Objective To investigate the efficacy of N-acetylcysteine on prevention of contrast -induced nephropathy (CIN).Methods According to the regulation of evidence-based medicine,the selection criteria,elimination criteria and search strategy were defined.PubMed,Cochrane Library,Wiley Online Library and Google Scholar were searched.The literature limited range was from January 2000 to December 2011.Two investigators extracted the data independently from all the studies that accorded with selection criteria using a suitable form.All the statistical analyses were performed with RevMan version 5.1.Results A total of 151 potential literatures were screened and 16 remained literatures (including 4588 patients) were identified to accord with the criteria in this meta-analysis.In 14 literatures,the Jadad score was 3 at least.The meta-analysis of 16 trials showed N-acetylcysteine could prevent CIN from happening [odds ratio (OR)=0.65,95％ CI 0.46-0.92,P=0.01].In the groups of average Scr baseline ＜ 132.6 μmol/L,result displayed the OR of incidence associated with Nacetylcysteine for prevention of CIN was 0.93 (95％ CI 0.75-1.15,P=0.49).In the groups of average Scr baseline ≥ 132.6 μmol/L,the OR for N-acetylcysteine associated with incidence of CIN was 0.52 (95％ CI 0.30-0.93,P=0.03).Conclusion There is specific effect that N-acetylcysteine prevents CIN from happening in the groups of average Scr baseline ≥ 132.6 μmol/L.

Objective To better understand the clinical characteristics and predisposing factors in non-pregnant patients with Listeria monocytogenes (Listeria) sepsis.Methods Clinical data were collected at Peking Union Medical College Hospital between January 2002 and December 2014.A case with non-pregnant Listeria sepsis is defined as a non-pregnant person with clinically compatible illness and from whom Listeria was isolated from his/her blood culture.We define an underlying condition if a patient has been diagnosed of and/or has been treated for a concurrent baseline disease within 1 month prior to the onset of Listeria sepsis.Results A total of 35 patients were enrolled.The age of all patients was (49.1 ± 17.0) years.The male to female ratio was 2∶ 3.Most patients were combined with at least 1 underlying condition (33,94.3％),including 42.9％ patients with an autoimmune disease,34.3％ with malignancies.The majority (91.4％) represented an acute onset (＜ 1 week) with median time of 3 days.Clinical manifestations included fever (34/35,97.1％),central nervous system (CNS) symptoms (17/35,48.6％),gastrointestinal tract symptoms (13/35,37.1％).Fourteen patients had undergone lumber puncture and cerebral spinal fluid (CSF) tests,which revealed abnormalities comparable of Listeria meningitis.Listeria was isolated from CSF in 11 of 14 patients (78.6％).There were 34 patients receiving empiric antibiotics including 54.3％ cephalosporins which are resistant to Listeria.Twenty five (71.4％) patients were switched to the target antimicrobials according to positive blood culture.Of the 35 patients with Listeria sepsis,21 (60.0％) recovered or were cured,however the rest (40.0％) had dismal outcome.Six patients died in hospital,8 critical patients were discharged and died after transferring to local hospitals.Conclusions Listeria sepsis is commonly associated with non-pregnant patients with compromised immune function.Clinical presentations include acute fever,CNS symptoms and gastrointestinal symptoms etc.Empiric antibiotics covering Listeria should be considered when sepsis is suspected among susceptible hosts.

Aim To synthesize and identify artificial antigen of podophyllotoxin for the production of podophyllotoxin polyclonal antibody. Methods The hapten was synthesized by two different chemical approaches and characterized by TLC, IR, NMR, and MS. Mixed anhydride reaction (MAR) and active ester method (AEM) were used to couple the podophyllotoxin to carrier proteins (BSA and OVA). Characterization of artificial antigens was done by using spectroscopy and electrophoresis. The anti-podophyllotoxin polyclonal antibodies were obtained through immunizing rabbits. Results The results from IR, NMR and MS showed that 4-O-succinoyl podophyllotoxin (hapten) was successfully synthesized. The coupling molar ratios of the hapten and carrier proteins were 88.6 for Hapten-BSA1, 40.3 for Hapten-BSA2, 17.8 for Hapten-OVA1, and 54.2 for Hapten-OVA2. Hapten conjugates coupled with BSA yielded two sets of the specific and affinitive polyclonal antibodies. One set of antibodies showed an IC50 value of 2.21 μg·mL -1 with a detection limit of 0.12 μg·mL -1. Conclusion Antigenic conjugates were artificially synthesized, and based on these artificial antigens, polyclonal antibodies against podophyllotoxin were raised from rabbits immunized with two different immunogens and characterized with an indirect ELISA format.

Objective To summarize the clinical characteristics and outcome of maternal listeriosis so as to improve the understanding of disease and the level of diagnosis and treatment.Methods Retrospectively,16 cases of maternal listeriosis,who were treated at Peking Union Medical College Hospital between March 2007 and December 2014 were reviewed.Maternal listeriosis is defined when a pregnant woman presents with symptoms as listeriosis,meanwhile Listeria monocytogenes is isolated from sterile tissue or peripheral blood,or from a non-sterile site (uterus swab) or pathological evidence of chorioamnionitis.The neonatal listeriosis is diagnosed as acute listeria sepsis.Results The mean age of these 16 patients was (30.0 ± 3.9) years old.There were 1,8,7 patients with listeriosis diagnosed in the first,second and third trimester of pregnancy,respectively.All had an acute onset of illness (≤2 weeks),the median time from onset to presentation was 2.5 days.Clinical manifestations included fever (93.8％,15/16),leukocytosis (78.6％,11/14),chorioamnionitis (77.8％,7/9),gastrointestinal symptoms (37.5％,6/16) and fetal movement decrease (31.3％,5/16).Listeria monoeytogenes were isolated from blood (6 cases),uterus swab (6 cases),blood plus uterus swab (1 case),and neonates (3 cases).All maternal cases recovered well after the termination of pregnancy,even none of them had received empiric antibiotics sensitive to listeria.A very high proportion of adverse pregnancy outcomes occurred (15/16,93.8％).There were 8 fetal losses.Seven neonates were complicated with listeria sepsis and treated successfully.Conclusions The patients with maternal listeriosis commonly presented with acute fever and an extremely high incidence of adverse pregnancy outcomes,however empiric antibiotics can hardly cover this pathogenic bacterium.So both pregnant women and clinicians should maintain a high level of vigilance against listeriosis and pay more attention to dietetic hygiene.

Objective To investigate the genotype distribution of microsatellite locus CAI among Candida albicans ( C.albicans ) strains and to evaluate its relationship with the epidemic of vulvovaginal candidiasis ( VVC) in Guizhou region .Methods Ninety independent C.albicans strains isolated from pa-tients with VVC in Guizhou were investigated based on single-strand conformation polymorphisms ( SSCP ) and GeneScan analysis .The genotypes of C.albicans strains were identified by microsatellite locus CAI pol-ymorphism analysis .The gene polymorphism and the cluster of C.albicans strains were analyzed by using software SPSS 19.0.A logistic regression model was used to analyze the relationship between genotype distri -bution of CAI microsatellite among C.albicans strains and VVC infection .Results Twenty-seven distinct CAI genotypes with various patterns were identified from 90 C.albicans strains by GeneScan analysis .Clus-ter analysis showed that the C.albicans strains were classified into three clusters ( ClusterⅠto Cluster Ⅲ) . Three predominant genotypes including 30-45, 32-46 and 30-46 and other 7 highly similar genotypes be-longed to clusterⅡthat accounted for 70.0%(63 strains) in all strains.The odds ratio for the predominant genotypes associated with VVC infection was 4.3.Conclusion The predominant distribution of genotypes was observed among the isolated C.albicans strains.The predominant genotypes of C.albicans were highly associated with the occurrence of VVC .

BACKGROUND: It is considered traditionally that epilepsy is a kind of complicated nervous conduct disorder caused by abnormally excited neuron in different area in brain. While the research on the function of astrocyte in epileptic attack is very rare.OBJECTIVE: To study the reaction of neuron and astrocyte in medullary visceral zone after epilepsy induced by pentetrazole in rats.DESIGN: A randomized controlled experimental research.SETTING and MATERIALS: The experiment was done in the Neurosurgery Laboratory of Zhujiang Hospital Affiliated to Southern Medical University and Neuroscience Institute of Fourth Military Medical University of Chinese PLA. Fourteen healthy adult SD rats, weighing 180 - 220 g, clean grade, were provided by the Experimental Animal Center of Fourth Military Medical University of Chinese PLA.INTERVENTIONS: Distribution of neuron and astrocyte in MVZ 1 hour after epileptic attack was shown by laserconfocal microscopic technique combined with triplication immunofluorescence histochemistry of anti-Fos protein, anti-tyrosine hydroxylase(TH) and anti-glial fibrillary acidic protein(GFAP).MAIN OUTCOME MEASURES: Observation of distribution of positive cells of Fos, GFAP and TH in MVZ and relationship between GFAP positive astrocyte and neuron.RESULTS: Fos positive neurons and GFAP positive astrocytes in MVZ increased significantly. Triplication immunofluorescence histochemistry showed reaction neuron(Fos positive) closely related with reaction astrocyte(GFAP positive) . Three kinds of N-ASC compounds with different labels were found, which were TH +/Fos +/GFAP + three labeled compound, TH + /GFAP +/Fos- and Fos+/GFAP +/TH- two labeled compound.CONCLUSION: Neuron and astrocyte in MVZ reacted strongly when epilepsy attacks. N-ASC as a functional unit may regulate onset of epilepsy.

BACKGROUND: Lipopolysaccharide(LPS), as a polyclonal immune exciter, can simulate immune excitation status, which is useful in the observation of whether the catecholaminergic neurons in paraventricular nucleus of hypothalamus(PVN) projected from medullary visceral zone(MVZ) react towards LPS stimulation that is to provide a theoretical gist for the researches on the protection of brain function.OBJECTIVE: To observe whether PVN catecholaminergic neurons projected from MVZ react towards LPS stimulation for the exploration of the impacts of MVZ-PVN catecholaminergic access in "immune-to-brain communication".DESIGN: A randomized controlled study using experimental animals as subjects.SETTING: An Institute of Neurosurgery and Neurology of one Military University of Chinese PLA.MATERIALS: The study was conducted in the Department of Neurosurgery of Zhujiang Hospital affiliated to Southern Medical University and the Institute of Neurology of the Fourth Military Medical University of Chinese PLA from January to December in 2002. Ten healthy adult SD rats in cleanness grade were obtained from the experimental animal center of the Fourth Military Medical University of Chinese PLA.METHODS: WGA-HRP was injected into PVN of one side of the rat, and the immune exciter LPS was injected into the abdominal cavity after 48 hours of survival to induce immune response. Samples were stained by triple labels of WGA-HRP method and double immunohistochemical staining of anti-Fos and anti-TH antibodies.MAIN OUTCOME MEASURES: To observe the distributions and expressions of WGA-HRP labeled cells, Fos protein, and catecholaminergic neuron(labeled by TH) in MVZ.RESULTS: Seven immune-reactive(IR) positive neurons were found in MVZ, i. e., HRP, Fos or TH single labeled cells, Fos/HRP, Fos/TH or HRP/TH double labeled cells, and Fos/HRP/TH triple labeled cells. Fos/HRP double labeled neurons and Fos/HRP/TH triple labeled neurons accounted for 12. 5% and 39.6% of HRP labeled cells respectively.CONCLUSION: MVZ reacts to LPS immune stimulation, which could upload the immune message to PVN through Catecholaminergic neurons.MVZ might be a relay station in "immune-to-brain communication", which exerts immune modulatory impact through "MVZ→PVN" access.

Objective To determine the impact of family cohesion and adaptability on depression of young patients with stroke.Methods A total of 188 young patients with stroke were recruited from rehabilitation departments of three class Ⅲ grade A hospitals in Wenzhou by convenience sampling method from January to December 2016. The status quo of family cohesion and adaptability and depression of these patients was investigated, and the relationship between them was analyzed by correlation and regression analysis.Results The total score of depression in young patients with stroke was (25.71±6.11)points. The correlative analysis showed that there were negative correlations between score of actual family cohesion, score of actual family adaptability and score of depression(P<0.05). The regression analysis showed that actual family cohesion and actual family adaptability could independently explain 41.6% of the variance for depression of young patients with stroke after controlling demographic variables.Conclusions Family cohesion and adaptability could predict depression of young patients with stroke. Improve the actual family cohesion and actual family adaptability can help to reduce the level of depression in young stroke patients

Objective? To explore the effects of bladder management on urinary tract infection and recovery of bladder function among stroke patients with neurogenic bladder. Methods? From January 2017 to June 2018, we selected 90 stroke inpatients with neurogenic bladder in the First Affiliated Hospital of Wenzhou Medical University. According to admission time, a total of 43 patients admitted between January and September 2017 were set in control group, and 47 patients admitted between October 2017 to June 2018 were set in observation group. Control group carried out routine nursing model. On the basis of routine nursing, observation group implemented bladder management. Finally, we compared the urinary tract infection and recovery of bladder function of patients between two groups. Results? The incidence of urinary tract infection of patients in observation group was 31.91% lower than that in control group; the rate of effective establishment of balanced bladder in observation group was 61.70% higher than that in control group; the differences were all statistical (P＜ 0.05). Conclusions? The application of bladder management nursing in stroke patients with neurogenic bladder can effectively reduce the incidence of urinary tract infection and promote the recovery of bladder function, which is worth to be widely used in clinical application.

Objective:To explore the diagnostic value of radiomics based on arterial-venous mixed images derived from dual-energy CT (DECT) data in diagnosis of cervical lymph nodes (LNs) metastasis of papillary thyroid cancer (PTC).Methods:From June 2017 to December 2018, eighty-four patients with preoperatively DECT scanning and pathologically confirmed PTC (129 non-metastatic LNs and 97 metastatic LNs) in the First Affiliated Hospital of Nanjing Medical University were included in this study. The clinical and imaging data of all patients were retrospectively analyzed. The training cohort consisted of 62 PTC cases with 156 LNs (91 non-metastatic LNs and 65 metastatic LNs). An independent validation cohort consisted of 22 PTC patients with 70 LNs (38 non-metastatic LNs and 32 metastatic LNs). Semi-automatic LNs segmentation was conducted on arterial-venous mixed images derived from DECT using Syngo.via Frontier Radiomics software. Totally 1 226 radiomics features were extracted from arterial-venous mixed images for each LN. The least absolute shrinkage and selection operator (LASSO) regression was applied for radiomics features selection and signature building. The logistic regression modeling was used to construct diagnostic models based on the CT image features of LNs (model 1), the radiomics signature (model 2) and the combination of the CT image features and radiomics signature (model 3). An intuitive nomogram was plotted for model 3. The ROC curve analyses and area under the curve (AUC) were performed to evaluate the diagnostic efficiency of the three models, with the performances compared using the Delong test.Results:Model 1 was developed with LNs shape, degree of enhancement, pattern of enhancement, calcification and extra nodal extension. Three arterial phase radiomics features were selected and used to establish radiomics signature using LASSO regression (model 2). Model 3 was developed with LNs size, shape, degree of enhancement and radiomics signature. In both the training and validation cohort, model 3 showed the best diagnostic performance (AUC=0.965, 0.933), followed by model 2 (AUC=0.947, 0.910), and both these two models significantly outperformed model 1 (AUC=0.850, 0.846) (training cohort, Z=4.066 and 3.758, P both<0.001; validation cohort, Z=2.871 and 1.998, P=0.017 and 0.042) respectively. Conclusion:The radiomics model based on arterial-venous mixed images derived from DECT data can realize effective diagnosis of LNs metastasis in patients with PTC; and the combination model of radiomics signature with CT image features can further improve the diagnostic accuracy.