Objective To investigate the methodology and feasibility of an anatomic survey of fetal limbs in the first trimester. Methods In this study, 533 normal fetus and 6 fetal corpse without limb abnormalities form June 2011 to August 2012 underwent an anatomic survey on the limbs in our consultation center. The limbs were scanned using a systematic continuous sequence approach:(1) Displaying upper arm and humerus, forearms and radius/ulna, hands in proximal to distal direction. (2) The thigh and femur, crus and tibia/fibula, feet was attempted from the sagittal section of each structure. (3) If the whole limb couldn′t be visualized in a section then the three segments will be demonstrated respectively. The position and move-ment also should be observed during the scan. Data were collected regarding gestation age, examining time and the structures. Results The limbs except toes of 533 normal fetus were clearly observed, which was completely unaffected by gestational age, with the mean time of scanning is 98.6±37.4 s (rang:36-189 s). The structures (including upper arms and humerus, forearms ,radius and ulna, hands, thigh and femur, crus and tibia, fibula, feet) of fetal limbs were clearly observed on the 6 fetal corpse, but the ossification center of fingers were steadily visualized until 13 weeks and toes after 13 weeks. Conclusions Scanning fetal limbs in the first trimester were feasible by a systematic continuous sequence approach in a short period of time.

Objective To systematic review the methodological quality of guidelines for Guillain-Barré syndrome (GBS) in children, to provide a reference for clinical evidence-based medicine. Methods Guidelines concerning GBS were electronically retrieved from PubMed, EMbase, CBM, Wanfang data, CNKI and Vip. The guide databases includes major medical institutions and industry sites such as NGC, GIN, TRIP , CDC, IDSA, AAP, WHO, Chinese Health and Family Planning Committee website, library of clinical guidelines China and Chinese clinical guidelines for collaboration. All the data were searched from inception of the database or network to Oct. 2013. Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline using the AGREEⅡ. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters' evaluation scores. Results A total of 5 guidelines concerning GBS were included, with a time range from 2003 to 2012, and origins from USA, EU and Canada. The final recommendation levels of the 5 articles were level B. According to the AGREEⅡ, domain 3 and 4 showed the higher scores, and scores were generally low in domain 5. Plasma exchange (PE) and intravenous immuneglobulin (IVIG) showed positive effects on the treatment of GBS. But it was not recommended that combined PE and IVIG. Corticosteroids are also not recommended for GBS treatment. Conclusions The recommendations of medicines for GBS are basically consistent. However, the classification criteria of the levels of evidence and recommendation are still unconsistent and suboptimal. The guidelines on GBS should be improved in“Applicability”in future.

Objective To investigate the clinical efficiency of serum cystatin C as a marker of renal function to predict serum trough concentrations of vancomycin. Methods Data on trough concentrations of vancomycin(Cmea ),serum creatinine (Scr)concentrations,cystatin C( Cys C) concentrations were collected from 81 hospitalized patients who received vancomycin therapy. Predicted vancomycin trough concentrations(Cpre )were calculated based on Scr or Cys C concentrations associating with Bayesian forecasting method through NONMEM software. Finally,the correlations and distinctions between Cpre and Cmea were comparatively analyzed. Results There were both correlation between Cpre and Cmea in relation to Scr or Cys C(r = 0. 678,P<0. 01;r=0. 727,P<0. 01). Besides,the errors of mean predictive error(ME),mean absolute error(MAE)and root-mean-square error(RMSE)for Scr was - 5. 79,6. 86,9. 86 μg · mL-1 , respectively, where as the errors for Cys C was - 0. 82,5. 42, 7. 74 μg·mL-1 ,respectively. Conclusion Cystatin C is a good marker of renal function available for predicting serum vancomycin concentrations.

Objective To evaluate the effects of L-alanyl-L-glutamine (LALG) intensified parenteral nutrition support in advanced malignant carcinoma patients.Methods 68 patients were randomly divided into two groups,control group (n =34) received only parenteral nutrition,treatment group (n =34) received parenteral nutrition combined with a dose of 0.3 g ·(kg·d)-1 LALG.Nutrition status and immune functions were determined at pre-therapy and 15th days after therapy.Results After the therapy,the pALB and TRF of treatment group were significantly increased [(24.9±8.06) mg/dl vs (27.3±6.05) mg/dl; (1.62±0.43) g/L vs (2.06±0.32) g/L].Before therapy,no significant change in IgA,IgM and IgG was found in two groups (P ＞ 0.05).After the therapy,IgA and IgG of the treatment group after the therapy were significantly different from those before the therapy [(2.85±1.43) mg/L vs (3.63±5.36) mg/L; (0.95±0.43) mg/L vs (1.13±0.09) mg/L],IgA,IgM and IgG of the control group had no difference compared with those before the therapy (P ＞ 0.05),CD4+ of treatment group was significandy different compared with those of control group [(39.19±4.23) ％ vs (36.62±3.58) ％] (P ＜ 0.05).There is no significantly difference between CD:/ CD8+ CD8+ of treatment group and those of control therapy (P ＞ 0.05).After therapy,the score of quality of life in treatment group was higher than that in control group (P ＜ 0.05).Conclusion LALG intensified parenteral nutrition has better effects on improvement of the nutrition and immune functions.

OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,scope and purpose and clarityshowed the higher scores in AGREEⅡ,more than 70%,and applicability showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved inrigourandapplicabilityin future.

Objective To investigate the detection of BJ-75A-9 mHNA, WNX and CK19 mRNA in peripheral blood cells of lung cancer patients and evaluate its diagnostic value. Methods The expression of BJ-TSA-9, LUNX and CK19 mRNA in peripheral blood cells was delected from 84 lung cancer patients, 32 benign lung lesions and 20 healthy volunteers by nested reverse transcription polymerase chain re-action (Nested-RT-PCR). Results The positive detection rates of BJ-75A-9,LUNX and CK19 mRNA in the peripheral blood of the pa-tients with lung cancer were 59.5%,40.4%and 22.6% respectively. In the 32 peripheral blood samples of the patients with benign lung le-sions,the positive detection rate of BJ-TSA-9,LUNX and CK19 mRNA were 9.3%, 12.5% and 6.3% respectively. No expression of BJ-TSA-9,LUNX and CK19 was detected in lhe samples of the healthy volunteers. The expression level of BJ-TSA-9, WNX and CKI9 mRNA in the peripheral blood of lung cancer stage IV patients was significantly higher than those of stages II and ID (P< 0.05). Conclusion RT-PCR amplification of BJ-TSA-9, LUNX and CK19 mRNA are an efficient way to detect early haematogenous dissemination of cancer cells for lung cancer patients. The detection of BJ-TSA-9 expression is sensitive and specific for lung cancer,and it is superior to both LUNX and CK19 mRNA. The expression of BJ-7SA-9 mRNA in peripheral blood might predict the hematogenous metastatic spreading of lung cancer cells.

Objective To explore the effects of tumor necrosis factor-α (TNF-α) on ventricular arrhythmias resulted from acute myocardial infarction (AMI) in rats. Method Two hundred and forty male Wistar rats were randomized (random number) into sham operation group, AMI group and recombinant human tumor necrosis factor receptor (rhTNFR) fusion protein (Fc) group. Acute anterior wall myocardial infarction was produced in rats of AMI group with ligating the left anterior descending coronary artery (LAD) , and the rats were just operated without ligation of LAD in sham group. The rats of Fc group were treated with rhTNFR-Fc (10 mg/kg), a TNF-α antagonist, 24 hours before LAD ligation. The original ECG was recorded 10 min before ligation and the ECGs of ventricular arrhythmias occurred spontaneously or induced by programmed electrical stimulation were recorded 10 min, 20 min, 30 min, 60 min, 3 h, 6 h and 12 hours after ligation. The protein levels and mRNA expressions of TNF-α in rats in different groups were detected with histochemistry and real-time fluorescent quantitative PCR. Results The expressions of TNF-α mRNA and levels of TNF-α protein markedly increased 10 min after infarction, reached the climax 20-30 min later, and then gradually returned to the original level in AMI group and Fc group. The time-windows of spontaneous and induced ventricular arrhythmias were consistent with the time-window of expressions of TNF-α mRNA and levels of TNF-α protein. Compared with AMI group, there were lower levels of TNF-α protein and lower incidence of ventricular arrhythmias in Fc group ( P < 0.05) , but there was no significant difference in TNF-α mRNA between two groups. There was no obvious change in TNF-α in rats of sham operation group. Conclusions The expressions of TNF-α mRNA and levels of TNF-α protein induced by AMI could contribute the initiation of ventricular arrhythmias.

Objective To analyze the relationship between obesity and arterial stiffness among population of different glucose tolerance status. Methods A cross-sectional study recruited the population aged 40 years or older from ShiJingShan district in Beijing. 9080 subjects were included by measured weight, waist circumference (WC), body mass index (BMI), waist/hip ratio (WHR) and WC/height ratio (WHtR) and hemodynamic indexes and the aortic stiffness (using brachial-ankle pulse wave velocity(baPWV). They were divided into 3 groups based on the results of OGTT and diabetes history: normal glucose tolerance group ( NGT group) ,impaired glucose regulation group ( IGR group) and diabetes mellitus group ( DM group) . The association between baPWV and different obese indexes was analyzed by multi-ple linear regression. Results According to the criterion of WC, WHR and WHtR, baPWV of central obesity group was significantly higher than the normal group(P<0. 01). There was no statistically significant differences based on BMI in DM group(P>0. 05), but it was of sta-tistically significant differences in NGT group and IGR group. Central obese indexes( WC、WHR、WHtR) showed a positive correlation to PWV in the studied groups(P<0. 05). BMI was only positively correlated with baPWV in NGT group, there was no significant correlation in IGR and DM group(P>0. 05). After adjusting for age, gender and cardiovascular risk factors, the multiple regression analysis found that for every 0. 1 point increase in WHR and WHtR, the PWV increased 40. 6 cm/s and 55. 3cm/s respectively. Conclusion There is a positive correlation between central obese indexes (WC、WHR、WHtR) and arterial stiffness, and the central obese indexes correlated with arterial stiffness better than BMI.

Objective The purpose of this study was to investigate the reproductive characteristics of indoor-housed Meriones meridianus.Methods According to the data of Meriones meridianus from 1996 to 2002 in the Center for Laboratory Animal research of Xinjiang, the sexual maturity period of male and female animals, the gestation period of female animals, the litter size, weaning rate, survival rate, sex ratio per month and different fetal times were statistically analyzed.Results Sexual maturity period of male and female animals was 109.3 ±21.0 days and 106.3 ±21.7 days, and gestation period of female animals was 21.3 ±1.4 days.The litter size, weaning rate of different fetal times showed no significant difference compared between those of the first to seventh litter ( P>0.05) , and the survival rate of fourth and sixth litter were lower than that of the average offspring per litter, but the difference was no significant (P>0.05).The sex ratio of from first to sixth litter indicated no significant difference ( P>0.05 ) , and the average proportion of male and female was 1.4:1.0.During a year, the animals almost stopped to reproduce from September to November, however, the differences of litter size between the other months were statistically not significant ( P >0.05 ) , the weaning rate and survival rate per month suggested a significant difference ( P <0.05 ) between some of the months.Conclusions Compared with the background data of wild Meriones meridianus, the laboratory reproduction of Meriones meridianus show some differences, mainly, the season of breeding is shifted to December, and the number of reproduction increased by one or two litters.Our results provide useful reference for laboratory animalization of Meriones meridianus.

Objective To research fetal optic nerve,optic chiasma and optic tract size using high resolution prenatal ultrasound,establish a scan method and the reference range of optic nerve,optic chiasma and optic tract in normal fetus.Methods Based on the section of circulus arteriosus cerebri,the probe were rotated to get the chiasma section for measuring the diameter of bilateral optic nerve,optic tract and area of optic chiasma in 453 normal fetus respectively.Used gestation age and corresponding biological parameters as independent variables,the regression equation was established analyse the gender differences.Results 26-33 weeks was the preferable gestational age to visualize the chiasma section.It had good repeatability except chiasma area.The bilateral optic nerve and optic tract diameter,optic chiasma diameter and area had an increased along with the gestational age reposefully.There was no significant difference between the two sides of optic nerve and the gender.Conclusions Prenatal ultrasound can assess the size and shape of fetal optic nerve,optic chiasma and optic tract.The normal reference range,established by ultrasound,is helpful to diagnose the abnormality of optic chiasma.