Objective To investigate the myocardial protective effect of adenosine preconditioning against ischemia-reperfusion injury in patients who were undergone valve replacement during cardiac pulmonary bypass.Methods 42 patients scheduling for valve replacement operation were divided randomly into two groups:experiment group(n=23) and control group(n=19).Adenosine preconditioning were performed in experiment group before cardiac pulmonary bypass.To estimate the plasma level of cardiotroponin I (cTnI),creatine kinase isoenzyme (CK-MB ),radialis arterial blood was drown at following time points respectively: before operation,30 minutes before and after aortic clamp,1 hour and 3 hours after aortic opened.Meanwhile the rate of heart spontaneous rebeating,defibrillation,arrhythmia and cardiac inotropic agents used and its duration were recorded.Results The elevated range of plasm cTnI and CK-MB in experiment group were obviously lower than that in control group.In experiment group,the rate of heart spontaneous rebeating were higher,but the frequency of defibrillation,arrhythmia and the cardiac inotropic agents used and its duration were lower than those of control group.Conclusion Adenosine preconditioning has notable clinical protective effects on myocardial ischemia-reperfusion injury in patients undergone valve replacement during cardiac pulmonary bypass.

Objective To investigate the role of micro-RNAs (miR-101 and miR-125a-5p) in autophagy of lipopolysaccharide (LPS) derived human THP-1 macrophages.Methods Human monocytic leukemia cell line THP-1 was cultured in vitro,and it was differentiated into macrophages after being induced with phorbol (50 μg/L) for 48 hours.THP-1 macrophages were stimulated with LPS in 0,250,500,1 000 μg/L respectively for 12 hours,miR-mimic was transfected into THP-1 macrophages as induced by Lipofectamine RNAiMAX,and the transfection efficiency of miRNA was determined with fluorescence microscopy.Enzyme linked immunosorbent assay (ELISA) was used to determine the levels of tumor necrosis factor-α (TNF-α) and monocyte chemotaxis protein-1 (MCP-1) in the supernatants of culture.Western Blot was used to detect the protein expressions of autophagy proteins ATG4D,Beclin1,and LC3 Ⅱ.The expression levels of miR-101 and miR-125a-5p were determined by quantitative reverse transcription-quantitative polymerase chain reaction (RT-qPCR).Results ① The releasing levels of TNF-α and MCP-1 induced by LPS with 250,500,1 000 μg/L were significantly increased as compared the cells without LPS stimulation [TNF-α (ng/L):1 336.1 ± 18.5,1 340.6±24.8,1 364.5± 14.9 vs.47.6±4.4;MCP-1 (ng/L):996.3 ±51.3,934.6±84.3,974.2±69.5 vs.21.3±6.5,all P ＜ 0.01],but no significant differences were found among the three LPS stimulation groups.The protein expressions of ATG4D,Beclin1 and LC3 1Ⅱ were up-regulated in the presence of different LPS concentrations (0,250,500,1 000 μg/L) for 12 hours in THP-1 macrophages (when compared with the cells without LPS stimulation,t value of ATG4D was 8.103,38.410,52.020,P value was 0.015,0.001,＜ 0.001;t value of Beclin1 was 3.026,5.328,3.482,P value was 0.047,0.034,0.037;t value of LC3 Ⅱ was 3.836,6.200,4.665,P value was 0.018,0.003,0.010),and the optimal concentration was 500 tg/L LPS.When THP-1 macrophages were stimulated with 500 μg/L LPS for 12 hours,the expression levels of miR-101 and miR-125a-5p were down-regulated significantly as compared with the cells without LPS stimulation [miR-101 (2-△ △Ct):0.68 ± 0.08 vs.1.95 ±0.26,t =8.047,P =0.001;miR-125a-5p (2-△ △Ct):0.23 ± 0.06 vs.1.69± 0.42,t =5.975,P =0.004].② The higher transfection efficiency was showed under fluorescence microscope.Westem Blot results showed the protein expressions of ATG4D,Beclin1 and LC3 Ⅱ were down-regulated as induced by an over-expression of miR-101 or miR-125a-5p in THP-1 macrophages,and more obviously down regulated by co-transfected with miR-101 and miR-125a-5p (compared with negative control group,t value was 14.550,5.855,14.180,P value was 0.005,0.014,＜ 0.001).Conclusion miR-101 and miR-125a-5p can inhibit the autophagy in LPS challenged THP-1 macrophages,and the potential mechanism might be related to target regulation of ATG4D.

Objective To understand the pathogen of viral encephalitis(VE)in children,and establish a rapid and specific method for detecting human rhinovirus(HRV),and investigate the correlation between HRV and viral encephalitis(VE). Methods 169 CSF specimens were collected from children with convulsions and fever,who were admitted to the pediatric intensive care unit (PICU)of Second Affiliated Hospital of Shantou University Medical College between January 2012 and December 2012.Nested RT-PCR was used to detected HRV in CSF specimens,and the positive PCR products were se-quenced,then analyzed and constructed the phylogenetic tree by software.Results 39 (23.1%)out of 169 samples were HRV positive.Among them,148(87.6%)children were below 5 years old.The detection rate of HRV increases from July to September,and reached its highest point in September.Sequence analyzed showed that the 39 HRV positive specimens inclu-ding 18(46.1%,18/39)positive for HRV-A,7(17.9%,7/39)positive for HRV-B,14(35.9%,14/39)positive for HRV-C. There were 8 out of 28 VE cases were detected in HRV,including 3(50%,3/6)positive for HRV-C.Conclusion HRV could be detected in CSF specimens by nested RT-PCR,including three types of HRV,combined with clinical symptoms con-sidered that HRV may be one of the VE pathogen.

Objective To discuss the significance of different types of human rhinovirus (HRV) as pathogen and the clinical features of different types of HRV in pediatric intensive care unit(PICU).Methods Eight hundred and fifty-two nasopharyngeal aspirates specimen (NPA) were collected from children who were admitted to PICU,the Second Affiliated Hospital of Shantou University Medical College from November 2010 to October 2015 and were tested by using nested reverse transcription-polymerase chain reaction (RT-PCR).Gene fragments for VP4/VP2 capsid protein amplified from HRV positive specimens were sequenced for HRV genotype confirmation.Then clinical characteristics of these HRV positive cases were analyzed.Results Among these 852 specimens tested,214 (25.12％) were HRV positive,including 95 samples(44.39％) positive for HRV-A,17 samples (7.94％) for HRV-B,and 55 samples(25.70％)for HRV-C determined by sequence analysis;while the species of 47 samples (21.96％) of the total were unclassified clearly.HRV-A,HRV-B,HRV-C co-infection with other respiratory viruses accounted for 33.68％ (32/95 cases),29.41％ (5/17 cases),and 29.09％ (16/55 cases),respectively.The clinical characteristics of children infected with HRV-A,HRV-B,HRV-C were similar,and wheezing and polypnea were more common with HRV-C infections than HRV-A and HRV-B infections.The severity among children positive for different groups HRV showed no significant difference (H =0.631,P ＞ 0.05),as well as that between children co-infected with HRV and other viruses and those infected with HRV only (H =0.886,P ＞ 0.05).Conclusions Different types of HRV were major causes of infectious disease in pediatric critical disease.The clinical characteristics of children infected with HRV-A,HRV-B,HRV-C were similar.Wheezing and polypnea were more common with HRV-C infections than HRV-A and HRV-B infections.

Objective To analyze the clinical features of PICU patients with bocaviral infection.Meth-ods Nasopharyngeai aspirates specimens were collected from 450 children who were admitted to PICU with a-cute respiratory tract infection in our hospital from June 2010 to December 2011 .Multiplex PCR was applied to detected human bocavirus and emerging respiratory virus.Bocavirus positive PCR results were sequenced and the clinical data of the positive cases were analysed.Results Human bocavirus positive samples were detected in 30 cases(6.7%) among 450 throat swab specimens.Human bocavirus as a single infection was found in 16 cases (53.3%).Mixed infections were found with in 14 cases(46.7%) of 30 positive samples.According to pediat-ric critical illness score,there were 13 cases of non-serious,2 cases of serious and 1 case was extremely serious in 16 single infections cases.There were 12 cases of non-seriuo s and 2 serious cases in 14 mixed infections. There were no statistically significant differences between single and mixed infections in the severity of the dis-ease( P>0.05 ) .Conclusion Bocavirus can cause severe respiratory tract infections.Mixed infections does not increase the severity of the disease.

Objective: To evaluate the efficacy of reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation (RIC-allo-HSCT) for patients with myelofibrosis (MF). Methods: The clinical data of 10 patients with myelofibrosis (MF) who underwent RIC-allo-HSCT. Results: Of all 10 patients, 6 were male and 4 women, with a median age of 28.5 (22-54). Using fludarabine/busulfan plus total body irradiation (FB+TBI) pretreatment scheme based. Hematopoiesis reconstitution was achieved in 9 patients (90%). The median time of neutrophil and platelet engraftment was 13.5 (10-22) day and 16.5 (13-40) day, respectively. Acute GVHD occurred in 4 cases while chronic GVHD in 5 cases. The prospective OS for 3 years was (90.0±8.5)% after a median follow-up time of 17 months. Transplant related mortality was 1 case. Conclusion RIC-HSCT with FB+TBI is a feasible and effective alternative for MF patients.

Objective To investigate the clinical performance of ultrasound screening for fetal structural anomalies at 11-13+6 weeks of gestation and to evaluate the relation of structural anomalies with karyotypes and copy number variations. Methods A retrospective analysis was conducted on fetuses with structural anomalies detected by ultrasound examination at 11-13+6 gestational weeks in First Affiliated Hospital of Sun Yat-Sen University from January 2013 to December 2017. Karyotype and chromosomal microarray analysis(CMA) were offered to these fetuses and ultrasound scans were repeated at 16-18 gestational weeks. All fetuses were followed up to termination or birth. Fisher's exact test was used for statistical analysis. Results A total of 362 fetuses with structural anomalies were studied including 101 (27.9%) fatal malformations, 253 (69.9%) major malformations and eight (0.2%) minor malformations. Cardiac malformation (32.6%, 118/362), central nervous system anomalies (24.9%, 90/362) and anterior abdominal wall defects (20.9%, 76/362) were the three most common abnormalities. Invasive prenatal test was performed in 107 cases including 25 fatal, 79 major and three minor malformations. Thirty (28%) out of the 107 cases had abnormal karyotypes, which were chromosomal aneuploidies (n=28) and chromosomal fragment abnormalities (n=2). Among the 99 cases received CMA, 25 had abnormal karyotypes, and copy number variations were identified in eight [three (4.05%) were pathogenic variations] out of the rest 74 with normal karyotypes. The incidence of chromosomal abnormalities in fetuses with major malformations was higher than that of fetuses with fatal malformation [32.9% (26/79) vs 12.0% (3/25), P=0.045]. Altogether, 117 cases repeated second-trimester ultrasound among which 16 (13.7%) were normal; 19 (16.2%) had cardiac defect which was discordant with the first-trimester evaluation and five (4.2%) were found to have additional malformations. Diagnosis of the other 77 cases were consistent with the first-trimester ultrasound findings. After the second-trimester ultrasound scanning, 49 pregnancies were terminated; 39 twin pregnancies and four triplet pregnancies underwent selective fetal reduction; 25 continued to delivery with good neonatal outcomes. Out of the 23 699 cases without abnormal ultrasound findings at 11-13+6 gestational weeks, 20 182 (85.2%) were successfully followed up, among which structural abnormalities were found in 178 during the second trimester and in 31 after birth. Conclusions A detailed ultrasound examination at 11-13+6 weeks of gestation is important to identify fetal structural defects. However, it could not replace the second-trimester ultrasound. There is a high risk of chromosomal abnormalities in fetuses with early-detected structural defects. CMA is able to identify pathogenic copy number variations with a relatively low detection rate.

Objective To discuss the change trends of pathogen of severe hand,foot and mouth dis-ease(HFMD) in Chaoshan area during 2011 to 2015. Methods All 1410 throat swabs of cases who were diagnosed as HFMD were collected from children hospitalized in our hospital during May 2011 to August 2015. Enterovirus were detected by nest RT-PCR,and the results of these positive cases diagnosed as severe HFMD were analyzed. Results (1) There were 216 positive cases(67. 29％,216/321) diagnosed as severe HFMD,including 53. 70％ ( 116/216 ) enterovirus 71 ( EV71 ), 19. 91％ ( 43/216 ) coxsackievirus A16 (CA16),12. 04％(26/216) CA6,8. 80％(19/216) CA10,3. 24％(7/216) CA4,0. 93％(2/216) coxsack-ievirus B5, 0. 46％ ( 1/216 ) enteric cytopathogenic human orphan virus and 0. 93％ ( 2/216 ) unclassified samples were unclassified to species. (2) Five cases of critical HFMD were all caused by EV71. (3) The EV71 positive samples were given priority to severe cases ( 51. 79％,116/224 ) and the non EV71 positive samples were given priority to mild cases ( 82. 08％, 458/558 ) , the difference was statistically significant (χ2 =91. 68,P<0. 001). (4) The change trends of severe HFMD year by year were consistent with the change trends of EV71 composition,and were highly correlated(Rs=0. 9,P=0. 037). (5) Severe HFMD caused by non EV71 virus gradually increased. Conclusion Severe HFMD in Chaoshan area during 2011 to 2015 were mainly caused by EV71,non EV71 viruses including CA16,CA6,CA10,CA4,coxsackievirus B5, enteric cytopathogenic human orphan virus 6 could also develop to severe HFMD. The composition ratio of severe HFMD increased accordingly in the year of EV71 as the dominant pathogen. The proportion of severe HFMD caused by non EV71 virus gradually increased after 2013 year.

Background/Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with the development of cardiovascular disease. While existing studies have examined cardiac remodeling in NAFLD, there has been less emphasis on the development of carotid atherosclerosis and stroke. We sought to conduct a meta-analysis to quantify the prevalence, risk factors, and degree of risk increment of carotid atherosclerosis and stroke in NAFLD. Methods: Embase and Medline were searched for articles relating to NAFLD, carotid atherosclerosis, and stroke. Proportional data was analysed using a generalized linear mixed model. Pairwise meta-analysis was conducted to obtain odds ratio or weighted mean difference for comparison between patients with and without NAFLD. Results: From pooled analysis of 30 studies involving 7,951 patients with NAFLD, 35.02% (95% confidence interval [CI], 27.36–43.53%) had carotid atherosclerosis with an odds ratio of 3.20 (95% CI, 2.37–4.32; P<0.0001). Pooled analysis of 25,839 patients with NAFLD found the prevalence of stroke to be 5.04% (95% CI, 2.74–9.09%) with an odds ratio of 1.88 (95% CI, 1.23–2.88; P=0.02) compared to non-NAFLD. The degree of steatosis assessed by ultrasonography in NAFLD was closely associated with risk of carotid atherosclerosis and stroke. Older age significantly increased the risk of developing carotid atherosclerosis, but not stroke in NAFLD. Conclusions This meta-analysis shows that a stepwise increment of steatosis of NAFLD can significantly increase the risk of carotid atherosclerosis and stroke development in NAFLD. Patients more than a third sufferred from carotid atherosclerosis and routine assessment of carotid atherosclerosis is quintessential in NAFLD.