The new revision of Declaration of Helsinki in 2013 has adjusted the structure, added or deleted some provisions on the content and modification, and modificated on the details of some words.Revision of the new version has improved the architecture, perfected the content of the declaration, strengthened the protection of the subjects, increased demand for researchers, and cleared the duty of country, research institutions and bidders.The enlighten-ment to our country are:constantly revised involving human clinical trials of the relevant laws and regulations , to pro-tect rights and interests of the subjects;National obligations for protection of the subjects, clinical trials explore the establishment of national compensation system;Ethics committee responsibilities and clearly positioning, exploring to establish an independent ethical review body.

Objective To evaluate the sensitivity and optimized scanning parameter of 64-slice spiral CT in detection of pulmonary nodules with different size and density. Methods Three groups of prosthesis nodules with diameter of 2.5～13 mm and different density (soft-tissue, low density, and ground glass opacity,GGO)were taken into the chest phantom equivalent to human tissue,then scanned with Philips Brilliance 64 scanner in standard dose(tube voltage:120 kV, tube current: 250 mAs)and low-dose(tube voltage:120 kV, tube current: 50, 30,and 21mAs) respectively. The radiation dose(CTDIw and DLP) of the scans, Hounsfield unit(HU) and standard deviation(SD) of CT values in different regions of the phantom, and visibility of the nodules was assessed and recorded.Results The radiation dose of 64-slices spiral CT scanning in low-dose(tube current 21～51 mAs) decreased to 8%～20% of which scanning in standard-dose(250 mAs). There was no statistical difference between the CT values in different regions of the phantom (P>0.05), while the SD of CT values was of statistical significantce (P<0.001) and SD increased with the increment of the density under different scanning parameters. None of the nodules besides of GGO nodules with 2.5 mm and 4 mm in size scanned at 21 mAs was invisible. Conclusion GGO nodules of 2.5 mm in diameter can be detected with 64-slice spiral CT using 30 mAs at experimental study, which might be the optimized dose for detecting pulmonary nodules.

Objective To analyze the image noise and artifact of low-dose chest CT scanning and the distribution pattern. Methods A chest phantom equivalent to human tissue was scanned by 64 slices spiral scanner at standard dose (250 mAs) and low-dose (50, 30,and 21 mAs) respectively, HU in sites of the phantom and SD of which was recorded. 200 patients with pulmonary nodules were scanned at 30 or 21 mAs for minimal length. The relationship between severity of noise and artifact in chest low-dose CT scanning and gender or body mass index (BMI) of the patients, as well as the distribution of noise and artifact was evaluated. Results There was no statistical difference between the HU in sites of the phantom: lung (-777.3-- -758.2 HU, F=0.992, P<0.01), chest wall (107.9--111.3 HU, F=2.044, P>0.05), vertebra (835.6--875.3 HU, F=1.453, P>0.05), while the SD of which was of statistical signification: lung (9.5--29.0 HU, F=108.7, P<0.01), chest wall (10.1--32.4 HU, F=84.3, P<0.01), vertebra (19.2--57.1 HU, F=30.6, P<0.01),tbe SD increased with the decrease of the tube current. There was no statistical difference between male (in which 74 cases no or mild, 17 cases severe)and female (81 cases no or mild, and 28 cases severe)in image noise and artifact in low-dose images (X~2=2.294, P>0.05), and significant difference between groups of different BMI(in BMI<18.5 group, 29 cases no or mild,2 cases severe, in group of 18.5≤BMI<24.0, 120 cases no or mild, 13 cases severe, and in group of BMI≥24.0, 6 cases no or mild, 30 cases severe, X~2=128.274, P<0.01). The noise andartifact was greater in the upper (80 cases no or mild, 38 cases severe, X~2=18.918, P<0.01) and dorsal field (89 cases no or mild, 33 cases severe, X~2=6.760, P<0.05). Conclusions The image noise and artifact was significant in low-dose CT, especially in the dorsal and upper field of the lung, which might be attributed to the distribution of skeleton in the chest. It was recommended that scanning protocol (mAs value) be individualized adjusted in according to the patients BMI.

Objective:To investigate the expression of MACC1 in Klatskin tumor and the relationship between the clinicopathological features and prognosis and the expression of MACC1.Methods:Immunohistochemistry staining was employed to assess the expression of MACC1 protein in Klatskin tumor tissues and matched adjacent non-tumor bile duct tissues.Quantitative real-time PCR was performed to examine MACC1 mRNA expression in Klatskin tumor tissues and the adjacent non-tumor bile duct tissues and normal bile duct tissues.The correlation between MACC1 expression and the clinicopathological features and prognosis was analyzed.Results:The positive rate of MACC1 in Klatskin tumor tissues was significantly higher than that in matched adjacent non-tumor bile duct tissues(P＜0.05).MACC1 mRNA expression in carcinoma tissues was significantly higher than that in the non-tumor bile duct tissues and normal bile duct tissues(P＜0.05).MACC1 expression in Klatskin tumor tissues was related to tumor size,recurrence and lymphatic metastasis(P＜0.05).Survival analysis indicated that the 1-year,3-year,5-year survival rate were with significantly differences between the two groups (P＜0.05).Conclusion:MACC1 expression was significantly higher in Klatskin tumor and it was related to the tumor size,recurrence and lymphatic metastasis.It would affect the prognosis of patients.

The research progress on new technologies for high throughput screening of effective traditional Chinese med-icine (TCM) components was summarized based on the recent documents at home and abroad ,among which bio-chromatogra-phy ,chip-technology and computer-aided virtual screen technology were widely used .Compared with traditional screening technology ,those new ones had shown advantages in efficiency ,automation and high-throughput ,providing new ways to screen effective components of TCM with high throughput .

OBJECTIVE: To explore the clinical features and genetic variant in a child with Cerebral creatine deficiency syndrome (CCDS). METHODS: A child who had presented at the Affiliated Children's Hospital of Fudan University on March 5, 2021 was selected as the study subject. Whole exome sequencing (WES) was carried out for the child, and candidate variant was verified by Sanger sequencing. The level of creatine in the brain was determined by magnetic resonance spectroscopy. RESULTS: The patient, a 1-year-and-10-month male, had presented with developmental delay and epilepsy. Both his mother and grandmother had a history of convulsions. MRS showed reduced cerebral creatine in bilateral basal ganglia and thalamus. The child was found to harbor a hemizygous splicing variant of the SLC6A8 gene, namely c.1767+1_1767+2insA, which may lead to protein truncation. The variant was not found in the public databases. Both his mother and grandmother were heterozygous carriers for the same variant. CONCLUSION The hemizygous c.1767+1_1767+2insA variant of the SLC6A8 gene probably underlay the CCDS in this child. Discovery of the novel variant has also expanded the mutational spectrum of the SLC6A8 gene.
Humans ; Male ; Amino Acid Metabolism, Inborn Errors ; Brain ; Creatine/genetics* ; Heterozygote ; Mothers ; Nerve Tissue Proteins ; Plasma Membrane Neurotransmitter Transport Proteins/genetics* ; Infant

Objective To investigate some improvements in the surgical techniques of adult-to-adult living donor liver transplantation( A-A LDLT) without the middle hepatic vein(MHV) for hepat-ic vein reconstruction. Methods The retrospective analysis was made on the clinical data of 11 recipi-ents who underwent the operation in A-A LDLT including the hepatic vein reconstructed in right liver lobe without MHV from June 2007 to January 2008. The key techniques included reconstructing out-flow of graft on shaping the tips of vena cava and right hepatic veins, cadaveric vein allografts stored in 4℃ UW solution within 7d being used for significant-sized hepatic vein reconstruction such as tributa-ries of the middle hepatic vein from V5, V8 and right inferior hepatic vein. Results 10 cases success-fully underwent reconstruction of outflow of graft on shaping the tips of vena cava and right hepatic veins and the outflow reconstruction ratio of V5, V8 and right inferior hepatic vein was 81. 8% (9/11), 7 one-vein reconstruction, 1 two-vein reconstruction and 1 three-vein reconstruction. 1 recipient died of renal failure and pulmonary infection 14 days after operation without venous outflow obstruc-tion. Doppler ultrasonography showed no thrombosis and the blood flowed smoothly in the right he-patic vein of other 8 recipients during the 9th to 15th mouth of follow-up. The cumulative patency rates of these 8 survivals for interposition vein grafts were 100% (11/11), 72. 7 %(8/11), 54. 5%(6/11) and 36. 5%(4/11) in 1, 3, 6 and 9 mouths, respectively. The regeneration of paramedian sectors was equivalent. Conclusion Shaping the tips of vena cava and right hepatic veins and using cadaveric vein allografts in adult-to-adult right lobe living donor liver transplantation for hepatic vein reconstruc-tion are both safe,simple and effective methods.This approach can be recommended.

Objective To screen potential active anti-cancer components of Brucea javanica.Methods This research has em-ployed comprehensive two dimensional chromatographic technology and cell membrane chromatographic technology simultaneously with mass spectrometry as detector .Results Adenosine and Bruceine B were found to be potentially anti-cancer active .Conclusion This study has combined the advantages of online , high speed and high throughput for the screen of potential active components of traditional Chinese medicine .

Objective To explore influences of bedside sitting nursing on mechanical ventilation duration of patients with chronic obstructive pulmonary disease (COPD). Methods Ninety six patients with COPD admitted in the hospital from January 2013 to January 2014 were selected as research subjects, who were divided into control group and obser-vation group with 48 patients in each group according to different nursing modes. The patients in the control group were subjected to conventional treatment and nursing, while the patients in the observation group were subjected to bedside sitting nursing on the basis of that applied in the control group, mechanical ventilation duration, length of hospital stay, changes in blood and vigor indexes before and after nursing of two groups of patients were compared and analyzed. Re-sults The differences in comparisons of PaO2, PaCO2 and SpO2 levels of patients in two groups had no statistically signif-icant before nursing (P>0.05); and PaO2, PaCO2 and SpO2 levels of patients in the observation group after nursing were better than those indexes of patients in the control group (P<0.05). Mechanical ventilation duration and length of hospital stay of patients in the observation group were lower than those of patients in the control group, the successful removal of respirators used in the observation hit was 85.4%, was higher than 64.6% in the control group, the incidence of ven-tilator associated pneumonia was 4.2%, was lower than 22.9% in the control group, and the difference was significant (P<0.05). Conclusion The bedside sitting position can effectively improve the ventilation function of patients with COPD, reduce the duration of mechanical ventilation, decrease the occurrence of ventilator associated pneumonia, shorten hospitalization time, and improve the quality of survival, delivering high clinical application value.

Objective:To evaluate the value of serum pepsinogen Ⅰ and Ⅱ combined with gastrin-17 in screening precancerous lesions of gastric cancer in physical examination population.Methods:Serum pepsinogen, gastrin-17 and Helicobacter pylori (Hp) antibody were detected in 18 354 physical examination people from July to December 2017 in Wenrong Hospital, Hengdian, Dongyang. The patients were divided into youth group (18 to 39 years old), middle-aged group (40 to 59 years old) and elderly group (≥60 years old) according to their ages. The correlation between the serological level of the above indexes and age was analyzed; according to the new ABC method, the test results were divided into groups A, B, C and D. The patients in group C and D were examined by gastroscopy. The differences of gastric mucosal atrophy or intestinal metaplasia and other precancerous lesions detected by gastroscopy in different age groups were compared.Results:Finally, 18 354 cases were enrolled, including 9 614 males and 8 740 females. With the increase of age, the proportion of group C and D increased gradually. In group C, 181 cases underwent gastroscopy, including 39 cases of atrophic gastritis, 29 cases of intestinal metaplasia and 3 cases of dysplasia/intraepithelial neoplasia, the detection rate of precancerous lesions was 39.23%; in group D, 94 cases underwent gastroscopy, including 22 cases of atrophic gastritis and 13 cases of intestinal metaplasia, the detection rate of precancerous lesions was 37.23%. The proportion of gastric precancerous lesions in group C and D was 29.63% in the young group, 69.70% in the middle-aged group and 71.58% in the old group, respectively. There was significant difference compared with the young group ( P<0.01); atypical hyperplasia occurred in 2.02% and 9.47% of the middle-aged group and the elderly group. Conclusions:The combined detection of serum pepsinogen Ⅰ and Ⅱ and gastrin-17 levels is of great value in the screening of precancerous lesions of gastric cancer; when this method used for early gastric cancer screening in healthy population, it is necessary to consider the influence of age for the risk stratification of gastric cancer.