BACKGROUND:Growth-associated protein-43 is the primary substance for constructing plasticity of central nervous system, which is recognized as the first molecular marker for studying growth and repairing injury of nerves. OBJECTIVE: To explore the expression of growth-associated protein-43 in rats with focal cerebral ischemia following bone marrow mesenchymal stem cells (MSCs) transplantation.DEISNG, TIME AND SETTING: A randomized, controlled, animal study was performed at the Laboratory of Department of Neurology, Renmin Hospital of Wuhan University and Doctoral Scientific Research Work Station of C-BONS Pharmacy, Hubei, China, from March 2006 to October 2007.MATERIALS: Sixty adult Sprague Dawley rats, with clean grade, irrespective of genders, weighing (180±20) g, were randomly divided into the model, sham operated, and MSCs transplantation groups, with 20 animals in each group. METHODS: Additional 4 Sprague Dawiey rats, aged 2 months, were selected to isolate and culture MSCs, which was labeled with 5-Bromo-2,-deoxyuridine (BrdU). In the sham operated group, the right internal carotids were deligated after anaesthesia. The remained rats were prepared for models of right middle cerebral artery ischemia. At 24 hours after model preparation, 20 μL culture solution containing 5×105/L MSCs was injected into the left lateral ventricle of rats in the MSCs group, the same volume of phosphate buffer saline was injected in the model group.MAIN OUTCOME MEASURES: The rats were sacrificed prior to and at days 7, 14, and 21 after transplantation. The expression of growth associated protein-43 at the infarcted areas, the survival and migration of transplanted cells were examined by immunohistochemistry, at the same time, neurological deficit scores were recorded.RESULTS: The transplanted MSCs migrated from the left lateral ventricle to the infracted areas. Seven days after transplantation, the expression of BrdU-positive cells was found, reached a peak at day 14, and gradually decreased, until disappeared at 28 days after transplantation. Results of immunohistochemistry image analysis showed that immunological activity of growth associated protein-43 around the infarcted area of the MSCs group was obviously greater than that of the model group at days 7 and 14 after transplantation (P<0.06). There was no neurological deficit in the sham operated group. Moreover, with time prolonged, the neurological deficit scores gradually decreased in the model and MSCs groups, which were significantly lower in the MSCs group compared to the model group at day 14 after transplantation (P<0.05).CONCLUSION: MSCs transplantation up-regulates the expression of growth associated protein-43 around the infarcted area, which is consistent with the recovery of neurological function.

Objective:To explore the effect of standardized operation procedure of prone position placement in patients undergoing posterior vertebral pedicle screw system internal fixation.Methods:From May 2019 to May 2021, 98 patients with spinal stenosis who were treated with posterior vertebral pedicle screw system internal fixation in Wuxi Second People's Hospital were selected as the study subject by convenience sampling. The patients were randomly divided into the control group and the observation group with 49 cases in each group. The control group was given routine nursing, and the observation group received standardized operation procedure of prone position placement. The time needed to complete the position placement, the time of position recovery, the incidence of pipeline accidents and the total incidence of pressure injuries were compared between the two groups.Results:After the intervention, the time of position placement and recovery in the observation group were shorter than those in the control group, with statistical differences ( P<0.05) . The incidence of pipeline accidents in the observation group was 2.05%, lower than that in the control group 12.24%; the total incidence of stress injury in the observation group was 6.12%, lower than 18.37% in the control group; but there was no significant difference between the two groups ( P>0.05) . Conclusions:Standardized operation procedure of prone position placement can clarify the division of labor, shorten the prone position placement and recovery time of patients undergoing posterior vertebral pedicle screw system internal fixation, to some extent, it can reduce the risk of pipeline accidents and pressure injuries, and provide safe surgical experience for patients.

Objective:To analyze the clinical characteristics of a case of CNNM2 gene heterozygous mutation causing hypomagnesemia epilepsy mental retardation (HOMGSMR1) [MIM: 616418] in a child, and explore the association between genotype and phenotype.Methods:We followed up and retrospectively analyzed the clinical characteristics of a case of HOMGSMR1 caused by CNNM2 gene heterozygous mutation treated at Maternal and Child Health Care Hospital of Liuyang. Through whole exome sequencing of the family and bioinformatics analysis of the original data, we consulted databases and literature materials such as Online Mendelian Inheritance in Man (OMIM), ClinVar, gnomAD, GeneReviews, Pubmed, and China National Knowledge Infrastructure (CNKI), The American College of Medical Genetics and Genomics (ACMG) guidelines were used to rate heterozygous deletion mutations in the locked CNNM2 gene.Results:Patient, male, 3 months and 18 days old, mother gave birth to 1 child with 1 pregnancy, recurrent convulsions for more than 10 days, and multiple tests showed that blood magnesium levels were below normal, fluctuating between 0.51-0.55 mmol/L; After oral administration of " oxcarbazepine" and " magnesium sulfate", convulsions improved and blood magnesium concentration increased, but remained below normal, with the highest being 0.61 mmol/L. The sequencing results of the whole exome display of the family showed that the child carried a heterozygous deletion mutation in the exon region of the CNNM2 gene (c.838_843delATGGCCp. M280-A281del), which was not detected in their parents, indicating a new mutation. The large-scale population frequency database gnomAD did not include this mutation, and no literature reported this mutation. According to the ACMG guidelines, it was rated as a suspected pathogenic variant. The pathogenic variation of this gene can lead to autosomal dominant HOMGSMR1, which was consistent with genetic patterns.Conclusions:CNNM2 gene c. 838_ 843delATGGCC (p.M280_A281del) is a suspected pathogenic variant in this patient, with genotype and phenotype matching and heterozygous mutations following genetic patterns. Autosomal dominant inheritance is the molecular cause of clinical manifestations in this patient, and it is an unreported novel mutation.

Objective:To investigate the application effect of population/patient, intervention/exposure, comparison/control, and outcome (PICO) principles based on evidence-based medicine in case reports of residents in operative dentistry and endodontics.Methods:A total of 56 residents in Department of Conservative Dentistry and Endodontics in Hospital of Stomatology, Sun Yat-sen University, were selected and randomly divided into experimental group and control group, with 28 residents in each group. The residents in the experimental group were guided by the teachers to apply PICO principles in preparing case reports, and those in the control group were guided by the teachers to prepare traditional case reports. The two groups were compared in terms of the language expression of case reports, the completeness of case records, the rationality and advancement of the diagnosis and treatment regimen, and the logicality and scientificity of discussion, and a questionnaire survey was performed for both groups. SPSS 24.0 software was used to perform the descriptive statistical analysis, the t-test, and the chi-square test. Results:The experimental group had a significantly higher mean score of case report than the control group in department examination [(89.25±3.24) vs. (86.32±3.55), t=3.23, P=0.002], especially the score of the logicality and scientificity of discussion [(27.25±0.16) vs. (23.78±0.36), t=8.77, P<0.001]. The questionnaire survey showed that the experimental group had a significant increase in the frequency of participating in case reports ( P=0.035). Conclusions:The application of PICO principles can enhance the overall quality of case reports by residents and improve their enthusiasm in participating in case reports in department of operative dentistry and endodontics.