Objective To study the risk factors for children with acute central nervous system(CNS)viral in-fection,so that pediatrician may identify children with poor prognosis at early stages of the disease,and provide them with a theoretical basis for clinical treatment. Methods The clinical data of a cohort patients of acute CNS viral infec-tion who were hospitalized at the First Affiliated Hospital of Fujian Medical University between January 2010 and June 2013 were retrospectively collected and analyzed. According to Glasgow outcome scale on discharge,children were di-vided into good prognosis group and poor prognosis group. Clinical data and outcomes were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results Three hundred and one cases were enrolled,278 (92. 36% )patients were assigned to the good prognosis group,and 23(7. 64% )patients were assigned to the poor prognosis group. By univariate analysis,the patients in the poor prognosis group had longer duration of sickness before admission,longer time of fever,lower white blood cell count in cerebrospinal fluid,a relatively lower calcium level,con-scious disturbance at the early stage,multiple seizures,convulsive status epilepticus,meningeal irritation sign,muscle weakness,severe changes in electroencephalogram(EEG),and abnormal neuroimaging findings(computed tomography or magnetic resonance imaging,or both)had significant differences between the good prognosis group and the poor short - term outcome groups(all P < 0. 05). By binary Logistic regression multivariate analysis,factors indicating a poor prognosis during the early stage were conscious disturbance at the early stage(0R = 4. 885,95% CI:1. 523 - 15. 670, P = 0. 008),multiple seizures(0R = 6. 352,95% CI:1. 905 - 21. 178,P = 0. 003),severe changes in EEG( 0R =4. 269,95% CI:1. 708 - 10. 666,P = 0. 002),and abnormal neuroimaging findings( 0R = 9. 740,95% CI:2. 360 -40. 192,P = 0. 002). Conclusions Conscious disturbance at the early stage,multiple seizures,severe changes in EEG and abnormal neuroimaging findings are risk factors for acute viral infection of CNS in children.

Objective To investigate the relationship of epidermal growth factor receptor (EGFR) mutation with clinical features of baselines as well as serum CEA level in patients with recurrent non-small cell lung cancer (NSCLC). Methods A total of 54 patients with first recurrence of advanced lung cancer who had received chemotherapy were included in this study. ADx-ARMS was performed to detect EGFR gene mutations in surgical specimens taken from the primary tumor. Serum CEA level was measured by the electrochemical luminescence method. Results The mutation rate of EGFR was significantly higher in females than in males (χ2= 11.868, P =0.006), with a total mutation rate of 60.8%in 106 patients. The rate was higher in adenocarcinoma than in other histological types(χ2=6.002,P=0.014), and significantly higher in non-smokers than in smokers (χ2= 8.502,P=0.004) and in the patients with serum CEA level over or equal to 5.0 ng/mL than those with CEA level less than 5.0 ng/mL (χ2=22.543,P=0.000). A multivariate analysis revealed that a higher serum CEA level at the time of disease recurrence was associated with EGFR gene mutations (P = 0.002). Conculsions Serum CEA level is closely associated with the presence of EGFR gene mutations in patients with first recurrence of advanced NSCLC. A higher serum CEA level at the time of disease recurrence is independently associated with EGFR gene mutations. CEA level can be used as a potential indicator to determine EGFR mutation.

Objective To explore the effects of mouse nerve growth factor (mNGF) on expression of metallothionein I/II (MT I/II) and cytochrome C (Cyt C) in hippocampus of pentylenetetrazol (PTZ)-induced epileptic (EP) young rats. Methods Fif-ty SD rats aged 19 days were randomly divided into control group, EP group, mNGF low, medium, and high dose groups. Each group had 10 rats. Control group was injected with normal saline every day, and EP group was intraperitoneally injected with PTZ 40 mg/(kg·d) for 21 days in succession. The mNGF low, medium, and high dose groups were respectively intramuscularly injected with mNGF 500, 1 000, 2 000 AU/(kg·d) for 7 days in succession after PTZ injection. Changes of body weight, behav-ioral performance were recorded. The positive cells of MT I/II, Cyt C were examined by immunohistochemisty. The levels of MT I, Cyt C mRNA in hippocampus were measured by real-time PCR. Results The number of MT I/II, Cyt C positive cells and the levels of MT I, Cyt C mRNA in hippocampus had signiifcant differences among groups (F=15.98-105.76, P=0.000). The number of MT I/II, Cyt C positive cells and the levels of MT I, Cyt C mRNA of EP group were higher than those in control group, mNGF low, medium, and high dose groups (P<0.05). The number of MT I/II, Cyt C positive cells of mNGF low group were higher than those in mNGF high dose group (P<0.05). The levels of MT I, Cyt C mRNA of mNGF low group were higher than those in mNGF medium and high dose groups (P<0.05). The number of MT I/II, Cyt C positive cells and the levels of MT I, Cyt C mRNA had no differences between mNGF medium and high dose groups (P>0.05). Conclusions As a stress protein, metallothionein is involved in the process of chronic epilepsy along with Cyt C. mNGF has neuroprotective effects on the hippocampus of epileptic rats in dose dependent manner.

Objective To assess the value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of pancreatic neuroendocrine neoplasms (PNEN) and to analyze the factors influencing thepreoperative imaging diagnosis of PNEN.Methods From January 2016 to November 2016, patients with PNEN diagnosed by surgery and biopsy were collected. CT and MRI data of them were analyzed. The CT values or signal intensity of the lesions and the pancreatic parenchyma were measured and the contrast-to-noise ratio (CNR) of the lesion was calculated. Detecting sensitivity and diagnosis accuracy of CT and MRI were compared. Detecting sensitivity of different MRI sequences was also analyzed. Diagnosis accuracy of non-functional PNEN and functional PNEN was compared and analyzed. Lesion CNR was compared between arterial phase and portal venous phase of the contrast enhanced CT. The sensitivity, accuracy and constituent ratio were compared by nonparametric analysis. Independent sample t test and one-way analysis of variancewere performed for the quantitative parameters comparison. Results A total of 54 patients with 56 lesions of PNEN were included for two of whom had two lesions each. CT and MRI were both performed in 44 patients (46 lesions).Detecting sensitivity and diagnosis accuracy of CT were 97.8% (45/46) and87.0% (40/46), respectively. Detecting sensitivity of MRI were 97.8% (45/46) and89.1% (41/46), respectively. There was no significant difference in detecting sensitivity and diagnosis accuracy between CT and MRI (both P>0.05). The CNR of lesion in arterial phase was higher than that of portal venous phase(4.7±3.8 vs 3.4±2.5), and the difference was statistically significant (t=2.949, P<0.05). Detecting rates of T1 weighted imaging with fat suppression (T1WI-FS) image, T2 weighted imaging with fat suppression (T2WI-FS) image, diffusion weighted imagingand dynamic contrast enhanced T1WI-FS image were 90.0% (45/50), 88.0%(44/50), 86.0%(43/50), and 91.7% (44/48), respectively. There was no significant difference in detecting rate among these images sequences (Q=2.526, P=0.510). Tumor diameter in non-functional PNEN was significantly larger than that in functional PNEN ((2.9±1.6) cm vs (1.7±0.7) cm)(t=3.479,P<0.05). The overall diagnosis rate of non-functional PNEN with CT and MRI before operation was 70.8% (17/24), which was significantly lower than that of functional PNEN (100.0%, 31/31) (χ2=10.360，P=0.002).Conclusions CT and MRI are both sensitive in detectingPNEN, and they were two complementary modalities. CT image in arterial phase delineated the lesion better than that in portal venous phase. MRI images with different sequences can becomplementary and there is no significant difference in detecting sensitivity for PNEN among different sequences. CT and MRI play an equal rolein the diagnosis of PNEN before operation. Because of atypical CT and MRI findings, the diagnosis of non-functional PNEN is more difficult thanfunctional PNEN.

Background The pathological basis of human primary open angle glaucoma mainly is the degeneration of trabecular meshwork and Schlemm canal.As the outflow pathway of aqueous humor, the tissue origin and characteristics of trabecular meshwork remain less clear.Studying the characteristics of trabecular meshwork may contribute a new thought to the treatment of primary open angle glaucoma.Objective This study was to explore the histological property of trabecular meshwork by detecting the expression of D2-40, a lymphatic biomarker,and CD31,CD34 and smooth muscle actin (SMA), some vascular endothelial biomarkers.Methods Twenty specimens of adult eyeballs were collected from Zhongshan Ophthalmic Center of Sun Yat-sen University,including l0 eyeballs from accident death donors,3 enucleated eyeballs due to posterior segment of choroidal malignant melanoma and 7 orbital exenterated eyeballs.The series ocular meridian sections with the thickness of 4 μm were prepared for the haematoxylin-eosin staining.Immunohistochemistry was employed to detect the expression of D2-40,CD31 ,CD34 and SMA in trabecular meshwork and Schlemm canal.Results Intact structure of chamber angle was observed under the optical microscope by haematoxylin-eosin staining.Human trabecular meshwork tissue was presented with meshlike structure,while Schlemm canal showed the lumen structure.No abnormal substance and periphery synechia were found.D2-40 was strongly expressed in the trabecular meshwork endothelial cells with staining score for 3 points, but CD31, CD34 and SMA were negatively expressed.In contrast, CD31, CD34 and SMA rather than D2-40 were positively expressed in the Schlemm canal.In addition, CD31 and CD34 were also positively expressed in the vascular endothelial cells around the trabecular meshwork.Conclusions The trabecular meshwork expresses lymphatic biomarker rather than vascular biomarkers.This result indicates that trabecular meshwork of human eyes is lymphatic vessel-like tissue.

Objective To investigate the development of tidal breathing lung function in very low birth weight infants with bronchopulmonary dysplasia(BDP).Methods Two hundred and sixty-two very low birth weight infants hospitalized in Wenzhou Children′s Hospital were enrolled as objects.All infants were given the tidal breathing pulmonary function test within a week before discharge and at the corrected age of 6 to 8 months.According to clinical diagnosis,they were divided into BPD group(n=65) and non-BPD group(n=197),and BPD group were divided into mild group(n=31),moderate group(n=20) and severe group(n=14) according to the severity.The lung function indexes were compared between different groups.Results The results of the test within a week before discharge displayed that the respiratory rates in the BPD groups were higher than those in the non-BPD group(all P＜0.05).The peak expiratory flow(TPEF),tidal expiratory flow at 75%,50%,and 25% tidal volume(TEF75,TEF50,TEF25) in moderate to severe BPD group were higher than those in other groups(all P＜0.05),while in mild BPD group were higher than those in non-BPD group(all P＜0.05).The ratio of time to peak tidal expiratory flow to total expiratory time (TPEF/TE),ratio of volume to peak tidal expiratory flow to total expiratory volume (VPEF/VE) were lower in BPD group than those in non-BPD group,the decline was more obvious as the BPD was more serious(all P＜0.05).No significant differences were found between groups in tidal volume(P＞0.05).The result at the corrected age of 6 to 8 months displayed that TPEF,TEF75,TEF50,TEF25 in severe BPD group were still higher than those in any other group(all P＜0.05),while TPEF/TE,VPEF/VE were lower than those in any other group(all P＜0.05),no significant differences were found between other groups in other indicators(P＞0.05).Conclusion Preterm infants BPD have different degrees of lung injury,but as the age grows some lung function indexes can improve gradually(at the corrected age of 6 to 8 months).However,early severe small airway obstruction is still serious.Therefore,it′s important to prevent and treat BPD for the prevention and regulation of respiratory tract disease in future.

Objective To explore the value of CT spectral imaging in the demonstration of pancreatic ductal adenocarcinoma (PDAC).Methods 113 patients were scanned by CT spectral,and gemstone spectral imaging (GSI) was performed in late arterial phase (AP) and portal venous phase (PP).All diagnosis were pathologically confirmed.The ROIs were placed on the lesion and on the pancreatic parenchyma.The ROI files including the CTmono values and the normalized CTmono values (normalized to pancreatic parenchyma) were saved.The works were performed three times repeatedly.CNR values ranged from 40 keV to 140 keV and the optimal keV in AP and PP were calculated.The differences of CTmono values, normalized CTmono values,and CNR were compared between the optimal keV and 70 keV(equivalent to conventional 120 kVp energy level).Paired t-test and Wilcoxon signed rank test were performed.P<0.05 was considered statistically significant.Results The optimal monochromatic energy of PDAC were 40 keV in both AP and PP.The optimal CNR values(mean±standard) were 2.31±1.02 and 2.38±1.02 in AP and PP,while the corresponding values of 70 keV were 2.08±0.98 and 2.12±0.96.The CNR of 40 keV was higher than that of 70 keV in both AP and PP.The CTmono values of PDAC were (58±13) HU and (71±19) HU at 70 keV and were (111±44) HU and (155±57) HU at 40 keV in AP and PP.The CTmono value in PP was higher than in AP.The median of normalized CTmono values of PDAC at 40 keV were 47.0% and 53.9% in AP and PP, and were lower than those of 70 keV,which were 57.7% and 61.8%.The differences of normalized CTmono values between 40 keV and 70 keV were significant.Conclusion CT spectral imaging manifests that PDAC is hypovascular both in AP and PP and is progressively enhanced form AP to PP.There is maximal conspicuity of tumor in AP, and the optimal monochromatic imaging can improve the conspicuity of PDAC lesion.

Objective To investigate the preventive effect of endoclips and endoloops on postpolypectomy bleeding of large colorectal polyps.Methods Data of patients,who underwent polypectomy during January 2013 to March 2016,were retrospectively collected.The diameters of all polyps were more than 10 mm.Cases were divided into 4 groups.Before large pedunculated (with thick stalks) polyps were resected,endoclips were used to ligate the pedicles of polyps in Group A,and endoloops were used in Group B.After large sessile and pedunculated (without thick stalks) polyps were resected,endoclips were used to close the incision of polypectomy in Group C,but not in Group D.The immediate and delayed postpolypectomy bleeding rate and clinicopathologic features were studied.Articles about endoclip or endoloop on preventing post-polypectomy bleeding in PubMed in last five years were searched and analyzed.Results A total of 2 006 polyps were included.The immediate bleeding rate was 3.4％ (5/147) and 3.8％ (5/132) of Group A and B,respectively.The delayed bleeding rate was 6.1％ (9/147) and 7.6％ (10/132) of Group A and B,respectively.The delayed bleeding rate of Group C and D was 3.2％ (28/888) and 1.9％ (16/839),respectively.None of the bleeding cases needed a surgical operation.And no perforation occurred.Six articles were included for analysis.Most of articles revealed that endoclip and endoloop were effective tools in prevention of post-polypectomy bleeding.Conclusion Endoclips and endoloops are useful to prevent bleeding after resection of large pedunculated (with thick stalks) polyps.For large sessile and pedunculated (without thick stalks) polyps (diameter＞ 10 mm),the effect of endoclips to prevent postpolypectomy bleeding still needs further discussion.

Objective To evaluate image quality of 640-slice coronary CT angiography by combined anesthesia in Tibet minipigs. Methods Tibet minipigs underwent 640-slice coronary CT angiography after anesthesia with xylazine hydrochloride and pentobarbital sodium. The effect of anesthesia was observed and the image quality was evaluated.Results The anesthesia maintained in 40 minutes.The heart rate was (66.66±6.62)beat per minutes.The respiratory frequency was (15.62±1.53)beat per minutes.The revived time was 30 -60 minutes. All of images were good enough to be diagnosed.Conclusion Combined anesthesia with xylazine hydrochloride and pentobarbital sodium has excellent anesthetic effect.It is also simple,convenient and safe.Therefore,it is one of ideal anesthetic methods on such study for 640-slice coronary CT angiography in Tibet minipigs.

Objective To explore the clinical value of expression levels of serum COX-2 in patients with advanced NSCLC before and after EGFR-TKI treatment. Methods The serum was collected from 58 cases. Before and after targeted therapy , the serum COX-2 level was examined by ELISA. Meanwhile , CT scan was exercised to evaluate the treatment. Follow-up interview was done. The relationship among the change in expression level of serum COX-2 , efficacy and PFS was analyzed. Results The serum COX-2 level significantly decreased in the response group (t = 11.258, P = 0.000) and increased in the PD group (t = -7.759, P =0.000) after EGFR-TKI treatment, and not significantly changed in the SD group (t = 1.424, P = 0.170). Before treatment, the baseline serum COX-2 level in the response group was significantly higher than that in the SD group and the PD group (F = 20.852, P = 0.000 ). Before the targeted therapy, the higher the level of serum COX-2 was, the longer PFS patients would enjoy. Conclusion Detection of the serum COX-2 contributes to the judgment of therapeutic effect of EGFR-TKI and can be used as a prediction of EGFR-TKI drugs outcomes for patients with advanced NSCLC.