The diagnostic criteria for autism was revised in the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅴ) in 2013. This year also marks the 70th anniversary of psychiatrist Leo Kanner’s ifrst clinical description of autism. The great changes in the diagnostic criteria within the 70 years relfect the challenge and dififculty of the diagnostics of autism. In DSM-Ⅴ, autism spectrum disorder is under the category of neurodevelopmental disorder, with the cancellation of the deifnition of pervasive developmental disorder;“persistent impairment in social communication and social interaction”plus“restricted, repetitive patterns of behavior”;the symptoms have to be present in the early development period. Compared with DSM-Ⅳ, DSM-Ⅴis justiifed to remove the“discrete”sub-categories including autistic disorder, Asperger disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified in DSM-Ⅳ, and the deleted ones are absorbed into a single category, autism spectrum disorder;the numbers of general items of diagnostic criteria are reduced to 7, while the number of minimal items for diagnostics are decreased to 5. The concept of DSM-Ⅴdeifning autism spectrum disorder as a single category will profoundly result in changes of prevalence, diagnostics, intervention, prognosis, and other related regions of autism.

BACKGROUND:Studies have shown that bone morphogenetic proteins play a key role in skeletal development. Platelet-rich plasma alone in animal or clinical trials cannot significantly promote bone graft healing.
OBJECTIVE:To investigate the osteogenesis effect of bone morphogenetic protein-4 compounded with platelet-rich plasma the bone defect area.
METHODTwenty-four New Zealand white rabbits were selected to establish maxil ary bone defect models, and then were randomly divided into four groups, six rats in each group. Group A was blank control group;Group B wasβ-tricalcium phosphate (0.1 g)+Bio-gide group;group C wasβ-tricalcium phosphate (0.1 g)+Bio-gide+platelet-rich plasma (1 mL) group;and group D wasβ-tricalcium phosphate (0.1 g)+Bio-gide+platelet-rich plasma (1 mL)+bone morphogenetic protein-4 (5μg). Gross observation, histological observation and imaging analysis were performed for analysis of new bone formation at weeks 4, 8, 12 after modeling.
RESULTS AND CONCLUSION:After 4 weeks, group D had more new bone and vessels formed in the bone defect area than the group B (P<0.01);however, the amount of new bone was higher in the group B than the group A (P<0.01). After 4, 8, 12 weeks, the amount of new bone in the bone defect area was higher in the group D than the groups B and C (P<0.01), and lowest in the group A (P<0.01). In theβ-tricalcium phosphate scaffold, platelet-rich plasma combined with bone morphogenetic protein can significantly promote the healing of bone defects.

[Objective]To study the transfection and expression of green fluorescent protein gene in rat chondrocytes by constructing a combination lentiviral vector containing green fluorescent protein gene.[Method]293T cells were co-transfected with the vector plasmids pLentiLox 3.7,the packaging plasmids pRSV-REV,pMDL g/p RRE and the envelope plasmids VSV-G to produce lentiviral vector particles.Rat chondrocytes were isolated,cultured and infected by the lentiviral vector particles.The expression of reporter gene GFP was observed under fluorescent microscope.[Result]At 96 hours after transfection,a strong expression of GFP could be found in 293T cells.The viral titer was 3.0?103ifu/?l.GFP expression was observed in about 80% of the rat chondrocytes.[Conclusion]A combination lentiviral vector containing green fluorescent protein gene was successfully established and it could infect rat chondrocytes efficiently,which will provide a basis for gene modification of chondrocytes through RNA interference.

0.05). Blood lactate levels in surviving group gradually went down to the normal, while it consistently deteriorated in fatal group.ConclusionsSeptic shock patients had defective oxygen consumption. Patients with higher initial DO 2 had a good outcome. Contineous elevation in blood lactate levels predicts a poor prognosis.

0.05).Conclusions The patients with sepsis lasting more than 7 days had high mortality (50%). While percentage of CD14 and CD14MFI of peripheral blood are increased,the total scores of SOFA and numbers of MOF are decreased.The improvement of monocytes function indicates good prognosis. The changes of expression of ICAM-1,serum TNF-? and IL-10 can not reflect prognosis in septic patients.

Objective: To study the relation between hyperglycemia and mechanical ventilatory time, the days in the intensive care unit,infection rate,mortality . Methods: 572 patients' blood glucose levels in the morning were measured,and divided into two groups by the level of 7.78 mmol/L.The mechanical ventilatory time, days in the intensive care unit,infection rate and mortality were compared between two groups. Results: The mechanical time,stay in ICU and infection rate in the group with blood glucose level below 7.78 mmol/L were significantly less than in the group with blood glucose level above 7.78 mmol/L(P

OBJECTIVE To summarize the clinical characteristics,diagnositic and therapeutic strategies of severe cytomegaloviral (CMV) pneumonia after kidney transplantation. METHODS To analyze retrospectively pertinent clinical information of 6 cases of severe cytomegaloviral pneumonia after kidney transplantation, including developing process of disease, clinical manifestation of pre-and post-hospitalization ,various assistant examination,therapeutic procedures and prognosis. RESULTS 6 cases had similar characters of episode as follows:CMV pneumonia occurred after 1～3 months after kidney transplantation. Major clinical symptoms included fever, coughing,few sputum without obvious manifestation of breathholding.Peripheral white blood cell was normal or less than normal range, serum CMVpp65 was finally positive during hospital stay. Radiological image of the lung presented inflammatory infiltration and obvious interstitial lesion after 7～10 days of fever, which went worse rapidly. Renal function descended with deterioration of pulmonary infection. All of patients had been treated with multiple antibiotics,glucocorticoid and mechanical ventilation, Etiological diagnosis of the 3th～6th cases were earlier than 1th～2th cases , the 3th～6th cases who finally survived were treated with longer and higher doses of antivirus and glucocorticoid, than 1th～2th cases who died of refractory hypoxemia and acute renal failure during hospital stay. CONCLUSIONS Severe cytomegaloviral pneumonia had similar clinical characteristics of episode. early diagnosis of etiology,continuous application of antivirus and glucocorticoid were crucial for Severe cytomegaloviral pneumonia after kidney transplantation.

Objective To investigate the clinical features and the imaging examination changes of bacterial meningitis in children of different age groups,and to offer theoretical basis for the clinic diagnosis of bacterial meningi-tis. Methods The sick children with bacterial meningitis treated in Guangzhou Women and Children′s Medical Center from January 2011 to June 2013,were recruited and divided into three groups according to the age,including newborns group,infants group and more than 1 year group. Eighty-nine cases with purulent meningitis were recruited,included 58 males and 31 females. Among them,there were 34 cases in the newborns group,41 cases in the infants group and 14 ca-ses in the more than 1-year group. The information on the clinical features,laboratory examination and the imaging ex-amination were summarized and analyzed,and were compared among the 3 groups. Results (1)Among them,54 cases with high fever,44 cases with respiratory symptoms,12 cases with alimentary tract symptoms. (2)The major neurologi-cal features included convulsions(44 cases,49. 4%),fatigue(36 cases,40. 4%),vomiting(21 cases,23. 6%),cervical rigidity(9 cases,10. 1%),fontanel full(7 cases,7. 9%),headache(6 cases,6. 7%),limb paralysis(5 cases,5. 6%). The percentage of high fever,vomiting,headache,cervical rigidity in the more than 1 year group were significantly more than those of the newborns group and the infants group(χ2=10. 093,12. 063,34. 466,7. 177,all P<0. 05). (3)Among them,whitebloodcell(WBC)accountswerefrom2.20to60.60×109/L,themeanwas(16.49±10.37)×109/L.Hy-persensitive C-reaction protein concentration in blood was 4. 00 to 376. 53 g/L,the mean was (131. 07±86. 91) g/L. In cerebrospinal fluid(CSF),WBC accounts were from 1 to 21 800×106/L,the mean was (910. 05±274. 07)×106/L, the glucose concentration from 0. 00 to 4. 50 mmol/L,the mean (1. 72±1. 03)mmol/L,the protein concentration from 0. 42 to 4. 89 g/L,the mean was(1. 64±1. 03)g/L. In 40 cases with atypical CSF change, 23 cases with CSF glucose ratio(CSF glucose/blood glucose) less than or equal to 0. 4, and 15 cases with blood cultures positive. (4)The image examination showed magnetic resonance imaging( MRI) abnormalities in 51/75 cases,computerized tomography( CT) scan abnormalities in 15/30 cases. The percentage of convulsions,the brain MRI abnormalities and the MRI display rate of bacterial meningitis in the infants group were significantly more than those of the newborns group and the more than 1 year group(χ2=11. 768,9. 047,7. 674,all P<0. 05). The display rate of meningitis and subdural hydroma by the brain MRI were significantly more than those of the head CT scan(χ2=7. 430,5. 291,all P<0. 05). Conclusions Be-cause of the atypical clinical features of bacterial meningitis in newborn and infant, lumber puncture should be per-formed in all doubtful cases who had a fever and/or seizure. CSF glucose less than or equal to 0. 4 of simultaneously ob-tained blood glucose value,the enhanced MRI sequence or blood cultures were useful for the likelihood of meningitis,if CSF chemistries and cytology vary atypically. The MRI sequence can significantly mostly improve the display rate of bacterial meningitis than the enhance CT.

0.05). Serum IL-10 and IL-10/TNF? ratio in the dead were significantly higher than that in the survivors( P 0.05). Conclusions The septic patients with high serum IL-10 or IL-10/TNF? ratio fared with poor prognosis.

Objective:To explore the clinical characteristics and treatment of a family with inherited generalized epilepsy with febrile seizures plus (GEFS + ) caused by the KCNT2 gene mutation and review the literature. Methods:Clinical data of a child with GEFS + and his family members who visited Department of Pediatric Neurology, Guangzhou Women and Children′s Medical Center in May 2019 were collected.DNA samples were collected from the peripheral blood of the proband, his parents, his elder brother, and his maternal grandparents, and genetic analysis and verification were performed using the next-generation sequencing technique.Using " KCNT2" as the key word, literature was retrieved from PubMed, China National Knowledge Infrastructure and Wanfang databases (up to August 2019). Results:The proband was a 3-year-old boy who was admitted to Guangzhou Women and Children′s Medical Center because of frequent epileptic seizures in the past 5 months.He presented with a binocular gaze and experienced 3 to 8 times of extremities myoclonic-spastic epileptic attacks every day.He had a history of 3 times of febrile seizures at the age of 2 years old.His seizures were refractory to Sodium valproate, Topiramate, Nitrazepam and Levetiracetam.His elder brother and mother had a history of childhood febrile seizures.Other members in the family had no history of convulsion.Ictal electroencephalogram showed general 1 Hz high voltage spike-slow waves.A heterozygous nonsense mutation of KCNT2 gene c. 574C>T(p.Q192X) that was never reported previously was detected in the proband, his brother, mother and maternal grandmother.Furthermore, no other family members carried the mutation at the c. 574 locus of the KCNT2 gene.No article in Chinese was found, and 2 articles in a language other than Chinese provided the complete data of 3 sporadic cases.Together with 4 cases in the family studied in this article, there were 7 cases and 4 mutation sites in KCNT2 gene.Of these mutations, there were 3 missense mutations and 1 nonsense mutation.Three sporadic patients presented with early infantile epileptic encephalopathy.The family of this study was characterized with febrile seizures and febrile seizures plus. Conclusions:A de novo mutation and phenotype of the KCNT2 gene is found in a family with GEFS + .It would expand the gene mutation spectrum and provide basis for family genetic counseling. KCNT2 mutation induced GEFS + is refractory to antiepileptic drugs.