Objective To investigate the clinical features of familial moyamoya disease in China. Methods The patients w ith familial moyamoya disease admitted to the department of Neurosurgery, the 307th Hospital of PLA from March 2009 to June 2012 w ere analyzed retrospectively. Results Of 1 108 patients w ith moyamoya disease admitted to the department of Neurosurgery, the 307th Hospital of PLA, 87 patients (7.8%) w ith familial moyamoya disease w ere identified. Familial moyamoya disease w as observed both in the Han nationality and the minority nationalities. The male to female ratio w as 1∶1.02. The age at first onset ranged from 8 months to 59 years. There w ere tw o peak ages -of-onset, 5-9 years and 30-34 years, respectively). The most common initial symptom w as cerebral ischemia (74 .7%). The first degree relatives w ere the most affected in patients w ith familial moyamoya disease (78/87, 89 .66%), in w hich the siblings accounted for most of the disease ( 38/78, 48.72%), and the proportions of mother-to-child inheritance (21/78, 26.92%) and father-to-child inheritance ( 19/78, 24.36%) w ere similar. Conclusions There are tw o peak ages-of-onset, cerebral ischemia is the most common initial symptom, the first degree relatives are the most affected in patients w ith familial moyamoya disease in China.

Headache is one of the most common symptoms in children w ith moyamoya disease. Its related pathogenesis, clinical manifestations, and operation effect remain unclear. This article review s the advances in headache in children w ith moyamoya disease by review ing the related literatures on the study of headache in children w ith moyamoya disease.

ObjectiveToinvestigatetheclinicalfeatures,riskfactorsforbleedingandtreatment outcomes in moyamoya disease patients w ith intracranial aneurysms. Methods The clinical symptoms, location and size of aneurysm, treatment and the long-term folow-up results of the moyamoya disease patients w ith intracranial aneurysms w ere analyzed retrospectively. Results A total of 34 moyamoya disease patients w ith intracranial aneurysms (35 aneurysms) w ere enrol ed, including 22 (64.7%) in the intracranial hemorrhage group and 12 ( 35.3%) in the non-intracranial hemorrhage group. Of the 35 intracranial aneurysms, 23 (main artery type 11, peripheral artery type 12) w ere in the intracranial hemorrhage group and 12 (main artery type 11, peripheral artery type 1) w ere in the non-intracranial hemorrhage group. There w ere 29 smal aneurysms and 6 medium aneurysms (al w ere patients w ith hemorrhagic moyamoya disease). The aneurysms w ere mainly peripheral arterial type in the intracranial hemorrhage group, and the aneurysms w ere mainly artery type in the non-intracranial hemorrhage group. There w as significant difference in aneurysm typing betw een the tw o groups ( P= 0.013 ). Tw o patients did not perform encephalo-duro-arterio-synangiosis (EDAS) in the intracranial hemorrhage group, other patients and those of the non-intracranial hemorrhage group performed EDAS. Angiographical reexamination revealed that 3 patients w ith peripheral aneurysm disappeared, and 1 aneurysm recurred after aneurysm embolization, and the remaining aneurysms did not have any change. Long-term fol ow-up show ed that 1 patient died of sudden cerebral hemorrhage at 1 year after procedure in the intracranial hemorrhage group, and the others did not have ischemic or hemorrhagic stroke. The modified Rankin scale scores w ere improved in 21 patients. Conclusions There are differences in moyamoya disease patients w ith intracranial aneurysm typing w ith different clinical manifestations. Moyamoya disease patients w ith intracranial aneurysms are mostly smal aneurysms and they can not temporarily be treated directly and can perform EDAS directly. Intracranial aneurysms after procedure may remain long-term stability, and some peripheral aneurysms may disappear.

Objective To investigate the clinical features and prognosis of patients with moyamoya disease and renal artery stenosis. Methods The clinical data such as the first symptom,intracranial vascular lesions,renal artery lesions,treatment and follow-up results of the 15 patients with moyamoya disease and complicated with renal artery stenosis (RAS group)and the baseline-matched 30 moyamoya diseased patients without renal artery stenosis (MMD group)treated at the Department of Neurosurgery,the 307 th Hospital of People′s Liberation Army from March 2009 to June 2012 were analyzed retrospectively. Results (1)The moyamoya diseased patients with renal artery stenosis accounted for 1. 6%(15 / 927)of the total number of patients with moyamoya disease admitted in the same period. In the RAS group,the left renal artery stenosis accounted for 5 cases,the right renal artery stenosis accounted for 4 cases,and the bilateral renal artery stenosis accounted for 6 cases. Mild stenosis accounted for 71. 4%(15 / 21 sides), proximal stenosis accounted for 85. 7% (18 / 21 sides). The incidence of hypertension (80. 0%,n = 12) of the RAS group was significantly higher than that of the MMD group (30. 0%,n =9). There was significant difference (χ2 = 10. 045,P < 0. 05). There was significant difference in the distribution of Suzuki stage between the patients of the two groups (Z = -6. 184,P <0. 01). (2)Four patients underwent interventional therapy,their blood pressure decreased to normal level after procedure. Three patients were followed up for 9 months to 108 months with angiography after interventional treatment. No restenosis occurred in renal artery.
Conclusion The incidence of hypertension in patients with RAS is significantly higher than that without RAS,and there is difference between the degree of intracranial vascular lesions and the patients without RAS. Renal artery stenosis is mainly the proximal mild stenosis. Interventional therapy is an effective method for the treatment of moyamoya disease with severe renal artery stenosis;however,the long-term prognosis needs to be further followed up.

Abstract: Objective　To explore the antiviral effect of baricitinib in the SARS-CoV-2 infection and influence on cytokine levels. Methods　Calu-3 cells were infected with SARS-CoV-2 at MOI of 0.1, and the levels of inflammatory cytokines (IL-6, IL-8, TNF-α and IL-1β), interferon β (IFN-β) and interferon-stimulated gene, IFIT2 in the infected cells were analyzed by qRT-PCR methods. At the same time, Calu-3 cells were infected with SARS-CoV-2 (MOI=0.1) after being treated with baricitinib for 2 hours. Cells were collected at 0, 24, 36, and 48 hours, and analyzed for the mRNA of the above genes in the drug-treated and untreated groups. Results　The mRNA levels of IL-6, TNF-a, IL-1β, IFN-β and IFIT2 in Calu-3 infected by SARS-CoV-2 cells were increased significantly. These cytokines were increased by nearly 100-fold post-infection 48 h compared with the control (P<0.000 1), and continued to increase with the infection time (P<0.001 or P<0.000 1). The increase of IL-8 mRNA level was not as significant as IL-6, TNF-α, IL-8, IL-1β, but it also showed a 2-4 folds increase. Baricitinib does not affect the level of viral RNA in Calu-3 cells after SARS-CoV-2 infection (P>0.05). However, baricitinib can significantly inhibit the up-regulation of IL-6 and TNF-α levels induced by SARS-CoV-2 infection (5.25-fold and 3.90-fold down-regulation, respectively, P<0.01), and has little effect on the levels of IL-8 and IL-1β . In addition, the drug could also significantly down-regulate the increase in IFN-β and IFIT2 levels caused by viral infection (10.51-fold and 90.78-fold down-regulation, respectively, P<0.000 1). Conclusions　Baricitinib inhibits the release of inflammatory cytokines to some extent, but it drastically down-regulates the expression of interferons and interferon-stimulated genes (ISGs), and has limited antiviral effect on SARS-CoV-2. Considering that interferon signal pathways play important roles on viral infection, caution should be exercised when using baricitinib to treat COVID-19 patients.

Objective To develop a novel method for treating complete heart block by autotransplantation of simus node node cells to right ventricular anterior wall.Methods Twenty healthy mongrel dogs were involved in the present study.The dogs were randomly assigned to transplant group or control group(n=10).The sinus node (SN)was harvested and isolated in vitro after an electronic pacemaker was implanted and complete heart bolck was introduced.The SN cells from dogs of transplant group were injected to autogenic right ventricular wall.Commensurable culture medium was implanted to ghe same position of dogs in control group.Two weeks later,detailed electropohysiological study was performed.For investigating the variation of the rhythm,epinephrine was administrated through femoral vein to dogs of transplant group.Results Most of isolated SN cells from dogs were thin-spindle shape,and cell activity was fine.The SNs by VG stained displayed typical structural feature.2 weeks after cell autotransplantation,higher heart rates were achieved from transplant group than that in control group(P＜0.05).This rhythm was stable in 4 weeks and became faster remarkably after administration of eninephrine(P＜0.05).Conclusion SN cell of dogs tutorgrfted into right ventricular anterior wall can form new pacemaker site in ventrcle and improve ventricular rate of complete heart bolck.This pacemaker site can also be regulated by epinephrine.

This study was aimed to establish the thin layer chromatography (TLC) identification and content determination of Tibetan medicineJi-Ni De-Xie (JNDX). TLC was used to identifyBerberis kansuensisSchneid,Terminalia chebula Retz.,Phyllanthus emblicaandCurcuma LongaL. The high performance liquid chromatography (HPLC) was used to determine the content of berberine hydrochloride. The results showed that the TLC identification had a good resolution with clear spots and no interference from the negative reference. The content of berberine hydrochloride showed a good linear relationship with the peak area in the range of 0.05-0.45 mg·mL-1. The regression equation wasY = 40 679X-130.56. The average recovery was 99.07%. It was concluded that the established method was easy to operate with good repeatability. It can effectively control the quality of Tibetan medicine JNDX.

Objective To evaluate the effects of 6-week atypical antipsychotics treatment on serum brain-derived neurotrophic factor (BDNF)level,and the correlation between BDNF level and clinical efficiency in first-episode antipsychotic-na?ve schizophrenia.Methods We recruited 39 hospitalized patients with first-episode antipsychotic-na?ve schizophrenia that met with Diagnostic and Statistical Manual of Mental Disorders—4th Edition (DSM-IV).Both Positive and Negative Syndrome Scale (PANSS)and the level of serum BDNF were measured before and after 6 weeks’treatment with atypical antipsychotics.We also studied 30 healthy controls.Serum BDNF was assayed at baseline.Results Pre-treatment BDNF level was significantly lower in the schizophrenic patients than in the controls [(6.82±2.1 5 )μg/L vs .(1 1.6 ± 3.32 )μg/L,t = 7.239,P < 0.001 ].Although BDNF level increased with treatment (t =2.349,P =0.021)in the schizophrenics,post-treatment BDNF level was still lower than in the normal controls (t =4.634,P <0.001).After 6 weeks’treatment for schizophrenia,the total score of PANSS,the scores of positive and negative symptoms,and the score of general psychopathology scale were all decreased (t =6.1 64,P < 0.001;t = 4.520,P < 0.001;t = 4.132,P < 0.001;t = 5.142,P < 0.001 ).Pre-treatment BDNF levels were directly correlated not only with the rate of decreased PANSS total score (r =0.348, P <0.05),but also with the rate of decreased negative symptoms score (r = 0.35 1,P < 0.05 ).However,pre-treatment BDNF levels were not correlated with improved positive symptoms,general psychopathology (r =0.204, 0.186,P >0.05),or duration of illness (r = - 0.058,P > 0.05 ).Changes in BDNF levels with treatment were correlated with the duration of illness (r =-0.345,P <0.05),but not with psychiatric improvement (r =0.036-0.1 74,P >0.05).Conclusion BDNF level is significantly lower in patients with first-episode antipsychotic-na?ve schizophrenia than in normal controls.It could be improved by using antipsychotics.Higher pre-treatment BDNF level may predict better response to antipsychotics.

Objective To study the features of treatment on neurochemical metabolites in prefrontal lobe and thalamus by proton magnetic resonance spectroscopy (1H-MRS) in first-episode drug-naive patients with early-onset schizophrenia (EOS).Methods Forty-two EOS (study group) met with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-Ⅳ) were recruited.Prefrontal lobe and thalamus were evaluated by multi-voxel 1H-MRS before and 4-week after treatment with a single atypical antipsychotic.The levels of N-acetylaspartate (NAA),creatine compounds (Cr) and choline-containing compounds (Cho) were measured.The patients also received Positive and Negative Syndrome Scale (PANSS).Forty normal controls (normal control group) underwent the same 1H-MRS detection.Results Before treatment,the NAA/Cr ratios in left prefrontal lobe,right prefrontal lobe and lefi thalamus in study group were lower than those in normal control group (1.45 ± 0.26 vs 1.60 ± 0.34,t =2.251,P =0.027;1.43 ±0.26 vs 1.60 ±0.35,t =2.505,P=0.014;1.48 ±0.27 vs 1.65 ±0.35,t =2.470,P =0.016).After 4-week treatment,the NAA/Cr ratios in both left prefrontal lobe and left thalamus of study group were significantly increased compared with those before treatment (1.58 ± 0.30 vs 1.45 ± 0.26,t =2.122,P =0.037;1.62 ± 0.32 vs 1.48 ± 0.27,t =2.167,P =0.033).After 4-week treatment in study group,the total score,positive symptom score,negative symptom score and general pathologic score of PANSS,and the total score of Clinical Global Impression (CGI) were significantly lower compared with those before treatment (59.1 ± 10.2 vs 82.0 ± 13.2,t =8.896,P=0.000;15.3 ±5.1 vs 22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2 vs 21.1 ±7.8,t =3.249,P =0.002;27.4 ±7.6 vs 38.1 ± 8.8,t =5.963,P =0.000;3.6 ± 0.4 vs 4.4 ± 0.5,t =8.097,P =0.000).There was no correlation between the changes of neurochemical metabolite levels such as NAA/Cr and Cho/Cr both in prefrontal lobe and left thalamus,and the clinical symptoms changes,such as total score and every score of PANSS,the total score of CGI in study group after treatment (all P ＞ 0.05).Conclusions The ratios of NAA/Cr are decreased not only in bilateral prefrontal lobe,but also in left thalamus,and the ratios may increase both in left prefrontal lobe and left thalamus after 4 weeks' treatment with atypical antipsychotics in EOS.The treatment outcomes of NAA/Cr do not agree with the improvement of the clinical symptoms.

OBJECTIVETo study whether hypoalbuminemia after pediatric cardiopulmonary bypass (CPB) for cardiac surgery is a risk factor for postoperative acute kidney injury (AKI).

METHODSA retrospective analysis was performed on the clinical data of 1 110 children who underwent CPB surgery between 2012 and 2016. According to the minimum serum albumin within 48 hours postoperatively, these patients were divided into hypoalbuminemia group (≤35 g/L) and normal albumin group (>35 g/L). The two groups were compared in terms of perioperative data and the incidence of AKI. Furthermore, the incidence of AKI was compared again after propensity score matching for the unbalanced factors during the perioperative period. The perioperative risk factors for postoperative AKI were analyzed by logistic regression.

RESULTSThe overall incidence rate of postoperative AKI was 13.78% (153/1 110), and the mortality rate was 2.52% (28/1 110). The mortality rate of children with AKI was 13.1% (20/153). The patients with hypoalbuminemia after surgery (≤35 g/L) accounted for 44.50% (494/1 110). Before and after propensity score matching, the hypoalbuminemia group had a significantly higher incidence of AKI than the normal albumin group (P<0.05). The children with AKI had a significantly lower serum albumin level after surgery than those without AKI (P<0.05). The multivariate logistic regression analysis showed albumin ≤35 g/L was one of the independent risk factors for postoperative AKI.

CONCLUSIONSAlbumin ≤35 g/L within 48 hours postoperatively is an independent risk factor for postoperative AKI in children after CPB surgery.

Acute Kidney Injury ; epidemiology ; etiology ; Adolescent ; Cardiopulmonary Bypass ; adverse effects ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Heart Diseases ; surgery ; Humans ; Hypoalbuminemia ; epidemiology ; etiology ; Infant ; Infant, Newborn ; Male ; Perioperative Period ; Postoperative Complications ; epidemiology ; etiology ; Propensity Score ; Retrospective Studies