Objective To observe the clinical effect of metformin and insulin in gestational diabetes mellitus(DM) patients and their effects on neonates.Methods From August 2012 to October 2016,60 patients with gestational diabetes mellitus were divided into control group(n=30) and observation group(n=30) by random number method.The control group was treated with insulin and the observation group was treated with metformin on the basis of the control group.The clinical effect and the effect on neonatal were compared between the two groups.Results The level of glycosylated hemoglobin in the observation group was higher than that in the control group(P<0.05).In the observation group,the levels of fasting plasma glucose,postprandial blood glucose 2 hours after meals and 4 hours postprandial blood glucose were lower than those in the control group(P<0.05).There were no significant differences in the levels of CysC and Hcy between the two groups before treatment(P>0.05).The incidence of fetal distress,respiratory distress,macrosomia and the incidence of premature delivery were significantly lower than those of the control group(P<0.05).The amount of insulin in the observation group was less than that in the control group(P<0.05).The level of CysC and Hcy in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Compared with insulin therapy,metformin could improve the outcome of neonatal patients,which might be worthy to be popularized and used in the treatment of gestational diabetes mellitus.

Objective To study the characteristics of MR imaging and proton MR spectrscopy(~1H MRS)of stroke-like lesions in MELAS.Methods Clinical,MR imaging and proton spectroscopic findings of stroke-like lesions in 7 patients with confirmed MELAS were analyzed retrospectively.Results A total of 12 MR investigations had been performed in 7 patients.Stroke-like lesions showed by MR imaging included superacute in 12,acute in 12,subacute in 10 and chronic stage in 6.Early stroke-like lesions were demonstrated as focal edematous foci mainly involved cortex/subcotical areas of occipital,temporal and parietal lobes.At MR diffusion imaging,stroke-like lesions in the superacute(＜3 days)stage were showed as well-circumscribed lesions with high signal intensities for cytotoxic edema.During the acute(4～7 days),sub-acute(2～4 weeks)and chronic(＞4 weeks)stages,the lesions gradually expanded,and became blur,and presented with vasogenic edema mainly.Proton spectroscopy showed a prominently elevated lactate,varied decrease of NAA concentration and other brain motabolites in the stroke-like lesions early after onset,and depicted gradual decrease of lactate level and partial recovery of NAA concentration subsequently.Conclusion Stroke-like lesions in MELAS mainly involve the cerebral cortex and subcortical areas,in which cytotoxic edema appears early but for a short period.In ~1H MRS,the lesions are characterized by a double lactate peak with decrease of NAA concentration.

Objective To verify the accuracy of ARS scale.Methods A cohort study was conducted in 10 counties (city)the in-troduction of the ARS scale from 2013 November to 2014 May (6 months),the registrations were undertake score,and score < 4 were compliance group,more than 4 cent were nonadherence group.Follow-up observation include review at the end of 2nd month after treatment and medicine compliance.Results There was no significant difference in age,gender,nationality and whether the floating population between the compliance group and non compliance group (P >0.05),initial treatment and retreatment was sta-tistically significant (P <0.05).1 824 patients had a mean score of 3.40±1.40,including compliance group mean score was 2.34± 0.73,is not in compliance with group mean score was 4.69±0.81.Mainly concentrated in the 2-5 scores accounted for 86%.The ARS score of 2 at the end of the packet and judge review the results of test,the Kappa coefficient was 0.403 (P <0.05).The sensi-tivity was 71.1%,specificity was 70.2%,the correct index 0.41.Multivariate Logistic and review the compliance of patients re treatment ARS score,at the beginning of the results of regression analysis showed that ARS score,under the same conditions,re-treatment review compliance was initially treated patients with difference (OR=0.41,P <0.05);in the initial treatment and retreat-ment premise under the same circumstances,review of compliance with the ARS score less than 4 points.It′s 5.65 times greater than or equal to 4 points (P <0.05).Conclusion The ARS scale can accurately judge the patient compliance,with high sensitivity and specificity,suitable for application in Guizhou Province,but we should consider other interference factors of promotion.

BACKGROUND:Transformation growth factor-β(TGF-β) and brain-derived neurotrophic factor (BDNF) are the main regulatory factors in the process of spinal cord injury. There are many researches for TGF-βand BDNF pathogenesis in the spinal cord injury, but the regulation of Ginsenoside Rg1 intervention on TGF-βand BDNF in the spinal cord injury is rarely reported.
OBJECTIVE:To observe the effect of Ginsenoside Rg1 intervention on TGF-βand BDNF expression at themolecular protein levels, and to study the protection effect of Ginsenoside Rg1 on the spinal cord and nerve function after spinal cord injury.
METHODS:Experimental rats were randomly divided into blank control group, model group and Ginsenoside Rg1 group. In the model and Ginsenoside Rg1 groups, spinal cord injury model was established with the impact method in rats. In the Ginsenoside Rg1 group, rats were intraperitoneal y injected with 10 mg/kg Ginsenoside Rg1 24 hours after modeling, once per day, for 14 days. Rats in the blank control and model groups were injected with equal saline.
RESULTS AND CONCLUSION:Compared with the control group, serum malondialdehyde levels increased, the content of superoxide dismutase decreased, TGF-βexpression levels in spinal cord tissue increased, and BDNF expression levels decreased in the model and Ginsenoside Rg1 groups. Compared with the model group, serum malondialdehyde levels decreased, the content of superoxide dismutase increased, TGF-βexpression levels in spinal cord tissue decreased, and BDNF expression levels increased in the Ginsenoside Rg1 group. Ginsenoside Rg1 can protect the injury spinal cord in rats after spinal cord injury.

BACKGROUND:Chinese herb extracts can restore and protect the nervous system of rats through intervention of neural stem cels. OBJECTIVE:To explore the role of ginsenosides Rg1 in the proliferation and protection of neural stem cels. METHOD:Sprague-Dawley rats at pregnant 19 days were dissected to take out fetal rats, and then the hippocampal tissues from fetal rats were isolated to extract neural stem cels. Neural stem cels were co-cultured with DMEM/F12 medium containing 50 g/L ginsenosides Rg1 as intervention group, with DMEM/F12 medium as blank control group, and with DMEM/F12 containing 0.64% phenol as positive control group, respectively. MTT assay was used to detect the proliferation of neural stem cels in each group, and western blot method to detect the protein expression of brain-derived neurotrophic factor and transforming growth factor-β in neural stem cels. RESULTS AND CONCLUSION:Rat neural stem cels were round single cels with clear border at early period after isolation but at 2 days after inoculation, the cels were adherent and aggregated into smal cel spheres. Compared with the blank control group, the proliferative rate of neural stem cels was significantly increased in the ginsenosides Rg1 group (P < 0.05), but decreased in the positive control group (P < 0.05). Compared with the blank control group, in the ginsenosides Rg1 group, the expression of brain-derived neurotrophic factor was elevated, and the expression of transforming growth factor-β was reduced, indicating ginsenosides Rg1 has a certain effect to promote the proliferation of neural stem cels as wel as to protect the neural stem cels.

Objective To evaluate the sensitivity, repeatability and accuracy of microarray digital PCR system in detecting JAK2 V617F mutation, which was closely related to myeloproliferative neoplasms (MPN).Methods All of the 31 MPN patients with JAK2 V617F mutation, including 18 cases of polycythemia vera(PVs),11 primary thrombocythemias (ETs) and 2 primary myelofibrosis (PMFs), were collected from Huashan Hospital, Fudan University during 2014 -2015, while 10 normal controls and 6 cases with abnormal increased hemoglobin were involved.Human erythroleukemia cell line ( HEL ) and colorectal cancer cell SW480 were used as the mutant and the wild type control, respectively.The sensitivity of microarray digital PCR were verified by detecting the gradient diluted mutation standard harboring 30%, 10%, 1%, 0.1%and 0.01%mutant allele burden, respectively .Repeatability was evaluated by detecting 1%and 10% mutated samples for 5 times, respectively.MGB probe real time PCR was selected as the reference method to verify the accuracy of the digital PCR.Results With digital PCR, the accurate quantitation of JAK2 V617F mutation was achieved down to 0.1%, which is approximate to 0.16 copies per microliter.The results obtained from the two kinds of technique showed a high correlation by linear regression analysis (R2 =0.998 3).The results of repeated samples showed CVs as 17.18% for 1%mutant allele burden and 7.50%for 10%.Among all cases, the 31 patients known mutated were detected as positive and 10 controls as negative by both digital PCR and Real time PCR.In another 6 cases, 2 were found JAK2 V617F mutation of low allele burdens of 0.37% and 0.18% by digital PCR but detected as negative by real time PCR.Conclusions Microarray digital PCR offers a higher sensitivity and better repeatability than real time PCR which could help detect rare JAK2 V617F mutations in MPNs accurately.

Objective:To translate the 16-item version of Quality of Life in Children with Epilepsy (QOLCE-16) into Chinese, and conduct reliability and validity analysis in Chinese children with epilepsy.Methods:The International Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. Three bilingual translators pre-translated the source scale, and another three bilingual translators performed back translation. The QOLCE-16 was adjusted through the cognitive interview and expert consultation. This study was a cross-sectional study. Convenience sampling was used to select 256 children with epilepsy who were admitted to the Department of Neurology of Children's Hospital of Shanghai from June to December 2020. All questionnaires were filled out by long-term caregivers, and 256 copies were finally recovered effectively to analyze the reliability and validity of the QOLCE-16 after cultural adjustment in the evaluation of the health-related quality of life of children with epilepsy. A total of 40 subjects were selected from the sample, and the Chinese version of QOLCE-16 was filled out again at an interval of 2 to 3 weeks. Finally, 32 samples were effectively recovered to evaluate the test-retest reliability of the scale.Results:The Chinese version of QOLCE-16 had 16 items in total, including 4 dimensions of cognition, emotion, social interaction, and physical function. Each item had a good degree of discrimination, and there was a statistical correlation with the total score of the scale ( P<0.05) . The scale-level content validity index ( S- CVI) was 1.00, and the item-level content validity index ( I- CVI) was from 0.89 to 1.00. The KMO value of exploratory factor analysis was 0.909, the eigenvalues of each dimension were 3.482, 3.223, 3.136, 2.955 respectively, and the cumulative variance contribution rate was 79.976%. The Cronbach's α coefficient of the scale was 0.938, and the Cronbach's α coefficient of each dimension was from 0.866 to 0.939. The split-half reliability was 0.814, and the split-half reliability of each dimension ranged from 0.840 to 0.942. The test-retest reliability of the scale was 0.724, and the test-retest reliability of each dimension was from 0.615 to 0.716. Conclusions:The Chinese version of QOLCE-16 has good reliability and validity, and can be used as a simple tool for evaluating the health-related quality of life of children with epilepsy between 4 and 18 years of age.

Objective:To explore the mediating effects of parental perceptions of child vulnerability (PPCV) and child anxiety in the relationship between parental social support and the quality of life in children with epilepsy.Methods:This was a cross-sectional study. Totally 315 children with epilepsy and their 315 parents who visited the neurologic outpatient clinic for video EEG monitoring from September 2021 to April 2022 were selected by convenience sampling and investigated with General Information Questionnaire, Child Vulnerability Scale (CVS), Social Support Rating Scale (SSRS), PROMIS Parents Report Anxiety Short Form, and the Quality of Life in Children with Epilepsy-16 (QOLCE-16). Pearson correlation was used to analyze the relationships between quality of life in children with epilepsy and variables such as parental social support, PPCV, and child anxiety. AMOS 22.0 was utilized to establish a structural equation model to examine the relationships among the variables. A total of 315 questionnaires were distributed, with 295 valid questionnaires retrieved, yielding a response rate of 93.7%.Results:The scores for the 295 parents on the SSRS, CVS, PROMIS Parents Report Anxiety Short Form, and QOLCE-16 were (40.75±10.24), (8.08±4.84), (16.40±5.98), and (72.01±15.43), respectively. Parental social support was negatively correlated with PPCV and child anxiety ( P<0.01), and both PPCV and child anxiety were negatively correlated with the child's quality of life ( P<0.01), while parental social support had a positive correlation with the child's quality of life ( P<0.01). PPCV and child anxiety mediated the relationship between parental social support and the child's quality of life ( P<0.01), with the direct and indirect effects being 0.301 and 0.205 respectively. Conclusions:Parental social support can directly affect the quality of life of children with epilepsy, and also indirectly influence it through PPCV and child anxiety. Clinical nursing staff should provide more care and support for children with epilepsy and their parents, helping to deepen their understanding of the disease, reduce levels of PPCV and child anxiety, thereby enhancing the quality of life for children with epilepsy.

Objective To summarize the management experience of Children's Hospital of Shanghai in extracorporeal membrane oxygenation (ECMO) bedside first-aid coordination, and to further strengthen the operation room's emergency management capacity for first-aid of children.Methods Our hospital formed a technical group for ECMO surgical nursing, cultivated nurses' capacity in ECMO first-aid coordination, standardized surgical safety management in multiple departments and areas, and improved relevant management systems to ensure easy access to ECMO first-aid.Results In 2016, our hospital conducted totally 11 ECMO bedside treatment, and there was no wound infection after the treatment, with a weaning success rate of >90% and a hospitalization survival rate of >70%.Conclusions Emergency management strategies play a positive part in improving surgical safety and the operation room's emergency service capability.