Objective To evaluate the diagnostic value of proton magnetic resonance spectroscopy (1H MRS) in multiple sclerosis (MS).Methods MRI and 1H MRS were carried out in 29 patients with MS (MS group) and 26 matched normal control subjects(NC group). By calculating the area below peak, the N-acetylasparatate(NAA), creatine (Cr), choline (Cho) in brain were quantified. The NAA/Cr and Cho/Cr ratios were compared between the two groups. Every patient was measured by EDSS. The correlation analysis was done between NAA/Cr, Cho/Cr ratios and EDSS scores.Results The ratios of NAA/Cr, Cho/Cr were 1.38?0.43, 1.99?0.84 in MS group, 1.89?0.49, 1.48?0.36 in NC group. NAA/Cr decreased in MS group. The difference between two groups was statistically significant ( P0.05). Conclusions The metabolic ratios measured by 1H MRS in MS patients are changed significantly. The ratio of NAA/Cr can reflect the severity of the clinic neurological disability in MS patients.

AIM: To investigate the effect of glibenclamide (Glib) on the viability and acid-base equilibrium of glioblastoma cells.METHODS: U251 cells and U87 cells were treated with Glib at different concentrations.The inhibitory rates were detected by CCK-8 assay.The effective dose was screened and the experiment was divided into control group and drug treatment groups.The migration ability was monitored by wound healing assay, and intracellular pH was detected by pH indicator fluorescent probe.The protein expression levels of inwardly-rectifying potassium channel 4.1 (Kir4.1) and monocarboxylate transport protein 1 (MCT1) were determined by Western blot.RESULTS: The half maximal inhibitory concentrations (IC50) of Glib for 48 h exposure of U251 cells and U87 cells were 400.20 μmol/L and 553.70 μmol/L, respectively.The effective inhibition doses of Glib for U251 cells were from the ranges of 100 μmol/L to 1 600 μmol/L, and those for U87 cells were from 50 μmol/L to 1 600 μmol/L in a concentration-dependent manner (P<0.05).Glib not only inhibited the migration (P<0.05) of U251 cells and U87 cells, which was negatively correlated with drug concentration (P<0.05), but also reduced the intracellular fluorescence intensity in experimental group (P<0.05), suggesting that with the increase in drug concentration, the intracellular pH decreased gradually (P<0.05).The protein expression of Kir4.1 and MCT1 was down-regulated by treatment with Glib, and was negatively correlated with concentration of Glib.CONCLUSION: Glib, a kind of potassium channel blocker, induces intracellular acidification via down-regulating the expression of Kir4.1 and MCT1, thus inhibiting the growth of glioblastoma in a certain dose range.

Objective To evaluate the efficacy of Glutamine enriched enteral nutrition in the treatment of severe traumatic brain injury (sTBI).Methods PubMed,Cochrane Library,Chinese National Knowledge Infrastructure (CNKI),VIP Database for Chinese Technical Periodicals,and Wanfang databases were searched to identify randomized controlled trials (RCT) on the application of Glutamine enriched enteral nutrition for severe TBI patients from database establishment time to May 2017.Two investigators screened the literature strictly according to the inclusion and exclusion criteria,extracted the data,evaluated the literature quality,and performed meta-analysis using RevMan 5.3 software.The effects of glutamine enhanced enteral nutrition on albumin content,immunoglobulin G (IgG) level,the incidence of diarrhea,incidence of pulmonary infection,blood glucose,Glasgow Coma Scale (GCS),length of hospital stay,and mortality were evaluated.Results A total of 17 articles involving 939 sTBI patients were included,with 512 patients in Glutamine group and 427 controls in control group.There were no significant differences in the length of hospital stay and mortality between the two groups (P ＞ 0.05).Significant differences were found in albumin content (95 ％ CI 0.19-2.54,Z =2.27,P＜0.05),level of IgG (95％ CI 0.67-1.80,Z =4.25,P ＜0.01),incidence of diarrhea (95％ CI 0.23-0.57,Z =4.41,P ＜ 0.01),incidence of lung infections (95％ CI 0.14-0.56,Z =3.62,P＜0.01),blood sugar (95％ CI-2.53--0.52,Z=2.98,P＜0.01),and the GCS score (95％CI0.50-2.68,Z=1.49,P＜0.01) between the two groups.Conclusion Compared with routine enteral nutrition,Glutamine enriched enteral nutrition can increase albumin content and IgG level,reduce the incidence of diarrhea and lung infections,reduce blood sugar,and improve the GCS score,but it cannot shorten hospital stay or reduce mortality.

Objective:To evaluate the biomechanical performance of our self-designed anatomical plate for posterolateral tibial plateau in comparison with conventional plates for treatment of posterolateral tibial plateau fractures.Methods:A novel anatomic plate for posterolateral tibial plateau was designed according to the data measured in the superior fibular capitulum and 3D CT segmentation. Twenty-four knee joints were obtained from 12 freshly frozen adult cadavers to make models of posterolateral tibial plateau fracture. The models were divided into 3 groups( n=8). In group A, fixation was simulated via the supra-fibular-head approach after autogenous iliac bone-graft by our self-designed anatomic plate for posterolateral tibial plateau; in group B, fixation was simulated via the posterior tibial approach after autogenous iliac bone-graft by a small T-plate; in group C, fixation was simulated via the supra-fibular-head approach after autogenous iliac bone-graft by a normal L-plate. Biomechanical tests were carried out in the 3 groups to measure the vertical displacements of split bone fragment under the vertical compression loads of 500 N, 1,000 N and 1,500 N and the maximum compression upon failure of internal fixation (compressed displacemen t=3 mm). Results:At the vertical compression loads of 500 N, 1,000 N and 1,500 N, the vertical displacements of split bone fragment showed significant differences among the 3 groups ( P<0.05); there was a significant difference between group C and groups A and B, respectively ( P<0.05), but an insignificant difference between group A and group B ( P>0.05) though group A performed slightly better. In terms of the maximum compression upon failure of internal fixation, significant differences existed among the 3 groups ( P<0.05); there was a significant difference between group C and groups A and B, respectively ( P< 0.05), but an insignificant difference between group A and group B ( P>0.05). Conclusions:Our self-designed anatomic plate for posterolateral tibial plateau can firmly fixate the fracture fragments of posterolateral condyle.

Objective To reveal the characteristics of S gene sequence of hepatitis B surface antigen (HBsAg) in hepatitis B virus (HBV)-infected patients with low HBsAg level.Methods From February 2016 to December 2017, 1 308 serum samples of inactive HBsAg carriers were collected from the 903rd Hospital of PLA and Hangzhou Jianggan District People′s Hospital.The cases were divided into high-level group and low-level group according to the level of serum HBsAg (10 IU／mL) expression.The HBV S gene was sequenced in patients with low-level HBsAg expression.In addition, in patients with high-level HBsAg, 100 patients were randomly selected (stratified sampling) for HBV S gene sequencing based on the matching of age and serological pattern (hepatitis B e antigen [HBeAg] negative) of low-level HBsAg group.A comparative analysis was conducted between HBV S gene sequences from inactive HBsAg carrier in low HBsAg expression group and the HBV reference S gene sequences from inactive HBsAg carrier in high HBsAg expression group .The results of normal distribution data were expressed as Mean ±SD, and analyzed using t-test.The results of non-normal distribution data were expressed by M(QR), and analyzed using Mann-Whitney U test.Chi-square test or Fisher exact test was used to compare continuous variables and classification variables between the two groups .Results There were 276 serum samples from the low level group and 1 032 serum samples from the high level group , including 257 HBsAg／HBeAg／anti-HBc-positive cases, 753 HBsAg／anti-HBe／anti-HBc-positive cases, and 22 HBsAg／anti-HBc-positive cases.Successful HBV S gene sequencing was performed on 126 out of 276 patients in the low-level HBsAg group.According to the age inthe low-level HBsAg group, 100 samples with negative HBeAg in the high-level HBsAg group were randomly selected , among which 94 patients were genotyped and hemotyped.The results showed that there were statistically significant differences in HBV serological markers , HBV DNA level and HBV genotype distribution between the high level group (94 cases) and the low level group (126 cases) (all P＜0.05).The ASC-R-B and ASC-R-C genotypes reported in this study had high homology (99.6%-100.0%) with those reported in Shanghai , Chengdu, Wuhan, Yunnan and Beijing of China , and high homology (98.2%-99.6%) with those reported in Japan and Korea of NCBI genotype B and C reference sequences, but had low homology with patients far away from China (98.2% in Canada and 98.7% in Indonesia).In genotype B of the low level group , the amino acid mutation number of SHB protein was 71, and the hot spot mutation number was 19, both higher than those in the high level group (39 and 8, respectively). The difference was statistically significant (χ2 ＝12.303 and 4.766, respectively, both P＜0.05).Amino acid mutation sites in the low HBsAg group were mainly distributed on both sides of the major hydrophilic region (MHR) (amino acid residues 40 -49 and 198 -220).There were no significant differences in amino acid mutation number and hot spot mutation number between the two groups of C genotype (χ2 ＝0.383 and 0.409, respectively, both P＞0.05).For genotype B, 12 single point mutations and 4 dual co-mutations were found in low level group.Among them, one single point mutation (S210R) and 3 dual co-mutations (G44E／V+T45P／I, G44E／V+L49P／R and N40S+I208T) were not hot spot mutations , while 2 dual co-mutations and 2 single point mutations were found in high level group.The difference between two groups was statistical significant (χ2 ＝7.533,P ＝0.006).For genotype C, 5 single point mutations ( T5A, A45T, T47A／K, Q101R and I126S／T) were found in low level group and 1 single point mutation (N3S) in high level group.The difference in mutation frequency between two groups were statistical significant (χ2 ＝47.914,P＝0.000).Conclusions Significant mutations in multiple regions and at multiple sites ( including co-mutations) on both sides of the MHR may be one of the causes of low HBsAg expression level in this population .

Objective:To compare the application effectiveness of conventional rehabilitation combined with thoracic spine mobility exercises and conventional rehabilitation in postoperative rehabilitation of patients with rotator cuff injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 204 patients with rotator cuff injury admitted to First Affiliated Hospital of Jinan University from February 2019 to February 2022, including 88 males and 116 females; aged 18-87 years [(54.1±11.8)years]. Initial unilateral arthroscopic rotator cuff repair was performed on all the patients. A total of 98 patients received a conventional rehabilitation plan (conventional rehabilitation group), and 106 patients received additional thoracic spine mobility exercises as well as conventional rehabilitation (additional exercise rehabilitation group). The visual analog scale (VAS), Constant shoulder joint score, University of California at Los Angeles (UCLA) shoulder joint score, and shoulder range of motion (forward flexion, abduction, and external rotation) before surgery and at 1, 3, and 6 months after surgery were compared between the two groups. The occurrence of complications after rehabilitation was observed.Results:All the patients were followed up for 6-18 months [(8.4±3.5)months]. The VAS score, Constant shoulder joint score, UCLA shoulder joint score, and shoulder joint range of motion of both groups were improved significantly at 1, 3, and 6 months after surgery compared with those before surgery (all P<0.01). There was no statistically significant difference in VAS score between the two groups before surgery and at 1, 3, and 6 months after surgery respectively (all P>0.05). At 3 and 6 months after surgery, the values of the Constant shoulder joint score of the additional exercise rehabilitation group were (77.7±5.8)points and (88.4±7.7)points respectively, which were higher than those of the conventional rehabilitation group [(73.7±6.6)points and (85.5±4.9)points] (all P<0.01). There was no statistically significant difference in the Constant shoulder joint score between the two groups before and at 1 month after surgery (all P>0.05). At 3 months after surgery, the value of the UCLA shoulder joint score of the additional exercise rehabilitation group was (25.5±3.7)points, significantly higher than that of the conventional rehabilitation group [(21.8±5.6)points] ( P<0.01). There was no statistically significant difference in the UCLA shoulder joint score between the two groups before surgery and at 1 and 6 months after surgery (all P>0.05). At 3 and 6 months after surgery, the forward flexion angles of the additional exercise rehabilitation group were (135.5±12.8)° and (165.1±11.3)° respectively, which were higher than those of the conventional rehabilitation group [(129.3±12.3)° and (151.1±11.2)°]; the abduction angles of the additional exercise rehabilitation group were (102.3±12.9)° and (130.4±15.1)° respectively, which were higher than those of the conventional rehabilitation group [(93.2±11.0)° and (123.5±13.7)°]; the external rotation angles of the additional exercise rehabilitation group were (57.2±13.1)° and (72.3±12.3)°respectively, which were higher than those of the conventional rehabilitation group [(46.4±8.8)° and (67.4±14.1)°] (all P<0.01). There was no statistically significant difference in the forward flexion, abduction and external rotation angles between the two groups before surgery and at 1 month after surgery (all P>0.05). At 6 months after surgery, recurrent rotator cuff tear occurred in 1 patient (1.0%) in the conventional rehabilitation group and in 2 (1.9%) in the additional exercise rehabilitation group; shoulder joint adhesion deveplpoed in 5 patients (5.1%) in the conventional rehabilitation group and in 3 (2.8%) in the additional exercise rehabilitation group. No statistically significant difference was found in the incidence rate of postoperative complications between the two groups (all P>0.05). Conclusion:Compared with the conventional rehabilitation plan, addition of thoracic spine mobility exercise to the rehabilitation after arthroscopic repair surgery in patients with rotator cuff injury can achieve better joint function and range of motion, with no increase in the incidence of complications.

Objective To analyze the sequence of Pre-S gene in asymptomatic chronic HBV carriers (ASCs) with low-level HBsAg.Methods The serum samples were collected from 654 ASCs in the First Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou Sixth People’s Hospital and the 903th Hospital of PLA.According to the level of HBsAg , ASCs were divided into low-level HBsAg group (≤10 IU／mL ) and high-level HBsAg group (＞10 IU／mL ).The pre-S／S gene amplification and sequencing were performed in 138 ASCs with low-level HBsAg and 100 age-matched ASCs with high-level HBsAg.A phylogenetic tree was constructed to determine the genotype , based on the successful sequencing results of Pre-S gene in the high level HBsAg group , the Pre-S gene reference sequences of the main ASCs genotypes in Eastern China were established.The sequence of Pre-S gene in low-level HBsAg group was analyzed and compared with the reference sequences.SPSS 12.01 statistical software was used to analyze the data.Results Sixty-three cases of Pre-S／S were successfully sequenced in 138 ASCs of low-level HBsAg group, including 52 cases of B genotype and 11 cases of C genotype.Among the 100 cases of high-level HBsAg group, 94 cases of Pre-S／S were successfully sequenced , including 48 cases of B genotype and 46 cases of C genotype.The sequence analysis indicated that in the B genotype , 81 amino acid mutation sites were found in the Pre-S protein of the low-level HBsAg group, including 4 significant mutations: F56I／V, T76A／N／P in the Pre-S1 region, P15L／S／T and Y21T／F／H／N in the Pre-S2 region; while 47 amino acid mutation sites were found in Pre-S protein of high-level HBsAg group, including 3 significant mutations :L34F, V49A and P59S／L in Pre-S1 region.The total number of amino acid mutation sites in the low-level HBsAg group of B genotype was higher than that of the high-level HBsAg group (χ2 ＝14.008, P＜0.05). In the C genotype, 19 amino acid mutation sites were found in the Pre-S protein of the low-level HBsAg group, including 3 significant mutations : W66V／G and A79V in the Pre-S1 region,V32A in the Pre-S2 region; while 39 amino acid mutation sites were found in Pre-S protein of the high-level HBsAg group, including 2 significant mutations: A79V in Pre-S1 region and T49I in Pre-S2 region.The total number of amino acid mutation sites of Pre-S protein in the C genotype was significantly different between the two groups (χ2 ＝7.571, P＜0.05).Conclusion Significant mutations in Pre-S gene may be associated with the persistent expression of low-level HBsAg in ASCs.

Objective To study the expression of epidermal growth factor receptor 1 (EGFR) protein in breast cancer and its correlation to molecular subtyping and hormone receptor status.Methods 467 cases of breast cancer were included.According to ER,PR,HER2,and Ki-67 status,the cases were categorized into 4 molecular subtypes,including 185 cases of luminal A,109 cases of luminal B,76 cases of HER2-enriched,and 70 cases of triple-negative breast cancer (TNBC).According to ER and PR status,the cases were divided into 4 subtypes,including 240 cases of ER+/PR+,50 cases of ER+/PR-,4 cases of ER-/PR+,and 173 cases of ER-/PR-.Results EGFR protein expression rates in Luminal A,Luminal B,HER2-enriched and TNBC were 16.8％(31/185),54.1％(59/109),97.4％(74/76),78.6％(55/70),respectively.The EGFR expression in HER2-enriched was significantly higher than those in TNBC,Luminal B and Luminal A(P＜0.01),and EGFR expression in TNBC was significantly higher than those in Luminal B and Luminal A (P＜0.01),furthermore,EGFR expression in Luminal B was significantly higher than that in Luminal A (P＜0.01).EGFR protein expression rates in ER+/PR+ subtype,ER+/PR-subtype,ER-/PR+ subtype and ER-/PR-subtype were 25.4％ (61/240),52.0％ (26/50),75.0％ (3/4),88.4％(153/173),respectively.The EGFR expression in ER-/PR-subtype was significantly higher than in ER+/PR+ subtype and ER+/PR-subtype (P＜0.01),and EGFR expression in ER+/PR-subtype was significantly higher than that in ER+/PR+ subtype (P＜0.01).EGFR protein expression rate was higher in ER-/PR-subtype than in ER-/PR+ subtype,and EGFR protein expression rate was higher in ER-/PR+ subtype than that in ER+/PR+ subtype and ER+/PR-subtype,but all of the difference were not statistically significant (P＞0.05).Conclusion EGFR protein expression is closely related to breast cancer molecular subtyping and negative hormone receptor expression,which is a potential biomarker of anti-breast cancer therapy.

Objective To study the relationship between circulating tumor cells(CTCs) in peripheral blood of the pa‐tients with hepatocellular carcinoma (HCC) and its metastasis and prognosis .Methods 35 patients with hepatocellular carci‐noma were collected as the research objects .CTCs density were enriched through gradient centrifugation and negative‐immu‐nomagnetic methods ,then the cells were detected by chromosome fluorescence in situ hybridization combined with immunofluo‐rescence tests to identify CTCs .The clinical characters were recorded and the data were statistically analyzed .Results All the patients were detected CTC positive .The number of CTC was (4 .1 ± 2 .5) .The patients were divided into 2 groups .Group Ⅰincluded patients whose CTCs were <5 ,and others were included in group Ⅱ .The difference between number of group I and group Ⅱ had significant significance(P=0 .001);Metastasis had nothing to do with patients′sex and age(P=0 .581 ,0 .531);The number of CTCs was related to metastasis and prognosis(P=0.024 ,0.01) ,and there was significant statistic significance between group I and groupⅡ .Conclusion The number of CTCs was related to tumor metastasis .The tumor may be more prone to occur metas‐tasis and may had worse prognosis ,and the patients may had shorter life time when the number of CTCs was≥5 .

Objective To explore the expression of Fascin-1 and EGFR in triple-negative breast cancer (TNBC) and non-triple-negative breast cancer (non-TNBC) and its correlation.Methods According to ER,PR,and HER2 status,breast cancer were categorized into 2 subtypes:70 cases of TNBC and 370 cases of non-TNBC.The immunohistochemical technique,EnVision method,was used to evaluate the expression of Fascin-1 and EGFR in breast cancer.Results Expression rate of Fascin-1 and EGFR protein in TNBC was 88.6％(62/70)and 78.6％(55/70),while it was 19.2％(71/370)and 44.3％(164/370)in non-TNBC,respectively.Fascin-1 expression rate was significantly higher in EGFR positive non-TNBC cases (34.8％,57/164) than in EGFR negative cases (6.8％,14/206)(x2=46.032,P=0.000).The positive rate of Fascin-1 protein in EGFR-positive TNBC cases (92.7％,51/55) was higher than that in EGFR negative cases (73.3％,11/15),and the difference had no statistically significance (x2=2.673,P=0.102).Conclusions EGFR signal pathway may positively regulate Fascin-1 expression in non-TNBC.The relationship between EGFR and Fascin-1 in TNBC is needed for further study.