Objective To explore the relationship between serum uric acid and pulmonary hypertension (PH) in patients with systemic sclerosis (SSc). Methods The echocardiography, electrocardiogram, nailfold videocapillaroscopy and laboratory parameters of 62 patients with SSc were retrospectively analyzed . Patients were divided into two groups according to presence of PH . Statistical analysis was performed using SPSS 17 software . Results Compared to patients without PH , patients with PH had significantly higher serum uric acid levels ( P < 0 . 01 ) , systolic pulmonary arterial pressure ( P < 0 . 01 ) , abnormality of electrocardiogram (P < 0.01), abnormality of nailfold video capillaroscopy and lower serum albunin levels (P < 0.01). Systolic pulmonary arterial pressure had correlation with Serum UA ( r = 0 . 26 , P < 0 . 01 ) as well as serum ablumin (r = -0.28, P < 0.03). Moreover, the mean value of serum UA was significantly different in two ECG groups (P < 0.01) and two nailfold videocapillaroscopy groups (P < 0.01). At the cutoff level of 374 μmol/L, serum uric acid had reasonable accuracy for predicting the presence of PH in SSc patients ( sensitivity 66 . 7% and specificity 84 . 0%) . Conclusion The serum uric acid may be useful as a practicable marker for predict PH in patients with SSc .

Objective To report two cases of familial Gitelman syndrome and literature review regarding the updates of relevant genes,classification,treatment,and prognosis.Methods The clinical data of two sisters with Gitelman syndrome were retrospectively analyzed.Results Their blood pressures were within normal range.Hypokalaemic alkalosis,hypomagnesemia,and hypocalciuria were corrected almost completely after three days of intravenous magnesium and potassium infusion,spirolactone and indometacin.However,the maintenance of normal potassium was unsuccessful over one year.Conclusion Hypokalaemic alkalosis,hypomagnesemia,and hypocalciuria were normalized in Gitelman syndrome.There was some debate in regard to using PGE2 synthetase inhibitors.Tolerance of long-term medication will be the big challenge for curative effect.

Objective To analyze the frequencies of HLA-DQA1 alleles and their clinical values in the donor-recipient HLA-A,-B,-C,-DRB1,-DQB1 (10/10) matched hematopoietic stem cell transplantation (HSCT).Methods This study recruited 127 patients who received allogeneic HSCT and 127 unrelated donors.High-resolution (High Res) DNA typing for HLA-DQA1 alleles were performed on the 254 subjects by using sequence specific oligonucleotide probes (SSOP) and high resolution of sequence specific primer(High Res SSP).Results The DQA1 allele genotypes of 36 pairs of donor-recipient were directly identified by using SSOP.The ambiguous DQA1 allele genotypes of the rest 91 pairs were identified by using High Res SSP.Among the 127 pairs of donor-recipient,5 pairs were HLA-DQA1 alleles mismatched,while the others were all matched.No significant differences in the distribution of HLA-DQA1 alleles were observed between the donors and the recipients.Sixteen HLA-DQA1 alleles were detected in the 127 donors,which were DQA1 * 02 ∶ 01 (19.3％),DQA1* 01 ∶ 02(19.3％),DQA1 * 03 ∶ 02/03 (17.0％),DQA1 *01∶03 (9.8％),DQA1*06∶01(9.1％),DQA1*05∶ 01(7.1％),DQA1*05∶05(5.9％),DQA1*03∶01 (4.7％),DQA1*01 ∶04(2.4％),DQA1*01∶05(2.0％),DQA1*01∶01(1.2％),DQA1*05 ∶ 03(0.8％),DQA1 *05 ∶ 08(0.8％),DQA1*04 ∶ 01(0.4％),DQA1*05 ∶ 06(0.4％) from high to low frequency.Moreover,a new allele was detected in the patients.The haplotypes' frequencies and linkage disequilibrium(LD) analysis of HLA-DQA1 and HLA-DQB1 showed that the most common haplotype was DQA1 *02 ∶ 01-DQB1 *02 ∶ 02(16.1％),followed by DQA1 *03 ∶ 02/03-DQB1 *03 ∶ 03 (11.8％)and DQA1 *01 ∶ 03-DQB1 * 06 ∶ 01 (9.1％).Stronger LD were observed between DQA1 * 02 ∶ 01 and DQB1*02 ∶ 02,DQA1 *03 ∶ 02 and DQB1*03 ∶ 03,DQA1 *01 ∶ 03 and DQB1*06 ∶ 01,HLA-DQA1*06∶01 andDQB1*03 ∶ 01,DQA1*05 ∶ 01 and DQB1*02 ∶ 02(P＜0.001).Conclusion There was strong linkage disequilibrium between HLA-DQA1 and HLA-DQB1 genes.The polymorphism of HLA-DQA1 gene was less than that of HLA-DQB1 gene.No more guidance was provided to donor selection in unrelated donor-recipient HLA matched HSCT by adding HLA-DQA1 genotyping,but it might have clinical application values in HSCT with HLA Ⅱ locus mismatched donor and recipient.

Objective To investigate the ultrasonographic features and its diagnostic value in portal vein stenosis (PVS) after pediatric liver transplantation. Methods Clinical data of 84 pediatric recipients undergoing liver transplantation who were followed up by routine ultrasound were retrospectively analyzed. According to ultrasound and digital subtraction angiography (DSA) results, all recipients were divided into the normal group (n=57) and PVS group (n=27). The incidence of PVS was assessed by ultrasound. The measurement parameters consisted of diameter of portal vein anastomosis, flow velocity of portal vein anastomosis, hepatic artery velocity, resistance index (RI) of hepatic artery and maximum diameter of the spleen, etc. The ultrasound parameters were statistically compared between the PVS and normal groups. The diagnostic value of ultrasound parameters for PVS after pediatric liver transplantation was evaluated. Results The diameter of portal vein anastomosis in the normal group was significantly larger than that in the PVS group[(0.44±0.08) cm vs. (0.27±0.10) cm], and the flow velocity of portal vein anastomosis in normal group was significantly lower than in the PVS group[(43±12) cm/s vs. (119±58) cm/s] (both P < 0.001). The hepatic artery velocity, RI of hepatic artery and maximum diameter of the spleen did not significantly differ between two groups (all P > 0.05). The diameter of portal vein anastomosis for the optimal diagnosis of PVS in pediatric liver transplantation, pediatric liver transplantation from organ donation after citizen's death and living-related donor pediatric liver transplantation was 0.35 cm, 0.35 cm and 0.33 cm, respectively. The corresponding area under curve (AUC) was 0.906, 0.916 and 0.906, the sensitivity was 0.947, 0.951 and 0.938, and the specificity was 0.852, 0.833 and 0.889, respectively. The flow velocity of portal vein anastomosis for the optimal diagnosis of PVS was 62.7 cm/s, 69.6 cm/s and 61.2 cm/s. The AUC was 0.990, 0.993 and 1.000, the sensitivity was 1.000, 1.000 and 1.000, and the specificity was 0.930, 0.951 and 1.000. Conclusions Ultrasound features of the pediatric recipients with PVS after liver transplantation include the smaller diameter of portal vein anastomosis and faster anastomotic flow velocity, which possess high diagnostic value.

To confirm that Bartonella and Wolbachia were carried by sheep keds (Melophagus ovinus) in southern Xinjiang of China, 17 M. ovinus samples, which were collected in Aksu Prefecture, Xinjiang, were randomly selected. In this study, the Bartonella gltA and Wolbachia 16S rRNA gene were amplified through conventional PCR and the sequence of those amplified products, were analyzed. The results demonstrated that Bartonella was carried by all of the 17 sheep keds and Wolbachia was carried by 15 out of them. Bartonella was identified as B. melophagi. Three strains of Wolbachia were supergroup F and 1 strain has not been confirmed yet. It is the first report about Wolbachia supergroup F was found in sheep keds and provided the molecular evidence that B. melophagi and Wolbachia supergroup F were carried by sheep keds in Aksu Prefecture of southern Xinjiang, China. The 2 pathogens were found in sheep keds around Taklimakan Desert for the first time.
Bartonella ; China ; Genes, rRNA ; Polymerase Chain Reaction ; Sheep ; Wolbachia

Objective To evaluate the defecation function of patients with low rectal cancer after laparoscopic-assisted transanal total mesorectal excision (TaTME),and analyze the influencing factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 55 patients with low rectal cancer who underwent laparoscopic-assisted TaTME in the First Hospital of Jilin University from May 2017 to December 2018 were collected.There were 39 males and 16 females,aged (60-± 11) years,with a range from 24 to 80 years.Among the 55 patients,21 were in TNM stage Ⅰ,14 were in TNM stage Ⅱ,and 20 were in TNM stage Ⅲ;24 were in pathological stage T1-2 and 31 were in pathological stage T3.Observation indicators:(1) surgical and postoperative conditions;(2) follow-up;(3) analysis of influencing factors for postoperative defecation function.Follow-up was performed using questionnaires by telephone interview to detect the complications at 3 and 6 months after surgery up to June 2019.The measurement data with normal distribution were expressed as Mean± SD,and comparison between groups was done using the t test.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Univariate and multivariate analyses were performed using logistic regression models.Results (1) Surgical and postoperative conditions:55 patients successfully underwent laparoscopic-assisted TaTME without conversion to open surgery.The operation time,volume of intraoperative blood loss,diameter of postoperative pathological specimen,time to urinary catheter removal,distance between the anastomostic stoma and anal verge,and tumor diameter were (246±62) minutes,(69±27) mL,(3.5±0.7) cm,(2.1±0.9) days,(2.4±0.5) cm,and (3.9-± 1.6)cm,respectively.(2) Follow-up:55 patients were followed up at 3 months and 6 months after surgery,and the low anterior resection syndrome questionnaires were completed.Among the 55 patients,35 had low anterior resection syndrome at 3 months after surgery,and 24 had low anterior resection syndrome at 6 months after surgery,showing a significant difference (x2 =4.42,P＜0.05).There was no new onset low anterior resection syndrome in 55 patients after 3 months.(3) Analysis of influencing factors for defecation function:univariate analysis showed that the distance between the anastomotic stoma and anal verge and tumor diameter were influencing factors affecting defecation function of patients at 3 months after surgery (x2 =19.075,8.185,P＜ 0.05).The distance between the anastomotic stoma and anal verge was a influencing factor affecting the defecation function of patients at 6 months after surgery (x2=9.183,P＜0.05).Multivariate analysis showed that the distance between the anastomotic stoma and anal verge ＜ 2 cm,and tumor diameter ＞5 cm were independent risk factors affecting the defecation function of patients at 3 months after surgery (odds ratio =1.135,6.057,95％ confidence interval:1.089-1.323,1.206-30.435,P＜0.05).The distance between the anastomotic stoma and anal verge ＜ 2 cm was an independent risk factor affecting the defecation function of patients at 6 months after surgery (odds ratio =2.724,95％ confidence interval:1.982-3.066,P＜0.05).Conclusions The incidence of low anterior resection syndrome after laparoscopic-assisted TaTME for low rectal cancer is high.Distance between the anastomotic stoma and anal verge and tumor diameter are independent risk factors for the postoperative defecation founction.

Objective:To develop employer's satisfaction evaluation index system towards post competency of residents.Methods:Using Delphi method, the employer's satisfaction evaluation index system towards post competency of residents was formulated through a two-round expert consultation among 19 experts. SPSS 20.0 was used for statistical analysis to calculate the positive coefficient, authority coefficient and coordination degree of experts.Results:For the two rounds of the expert consultation, the questionnaire recovery rate was 95.0% and 100% respectively. The experts' authority coefficient was 0.92, and the system was ultimately determined, including 5 first-level indicators, and 32 secondary indicators. The coefficient of variation (CV) of first-level indicators was 0.00, and the Kendall's W of secondary indicators was 0.663. Conclusions:Employer's satisfaction evaluation index system towards post competency of residents is scientific and reliable, which could provide employer with systematic and objective tool to evaluate residents' post competency.

Objective:To investigate whether astragaloside IV (AS-IV) exerts neuroprotective effects via zinc ion (Zn 2+) modulation of mitochondria-associated endoplasmic reticulum membranes (MAMs) and to elucidate the possible mechanisms. Methods:PC12 cells (rat adrenal pheochromocytoma cells) were routinely cultured; they were divided into 7 groups: control group (routinely cultured), 2-DG group (treated with 2-DG at 50 μmol/L for 30 min), astragaloside IV+2-DG group (treated with 50 μmol/L astragaloside IV for 20 min, and then treated with 50 μmol/L 2-DG for 30 min), astragaloside IV group (treated with 50 μmol/L astragaloside IV for 20 min), N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (a zinc chelator, TPEN)+astragaloside IV+2-DG group (treated with 10 μmol/L TPEN for 10 min, 50 μmol/L astragaloside IV for 20 min, and then 50 μmol/L 2-DG for 30 min); TPEN group (treated with 10 μmol/L TPEN for 10 min), TPEN+2-DG group (treated with 10 μmol/L TPEN for 10 min and then treated with 50 μmol/L 2-DG for 30 min). The expressions of glucose-regulated protein (GRP)78, GRP94, cysteine-containing aspartate proteolytic enzyme caspases-8, B cell receptor associated protein 31 (BAP31) and mitochondrial fission protein 1 (Fis1) were detected by Western blotting. Annexin V-FITC/PI kit was used to detect the apoptosis level. Immunofluorescence was used to detect the Fis1 protein expression, and mitochondrial fluorescence probe TMRE was used to detect the opening of mitochondrial permeability transition pore (mPTP).Results:(1) Compared with the control group, the 2-DG group had significantly increased expressions of GRP78, GRP94, Caspase-8, Bap31 and Fis1, and green fluorescent intensity of Annexin V-FITC ( P<0.05); compared with the 2-DG group, the astragaloside IV+2-DG group had significantly decreased expressions of GRP78, GRP94, Caspase-8, Bap31 and Fis1, and green fluorescent intensity of Annexin V-FITC ( P<0.05); compared with the astragaloside IV+2-DG group, the TPEN+astragaloside IV+2-DG group had significantly increased expressions of GRP78, GRP94, Caspase-8, Bap31 and Fis1, and green fluorescent intensity of Annexin V-FITC ( P<0.05). (2) Compared with the control group, the 2-DG group had significantly enhanced Fis1 protein fluorescent intensity ( P<0.05); the astragaloside IV+2-DG group had significantly decreased Fis1 protein fluorescent intensity compared with 2-DG group ( P<0.05); Compared with astragaloside IV+2-DG group, TPEN+astragaloside IV+2-DG group had significantly enhanced Fis1 protein fluorescence intensity ( P<0.05); compared with the control group, the TPEN+2-DG group had significantly enhanced Fis1 protein fluorescent intensity ( P<0.05). (3) TMRE fluorescence intensity in 2-DG group was significantly decreased compared with control group ( P<0.05); TMRE fluorescence intensity in astragaloside IV+2-DG group was significantly enhanced compared with 2-DG group ( P<0.05); TMRE fluorescence intensity in TPEN+astragaloside IV+2-DG group was significantly decreased compared with astragaloside IV+2-DG group (P<0.05); TMRE fluorescence intensity in TPEN+2-DG group was significantly decreased compared with the control group ( P<0.05). Conclusion:Astragaloside IV can exert neuroprotective effects through Zn 2+ inhibiting endoplasmic reticulum stress-induced apoptosis and preventing mPTP opening in PC12 cells, whose mechanism may be related to Fis1 and Bap31 expressions.

Objective:To explore the clinical characteristics of hemoglobin H (HbH) disease during pregnancy, and evaluate the impact of prepregnant anemia on maternal and fetal outcomes.Methods:Clinical data of 12 pregnant women, who were diagnosed with HbH disease by genetic testing in the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2017, to December 31, 2022, were retrospectively collected. Thalassemia genotypes, general conditions before and during pregnancy, and perinatal outcomes were analyzed using descriptive analysis.Results:The 12 patients were categorized into moderate anemia (Hb<90 g/L, n=5) and mild anemia (Hb≥90 g/L and <110 g/L, n=7) groups according to the level of Hb before conception. In the moderate anemia group, with one deletional HbH disease and four non-deletional type, all had blood transfusion histories, and four developed severe anemia during pregnancy with four cases of fetal growth restriction. The mild anemia group comprised six deletional and one non-deletional genotype, with no severe anemia or transfusion requirement during pregnancy. In terms of maternal and fetal outcomes, two moderate anemia cases opted for pregnancy termination, while three delivered via cesarean section with two preterm infants having mild asphyxia and one full-term. In the mild anemia group, one case terminated due to intrauterine fetal death, and the remaining six continued the pregnancies, including two were delivered normally, one was assisted by forceps, and three through cesarean section. Among the six delivered cases, one was preterm birth, one infant was born with severe asphyxia and four mothers developed postpartum complications such as puerperal infection and postpartum hemorrhage. Conclusions:Clinical manifestations of HbH disease vary greatly. Individualized management should be offered based on the degree of anemia before pregnancy. For women with moderate anemia, close monitoring and appropriate intervention are required during pregnancy to improve both maternal and infant outcomes.

[Objective]To summarize the clinical experience of Professor MA Ruijie in the treatment of insomnia by using Hewei-acupuncture,with a view to illustrating the theoretical basis and clinical application of Hewei-acupuncture in the treatment of insomnia.[Methods]Through the clinical study with the teacher,combined with the review of Chinese medical textbooks and modern medical clinical research literature on insomnia.Professor MA's understanding of the etiology and pathogenesis of insomnia,the composition and basis of the acupuncture points of Hewei-acupuncture,and the theoretical and mechanistic study of Hewei-acupuncture for the treatment of insomnia were elaborated,and Professor MA's ideas of identification and treatment of this disease were analyzed.[Results]Professor MA believes that the sleep and wakefulness of human beings are controlled by the heart and spirit,and regulated by the Yin and Yang of Ying and Wei,which are related to the functions of internal organs,among which the malfunctioning of the spleen and stomach is closely related to the occurrence of insomnia.Professor MA's treatment of this disease is characterized by the importance of the theory of meridian and collateral disease and the Qi of the spleen and stomach in the middle-Jiao,and she believes that the foot Yangming stomach meridian Qi reversal,Ying and Wei are out of harmony;the spleen and stomach deficiency,the heart and spirit of the loss of nourishment;and elevation disorders,misdirection of the good offices are important reasons for the occurrence of insomnia.Hewei-acupuncture is a summary of Professor MA's clinical experience in treating insomnia and other neurological disorders by taking"Tianshu"(ST25),"Zusanli"(ST36),"Neiguan"(PC6)and"Gongsun"(SP4)as the main acupoints.This method relieves insomnia by regulating Qi of the spleen and stomach,strengthening the function of the spleen and stomach,and balancing Yin and Yang of the organism.[Conclusion]Hewei-acupuncture in the clinical treatment of insomnia is characterized by streamlining of acupoints,light pain,and good long-term efficacy,which is of practical significance in guiding the clinical treatment of insomnia.