Microfluidic chip exhibit a great promising development in clinical diagnosis and disease screening due to their advantages of precise controlling of fluid flow,requirement of mini amount sample,rapid reaction speed and convenient integration.A lot of demonstrations on the diagnostic applications related to genes,proteins,and cells have been reported because of their advantages associated with miniaturization and automation.Here,the applications and developments of on-chip nucleic acid amplification and analysis,protein analysis and detection,cell selection and cell drug screening were discussed.Microfluidic chip can provide an easy integration platform for biomarkers in a high throughput and accurate detection.

Objective To discuss the appropriate timing of providing enteral nutrition through nasojejunal tube for patients with severe craniocerebral injury.Methods 126 cases of patients were divided into 3 groups randomly,providing enteral nutrition through naso-jejunal tube for the first group,the second group and the third group within 12～24 hours,48 hours later and 72 hours later after injury respectively.The nutrition situation of 3 groups was recorded 6 hours later,48 hours later,on the 5th day and the 10th day,including indicators such as total serum protein,blood albumin,serum creatinine,etc and complication cases of diarrhea,hemorrhage of digestive tract,palirrhea,aspiration,inhalation pneumonia and so on within 2 weeks after injury.Results In terms of indicators of albumin,creatinine 48 hours after injury and total protein,albumin and creatinine on the 5th day and 10th day,the first group were better than the second and third group,there were statistic differences between the three groups.Complication comparison within 2 weeks after injury:the difference of palirrhea cases among the three groups was significant,the third group had a higher ratio than the first and second group.And there was no statistic difference in the other indicators like diarrhea,hemorrhage of digestive tract,aspiration and inhalation pneumonia.Conclusions It is high time that patients with simple severe craniocerebral injury are provided with enteral nutrition through naso-jejunal tube within 12 to 24 hours,which can improve patients nutrition situation without the increase of the complications.

Objective To undertake an updated genetic spectrum analysis in patients with hereditary spinocerebellar ataxia (SCA) in mainland China. Methods SCA 1, 2, 3, 6, 7, 8, 10, 12, 17 and dentatorubral-pallidoluysian atrophy (DRPLA) nucleotide repeat mutations were detected in 430 families with autosomal dominant SCA (ADCA) and 237 patients with sporadic ataxias by PCR and DNA sequencing. Subsequently, point and Indel (Insertion/deletion) mutation analyses of SCA5, SCA11, SCA13, SCA14, SCA15/16/29, SCA27, SCA31 and SCA35 were detected in 91 families with ADCA and 196 patients with sporadic ataxias excluded from SCA1, 2, 3, 6, 7, 8, 10, 12, 17 and DRPLA genotypes via PCR and Denaturing High Performance Liquid Chromatography (PCR-DHPLC), Multiplex ligation-dependent probe amplification and DNA direct sequencing analysis. Results Among the 430 ADCA families, there were 25 SCA1 (5.81%), 27 SCA2 (6.28%), 267 SCA3/MJD (62.09%), 8 SCA6 (1.86%), 8 SCA7 (1.86%), 1 SCA12 (0.23%), 1 SCA17 (0.23%) and 2 SCA35 (0.47%), and the remaining 91 families (21.16%) were genetically unidentified. Among the 237 sporadic SCA patients, there were 6 SCA1 (2.53%), 9 SCA2 (3.80%), 23 SCA3/MJD (9.70%) and 3 SCA6 (1.27%), and the remaining 196 (82.7%) were genetically unidentified. No pathogenic point mutation causing SCA5, SCA11, SCA13, SCA14, SCA27 or SCA31 subtypes was found. Conclusion SCA3/MJD is substantially the most common subtype in patients with ADCA and sporadic forms in mainland China, followed by SCA2, SCA1, SCA6 and SCA7. While SCA12, SCA17 and SCA35 are seldom found, SCA5, SCA8, SCA10, SCA11, SCA13, SCA27, SCA31 and DRPLA are very rare. The high proportion of genetically unidentified cases further verify that SCAs are of highly genetic heterogeneity, suggesting that other disease-causing genes might be involved in the negative ADCA pedigrees, and other etiological factors may involve in those sporadic cases other than genetics.

At present, the situation of COVID-19 epidemic prevention and control in China is gradually improving, but the situation of overseas import prevention and control remains difficult. The COVID-19 epidemic may exist for long due to the undetermined source of infection, the difficulty in completely cutting off the transmission route, and a large number of susceptible people. Therefore, prevention and control will be a long-term and arduous task, making it necessary to adhere to the principle of combining emergency response with regular prevention and control, coordinating the epidemic prevention and social-economic development in a balanced way. In retrospect, the epidemic has exposed the ambiguous positioning and unsatisfying hardware construction of hospital laboratory departments, and delayed intervention of laboratory experts in the public health treatment system of China. This paper reflects on the hospital laboratory departments′ problems during the anti-epidemic activities, and put forward suggestions to improve the future development of clinical laboratories in the national public health system.

OBJECTIVETo evaluate efficacy and outcome of endovascular therapy for complex arteriosclerosis obliterans of the lower extremities.

METHODSIn this single-center retrospective study, the clinical data of consecutive 114 cases with TASC II type C/D lower extremity obstructive disease and clinical stage of Fontaine ≥ IIb and ankle brachial index <0.9 underwent endovascular therapy from December 2011 to January 2013 were collected. Telephone or clinic interviews were conducted to investigate the clinical outcomes.

RESULTSThere were 39 TASC II type C patients and 75 TASC II type D patients, 78 patients were in Fontaine IIb, 30 patients in Fontaine III and 6 patients in Fontaine IV stages. Immediate procedural success rate was 94.9% (131/138). Ankle brachial index was increased from 0.54 ± 0.26 at baseline to 0.83 ± 0.30 at discharge (P < 0.01). No adverse event was observed during the perioperative period. During (15.7 ± 8.7) months follow-up, cumulative patency rate of 6, 12 and 18 months was 75.8% (94/124) , 68.7% (68/99) and 39.2% (20/51) respectively and limb salvage rate was 100%.

CONCLUSIONEndovascular therapy for complex arteriosclerosis obliterans of the lower extremities is effective and safe.

Ankle Brachial Index ; Arteriosclerosis Obliterans ; therapy ; Femoral Artery ; Humans ; Limb Salvage ; Lower Extremity ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Nano-antibodies (Nbs) were first discovered in the peripheral blood of alpacas. Compared with traditional antibodies, Nbs have the characteristics of small volume, good stability, strong tissue permeability, and easy production through microbial systems, etc. They are currently the smallest known functional antigen-specific binding fragments. Therefore, Nbs have been considered as valuable proteins in recent years and widely used in many fields, such as basic research, new drug development, disease treatment and so on. This article reviews the structural and biochemical properties of Nbs and the research progress on Nbs in the fields of tumor diagnosis and treatment, as well as their application prospect.

Objective To summarize the clinical data of macrophage activation syndrome (MAS) in adult-onset Still's disease (AOSD) patients and provide evidence for clinical diagnosis and treatment. Methods We retrospectively reviewed the clinical data of AOSD with MAS patients in the First Affiliated Hospital of Zhengzhou University from January 2012 to August 2018, and compared with patients with AOSD alone. Data were analyzed by t-test, Mann-Whitney U test, x2 test or Fisher exact test. Results A total of 14 AOSD with MAS patients were enrolled, accounting for 7.6％(14/185) of AOSD patients at the same period, including 2 males and 12 females. The median duration of AOSD in MAS was 1.3 (0.25, 4) months. Compared with the AOSD group, the age of onset was younger in the MAS group (t=-2.038, P=0.037), and the proportion of splenomegaly (t=9.020, P=0.003), pericardial effusion (t=8.663, P=0.003), pleural effusion (t=4.754, P=0.029) was higher. The white blood cell count (t=-4.171, P<0.01), hemoglobin level (t=-2.661, P=0.008), platelet count (t=-5.672, P<0.01), neutrophil count (t=-5.082, P<0.01), albumin (t=-3.426, P<0.01), fibrinogen (t=-5.986, P<0.01), ESR (t=-2.941, P=0.003), CRP (t=-2.014, P=0.044) was significantly decreased, ALT (t=-3.227, P<0.01), AST (t=-3.105, P=0.002), triglyceride (t=-5.612, P<0.01), ferritin>2000 μg/L (t=7.833, P=0.005) was significantly increased. Fourteen patients with AOSD complicated with MAS were treated with glucocorticosteroids, 5 with methylprednisolone, 8 with cyclosporine A, 8 with intravenous immunoglobulin (IVIG), 2 with etoposide, and 1 with tocilizumab. After treatment, 11 cases recovered and 3 cases died. Conclusion Younger AOSD patients tend to complicated with MAS, especially at the early course of the disease, and splenomegaly occur more frequently clinically compared to patients without MAS. When blood cell count, fibrinogen and ESR decreases, triglyceride and ferritin levels increases in AOSD patients, the occurrence of MAS is indicated. Timely treatment can improve the prognosis of patients.

Objective To investigate the clinical features of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated hypertrophic pachymeningitis (HP).Methods Clinical data of 4 casesdiagnosed with MPO-ANCA vasculitis complicated with HP in our hospital were analyzed retrospectively and the related literaturewere reviewed.Results Four male patients with an age range from 44 to 66 years were diagnosed with ANCA-associated HP.The main clinical manifestations included headache and withvarious degree ofmultiple cranial paralysis.During active phase of the disease,all patients showed perinuclear(p)-ANCA positive,elevated levels of inflammatory biomarkers and titers of MPO-ANCA,whereas renal function,cytoplasmic (c)-ANCA and protease 3 (PR3)-ANCA were negative.Contrast-enhanced cranial magnetic resonance imaging (MRI) scan showed obviously thickened dura mater and sinusitis or mass in paranasal sinus.Four patients were sensitive to glucocorticoid.Three patients had a relapse during glucocorticoid tapering and were undercontrol when the dosage of glucocorticoid was increased and immunosuppressive agents were added.Levels of inflammatory biomarkers,titers of MPO-ANCA and p-ANCA recovered to normal,and the dural thickness on MRI was reduced in the remission stage.Conclusion MPO-ANCA associated HP is a type of central nervous system involvement in ANCA associated vasculitis (AAV).It involves the upper respiratory tract more frequently,and less frequently progresses to systemic AAV.This should be taken into consideration when middle-aged and elderly patients presented with headache and multiple cranial neuropathies.Enhanced MRI is the preferred examination for diagnosis,and dural biopsy should be done when necessary.

COVID-19 associated Guillain-Barré syndrome (GBS) caused by peripheral nerve damage after SARS-CoV-2 infection is one of the most common COVID-19 related nervous system inflammatory diseases, with high incidence of respiratory failure and mortality. Positive SARS-CoV-2 RNA in cerebrospinal fluid of COVID-19 associated GBS patients has been rarely reported. This paper reports 4 patients with COVID-19 associated GBS in China who developed neurological symptoms 4-15 days after fever and were confirmed SARS-CoV-2 infection. All patients presented with progressive weakness of both lower limbs, 3 patients with autonomic dysfunction such as defecation and urination disorders, and 1 patient with polycranial neuritis and Miller-Fisher syndrome such as bilateral facial palsy, dysphagia, diplopia and ataxia. Nerve conduction velocity and F wave were abnormal in 3 patients, and motor conduction pathway was abnormal in 1 patient. Anti-ganglioside antibodies were tested in 3 patients, and GD1a-IgG was positive in 1 patient. All 4 patients underwent metagenomic next-generation sequencing examination in blood and cerebrospinal fluid. SARS-CoV-2 RNA was positive in blood and cerebrospinal fluid of 3 patients, and SARS-CoV-2 RNA was positive in cerebrospinal fluid of 1 patient.

Objective:To study the clinical and immunological features of two case of rare antisynthetase syndrome (ASS), so as to improve the level of diagnosis and treatment.Methods:Two cases with rare antisynthetase syndrome admitted to the First Affiliated Hospital of Zhengzhou University from July 2020 to August 2022 were collected.Results:The two rare ASS were anti-Zo antibody and anti-Ha antibody positive patients, both of which had interstitial lung disease (ILD) as the main clinical manifestation and positive anti-Ro52 antibody. Two rare antisynthetase autoantibodies manifested cytoplasmic ANA indirect immunofluorescence (IIF) staining pattern, but it is different from the cytoplasmic dense speckled pattern of several common ASS antibodies. After treatment with glucocorticoids and immunosuppressants, case 1 died of respiratory failure due to a long course of disease and late diagnosis, the lung lesions of case 2 improved significantly.Conclusion:When encountering the cytoplasmic ANA fluorescent pattern in ILD patients, especially with anti-Ro52 antibody, it is necessary to screen more myositis specific antibodies to rule out the possibility of rare ASS.