Objective　To approach the relationship betwe en glycosaminoglycan metabolism in cartilages and pathogenesis of KBD.Methods　Rhesus monkey was fed with grains and water from KBD endemic area for 18 months to produce the animal model with KBD . The glyc osaminoglycans in the monkey cartilage were extracted by the improved Dish method of Bitter. Purified glycosaminoglycans were digested with chondroitinaseABC, and the enzymatic digests were analyzed by HPLC. Results　Comparing with those of the control, the glycos aminoglycans in the head of femur, tibia plateau and costal cartilage from the Rhesus monkey fed with grains and water from KBD endemic area were undersulfated . Decreased unsaturated 4-sulphated disaccharide (△Di-4S) from the glycosa minoglycans in the head of femur and tibia plateau and decreased unsaturated 6- sulphated disaccharide (△Di-6S) from the glycosaminoglycans in the costal cart ilage were discovered.Conclusions　Detrimental factors in grains and water from KBD endemic area cause undersulfate of the cartilages glycosaminoglycans from Rhesus monkey. The glycosaminoglycans changes have a direct bearing on the patho logical alterations in morphology on the cartilages from the animal model with K BD.

Objective To explore the clinical features and gene mutations of blepharophimosis-ptosis-intellectual-disability syndrome (BPID). Methods The clinical data, diagnosis and treatment of a child with BPID in neonatal intensive care unit (NICU) were reviewed. Based on the literature retrieved from PubMed database, the common classification, clinical features, diagnosis and genetic counseling of BPID and its affiliated blepharophimosis-mental retardation syndromes (BMR) were reviewed. Results This male infant was 39 weeks of gestational age with birth weight of 1920 g, and was admitted to NICU 15 min after birth due to dyspnea. The main clinical manifestations were facial deformity such as biepharophimosis, ptosis and micromandible, inspiratory dyspnea with laryngeal cartilage softening, malformations of the thorax and feeding difficulties. A heterozygous mutation in UBE3B gene was identified by complete exon sequencing and he was diagnosed of BPID, a rare genetic disorder. Reviewing the literature, there was no relevant report in domestic. While one foreign literature was found to report 5 patients from 4 families having a subtype of BMR, a kind of autosomal recessive diseases caused by mutations in the UBE3B gene. Conclusion BPID is a rare clinical entity of BMR. Complete exon sequencing can be used to diagnose the disease.

Objective: To explore the expression and gene amplification status of human epidermal growth factor receptor-2 (HER2) in the different stages of invasive urothelial bladder carcinoma. Methods:Tumor tissues from 49 patients with different stages of invasive urothelial bladder carcinoma were tested by immunohistochemical staining for HER2 and HER2 gene fluorescence in situ hybridization. Results:The number of male patients was higher than that of females. The positive rate of HER2 protein expression was higher in the patients with the higher stage of invasive urothelial bladder carcinoma. However, no gene amplification was observed in all patients. Twelve patients had ployploid chromosome 17. More ployploids were observed in the patients with the higher stage of inva-sive urothelial bladder carcinoma. Conclusion:The increase in the protein expression of HER2 in the invasive urothelial bladder carci-noma patients was not caused by gene amplification. Other transcriptional and post-transcriptional mechanisms were probably involved in the regulation of the HER2 protein.

OBJECTIVETo investigate the clinical effects of close reduction and minimally invasive percutaneous plate osteosynthesis in treating proximal humerus fractures in the aged.

METHODSFrom February 2012 to December 2013,39 patients with proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO group, 21 cases) and open reduction internal fixation (ORIF group, 18 cases). Including 17 males and 22 females in the study, and aged from 67 to 88 years old with an average of (71.8 ± 5.2) years old. In MIPPO group, there were 11 males and 10 females with an average age of (70.0 ± 5.3) years old;and in ORIF group, there were 10 males and 8 females with an average age of (72.0 ± 4.2) years old. Operation time, blood loss during operation, fracture healing time and postoperative complications were recorded. The functions of the shoulder joints were assessed according to Constant-Murley score at final follow-up.

RESULTSAll the patients were followed up from 11 to 27 months with an average of 18.1 months. The mean blood loss of the MIPPO group was (176.0 ± 57.4) ml,while the ORIF group was (356.0 ± 66.9) ml (t = 7.22,P = 0.01). The operation time of the MIPPO group was (47.4 ± 14.9) min, while the ORIF group was (92.7 ± 15.8) min (t = 0.79, P = 0.03). Fracture healing time in the MIPPO group and ORIF group was (17.6 ± 5.8), ( 21.7 ± 4.9) weeks, respectively (P < 0.05). The mean Constant-Murley score at final follow-up was 89.7 ± 14.5 in MIPPO group, and 81.8 ± 13.2 in ORIF group (P < 0.05).

CONCLUSIONMIPPO has advantages of little trauma, less blood loss, rapid recovery, less vascular damage and so on and can effectively treat the proximal humerus fracture in the aged.

Aged ; Aged, 80 and over ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Shoulder Fractures ; surgery

In order to develop an anti-FMDV Asial type monoclonal antibody (mAb), BABL/c mice were immunized with recombinant FMDV VP1 protein. Three mAbs, 1B8, 5E1 and 5E2, were then further optimized. The result indicated that prepared anti-FMDV Asial mAbs had no cross-reactivity with Swine vesicular disease (SVD) and FMDV O, A and C type antigen. Their titers in abdomen liquor were l:5×106, l:2×106 and l:5×l06, respectively. 1B8 was found to be of IgGi subtype, 5E1 and 5E2 belonged to IgG2b subtype. In this study, the prepared mAbs are specific for detecting FMDV type Asial, and is potentially useful for pen-side diagnosis.

In this study,the coding region of type O FMDV capsid protein VP1 and a series of codon optimized DNA sequences coding for VP1 amino acid residues 141-160(epitopel),tandem repeat 200-213(epitope2(+2))and the combination of two epitopes(epitope1-2)was genetically cloned into the prokaryotic expression vector pPROExHTb and pGEX4T-1,respectively.VP1 and the fused epitopes GST-E1,GST-E2(+2)and GST-E1-2 were successfully solubly expressed in the cytoplasm of Escherichia coli and Western blot analysis demonstrated they retained antigenicity.Indirect VP1-ELISA and epitope ELISAs were subsequently developed to screen a panel of 80 field pig sera using LPB-ELISA as a standard test.For VP1-ELISA and all the epitope ELISAs,there were clear distinctions between the FMDV-positive and the FMDV-negative samples.Cross-reactions with pig sera positive to the viruses of swine vesicular disease virus that produce clinically indistinguishable syndromes in pigs or guinea pig antisera to FMDV strains of type A,C and Asial did not occur.The relative sensitivity and specificity for the GST-E1 ELISA,GST-E2(+2),GST-E1-2 ELISA and VP1-ELISA in comparison with LPB-ELISA were 93.3% and 85.0%,95.0% and 90%,100% and 81.8%,96.6% and 80.9% respectively.This study shows the potential use of the aforementioned epitopes as alternatives to the complex antigens used in current detection for antibody to FMDV structural proteins.

OBJECTIVETo discuss the efficacy of the myogenic elephant skin cream combining with VSD for treating severe bedsores.

METHODSTwenty-nine cases of III and IV degree bedsores were treated from June 2009 to June 2013. Among them, 15 cases were treated by myogenic elephant skin cream combined with VSD (VSD group) including 7 males and 8 females with an average age of (69.0±5.3) years old ranging from 17 to 96 years;other 14 cases were treated by the treatment of conventional dressing change (control group) including 6 males and 8 females with an average age of (71.0±4.2) years old ranging from 40 to 86 years. At 7, 14, 21, 28 d after treatments, specimens of wound two groups were respectively taken to examine immunohistochemical CD34 adopted SABC, the number of wild vascular cross were observed as capillary density value under high magnification microscope. It was used to assess the hyperplasia of granulation tissue of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy.

RESULTSSeventeen of 19 cases got complete data of specimens of wound at 7, 14, 21, 28 d,included 9 cases of VSD group,8 of control group. In the microscope view, the capillary density of VSD group was higher than that of control group significantly (P<0.05), it showed the application of VSD technology improved hyperplasia of granulation tissue much faster than conventional dressing change. In VSD group, 13 cases with 15 wounds healed, 2 cases with 3 wounds improved; in control group,3 cases with 3 wounds healed,7 cases with 9 wounds improved, 4 cases with 5 wounds were unhealed.

CONCLUSIONUsing the VSD technology with continuous high pressure suction to clean the drainage of wound and lacuna thoroughly can effectively control infection,promote the growth of granulation tissue, and then applying myogenic elephant skin cream to improve partial blood supply while prompting rapid growth of new granulation tissue and epithelial cell. The risk of this treatment is low,and the course of treatment is short, this provides a safe and effective method for treating bedsores.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; therapy ; Skin Cream ; therapeutic use

Objective To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA).Methods A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed.Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA).All patients received CCT.24 h urine sodium was measured in partial patients.Plasma renin activity (PRA), aldosterone (ALD) were detected.Results Compared with EH [PRA: before 0.5(0.2,0.9) μg·L-1·h-1, after 0.8(0.4,1.5) μg·L-1·h-1;ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1,0.9) μg·L-1·h-1, after 0.4(0.1,1.6) μg·L-1·h-1;ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1,0.2) μg·L-1·h-1, after 0.1 (0.1,0.2) μg·L-1·h-1;ALD: before (468±216) pmol/L;after (457±199) pmol/L].After CCT, the suppression rate of ALD [2.8% (-8.8%,15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0,50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients.The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients.In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT.No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group.The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium.No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT.Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without.A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit:ng/dl;PRA unit:μg·L-1·h-1) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%.Conclusions ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2.Seated CCT could replace recumbent CCT as a more confirmatory test.The PRA increasing rate should be taken into consideration when diagnosis of PA.

Objective To analyze clinical features and sum up experience for the treatment of ischemic bowel disease. Methods Clinical data of 73 patients with the diagnosis of ischemic bowel disease were retrospectively analyzed. ResultsTwenty-eight patients were male and 45 patients were female. The median of age was 65 years (range of 38 to 89 years). Forty-eight patients were associated with hypertension, 23%(17/73) patients had a history of coronary disease and 15% (11/73) had diabetes. Seventy patients presented symptom of abdominal pain and 93% (68/73) had hematochezia. Symptoms relieved by conservative treatment in 96% (63/66) patients. Nine patients underwent a surgery. One patient died of sepsis postoperatively. One suffered from colostomy necrosis and leakage of the rectum segment. Conclusion 1. Elder patients presenting symptoms of abdominal pain and hematochezia, especially with a history of cardio-cerebrovascular disease and diabetes should be considered for the possibility of ischemic bowel disease. 2. Most patients with ischemic bowel disease could be successfully treated by conservative therapy. 3. Surgery for patients with chronic relapsing and nonresponsible symptoms was difficult and patients often suffer from high postoperative complications.

Objective To study the influence of obesity on outcome of rehabilitation for the hemiplegic post stroke. Methods 118 hospitalized stroke patients were divided into the normal weight, overweight and obesity groups according to the Body Mass Index. All the patients received rehabilitation for 12 weeks. They were assessed with National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI) before and after rehabilitation. Results The scores of NIHSS, FMA, BBS and MBI improved significantly after rehabilitation in all the groups (P<0.001), and improved the lest in the obesity group in the scores of NIHSS, BBS and MBI (P<0.05). There was no significant difference in FMA score among groups (P>0.05). Conclusion Obesity influences the outcome of rehabilitation, results in poor functioning.