Objective To make clear glial acidic protein and excitatory amino acid levels in the early expression of neonatal brain injury and the mechanism of brain injury,and the value of early diagnosis and prediction of serum glial fiber acidic protein and excitatory amino acid in neonatal cerebral palsy.Methods This study chose high-risk infants with cerebral palsy as the research object,the concentration of excitatory amino acid and enzyme linked immunosorbent assay were detected by reverse phase high performance liquid chromatography,followed up for 12 months,the occurrence of cerebral palsy was analyzed statistically.Results Compared with the normal group of glial fibrillary acidic protein,glutamic acid and aspartic acid levels,three indexes of children with cerebral palsy were higher than normal group(glial fibrillary acidic protein:(119.46±43.68),(119.46±43.68),(62.57±35.31),(134.02±32.79) ng/L;glutamic acid:(7.52±3.94),(6.49±2.88),(8.15 ±2.03),(1.72±0.59) μmol/L;aspartic acid:(3.81±1.09),(4.23±1.91),(3.67±2.14),(1.35±0.71) μmol/L;F=4.117,4.117,4.117;P<0.05).Glial fibrillary acidic protein,glutamic acid and aspartic acid levels in the high-risk group,the perinatal high-risk group and the pre birth high-risk group had no significant difference (P>0.05).The levels of serum glial fiber acidic protein,glutamic acid and aspartate in children with cerebral palsy were higher than those in the normal group,comparison between spastic group,athetotic group and mixed group(F=5.032,6.004,3.792),there was no significant difference in the levels of glial acidic protein,glutamic acid and aspartate(P>0.05).Conclusion The concentration of excitatory amino acids and acidic protein in the serum of the patients with high risk of cerebral palsy has some value,the concentration of serum excitatory amino acid and the concentration of glial fiber acidic protein are correlated with the degree of brain injury and the time in children with cerebral palsy.

Objective To assess the morphological characteristics of bone marrow in patients of severe fever with thrombocytopenia syndrome ( SFTS) and its value in diagnosis.Methods The bone marrow morphology was retrospectively reviewed in 28 laboratory confirmed patients with SFTS from Zhoushan Hospital during January 2012 and December 2015.The correlation between bone marrow -derived macrophage and peripheral blood cells was analyzed with t test.Results All patients presented leukocytopenia and thrombocytopenia.Poor bone marrow hematopoietic function was observed in 23 patients (82%) showing granulocyte, erythrocyte and megakaryocyte hypoplasia , but no pathological hematopoietic disorder was observed.Eighteen patients (64%) had various degrees of increased amount of macrophage in the bone marrow; peripheral white blood cell count and platelets in patients with macrophage ≥0.5% were lower than those with macrophage <0.5%, and the difference was of statistical significance (t =3.836 and 4.499, P<0.01).Conclusion SFTS patients have characteristic bone marrow morphology , and bone marrow examination is beneficial for differentiation of SFTS from blood lymphatic system diseases and other virus infection.

Objective:To investigate the efficacy of nourishing feeding in patients with acute respiratory failure.Methods:One hundred patients with acute respiratory failure who received treatment in the First Affiliated Hospital of Wenzhou Medical University, China from December 2018 to March 2020 were included in this study. They were randomly divided into a control group and an observation group ( n = 50/group). After admission, all patients were actively treated and given enteral nutritional support. The gastric tube was indwelled. The head of the bed was elevated by 30-40°. The control group was given enteral nutrition which could reach the target dose within 2 days. The observation group was given nourishing feeding. Before and after 7 days of treatment, serum levels of hemoglobin (Hb), albumin (ALB) and total plasma protein as well as white blood cell and lymphocyte counts were determined. Intestinal tolerance was monitored during the treatment period. Mechanical ventilation time, length of intensive care unit stay, total hospital stay, and infection were compared between the control and observation groups. The number of deaths within 60 days after admission was recorded. Results:After treatment, serum levels of ALB, Hb and total plasma protein in the observation group were (49.86 ± 2.41) g/L, (134.96 ± 9.23) g/L, (54.18 ± 3.96) g/L, respectively, which were significantly higher than those in the control group [(42.34 ± 2.29) g/L, (127.49 ± 6.11) g/L, (42.86 ± 2.88) g/L, ( t = 15.99, 4.77, 16.35, all P < 0.01). After treatment, serum levels of ALB, Hb and total plasma protein in each group were significantly increased compared with before treatment (all P < 0.05). After treatment, white cell count in the observation group was significantly lower than that in the control group [(7.96 ± 1.06) × 10 9/L vs. (10.27 ± 2.35) × 10 9/L, t = 6.34, P < 0.01]. Lymphocyte count in the observation group was significantly higher than that in the control group [(1.19 ± 0.47) × 10 9/L vs. (1.02 ± 0.34) × 10 9/L, t = 2.07, P = 0.04]. After treatment, white cell count in each group was significantly decreased, and lymphocyte count in each group was significantly increased compared with before treatment (both P < 0.05). Intestinal intolerance rate in the observation group was significantly lower than that in the control group (22.0% vs. 52.0%, χ2 = 9.65, P < 0.01). The duration of mechanical ventilation, intensive care unit stay and total hospital stay in the observation group were (14.75 ± 5.36) d, (15.81 ± 6.28) d and (24.94 ± 7.18) d, respectively, which were significantly shorter than those in the control group [(18.69 ± 8.64) d, (27.96 ± 8.44) d and (29.84 ± 8.65) d, t = 2.74, 8.17 and 3.08, all P < 0.01]. The infection rate in the observation group was significantly lower than that in the control group (24.0% vs. 44.0%, χ2 = 4.46, P = 0.03). Conclusion:Nourishing feeding for enteral nutrition in patients with acute respiratory failure can better improve the nutritional status, reduce the level of systemic inflammation, improve the immune function, can be tolerated by the intestine, avoid infection, and promote the rehabilitation of patients with acute respiratory failure.

BACKGROUND: A skull defect is inevitable after decompression treatment for traumatic brain injury. Titanium mesh as the most recognized skull repair material has good biocompatibility and has been widely used in clinical practice. However, the timing for skull repair after brain injury is still in dispute.OBJECTIVE: To compare the changes of brain perfusion and the recovery of neurological function in patients with skull defects before and after early and late-stage titanium mesh repair based on CT perfusion technique.METHODS: This was a single-center, prospective, observational clinical trial that was completed at the Taihe Hospital,Hubei University of Medicine in Hubei Province, China. Eighty-six patients with craniocerebral injury who had undergone decompression with removal of bone flap from January 2013 to January 2016 were recruited and subjected to skull repair using titanium mesh. All the patients were randomized into two groups: test group (n=40) with early skull repair within 1-3 months after decompression and control group (n=46) with late-stage skull repair within 6-12 months after decompression. CT perfusion technology was used to observe changes of brain perfusion at 3 days operatively and at 10 days postoperatively. The Barthel index was evaluated at 30 days postoperatively. The trial was registered with ClinicalTrial.gov (identifier: NCT03222297) on July 12th, 2017. The study protocol was approved by the Ethics Committee of Taihe Hospital with the approval No. 2012 (08), and performed in accordance with the Declaration of Helsinki,formulated by the World Health Organization and the hospital's ethical requirements for human research. All the patients and their families were voluntary to participate in the trial, were fully informed of the trial process, and then signed the informed consent prior to the initialization of the trial.RESULTS AND CONCLUSION: The postoperative cerebral blood volume and cerebral blood flow at the parietal cortex on the side of skull defect and at the cortex in the defect region were significantly higher in the two group than the baseline (P < 0.05), while the time to peak was lower than the baseline (P < 0.05). Compared with the control group,significantly higher cerebral blood volume and cerebral blood flow as well as shorter time to peak were observed in the test group (P < 0.05). The Barthel index of the test group was also significantly higher than that of the control group at 30 days postoepratively (P < 0.05). Overall, early skull repair with titanium mesh is helpful to improve the cerebral blood perfusion at the affected side and the recovery of neurological function. In addition, CT perfusion technology is a safe and effective method to monitor hemodynamic changes in the brain.

Objective To investigate the prevalence of anti-endothelial cell antibody fAECA) in the sera of patients with connective tissue diseases(CTD)complicated with pulmonary arterial hyperten-sion (PAH)and to detect the specific antigens of AECA which may be related to clinical manifestations.Methods AECA was detected with Western blotting in 39 CTD patients with PAH.22 CTD patients without PAH and 30 healthy donors.Results The prevalence of AECA was 82%in CTD patients with PAH.73%in CTD patients without PAH and 20%in healthy donors.Anti-22 000 AECA was only detected in CTD patients with PAH(15%).Anti-75 000 AECA was more frequently detected in CTD patients with PAH than in thosewithout PAH(51%vs 23%.P＜0.05).In CTD patients complicated with PAH.anti-75 000 AECA was morefrequently detected in those with Raynaud's phenomenon or with positive anti-RNP antibody.Conclusion AECA can be more frequently detected in CTD patients with or without PAH.Furthermore,anti-22 000 and anti-75 000 AECA may play a special role in CTD patients with PAH.

Objective To investigate the clinical characteristics of Takayasu's arteritis (TA) with pulmonary hypertension (PAH) in order to improve the diagnosis and treatment earlier. Methods Twelve out of 191 patients with TA registered in Peking Union Medical College Hospital from 1987 to 2007 were diagnosed as PAH, the clinical data of 12 patients were analyzed. Results Ten patients were females. The range of age were from 14 to 47 years old, the average age was (27±10) years old. Eleven patients had the clinical manifestations or/and signs of pulmonary artery involvement. Seven patients presented with short breath after exercise or hemoptysis as the first manifestation, four patients with fatigue, four patients with intermittent claudication or pain or numbness of extremities, three patients with dizziness. Seven patients belonged to type Ⅰ+Ⅳ, one patient to type Ⅱ+Ⅳ, three patients to type Ⅲ+Ⅳ, one patient to type Ⅴ. Elevated ESR/CRP was found in ten patients. All patients took the glucocorticoid and DMARDs, stent implantation in pulmonary artery was done in one patient, Bentall was operated in another patient.The symptoms of all patients improved except one patient died for low cardiac output after operation. Conclusion PAH is one of the severe complications in late stage of TA, and other arteries are usually involved too. Because it is difficult to observe PAH in TA patients in early stage, CTA or pulmonary angiography and UCG should be taken in early stage. The stent implantation or dilating the artery should be considered aa a treatment, but at on the same time, glucocorticoid and DMARDs should be taken to avoid the relapse.

Objective To explore the potential role of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the assessment of patients with connective tissuediseases(CTD) associated pulmonary arterial hypertension (PAH). Methods Thirty patients with CTD associated PAH were evaluated by WHO function, echocardiography, right heart catheterization and blood biomarkers. All the clinical data was analyzed statistically. Results All patients [age (39.5 ± 11.6) yr]were female. Both NT-proBNP and BNP were significantly increased and significantly correlated ( all P ＜0. 05 ) respectively with mean pulmonary arterial pressure ( r = 0. 53 and r = 0. 40 ), right arterial pressure ( r = 0. 55 and r = 0. 42 ), pulmonary vascular resistance ( r = 0. 69 and r = 0. 61 ), cardiac index ( r = - 0. 58and r = - 0. 46), mixed venous blood oxygen saturation ( r = - 0. 62 and r = - 0. 54 ), pericardial effusion ( r = 0. 46 and r = 0. 43 ), right atrial sizes ( r = 0. 40 and 0. 53, and r = 0. 39 and 0. 45 ) and right ventricular size ( r = 0. 55 and r = 0. 37 ). Furthmore, NT-proBNP, but not BNP, significantly correlated with WHO function class ( r = 0. 55 ). Conclusion Blood NT-proBNP and BNP were elevated in patients with CTD associated PAH and paralleled the extent of function class, pulmonary hemodynamic changes and right ventricular remodeling.

Objective To investigate the clinical and pathological features of eosinophilic diseases with cardiac involvement Methods We analyzed the clinical and cardiac pathological data of 7 patients with eosinophilic diseases with cardiac involvement under endomyocardial biopsy or autopsy.Results Seven patients (5 male, average age 51 years) were enrolled.Four patients were diagnosed as idiopathic hypereosinophilic syndrome and three were Churg-Strauss syndrome.Peripheral blood eosinophila count increased significantly in all patients.Cardiac involvement included angina pectoris, myocardial infarction, heart failure, presyncope and sudden death.Electrocardiogram showed cardiac ischemia, bundle branch block and third degree atrioventricular block.Echocardiography suggested ventricular and atrial enlargement, decreased ventricular systolic function, pulmonary hypertension, valvular prolapse and insufficiency and endocarditis.Pathology displayed infiltration of eosinophils, formation of granulomata, necrotizing vasculitis, myocardial necrosis and endomyocardial fibrosis in heart.Coronary artery could be also affected and led to myocardial infarction.Conclusions Cardiovascular complications of eocinophilic diseases are a major source of morbidity and mortality in these disorders.The manifestations are multiple and early recognition and treatment with steroid and immunosuppressant can improve prognosis.

Objective To detect the positive rate of anti-endothelial cell antibody (AECA) in patients with pulmonary arterial hypertension (PAH) associated with connective tissue diseases(CTD)and to investigate the specific target antigen.Methods Sera of 68 patients with CTD associated PAH were collected to detect AECA by Western blotting with extracted membrane protein of the endothelial cell line EA.hy926.Sera of 61 CTD patients without PAH,20 with idiopathic pulmonary arterial hypertension(IPAH),20 with chronic obstructive pulmonary diseases and pulmonary arterial hypertension (COPD-PAH) and 20 healthy donors were collected as controls.The correlation between PAH and specific bands of AECA was studied by X2 test.Liquid chromatography-electrospray ionization mass spectrography was used to detect the target antigens related to PAH associated with CTD.Results The specific molecular size of antigen was 78 000.The AECA-78 000positive rate of CTD patients with PAH was 79% (54/68).not significantly ditierent from that of CTD with glomerulonephritis(71%,15/21),but significantly higher than those of CTD with interstitial lung disease (ILD)(15%,3/20)and CTD without systemic involvement(P<0.01 and P<0.05 respectively).also higher than those of IPAH(8%,1/12).The AECA-78 000 was negative in COPD-PAH and healthy controls.The target antigen of AECA-78 000 was identified by proteomic techniques as moesin.Conclusion CTD patients with different target organ involvement have different AECA-78 000 positive rates,which could be frequently detected in CTD associated PAH and those with glomerulonephritis.The common antigen is moesin.

Objective To explore the association between Doppler echocardiography parameters and pulmonary capillary wedge pressure (PCWP) obtained by right heart catheterization (RHC) in patients with pulmonary hypertension (PH).Methods RHC and a simultaneous echocardiography were performed in 86 PH patients.The correlation between the echocardiographic parameters and PCWP was analyzed.Results The early diastolic velocity(E) of mitral valve blood flow was significantly correlated with PCWP ( γ =0.36,P ＜0.01 ).Tissue Doppler imaging measured the diastolic velocity of mitral annulus on the lateral(E'L)and the septal (E'S) wall.Then the average E'M was calculated.The ratio of E to E'L,E'S and E'M showed a strong correlation with PCWP ( γ =0.62,0.34 and 0.47 respectively,P ＜ 0.01 ).E/E'L ＜ 6 accurately predicted 100％ PCWP≤ 15 mm Hg (1 mm Hg =0.133 kPa),and E/E'L ＞ 15 could predict PCWP ＞ 15 nun Hg with specificity of 98.5％.Conclusion There are positive correlation between E/E' and PCWP obtained by RHC in PH patients.