Objective　To study diagnostic significance of blink reflex(BR) in cranial Guillain-Barré Syndrome (cGBS). Methods　A comparative study was carried out on BR in 7 cGBS cases and 39 normal subjects.Results　As compared with controls,the cGBS group showed significant differences on latency and amplitude of R1,R2i, R2c component of BR,M wave and R1 conduction time (R1CT) inside the cranial part(P<0.001). Conclusion　The result suggested that BR and facial electromyogram were of great significance in the diagnosis of cGBS and might provide an objective index for clinical differential diagnosis.

Objective To investigate the effect of total sleep deprivation (TSD) shown in the electroencephalogram (EEG) power spectra in healthy young men. Method 20 healthy young male volunteers (19～22 years old) were subjected to 50 hours of TSD. EEGs were recorded 8 times (6 hours intervals) during TSD. EEG power was calculated for six bands at all 16 derivations.Results 50 hour TSD induced an increase in ? power at the other derivations except both occipitals ( P

Objective To summarize the clinical course of acute interstitial pneumonitis (AIP) associated pediatric acute respiratory distress syndrome (PARDS) in 8 recipients after liver transplantation,and further discuss the potential risk factors and therapeutic highlights.Methods A total of 476 pediatric patients received liver transplantation in Tianjin First Center Hospital from January 2012 to September 2016.Among them,8 cases of AIP associated PARDS in ICU were recruited in this study.Medical data including clinical presentation,ICU management and outcomes were analyzed retrospectively.Results The onset time-window of AIP associated PARDS was (2.67 ± 0.77) months after liver transplantation,and the time interval between initial symptom and ICU administration was (6.75 ± 5.82) days.Five cases had the history of acute rejection therapy,and 5 cases had CMV and/or EBV viremia history.All 8 cases received mechanical ventilation,2 cases given nasal non-invasive ventilation and the rest 6 cases given invasive ventilation,3 of which were switched to high frequency oscillatory ventilation (HFOV) combined with inhaled nitric oxide.At the stage of hypoxic climax,the fraction of inspired oxygen (FiO2) was up-regulated to 1.0 to maintain the oxygenation index (OI) of (25.24 ± 5.94).Temporary replacement of immunosuppressants with intravenous glucocorticoids was implemented in all 8 cases without acute rejection episode.Of 8 cases,2 cases died from PARDS,1 case died from portal thrombosis associated hepatic failure,and the rest 5 cases survived.Conclusion AIP associated PARDS is a critical complication with high mortality in pediatric patients after liver transplantation.Excessively strong immunosuppression therapy at early post-transplant stage shows a risk factor for AIP.Lung protective ventilation strategy and HFOV are recommended to reduce ventilator induced lung injury in pediatric patients.Temporary intravenous glucocorticoids may reduce acute inflammatory reaction in PARDS patients without increasing the risk of acute rejection.

Objective To evaluate the value of differential diagnosis between benign and malignant thyroid lesions by susceptibility weighted imaging(SWI).Methods 53 patients with 20 malignant thyroid lesions and 71 benign thyroid lesions confirmed by surgery and pathology were analyzed retrospectively.All cases received conventional MRI and SWI preoperatively.Location,volume,SWI parameters including signal to noise ratio(SNR),contrast noise ratio(CNR)and intratumor susceptibility hypointensity (ITSHIA)datas in benign and malignant lesions were compared and analyzed.Results There was no statistical significance between benign and malignant thyroid lesions in the location,volume,SNR and CNR(χ2 or t =0.014,0.286,0.927,1.169;P =0.907,0.778,0.368,0.259 respectively).The maximum diameter (1.90 mm±0.32 mm),degree of maximum diameter(1.33±0.47),frequence(1.40±0.20)and area ratio(1.09±0.28)for benign thyroid lesions were less than those for malignant lesions(3.39 mm±0.79 mm,2.25±0.44,1.40±0.68,1.70±0.47)respectively (t or Z =12.629,5.788,3.41 5,5.795;P =0.000,0.000,0.001,0.000).Conclusion SWI semiquantitative assessment of pathlogical vascularity is useful in differential diagnosis of benign and malignant thyroid lesions.

Objective To investigate the expression and significance of P-glycoprotein in triple negative breast cancer (TNBC).Methods One hundred and seventy-one cases of breast invasive ductal carcinoma in our hospital were retrospectively analyzed.According to the expression of ER,PR,Her2,we categorized those paitents into triple negative breast cancer group (58 cases) and non triple negative breast cancer group (113 cases).The different expression of P-glycoprotein was detected by immunohistochemieal technology in two groups.We analyzed the relationship between the expression of P-glycoprotein and clinical and pathological features in TNBC,and investigated the effect of P-gp on the rate of recurrence and metastasis in 3 years.Results (1) The expression of P-gp in TN BC was significantly higher than that of NTNBC (53.45％ vs 37.17％) (P ＜ 0.05).(2) The expression of P-gp in TNBC was associated with TNM stage,histological grade,lymph node status and vascular invasion (P ＜ 0.05),but not with age and size of the tumor (P ＞ 0.05).(3) The rate of recurrence and metastasis in positive expression of P-gp in TNBC was 58.06％,which was significantly higher than negative expression of P-gp in TNBC (44.44％),but no statistically significant was found(P ＞ 0.05).Survival analysis showed that P-glycoprotein expression had no relationshiop to 3-year cumulative survival rate (P =0.161 ＞ 0.05).Conclusions The positive expression of P-gp in TNBC is associated with drug resistance and metastasis,but has no obvious significance to recurrence and metastasis,so as to 3-year cumulative survival rate.

ObjectiveTo explore the effects of hepatitis B virus X protein (HBx) on the expression and promoter methylation of the p16 tumor suppressor gene, and to investigate the epigenetic role of HBx in the development and progression of hepatitis B virus (HBV)-associated hepatocellular carcinomas (HCC). MethodsExperiments were performed in the human hepatoblastoma cell line HepG2, HepG2 cells expressing green fluorescent protein (HepG2/GFP), and HepG2 cells stably expressing GFP-HBx fusion protein (HepG2/GFP-HBx). Western blot was used to determine the expression levels of the p16 protein in HepG2 cells, HepG2/GFP cells, and HepG2/GFP-HBx cells. HepG2/GFP-HBx cells were treated with a universal inhibitor of DNA methyltransferase (DNMT), 5-aza-2'-deoxycytidine (5-aza-2'-dC). Methylation-specific polymerase chain reaction (MSP) was used to determine the promoter methylation of the p16 tumor suppressor gene in HepG2 cells, HepG2/GFP cells, and HepG2/GFP-HBx cells treated with or without 5-aza-2′-dC. Multiple-group comparison was made by analysis of variance. ResultsAccording to the results of Western blot, HepG2/GFP-HBx cells had a significantly lower expression level of the p16 protein than HepG2 cells and HepG2/GFP cells (P=0.0007; P=00014); there was no significant difference in the expression level of the p16 protein between HepG2/GFP and HepG2 cells (P＞0.05). The MSP assay revealed partial CpG methylation in the p16 promoter region in HepG2/GFP-HBx cells. No promoter methylation was detected in HepG2 cells or HepG2/GFP cells. Non-methylation in the p16 promoter region was restored in HepG2/GFP-HBx cells treated with 5-aza-2′-dC. ConclusionIn the hepatoblastoma cell line, HBx down-regulates the expression of the p16 tumor suppressor gene by inducing methylation in its promoter region. The DNMT inhibitor, 5-aza-2′-dC, restores non-methylation in the p16 promoter region. The reversible modification provides new insights for the treatment and prevention of HBV-associated HCC.

Objective To explore the molecular mechanisms of hepatic stimulator substance (HSS) gene knockout in promoting the development and progression of nonalcoholic steatohepatitis (NASH).Methods NASH model mice (n=20) with HSS wild-type (HSS+/+) or HSS gene knockout (HSS-/-) were constructed using modified choline-deficient diet (CD-diet),untreated C57BL6-HSS-/-and C57BL6-HSS+/+ mice (n=20) were considered as control.Ten mice of each group were killed at month 1 and 2,respectively.The levels of triglyceride (TG) and total cholesterol (TC) in liver were measured using ELISA method.Histopathology and collagen deposition in liver tissue were observed using HE staining and Masson staining,respectively.Lipid content in liver tissue was observed and calculated using oil red O staining.The levels of mRNA and proteins of peroxisome proliferators activated receptor gama coactivator 1 alpha (PGC-1α),mitochondrial transcription factor A (TFAM),transcription factor-E2 related factor α (Nrf2),[-loop,dynamin-related protein 1 (Drp1),mitochondrial fission 1 protein (Fis1),mitofusins 1 (Mfn1),autophagy related gene 3 (Atg3) in liver tissue were detected using Real-time PCR and Western blot,respectively.Content of malonaldehyde (MDA),cyclooxygenase Ⅳ (COX Ⅳ) and adenosine tirphosphate (ATP) were measured using kits,and the activity of respiratory chain complex Ⅴ and cytochrome C oxidase in liver tissue were measured using spectrophotometry.the comparison between groups was done by t test.Results The levels of HSS mRNA and protein in mice-HSS-/-were 0.154± 0.04 and 0.08± 0.01,respectively,which were both significantly lower than those in mice-HSS+/+ (0.952 ± 0.08 and 1.362±-0.130,respectively),and t he differences had statistical significance (t =10.244 and 10.375,respectively,both P＜0.05).One month and 2 months after NASH modeled,TC contents in mice-HSS-/ were (248.6±21.5) μmol/g and (217.4±18.0) μmol/g,respectively,which were both remarkably higher than those in mice-HSS+/+ [(153.5 ± 11.2) μmol/g and (140.8 ±7.5) μmol/g,respectively],and the differences had statistical significance (t=15.270 and 10.524,respectively,both P＜0.05).The results form HE staining,oil red O staining and Masson staining indicated that fat deposition,collage deposition and inflammation in liver tissues of mice-HSS-/-were severer than those in mice-HSS+/+.One month after NASH modeled,protein levels of Drp1,Fis1,Mfn1 and Atg3 in liver tissues of mice-HSS-/ were all significantly decreased compared with those in mice-HSS+/+,and the differences had statistical significance (t=10.705,24.072,9.892 and 17.540,respectively,all P＜ 0.05).Two months after NASH modeled,protein levels of Drp1,Fis1,Mfn1and Atg3 in liver tissues of mice-HSS-/ were all significantly decreased compared with those in mice-HSS+/+,and the differences had statistical significance (t=125.378,15.926,34.330 and 13.437,respectively,all P＜0.05).One month after NASH modeled,mRNA levels of Drp1,Fis1,Mfn1 and Atg3 in liver tissues of mice-HSS-/-were all significantly decreased compared with those in mice-HSS+/+,the differences had statistical significance (t=36.337,40.825,33.508 and 28.104,respectively,all P＜0.05).Two months after NASH modeled,mRNA levels of Drp1,Fis1,Mfn1 and Atg3 in liver tissues of mice-HSS-/-were all significantly decreased compared with those in mice-HSS+/+,and the differences had statistical significance (t=35.210,42.375,27.753 and 20.560,respectively,all P＜0.05).The protein levels of PGC-1α,TFAM,Nrf2 and D-loop in liver of C57BL6-HSS-/-group were lower than those in liver of C57BL6-HSS+/+ group,and the differences had statistical significance (one month:t=20.548,31.036,19.445 and 10.974,respectively;two months:t=9.887,13.330,22.375 and 18.903,respectively,all P＜0.05).The mRNA levels of PGC-1α,TFAM,Nrf2 and D-loop in liver of C57BL6-HSS-/-group were all lower than those in C57BL6-HSS+/+ group,and the differences had statistical significance (one month:t=9.087,12.582,21.451 and 7.774,respectively;two months:t=23.758,17.924,9.924 and 15.209,respectively,all P＜0.05).One month and 2 months after NASH modeled,the levels of ATP mRNA in liver of C57BL6-HSS / group were both significantly lower than those in C57BL6-HSS+/+,and the differences had statistical significance 0=43.775 and 28.375,respectively,both P＜0.05);the levels of COXⅣ mRNA in liver of C57BL6-HSS / group were 0.142 ± 0.06 and 0.068± 0.001,respectively,which were both significantly lower than those in C57BL6-HSS+/+ group (0.255± 0.08 and 0.172 ±0.06,respectively),and the differences had statistical significance (t=28.337 and 19.782,respectively,both P＜0.05);the levels of MDA mRNA in liver of C57BL6-HSS-/-group were 0.973 ±0.112 and 1.253±0.054,respectively,which were both significantly lower than those in C57BL6-HSS+/+ group (0.366±0.02 and 0.872±0.05,respectively),and the differences had statistical significance (t=8.357 and 6.582,respectively,both P＜0.05).Conclusion Deletion of HSS accelerates NASH progression via inhibiting mitochondrial fusion,which leads to dysfunction of mitochondrial respiratory chain and inhibition of fatty acid oxidation.

Objective: This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. Methods: This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004–2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal–Wallis test. Results: In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women’s and children’s hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). Conclusion Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.

Objective To discuss the surgical strategy for children with complex congenital heart disease (CHD) and end-stage liver disease (ESLD).Methods We reported two eases of pediatric liver transplantation in patients with complex CHD and ESLD.Medical data including operation procedure,ICU management and outcomes were reviewed retrospectively.Also we reviewed the literature on the topic of clinical outcomes resulted from different surgery options.Results The first case was a seven-month-old male patient with biliary atresia and complex CHD (unroofed coronary sinus syndrome,persistent left superior vena cava,patent foramen ovale,and peripheral pulmonary stenosis).Liver transplantation was successfully performed without corrective heart surgery.The operation time was 6 h and 35 min.The patient suffered acute cardiac dysfunction and significant hypoxemia after extubation,then pneumonia developed,and eventually the patient died on post-operative day 12.The second case was a seven-month-old male patient with biliary atresia and complex CHD (ventricular septal defect,patent foramen ovale,patent ductus arteriosus,pulmonary stenosis).Liver transplantation was performed on the same day following total correction of cardiac defects by open-heart surgery.The operation time was 16 h and 15 min.The patient was extubated after 60 h ventilation,and was transferred to ward from ICU on post-operative day 6 with stable cardiopulmonary function.However,hepatic artery occlusion occurred on early postoperative stage,and consequently the patient received the second liver transplantation for ischemic biliary complication on post-operative day 40.The second liver transplantation procedure was uneventful.The liver graft recovered smoothly with stable hemodynamics.Conclusion Children with complex CHD undergoing liver transplantation are at an increased perioperative risk.The surgical strategy for each patient must be tailored individually according to specific cardiovascular status and limited hepatic reserve.

Objective To explore the effectiveness of octreotide therapeutic strategy to attenuate portal hyperperfusion resulted from small-for-size graft in infant liver transplantation.Methods A total of 22 infants received small-for-size liver graft (defined as GV/SLV＜0.5,and GV＜ 150 g) in our hospital from December 2013 to August 2016.Twelve cases (octreotide group) were treated with intravenous octreotide infusion (300 g daily for 24-96 h) to attenuate the portal hyperperfusion after transplantation,and the rest 10 cases given liver transplantation at the early stage did not receive the intervention of octreotide and served as control group.Results The initial portal vein flows (PVFs) in octreotide group and control group were (413.43 ± 76.24) (390.83 ± 107.89) ml/(min 100 g),and there was no significant difference between two groups (P＞0.05).The PVFs on postoperative day (POD) 3 and POD5 in octreotide group and control group were (334.90 ± 96.67) and (441.04 ± 117.41),and (322.20 ± 81.04) and (423.23 ± 100.81) mL/(min 100 g) respectively (P＜0.05 for all).However,there were no significant differences in serum AST and bilirubin levels at four time points (initial,POD3,POD5 and POD7) after transplantation between two groups (P＞0.05).The incidence of hepatic artery occlusion,and biliary complications in octreotide group and ontrol group was 33.33％ and 44.44％,and 33.33％ and 11.11％ respectively (P ＞ 0.05 for all).Conclusion Octreotide treatment attenuated portal hyperperfusion resulted from small-for-size graft in infant liver transplantation.However,the effects of octreotide therapy on graft biochemical tests,the hepatic artery and biliary complications were still unclear,and further investigation is needed.