Objective To analyse the etiology and clinical characteristics of 26 critically ill children with severe hand foot and mouth disease (HFMD) of Shanxi province in 2010.Methods We retrospectively analysed the clinical data of 26 children with severe HFMD from Mar to Sep 2010.Nucleic acid of enterovirus 71 ( EV71 ) and Coxsackie virus A 16 ( CoxA16) were detected in 20 out of 26 children with HFMD by reversed real time polymerase chain reaction (rRT-PCR),and the whole VP1 gene of EV71 deriving from 6 different areas of Shanxi province was amplified,sequenced,and compared with strains from other areas in china.Results EV71 nucleic acid were positive in 18 out of 20 children,while the other two were negative for EV71 and CoxAl6.Among all the critical cases,20 cases (76.9％) occurred in Weinan area,four in Xianyang area,and two in Xi'an urban area.Compared with those of Fuyang Anhui,Hong Kong China,Guangzhou,Shenzhen,Shandong,Beijing,the homology of the whole VP1 gene sequence from 6 strains of Shanxi area was 96％ ～ 100％.Most of the critical children were under 3-year-old,and the incidence rate of male children was higher than that of female children.All affected children had persisted fever,poor energy,hyperarousal,hypersomnia,and limb shaking.Meanwhile their peripheral blood leukocytes,C-reactive protein and blood glucose were markedly increased,but renal injuries were rare.Eighteen children clinically recovered on discharge,among which 2 cases had sequelae of limb activity obstacle,and 8 cases died.Conclusion Weinan is the area with the highest incidence rate of critical HFMD cases in Shanxi Province,and the major etiological organism is EV71,which is highly homologous to EV71 found in other regions of mainland China.As many cases are in dangerous condition,thus early identification and intervention could inhibit the disease progression,and play a key role in reducing the mortality.

Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1,2014 and February 1,2016.Patients were divided into good collaterals group (n =31) and poor collaterals group (n =18) according to their distribution of leptomeningeal arteries with CTA.Thirty day mortality rate,the incidence of symptomatic intracranial hemorrhage,24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups.Corrected chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0％ vs.16.7％,P ＜ 0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups (P ＞ 0.05),however,30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2 ± 3.1 vs.9.6 ± 2.7,P ＜ O.05).Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis,good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis.However,good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.

Objective To evaluate the diagnostic and staging value of orbital structures quantitative measurement with 3T mag-netic resonance imaging in patients with Graves’ophthalmopathy (GO).Methods Twenty-three GO patients (patient group)and eighteen healthy volunteers (contrast group)were enrolled.Quantitative measurement of orbital structures including exophthalmos values,fatty tissue thickness of the inner side of eye balls,cross-sectional areas of extraocular muscles and signal intensity ratios of extraocular muscles to the ipsilateral temporal muscles (SIR values),and they were compared between two groups.Correlations be-tween the quantitative values and clinical active score (CAS)were accessed.Receiver operating characteristic (ROC)analysis was performed to evaluate the most relevant quantitative parameter and its diagnostic value in discriminating active from inactive GO pa-tients.Results There were significant differences between the GO group and contrast group regarding to all the quantitative parame-ters (P <0.05).Strong correlation was found between SIR values and CAS (r =0.730,P <0.001 ).Significant difference of SIR was found between patients with active GO and inactive GO (P =0.002),and a cut off value of 3.25 might be the critical threshold value,with diagnostic sensitivity of 81.8% and specificity of 83.3% respectively.Conclusion Quantitative measurement of orbital structures with 3T MR imaging could provide assistant in diagnosing and staging of GO.

Objective To investigate the diagnostic value of conventional MRI combined with DWI in the differential diagnosis of orbital lymphoproliferative disorders (LPD). Methods As a retrospective study, 42 patients were enrolled, including 23 orbital lymphoma and 19 benign orbital LPD confirmed pathologically or clinically. These patients underwent conventional MR, DWI and contrast?enhanced MRI examination of orbit. Qualitative MR imaging features [location, margin, patient ratio of involved quadrants (≥2), signal intensity,“flow void sign”, sinusitis] and quantitative features [ADC and contrast enhanced ratio of the lesion to temporal muscle (CER)] were evaluated. Chi?square test and t test were used for the analysis of qualitative and quantitative features between lymphoma and benign orbital LPD groups, respectively. Multivariate Logistic regression analysis was employed to identify the significant variable for predicting malignant LPD. ROC analysis was used to evaluate the ability of the diagnostic models established based on identified variables. Results “Flow void sign”(9 lymphomas and 17 benign LPDs) and sinusitis (5 lymphomas and 13 benign LPDs) were statistically significant (P<0.05). The MR imaging features [location, margin, patient ratio of involved quadrants (≥2), and signal intensity] had no significant difference between the two groups (P>0.05). Both ADC [(0.79±0.09)×10?3 mm2/s of lymphoma, (1.29±0.35)×10?3 mm2/s of benign LPD] and CER (1.43±0.17 of lymphoma, 1.79±0.31 of benign LPD) between the two groups had significant difference (t=-6.630, -8.257;P<0.01). Multivariate logistic regression analysis showed that ADC value, CER and“flow void sign”were significant variables for predicting malignant orbital LPD (P<0.05). ROC curve showed that ADC value was the most significant single variable in differentiating orbital LPD [threshold value, 0.74 × 10- 3 mm2/s; areas under ROC curve (AUC), 0.97; sensitivity, 87.0%; specificity, 94.7%]. Combination of ADC and CER could further improve the specificity in differentiating benign from malignant orbital LPD (AUC, 0.90;sensitivity, 78.3%;specificity, 100.0%, accuracy 88.1%). Conclusions ADC, CER and“flow void sign”on T2WI were significant variables for predicting malignant orbital LPD. ADC value was the most significant single variable. Combination of ADC and CER could further improve the specificity in differentiating benign from malignant orbital LPD.

Objective To evaluate the diagnostic value of CT and PET-CT characteristics in predicting the presence of epidermal growth factor receptor(EGFR) gene mutations in lung adenocarcinomas. Methods One hundred and sixty-eight lung adenocarcinomas cases confirmed by pathology were enrolled in our study. They were divided into EGFR gene mutations group (89 cases) and wild types group (79cases) according to whether EGFR gene mutation occurred. All patients underwent CT examination. Seventy-five patients underwent PET-CT examination, including 37 gene mutationsand 38 wild types.The demographic (the patients' age, the gender and smoking history), CT characteristics(lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram, ground glass opacity/tumor ratio(G/T) and the maximum diameter of tumor(Dmax)) and PET-CT characteristics(the maximum standardized uptake value, (SUVmax))between these two groups were retrospectively compared. The independent sample t test was used to analyze the
difference between these two groups regarding the patients' age,Dmax,SUVmax. The χ2 test was used to demonstrate the difference between these two groups regarding the gender, smoking history and CT features including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram and G/T.The trend analysis between SUVmax and EGFR gene mutations was performed by usingχ2 test for trend.Results No significant difference was found regarding partial CT characteristics of lesions including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram (P>0.05),however, the Dmax of EGFR gene mutations group and wild types group were(2.53±1.39),(3.00±1.77)cm, respectively. The amount of G/T>50%in EGFR gene mutations group and wild types group was 21 and 5, respectively. Significant differences were found regarding the G/T and Dmax(χ2=9.538, P<0.05;t=1.974,P<0.05). The SUVmax in EGFR gene mutations group (37 cases) and wild types group (38 cases) were 5.13 ± 4.35 and 9.64 ± 5.12, respectively. Significant difference was found regarding SUVmax(t=4.104, P<0.05). The sensitivity and specificity in predicting EGFR gene mutations were 24%and 93%, respectively, using G/T>50%as diagnostic criterion. Receiver operating characteristic (ROC) results indicated Dmax=1.85 cm was the optimal value in predicting EGFR gene mutations, with the sensitivity and specificity of 76% and 42%, respectively. Meanwhile, SUVmax=6.85 was the optimal value, with the sensitivity and specificity of 71% and 73%, respectively. Moreover,χ2 test for trend showed that an obvious trend was found to associate SUVmax with the incidence of EGFR gene mutations (χ2=15.755, P<0.05). Conclusion SUVmax may be helpful in predicting EGFR gene mutations in lung adenocarcinomas with relatively high diagnostic value.

Objectives To isolate cancer stem cells (CSCs) in pancreatic cancer cell lines PANC1 and ASPC-1 with serum-free medium( SFM ), and to detect the expression of miR-590-3p in CSCs. Methods PANC1 and ASPC-1 cells was cultured in serum-free medium. The monoclonal formation, differentiation and cell cycle, half inhibitory concentration ( IC50 ), and the expression of the surface markers CD24 + , CD44 + were detected. qRT-PCR was used to detect the expression of miR-590-3p. Results After SFM culture, (0.94 ±0.53 ) ％ of ASPC-1 and (0.57 + 0. 12 ) ％ PANC1 survived, and they formed spheres, and could continuously passage in vitro. Cell spheres differentiation recurred when serum was supplemented in SFM. The G0/G1 stage proportion, CD24+ , CD44 + , CD24+ CD44+ cells proportion, IC50 in ASPC-1 cell were (75.3 ± 5.4)％,0.96％ ～ 2.01％, 27.52％ ～ 34.47％, 0.35％ ～ 0.44％ and (224.37 ± 5.71 ) μg/ml, which were significantly higher than that those in parent cell [ (43.7 ± 3.8 ) ％, 0. 38％ ～ 0.42％, 17.65％ ～ 18.25％,0.05％ ～0.08％, (11.43 ±2.10)μg/ml, P＜0.05]. The G0/G1 stage proportion, CD24+ ,CD44+ ,CD24 +CD44 + cells proportion, IC50 in PANC 1 cell were ( 80. 1 ± 4.7) ％, 5.31％ ～ 9.84％, 72.05％ ～ 93.06％,4.91％ ～5.21％, (296.58±4.27) μg/ml, which were significantly higher than that those in parent cell [ (46.1 ±5.3)％, 4.09％ ～4.97％, 47.71％ ～55.66％, 1.48％ ～2.63％, (26.17 ±3.81)μg/ml, P＜0.05]. The expression of miR-590-3p in ASPC-1, PANC1 spheres was 4.67 and 4.52 times higher than the expression in parent cell lines. Conclusions Pancreatic cancer cell spheres can be isolated from ASPC-1, PANC1 by culture with SFM. miR-590-3p is up-regulated and may play an important role in regulating biological characteristics of pancreatic cancer stem cells.

ObjectiveTo investigate the methylation status in the promoter region of secreting frizzled related protein 2 (SFRP2) gene in patients with myelodyplastic sydrome (MDS) and to initially explore the relationship between the methylation of this gene and prognosis/survival time.MethodsMSP method was applied to examine the promoter methylation of SFRP2 gene in 43 bone marrow or peripheral blood samples of MDS patients.As controls,70 normal peripheral blood samples from volunteers of general outpatients were examined.Then some of the patients were followed up.ResultsIn 43 patients of MDS,10 samples (23.3 ％)showed SFRP2 gene methylation,and all of them were semi-methylation status.In 70 controls,no sample showed SFRP2 gene methylation.The frequency of SFRP2 gene methylation in MDS patients was significantly higher than that in controls (x2 =17.86,P ＜0.0001).Of the 10 SFRP2 gene methylation samples,5 were bone marrow samples and 5 were peripheral blood samples.In this group of patients,3 patients were diagnosed as RA,1 patient was diagnosed as RAS,2 patients were diagnosed as RCMD,3 patients were diagnosed as RAEB and 1 patient was diagnosed as MDS-U.There was no significant difference between the different sample source (bone marrow or peripheral blood) for the results of the methylation status (x2 =0.912,P ＞0.05).Either no significant difference between the different sex,age,type,chromosome and WPSS score (all P ＞0.05).The progress of disease didn' t influence the methylation rate (P ＞0.05).16 patients accepted follow-up and 11patients died,3 patients went to AML.2 died patients showed SFRP2 gene methylation.The survival analyses showed no relationship between the methylation of this gene and survival time(x2 =0.022, P ＞0.05).ConclusionIn this MDS group,there is a high level of methyl-modification in SFRP2 gene.The methylation of SFRP2 may be one of the molecular mechanisms that contribute to the progress of patients with MDS.The peripheral blood sample maybe a better substitute in detection of SFRP2 with MDS.

OBJECTIVETo study the baseline distribution of polymorphisms in the promoter of peroxisome proliferators activated receptor co-activator 1 (PPARGC1A) gene in ethnic Hans from Beijing, and to assess their association with type 2 diabetes (T2DM).

METHODSA 2-stage study was designed. Firstly, the promoter region of PPAGC1A gene was screened with PCRRFLP in a small population (n=216, T2DM/control: 104/112), which was followed by a replication study of a larger group (n=1546, T2DM/control: 732/814). Fasting plasma glucose, insulin, blood lipid, height, weight, waist circumference, and blood pressure were measured in all subjects. Potential association was assessed by logistic regression. Linkage disequilibrium and haplotype analysis were conducted with Haploview software.

RESULTSFive polymorphisms were identified with Sanger sequencing, among which T-2120C (rs3755857), -1999C/G (rs2946386) and -1437T/C (rs2970870) were included for genotypic analysis based on their moderate levels of heterozygosity. No significant difference was found between the two groups. When adjusted for age and gender confounding, we have combined the OR values from population 1 and population 2 based on Mantel-Haenszel fixed model, and recognized a mild contribution of C allele of -1999C/G (rs2946386) to the 1.18-fold risk of T2DM (P=0.03, OR=118). No haplotype was associated with T2DM after permutation correction.

CONCLUSIONThe C allele of -1999C/G ( rs2946386) in the promoter region of the PPARGC1A gene is mildly associated with T2DM. Variations in the promoter region of the PPARGC1A gene seem not to confer the risk of T2DM in our population.

Adult ; Aged ; Asian Continental Ancestry Group ; ethnology ; genetics ; Blood Glucose ; metabolism ; Case-Control Studies ; China ; ethnology ; Diabetes Mellitus, Type 2 ; blood ; ethnology ; genetics ; Ethnic Groups ; genetics ; Female ; Genetic Variation ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Transcription Factors ; genetics

Objective To analyze the mechanical properties of bone tissue engineering scaffolds with different pore structure and porosity, and improve the mechanical properties of scaffolds by changing pore structure. Methods Square pore, spherical pore and cylindrical pore with different porosities from 55% to 75% were established by SolidWorks software, and the surface-volume ratio of different structures was calculated. The stress distribution and equivalent compression modulus of different scaffolds were obtained by ANSYS Workbench software. According to the stress distribution results, the scaffold with rectangular pore structure and cuboid element structure was improved instead of square pores. Results With the increase of porosity, the surface-volume ratio of the three structures increased. For the same porosity, the surface-volume ratio of square pores and spherical pores was larger, while that of cylindrical pores was the smallest. The modulus and porosity of the three structures were approximately linear. The modulus of the square pore and the cylindrical pore were similar. The stress analysis on the square pore and two improved structures with 60% porosity showed that for the two improve structures, the wall stress on 4 edges parallel to the direction of applied stresses could be reduced by 15%. Conclusions The surface-volume ratio and mechanical property of square pores were more advantageous than spherical pores and cylindrical pores with the same porosity, and the two improved structures could improve the mechanical properties of square pores. The two improved pores enriched the structure of tissue engineering scaffolds. The research findings provide the mechanical references for their clinical application.

Objective To analyze the clinical characteristics and short-term prognostic factors in acute cerebral infarction patients who underwent recanalization. Methods This retrospective study enrolled 94 cases of acute cerebral ischemic patients in the First Affiliated Hospital of Nanjing Medical University between October 2014 and August 2016. Based on the clinical characteristics of the enrolled patients, a multivariate Logistic regression model was established to analyze the risk factors of unfavorable prognosis. Besides, patients were further divided into good collateral circulation group (1-2) and poor collateral circulation group (3-5) according to the Pial Collateral score, and the prognosis improvement rates between patients recanalized within 4 h and over 4 h were analyzed in each group. Chi-square test or Fisher's exact test was used to analyze statistical difference as indicated. Results By multivariate Logistic regression analysis, age older than 70 years old (OR=2.651, 95％CI: 1.013-6.937)and poor collateral circulation (OR=3.160, 95％CI: 1.113-8.977) were independent risk factors of short-term poor prognosis. In the poor collateral circulation subgroup, patients recanalized within 4 h exerted a relatively better prognosis than patients recanalized over 4 h (42.9％ vs.10.5％, P=0.047). However, the effect of recanalization duration on the prognosis in the good collateral circulation subgroups was not statistically significant (42.9％ vs. 10.5％, P=0.047), however, the effect of recanalization duration on prognosis in patients with good collateral circulation was not statistically significant (58.3％ vs. 37.8％, P=0.117). Conclusions For patients with acute cerebral infarction, age and collateral circulation status may influence the prognosis of recanalization therapy. The treatment time had a significant influence on the prognosis in patients with poor collateral, while it had minimal significance on patients with good collateral.