Objective To screen the differentially expressed proteins of blood stasis blocking tendon and vessel syndrome and liver-kidney deficiency syndrome of the steroid-induced osteonecrosis of the femoral head ( SONFH) by proteomic technology, so as to supply evidence for Chinese medical syndrome classification. Methods The serum was taken separately from 10 patients with blood stasis blocking tendon and vessel syndrome, 10 patients with liver-kidney deficiency syndrome and 10 healthy volunteers. The two dimensional electrophoresis combined with mass spectrometric method was applied to screen and identify the differentially expressed proteins, and then the obtained protein candidates were verified by Western blotting method. Results Seven proteins were identified from differentially expressed protein spots, including hemoglobin subunit delta, actin, complement C4, antithrombin-Ⅲ, apolipoprotein A-IV, leucine-rich alpha-2 glycoprotein and serum amyloid A-2 protein. We found that antithrombin-Ⅲ and serum amyloid A-2 protein had specific expression in the SONFH patients with blood stasis blocking tendon and vessel, and complement C4 and leucine-rich alpha-2-glycoprotein had specific expression in the SONFH patients with liver-kidney deficiency syndrome. The results of Western blot method showed that the expression levels of complement C4 and antithrombin-Ⅲ were down-regulated in SONFH patients ( P<0.05 compared with the healthy volunteers) , the down-regulation of complement C4 was more obvious in SONFH patients with liver-kidney deficiency syndrome (P<0.05) and the down-regulation of antithrombin-Ⅲ was more obvious in the patients with blood stasis blocking tendon and vessel (P<0.05), the results being accorded with those of proteomic detection. Conclusion Antithrombin-Ⅲand serum amyloid A-2 protein may be the specific serum protein markers of SONFH patients with blood stasis blocking tendon and vessel syndrome, and complement C4 and leucine-rich alpha-2-glycoprotein may be the specific serum protein markers of SONFH patients with liver-kidney deficiency syndrome.

Objective To evaluate the effect of acupuncture on the quality of recovery during the early period after gynecological laparoscopic surgery using the Quality of Recovery?40 questionnaire ( QoR?40). Methods Sixty patients, aged 20-60 yr, with body mass index of 18.5-28.0 kg∕m2, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for elective gynecological laparoscopic surgery, were equally and randomly divided into either control group ( group C ) or acupuncture group (group Acu) using a random number table. Bilateral Neiguan (PC6) and Hegu (L14) acupoints were stimulated for 30 min starting from the time point before skin incision and immediately after the end of surgery. The quality of recovery was assessed using the QoR?40 on 1 day before surgery, and at 24 and 48 h after surgery. The patient′s cognitive function was assessed using Mini?Mental State Examination. The requirement for rescue analgesics was recorded. The occurrence of nausea and vomiting was also recorded. Results Compared with group C, the global QoR?40 and Mini?Mental State Examination scores were significantly increased, and the incidence of nausea and vomiting and requirement for rescue analgesics were decreased at 24 and 48 h after surgery in group Acu ( P<0. 05 ) . Conclusion Acupuncture can improve the quality of recovery during the early period after gynecological laparoscopic surgery using the QoR?40.

Objective To study the AAAS gene mutations in a child with autosomal recessive Allgrove syndrome. Methods Clinical data were collected and blood samples were obtained from the proband of Allgrove syndrome and her parents. Genomic DNA was extracted and sequenced by PCR amplification. Subclone sequencing was performed to validate the gene mutations. The disease-causing potentials of mutation genes were evaluated by the Mutation Taster, and the target protein tertiary structure was modelled by the Swiss Model. Results A new heterozygous insertion mutation(c. 1347_1348insG) of exon 15 in the proband was identified and firstly reported. Other two reported mutations were detected, which were the heterozygous mutation c. 688C>T in the patient and her mother, and the homozygous mutation c. 855C>T in the proband and her parents. In addition, it was confirmed that the novel compound heterozygous mutations(c. 688C>T, c. 1347_1348insG) in the AAAS gene of the proband were pathogenic mutation locus. Conclusion The heterozygous mutation(c. 1347_1348insG) of AAAS gene was firstly reported. In case of the patients being clinically misdiagnosed, related-gene detection should be performed for the patients who were diagnosed with primary adrenal insufficiency during the period of infants and young childhood.

Objective:To explore the prognostic value of serum deoxyribonuclease 1 like 3 (Dnase1L3), C-reactive protein/albumin ratio (CAR) combined with monocyte to high-density lipoprotein cholesterol ratio (MHR) in decompensated hepatitis B cirrhosis patients.Methods:A prospective selection was conducted on 236 decompensated hepatitis B cirrhosis patients (liver disease group) admitted to the Third Hospital of Qinhuangdao from January 2020 to December 2021, and 185 healthy volunteers (control group) who underwent outpatient physical examinations. The serum levels of Dnase1L3, CAR, MHR, and liver function were detected, and Pearson analysis was conducted to investigate the correlation between Dnase1L3, CAR, MHR, and liver function. Tracking the survival status of patients after 30 days of hospitalization, the risk factors affecting 30 day mortality in decompensated hepatitis B cirrhosis patients were analyzed using a multivariate logistic regression equation. The receiver operating characteristic (ROC) curve analysis was used to assess the value of Dnase1L3, CAR, and MHR in predicting 30 day in-hospital mortality in decompensated hepatitis B cirrhosis patients.Results:The serum levels of Dnase1L3, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBiL), CAR, and MHR in the liver disease group were higher than those in the control group (all P<0.05). The serum levels of Dnase1L3, CAR, and MHR in the liver disease group were positively correlated with AST, ALT, and TBiL (all P<0.05). Among 236 patients, 32 died within 30 days. Model for end-stage liver disease (MELD) scores>18, high Dnase1L3, high CAR, and high MHR were risk factors for 30 day mortality in decompensated hepatitis B cirrhosis patients (all P<0.05). The combined prediction of Dnase1L3, CAR, MHR, and MELD scores for 30 day mortality in decompensated patients with hepatitis B cirrhosis showed an area under the curve of 0.904, which was higher than the predicted values of 0.719, 0.678, 0.763, and 0.742 for individual indicators. Conclusions:The serum Dnase1L3 levels, CAR, and MHR are elevated in patients with decompensated hepatitis B cirrhosis, and are associated with the degree of liver function damage and mortality within 30 days of hospitalization. They have high value in predicting the prognosis of decompensated hepatitis B cirrhosis.

Objective:To evaluate the effect of different doses of cisatracurium on the monitoring of motor-evoked potentials (MEPs) in the patients undergoing intracranial aneurysm clipping.Methods:Eighty patients of both sexes, aged 18-64 yr, with body mass index <30 kg/m 2, of American Society of Anesthesiologists physical statusⅠor Ⅱ, with Hunt-Hess grade 0-Ⅱ, undergoing intracranial aneurysm clipping under general anesthesia, were divided into 4 groups ( n=20 each) using a random number table method: conventional group (group R) and different doses of cis-atracurium groups (Cis 1-3 groups). After anesthesia induction, muscle relaxation was monitored, and train-of-four (TOF) stimulation (frequency 2 Hz, wave width 0.2 ms, interval 15 s) was applied to the ulnar nerve of forearm, and the TOF ratio was recorded as the baseline value (T 1). MEPs were assessed with a nerve electrophysiology monitor after induction of anesthesia.In Cis 1-3 groups, cis-atracurium 0.625, 0.833 and 1.000 μg·kg -1·min -1 were intravenously infused, while the equal volume of normal saline was given instead in group R when TOF ratio returned to the baseline value and MEPs could be effectively elicited.At T 1, immediately after dural incision (T 2), immediately after aneurysm occlusion (T 3) and immediately after dural closure (T 4), the TOF ratio, effective elicitation of intraoperative MEPs, and occurrence of intraoperative cardiovascular events, recovery of spontaneous breathing and body movement were recorded. Results:Compared with group R, no significant change was found in TOF ratio at each time point in group Cis 1 ( P>0.05), and TOF ratio was significantly decreased at T 2-4 in group Cis 2 and at T 2-4 in group Cis 3 ( P<0.05). Compared with group Cis 1, TOF ratio was significantly decreased at T 3, 4 in group Cis 2 and at T 2-4 in group Cis 3 ( P<0.05). The effective elicitation rate of MEPs was 100% in the four groups.There was no significant difference in the incidence of intraoperative cardiovascular events, recovery of spontaneous breathing and body movement among the four groups ( P>0.05). Conclusion:Continuous intravenous infusion of cis-atracurium 0.833-1.000 μg·kg -1·min -1 can maintain a certain degree of muscle relaxation without affecting MEP monitoring in the patients undergoing intracranial aneurysm clipping.