Objective:To investigate the differences in terms of blood cerebrospinal fluid barrier immune surveillance injury by lead acetate and nano-lead sulfide exposure in order to provide basis for the study of their mechanism of nerve injury caused by exposure to lead and nano lead.Methods:In June 2015, forty-five SPF SD male rats were randomly divided into control group, lead acetate group (20 mg/kg) and nano-lead sulfide group (20 mg/kg), with 15 rats in each group. The rats were intragastric five times a week, for nine weeks. The numbers of CD4 + T lymphocytes in blood and cerebrospinal fluid were detected by flow cytometry. The levels of interleukin-4 (IL-4) and interferon-γ (IFN-γ) in serum and cerebrospinal fluid were detected by ELISA. The expressions and distribution of intercellular cell adhesion molecule-1 (ICAM-1) and CD4 + T lymphocytes in choroid plexus were detected by laser confocal fluorescence immunoassay. The mRNA expression levels of IL-4, IFN-γ and ICAM-1 in the choroid plexus were detected by real-time PCR. Results:Compared with the control group, the proportion of CD4 + T lymphocytes in blood of rats in lead acetate group was increased, the proportions of CD4 + T lymphocytes in cerebrospinal fluid of rats in lead acetate group and nano-lead sulfide group were increased, the contents of IL-4 and IFN-γ in serum of rats in lead acetate group and nano-lead sulfide group were increased, the content of IL-4 in cerebrospinal fluid of rats in lead acetate group and the contents of IL-4 and IFN-γ in cerebrospinal fluid of rats in nano-lead sulfide group were increased, the differences were statistically significant ( P<0.05). The fluorescence intensity of ICAM-1 and CD4 + T lymphocytes in choriochoroid plexus of rats in lead acetate group and nano-lead sulfide group were stronger than those in control group, and the fluorescence intensity of CD4 + T lymphocytes of rats in nano-lead sulfide group was weaker than that in lead acetate group. Compared with the control group, the mRNA expression levels of ICAM-1, IL-4 and IFN-γ in choriochoroids plexus of rats in lead acetate group and nano-lead sulfide group were increased, and the mRNA expression levels of ICAM-1 and IL-4 in nano-lead sulfide group were higher than those in lead acetate group, while the mRNA expression level of IFN-γ in nano-lead sulfide group was lower than that in lead acetate group ( P<0.05) . Conclusion:Exposure to lead and nano-lead sulfide can cause the increase of CD4 + T lymphocytes, IL-4, IFN-γ and ICAM-1, which may be related to the damage to the immune surveillance of the blood cerebrospinal fluid barrier. And there is a difference in the injury caused by lead and nano-lead sulfide exposure.

Objective:To investigate the differences in terms of blood cerebrospinal fluid barrier immune surveillance injury by lead acetate and nano-lead sulfide exposure in order to provide basis for the study of their mechanism of nerve injury caused by exposure to lead and nano lead.Methods:In June 2015, forty-five SPF SD male rats were randomly divided into control group, lead acetate group (20 mg/kg) and nano-lead sulfide group (20 mg/kg), with 15 rats in each group. The rats were intragastric five times a week, for nine weeks. The numbers of CD4 + T lymphocytes in blood and cerebrospinal fluid were detected by flow cytometry. The levels of interleukin-4 (IL-4) and interferon-γ (IFN-γ) in serum and cerebrospinal fluid were detected by ELISA. The expressions and distribution of intercellular cell adhesion molecule-1 (ICAM-1) and CD4 + T lymphocytes in choroid plexus were detected by laser confocal fluorescence immunoassay. The mRNA expression levels of IL-4, IFN-γ and ICAM-1 in the choroid plexus were detected by real-time PCR. Results:Compared with the control group, the proportion of CD4 + T lymphocytes in blood of rats in lead acetate group was increased, the proportions of CD4 + T lymphocytes in cerebrospinal fluid of rats in lead acetate group and nano-lead sulfide group were increased, the contents of IL-4 and IFN-γ in serum of rats in lead acetate group and nano-lead sulfide group were increased, the content of IL-4 in cerebrospinal fluid of rats in lead acetate group and the contents of IL-4 and IFN-γ in cerebrospinal fluid of rats in nano-lead sulfide group were increased, the differences were statistically significant ( P<0.05). The fluorescence intensity of ICAM-1 and CD4 + T lymphocytes in choriochoroid plexus of rats in lead acetate group and nano-lead sulfide group were stronger than those in control group, and the fluorescence intensity of CD4 + T lymphocytes of rats in nano-lead sulfide group was weaker than that in lead acetate group. Compared with the control group, the mRNA expression levels of ICAM-1, IL-4 and IFN-γ in choriochoroids plexus of rats in lead acetate group and nano-lead sulfide group were increased, and the mRNA expression levels of ICAM-1 and IL-4 in nano-lead sulfide group were higher than those in lead acetate group, while the mRNA expression level of IFN-γ in nano-lead sulfide group was lower than that in lead acetate group ( P<0.05) . Conclusion:Exposure to lead and nano-lead sulfide can cause the increase of CD4 + T lymphocytes, IL-4, IFN-γ and ICAM-1, which may be related to the damage to the immune surveillance of the blood cerebrospinal fluid barrier. And there is a difference in the injury caused by lead and nano-lead sulfide exposure.

Hand osteoarthritis(HOA)is a disease of hand joint disorders,mainly manifested by hand interphalangeal joint and thumb carpal metacarpal joint pain,swelling,morning stiffness,limited movement,and even deformity,belonging to the category of TCM"bone arthralgia".The authors believe that HOA is more common with Taiyang Shaoyang disease,suitable for simultaneous treatment for Taiyang and Shaoyang,to operate the cardinal,regulate qi,blood,nutritive and defensive levels,dispel wind and cold,remove dampness and arthralgia,using modified Chaihu Guizhi Decoction,with confirmed efficacy.

Lumbar disc herniation is mainly manifested as lower back pain,numbness,weakness,and radiating pain in the lower limbs,which seriously affects the patients'work and quality of life.In clinical practice,it has been found that this disease always belongs to the category of deficiency in healthy qi and excess in pathogenic factors,often accompanied by kidney deficiency and cold dampness.Kidney deficiency is the root cause,while cold dampness is the symptoms.The two factors interact with each other and cause back pain.The treatment is based on dispersing cold and dampness,tonifying the kidneys and strengthening the waist,and the classic ancient formula Shenzhuo Powder is safe and effective.

OBJECTIVE: To explore the coagulation deficit and genetic basis for a Chinese pedigree affected with Congenital dysfibrinogenemia (CD). METHODS: Peripheral venous blood samples of the proband and her family members (including 4 individuals from three generations) were subjected to routine blood test and assays of liver and kidney functions and viral hepatitis to exclude related diseases. Clauss method and DFg-PT method were used to determine the fibrinogen activity (Fg:C), and an immunoturbidimetric assay was used to determine the level of fibrinogen antigen (Fg:Ag). All of the exons (22 in total) and their flanking sequences of the FGA, FGB and FGG genes were amplified by PCR and directly sequenced. Variants in the coding regions of the three genes and transcriptional splicing sites were screened by using Mutation Surveyor^TM software. RESULTS: The Clauss method showed that Fg:C was significantly reduced in the proband and her father, whilst her mother and son were normal. With the DFg-PT method, the proband, her parents and son were all within the normal range. The Fg:C/Fg:Ag ratio of the proband and her father was lower than 0.7, whilst her mother and son were above 0.7. No significant change in the prothrombin time, activated partial thromboplastin clotting time and thrombin time was noted. Two genetic variants were detected, which included a homozygous missense variant in the FGA gene [c.991A>G (p.Thr331Ala)], which was predicted to be benign, and a heterozygous missense variant of the γ chain of the FGG gene [c.1211C>G (p.Ser404Phe)], which is located in a conserved region and unreported in the CLINVAR/HGMD/EXAC/1000G databases and literature. CONCLUSION This pedigree has conformed to the autosomal dominant inheritance of CD. The c.1211C>T (p.Ser404Phe) missense variant of the γ chain of the FGG gene probably underlay the pathogenesis of CD in this pedigree. The variant was unreported previously and named as "Fibrinogen Harbin II Ser404Phe".
Female ; Humans ; Afibrinogenemia/congenital* ; East Asian People ; Fibrinogen/genetics* ; Mothers ; Mutation ; Pedigree

Objective:To analyze the influence of lifestyle changes on body weight and metabolic parameters during the early stage of corona virus disease 2019 (COVID-19) epidemic and regular epidemic prevention period in physical examination population.Methods:A total of 801 subjects from Nanjing enterprises and institutions who underwent physical examination in the Department of Health Promotion Center, the First Affiliated Hospital of Nanjing Medical University in May of 2019 to 2021 were included in this study. The basic information and data of body mass index, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride and uric acid were collected. Information about dietary and exercise habits was obtained through pre-examination questionnaires. The data of 2019 was set as baseline data, data of 2020 represented information during the early stage of COVID-19 epidemic and data of 2021 represented information in regular epidemic prevention period. The subjects were divided into underweight group, normal weight group, overweight group, and obese group according to the body mass index at baseline. The Friedman test was applied to compare changes in body mass index and metabolic parameters across the population. Chi-square test was used to compare changes in dietary and exercise habits. Multivariate logistic regression analysis was adopted to explore the influencing factors of body mass index changes.Results:During the early stage of COVID-19 epidemic, the proportion of weight gain was the highest in the underweight group (42.9%), the proportion of weight loss was the highest in the overweight group (24.2%), and the obese group has the most stable body weight (70.6%) ( P=0.004). Men ( OR=0.56, 95% CI: 0.36-0.87) were less likely to gain weight than women ( P=0.010). There was no significant differences in weight change among all groups in the regular epidemic prevention period ( P=0.380). During the early stage of COVID-19 epidemic, the levels of fasting blood glucose, total cholesterol and LDL-C were significantly lower than those of baseline [4.98 (4.66, 5.42) vs 5.23 (4.91, 5.66) mmol/L, 4.98 (4.36, 5.67) vs 5.11 (4.54, 5.77) mmol/L, 2.90 (2.45, 3.33) vs 3.23 (2.77, 3.74) mmol/L], and the uric acid level was higher [333.0 (275.5, 397.0) vs 311.0 (257.5, 368.0) μmol/L] (all P<0.001). In regular epidemic prevention period, the levels of body mass index, fasting blood glucose, total cholesterol and LDL-C were significantly higher than those in the early stage of the epidemic [24.0 (21.9, 26.3) vs 23.8 (21.7, 26.1) kg/m 2, 5.18 (4.85, 5.62) vs 4.98 (4.66, 5.42) mmol/L, 5.12 (4.42, 5.76) vs 4.98 (4.36, 5.67) mmol/L, 3.06 (2.59, 3.57) vs 2.90 (2.45, 3.33) mmol/L], while the uric acid was significantly lower [319.0 (265.0, 377.0) vs 333.0 (275.5, 397.0) μmol/L] (all P<0.001). During the early stage of the epidemic, the reduction proportion of unhealthy diet in the home group was significantly higher than that in the outing group (19.5% vs 11.4%), and the increment proportion of exercise in the outing group was significantly higher than that in the home group (5.1% vs 1.6%) (both P<0.05). In regular epidemic prevention period, the increase rate of unhealthy diet in the home group was significantly higher than that in the outing group (26.8% vs 13.0%) ( P<0.001), and there was no significant difference in exercise between the two groups ( P=0.325). During the early stage of COVID-19 epidemic and in the regular epidemic prevention period, unhealthy diet>3 times per week ( OR=3.85, 3.01, 95% CI: 1.74-8.51, 1.41-6.39) was positively correlated with weight gain, and regular exercise ( OR=4.35, 2.61, 95% CI: 2.05-9.23, 1.15-5.91) was positively correlated with weight loss (all P<0.05). Conclusions:During the early stage of COVID-19 epidemic and in the regular epidemic prevention period, the lifestyle in the physical examination population has an impact on body weight and metabolic indicators. In the early stage of the epidemic, unhealthy diet and exercise decreased, and metabolic indicators such as blood glucose and lipids decreased. People with low body weight tend to gain weight. In the regular epidemic prevention period, the subjects′ exercise increased but unhealthy diet also increased, and blood glucose, lipid and body weight elevated significantly.

Objective:To evaluate the efficacy of Jianpi-Yishen Decoction in treating sarcopenia aged patients with syndrome of spleen-kidney deficiency and cold-dampness. Methods:Eighty-two sarcopenia aged patients admitted to Beijing Longfu hospital from January of 2018 to May of 2019 were selected and divided into the control group and the observation group with 41 patients in each group according to the random number table. Patients in the control group were given routine western treatment such as nutritional support. In the observation group, the patients were given Jianpi-Yishen Decoction based on the control group. Both groups were treated for 12 weeks. Before and after the treatment, the upper limb muscle strength, scores of symptoms of syndrome of spleen-kidney deficiency and cold-dampness, the efficacy of traditional Chinese medicine syndrome, and serum level of 1,25-dihydroxyvitamin D3 were compared between the two groups. Results:During the treatment, one patient in the control group was dropped out. The total effective rate was 95.1% (39/41) in the observation group and 72.5% (29/40) in the control group, and the difference between the two groups was statistically significant ( χ2=6.103, P=0.013). After the treatment, the scores of languid limbs, cold limbs, weak waist and knee, clear urine and loose stool in the observation group were obviously lower than those of the control group ( t values were 9.964, 12.510, 14.103, 13.415, 14.599, respectively, all Ps<0.01). The left hand grip strength (52.75±7.91 kg vs. 46.10 ± 7.22 kg, t=3.954) and the right hand grip strength (53.93 ± 8.09 kg vs. 48.55 ± 7.17 kg, t=3.169) were both higher than those of the control group ( P<0.01). Serum level of 1,25-dihydroxyvitamin D3 (23.90 ± 3.34 ng/L vs. 19.44 ± 3.15 ng/L, t=6.184) were higher than those of the control group ( P<0.01). Conclusions:Jianpi-Yishen Decoction in treating sarcopenia aged patients with syndrome of spleen-kidney deficiency and cold-dampness can effectively relieve the symptoms, up-regulate serum level of 1,25-dihydroxyvitamin D3 with clinical efficacy.

Objective To evaluate the diagnostic value of A-F mnemonic performed by sonographers with limited experience in patients with acute chest pain. Methods This was a prospective observational study. Bedside cardiac ultrasound for patients with chest pain was performed by six sonographers with limited experience using A-F mnemonic, evaluating indexes including aortic dissection(A), both ventricles (B), regional wall motion abnormality (RWMA), left ventricular ejection fraction (LVEF) ≤ 50％ (C ,contractility), dimensions (D), pleural and pericardial effusion (E) and further abnormalities (F). Afterwards, experienced cardiac sonographers performed the same examinations, and the difference in the time of ultrasound examination was calculated. The diagnosis of experienced sonographers were referred as the control group, and kappa test was applied to analyze the sensitivity, specificity, positive predictive value and negative predictive value. Results There were 245 cases eligible for study, and 20 cases were excluded. Finally 225 cases of acute chest pain were included in the analysis, containing 158 fatal chest pain and 67 low-risk chest pain. The experienced sonographers diagnosed 20 cases of ascending aortic dissection, 5 cases of right ventricular dilatation, 72 cases of RWMA, 12 cases of LVEF ≤ 50％, 45 cases of left ventricular dilatation, 6 cases of hydropericardium, and 6 cases of other abnormalities. The consistency between beginners and experienced sonographers were as follows:completely same (hydropericardium, Kappa=1.000), highly consistent (ascending aortic dissection, Kappa=0.853, right ventricular dilatation, Kappa=0.931, and other abnormalities, Kappa=0.829), moderately consistent (RWMA, Kappa=0.768, LVEF ≤ 50％, Kappa=0.713 and left ventricular dilatation, Kappa=0.766). The sensitivity and negative predictive value of RWMA and LVEF ≤ 50％ and the positive predictive value of left ventricular dilatation in the beginner sonographers were lower than those in the experienced sonographers. Conclusions A-F mnemonic was a simple and practical way for the beginner sonographers to perform bedside cardiac ultrasound. It was of significant value in making correct diagnosis of most acute chest pain patients and providing quick and reliable information for clinicians.

Objective To investigate the application of fetal intelligent navigation echocardiography ( FINE ,5D Heart) in the diagnosis of conotruncal anomalies ( CTD ) . Methods For prospective study , volume transducer was used to collect the three-dimensional data of fetal heart at 20th - 30th week of gestation . The STIC volume images were processed by three independent physicians of different hierarchies via 5D Heart software afterwards ,and the quality of the STIC diagnosis as well as the consistence among the physicians were analyzed according to the gold standard of postpartum ultrasonic follow-up or surgery results . Results Twelve out of 16 CTD cases were finally included in the study ,and the volume data were analyzed . Senior physicians A could apply 5D Heart diagnosis to achieve 2D-US diagnosis efficiency and gold standard consistently( P = 0 .157 ,0 .083) ,medium and low seniority physician B and C got roughly equal score using 5D Heart diagnosis( P = 0 .705) ,but the diagnostic performance could not reach 2D-US ( P =0 .000 ,0 .000) and gold standard( P = 0 .000 ,0 .000) . Conclusions Fetal cardiac anomalies of CTD can be diagnosed correctly by an expert using 5D Heart ,which has important application prospects in remote consultation , training and scientific research and teaching of congenital heart disease of fetus .

Objective: To investigate the clinicopathologic features, immunohistochemical phenotypes and biological behavior of pseudosarcomatous myofibroblastic proliferation (PMP) of the urinary bladder which may be misdiagnosed as a malignant neoplasm and undergo extensive treatment. Methods: Six cases of PMP of the urinary bladder were collected from 2001 to 2016 at Beijing Tiantan Hospital, Capital Medical University. The clinicopathologic features and immunophenotypic profile were studied by histopathological and immunohistochemical investigations with clinical follow-up. At the same time, the translocation of ALK gene was detected by fluorescence in situ hybridization (FISH). Immunohistochemistry was carried out using EnVision method for the expression of AE1/AE3, vimentin, EMA, SMA, Caldesmon, Calponin, desmin, ALK, Ki-67, MyoD1, myoglobin, CD34, S-100, CD117, CK7, CK20, GATA3, p63 and CK5/6. The related literature was reviewed. Results: There were two male and four female patients, significantly more common in women. The age of the patients was 27 to 53 years, and the median age was 35 years. The main clinical symptom was painless gross hematuria, one case with dysuria, and one case showed recurrent cystitis. There was no history of surgery and trauma. Follow-up ranged from 4 months to 13 years and showed five cases without recurrence and one case with recurrence. Microscopy showed submucosal lesion with inflammatory exudate and bleeding on the surface, in some cases extending to the superficial muscles of the bladder wall. The lesion was characterized by the proliferation of plump spindle cells, which were loose or dense in arrangement. There were varying degrees of acute and chronic inflammatory cells infiltration in the myxoid matrix. Spindle cells arranged in disorder, or a dense stranding, especially abundant in the cell region. The median mitotic rate was <2/10 HPF cells, but there were no pathological mitotic figures and without nuclear atypia in most spindle cells. Spindle cells with eosinophilic cytoplasm showed long tapering cytoplasmic projections. Oval or short spindle nuclei had vacuolization with prominent nucleoli, looking like ganglionic cells. There were scarce collagen fibers, and a few spindle cells degenerated with chromatin blurred. Some areas showed a granuloma-like pattern and neutrophils within vascular cavity. Immunohistochemically, the spindle cells were diffusely positive for vimentin, SMA and caldesmon. CKpan was strongly and diffusely positive. Desmin and calponin expression was varying. Ki-67 positive cells were about 35% to 55%, but the spindle cells were negative for myoglobin, S-100, CD117, CD34, p63 and CK5/6. FISH test showed that there was no ALK isolated signal in 6 cases of PMP, and so no positive cases were found. Conclusions PMP of the urinary bladder is a benign non-neoplastic myofibroblastic proliferative lesion. Morphology is extremely easy to be misdiagnosed as malignant tumors, and therefore more attention should be paid to avoid this misdiagnosis.