[Analysis of Correlation of Immune T Cell Subsets, TNF-α, IFN-γ and sFas levels with Severity and Prognosis in Aplastic Anemia Patients].

OBJECTIVE: To explore the correlation of immune T cell subsets and expression levels of TNF-α, IFN-γ and sFas with the severity and prognosis of aplastic anemia(AA) patients. METHODS: Ninety-five patients with aplastic anemia treated in our hospital were selected and enrolled in AA group, 43 cases of which were included in the acute group and 52 cases in the chronic group according to the disease status of patient's. Then, 50 cases of healthy volunteers in the same period were enrolled in the control group, and the changes of immune T cell subsets, and sFas serum TNF-α, IFN-γ and levels of the 3 groups were compared. The ROC curve was used to analyze the value of each index for evaluating the severity of the disease, 95 patients with aplastic anemia were followed up and the Kaplan-Miere survival curve was used to analyze the effect of different index levels on the progression-free survival of the patients. RESULTS: the serum level of CD4+ level and CD4+ /CD8+ ratio in AA group were significantly lower than those in the control group (P<0.05), and the CD8+ level in AA group was significantly higher than that in the control group (P<0.05). The CD4+ level and CD4+ /CD8+ ratio in the acute group was significantly lower than those in the chronic group (P<0.05), and the CD8+ level in the acute group was significantly higher than that in the chronic group (P<0.05). The serum level of TNF-α and IFN-γ of the patients in AA group was significantly higher than those in the control group (P<0.05), and the level of sFas in AA group was significantly lower than those in the control group (P<0.05). The levels of serum TNF-α and IFN-γ in the acute group were significantly higher than that in the chronic group (P<0.05), and the level of sFas was significantly lower than that in the chronic group (P<0.05). The analysis of each index value for predicting the severity of AA by ROC showed that the area under curve of CD4+ /CD8+ , TNF-α, IFN-γ and sFas for predicting the patients' condition was 0.954, 0.763, 0.853 and 0.857, respectively. Kaplan-Miere survival curve analysis showed that CD4+ /CD8+ ratio had a significant effect on progression-free survival (P<0.05), the TNF-α, IFN-γ and sFas levels had no significant effect on progression-free survival (P>0.05). CONCLUSION: The patients with aplastic anemia have significantly abnormal T lymphocyte subsets, there is a certain correlation between the serum TNF-α, IFN-γ and sFas levels with aplastic anemia, each index can reflect the disease severity, and the changes of T lymphocyte subsets has important influence on the clinical prognosis of the patients.

Acetyl-l-carnitine prevents homocysteine-induced suppression of Nrf2/Keap1 mediated antioxidation in human lens epithelial cells.

Previous studies have revealed that high levels of serum homocysteine (Hcy) are closely associated with the development of juvenile and age-related cataracts. An increased concentration of Hcy is likely to induce gene specific demethylation in DNA promoter regions. The aim of the present study was to prevent this demethylation by administering acetyl-l-carnitine (ALCAR) to human lens epithelial cells (HLECs). Different concentrations of Hcy were used to treat HLECs for 3, 6, 12 and 24 h and the findings were used to determine the optimum dose to induce endoplasmic reticulum (ER) stress. Similarly, the concentration of ALCAR was standardized. The production of reactive oxygen species (ROS) and the percentage of cells undergoing cell death were measured. The levels of antioxidants, ER stress-associated proteins, mRNA levels of nuclear factor erythroid-2-related factor 2 (Nrf2), Kelch-like ECH-associated protein 1 (Keap1) and promoter DNA methylation of the Keap1 gene were also assessed. Hcy was observed to induce ER stress, produce ROS and lead to cell death. However, administration of ALCAR prevented these effects to a significant degree. Additionally, western blot analysis revealed that ALCAR increased the levels of antioxidant proteins, including catalase, superoxide dismutase, glutathione peroxidase, Nrf2, Keap1 and glutathione. Similarly, the reverse transcription-quantitative polymerase chain reaction experiments on Nrf2 and Keap1, as well as the bisulfite genomic DNA sequencing analysis revealed a preventive effect of ALCAR against Hcy-induced ER stress. The ER stress-induced activation of the unfolded protein response is responsible for demethylation of Keap1 promoter DNA to activate the expression of the Keap1 protein, which then increases the targeting of Nrf2 for proteosomal degradation. This decrease in Nrf2 activity represses the transcription of numerous antioxidant enzyme genes and alters the redox-balance towards lens oxidation. However, treatment with ALCAR led to significant protection from these effects. The present results suggested that ALCAR either prevents or ameliorates the actions of the antioxidant system in HLECs at the level of the protein and the gene. Further advanced studies are required for the development of ALCAR as an anti-cataract agent.

Relationship between glycated haemoglobin and subclinical atherosclerosis in obese children and adolescents.

OBJECTIVE: To explore the relationship between glycated haemoglobin A1C (HbA1C) and subclinical atherosclerosis as assessed by carotid intima-media thickness (cIMT) in Chinese Han obese children and adolescents without diabetes. METHODS: A total of 524 obese children and adolescents without diabetes were analysed. All participants underwent HbA1C measurements, oral glucose tolerance tests and ultrasound measurements of cIMT. The logistic regression models were implemented to evaluate the adjusted OR of HbA1C for increased cIMT. RESULTS: In obese boys, HbA1C was associated with increased cIMT independently of age, measurements of anthropometry, blood pressure, plasma lipid and lipoprotein, fasting plasma glucose, 2 h postchallenge glucose, uric acid and hepatic function. After adjustment for all these risk factors, the OR of increased cIMT for every 1% (11 mmol/mol) increase in HbA1C was 2.702 (95% CI 1.640 to 4.452). However, in girls, the major risk factor independently associated with cIMT was measurement of abdominal obesity instead of HbA1C. CONCLUSIONS: Our research suggests that the adoption of HbA1C as a diagnostic criterion of prediabetes and diabetes in obese boys may help to identify early macrovascular complications.

Carotid intima-media thickness and serum endothelial marker levels in obese children with metabolic syndrome.

OBJECTIVE: To investigate carotid intima-media thickness (IMT) and serum endothelial marker levels in obese Chinese children. DESIGN: Observational and descriptive study. SETTING: Hangzhou, China. PARTICIPANTS: A total 131 obese children, including 29 with at least 2 components of metabolic syndrome (MS) (MS group), 102 with less than 2 components of MS (obese group), and 31 nonobese children (control group) were enrolled. MAIN OUTCOME MEASURES: Intima-media thickness, von Willebrand factor (vWF) level, and thrombomodulin level. RESULTS: Compared with the control group, the obese group had greater IMT and higher vWF level (P < .05 for all). The mean (SD) vWF levels in the obese, MS, and control groups were 2.08 (0.78), 2.42 (0.98), and 1.54 (0.48) IU/mL, respectively, which were significantly different (P < .001). Intima-media thickness in the obese and MS groups was significantly greater than that in the control group. Intima-media thickness in the MS group was greater than that in the obese group. Multiple regression analysis showed that ratio of waist to height, vWF level, and triglycerides level were independent determinants of IMT. CONCLUSIONS: Our findings suggest endothelial injury in obese children. Intima-media thickness and vWF level might be useful to identify the degree of endothelial damage.

Ultrasonographic characteristics of urolithiasis in children exposed to melamine-tainted powdered formula.

BACKGROUND: Since the outbreak of renal diseases among children who had consumed melamine-tainted powdered formula in 2008, urinary system ultrasound examination was carried out for these children at our hospital. This study aimed to investigate the ultrasonographic characteristics of urolithiasis caused by melamine-tainted powdered formula. METHODS: From September 12 to October 9, 2008, urinary system ultrasound examination for children after consumption of melamine-tainted powdered formula was carried out at the Children's Hospital of Zhejiang University, China. A total of 15,577 infants and children were subjected to the examination. A questionnaire with items including demographic characteristics, history of exposure and clinical symptoms were completed before examination. RESULTS: Among the 15,577 children, 7988 were boys and 7,589 girls with age ranging from 1 month to 15 years (mean age, 22 months). Urolithiasis was found in 562 patients with an identification rate of 3.6%. Urolithiasis was identified mainly in the children aged 36 months or younger (88.6%). Unilateral kidney calculi were found in 431 children and bilateral kidney calculi in 131 children. Eleven of these children also had ureteric calculi, 1 had bladder calculi, 2 had urethral calculi, and 2 had gallbladder calculi. Fifteen children had urinary tract obstruction. Ultrasonographic characteristics of these melamine calculi were different from the calcium oxalate calculi, i.e., the lesions were less echogenic, had a more "sandy" appearance and were less dense. The posterior portion of the calculi could be observed and was accompanied with a feeble or absent acoustic shadow. CONCLUSIONS: Melamine-induced calculi were ultrasonographically less echogenic, sand-like and discrete; the posterior portion of the calculi was accompanied with a feeble or absent acoustic shadow. It might be a new type of urolithiasis in children.

[Assessment of the characteristics of echocardiography in pediatric patients with total anomalous pulmonary venous connection].

OBJECTIVE: To assess the accuracy of echocardiography in diagnosis of total anomalous pulmonary venous connection (TAPVC). METHODS: A combination of suprasternal, parasternal, subcostal and apical views were employed to diagnose TAPVC and to trace the course of the anomalous pulmonary venous connection, the direction of the inter-atrial shunt, enlargement of right atrium (RA) and right ventricle (RV), superior and inferior vena cava. All pediatric patients underwent surgical repair. The results of echocardiography were compared with surgical findings. RESULT: A total of 28 consecutive pediatric patients with suspected TAPVC were included in this study. The TAPVC diagnosis was confirmed in 26 cases after surgery, partial anomalous pulmonary venous connection (PAPVC) in one case, and Cor Triatriatum and possible TAPVC in another. The diagnostic accuracy of TAPVC by echocardiography in the study was 92.86%. There were 17 supracardiac TAPVC, 11 intracardiac TAPVC. In all patients, enlargement of the RA and RV, inter-atrial right-to-left shunt via atrial septal defects were documented in parasternal and subcostal views. Common pulmonary vein or four pulmonary vein direct to RA or via coronary sinus to RA were the draining sites of intracardiac TAPVC. The enlargement of left innominate vein-right superior vena cava draining to RA was seen in supracardiac TAPVC. CONCLUSION: A combination of suprasternal and subcostal multi-views in echocardiography can increase the diagnostic accuracy of TAPVC in pediatric patients.

[Study on the status and quality of sleep-related influencing factors in medical college students].

OBJECTIVE: To study the status and influencing factors on sleep quality in some medical college students. METHODS: Stratified sampling, pittsburgh sleep quality index (PSQI), self-evaluation depression scale (SDS), self-evaluation anxiety scale (SAS) and self-developed questionnaire of influencing factors on the quality of sleep in medical college students were used. Cumulative odds logistic model was performed to analyze the related factors on the quality of sleep. RESULTS: 19.17 percent of the medical college students showed poor quality of sleep and the difference between genders was not statistically significant (P > 0.05). Statistically significant (P < 0.05) difference was seen among different years of students and correlation was found between sleep quality and depression or anxiety (P < 0.0001). Factors influencing on the quality of sleep in medical college students would include: worry of sleep, irregular work/rest, worry on examination, stress, relationship with classmates, self-evaluated health condition, environments of the dormitory and late to bed. CONCLUSION: Influencing factors were identified and comprehensive measures should be taken to improve the quality of sleep.

[PCR in evaluating the effect of allicin and its combination with SMZco on murine toxoplamosis].

OBJECTIVE: To evaluate the effect of allicin alone or combined with SMZco on murine toxoplasmosis by a specific, rapid, and sensitive PCR technique. METHODS: 147 mice were infected with 2 x 10(4) tachyzoites intraperitoneally and divided into 5 groups at random. Each group was divided into two sub-groups except an untreated group. One subgroup was used to get samples for PCR test and the other for observing the survival duration. The therapeutic grouping was as follows: group A, a combination of allicin and SMZco administered orally for 7 days and continued by allicin alone till 21 days; group B, the combination administered for 14 days and continued with allicin till 21 days; group C, allicin alone for 21 days; group D, SMZco alone for 7 days; group E, untreated control. The dosage was: SMZco 400 mg/(kg.d) and allicin 35 mg/(kg.d). PCR test was used to detect the parasites in samples of liver and blood from infected mice at 5, 10, 15, 20, 25, 30, 40 and 50 days after infection. RESULTS: Parasites were eliminated in the blood because no signal was seen in all the blood samples except for samples from group C at day 5 after infection. From day 10 after infection until the end of the experiment, no amplification of DNA was seen in all the samples. As for liver samples, signals were clear at day 5 post infection. From day 10 post infection till the day 50 post-infection, parasites were still detected, but the PCR products decreased significantly than that of day 5 post-infection. Result showed that a combination of SMZco with allicin provided a significant protection. SMZco alone was also effective, but allicin alone was not. CONCLUSION: When SMZco is used in combination with allicin, a much higher efficacy is received in the treatment of acute murine toxoplasmosis.