Objective To explore the acquired deficiencies of vitamin K-dependent coagulation factors in etiology, clinical characteristics and treatment. Methods Retrospective analysis was performed on the data of etiology, clinical manifestations of 45 patients with acquired deficiencies of vitamin K-dependent coagulation factor. All patients were treated with Vitamin K1 10 -40 mg/d, i. v. , for three months. Some patients with severe blooding were additionally treated with fresh freezing plasma or prothromibin complex. Prothrombin time(PT) and activated partial thromboplastic time(APTT) were measured using Stago automatic blood coagulation analyzer before and after treatment. Ⅱ , Ⅶ, Ⅸ and Ⅹ were measured in some patients. Results Among the 45 cases, no certain cause was found in 19 cases (42.2%), anticoagulant rodenticides poison was a common cause ( 11 cases,42.3% ). The main presentations was hemorrhage, the most common bleeding sites were mucosa (77.8%) (35/45)and hematuria (46.7%) ( 21/45 ). After vitamin K1 treatment, PT and APTT had shortened remarkably from ( 110.35 ± 35.36 ) s,(98.91 ±48.98)s to (13.48 ±2. 17)s,(33.25 ±6.95)s,respectively(t=19.10 and 6.19,Ps ＜0.01)and the activities of factor Ⅱ、Ⅶ、Ⅸ、Ⅹ had rapidly increased from ( 17.48 ± 10.93 ) %, ( 10.23 ± 5.68 )%, ( 11.98 ±4.69)%,(12.93±7.48)% to (70. 12 ±21.31)%,(92.76 ±29. 15)%,(88.64 ±40. 21)%,(63.97 ±20.11)%(t=12.13,14.43,13.27and9. 74,respectively,Ps＜0. 01).Conclusions The histories of patients with acquired deficiencies of vitamin K-dependent coagulation factors are usually hiding, therefore it is easily misdiagnosed. It is worth of detecting PT and APTT in diagnosis and monitoring. Using vitamin K1 10 -40 mg/d is effective and safety.

Background It is well known that sclera remodeling occurs during axial elongation in myopia under the control of growth hormone or its downstream effectors.The role of transforming growth factor-β (TGF-β) in myopia has been determined in previous studies.Bone morphogenetic protein (BMP) is one of members of the TGF-β superfamily,but if it plays an important role in the genesis and development of myopia is not completely clear.Objective This study was to identify the presence of BMPs in normal guinea pigs sclera and investigate the change of BMPs in the sclera in form-deprivation myopia (FDM) of guinea pigs.Methods Thirty young guinea pigs were randomized into normal control group and experimental group using table of random number.FDM models were established by occluding unilateral eyes of guinea pigs with a translucent lens for 14 days in the experimental group,and the fellow eyes served as the controls.Diopter of all eyes was tested by retinoscopy optometry,and ocular axial length was measured by A-sonography before and after modeling.Posterior sclera tissue of the animals was obtained on 14 days,and the relative expression level of BMPs mRNA and protein were assayed by reverse transcription PCR (RT-PCR) and Western blot.The use and care of the animals complied with ARVO Statement.Results On 14 days after occluding of unilateral eyes,the refraction diopter of the experimental group was (-0.48±0.51) D,and that of the fellow eyes was (3.22 ±0.34) D,showing a significant difference between them (t =-12.814,P =0.000).Also,a significant difference in the diopter was seen between the experimental group and normal control group ([-0.48±0.51]D vs.[2.97±0.70]D,t =-11.878,P=0.000).Axial length was (8.30 ± 0.05) mm in the experimental group,(8.11 ±0.06) mm in the fellow eyes and (8.06±0.06) mm in the normal control group,showing a significant increase in the experimental group compared with the fellow eyes and normal control group (t =7.230,P =0.000 ; t =9.084,P=0.000).The expressions of BMP-2 mRNA,BMP-4 mRNA,BMP-5 mRNA in posterior sclera were detected in the normal guinea pigs.Fourteen days after the induction of myopia,the relative levels of BMP-2 mRNA and BMP-5 mRNA in sclera were 0.41 ± 0.11 and 0.65 ± 0.06 in the experimental eyes,which were significantly lower than 0.62 ± 0.07 and 0.84 ± 0.03 in the fellow eyes with the descent range of 34.48％ and 23.67％ respectively (t=2.838,P=0.017; t=2.524,P=0.028).The relative values of BMP-2 protein and BMP-5 protein were 0.44±0.06 and 0.70±0.05 in the experimental eyes,and those of the fellow eyes were 0.61±0.05 and 0.82±0.03,showing significant decline in the experimental eyes with the lowing range of 23.42％ and 15.21％,respectively (t =2.465,P =0.030;t =2.445,P=0.031).No significant differences were found in the expression of BMP-4 mRNA and protein in posterior sclera between the experimental eyes and the normal control eyes (mRNA:t =0.704,P=0.460;protein:t=0.987,P=0.365).Conclusions The expressions of the BMP-2 and BMP-5 in sclera down-regulate significantly in FDM eyes,which suggest that BMP-2 and BMP-5 participate in sclera remodeling during myopia induction.

Objective To evaluate the performance of DNA microarray for rapid detection resistance to rifampin and isoniazid in Mycobacterium tuberculosis clinical isolates and identify suitable target sites for molecular genetic test.Methods Twenty-four clinical Mycobacterium tuberculosis isolates were collected retrospectively from Shenzhen Center for Chronic Disease Control in 2009 and 127 isolates from project on anti-tuberculosis drug resistance surveillance in Shenzhen during 2007 to 2009.Drug susceptibility to rifampin and isoniazid of the stains were determined by DNA microarray,and results were compared to that obtained with reference proportion method drug susceptibility testing for sensitivity,specificity and accuracy.The consistency of microarray and phenotypic susceptibility testing was evaluated by Kappa test.Genetic mutations in rpoB,katG,inhA,regulatory region of inhA,and regulatory region of ahpC were investigated by DNA sequencing to assess proper loci for rapid molecular diagnosis.Results Compared against results of proportion method,the sensitivity,specificity and accuracy of the DNA microarray assay for rifampin resistance were 94.4％,97.5％ and 96.0％ respectively,and for isoniazid resistance were 79.1％,100％ and 86.8％ respectively.Mutations in resistance-determining region of rpoB were observed in 97.2％ (70/72) of the isolates resistant to rifampin,which contributed in the 531,526,516,511 and 533codon region.Mutations in katG315 codon,inhA-15,and ahpC regulatory region were found in 70.3％ (64/91),11.0％ (10/91) and 9.9％ (9/90) of the isolates resistant to isoniazid,respectively.Mutations of ahpC promoter region consists of ahpC-9 (4 strains),ahpC-10 (2 strains),ahpC-6 (2 strains),ahpC-12 (1 strain),and ahpC-32 (1 strain).Conclusions DNA microarray provided a rapid method for the detection of drug-resistant Mycobacterium tuberculosis isolates,and demonstrated good performance except less sensitive for isoniazid resistance.The mutations in ahpC regulatory region might be good target loci for detection of isoniazid-resistant Mycobacterium tuberculosis,so screening the region may significantly improve the sensitivity for molecular genetic tests.

Objective To study prognosis of patients with fulminant hepatitis after plasma ex- change treatment using model for end-stage liver disease(MELD)scoring system.Methods 160 pa- tients were randomly divided into plasma exchange group and control group,and MELD score was calculated according to the original formula for each patient.The efficacy of plasma exchange was as- sessed by mortality and improvement in biochemical parameters and MELD score.Results The levels of total bilirubin(TBIL),INR and MELD score of patients whose MELD scores were between 30 and 40[TBIL,(379.4?40.4)?mol/L; INR,2.5?0.2; MELD,30.8?3.8]were lower than before PE treatment[TBIL,(509.7?64.6)?mol/L;INR,3.5?0.3;MELD,37.3?3.5].The levels of TBIL and INR and MELD score of patients whose MELD scores were higher than 40 [TBIL,(595.6?61.5)?mol/L;INR,3.8?0.4;MELD,39.8?3.5]were lower than before PE treatmem [TBIL, (650.4?66.3)?mol/L;INR,4.4?0.6;MELD,45.2?4.2].The mortality of patients in PE group with MELD score from 30 and 40 was 50.0%,while it was 86.7% in control group,showing significant differ- ence between PE group and control group(P＜0.01).The mortality of patients with MELD scores higher than 40 was 91.2% in PE group and 100% in control group,showing no significant difference between these two groups(P＞0.05).Conclusions Plasma exchange treatment can decrease the serum TBIL level, INR and MELD score of patients with fulminant hepatitis and improve liver function.Compared with the control group,plasma exchange can significantly decrease the mortality of patients in PE group with MELD score from 30 to 40,but no effect on patients with MELD score higher than 40.

Objective To investigate the efficacy and safety of a schedule of 2 cycles' high-dose dexamethasone (HD-DXM) as an initial therapy in adults immune thrombocytopenia (ITP), and compare with conventional dose prednisone therapy. Method A total of 59 newly diagnosed ITP patients were divided into 2 groups randomly. In 30 patients ( Dexamethasone group), oral HD-DXM was administered at 40 mg/d for 4 consecutive days, repeated one week later, and then failed to maintain. In the remaining 29and then gradually tapered. Results For short-term efficacy, after 1 and 2 weeks of treatment, the response rate in Dexamethasone group was significantly higher than that in Prednisone group (50. 0% vs 24. 1%, P ＜0. 01; 73.3% vs 55.2%, P ＜0. 05 ), while 3 weeks later, there was no remarkable difference between the two groups(83.3% vs 68.9%, P ＞ 0. 05 ), though the response rate in Dexamethasone group remained higher. For long-term effect, at the end of the 2nd and 3rd months of follow-up, the relapse rate in Dexamethasone group was significantly lower than that in Prednisone group(24. 0% vs 40. 0%, P ＜ 0. 05;32.0% vs 65. 0%, P ＜ 0. 01 ), while at the end of the 1st month of follow-up, there was no significant difference( 16. 0% vs 20. 0%, P ＞0.05 ). In addition, it's well tolerated and no complications such as severe infection or Cushing syndrome were complained in Dexamethasone group. Conclusion HD-DXM possesses an advantage over conventional dose prednisone therapy in efficacy and safety.

·AIM: To study the tear function changes in patients with pterygium before and after pterygium transposition.·METHODS: Twenty eyes of 20 patients were enrolled in this study.Schirmer I test and tear break-up time (BUT) were evaluated in patients before and after pterygium transposition.·RESULTS: There was no significant difference in the results of Schirmer I test before and after the surgery.The results of BUT were not significantly different before and up to 4 weeks after surgery. However, BUT prolonged significantly 6 weeks after surgery (P<0.05).·CONCLUSION: Pterygium transposition can improve the tear film function in patients with pterygium.

AIM: To evaluate the relationship between the medial rectus cells counts in concomitant exotropia and surgical results. METHODS: A total of 32 pieces of medial rectus muscle were collected for HE staining in this study, of which 18 pieces were from patients with concomitant exotropia and 14 pieces were from healthy individuals. A method of strabismus score was used to assess the operative effect.RESULTS: The difference of strabismus score before and after the operation in the intermittent exotropia group was significantly higher than that in constant exotropic group (P<0.01). Under light microscope, the loosen muscle fibers and the increased stromal components in the cross sectional area of medial rectus were observed in strabismic group. The muscle cells counts was obviously lower in strabismic group than in control group (P<0.01), which was related to the difference of strabismus score before and after the operation (P<0.05).CONCLUSION: The decreased medial rectus cells counts induce concomitant exotropia directly. It is the crucial causes of the bad surgical results.

Objective To explore the feature of electrical physiology and the key aspect of diagnosis in early stage of spinal muscular atrophy in infants.Method The back clinical data of the musle change of electrical physiology within 25 cases were analyzed.Results The children were ill in 1 year old,with the symptom that four limbs present symmetry and paralysing slowly,low limbs being more serious than upper limbs,the close and the distant of the four limbs.The levels of creatine kinase(CK) and lactate dehydrogenase(LDH) in serum were normal and the case unconcentrated was not seen rarely.The show of electromyogram(EMG) was that three limbs presenting wide-range losing nerve electric potential in peace state,when straingently the deadline was long and the motor unit potential(MUP) was high,when strain highly the eletric potential was decreased;the speed of nerve conduction was common.Muscle inspection was typical nervine myatrophy.Conclusion The clinical feature,the changes of muscle electrical physiology and the muscle inspection are valuable for diagnosis so as to afford reliable evidence for further gene diagnosis.J Appl Clin Pediatr,2006,21(3):167

Objective To analyze the ability of rheumatologistto read the magnetic resonance imag of sacroiliac joint of spondyloarthritis patients.Methods The questionnaire survey were conducted among rheumatologists and the answers of the questionnaires were analyzed by quantitative analysis.Results 66.9％ (75/112) rheumatologist did not known how to choose the sequence of magnetic resonance imaging,and 55.4％(62/112) rheumatologist thought that bone marrow edema was very important for the diagnosis of spondyloarthritis,but only less than 10％ rheumatologists thought that erosion and fat infiltration could also h elp to make the diagnosis of spondy-loarthritis.Conclusion It is very important for rheumatologists to receive training on the reading of magnetic resonance images of sacroiliac joint of spondyloarthritis patients.

AIM: To study the protective effect of mese nt eric lymph duct ligation on the functions of liver, kidney and heart, and morpho logy in multiple organ dysfunction syndrome (MODS) rats subjected to two-hit. METHODS: Male Wistar rats were divided into three groups: the me senteric lymph duct ligation group, the non-ligation group and sham group. The M ODS model of two-hit was established by bleeding and LPS administration in both ligation group and non-ligation group. After 24 h, all rats were cannulated to f acilitate blood withdrawal for serum sample, then all rats were killed and organ s including kidney, liver, lung and heart were collected for making microscopic sectio ns. The biochemical indexes of hepatic and renal functions and myocardial enzyme in s erum were determined before and after experiment. RESULTS: After two-hit, the serum contents of AST, ALT, TBA, BUN , Cr and LDH-1 in both non-ligation group and ligation group, and UA content in non-ligation group were obviously increased than those in pre-experiment and sh am group (P