Reflex tests are ordered when a particular test result indicates that additional testing should be performed according to the guidelines or the feedback process formulated by clinical consultation. The application scope of the reflex tests involves various subspecialties of laboratory medicine. The clinical application needs the support of qualified laboratory doctors, comprehensive information and financial system, clinical guidelines, and so on. Active application of reflex tests can promote the standardization of evidence-based medicine in clinical practice, save medical resources, and shorten the diagnosis and treatment time of patients.

Objective To investigate the changes of plasma adrenodullin(ADM) and C-type natriuretic peptide(CNP) level in children with chronic heart failure(CHF) and its clinical implications.Methods Forty-two children with CHF were collected.The patients suffered from dilated cardiomyopathy,congenital heart defects,and other heart diseases.According to a modified scoring system described by Ross and Reithman,16 patients were classified as class Ⅱ,14 as class Ⅲ,and 12 as class Ⅳ.Plasma levels of ADM and CNP were measured by radioimmunoassay assay in these patients and 11 healthy children.Echocardiography was performed to measure left ventricular function and the ratio of E/A.Results Plasma ADM and CNP levels of CHF patients were significantly elevated as compared with those of the control subjects [(218.27?106.53) ng/L vs(74.39?53.99) ng/L,P=0;(190.27?108.38) ng/L vs(92.59?(59.46) ng/L),P0.05).ADM levels were elevated with the advancing severity of CHF determined by a modified scoring system described by Ross.However,the plasma CNP levels in the normal state wasn′t significantly different from those observed in class Ⅱ.Likewise,the plasma CNP level in the class Ⅲ was not significantly different from that observed in class Ⅱ.Conclusions ADM and CNP might play a compensatory and defensive roles in the pathophysiology of the pediatric CHF.ADM may be a biochemical marker for evaluation the severity of the chronic heart failure in children,but also a new prognostic indicator of this syndrome.

Objective To discover the role of interleukin-18(IL-18) and CD_(54) in congestive heart failure(CHF),and evaluate the diagnostic value of IL-18 and CD_(54) in CHF.Methods Blood samples were collected from 52 children with CHF,included 18 cases in classⅡ,17 cases in class Ⅲand 17 cases in class Ⅳ.Fifteen healthy children were normal control group.The levels of IL-18 was(detec-)ted by ELISA method and the expression of CD_(54) was examined by flow cytometry.Results The levels of IL-18 and CD_(54) in CHF were significantly higher than those of control subjects(P0.05),but the levels were respectively significantly higher than that of control subjects(P

10% and 20% HRP aqueous solution was injected into the anterior wall of the stomach of rabbit, and both the afferent and efferent nerve connections of this region were examined.1. Large number of labeled cells appeared in the dorsal motor nucleus of the vagus nerve (dmnX) on both sides throughout its whole length, except the very rostral and caudal ends of it. The labeled cells were more numerous in the middle part of the nucleus at levels above and below the obex. The distribution of the labeled cells showed certain localization characteristics. Those in the caudal part of the nucleus occupied the medial portion, those in the levels around the obex distributed widely in the nucleus, while in the rostral part they were smaller in number and showed no definite localization.2. In the area between the dorsomedial border of the dmnX and the area pos- trema, the so-called area subpostrema, some disseminated labeled cells, the form of which was similar to that the labeled cells in the dmnX, were also observed.3. Numerous labeled cells appeared in the nodose ganglia on both sides, the number of which was several times more than that in the spinal ganglia, indicating that the afferent connection of the stomach via the vagus nerve predominated over that via the sympathetic nerve. The small-sized labeled cells in the ganglion, however, appeared up to more than 40% of all the labeled cells in it, the functional significance of them, as well as the relation between them and the labeled small cells in the spinal ganglia, is worth further investigation.4. The labeled neurons appeared in the spinal ganglia from Th_3 to L_3, most of them were in Th_3 to Th_(10), showing that the afferents of the stomach via the sympathetic system were diffusely arranged and at the same time concentrated in certain segments.5. Our observations confirmed that the stomach is innervated by elements of bilateral origin. In the vagus system the afferent and efferent neurons appeared almost equally in both dmnX and both nodose ganglia. And in the sympathetic system, the afferent neurons on the left side were 1 to 2 times more than those on the right, i. e., the left side is predominant.

Objective To explore the feasibility of in-flow inversion recovery (IFIR)sequence of magnetic resonance imaging (MRI)at 1.5T in diagnosis of Budd-Chiari syndrome (BCS).Methods A total of 45 patients with Budd-Chiari syndrome diagnosed by surgery or interventional surgery in our institution were enrolled.The prerequisite of the study was that all medical imaging data including MRI and digital subtraction angiography (DSA)should be integrated.Then,the diagnostic accuracy rates between IFIR sequence and DSA were analyzed and compared.Results Of all 45 patients with BCS,40 (88.9%)were diagnosed accurately by IF-IR sequence,including typeⅠa in 10,typeⅠb in 14,typeⅡ in 10 and type Ⅲ in 6.Meanwhile,41 (91.1%)were diagnosed accu-rately by DSA,including typeⅠa in 8,typeⅠb in 14,typeⅡ in 13 and type Ⅲ in 6.No significant difference was showed in diag-nostic accuracy between two imaging methods (P >0.05).Spearman rank correlation analysis revealed that the diagnostic accuracy of IFIR sequence was highly consistent with that of DSA(r =0.853,P <0.001 ).However,there existed significant difference be-tween two methods in accurate diagnosis of typeⅠa and typeⅡ BCS (P <0.05).Conclusion MRI IFIR sequence at 1.5T is highly consistent with DSA in diagnosis and classification of BCS,which can be used as a reliable method of preoperative screening for BCS diagnosis.

Human herpesvirus 7 (HHV-7) infection is dependent on the functions of structural glycoproteins at multiple stages of the viral life cycle. These proteins mediate the initial attachment and fusion events that occur between the viral envelope and a host cell membrane, as well as cell to cell spread of the virus. To characterize the HHV-7 glycoproteins that can mediate cell fusion, a cell-based fusion assay was used. 293T cells expressing the HHV-7 glycoproteins of interest along with a luciferase reporter gene under the control of the T7 promoter were cocultivated with SupT1 cells transfected with T7 RNA polymerase. HHV-7 glycoproteins gB, gH, gL and gO can mediate the fusion of 293T cells with SupT1 cells, and the fusion can be inhibited by anti-CD4 mAbs. Thus, the coexpression of HHV-7 gB, gO, gH and gL is sufficient and necessary for HHV-7 induced membrane fusion, and one of these glycoproteins or protein complex formed by these glycoproteins might be the ligand(s) of CD4 molecule.

Objective To evaluate the role of aquaporin 1(AQPI)expression in the cartiopulmonary bypass(CPB)-induced lung injury in dogs.Methods Twenty-four healthy dogs,weighing 15-20 kg,were randomly divided into 4 group(n =6 each):control group(group C),acetazolamide Ⅰ group(group A Ⅰ),acetazolamide Ⅱ group(group A Ⅱ),and acetazolarnide Ⅲ group(group AⅢ).Lung injury was produced by CPB.The traditional priming solution was infused in group C.Priming solutions containing acetaaolamide 20,40 and 60 mg/kgwere infused in groups A Ⅰ,A Ⅱ and A Ⅲ respectively.Blood samples were collected from the femoral artery before mechanical ventilation,at the end of CPB and at 1 h after end of CPB(T1-3)for arterial blood gas analysis.Respiration index(RI)and oxygenation index(OI)were calculated.The lung specimens were oblained for determination of AQPI mRNA and protein expression(by RT-PCR and Western blot)and for microscopic examination.The pathological changes of the lung were scored.Results Compared with group C,P(A-a)O2,RI and the pathological score were significantly increased at T2.3,OI was significantly decreased at T2.3,and AQP1 protein expression was down-regulated at T2.3 in groups A Ⅰ,A Ⅱ and AⅢ,and AQP1 mRNA expression was down-regulated at T2.3 in groups AⅡ and AⅢ(P＜0.05).Compared with group A Ⅰ,P(A-a)O2,RI and the pathological score were significantly increased at T2.3,OI was significantly decreased at T2.3,and AQP1 protein expression was down-regulated at T2.3 in groups A Ⅱ and AⅢ,and AQP1 mRNA expression was down-regulated at T2.3 ingroup A Ⅲ(P ＜ 0.05).Compared with group A Ⅱ,RI and the pathological score were significantly increased at T2.3,and AQP1 protein expression was down-regulated at T2.3 in group A Ⅲ(P ＜ 0.05).Conclutsion Down-regulation of AQPI expression is involved in the CPB-induced lung injury in dogs.

Objective To investigate the effects of endogenous estrogen on blood glucose level,serum insulin level,and plasma total antioxidant capacity in streptozotocin-induced diabetic female mice,and to explore possible protective effects of estrogen on pancreatic islet cells.Methods Female mice were randomly according to body weight divided into four groups:( 1 ) Sham( Sham operation and vehicle administration) ; ( 2 ) Ovx( ovariectomy and vebicle administration ) ; ( 3 ) Sham + STZ ( Sham operation and STZ administration ) ; and ( 4 ) Ovx + STZ ( ovariectomy and STZ administration).The diabetic mice were induced by intraperitoneal injection of streptozotocin (STZ,50 mg/kg ).Blood glucose levels were measured once a week.Results The blood glucose level and malondialdehyde of Ovx group were higher than that in Sham group,while total anti-oxidant capacity ( T-AOC ) was lower than those in Sham group.the blood glucose level and MDA of Ovx+ STZ group were higher than those in Sham +STZ group,while T-AOC and serum insulin level were lower than those in Sham + STZ group.Conclusions Endogenous estrogen may have some protective effects on pancreatic islet function from streptozotocin-induced diabetes mellitus in female mice.

Objective To evaluate the effects of modified ultrafiltration on the expression of aquaporin 1 (AQP1) in cardiopulmonary bypass (CPB)-induced lung injury in dogs.Methods Eighteen healthy adult dogs of either sex,weighing 15-20 kg,were randomly divided into 3 groups (n =6 each):control group (group C),group CPB and modified ultrafiltration group (group MUF).The dogs were anesthetized with intraperitoneal 2.5％pentobarbital 25 mg/kg.Thoracotomy was performed in all the three groups and in addition lung injury was produced by CPB in CPB and MUF groups.In group MUF,modified ultrafiltration was performed at 10-15 min after termination of CPB.Arterial blood samples were collected before mechanical ventilation (T1),at end of CPB (T2),and at 1 h after termination of CPB (T3) to calculate respiration index (RI) and oxygenation index (OI).The lungs were removed for microscopic examination of pathologic changes in lung tissues under light microscope and for detection of AQP1 mRNA expression by real-time PCR.Results RI and OI were significantly higher and AQP1 mRNA expression was lower at T2 and T3 than at T1 in CPB and MUF groups (P ＜ 0.05).Compared with group C,RI was significantly increased and AQP1 mRNA expression was down-regulated at T2,3 in CPB and MUF groups,and OI at T2.3 in CPB group and at T2 in MUF group was decreased (P ＜ 0.05).Compared with group CBP,RI was significantly decreased,OI was increased and AQP1 mRNA expression was up-regulated at T3 in group MUF (P ＜ 0.05).Conclusion Modified ultrafiltration can reduce CPB-induced lung injury in dogs and upregulation of AQP1 may be involved in the mechanism.

Objective:To identify causative genes for autosomal recessive woolly hair (ARWH) in a family.Methods:Clinical data were collected from two patients and other family members in a Chinese pedigree of Han nationality with ARWH. Peripheral blood samples were obtained from the two patients, their unaffected parents and 100 unrelated healthy individuals, and DNA was extracted from the blood samples. A next-generation skin-targeted sequencing panel was used to detect gene mutations in the patients, and Sanger sequencing was performed to verify the sequencing results. The function of protein encoded by the mutant gene was predicted.Results:Two missense mutations c.530T>G (p.Leu177Arg) and c.736T>A (p.Cys246Ser) were both identified in the LIPH gene of the two patients, which were inherited from their father and mother respectively. Neither of the two mutations was identified in the 100 unrelated healthy controls. Interspecies sequence alignment showed that leucine at amino acid position 177 and cysteine at amino acid position 246 of the protein encoded by the LIPH gene were highly evolutionarily conserved. As SIFT and Polyphen-2 softwares showed, the mutations c.530T>G (p.Leu177Arg) and c.736T>A (p.Cys246Ser) were both predicted to be detrimental variations.Conclusion:Two missense mutations c.530T>G (p.Leu177Arg) and c.736T>A (p.Cys246Ser) in the LIPH gene may contribute to the clinical phenotype of the two patients with ARWH in this family.