ObjectiveTo evaluate the diagnostic performance of bone SPECT and CT fusion imaging in bone metastases from pediatric neuroblastoma.MethodsTwenty-four pediatric patients with neuroblastoma were included in this retrospective study.All patients underwent planar imaging and SPECT integrated with CT.Lesion visibility,diagnostic certainty and diagnostic performance were evaluated with KolmogorovSmirnov test andx2 test.ResultsLesion visibility of SPECT alone,SPECT integrated with CT were significantly better than that of planar imaging ( both H =69.000,P ＜ 0.05 ).SPECT and CT fusion imaging,SPECT alone both detected five more bone lesions than planar bone imaging (77 vs 72).The diagnostic accuracy of SPECT imaging (62.34％,48/77 )was significantly higher than that of planar imaging (45.45％,35/77; x2 =4.416,P ＜ 0.05 ).The sensitivity,specificity and accuracy of SPECT and CT fusion imaging for diagnosing malignant bone lesions were significantly higher than those of planar imaging:82.35％ (42/51) vs 53.19％ ( 25/47),88.46％ ( 23/26 ) vs 40.00％ ( 10/25 ),84.42％ ( 65/77 ) vs 45.45％ (35/77 ; x2 =12.571,14.016,25.667,all P ＜ 0.01 ).The diagnostic specificity and accuracy of SPECT and CT fusion imaging were significantly higher than those of SPECT alone ( 53.85％,14/26 ;62.34％,48/77) (x2 =7.589,9.606,both P ＜0.01 ).However,there was no significant difference of sensitivity between the two methods (x2 =2.942,P ＞ 0.05 ).Diagnostic certainty by SPECT and CT fusion imaging was significantly higher than that by SPECT alone ( H =28.000,P ＜ 0.05 ) and by planar imaging (H =21.000,P ＜ 0.05).ConclusionSPECT and CT fusion imaging can detect more bone lesions in patients with pediatric neuroblastoma.It is helpful for diagnosing bone metastases from pediatric neuroblastoma.

Objective To evaluate changes of regional cerebral metabolism by proton MR spectroscopy (~1H-MRS) in patients with minimal hepatic encephalopathy (MHE) and to correlate these changes with the neuropsychological test. Methods Fifty-four patients with cirrhosis including nine patients with hepatic encephalopathy (HE),23 patients with MHE,22 patients without HE and 13 controls underwent neuropsychological tests and ~1H-MRS scanning. The volumes of interest included occipital gray matter and left parietal white matter regions. Ratio of spectral peak areas of N-acetylaspartate (NAA),choline (Cho),myo-inositol (mI),and glutamine/glutamate (Glx) relative to creatine (Cr) were acquired. Statistical analysis was conducted using independent t test and one-way analysis of variance. The results of different groups were compared by using the nonparametric Mann-Whitney U test with Bonferroni correction. Correlations among the ~1H-MRS ratios, the grade of HE, neuropsychological test and ammonia data were calculated with Spearman correlation test. Results The ratios of NAA/Cr,Cho/Cr,mI/Cr,Glx/Cr of the occipital gray matter and left parietal white matter regions in patients with cirrhosis are 1.55±0.12,0.48±0.10,0.42±0.14,2.52±0.48 and 1.73±0.17,0.75±0.16,0.42±0.16,2.75±0.59respectively,and they are 1.53±0.10,0.48±0.09,0.51±0.11,2.20±0.39 and 1.69±0.15,0.82±0.14,0.53±0.12,2.40±0.40 in patients without HE,1.58±0.13,0.48±0.08,0.38±0.13,2.62±0.39 and 1.78±0.18,0.74±0.14,0.38±0.15,2.84±0.58 in patients with MHE,1.54±0.12,0.50±0.13,0.29±0.07,3.04±0.31 and 1.70±0.19,0.62±0.16,0.29±0.07,3.37±0.38 inpatients with HE.Compared with controls, decreased mI/Cr and Cho/Cr ratios and elevated Glx/Cr ratios were found in patients with cirrhosis (t=3.196,9.394,-6.527,P＜0.01,occipital gray matter. t=5.592,9.717,-6.681,P＜0.01,left parietal white matter＝ and in subgroup of patients without HE, with MHE and HE (F=5.097,25.896,20.204,P＜0.01,occipital gray matter.F=16.435,28.660,21.283,P＜0.01,left parietal white matter).Significant difference in these metabolic alterations was also found among the different groups of cirrhosis especially the ratios of Glx/Cr in occipital gray matter and left parietal white matter (P＜0.0084).The ratios of mI/Cr also significantly altered between patients without HE and with MHE (P＜0.0084).There was a significant negative correlation between the ratios of Cho/Cr,mI/Cr and the grade of HE (P＜0.01＝ and a significant positive correlation between the ratios of Glx/Cr and the grade of HE (r=0.709,P＜0.01,occipital gray matter; r=0.720,P＜0.01,left parietal white matter＝.NCT-A and DST of controls is (49±8) s and 39±6.They are (134±37),(83±26),(64±22) second and 15±2,25±9,35±8 in patients with HE,MHE and without HE respectively.The metabolic alterations of Cho/Cr,mI/Cr,Glx/Cr correlated significantly with neurepsychological tests in all subjects (P＜0.01＝.There was a significant positive and a negative correlation between the ratios of Glx/Cr and the data of NCT-A and DST respectively (r=0.570,-0.642,occipital gray matter; r=0.541,-0.632,left parietal white matter).The metabolic alterations of Glx/Cr had no correlation with ammonia data as well as other metabolic alterations.Conclusions ~1H-MRS study shows cerebral metabolic alterations of gray and white matter in patients with cirrhosis,especially the reduction in mI/Cr ratio and increase in Glx/Cr ratio. These changes correlate well with the neuropsychological tests and may be useful in predicting the presence of MHE.

BackgroundThe quest to look for seed cells is a hot spot of cornea transplant research in solving the problem of the lack of donor. Bone marrow mesenchymal stem cells(BMSCs) have been successfully induced into retinal ganglion cells(RGCs) in vivo,but the successful induction of BMSCs into corneal endothelial cells has not been reported.Objective This experiment was to study the transplantation of BMSCs on corneal endothelial surface using the splitting Descemet's membrane. MethodsFour healthy adult rhesus monkeys were divided into the experimental group ( 3 monkeys) and control group ( 1 monkey). Mesenchymal stem cells (MSCs) were isolated from bone marrow by density gradient centrifugation combined with adhering means. The cultured cells were identified by flow cytometry and its ability to differentiate was determined by allowing them to differentiate into adipocytes in vitro and labeled by 5-bromodeoxyuridine ( BrdU ) for subsequent identification. Corneal grafts of 7 mm in size with tearing of the Descemet' s membrane were prepared in the experimental group and control group. After labeling by 5-bromodeoxyuridine( BrdU ) ,cultured cells were transplanted onto the endothelial surface of cornea grafts in the experimental group, but no cultured cells were seeded in the graft of the control group. The corneal grafts were then sutured in situ, and were removed 1,2 or 3 months after operation to examine the distribution and connection between transplanted cells and their morphologic changes under the electron microscope. Results High purity MSCs were harvested by density gradient centrifugation combined with adhering method. Cultured cells reached confluency after 12 to 16 days, presenting with a spindle shape and parallel or swirling arrangement. Flow cytometry analysis showed that 94.26％ of cells were positive for CD29,7. 51％ for CD34 and 4. 02％ for CD45. Larger nuclei filled with plastosomes, golgiosomes and rough endoplasmic reticula were found on the graft under the transmission electron microscope( TEM ). After 3 weeks, MSCs were differentiated into adipocytes where Oil Red O staining resulted in an orange-red staining in the cytoplasm and blue staining in the nuclei. The transplanted cells attached loosely on the endothelial surface of the corneal graft and came in contact with each other in one month. The shape of the cells appeared as spindle-shaped and polygonal after 2 months and became tightly packed after 3 months. The positive cells retained the BrdU label and presented with brown nuclei. No endothelia cells grew in the cornea graft in the control group, with an absence of BrdU labeling. Conclusions Mesenchymal stem cells can be transplanted onto the corneal endothelial surface successfully and form a monolayer using the centrifugation method, and present with good survival and proliferation ability.

Objective To evaluate the clinical efficacy and safty of le-vocarnitine combined with alprostadil in the treatment of diabetic ne-phropathy.Methods A total of 68 patients with diabetic nephropathy were randomly divided into control group ( n=34 ) and treatment group (n=34).Control group was given alprostadil 1 mL, qd by intravenous drip.Treatment group was received levocarnitine 1 g, qd by intravenous drip on the basis of control group .The course of two groups was 28 d. The clinical efficacy , biochemical indexes before and after treatment and the incidence of adverse drug reactions were compared between two groups.Results After treatment , the total effective rate of control group was significantly lower than that of treatment group ( 67.65% vs 94.12%, P<0.05).After treatment, the levels of serum 24 h urinary protein , urinary microglobulin , urea nitrogen , cystatin C , homocysteine , glycosylated hemoglobin , transforming growth factor -β1 ,Ⅳcollagen in two groups were significantly decreased ( P<0.05 ) , and those indexes of treatment group after treatment were significantly lower than those of control group (P<0.05).After treatment, the levels of serum of serum creatinine , 25 -hydroxy vitamin D 3 in two groups were decreased with significant difference ( P <0.05 ) , and the treatment group was more obvious ( P<0.05 ).The incidence of adverse drug reactions in control group was significantly higher than that in treat -ment group (23.53%vs 8.82%,P<0.05 ) .Conclusion Levocarnitine combined with alprostadil have a definitive clinical efficacy and safety for the treatment of diabetic nephropathy .

OBJECTIVETo investigate the effect of p65 gene inhibited by siRNA on neuronic differentiation in the marrow mesenchymal stem cells (MSCs).

METHODSThe MSCs were transfected with Rn-p65-siRNA. Fasudil hydrochloride induced MSCs differentiating into neurons. The non-transfected group and negative control group (transfected with negative control siRNA marked by Cy3) were used as controls. The fluorescence expressed by transfected MSCs were observed under inverted fluorescence microscope at 24 h,48 h and 72 h after transfected with negative control siRNA. The viability of MSCs was detected by MTT at 24 h, 48 h and 72 h after transfected with Rn-p65-siRNA. The expressions of p65 mRNA and protein in MSCs were detected by RT-PCR and Western blot respectively. The expressions of p65 protein, NSE, MAP-2 and glial fibrillary acidic protein (GFAP) were detected by immunocytochemical method after transfection for 6 h.

RESULTSThe fluorescence of MSCs was mostly displayed after transfection of 72 hours and the efficiency of transfection was up to 83.3% ± 3.8%. Meanwhile, the p65 mRNA and p65 protein expressed by MSCs of transfected group were significantly decreased (P < 0.05); MTT displayed that the viability of MSCs was also significantly reduced (P < 0.05). The best efficiency of induction was observed in the transfected group. There were higher expressions of NSE and MAP-2 than the other group (P < 0.05).

CONCLUSIONThe p65 gene inhibited by siRNA can promote the marrow mesenchymal stem cells to differentiate into neurons.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine ; analogs & derivatives ; Animals ; Cell Differentiation ; Glial Fibrillary Acidic Protein ; metabolism ; Mesenchymal Stromal Cells ; cytology ; Neurons ; cytology ; RNA, Messenger ; RNA, Small Interfering ; Rats ; Transcription Factor RelA ; antagonists & inhibitors ; metabolism ; Transfection

OBJECTIVETo investigate the prevalence and the risk factors of retinopathy of prematurity (ROP).

METHODSTotally 172 premature infants who were less than 37 weeks postconceptional age, or more than 37 weeks but weighing < 2 500 g at birth, and born at PUMC hospital from May 1, 2003 to November 30, 2004, were enrolled in this study. Their fundus were routinely checked. Diagnosis and staging of ROP were performed according to the international guidelines. Another 20 mature infants were selected as the control group.

RESULTSTwelve infants quitted the treatment or died. The remaining 160 infants completed the follow up. The prevalence of ROP in the premature group was 19.4%, while no ROP was found in the control group. The prevalence of ROP in subgroup with body weight < or = 2 000 g (28.4%) was significantly higher than in subgroup with body weight > 2 000 g (8.3%, chi2 = 10.217, P = 0.001) at birth. The prevalence of ROP in subgroup with postconceptional age < or = 32 weeks (42.5%) was significantly higher than in subgroup with postconceptional age > 32 weeks (11.7%, chi2 = 18.258, P = 0.000). The postconceptional age (OR = 0.959, P = 0.036) and body weight (OR = 0.999, P = 0.026) were the most important risk factors of ROP. Furthermore, blood transfusion ( OR = 0.076, P = 0.029) and Apgar score ( OR = 23.62, P = 0.012) were inversely correlated with ROP. Correlation was not found between ROP prevalence and oxygen inhalation mode, surface active substance, administration of dopamine and dexamethasone, and mother conditions.

CONCLUSIONSThe prevalence of ROP is higher in premature infants than in mature infants. Shorter postconceptional age and lower body weight may result in higher ROP incidence. Routine screening of fundus in premature infants may be helpful for the early detection of ROP.

Apgar Score ; China ; epidemiology ; Female ; Gestational Age ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Male ; Neonatal Screening ; Oxygen Inhalation Therapy ; adverse effects ; Prevalence ; Retinopathy of Prematurity ; epidemiology ; Risk Factors

Objective: To investigate the effect of pituitrin-water separation on hemoglobin and ovarian function in laparoscopic ovarian chocolate cyst removal. Methods: From February 2018 to February 2019, 82 patients with ovarian chocolate cyst removed by laparoscopy were selected from the Second Affiliated Hospital of Wenzhou Medical University.They were randomly divided into observation group and control group according to the digital table, with 41 cases in each group.The control group underwent traditional laparoscopic tear-and-tear ovarian cyst removal, while the observation group underwent pituitrin-water separation.The changes of perioperative indicators, the decrease of hemoglobin (Hb) before and after operation, the positive rate of normal ovarian tissue on cyst wall and the number of normal follicles attached to cyst wall, the changes of serum hormone levels before and after operation were compared between the two groups. Results: The amount of bleeding during operation in the observation group [(58.97±8.74)mL] was less than that in the control group [(118.93±24.21)mL], and the operation time in the observation group[(57.46±8.27)min] was shorter than that in the control group [(87.38±10.19)min] , the differences were ststistically significant between the two group(t=14.916, 14.598, all P<0.05). There was no statistically significant difference in the time of anal exhaust between the two groups (P>0.05). The decrease of Hb in the observation group [(0.71±0.16)g/L] was lower than that in the control group [(1.27±0.35)g/L] (t=9.318, P<0.05). The positive rate of normal ovarian tissue on cyst wall in the observation group (21.95%) was lower than that in the control group (56.10%), the number of normal follicles attached to the cyst wall in the observation group (2.65±0.49) was less than that in the control group (4.86±1.24) , the differences were ststistically significant between the two group(χ²=10.045, t=10.613, all P<0.05). The serum level of E₂ [(398.21±17.84)pmol/L] in the observation group was higher than that in the control group [(367.83±15.21)pmol/L], while FSH [(6.72±0.28)mIU/mL] and LH [(5.23±0.38)mIU/mL] levels in the observation group were lower than those in the control group [(7.19±0.35)mIU/mL and (5.69±0.31)mIU/mL], the differences were ststistically significant between the two group (t=8.298, 6.714, 6.006, all P<0.05). Conclusion The method of pituitrin-water separation is effective in laparoscopic ovarian chocolate cyst removal, which can reduce the injury during operation, has little effect on hemoglobin and improve the ovarian reserve function of patients.

BACKGROUND: The type of brackets is closely related to the efficiency of orthodontic treatment. A self-ligating bracket is characterized by low friction, simple operation, mild pain and discomfort, and it has been an issue of concern in orthodontics. In recent years, studies on the therapeutic efficiency of self-ligating brackets versus conventional brackets for orthodontic correction have been reported, but there is no conclusion. OBJECTIVE: To systematically compare the conventional and self-ligating brackets concerning treatment efficiency. METHODS: A computer-based search of PubMed, EMBASE, MEDLINE, WanFang, VIP and CNKI was performed for randomized controlled trials concerning self-ligating brackets versus conventional brackets for orthodontic correction. The keywords were "orthodontic brackets/ self-ligating, random" in English and "appliance/self-ligating/ conventional/orthodontic correction efficiency" in Chinese. The retrieve time was set from inception to December 2017. Stata12.0 software was used for meta-analysis following literature screening, data extraction and risk assessment of bias. RESULTS AND CONCLUSION: A total of 9 randomized controlled trials involving 603 patients were included. The results of meta-analysis on the efficiency of the two groups showed that there was no significant difference in overall treatment time, number of visits, time of alignment and time of space closure (P ＞ 0.05). Only the time of chairside operation showed significant difference between the two groups (P ＜ 0.05). These findings indicate that compared with the conventional bracket, the self-ligating bracket has no obvious advantage in the therapeutic efficiency.

Objective To study the atopy spectrum and its related factors in 1 to 3 years old children with allergic rhinitis.Methods Ninety-six children with allergic rhinitis,aged between 1 and 3years old,referred to ENT department of Beijing Children's Hospital between August 2009 and November 2010 were retrospectively reviewed.Data were recorded for patients' age,age stratification,sex,the age of first symptom,the duration of history,and the allergic history of children,the allergic history of parents.The screening tests on inhalant and food allergens were conducted by immunoblot assay using the Allergy Screen system.The total serum IgE level was also measured.The distribution of the inhalant and food allergens was summarized.The influence of the clinical characteristics was analyzed according to the age subgroup determined by month,allergen category and positiveness of eczema or asthma Logistic regression was used to analyze the relationship of clinical characteristics and allergen spectrum.Results The total positive rates of allergic screening test rate were 81.3％.The inhalant and food allergens were 62.5％ and 53.1％ respectively.The commonest allergy was mixed fungal(50.0％ ),followed by milk(34.4％ ),lamb (31.3％),beef(26.0％ ),dust mite ( 21.0％ ),wheat ( 18.8％ ),mugwort ( 12.5％ ),egg white or egg yolk( 11.5％ ).62.5％ of patients could be diagnosed as AR,the remaining could be diagnosed temporarily as non-allergic rhinitis temporarily.Single factor analysis of clinical characteristics in different subgroup determined by month showed that:inhalant allergen(positive/negative) ( x2 =13.699,P =0.001 ),father suffered from AR( x2 =14.060,P =0.001 ),and father or mother suffered from AR ( x2 =7.396,P =0.025) were statistically significant at three monthly age groups.The personal history of eczema ( OR =3.143,P=0.034 ) might increase the possibility of sensitization to allergens.The personal history of eczema ( OR=3.125,P=0.015) and the total serum IgE level ＞ 200 IU/ml ( OR=3.119,P=0.030)might increase the possibility of sensitization to inhalant allergens.No clinical features for food allergen sensitization was statistically significant.There was no significant difference in positive rates between inhalant and food allergens groups.The presence of inhalant allergens ( OR=3.594,P=0.046 ),insect bites dermatitis ( OR=11.941,P=0.002) were the risk factors for positiveness of eczema or asthma,and the father with AR ( OR=0.251,P=0.040 ) as protective factors.Conclusions Inhalant and food allergens all can be sensitized in the children with AR symptoms between 1 to 3 years old,and the positive rate of inhalant group is slightly higher.The differences of the inhalant allergen (positive/negative) and father suffered from AR are statistically significant at three monthly age groups.The history of eczema is the risk factor for allergen screening positive.Serum total IgE ＞ 200 IU/ml and eczema history are risk factors for inhalant allergen screening positive.The factors of inhalatant allergens,insect bites dermatitis and father suffered from AR relate to any positive of eczema or asthma.

OBJECTIVETo investigate the differentiation of human amniotic epithelial cells (hAECs) into insulin secreting cells (ISCs) in vitro.

METHODSThe hAECs were isolated from human amnion by trypsin digestion, and the phenotype of the isolated cells were identified by flow cytometry and immunocytochemical staining. The hAECs at passage 3 were treated with nicotinamide and N2 supplement to investigate their differentiation into ISCs. At different times after differentiation, the expression of insulin and beta2 microglobulin (beta2-MG) was determined by immunocytochemical staining, while the content of insulin in supernatant from cultured hAECs was detected by radioimmunoassay and the expressions of insulin, pancreatic and duodenal homeobox factor-1 (PDX-1) mRNA were detected by reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS(1) hAECs expressed high percent of CD29, CD73, CD166 and CK19. (2) At 7, 14 and 21 days, the percentages of insulin-positive cells in induced groups were 74.00% +/- 1.73%, 75.33% +/- 1.15% (see symbol) 75.67% +/- 0.58% respectively, which were negative in control groups. (3) At 7, 14 and 21 days, contents of insulin in supernatant from induced groups were (328.47 +/- 3.22) microIU/ml, (332.26 +/- 1.22) microIU/ml and (329.68 +/- 2.57) microIU/ml respectively, they were significantly higher than those in control groups (All P < 0.01). (4) PDX-1 mRNA and beta2-MG were expressed before and after the induction of hAECs, but insulin mRNA was expressed only in the induced groups.

CONCLUSIONhAECs can differentiate into ISCs, having the potential application for therapy of type I diabetes.

Amnion ; cytology ; Cell Culture Techniques ; Cell Differentiation ; physiology ; Cells, Cultured ; Epithelial Cells ; cytology ; Flow Cytometry ; Homeodomain Proteins ; metabolism ; Humans ; Insulin ; metabolism ; Insulin-Secreting Cells ; cytology ; RNA, Messenger ; genetics ; Trans-Activators ; metabolism ; beta 2-Microglobulin ; metabolism