OBJECTIVE:To investigate the early changes of ECG,cTnⅠ,LDH,α-HBDH and CKMB in patients with anthra-cyclines chemotherapy-induced heart damage after breast cancer surgery,and to explore their significances in the diagnosis of early heart damage. METHODS:Medical information of 152 cases of anthracyclines chemotherapy after breast cancer surgery in our hos-pital during Jan. 2015-Jun. 2016 were analyzed retrospectively. According to diagnosis criteria of drug-induced cardiotoxicity,the occurrence of heart damage was evaluated during hospitalization and 1-year follow-up. According to evaluation results,those pa-tients were divided into heart damage group(50 cases)and control group(102 cases). The early changes of ECG,cTnⅠ,LDH, CKMB and α-HBDH were analyzed before chemotherapy(T0),24 h after first chemotherapy(T1),24 h after second chemothera-py(T2),24 h after forth chemotherapy. RESULTS:At T1,T2,T3,the proprotion of ECG abnormalities in heart damage group was significantly higher than control group;the serum levels of cTnⅠ,LDH,CKMB andα-HBDH in heart damage group were signifi-cantly higher than control group, with statistical significance (P<0.01). CONCLUSIONS:For anthracyclines chemotherapy drugs-induced heart damage after breast cancer surgery,early regular monitoring of ECG,cTnⅠ,LDH,CKMB and α-HBDH can improve the efficiency of early diagnosis of heart damage,and improve prognosis.

Objective To investigate the guidance value of TOI classification in treating traumatic T-type atlantoaxial dislocation (ADD).Methods A retrospective case series study was made on 32 cases of traumatic TOI T-type ADD treated between January 2012 and December 2015.There were 19 males and 13 females,aged (38.4 ± 14.7) years.Fifteen cases of T1-type underwent external fixation or internal fixation without fusion,while 17 cases of T2-type underwent internal fixation with fusion.Symon-Lavender clinical standard,Japanese orthopedic association score (JOA),visual analogue scale (VAS),atlas-dens interval (ADI) and space available for the cord (SAC) were used to evaluate the therapeutic effect.Results Patients were followed up for 6-54 months (mean,32.4 months).At final follow-up,ADI was decreased to (2.3 ± 1.4) mm from preoperative (5.6 ± 1.6) mm,but SAC was increased to (15.4 ± 1.9) mm from preoperative (12.0 ± 2.9) mm(P ＜ 0.01).At final follow-up,cervical axial rotation range of motion was 102°-154° in T1-type cases and 57°-93° in T2-type cases.Range of motion for atlantoaxial joint was preserved in T1-type cases,but lost in T2-type cases.According to the Symon-Lavender clinical standard,there were 14 cases of mild disability,nine moderate disability,eight severe disability and one extremely severe disability before operation;there were 21 cases of mild disability,nine moderate disability and two severe disability at last follow-up.Significant difference was observed in the grades according to the Symon-Lavender clinical standard before operation and at last follow-up (P ＜0.05).At last follow-up,JOA score was increased to (14.6 ± 2.9) points from preoperative (9.9± 3.2) points,and VAS was decreased to (2.7 ± 1.3)points from preoperative (6.0 ± 1.6)points (P ＜ 0.01).Conclusions By using TOI classification,reconstruction of stability and improved neurological function can be achieved in treatment of traumatic T-type atlantoaxial dislocation.Non-fusion treatment of T1-type atlantoaxial dislocation can preserve range of motion for atlantoaxial joint.

OBJECTIVETo evaluate the consistency between the clinical diagnostic criteria and the ascertained diagnostic criteria for diabetic peripheral neuropathy (DPN) in the Preventive and Treatment Guidelines of Diabetes in China (2013) and explore an economic, convenient, and accurate approach to DPN diagnosis.

METHODSThe patients with type 2 diabetes admitted in our department from April to June, 2014 were examined for nerve conduction velocity, 10 g nylon silk, vibration threshold value, sense of temperature and pain, and ankle reflex. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and Kappa value were calculated to assess the diagnostic power of the two diagnostic criteria.

RESULTSOf the 151 patients enrolled, 106 (70.2%) had a diagnosis of DPN consistent with the ascertained diagnostic criteria, as compared to 86 (56.95%) who were diagnosed according to the clinical diagnostic criteria; the latter patients accounted for 81.13% of former cases. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and Kappa value of the clinical diagnostic criteria were 80.19%, 97.78%, 98.84%, 67.69%, 77.97%, and 0.69, respectively, which were highly consistent with those of the ascertained diagnostic criteria; the sensitivity to compression showed a poor consistency between the two diagnostic criteria. In the 5 screening tests, the combined test of temperature sensation, vibration perception, and ankle reflex showed the highest AUC value among their different combinations.

CONCLUSIONThe clinical diagnostic criteria for DPN show good consistency with the ascertained diagnostic criteria, and for patients with clinical symptoms or with only one positive sign, combination of the two diagnostic criteria can achieve the maximum diagnostic power.

China ; Diabetes Mellitus, Type 2 ; Diabetic Neuropathies ; diagnosis ; Humans ; Neurologic Examination ; methods ; Predictive Value of Tests ; Sensitivity and Specificity

OBJECTIVE: To validate a fetus with high risk for trisomy 13 suggested by non-invasive prenatal testing (NIPT). METHODS: The fetus was selected as the study subject after the NIPT detection at Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences on February 18, 2019. Clinical data of the pregnant woman was collected. Fluorescence in situ hybridization (FISH), chromosomal karyotyping analysis and chromosomal microarray analysis (CMA) were carried out on amniotic fluid and umbilical cord blood and the couple's peripheral blood samples. Copy number variation sequencing (CNV-seq) was also performed on the placental and amniotic fluid samples following induced labor. RESULTS: The pregnant woman, a 38-year-old G4P1 gravida, was found to have abnormal fetal development by prenatal ultrasonography. NIPT test suggested that the fetus has a high risk for trisomy 13. Chromosomal karyotyping analysis of fetal amniotic fluid and umbilical cord blood were 46,XN,add(13)(p10). The result of CMA was arr[hg19]1q41q44(223937972_249224684)×3, with the size of the repeat fragment being approximately 25.29 Mb, the fetal karyotype was thereby revised as 46,XN,der(13)t(1;13)(q41;p10). Chromosomal karyotyping analysis and CMA of the parents' peripheral blood samples showed no obvious abnormality. The CNV-seq analysis of induced placenta revealed mosaicisms of normal karyotype and trisomy 13. The CNV-seq test of induced amniotic fluid confirmed a duplication of chr1:22446001_249220000 region spanning approximately 24.75 Mb, which was in keeping with the CMA results of amniotic fluid and umbilical cord blood samples. CONCLUSION NIPT may yield false positive result due to placenta mosaicism. Invasive prenatal diagnosis should be recommended to women with a high risk by NIPT test. And analysis of placenta can explain the inconsistency between the results of NIPT and invasive prenatal diagnosis.
Humans ; Female ; Pregnancy ; Trisomy 13 Syndrome/genetics* ; DNA Copy Number Variations ; Placenta ; Chromosomes, Human, Pair 1 ; In Situ Hybridization, Fluorescence ; Prenatal Diagnosis/methods* ; Fetus ; Amniotic Fluid ; Chromosome Aberrations ; Trisomy/genetics*

Objective To evaluate the consistency between the clinical diagnostic criteria and the ascertained diagnostic criteria for diabetic peripheral neuropathy (DPN) in the Preventive and Treatment Guidelines of Diabetes in China (2013) and explore an economic, convenient, and accurate approach to DPN diagnosis. Methods The patients with type 2 diabetes admitted in our department from April to June, 2014 were examined for nerve conduction velocity, 10 g nylon silk, vibration threshold value, sense of temperature and pain, and ankle reflex. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and Kappa value were calculated to assess the diagnostic power of the two diagnostic criteria. Results Of the 151 patients enrolled, 106 (70.2%) had a diagnosis of DPN consistent with the ascertained diagnostic criteria, as compared to 86 (56.95%) who were diagnosed according to the clinical diagnostic criteria; the latter patients accounted for 81.13% of former cases. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and Kappa value of the clinical diagnostic criteria were 80.19%, 97.78%, 98.84%, 67.69%, 77.97%, and 0.69, respectively, which were highly consistent with those of the ascertained diagnostic criteria; the sensitivity to compression showed a poor consistency between the two diagnostic criteria. In the 5 screening tests, the combined test of temperature sensation, vibration perception, and ankle reflex showed the highest AUC value among their different combinations. Conclusion The clinical diagnostic criteria for DPN show good consistency with the ascertained diagnostic criteria, and for patients with clinical symptoms or with only one positive sign, combination of the two diagnostic criteria can achieve the maximum diagnostic power.

Objective To evaluate the consistency between the clinical diagnostic criteria and the ascertained diagnostic criteria for diabetic peripheral neuropathy (DPN) in the Preventive and Treatment Guidelines of Diabetes in China (2013) and explore an economic, convenient, and accurate approach to DPN diagnosis. Methods The patients with type 2 diabetes admitted in our department from April to June, 2014 were examined for nerve conduction velocity, 10 g nylon silk, vibration threshold value, sense of temperature and pain, and ankle reflex. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and Kappa value were calculated to assess the diagnostic power of the two diagnostic criteria. Results Of the 151 patients enrolled, 106 (70.2%) had a diagnosis of DPN consistent with the ascertained diagnostic criteria, as compared to 86 (56.95%) who were diagnosed according to the clinical diagnostic criteria; the latter patients accounted for 81.13% of former cases. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and Kappa value of the clinical diagnostic criteria were 80.19%, 97.78%, 98.84%, 67.69%, 77.97%, and 0.69, respectively, which were highly consistent with those of the ascertained diagnostic criteria; the sensitivity to compression showed a poor consistency between the two diagnostic criteria. In the 5 screening tests, the combined test of temperature sensation, vibration perception, and ankle reflex showed the highest AUC value among their different combinations. Conclusion The clinical diagnostic criteria for DPN show good consistency with the ascertained diagnostic criteria, and for patients with clinical symptoms or with only one positive sign, combination of the two diagnostic criteria can achieve the maximum diagnostic power.