembolism, 2 internal carotid artery dissection, 10 undetermined etiology). The proportions of females (53.6% vs. 30.0%; P= 0.043), progressive onset of stroke(58.9% vs. 20.0%;P=0.001),SBI alone(21.4% vs. 3.3%;P=0.029)and infarction involving small branches(80.4% vs. 46.7%;P=0.001)in the ACA atherosclerotic stroke group were higher than those in the non-ACA atherosclerotic stroke group, and CBI alone (17.9% vs. 55.3%, P=0.001) was lower. The follow-up times in the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group were 29.8 ± 16.5 months and 30.4 ± 18.5 months, respectively (P=0.534). Five-year cumulative incidence of adverse events (stroke, cardiovascular events and death) in the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group were 36.3% and 69.9% respectively(log rank test,P=0.021).Conclusions ACA atherosclerosis is the common etiology for isolated ACA territory infarction. The isolated ACA territory infarction due to ACA atherosclerosis had distinctive infarction patterns and a lower long-term incidence of adverse events compared with those due to non-ACA atherosclerosis.

Imidacloprid inhibits IgE-mediated RBL-2H3 cell degranulation and passive cutaneous anaphylaxis

BACKGROUND: Imidacloprid has been commonly used as a pesticide for crop protection and acts as nicotinic acetylcholine receptor agonists. Little information about the relationship between imidacloprid and allergy is available. OBJECTIVE: This study aims to examine the effects of imidacoprid on IgE-mediated mast cell activation. METHODS: The rat basophilic leukemia cell line RBL-2H3 (RBL-2H3 cells) were treated with 10⁻³ – 10⁻¹² mol/L imidacloprid, followed by measuring the mediator production, influx of Ca²⁺ in IgE-activated RBL-2H3 cells, and the possible effects of imidacoprid on anti-dinitrophenyl IgE-induced passive cutaneous anaphylaxis (PCA). RESULTS: It was shown that imidacoprid suppressed the production of histamine, β-hexosaminidase, leukotriene C4, interleukin-6, tumor necrosis factor-α, and Ca²⁺ mobilization in IgE-activated RBL-2H3 cells and decreased vascular extravasation in IgE-induced PCA. CONCLUSION: It is the first time to show that imidacloprid suppressed the activation of RBL-2H3 cells.

Applying a discriminant model based on combination of pediatric critical illness score,D - dimer and procalci-tonin in early predicting the severity of pediatric infection / 中华实用儿科临床杂志

Objective To establish a discriminant method based on clinical and laboratory data and common examinations for early predicting the severity of pediatric infection. Methods Consecutive hospitalized patients diag-nosed as septic shock were included who were admitted between June 2014 and May 2015 retrospectively. Gender (male - female ratio:1. 25∶ 1. 00)and age(1 month to 6 years old)were matched in all of 18 patients with septic shock,and 27 patients diagnosed as systemic inflammatory response syndrome(SIRS),sepsis and severe sepsis on ad-mission were included respectively in order of sequential admission number during the same period. Additional 36 gen-der - and age - matched children with common infection(non - SIRS)were enrolled as controls. The clinical and labo-ratory examination data of all the included patients were collected and then the pediatric critical illness scores(PCIS) were made according to the worst condition within 24 hours of hospitalization. The parameters correlated with the severi-ty of infection were evaluated by rank correlation and Logistic regression analysis. The discriminant models were estab-lished based on κth - nearest - neighbor analysis and evaluated with clinical diagnosis by interrater agreement test. Results Except for platelet count,the other indexes including PCIS,neutrophil count,C - reactive protein,procalcito-nin(PCT),international normalized ratio of prothrombin time,activated partial thromboplastin time,thrombin time,fi-brinogen,fibrin/ fibrinogen degradation product(FDP)and D - dimer(D - D)all had differences among groups with varying infection severity(all P ﹤ 0. 001). The Spearman's coefficient ρ of PCIS,PCT,D - D and FDP correlated to in-fection severity were - 0. 837,0. 680,0. 679 and 0. 648,respectively(all P ﹤ 0. 001). Multivariate cumulative odds Lo-gistic regression analysis showed PCIS,D - D and PCT were related to infection severity(all P ﹤ 0. 05). The total error rate of discriminant models based on 3 - index combination(Mahalanobis transformation,k = 2)was 0. 091 that was lower than any models based on 2 - index combination or single - index. Using the discriminant model based on three -index combination,the infection severity of 26 patients admitted during June 2015 were predicted with a high interrater a-greement(weighted Kappa coefficient:0. 670,P ﹤ 0. 001)compared to clinical diagnosis. Conclusion The discriminant model based on combination of PCIS,D - D and PCT could assist predicting the severity of pediatric infection earlier.

Effect of DDC on activity of SOD of Bifidobacteria infantis / 中国免疫学杂志

Objective:To investigate whether diethyldithiocarbamate (DDC) affect the activity of superoxide dismutase (SOD) of Bifidobacterium infantis ( BB ) .Methods: We used simple anaerobic activated ways to culture BB .After the bacterium reached platform growth period ,two concentrations (200 and 1 000 μmol/L) of DDC were added to bacterium medium for a specific period of time (0.5,1,2,4 and 24 h),which was in order to determine if this inhibitor affected the activity of SOD .As a positive control,the in-hibitory effect of DDC on the activity of SOD in murine intestinal samples was also checked .Results:It was found that incubation of BB with DDC for some specific periods showed no effect on the activity of SOD .However , the activity of SOD in intestine reduced dramatically after the mice were given DDC in vivo .Conclusion:DDC affect the SOD activity in mice ,while it showed no effect on SOD activity of BB.The suitable inhibitor for SOD of BB is not commercially available and further research is warranted .

Clinical and imaging characteristics in cryptogenic ischaemic stroke with right-to-left shunt / 中国神经精神疾病杂志

Objective To investigate the clinical and imaging characteristics in cryptogenic stroke with right-to-left shunt (RLS). Methods Fifty-two patients with cryptogenic ischaemic stroke were included in the study and divided into two groups according to transcranial Doppler (TCD) bubble test: RLS group (twenty-five patients) and non-RLS group (twenty-seven patients). The demographic data, traditional risk factors of stroke and characteristics of le?sion patterns were compared between two subgroups. Results There was no significant difference between the groups in age or sex ratio. The percentage of patients with no risk factors was significantly higher in RLS group than non-RLS group (44%vs. 14.8%, P=0.015). The lesion was more frequently observed in the vertebrobasilar artery territory in RLS group (56%vs. 14.8%, P0.05). Conclusions Vertebrobasilar Stroke without traditional cerebrovascular risk factors is more likely to be RLS-associated, which requires an advanced TCD bubble test to find the potential cause of stroke.

Risk of stroke recurrence and its predictors in young patients with ischemic stroke or transient ischemic attack / 中国脑血管病杂志

Objective Toinvestigatetheriskoflong-termrecurrenceofstrokeanditspredictorsin youngpatientswithischemicstroke/transientischemicattack(TIA).Methods Theclinicaldataofthe consecutive young patients (18-45 years)with ischemic stroke/TIA (within 2 weeks after onset)admitted to the department of neurology in the First Affiliated Hospital of Sun Yat-Sen University between August 2008 and July 2013 were enrolled prospectively. All patients were regularly followed up for a long time (The patients were followed up at the 1 st,6 th,and 12 th month after onset;then they were followed up once for every 6 months)in order to investigate stroke recurrence. The Kaplan-Meier curves were used to analyze the cumulative stroke recurrence rate of all patients. The last contact time for patients lost to follow was used as censored data to be enrolled in the analysis. The univariate analysis of the related risk factors for stroke recurrence using Log-rank test. Multivariate Cox proportional hazard regression was used to detect the related risk factors associated with stroke recurrence (adjusting for age and sex). The variables of the results of Log-ranktestP≤0.1wasselectedandenrolledinthemultivariateregressionanalysis.Results Atotalof 312 patients were enrolled in the analysis,including 294 with ischemic stroke and 18 with TIA. Their mean follow-up time was 34 ± 19 months. Thirty-four patients had recurrent stroke,including 23 with ischemic stroke,7 with TIA,and 4 with cerebral hemorrhage. The cumulative recurrence rates of stroke at 1 ,3 , and 6 years after onset were 6. 2%,10. 3%,and 16. 4%,respectively. The results of multivariate Cox proportional hazards regression analysis showed that hypertension (risk ratio [RR]2. 159;95% confidence interval [CI]1. 048-4. 447,P=0. 037)and cardioembolism (RR,2. 869;95%CI 1. 119-7. 357,P=0.028)weretheindependentpredictorsforstrokerecurrence.Conclusion Theoverall6-yearriskof recurrent stroke is not high in the Chinese young patients with ischemic stroke/TIA,but the risk of stroke recurrence is relatively higher in the first year. Hypertension and cardioembolism are the potential predictors of stroke recurrence;therefore,attention should be paid in clinical practice.

Assessments of intracranial arterial dissection causing ischemic stroke with magnetic resonance imaging / 中国脑血管病杂志

Objective To investigate the values of conventional magnetic resonance imaging (MRI),magnetic resonance angiography (MRA),and high-resolution MRI for diagnosing intracranial arterial dissection (IAD)caused ischemic stroke. Methods From August 2008 to April 2015,59 consecu-tive patients (age 45 ±15years,41males)with IAD caused ischemic stroke admitted to the First Affiliated Hos-pital of Sun Yat-Sen University were enrolled prospectively. All patients underwent conventional cranial MRI/MRA examination,25 of them underwent whole brain DSA examination,and 10 underwent high-resolution MRI. The findings of conventional MRI/ MRA and high-resolution MRI of IAD were analyzed. For patients undergoing DSA,the proportions of detection and compliance of IAD were compared between DSA and conventional MRI / MRA. Results (1)Conventional MRI / MRA revealed typical sign of artery dissection in 42 patients (71. 2%),among them,the intramural hematoma (n = 22,52. 4%)was most common. Other common signs included intimal flap/ double lumen sign (n = 13,31. 0%)and long irregular or thread-like stenosis (n = 9,21. 4%);while dissecting aneurysm (n = 7,16. 7%)and rat tail-shaped occlusion (n = 3, 7. 1%)were relatively rare. In 17 patients (28. 8%)with IAD that conventional MRI/ MRA did not detect the typical dissection sign,the dissections were involved in the middle cerebral artery (11 / 17,64. 7%), they were more common than the 42 patients with IAD (10 / 42,23. 8%)detected the typical dissection sign by conventional MRI/ MRA. There was significant difference (P = 0. 006). (2)Among the 25 patients undergoing DSA,DSA revealed that 15 patients (60%)had the typical dissection sign,and conventional MRI/ MRA only revealed 8 of them (32%)with the typical dissection sign,but there was no significant difference (P = 0. 088). In 15 patients with IAD that DSA detected the typical dissection sign;conventional MRI / MRA detected the typical dissection sign in 8 of them. The diagnostic coincidence rate was 8 / 15. (3)Both conventional MRI/ MRA and DSA revealed non-specific limitation stenosis or cut-off occlusion in 10 patients (16. 9%)with IAD,while the high-resolution MRI revealed intimal flap in 5 of them,intramural hematoma in 4,and intimal flap and intramural hematoma in 1. Conclusion Conventional cranial MRI/MRA is an effective technique for revealing IAD,whereas high-resolution MRI has the unique advantages for diagnosing IAD without typical dissection in other vascular imaging.

Risk factors, diagnostic evaluation, etiology and treatments in young patients with ischemic stroke：a prospective single center study / 国际脑血管病杂志

Objective To investigate the risk factors, diagnostic evaluation, etiology, and treatment in young patients with ischemic stroke. Methods The clinical data of young patients (age range 18 - 45 years) with ischemic stroke (within 2 weeks of stroke onset) admitted to the Stroke Center, the First Affiliated Hospital of Sun Yat-sen University from August 2008 to July 2013 were registered prospectively. Results A total of 300 patients were enroled, their age was 37. 8 ± 6. 8 years. There were 227 males (75. 7% ). The age of 84 patients (28. 0% ) was ≤35 years. The most common risk factors were smoking (43. 3% ), hypertension (38. 7% ), and hypercholesterolemia (38. 0% ). The positive result detection rates were lower in the antinuclear antibody (8/278), anticardiolipin antibody (34/250), 24-h Holter monitoring (2/60 ), and transthoracic echocardiography (38/232). According to the MRI findings, the detection rate of the white matter changes, old infarcts, single acute infarcts, and multiple acute cerebral infarcts were 40/282, 77/282, 145/282, and 137/282, respectively. The stroke subtypes of TOAST: large artery atherosclerosis (26. 7% ), smal artery occlusion (18. 0% ), cardioembolism (10. 0% ), other determined etiology (23. 0% ), and undetermined etiology (22. 3% ). Large artery atherosclerosis was mainly involved in anterior circulation (69/80) and intracranial arteries (75/80). In other definite causes, cerebral artery dissection was most common (36/69), and other causes included moyamoya disease (7/69) and infectious vasculitis (7/69), etc. The average length of hospital stay was 15. 4 d. The mean National Institutes of Health Stroke Scale score on admission was 7. 0, and the mean modified Rankin scale score at discharge was 2. 5. The complication rate during hospitalization was 9. 7% . 80. 3% and 48. 3% of patients received anti-platelet drugs and statins therapy during hospitalization.Conclusions This study used a prospective single-center method. It conducted a comprehensive analysis of risk factors, diagnostic evaluation, treatment, and etiology in current Chinese young patients with ischemic stroke. Its research data wil provide useful information for establishing a diagnostic strategy of high performance cost ratio, in-depth understanding of its pathophysiological mechanisms, and improving treatment strategies in Chinese young patients with ischemic stroke.

Detection of RASSF2 and sFRP1 promoter region methylation in sporadic colorectal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the methylation in promtor region of RASSF2 and sFRP1 in sporadic colorectal cancer patients in order to provide screening method for early colorectal cancer.</p><p><b>METHODS</b>The methylation in promoter region of RASSF2 and sFRP1 in serum samples of 59 sporadic colorectal cancer patients and 59 healthy volunteers was detected by methylation specific PCR. The association between clinicopathological features of sporadic colorectal cancer patients and methylation in promoter region of RASSF2 and sFRP1 was analyzed.</p><p><b>RESULTS</b>The methylation rates of RASSF2 and sFRP1 gene in serum of 59 sporadic colorectal cancer patients were 27.1% and 30.5%, significantly higher than those in healthy volunteers(0%, both P<0.01). The methylation of RASSF2 or sFRP1 occurred in 29(49.2%) patients, which was significantly higer than the methylation rate of single gene(P<0.05). No association was found between methylation ratio of RASSF2 and sFRP1 and clinicopathological features in sporadic colorectal cancer patients.</p><p><b>CONCLUSIONS</b>Methylation in promoter region of RASSF2 and sFRP1 is often detected in serum of colorectal cancer patients. The combination detection of methylation for the two genes may provide information for early screening of colorectal cancer.</p>

Transumbilical single incision laparoscopic cholecystectomy in 51 cases / 中国基层医药

Objective To explore the feasibility and safety of laparoscopic cholecystectomy through a transumbilical single incision.Methods The clinical data of 51 patients with gallbladdder calculi or polyps who underwent transumbilical single incision laparoscopic cholecystectomy were retrospectively analyzed,and compared with the clinical efficiency of 38 patients with gallbladdder calculi or polyps who underwent conventional laparoscope cholecystectomy.Results In the observation group and control group,it showed significant differences (P ＜ 0.05 or 0.01) in the length of hospital stay of (3.0 ± 1.2) d vs (5.7 ± 1.6) d,and the VAS score of (1.2 ± 1.0) vs (2.5 ± 1.2),the abdominal wound satisfaction of 96.08％ vs 22.68％,there was no difference in the operation time,the peri-operative bleeding and the complications situation (all P ＞ 0.05).Conclusion Transumbilical single incision laparoscopic cholecystectomy is a minimally invasive,safe and effective procedure for benign diseases of the gallbladdder with excellent cosmetic results,and deserves to generalize in clinic.