The main functions of modern Clinical Engineer(CE) is discussed. By combining experience of clinical engineering in developed country with clinical practice in our country, the work character problem of clinical engineering was proposed. According to the reality of equipment management and operation, the function of CE is not only to ensure medical equipment to run normally but also estimate the value of equipment in before buying or abandoning, PSS and technology study. Through the efforts of CE, the main functions of equipment can be made the best, medical therapy and new method research is more efficient.

Objective To analyze the clinical and laboratory phenotypes of Duchenne muscular dystrophy(DMD)in a retrospective study of 96 cases and to evaluate therapeutic efficacy of glucocorticosteroid.Methods The clinical phenotype,laboratory examinations resuhs and the records in the follow-up in 96 patients with DMD were collected.The level of serum creatine kinase(CK)and motor ability before and after glucocorticosteroid therapy were analyzed by statistical analysis.Their myocardium impairments and intelligence conditions were also assessed.Results(1)The level of serum CK (mmol/L)had three peaks at the age of ≤ 3 years old(16 547.9 ±770.9),5 years old(14 371.9 ± 696.7)and 8 years old(13 089.8 ± 877.6).The CK level significantly decreased after dexamethasone (5-10 mg,iv)treatment for 10-15 days,but increased again after prednisone acetate(0.50-0.75 mg · kg-1 · d-1,oral)administration for one month(F =6.758,P =0.003).(2)The motor ability improved in 51 DMD cases with long-term oral admission of prednisone,including 24 cases receiving repeated dexamethasone,iv.(3)The myocardial perfusion imaging in 37 DMD cases showed remarkable uneven “spotted like” radionuclide distribution in ventricle.(4)The intelligence quotients in 24 DMD were lower than normal population.Conclusions There are high CK hyperlipidemia and myocardial damage in the sub-clinical stage of DMD and myocardium impairment is positively correlated with age.Glucocorticosteroid therapy has an important effect on the protection of motor and cardiac functions,with recommendation of using in early stage of disease.

Objective To investigate the renoprective effect and its possible mechanism of Niaoduqing on the adriamycin(ADR)-induced nephropathy rats. Methods Forty eight male Sprague-Dawley rats were randomly divided into normal control(n=12), ADR-induced nephropathy(model, n = 12), Benazepril-treated ADR nephropathy(Benazepril, n=12)and Niaoduqing-treated ADR nephropathy(Niaoduqing, n =12)groups. The rat nephropathy model was established by adriamycin injection and unilateral nephrectomy. The rats were sacrifficed per batch at the 4th and 8th weekend.The pathological change of nephridial tissue, the 24-hour urinary protein excretion and renal function were examined. Immunohistochemistry was used to meassure the expression of fibronection(FN), collagenⅣ(COLⅣ), osteopontin(OPN). Results The 24-hour urinary protein excretion, BUN, Scr, triglyeride(TG), cholesterol(Cho)in model group were significantly higher than those in normal group(P<0.01), as well as more server glomerulosclerosis in kidney were observed in model group than those in control group(P<0.01), while the albumin(Alb)was lower (P<0.01). Compared with model group, the 24-hour urinary protein excretion, BUN, Scr, TG, Cho were significantly reduced and renal glomerulosclerosis was improved in Niaoduqing group(P< 0.01), while the Alb was higher(P<0.01). Conclusion Niaoduqing palys an important role in the prevention and treatment for nephropathy.

Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.

Objective:To explore the relationship between development of social skills and executive function and theory of mind in children and adolescents with autism.Methods:Forty-six children and adolescents with autism aged 6 to 17 years were recruited.The diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorder,Fourth Edition(DSM-Ⅳ),and severe mental disorders were excluded by the screening of the Schedule for Affective Disorders and Schizophrenia for School-Age children (K-SADS).The Rey Complex Figure Test (RCFT),Trail-Making Test,Verbal Fluency Test,Stroop Color-word Task,the First-Order Belief Test and the Second-Order Belief Test were used to assess executive function and theory of mind,and Social Response Scale (SRS) was used to assess social skills.The correlation between results of Executive Function and SRS was analyzed.The SRS scores between groups passing and without passing of First-Order Belief Test and Second-Order Belief were compared.Results:In the aspect of Executive Function,RCFT scores were positively correlated with autistic behavior factor score of SRS (r =0.31-0.41,Ps ＜ 0.05),meanwhile,immediate recall structure scores of RCFT were positively correlated with social motivation factor scores of SRS (r =0.30,P ＜ 0.05),delayed recall structure scores of RCFT were positively correlated with SRS total scores(r =0.34,P ＜ 0.05).In Stroop Colorword Task,errors of the first task were positively correlated with social cognitive factor scores of SRS (r =0.32,P ＜ 0.05).There were no correlation between other Executive Function results and SRS scores (r =-0.21-0.24,Ps ≥0.05).In the aspect of Theory of Mind,there was no significant difference in SRS scores between groups passing or without passing (t =-0.68-1.73,Ps ≥ 0.05).Conclusion:The development of social skill in children and adolescents with autism may have relationship withexecutive function,but have no relationship with the theory of mind.

Objective To observe the effect of down-regulated CDX2 gene on the migration and invasion abilities of colon cancer cells (SW480 and HT29) and investigate the role and mechanisms of CDX2 gene in occurrence and development of colon cancer metastasis.Methods CDX2 gene in HT29 and SW480 cells was down-regulated using lentivirus RNA interference (RNAi) vector.The interference efficiency of CDX2 was detected by qRT-PCR and Western blotting.The effect of down-regulated CDX2 expression on colon cancer cells'migration and invasion was determined by Transwell and wound heal methods.Then the effects of down-regulated CDX2 on the expressions of epithelial-mesenchymal transition (EMT)-related genes (E-cadherin,ZEB-1,Vimentin,Twist and Snail) were detected by RT-PCR and Western blotting.Results The constructed CDX2 siRNA expression vector could significantly inhibit the expression of CDX2 in HT29 and SW480 cells.Compared with those of the cells transfected with empty vector (LV-NT-shRNA) and non-transfected cells,the migration and invasion abilities of cells transfected with LV-CDX2-shRNA were markedly enhanced (P ＜ 0.05).E-cadherin expression was reduced while expressions of ZEB-1,Vimentin,Twist,and Snail were significantly increased (all P＜0.05).Conclusion Down-regulating the expression of CDX2 can induce the occurrence of EMT,thus enhancing the invasion and migration of colon cancer cells.

BACKGROUND:Among many transplanted cells,adult autologous bone barrow-derived mononuclear cells have beenused in clinical practice because they are easy to be obtained,without immunological rejection and ethical disputationand other advantages.How to distinguish donor cells from receptors and observe the survival of donor cells following stem cell transplantation still trouble people.OBJECTIVE: superparamagnetic iron oxide (SPIO)particles-labeled bone marrow-derived mononuclear cells from minipigs were used to observe the feasibility of in vivo tracking with magnetic resonance imaging(MRI).DESIGN:A controlled observation experiment.SETTING:Institute of Cardiovascular Disease,Zhongda Hospital Affiliated to Southeast University.MATERIALS:This experiment was carried out in the Institute of Cardiovascular Disease,Zhongda Hospital Affiliated to Southeast University between April 2006 and August 2006.Healthy Chinese minipigs,aged 3 to 4 months,weighing from 20 to 30 kg,were provided by the Experimental Animal Center of Southeast University[SYXK(Su)2002-0012].METHODS: Autologous bone marrow-derived mononuclear cells of minipigs were isolated and cultured. Bone marrow-derived mononuclear cells in the suspension were traced with SPIO particles.Ferrum in the cells were shown by Prussian blue staining, and cell viability was evaluated by trypan blue exclusion method. Eleven minipigs used for preparation of model of myocardial infarction were divided into experimental group(n=9)and control group(n=2).By means of percutaneous left or right cervical artery or femoral artery puncturation, 1.5 to 2.0 mm balloon was used to occlude 1/3 left anterior descending branch,304 to 405 kPa,60 minutes later,ischemic preconditioning was conducted 3 tO 4 times before operation. When pig models of myocardial infarction were successful that was proved by surface electrocardiogram,bone marrow-derived mononuclear cells were percutaneously injected into coronary artery.Coronary arteriography was performed through femoral artery acupuncture at 24 hours after establishing infarction models.Suspension of bone marrow-derived mononuclear cells was perfused into coronary artery with OTW catheter.Then,the injector and OTW catheter for containing cells were rinsed with normal saline containing heparin and infused with the residual cells within 10 minutes.Non-labeled cells were perfused in 2 minipigs of control group by the same method.Postoperatively, bone marrow-derived mononuclear cells were traced by magnetic resonance and compared with Prussian blue-stained myocardial tissue sections.RESULTS: Seven minipigs of experimental group and one minipig of control group were Involved in the final analysis.One of each group was used for preparation of model of myocardial Infarction.One minipig of experimental group died from anesthetic accident before magnetic resonance.①Bone marrow-derived mononuclear cells all were nearly labeled by SPIO particles. Bone marrow-derived mononuclear cells could further proliferate in culture medium containing Fe2O3-PLL without obvious changes of cellular shape. ②T2+WI showed that 5 of 8 models of myocardial infarction presented fuzzy low-echo signal region in peripheral myocardial infarction after transplantation of labeled cells and the low-echo signal disappeared 4 weeks Iater. Ex vivo T2+WI sequence showed there was a dot-distributed low-echo signal region in the peripheral infarction region.③It was found in histological examination that 5 models(cell number over 106) had Prussian blue-positive cells,which distributed the same as those in magnetic resonance signal reducing region.CONCLUSION:SPIO particles-labeled bone marrow-derived mononuclear cells are safe and effective;T2+ WI is sensitive to tracing SPIO particles-labeled bone marrow-derived mononuclear cells;Magnetic resonance can in vivo trace SPIO particles-labeled stem cells transplanted through coronary artery,magnetic resonance signal change is related with the number of stem cells and division growth.

Objective To explore the clinical efficacy of laparoscopic tumor resection combined with aspiration for central renal angiomyolipoma(RAML).Methods Retrospective analysis of clinical data of 11 patients with central RAML between November 2015 and August 2018,including 8 females and 3 males,aged 35-58 years,mean (45.3 ± 4.8) years;4 cases on the left side,7 cases on the right side,including 4 endophytic tumors,7 exophytic tumors;body mass index (BMI) 22-27 kg/m2,mean (24.9 ±1.8) kg/m2.The maximum diameter of these tumors were 4.2-8.9 cm,with an average of (6.7 ± 2.4)cm.The preoperative serum creatinine was 53-85 μmol/L,with an average of (64.6 ± 16.4) μmol/L,and the glomerular filtration rate (GFR) of the affected side was 42-55 ml/min,with an average of (45.5 ±3.6) ml/min.Lateral kidney function is normal.8 patients underwent retroperitoneal laparoscopic surgery and 3 cases underwent laparoscopic surgery.Based on the preoperative imaging,tumor tissue was aspirated as much as possible by suction device if the tumor got maximal fat component and had not abundant blood supply.Clamp the renal artery in case of bleeding affected the surgery vision.On the contrary,if the tumor had abundant blood supply,the renal artery was clamped first,then removed the section of tumor with scissor and the remaining basal tumor was aspirated totally by suction device.The operation time,warm ischemia time,intraoperative blood loss,postoperative hospital stay,postoperative complications and surgical results were analyzed.Results All the 11 cases were successfully completed without conversion to open surgery,only one case got injury of renal collection system.The operation time was 95-126 min,mean (110.5 ± 12.8) min,and the blood loss was 120-200 ml,mean (155.6 ± 38.4) ml.The warm ischemia time was 22-31 min,mean (27.6 ± 3.3) min,and the postoperative hospital stay was 5-7 days.RAMLs were diagnosed by the postoperative pathological examination.The renal function was normal and no recurrence occurred in these patients at a mean follow-up of 13.9 months.All the 11 cases were successfully completed.Postoperative pathological diagnosis was RAML.There was no complication in the 11 cases.Preoperative serum creatinine and serum creatinine in the first month after surgery [(64.6 ± 16.4)μmol/L vs.(66.7 ± 15.5)tμmol/L,P =0.38] and preoperative renal GFR and GFR in the first month after surgery [(45.5 ± 3.6)ml/min vs.(43.2 ± 3.3) ml/min,P =0.067],the difference was not statistically significant.No recurrence was observed in the 11 cases with an average follow-up of 13.9 months.Conclusions Our initial experience suggests that laparoscopic tumor resection combined with aspiration is a safe,effective and minimally invasive method for the treatment of central RAML.

Objective:To compare the consistency between bioelectrical impedance analysis(BIA)and dual-energy X-ray absorptiometry(DXA)in skeletal muscle mass assessment in elderly patients with advanced chronic kidney disease(CKD), and to provide a basis for accurate clinical diagnosis of sarcopenia.Methods:Elderly patients with advanced CKD at the Department of Nephrology of Shanghai Sixth People's Hospital were included.Parameters for physical performance included handgrip strength and gait speed, and body muscle mass was measured by DXA and multifrequency BIA.The consistency between the two methods was assessed by the intraclass correlation coefficient, Bland-Altman analysis and kappa coefficient test.Results:This study included 67 elderly patients with advanced CKD with a mean age of(70.7±6.1)years and an average BMI of(24.6±3.5)kg/m 2.The proportion of enrolled male patients was 61.2% and the mean estimated glomerular filtration rate was(27.7±12.7)ml·min -1·1.73m -2.The intraclass correlation coefficients of muscle mass and appendicular skeletal-muscle mass index(ASMI)measured by BIA and DXA ranged from 0.81 to 0.90.Bland-Altman analysis showed that BIA overestimated muscle mass against DXA, and the mean difference in ASMI was(0.44±0.13)kg/m 2.In addition, there was a moderate agreement between the two measurement methods for determining muscle loss(Kappa=0.47). Conclusions:BIA and DXA offer a fair level of consistency in the assessment of muscle mass in elderly patients with advanced CKD.However, compared with DXA, BIA overestimates muscle mass in elderly patients with CKD.

Objective:To screen the endoplasmic reticulum stress (ERS) signature-related differentially expressed genes (DEG) in gastric cancer and to construct a prognostic risk model based on a bioinformatics.Methods:Transcriptome sequencing data (RNA-seq) of 375 gastric cancer and 32 paracancerous tissue samples downloaded from The Cancer Genome Atlas (TCGA) database and the corresponding clinical information were obtained as training set samples; data of 387 gastric cancer patients (GSE84437) from Gene Expression Omnibus (GEO) database were downloaded as validation set samples. All data were obtained on December 25, 2021. A total of 785 ERS signature-related genes (ERS-RG) were obtained from the GeneCards database. DEG between gastric cancer tissues and paracancerous tissues in the TCGA database was analyzed. The identified gastric cancer DEG were intersected with ERS-RG from the GeneCards database to obtain gastric cancer ERS signature-related DEG, which were analyzed for gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Univariate Cox proportional risk model was used to screen ERS signature-related DEG with prognostic value in gastric cancer, and LASSO regression analysis was performed to construct a polygenic prognostic risk model, and to calculate the prognostic risk score. The patients in training set and validation set were divided into high-risk group and low-risk group according to the median of the prognostic risk score (2.369); Kaplan-Meier survival analysis was used to compare the overall survival (OS) and to draw time-dependent receiver operating characteristic (ROC) curves of patients in the two groups; nomogram was drawn based on the prognostic independent influencing factors of gastric cancer. The characteristic immune cell infiltration abundance between the two groups was analyzed by using the inverse convolution-based CIBERSORT algorithm. Cytolytic activity scores were calculated by using the geometric mean of granzyme A and perforin 1 expression. According to the median prognostic risk score (2.369) and median tumor mutation burden (TMB) (3.000), all patients with gastric cancer were divided into high risk score-high TMB group, high risk score-low TMB group, low risk score-high TMB group and low risk score-low TMB group to compare the OS of patients in each group.Results:A total of 444 ERS signature-related DEG in gastric cancer including 168 down-regulated genes and 276 up-regulated genes were obtained, which were mainly enriched in biological processes such as protein processing in the endoplasmic reticulum, extracellular matrix (ECM) receptor interactions and unfolded protein responses (all P < 0.05). Univariate Cox regression analysis showed that 12 prognostic-related ERS signature-related DEG in gastric cancer were screened out. LASSO regression analysis was performed to obtain a prognostic risk score = 0.052×NOS3+0.137×PON1+0.067×CXCR4+0.131×MATN3+0.116×ANXA5+0.090×SERPINE1. The results of Kaplan-Meier analysis showed that the OS of the low-risk group in both the training and validation sets was better than that of the high-risk group (all P < 0.01). The results of the time-dependent ROC curve analysis showed that the AUC for the 3-year, 5-year, 8-year OS rates was 0.695, 0.786, 0.698, respectively in the training set, while the AUC for the 3-year 5-year, 8-year OS rates was 0.580, 0.625, 0.627, respectively in the validation set. Multivariate Cox regression analysis showed that prognostic risk score ( HR = 3.598, 95% CI 2.290-5.655, P < 0.001) and tumor stage ( HR = 1.344, 95% CI 1.057-1.709, P < 0.05) were independent factors influencing the prognosis of gastric cancer. Among 375 gastric cancer patients in the TCGA database, the expression levels of ATF6, HSPA5, XBP1 and ATF4 in the high-risk group were higher than those in the low-risk group (all P < 0.05); CIBERSORT results showed that the abundance of activated CD4 memory T cells in the high-risk group was lower than that in the low-risk group, and the abundance of both M0 and M2 macrophages in the high-risk group was higher than that in the low-risk group (all P < 0.05). The expression levels of common immune checkpoints (CD274, CTLA4, TNFRSF9, TIGIT, PDCD1, LAG3) in the high-risk group were all higher than those in the low-risk group (all P < 0.05). Cytolytic activity score in the high-risk group was higher than that in the low-risk group ( P < 0.05). The prognostic risk score was negatively correlated with TMB ( r = -0.20, P < 0.001). Patients in the low-risk score-high TMB group had the best OS and those in the high-risk score-low TMB group had the worst OS (both P < 0.001). Conclusions:The prognostic risk score model is established based on 6 ERS signature-related DEG in gastric cancer and its prognostic risk score may be effective as an independent prognostic factor to predict the prognosis of gastric cancer patients.