Objective Comparative effect of WeChat platform nursing intervention and routine nursing intervention on reducing the incidence of complications of children skin expansion in the process of external ear reconstruction. Methods 132 cases of congenital microtia received skin expander implantation at our institution from Jan 2014 to Aug 20 14 were included as control group. 122 cases of congenital microtia received skin expander implantation at our institution from Sep 2014 to Apr 2015 were included as the intervention group. Children and their families in the control group were treated with routine propaganda and education, and the intervention group were added with internet nursing intervention. Collection and analysis the family health knowledge degree and the occurrence of complications in children of the two groups. Results The score of health knowledge about skin expansion in the intervention group was (33.67 ± 2.44),which was significant higher than that of in the control group (25.07 ± 2.02), t=9.71, P < 0.01. The incidence rate of complication in the intervention group was 2.46%(3/122), which was significant lower than that of in the control group, 8.33%(11/132),χ2=4.20, P<0.05. The satisfaction rate of patients′family member in the intervention group was 95.08%(116/122), which was significant higher than that of in the control group, 84.09%(111/132 ),χ2=15.65, P<0.05. Conclusions WeChat platform nursing intervention can reduce expansion flap complications occurrence rate in the periods of expander. It is worthy of clinical application.

Formation of the endoplasmic reticulum (ER) network requires homotypic membrane fusion, which involves a class of atlastin (ATL) GTPases. Purified Drosophila ATL is capable of mediating vesicle fusion in vitro, but such activity has not been reported for any other ATLs. Here, we determined the preliminary crystal structure of the cytosolic segment of Drosophila ATL in a GDP-bound state. The structure reveals a GTPase domain dimer with the subsequent three-helix bundles associating with their own GTPase domains and pointing in opposite directions. This conformation is similar to that of human ATL1, to which GDP and high concentrations of inorganic phosphate, but not GDP only, were included. Drosophila ATL restored ER morphology defects in mammalian cells lacking ATLs, and measurements of nucleotide-dependent dimerization and GTPase activity were comparable for Drosophila ATL and human ATL1. However, purified and reconstituted human ATL1 exhibited no in vitro fusion activity. When the cytosolic segment of human ATL1 was connected to the transmembrane (TM) region and C-terminal tail (CT) of Drosophila ATL, the chimera still exhibited no fusion activity, though its GTPase activity was normal. These results suggest that GDP-bound ATLs may adopt multiple conformations and the in vitro fusion activity of ATL cannot be achieved by a simple collection of functional domains.
Animals ; Dimerization ; Drosophila ; Drosophila Proteins ; chemistry ; genetics ; Endoplasmic Reticulum ; chemistry ; GTP Phosphohydrolases ; chemistry ; genetics ; GTP-Binding Proteins ; chemistry ; genetics ; Guanosine Diphosphate ; chemistry ; metabolism ; Humans ; Membrane Proteins ; chemistry ; genetics ; Mutation ; Protein Conformation ; Protein Structure, Secondary

Objective To investigate the interference of thyroglobulin antibodies ( TgAb ) on the measurement of thyroglobulin ( Tg) by 2 chemiluminescence immunoassays ( CLIAs) .Methods Data of 199 315 individuals with determined TgAb and Tg , including physical checkup subjects , differentiated thyroid carcinoma ( DTC) patients and patients with other diseases , were retrospectively collected in Peking Union Medical College Hospital from November 2012 to April 2015.The correlation between serum Tg level and serum TgAb concentration was analyzed and the positive rate of TgAb in physical checkup subjects was calculated.Furthermore, 290 serum samples with different TgAb concentration were applied in the recovery test by adding in confirmed serum Tg .The correlation between the recovery of confirmed serum Tg and TgAb concentrations was evaluated using Pearson correlation analysis .Results The serum Tg was all decreased with the elevated TgAb concentration in each group of subjects .The positive rate of TgAb was 10.84%(8 416/77 634) in physical checkup subjects .It was higher in females than in males and was increased with age.Recovery test showed that the average recoveries of confirmed serum Tg in TgAb-negative serum were 107.28%(86.30%-117.60%) and 107.94% (85.60%-124.10%) respectively in Roche and Beckman systems.But in TgAb-positive serum samples , the average recoveries in Roche and Beckman systems were 88.59% (35.85% -141.53%) and 95.77% (36.48% -131.78%) respectively, and 12.63%(24/190) and 13.68%(26/190) samples displayed a recovery less than 80%.The recovery rate of confirmed serum Tg showed a significantly negative correlation with elevated TgAb concentration , with r=-0.239 (P=0.001) in Roche and r=-0.251 (P<0.001) in Beckman.Conclusions TgAb-positive serum, especially with high concentration of TgAb , significantly interfered the measurement of Tg .Thus, serum TgAb should be determined together with serum Tg to explore whether there was an interference .To avoid misdiagnosis and inappropriate therapy , clinician should be informed once serum TgAb displayed positive.

Objective To evaluate the effects of different sedation depths of propofol on postopera-tive delirium in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB)and the relationship with regional cerebral oxygen saturation(rSO2). Methods Forty American Society of An-esthesiologists physical statusⅢorⅣpatients of both sexes, aged 26-64 yr, with body mass index of 17-25 kg∕m2, scheduled for elective aortic valve replacement with CPB, were divided into A and B groups (n=20 each)using a random number table. The infusion rate of propofol was adjusted to maintain the cor-responding anesthetic depth with 50≤BIS value<60 during CPB in group A and with 35≤BIS value<45 during CPB in group B. Bilateral rSO2was measured using the near infrared spectroscopy from admission to the operating room until the end of skin suturing. The minimum rSO2was recorded, and occurrence of low cerebral oxygen saturation(rSO2was less than 55% or the decrease in rSO2>20% of the baseline)was ob-served. Postoperative delirium was evaluated using Confusion Assessment Method for the Intensive Care Unit (ICU)from 12 h after admission to ICU until discharge from ICU. Results The incidence of postoperative delirium, low cerebral oxygen saturation and minimum rSO2were significantly lower in group B than in group A(P<005). Conclusion Maintaining 35≤ BIS value< 45 during CPB can reduce the develop-ment of postoperative delirium and is related to improving intraoperative rSO2in patients undergoing cardiac valve replacement.

Objective: To evaluate the effect of anesthesia management based on regional cerebral oxygen saturation (rSO₂)-bispectral index (BIS)-goal-directed hemodynamic multi-modal monitoring on acute kidney injury (AKI) after cardiac valve replacement. Methods: A total of 238 patients of both sexes, aged 18-75 yr, weighing 45-95 kg, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ (New York Heart Association class Ⅱ or Ⅲ ), undergoing elective cardiac valve replacement, were assigned into routine experience group (group C, n=122) and multi-mode monitoring group (group M, n=116) using a random number table method.After admission to the operating room, the invasive blood pressure of radial artery, central venous pressure, electrocardiogram, SpO₂ and end-tidal pressure of carbon dioxide were recorded in group C, and rSO₂, BIS, stroke volume variation, cardiac index and stroke volume index were monitored based on the monitoring in group C. The patients were tracheally intubated when BIS value was about 50.BIS value was maintained between 45 and 55, rSO₂ was maintained not less than 20% of the baseline value or the absolute value not less than 55%, and fluctuation in mean arterial pressure did not exceed 20% of the baseline value, and stroke volume index was maintained >25 ml/m² and cardiac index>2.5 L·min^-1 ·m^-2, maintaining not lower than the baseline value before induction in special conditions.The intraoperative volume of fluid infused, infusion of allogeneic blood, consumption of propofol, time of cardiopulmonary bypass, aortic cross-clamping time, anesthesia time, operation time, occurrence of AKI within 48 h after operation, renal replacement therapy, extubation time, duration of intensive care unit stay, postoperative length of hospital stay, development of other serious postoperative complications and fatality rate at day 30 after operation were recorded. Results: Compared with group C, the incidence of AKI was significantly decreased, the volume of plasma infused and consumption of propofol were reduced, the extubation time, duration of intensive care unit stay and postoperative length of hospital stay were shortened (P<0.05), and no significant change was found in the rate of renal replacement therapy, constituent ratio of AKI degree, incidence of other serious postoperative complications or mortality rate at day 30 after operation in group M (P>0.05). Conclusion Anesthesia management based on rSO₂-BIS-goal-directed hemodynamic multi-modal monitoring can decrease the occurrence of AKI after cardiac valve replacement.

Objective: To compare the differences and similarities in emotional and behavioral problems among children with developmental dyslexia (DD), attention deficit hyperactivity disorder (ADHD) or both, aiming to provide basis for targeted intervention. Methods: Strengths and Difficulties Questionnaire (SDQ) was used to investigate emotional and behavioral problems among four groups of children (DD=32, ADHD=32, DD+ADHD=14, TD=32). Hierarchical regression analysis was recruited to investigate the associations of emotional and behavioral problems with spelling impairment or ADHD symptoms. Results: Except for peer problems, emotional and behavioral problems varied in the four groups [prosocial DD: (641±2.75), ADHD: (5.53±2.49), combined: (7.07±2.37), control: (7.72±2.19), F=4.42, P<0.05; emotional problems DD: (1.81±1.94), ADHD: (3.66±1.66), combined: (3.21±2.33), control: (2.03±1.99), F=6.36， P<0.05; conduct problems DD: (2.31±1.23), ADHD: (3.66±1.77), combined: (2.64±1.98), control: (1.97±1.31), F=7.24, P<0.05; difficulties score DD: (6.94±2.96), ADHD: (10.28±3.90), combined: (9.07±3.17), control: (6.06±3.94), F=8.82, P<0.05 ], most serious in ADHD group. In addition, children in DD group scored higher than those in normal group in terms of prosocial behavior. Children in the combined group showed higher total scores of peer problems and difficult score than those in the normal group. Emotional symptoms were more serious among children in combined group than those in the DD group. Compared with the combined group, behavioral problems in ADHD group were more common. Hierarchical regression analysis indicated that occurrence of emotional and behavioral problems in combined group was mostly mediated by hyperactivity symptoms. Conclusion Compared with DD group, children with ADHD combined or not combined with DD show more emotional and behavioral problems. Emotional and behavioral problems are notably observed among those with hyperactivity symptoms than DD.

Objectives: . The simulation of microlaryngeal skills is rarely seen in surgical training, but it is particularly important in phonomicrosurgery. This study described and validated the laryngeal surgical simulator through surgical training. Methods: . A simple and low-cost simulator was developed for the fixation of the suspension laryngoscope and porcine larynges. Twenty participants with work skills and experience did preparation before training, and performed suture and carbon dioxide (CO2) laser cordectomy for simulator evaluation. The results were proposed by the aspects of time taken for each procedure, the global rating scale, a procedure-specific assessment, and a post-simulation questionnaire. Results: . All participants completed the preparation within 9 minutes and reached the conclusion that the microlaryngeal surgical simulator was helpful in improving their surgical skills. The performance of experts was superior to that of novices in both suture and CO2 laser cordectomy. Conclusion . This simulator could be easily assembled and was successfully validated by microlaryngeal surgical training both subjectively and objectively. It may be helpful to clinicians in microlaryngeal skills.

Objective To evaluate hemolyticinfluence on 41 chemistry and immunology tests and define the hemolysis alert index, which can be used as evidence for sample rejection and test report verification.Methods Method evaluation.As a pair, both hemolyzed and non-hemolyzed serum samples were collected from the same patient at the same time.Hemolysis index and 41 tests were analyzed.The effect of hemolysis in different hemolysis level was evaluated by comparing results of the paired samples.The alertindex were defined by senior laboratory techniciansand clinical professionals based on discussion of widely accepted quality requirements.Results The number of sample with hemolysis index of 1,2,3 and 4was 24, 17, 7 and 4 respectively.Of the 41 analytes, 6 analytes increased in hemolyzed samples comparing to non-hemolyzed samples, namelyaspartate aminotransferase(AST), creatine kinase(CK), potassium(K),lactate dehydrogenase(LD),inorganic phosphorus(iP)and total bilirubin(TBil).Another 9 analytesdecreased in hemolyzed samples comparing to non-hemolyzed samples.These analytes are alkaline phosphatase(ALP), chloride(Cl), creatinine(Cr), immunoglobin M(IgM), sodium(Na), prealbumin (PA),rheumatoid factor(RF),triglyceride(TG),uric acid(UA).Hemolysis alert index was defined as 1 for AST,K,Na and LD;2 for Cr;3 for CK,iP,PA and TBil; and 4 for the other 32 tests.Conclusions Hemolysisalertindex were defined based on the investigation of hemolyticinfluence on 41 chemistry and immunology tests in ourlaboratory.However, hemolytic influence on clinical laboratory tests are closely related to the assay systems.So clinical laboratory should evaluate the hemolytic influence on its own analysis system,and define assay specific hemolysis alert index.

Background: Thyroid diseases are highly prevalent worldwide, but their diagnosis remains a challenge. We established reference intervals (RIs) for thyroid-associated hormones and evaluated the prevalence of thyroid diseases in China. Methods: After excluding outliers based on the results of ultrasound screening, thyroid antibody tests, and the Tukey method, the medical records of 20,303 euthyroid adults, who visited the Department of Health Care at Peking Union Medical College Hospital from January 2014 to December 2018, were analyzed. Thyroid-associated hormones were measured by the Siemens Advia Centaur XP analyzer. The RIs for thyroid-associated hormones were calculated according to the CLSI C28-A3 guidelines, and were compared with the RIs provided by Siemens. The prevalence of thyroid diseases over the five years was evaluated and compared using the chi-square test. Results: The RIs for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3) were 0.71–4.92 mIU/L, 12.2–20.1 pmol/L, 3.9–6.0 pmol/L, 65.6–135.1 nmol/L, and 1.2–2.2 nmol/L, respectively. The RIs of all hormones except TT4 differed significantly between males and females. The RIs of TSH increased with increasing age. The prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was 0.5% and 0.8%, 0.2% and 0.6%, 3.8% and 6.1%, and 3.3% and 4.7% in males and females, respectively, which differed from those provided by Siemens. Conclusions Sex-specific RIs were established for thyroid-associated hormones, and the prevalence of thyroid diseases was determined in the Chinese population.

Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.