Objective To compare the effect of different sevoflurane induction methods on hemodynamics and immune function in elderly patients with tumor. Methods One hundred and sixty elderly patients with tumor underwent general anesthesia were enrolled, the patients were divided into observation group and control group according to the anesthesia method with 80 cases each. The observation group was received induction method of initial concentration of 2%sevoflurane and increased by 1% per 3 times breathing and then to a final concentration of 4%- 5%. The control group was received 5% sevoflurane induction concentration. The anesthesia induction time, intubation time, recovery time and untoward reaction were recorded. The changes of heart rate, mean arterial pressure (MAP), oxygen saturation of pulse (SpO2), bispectral index (BIS) and CD3+, CD4+, CD8+, CD4+/CD8+were observed. Results There were no statistical differences in BIS, heart rate, SpO2, CD3 +, CD8 + and incidence of untoward reaction between 2 groups (P>0.05). The MAP at immediate intubation in observation group was significantly higher than that in control group:(69.38 ± 10.42) mmHg (1 mmHg=0.133 kPa) vs. (58.52 ± 6.12) mmHg, but the MAP at after intubation was significantly lower than that in control group: (77.12 ± 11.31) mmHg vs. (90.13 ± 9.24) mmHg, there were statistical differences (P<0.05). The anesthesia induction time and intubation time in observation group were significantly longer than those in control group:(110.1 ± 14.2) s vs. (101.4 ± 15.8) s and (341.2 ± 57.3) s vs. (310.4 ± 60.8) s, but the recovery time was significantly shorter than that in control group: (271.2 ± 31.3) s vs. (321.8 ± 41.5) s, there were statistical differences (P<0.05). The CD4+and CD4+/CD8+at end of surgery and 1 d after surgery in observation group were significantly higher than those in control group, CD4+:0.241 ± 0.027 vs. 0.182 ± 0.034 and 0.332 ± 0.039 vs. 0.284 ± 0.042, CD4+/CD8+: 0.84 ± 0.12 vs. 0.69 ± 0.13 and 1.09 ± 0.52 vs. 0.93 ± 0.43, there were statistical differences (P<0.05). Conclusions Induction method of gradually increasing concentration of sevoflurane enables the hemodynamics of elderly tumor patients more stable. In addition, this method can reduce the inhibitory effect on T lymphocytes to some extent.

Objective To investigate the relationship between choroidal telangiectasia and subfoveal choroidal thickness in the patients with central serous chorioretinopathy.Methods Eighty-four patients (84 eyes) with central serous chorioretinopathy in our hospital from February 2015 to April 2016 were selected,based on the fluorescein angiography the patients were divided into 3 groups:Mild group (leakage at 9-10 minutes after injection,26 cases),moderate group (leakage at 5-8 minutes after injection,37 cases),severe group (leakage at 5 minutes after injection,21 cases).The choroidal capillary dilatation was assessed by OCTA,and subfoveal choroidal thickness in three groups and patients with different foveal choroidal expansion degree were measured by EDI-OCT,and correlation analysis was performed.Results The proportion of severe dilation of choriocapillae in mild group,moderate group,severe group were 7.69％,13.52％ and 23.81％,respectively.The subfoveal choroidal thickness was sequentially increased in mild group,moderate group,severe group (P ＜ 0.05).The subfoveal choroidal thickness in patients with mild,moderate and severe dilatation of choroidal capillaries were (306.59 ± 74.18) μm,(367.21 ± 85.04) μm and (416.27 ± 104.56) μm,respectively (P ＜ 0.05).The degree of choroidal telangiectasia in patients with central serous chorioretinopathy had a positive correlation with the thickness of subfoveal choroid (r =0.812,P =0.037).Conclusion The degree of choroidal telangiectasia and subchondral choroidal thickness in patients with central serous chorioretinopathy are significantly increased with the severity of the disease,and there is a positive correlation between them.

Objective To study the influence of collecting blood specimen of cancer patients through PICC on blood test result and catheter-related complication,and discuss the path and feasibility of collecting blood through PICC.Methods Adopting clinical self-contrast experiment,collecting blood specimens of 100 patients at one side through PICC (the observation group)and by ordinary method at the other side of limbs (the control group),comparing the test differences of blood routine,blood biochemistry,and coagulation function,etc.between the two groups.The incidence of catheter-related complication was also observed a week after collecting blood through PICC.Results There was no statistic difference between the two groups in terms of test results.No case of catheter-related complication in a week after collecting blood occurred in the observation group.Conclusions The method of collecting blood specimen through PICC is accurate,safe and feasible,the key point is to implement scientific and standard collecting path and entry-qualification of operators strictly.

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 determine the prevalence of antibodies to cyclic citrullinated peptides (antiCCP) in patients with juvenile-onset systemic lupus erythematosus (JSLE) and its potential clinical significance. Methods Anti-CCP was measured in sera from patients with JSLE (n=47), juvenile idiopathic arthritis (JIA, n=54) and the sera from age-matched healthy children (n=40) using the third generation of anti-CCP ELISA commercial kit. The association of anti-CCP with other laboratory parameters and clinical features, especially arthritic symptoms in JSLE was also analyzed. T-test, Mann-Whitney U test, Chi-square and Fisher's exact test were used for statistical analysis. Results Out of the 47 JSLE patients, 6 (13%) were anti-CCP positive, which was significantly higher than that of the healthy controls( 13% vs 0, P＜0.05 ), but not different from that of the JIA group (26%, P=0.098). RF was more prevalent in JSLE patients with anti-CCP than patients without (83% vs 15%, P＜0.01 ), but there was no difference in other laboratory parameters and the clinical features ineluding the occurrence of arthritis (67% vs 51%, P＞0.05). As one of the initial symptoms, arthritis was observed in 25 of 47 JSLE patients and no one had developed deforming arthropathy.There was no statistical difference in anti-CCP positivity between JSLE patients with and without articular involvement ( 16% vs 9%, P＞0.05 ). Anti-CCP was not detected in any of the 3 patients with JSLE who had experienced joint pain and limited activity during 3 years follow-up. Conclusion Anti-CCP could be detected in patients with JSLE. It is noteworthy when differentiate from juvenile idiopathic arthritis, but the presence of anti-CCP does not relate with the occurrence of arthritis at presentation and persistence of arthritis in JSLE.

Animals ; Cannabinoid Receptor Antagonists ; therapeutic use ; Cannabinoids ; pharmacology ; Fibrosis ; metabolism ; Humans ; Liver Cirrhosis ; etiology ; metabolism ; therapy ; Piperidines ; therapeutic use ; Pyrazoles ; therapeutic use ; Receptor, Cannabinoid, CB1 ; metabolism ; Receptor, Cannabinoid, CB2 ; metabolism ; Receptors, Cannabinoid ; metabolism ; Scleroderma, Diffuse ; metabolism ; Signal Transduction ; drug effects ; Skin ; metabolism ; Smad Proteins ; metabolism ; Transforming Growth Factor beta1 ; metabolism

Objective:To investigate the inhibitory effects of rosmarinic acid (RA) on high glucose-induced angiogenesis of human retinal microvascular endothelial cells (HRMEC) and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome pathway-related proteins.Methods:The HRMEC were divided into control group, high glucose group, high glucose+ low concentration RA group, high glucose+ medium concentration RA group, and high glucose+ high concentration RA group, and were cultured in vitro with conventional medium, 30 mmol/L D-glucose medium, 30 mmol/L D-glucose+ 25 μmol/L RA medium, 30 mmol/L D-glucose+ 50 μmol/L RA medium and 30 mmol/L D-glucose+ 100 μmol/L RA medium accordingly.The 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H-tetrazolium bromide (MTT) assay was used to detect the cell proliferation.Transwell assay was performed to detect the cell migration.Matrigel assay was employed to determine the tube formation ability of cells.Western blot was utilized to detect the expression levels of NLRP3, apoptosis-associated speck like protein (ASC) and cysteinyl aspartate-specific protease-1 (Caspase-1). Enzyme-linked immunosorbent assay (ELISA) kit was used to detect the concentrations of interleukin (IL)-1β and IL-18 in supernatant of cell culture. Results:The cell proliferation rate, the number of migrated cells and the number of formed tubes were (100.00±0.92)%, 37.67±9.02 and 45.00±4.58 in the control group, (163.56±1.46)%, 117.33±7.23 and 95.00±9.54 in the high glucose group, (152.29±2.90)%, 78.67±4.04 and 84.67±1.53 in the high glucose+ low concentration RA group, (147.72±2.22)%, 65.33±4.16 and 71.00±3.61 in the high glucose+ medium concentration RA group, (132.47±0.74)%, 52.67±6.81 and 60.00±1.00 in the high glucose+ high concentration RA group, respectively.There were statistically significant differences in cell proliferation rate, the number of migrated cells and formed tubes among all groups ( F=537.07, 64.63, 45.58; all at P<0.001). Compared with the control group, the cell proliferation rate, the number of migrated cells and formed tubes were significantly increased in the high glucose group, high glucose+ low concentration RA group, high glucose+ medium concentration RA group and high glucose+ high concentration RA group, showing statistical significances (all at P<0.05). Compared with the high glucose group, the cell proliferation rate, the number of migrated cells and formed tubes were significantly decreased in the different concentrations RA groups (all at P<0.05). With the increase of RA concentration, the cell proliferation rate, the number of migrated cells and formed tubes were decreased, and there were statistical differences among high glucose+ low/medium/high concentrations RA groups (all at P<0.05). There were significantly differences in the relative expression levels of NLRP3, ASC and Caspase-1 proteins in cells and the concentrations of IL-1β and IL-18 in cell culture supernatant among all the five groups ( F=145.12, 422.82, 463.79, 2 019.96, 33 406.97; all at P<0.001). Compared with the control group, the relative expression levels of NLRP3, ASC and Caspase-1 proteins as well as the concentrations of IL-1β and IL-18 in cell culture supernatant were significantly increased in the high glucose group, high glucose+ low concentration RA group, high glucose+ medium concentration RA group and high glucose+ high concentration RA group (all at P<0.05). Compared with the high glucose group, the expression levels of NLRP3, ASC and Caspase-1 proteins as well as the concentrations of IL-1β and IL-18 were decreased in the different concentrations RA groups, and the differences were statistically significant (all at P<0.05). With the increase of RA concentration, the expression levels of NLRP3, ASC and Caspase-1 proteins as well as the concentrations of IL-1β and IL-18 were decreased, and there were statistically significant differences among high glucose+ low/medium/high concentrations RA groups (all at P<0.05). Conclusions:RA can inhibit proliferation, migration and tube formation of HRMEC induced by high glucose, and inhibit high glucose-induced activation of NLRP3 inflammasome signaling pathway.

Objective: To study the clinical characteristics, methods of diagnosis and treatment of hyperornithinemia-hyperammonemia- homocitrullinuria (HHH) syndrome. Method: From July 2011 to August 2016, 3 Chinese patients with HHH syndrome were enrolled in this study. The clinical course, biochemical features, brain MRI findings, and gene mutations were analyzed. Result: The three patients′ age at onset of symptoms was 3 months to 7 years, and the age of diagonosis was 3 years and 10 months to 9 years and 10 months. All of them presented with intolerance to protein-rich foods from the infant period, development retardation and abnormal posture. Case 1 and 2 had moderate mental retardation. Serum ammonia 25-276 μmol/L (reference range<60 μmol/L), alanine aminotransferase (ALT) 20-139 IU/L (reference range 9-50 IU/L), ornithine 29.12-99.44 μmol/L(reference range 15-100 μmol/L), urinary orotic acid 1.49-29.75 mmol/mol Cr (reference range 0-7 mmol/mol Cr), uracil 6.09-103.97 mmol/mol Cr (reference range 0-1.5 mmol/mol Cr). The cranial MRI revealed lesions in the basal ganglia, abnormal white matter signal, progressive demyelination and cerebral atrophy. On their SLC25A15 gene, a novel homozygous missense mutation c. 416A>G (p.E139G) was identified in case 1, a known pathogenic homozygous nonsense mutation c. 535C>T was found in case 2 and 3. Liver transplantation had been performed when case 1 was 6 years old. Significant improvements were observed in dietary habit, mental and motor functions, and biochemical parameters. After the dietary intervention with the supplements of arginine, L-carnitine, case 2 was improved, spastic paraplegia of case 3 had no mitigation. Liver transplant was recommended. Conclusion HHH syndrome has an aversion to protein-rich food, and the patients have recurrent vomiting and progressive neurological dysfunction. Clinical diagnosis of HHH syndrome is difficult and patients may present with incomplete biochemical phenotype. The genetic analysis is key for the diagnosis. Depending on their condition, individuals with HHH syndrome can be treated with a low-protein diet, drugs and liver transplantation.

Objective: To determine the CGG repeat number and methylation status of FMR1 gene for fetuses whose mothers have carried a FMR1 mutation. Methods: For 30 pregnant women, the fetal CGG repeat number was determined with a GC-rich PCR system by using chorionic villus, amniotic fluid or umbilical blood samples. The methylation status of the FMR1 gene was confirmed with Southern blotting. Results: In total 30 prenatal diagnoses were performed for 29 carriers of FMR1 gene mutations and 1 with FMR1 gene deletion mosaicism. Three fetuses were found to carry premutations, 9 were with full mutations and 1 with mosaicism of premutation and full mutations. Eighteen fetuses were normal. Conclusion Considering the genetic complexity of Fragile X syndrome (FXS), single method may not suffice accurate determination of their genetic status. The pitfalls and technical limitations of protocols requires adoption of personalized strategy for its prenatal diagnosis.

Fifteen patients with Crohn′s disease (CD) in remission diagnosed at Shanghai Jing′an District Central Hospital from February 2018 to June 2019, and 26 matched healthy subjects were recruited. All participants underwent resting-state functional magnetic resonance imaging (fMRI) scans of hippocampus. The amplitude of low-frequency fluctuations (ALFF) was calculated to determine differences in the brain. Left hippocampus was selected as seeds for functional connectivity (FC) analysis, and the results were compared between two groups. The relationship between disease duration and ALFF/FC values in abnormal regions were analyzed with Pearson correlation. Compared with the controls, the ALFF of the left hippocampus (voxel size 32) of CD patients decreased [family-wise error correstion(FWE correction), cluster level P<0.05], and the ALFF of the left medial superior frontal gyrus (voxel size 126), left supplementary motor area (voxel size 126) and left anterior cingulate gyrus increased (voxel size 37) (FWE corrected, cluster level P<0.05). Using the left hippocampus as the seed point for the whole brain functional connectivity analysis, CD patients showed increased FC strength with the left superior temporal gyrus, left medial superior frontal gyrus, left inferior frontal gyrus (opercular part), and right supplementary motor area(FEW corrected, cluster level P<0.05). Correlation analysis did not show a significantly differences between ALFF/FC value of altered brain areas and the disease duration. It suggests that there are changes in spontaneous activities and functional connectivity in the left hippocampus in patients with CD.