Objective To evaluate the combination of the mortality in emergency department sepsis (MEDS) score with blood lactate level in the risk stratification of patients with severe sepsis in the emergency department (ED).Methods 665 adult patients with severe sepsis admitted from May 2011 to December 2012 in ED were found to be eligible for the study.MEDS score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,and arterial blood lactate was determined,and the outcomes in 28 days were recorded.Logistic regression analysis was used to evaluate the relationship between each predictive factor score and prognosis.Each predictive factor was compared with the areas under the receiver operating characteristics (ROC) curve (AUC).Results The mortality in 28 days was 34.6％ in 665 patients.The mortality in group of MEDS score 12-27 was significantly higher than that group of MEDS score＜12 [51.0％ (156/306) vs.20.6％ (74/155),x2=28.414,P=0.000].In the meantime,APACHE Ⅱ score and blood lactate level were also significantly higher in group of MEDS score 12-27 than those in group with MEDS score＜12 [APACHE Ⅱ score:26.4 ± 10.6 vs.21.7 ± 8.1,t=-3.555,P=0.002; lactate (mmol/L):4.9 (2.3,9.9)vs.3.9 (1.5,8.9),Z=-2.352,P=0.023].Kaplan-Meier survival analysis showed significantdifference in the two groups (the Log Rank test 36.71,P ＜0.01).The levels of 3 predictive factors were predominantly higher in non-survivors than survivors [MEDS score:14.1 ± 6.7 vs.8.2 ± 4.5,t=-6.929,P=0.000; APACHE Ⅱ score:28.1 ±7.1 vs.22.2± 11.3,t=-6.472,P=0.000; lactate (mmol/L):5.4 (2.9,11.0) vs.3.8 (1.2,9.1),t=-6.472,P=0.004].The AUCs were 0.813,0.706 and 0.727 for MEDS score,APACHE Ⅱ score and blood lactate respectively.The predictive ability for 28-day mortality of MEDS score was better than blood lactate (P=0.008) and APACHE Ⅱ score (P=0.005).The AUC of MEDS score combined with lactate was 0.865,and 28-day mortality prediction was better than MEDS score (AUC 0.865 vs.0.813,P＜0.001).The sensitivity (83.1％),specificity (93.2％),positive prediction value (PPV,62.4％),and negative prediction value (NPV,92.1％) for MEDS score combined with lactate were highest among all predictors.Conclusion MEDS score combined with lactate is a good risk stratification tool for emergency patients with severe sepsis,and its prognostic capability is better than either MEDS score,APACHE Ⅱ score or blood lactate.

OBJECTIVE:Study regarding Smad3/transforming growth factor-β1(TGF-β1)signal transduction in pathological scars mainly focus on in vitro cultured fibroblasts,however,the correlation study was rare on keloid.The aim of this study is to detect the expressions of Smad3 and TGF-β1,and investigate their relationship in pathogenesis and development of pathological scars METHODS:Experimental samples were obtained frOm the patients who underwent burn and plastic surgery at the Department of Burn and Plastic Surgery,Workers'Hospital of Tangshan,Hebei Medical University,from June 2004 to June 2008,including 48 patients with Keloid,aged 16-52 years,and 40 patients with hypertrophic scars aged 18-56 years.Normal skins from additional 40 cases were served as controls The expressions of Smad3 and TGF-β1 protein in keloid,hypertrophic scars and normal skin were examined by flow cytometry.RESULTS:The expression of Smad3 and TGF-β1 were obviously greater in the experimental group than that of the control group (P＜0.05),but the difference between keloid and hypertrophic scars had no significance(P＞0.06).There was a positive correlation between Smad3 and TGF-β1 in keloid and hypertrophic scars(r=0 489 2,P=0.000 4:r=0.471 0,P=0.002 2).No notable correlation was found between Smad3 and TGF-β1 in normal skins(P=0.471 4).CONCLUSION:The expressions of Smad3 and TGF-β1 are up-regulated and the synergism of Smad3 and TGF-β1 may promote the development in pathological scars.

BACKGROUND:Autologous bone marrow mesenchymal stem cel transplantation for the treatment of cardiovascular disease has become one of the hotspots, but it is unclear whether the proliferation and directional differentiation of autologous bone marrow mesenchymal stem cels varies changes with age. OBJECTIVE: To explore the proliferation and differentiation changes of rat bone mesenchymal stem cels in different ages. METHODS:The bone marrow mesenchymal stem cels from Sprague-Dawley rats in different age groups were purified and cultured, and then examined by flow cytometry in terms of cel cycle. Meanwhile, neonatal rat cardiomyocytes were co-cultured with bone marrow mesenchymal stem cels. The morphologic changes of bone marrow mesenchymal stem cels and the protein expression of troponin T were detected with immunofluorescence technique. RESULTS AND CONCLUSION: The percentage of bone marrow mesenchymal stem cels in G0/G1 phase was increased with age; while the percentage of expression of troponin T proteins-positive bone marrow mesenchymal stem cels were decreased with age. These findings indicate that the proliferation and differentiation abilities of rat bone marrow mesenchymal stem cels descend with age.

OBJECTIVETo review the clinical features of a families affected with glutaric acidemia type I (GA-1) and screen potential mutations in glutaryl-CoA dehydrogenase (GCDH) gene.

METHODSClinical data of the patients and their family members was analyzed. Genomic DNA was extracted from peripheral blood samples. The 11 exons and flanking sequences of the GCDH gene were amplified with PCR and subjected to direct DNA sequencing.

RESULTSTwo patients have manifested macrocephaly. Imaging analysis revealed arachnoid cyst and subdural effusion. The elder sister had encephalopathy crisis. The younger sister had significantly raised glutaric acid, whilst the elder sister was normal during the non-acute phase. Genetic analysis has revealed a homozygous c.1244-2A> C mutation of the GCDH gene in both patients.

CONCLUSIONThe clinical features and mutation of the GCDH gene have been delineated in a Chinese family affected with GA-1. The c.1244-2A> C mutation may be particularly common in the Chinese population.

Adolescent ; Amino Acid Metabolism, Inborn Errors ; diagnostic imaging ; enzymology ; genetics ; Base Sequence ; Brain Diseases, Metabolic ; diagnostic imaging ; enzymology ; genetics ; China ; DNA Mutational Analysis ; Family Health ; Female ; Genetic Predisposition to Disease ; genetics ; Glutaryl-CoA Dehydrogenase ; deficiency ; genetics ; Homozygote ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Mutation ; Radiography

OBJECTIVE: To detect potential variation in glutaryl-CoA dehydrogenase (GCDH) gene among three Chinese families affected with glutaric acidemia type Ⅰ(GA-1) and correlate the genotypes with phenotypes. METHODS: Genomic DNA was extracted from peripheral blood samples derived from three patients with GA-1 and their family members. The coding regions of the GCDH gene were amplified with PCR and subjected to Sanger sequencing. RESULTS: The clinical manifestation of the patients varied from macrocephaly to severe encephalopathy, with notable phenotypic difference between siblings carrying the same variation. In pedigrees 1 and 2, the probands have carried compound heterozygous variations c.1133C>T(p.Ala378Val) and c.1244-2A>C, which were derived their fathers and mothers, respectively. In pedigree 3, the proband has carried compound heterozygous variation c.339delT (p.Tyr113) and c.406G>T (p.Gly136Cys). Among these, variations c.339delT and c.1133C>T were verified as novel by retrieval of dsSNP, HGMD and 1000 genome database. Bioinformatic analysis suggested that above variations can affect protein function and are probably pathogenic. CONCLUSION Above discovery has expanded the mutation spectrum of the GCDH gene. No correlation was found between the clinical phenotype and genotype of GA-1 patients.
Amino Acid Metabolism, Inborn Errors ; diagnosis ; genetics ; Brain Diseases, Metabolic ; diagnosis ; genetics ; China ; DNA Mutational Analysis ; Glutaryl-CoA Dehydrogenase ; deficiency ; genetics ; Humans ; Mutation

Objective:To investigate the effect of myeloid-derived suppressor cells (MDSC) on guanylate binding protein 1 (GBP1) in promoting the proliferation of glioma U87 cells and its mechanism.Methods:Glioma cells U87 with GBP1 overexpression (U87-GBP1) and control cells U87-Lacz transfected with empty vector were used as experimental cells. The mRNA and protein expressions of GBP1 and chemokine (C-C motif) ligand 2 (CCL2) in two groups of cells were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), Western blot and enzyme linked immunosorbent assay (ELISA), and the proliferation of U87 cells were detected by CCK-8. CD14 + monocytes and CD3 + T lymphocytes were isolated from peripheral blood of healthy people by immunomagnetic beads. The CD14 + monocytes were treated with culture medium of U87-Lacz cells or U87-GBP1 cells, and then the cells were divided into U87-Lacz culture medium group and U87-GBP1 culture medium group. The proportion of MDSC in CD14 + monocytes was analyzed by flow cytometry. CD14 + monocytes treated by two culture medium groups were cocultured with activated CD3 + T lymphocytes, and flow cytometry was used to detect the proliferation of activated CD3 + T lymphocytes. Monocytes untreated by U87 cells culture medium or activated CD3 + T lymphocytes were used as the control group. CD14 + monocytes were treated with U87-Lacz or U87-GBP1 cell culture medium anti-human CCL2 antibody, which were U87-Lacz+anti-CCL2 culture medium group and U87-GBP1 + anti-CCL2 culture medium group, and the proportion of MDSC in CD14 + monocytes was analyzed by flow cytometry. U87-GBP1 and U87-Lacz cells were inoculated into BALB/c nude mice to cause tumors in the brain. One week later, they were divided into chemokine (C-C motif) receptor 2 (CCR2) inhibitor RS504393 treatment group (U87-Lacz + RS nude mice group and U87-GBP1+RS nude mice group) and untreated control group (U87-Lacz nude mice group and U87-GBP1 nude mice group). After 30 days, the mice were sacrificed and the brain, spleen and bone marrow were isolated. Hematoxylin-eosin (HE) staining was used to observe the transplanted tumors in the brain of nude mice, and the volume of transplanted tumor was calculated, and flow cytometry was used to detect the proportion of MDSC in the tissues. Results:The protein expression of GBP1 in U87-GBP1 cells was significantly higher than that in U87-Lacz cells, but there was no significant difference in cell proliferation level between the two groups in vitro ( P > 0.05). The proportion of MDSC in U87-GBP1 culture medium group was significantly higher than that of U87-Lacz culture medium group [(7.75±0.80)% vs. (4.50±0.08)%], and both groups were higher than that of control group [(2.55±0.31)%)] ( F = 18.27, P = 0.002). The percentage of activated CD3 + T lymphocytes in U87-GBP1 culture medium group was lower than that in U87-Lacz culture medium group [(47.38±0.08)% vs. (61.70±5.05)%, P = 0.040]. The relative expression of CCL2 mRNA in U87-GBP1 cells and the expression level of CCL2 protein in U87-GBP1 cell culture medium [30.66±0.17 and (1 005.00±12.23) ng/L] were higher than those in U87-Lacz cells [1.29±0.15 and (111.60±11.44) ng/L] (both P < 0.01), the proportions of MDSC in U87-Lacz + anti-CCL2 culture medium group and U87-GBP1 + anti-CCL2 culture medium group was lower than those in U87-Lacz culture medium group and U87-GBP1 culture medium group (all P < 0.05). The volume of transplanted brain tumor in U87-GBP1 nude mice group was larger than that in U87-Lacz nude mice group; the volume of transplanted brain tumor in U87-GBP1 + RS nude mice group and U87-Lacz + RS nude mice group increased more slowly than the corresponding nude mice group without treatment, and the differences were statistically significant (all P < 0.05); the proportions of MDSC in transplanted brain tumor, spleen and bone marrow in U87-GBP1 nude mice group were higher than those in U87-Lacz nude mice group, and the proportions of MDSC in each tissue of U87-GBP1 + RS nude mice group and U87-Lacz + RS nude mice group were lower than those in the untreated by RS504393 corresponding nude mice group, and the differences were statistically significant (all P < 0.05). Conclusion:GBP1 might increase the expression of CCL2 in glioma U87 cells and recruit MDSC to form immunosuppression in glioma microenvironment, thus promoting the proliferation of glioma U87 cells in vivo.

Objective:To explore the predictive effect of European treatment and outcome study long term survival (ELTS) score on survival outcomes in chronic myeloid leukemia of chronic phase (CML-CP) children.Methods:A single-center retrospective cohort study was conducted. Clinical data of 216 children with CML-CP in Peking University People′s Hospital from January 2010 to December 2023 were analyzed. Children were divided into low, intermediate and high-risk groups according to ELTS score. The survival outcomes and prognostic factors were analyzed. Kaplan-Meier method and Log-Rank test were used for survival analysis.Cox regression model was applied for analysis of prognostic factors.Results:Among the 216 children with CML-CP, there were 122 males and 94 females, with the diagnosis age of 11.0 (8.0, 14.7) years. The follow-up time was 77 (57, 99) months. According to ELTS score, 145, 52, and 19 children were classified as low, intermediate and high-risk group. For the low-risk and intermediate/high-risk groups, the 6-year failure-free survival (FFS) rates were (83.0±3.1)% and (64.6±5.7)%, the 6-year progression-free survival (PFS) rates were (91.4±2.3)% and (78.7±4.8)%, and the 6-year event-free survival (EFS) rates were (80.8±3.3)% and (64.2±5.7)%, with statistically significant difference ( χ2=9.45, 7.16, 7.40, P=0.002, 0.007, 0.007), respectively.The 6-year overall survival (OS) rates were (98.5±1.0)% and (95.6±2.4)%, without statistically significant difference ( χ2=0.35, P=0.550). Multivariate analysis showed that ELTS score was an independent prognostic factor or tendency for FFS ( HR=1.97, 95% CI 1.11-3.49), PFS ( HR=2.95, 95% CI 1.18-7.39), and no independent prognostic factor for EFS and OS were found. Conclusions:ELTS score at diagnosis can help stratify the risk of children with CML-CP. The children in intermediate/high-risk group are more likely to have treatment failure, disease progression than those in low-risk group, but the predictive ability of ELTS score for OS is limited.

Objective:To explore the clinical characteristics and prognosis of children with chronic myeloid leukemia in the blast phase (CML-BP) .Methods:The clinical characteristics, treatment measures, and survival outcomes of 28 children with CML-BP were analyzed in our hospital from January 2008 to November 2022.Results:The male to female ratio of the 28 children with CML-BP was 1.15∶1. The median age of diagnosis of CML-BP was 10 years, and the median follow-up time was 79 months. During the diagnosis of CML, four children were in the BP, one was in the accelerated phase (AP) and 23 children were in the chronic phase (CP). Among the 23 children with CML-CP, 75% had progressed directly from CP to BP without experiencing the AP. Among the children diagnosed with CML-BP, 71.4% were classified as chronic myeloid leukemia lymphoid blast phase (CML-LBP), 25.0% belonged to the chronic myeloid leukemia myeloid blast phase (CML-MBP), and 3.6% belonged to the chronic myeloid leukemia mixed phenotype acute leukemia (CML-MPAL). Treatment with hemaopoietic stem cell transplantation (HSCT) after tyosine kinase inhibitor (TKI) combined with chemotherapy was administered to 19 children, two children received HSCT after TKI alone, and seven children received TKI combined with chemotherapy but without HSCT. The 5-year overall survival of the 28 children with CML-BP was 59.3%.Conclusion:The direct progression of BP from CP is greater in children with CML-BP compared with adults, and the overall prognosis of children with CML-BP is poor.