Objective To explore the serum levels of growth differentiation factor-15 (GDF-15) in patients with acute exacerbation of chronic heart failure (CHF) and its correlation with other common indexes,to provide reference for its clinical diagnosis,treatment and prognosis.Methods Two hundred patients with acute exacerbation of CHF were selected as CHF group,and 100 matched healthy volunteers were selected as control group.Serum levels of GDF-15 and N-terminal pronatriuretic peptide (NT-proBNP) were detected,and left ventricular end diastolic diameter (LVESD),left ventricular end diastolic diameter (LVEDD),and left ventricular ejection fraction (LVEF) were measured by echocardiography within 2 hours after admitted to hospital,and after the symptoms improved of CHF group,and on health examination day of control group.Patients in CHF group were followed up to record CHF related adverse events.Correlations between GDF-15 and other indicators were analyzed by Spearman correlation analysis,and the clinical value of serum GDF-15 on diagnosing CHF was analyzed by the receiver operating characteristic curve (ROC) and the area under the curve (AUC).Results The serum levels of GDF-15 and NT-proBNP in each time-point of CHF group were all higher than those of control group (t =4.70 ～ 7.11,P ＜ 0.05 orP ＜ 0.01).The serum levels of GDF-15 and NT-proBNP had negative correlation with LVEF (r =-0.539,-0.572,P ＜ 0.01),and had positive correlation with LVESD,LVEDD,and NYHA cardiac functional grading (r =0.505 ～ 0.861,P ＜ 0.01).Serum GDF-15 had positive correlation with serum NT-proBNP (r =0.528,P ＜0.01).With the increase of serum GDF-15 level,CHF group's readmission (rate) and death (rate) were both increased (x2 =36.86,26.59,P ＜0.01).AUC of predicting readmission risk by serum GDF-15 was 0.822 (95％ CI:0.719 ～0.890,P ＜0.01),and the best predictive cutoff point was 2 876.30 ng/L (sensitivity was 91.86％,specificity was 73.27％).AUC of predicting mortality risk was 0.816 (95％ CI:0.715 ～ 0.885,P ＜ 0.01),and the best predictive cutoff point was 3 487.05 ng/L (sensitivity was 91.72％,specificity was 69.05％).Conclusions Serum GDF-15 level in patients with acute exacerbation of CHF is higher,decreases with symptoms improvement,has positive correlation with LVESD,LVEDD,and NYHA cardiac functional grading,and has negative correlation with LVEF,has higher sensitivity on predicting CHF-related adverse events,and the mechanism may be related to the activation of SMAD pathway.Therefore,it may be a promising biomarker for clinical diagnosis and prognosis of cardiovascular diseases.

Objective To evaluate the feasibility and efficacy of subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping.Methods Between July 2008 and July 2013,152 limbs of venous ulceration after great saphenous vein stripping were divided into two groups (conservative therapy and subfascial endoscopic perforator surgery therapy) and followed up at least for 2 years,respectively compared symptoms and signs improvement,ulcer healing time,ulcer healing and ulcer recurrence rate after healing for 6,12,24 months.Results No patient underwent the surgery occured pulmonary embolism or death,2 limbs appeared hematoma.Conservative and subfascial endoscopic perforator surgery group's symptoms and signs improvement rates were 81.9％ (59/72) and 86.3％ (69/80) (not significant,P =0.528),while the ulcer healing time,ulcer healing and ulcer recurrence rate respectively were 65.3％ (47/72) and 78.8％ (63/80),(73 ±15.7) d and (41 ± 12.6) d,34.0％ (16/47) and 14.3 ％ (9/63) (significantly different,P ＜ 0.05).According to the three time-points' (6,12,24 months) follow-up,the non-recurrence rate were 89.4％ (42/47) and 96.8％ (61/63),P=0.135;72.3％ (34/47) and 92.1％ (58/63),P=0.006;66.0％ (31/47) and 85.7％ (54/63),P =0.014.Conclusions Subfascial endoscopic perforator surgery is a reliable,safe and minimally invasive surgery,and has a long-term effect in treating varicose ulcer after great saphenous vein stripping.

Objective Based on the published articles,this paper aims to study the pattern and probability of lymph nodes metastasis in nasopharyngeal carcinoma (NPC) and establish a radiotherapy standard for selecting and delineation of clinical target volume of neck lymphatics for NPC patients with N0 or N1.Methods Clinical trials about NPC by MRI as the main or only diagnostic imaging way were collected and extracted from database,such as WanFang,CBM,PubMed,Cochrane Library.Statistical analyses were performed using Stata software,version 12.0.Results Twenty-one clinical trials from 963 original articles were included in this analysis.The most commonly involved regions included retropharyngeal (67％) and level Ⅱ lymph nodes (71％).The overall probability of levels Ⅲ,Ⅳ and Ⅴnodal involvement were 37％,14％ and 21％,respectively.Low-risk node groups included levels ⅠA,ⅠB,Ⅵ nodes,and the rates of lymph node metastasis were 0,2％,2％ and 1％,respectively.Nodal metastases followed an orderly pattern of top-down,and the probability of skip metastasis between levels varied between 0.5％ ～7.9％.Conclusion Lymph node metastasis in NPC follows a predictable and orderly pattern.The rarity of metastasis in certain nodal groups andskip metastasis suggest that reduced treatment volume is feasible in conformal radiotherapy for NPC patients with No or N1.

We analyzed the epidemiological investigation results of the first case of human infected with avian influenza (H5N6) ,and summarized epidemiological characteristics of this case to provide reference to H 5N6 case screening and investiga‐tion in future works .We retrospectively described and analyzed the investigation progress ,specimen detection results of epi‐demic spot and intimate contact people ,and summarize epidemiological characteristics of this case .Result showed that the first case of human infected with H5N6 in Yunnan was a single case ,and did not showed human‐to‐human transmission .This case had contacts with wild bird and had birds’ market activity before diagnoses ;some environment specimen of birds market near patient’s home has detection results of H5N6 positive .This is a cases of local infection and did not show human‐to‐human transmission .From the investigation ,we could deduced that the transmission route is from birds to human or from birds to en‐vironment and then to human .

ObjectiveTo summarize the clinical significance of ultrasonic screening of fetal structural anomalies at 11-13+6 weeks.Methods We conducted a retrospective study of 4853 cases of nuchal translucency screening at 11-13+6 weeks in Maternal and Child Health Hospital of Bao?an of Shenzhen City from September 2011 to May 2014. The screening ultrasound planes included the median sagittal plane, neck sagittal section, cerebral transverse section, cardiac four-chamber view, three-vessel-trachea view, abdominal transverse section, bladder section, upper limb section and lower limb section of the fetuses. All the cases then underwent the ultrasonic structural screening in the second trimester (20-24 weeks) and the third (28-32 weeks) trimester and were followed up until 6 weeks after birth or the biopsy after abortion.Results Eighty-ifve fetal structural anomalies were detected among the 4853 pregnant women at 11-13+6 weeks of gestation with the detection rate of 1.75% (85/4853), including central nervous system abnormalities (28 cases), anterior abdominal wall anomalies (9 cases), cardiac anomalies (6 cases), urinary system malformation (3 cases), skeletal system malformation (2 cases), multilocular cystic tumor and dropsy embryo (35 cases), and abnormal twins (2 cases). Among above abnormal fetuses, 6 cases showed normal structure in the screening after 14 weeks and were born without malformations, while the rest 79 cases were taken artiifcial abortion (73 cases in the ifrst trimester and 6 cases in the second trimester). Only 9 cases were taken chorionic puncture or amniocentesis, including normal karyotypes (3 cases), 47, XN, +18 (3 cases) and 45, X (3 cases). The False negative rate in the ifrst trimester was 23% (25/110). Supplementary detection of fetal structural abnormalities in the second and third trimester were found in 22 cases (20%, 22/110). Two cases of VSD and 1 case of microtia were identiifed after birth.ConclusionsThe fetal malformation can be detected in the earlier gestation with the ultrasonic screening at 11-13+6 weeks, which provide the earlier termination to the abnormal fetus. It has important clinical signiifcance in effectively reducing fetal births with structural abnormalities.

Objective To investigate the clinical features of neonatal invasive fungal infection(IFI) so as to guide diagnosis,prevention and treatment of IFI.Methods Seventy-six neonates with IFI admitted to the Neonatal Intensive Care Unit (NICU) at Children's Hospital of Fudan University from 2004 to 2014 were included in the study.Pathogens,clinical manifestation,risk factor exposure,laboratory findings,complications,and clinical outcome of neonatal IFI were analyzed.Results Seventy-six cases were diagnosed as IFI between 2004 and 2014,with an yearly increasing trend.Sixty-eight patients were premature infants (89.5％).Of the 76 cases,except one with unknown birth weight,11(14.7％),34(45.3％),20(26.7％)and 10 (13.3％) cases had birth weight ＜ 1 000 g,(≥ 1 000-＜1 500) g,(≥ 1 500-＜2 500) g and ≥ 2 500 g,respectively.The pathogens were mainly Candida (74/76,97.4％),including 26 cases of Candida albicans (34.2％).However,the incidence of non-Candida albicans infection was increasing.Candida guilliermondii was the most common in nonCandida albicans,accounting for 29.2％ (14/48).All Candida albicans were sensitive to fluconazole.One strain of Candida glabrata was resistant to fluconazole.The most common risk factors included use of broad-spectrum antibiotics(93.3％,56/60),parenteral nutrition(70.0％,42/60),central vein catheterization(53.3％,32/60),invasive ventilation(40.0％,24/60) and history of abdominal surgery(21.7％,13/60).Clinical manifestations of IFI included temperature instability,frequent apnea,increased requirement of respiratory support and feeding intolerance.Among all cases,six were diagnosed as central nervous system infection.Of the patients who received cranial MRI,46.8％(22/47) showed multiple abnormal signals in cerebral parenchyma.Fiftytwo patients were cured and seven patients died before discharge,including one death due to fungal infection.Conclusions There is an increasing trend of IFI cases in NICU,especially in premature infants.Non-Candida albicans has become the main pathogenic fungus.There are no specific clinical manifestations in neonatal IFI.Use of broad-spectrum antibiotics,parenteral nutrition and central venous catheterization are common risk factors,and preventive measures should be taken in high-risk infants.In addition,IFI in neonates may affect important organs such as central nervous system,thus early treatment is necessary in suspected patients.

OBJECTIVETo investigate the expression of aquaporin 1 (AQP1) in endometrium of patients with menorrhagia.

METHODSRT-PCR and immunohistochemistry were carried out in twenty women with normal menstrual cycle to confirm the expression of AQP1 in endometrium and locate it. Then 51 women with menorrhagia and 40 women with normal menstrual cycle were included in the study. RT-PCR and immunohistochemistry were used to examine the expression of AQP1.

RESULTAQP1 mRNA was expressed in the human endometrium throughout menstruation cycle, which was mainly located in the endothelia of the capillaries and small blood vessels. Quantification of the immunostaining revealed higher density during secretary phase than that in proliferative phase (P<0.01). The staining intensity and density of AQP1-positive microvessel decreased significantly in simple hyperplasia group (P<0.01) and then gradually increased in complex hyperplasia and atypical hyperplasia groups (P<0.001).

CONCLUSIONDecreased expression of AQP1 may lead to disturbed endometrial vascular remodeling and may be involved in the occurrence of menorrhagia.

Adult ; Aquaporin 1 ; biosynthesis ; genetics ; Endometrium ; blood supply ; metabolism ; Female ; Gene Expression ; Humans ; Immunohistochemistry ; Menorrhagia ; genetics ; metabolism ; pathology ; RNA, Messenger ; biosynthesis ; genetics ; Reverse Transcriptase Polymerase Chain Reaction

Objective To explore the differential level of hypermethylated SFRP2 gene in colorectal cancers andadjacent nontumorous tissues,to analyze the relation of SFRP2 gene promoter hypermethylation status and its clinicopathologic significance in colorectal carcinoma,and to study the relationship between the level of hypermethylated SFRP2 and the invasion and metastasis of colorectal carcinoma.Methods Real-time quantitative PCR technique was performed to analyze the level of hypermethylated SFRP2 gene promoter in colorectal cancers and adjacent nontumorous tissues taken from 30 colorectal cancer patients.The relation of the level of hypermethylated SFRP2 gene promoter and its clinicopathologic features of colorectal cancers was analyzed.Results SFRP2 gene promoter hypermethylation occurred in both the tumor tissues and the adjacent tissues.The level of SFRP2 gene promoter hypermethylation was significantly higher in the patients with TNM Ⅲ and Ⅳ (7.24 ± 1.13)than in patients with TNM Ⅰ and Ⅱ ( 5.92 ± 0.97 ) ( P ＜ 0.05 ).The level of SFRP2 gene promoter hypermethylation was significantly higher in the patients with lower differentiation(7.31 ± 1.11 ) than in patients with higher differentiation (6.23 ± 1.03) ( P ＜ 0.05 ).No significant association was found between the level of SFRP2 gene promoter hypermethylation and the status of gender,age.tumor location and tumor size ( P ＞ 0.05 ).Conclusions SFRP2 gene hypermethylation in tissues may be a useful objective parameter for the malignant level,invasion,metastasis,recurrence and prognosis of the colorectal cancer.

OBJECTIVENeonatal lupus erythematosus (NLE) is an uncommon autoimmune disease passively transmitted from the mother in which there is transplacental passage of maternal antibodies. It is often misdiagnosed as intrauterine infection or sepsis. The main purpose of this retrospective study was to improve the understanding of pathogenesis and clinical manifestations of NLE.

METHODSClinical manifestations, results of the tests for antinuclear antibodies (ANA), anti-Ro/SSA, anti-La/SSB and anti-dsDNA antibodies in both infants with NLE (8 cases) and their mothers and head ultrasound and CT scans of the infants were analyzed. Follow-up was performed until one and ahalf years of age or all the abnormalities had been resolved.

RESULTSTotally 8 cases (3 males and 5 females) matched the criteria for diagnosis of NLE from September 2003 to February 2006, among whom 4 were small for gestational age and one was born prematurely. Mean gestational age was 38.1 +/- 1.9 weeks, mean birth weight 2 605 +/- 420 grams, mean admission age 22.4 +/- 27.7 days (2 hours-72 days) and mean age of onset 9.4 +/- 12.1 days (0 - 28 days). The common clinical manifestations included cutaneous lupus lesions (8 infants), neural system abnormalities (2 infants) and congenital heart block (2 infants). The skin of the infants exhibited annular, erythematous or desquamative lesions. They all disappeared before 6 months of age. One patient presented with grade III atrioventricular block and was delivered by cesarean section because of "fetal distress". He did not recover at one and a half years follow-up. One infant was hypotonic with delayed neuro-motor development initially and during follow-up with both abnormal neonatal behavioral neurological assessment (NBNA) and image findings. CT showed generalized low density involving periventricular area and deep white matter at one week of age. At the age of one and a half years, he presented with normal mental development index determined by CDCC infant intelligence mensuration. Other abnormal clinical findings included hepatosplenomegaly, anemia, thrombocytopenia, cholestasis and elevated liver enzymes, which were all resolved before 6 months of age. Only 3 mothers of the NLE infants were diagnosed as lupus erythematosus before parturition and only one received partial therapy. At least anti-Ro/SSA antibody or anti-La/SSB antibody or ANA was found in the affected patients. Seven cases had circulating anti-Ro and/or anti-La antibodies in the mothers and in the newborns, while ANA was positive in 7 newborns and in all mothers. All the clinical symptoms except congenital heart block disappeared before 18 months of age. No special intervention was applied.

CONCLUSIONSerum auto-antibodies should be investigated to rule out NLE when there is congenital heart block or rashes or thrombocytopenia presented in a neonate, despite there is no maternal history. Central nervous system abnormalities in NLE are likely to be transient and whether it will cause long term sequelae is uncertain.

Autoimmune Diseases ; pathology ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; Lupus Erythematosus, Cutaneous ; diagnosis ; pathology ; physiopathology ; Male ; Retrospective Studies

OBJECTIVETo investigate the susceptibility to carbon tetrachloride and benzene in offspring of expanded simple tandem repeats (ESTR) mutation mice exposed to formaldehyde (FA).

METHODSF5 and F10 offspring (200 mg/m3 x 2 hours) served as H group and ICR mice were used as control group (group C). The F5 and F10 offspring were exposed to 10 ml/kg carbon tetrachloride at the doses of 0.05%, 0.50% or 5.00% for 24 hours, respectively or 500 or 1000 mg/kg benzene for 24 hours, respectively by intraperitoneal injection. Serum alanine transaminase (ALT), aspartate transaminase (AST) and the hepatic superoxide dismutase (SOD) or malondialdehyde (MDA) were detected; also the hepatic pathological changes were observed under light microscope; the micronucleus in sternum bone marrow cells as the biomarker of benzene blood toxicity were measured.

RESULTSALT and AST activities in group C of F5 mice exposed to 0.50% and 5.00% CCl4, ALT in groups C and H of F10 mice exposed to 0.05%, 0.50%, 5.00% CCl4, AST in groups C and H of F10 mice exposed to 0.50% and 5.00% CCl4 were significantly higher than those in controls, respectively (P<0.05); as compared to the control, hepatic SOD activities in group C of F5 and F10 mice exposed to 0.50% and 5.00% CCl4, in group H of F5 mice exposed to 0.50% and 5.00% CCl4 and F10 mice exposed to 5.00% CCl4 were significantly reduced, respectively (P<0.05); however, MDA contents in group C of F10 mice exposed to 0.50% and 5.00% CCl4, in group H of F5 mice exposed to 0.05% and 0.50%, 5.00% CCl4 and F10 mice exposed to 0.50% and 5.00% CCl4 were significantly increased than those in control group, respectively (P<0.05). The susceptibility to CCl4 in ESTR mutation F5 mice exposed to FA was significantly higher than that in control F5 mice, but the susceptibility to CCl4 in ESTR mutation F10 mice exposed to FA was significantly lower than that in control F10 mice. The histopathological examination showed that the injury of hepatocytes in C and H groups significantly increased CCl4 doses, and the injury of hepatocytes in H group was higher than that in C group. The micronuclear rates in C and H group mice exposed to benzene(500 mg/kg C group, F5 and F10 mice; 1000 mg/kg C group, F5 and F10 mice; 500 mg/kg H group, F5 and F10 mice; 1000 mg/kg C group, F5 and F10 mice) were 5.88 per thousand +/- 4.55 per thousand, 8.25 per thousand +/- 2.06 per thousand, 7.50 per thousand +/- 6.99 per thousand, 10.67 per thousand +/- 1.16 per thousand, 7.88 per thousand +/- 3.09 per thousand, 9.20 per thousand +/- 1.30 per thousand, 9.63 per thousand +/- 4.34 per thousand and 13.33 per thousand +/- 2.08 per thousand, respectively, which were significantly higher than those (1.13 per thousand +/- 0.35 per thousand, 1.20 per thousand +/- 0.82 per thousand, 1.25 per thousand +/- 0.46 per thousand, 1.33 per thousand +/- 1.03 per thousand) in the solvent control group (P<0.05 or P<0.01).

CONCLUSIONFA could result in the change of susceptibility to CCl4 and benzene in offspring of ESTR mutation mice. ESTR mutation may be a biomarker of the susceptibility to chemicals, but the molecular mechanisms should be investigated in the future.

Alanine Transaminase ; metabolism ; Animals ; Aspartate Aminotransferases ; metabolism ; Benzene ; toxicity ; Carbon Tetrachloride ; toxicity ; Chemical and Drug Induced Liver Injury ; Environmental Exposure ; Female ; Formaldehyde ; toxicity ; Genetic Predisposition to Disease ; Liver ; drug effects ; pathology ; Male ; Malondialdehyde ; metabolism ; Mice ; Mice, Inbred ICR ; Mutation ; Superoxide Dismutase ; metabolism ; Tandem Repeat Sequences ; genetics