AIM: To observe the clinical efficacy and safety of vincamine sustained release capsules on non- arteritic anterior ischemic optic neuropathy ( NAION) . · METHODS: Patients who were diagnosed with monocular onset NAION in acute stage from January to September 2015 were divided into two groups. Routine treatment such as steroid pulse therapy and neurotrophic treatment were given to all the patients. Vincamine was added to the treatment group patients with 30mg twice a day for 3mo. The best corrected visual acuity ( BCVA), mean deviation ( MD) of visual field, retinal nerve fiber layer ( RNFL ) , ganglion cell complex ( GCC ) , pattern visual evoked potential ( PVEP ) and OCT results were analyzed before and after the treatment. ·RESULTS:Totally 42 eyes of 42 patients were enrolled in our study. There were 27 patients in the treatment group, aged from 33 to 79 years old, the average value was 55. 55± 11. 83 years old. The control group has 15 patients, aged from 40 to 70 years old, the average value was 55. 71 ± 10. 06 years old. There were no statistical differences between the two groups in the baseline. After 3mo of the treatment, MD value of the two groups were lower compared with the baseline, the difference was statistically significant in the treatment and control group respectively (t= 2. 342, 2. 692; P = 0. 027, 0. 041). The difference of PVEP amplitude and potential of the two groups before and after the treatment were not statistically significant. The thickness of retinal nerve fiber layer and the ganglion cell complex were all lower than the baseline, and the difference was statistically significant (P<0. 001). The treatment of the two groups were both effective, the treatment group has better treatment effect than the control group. Adverse events related to the treatment of vincamine had not been found. ·CONCLUSION:Vincamine is helpful in the treatment of non-arteritic anterior ischemic optic neuropathy.

BACKGROUNDIn this prospective randomized study, we compared the predicted blood and effect-site C 50 for propofol and remifentanil target-controlled infusion (TCI) and the bispectral index (BIS) values at loss of consciousness (LOC) and response to a standard noxious painful stimulus (LOS) in elderly and young patients, respectively. We hypothesized that the elderly patients will require lower target concentration of both propofol and remifentanil at above two clinical end-points.

METHODSThere were 80 American Society of Anesthesiologists (ASA) physical status I-II unpremedicated patients enrolled in this study, they were divided into elderly group (age ≥65 years, n = 40) and young group (aged 18-64 years, n = 40). Propofol was initially given to a predicted blood concentration of 1.2 μg/ml and thereafter increased by 0.3 μg/ml every 30 s until Observer's Assessment of Alertness and Sedation score was 1. The propofol level was kept constant, and remifentanil was given to provide a predict blood concentration of 2.0 ng/ml, and then increased by 0.3 ng/ml every 30 s until loss of response to a tetanic stimulus. BIS (version 3.22, BIS Quattro sensor) was also recorded.

RESULTSIn elderly group, the propofol effect-site C 50 at LOC of was 1.5 (1.4-1.6) μg/ml, was significantly lower than that of young group, which was 2.2 (2.1-2.3) μg/ml, the remifentanil effect-site C 50 at LOS was 3.5 (3.3-3.7) ng/ml in elderly patients, was similar with 3.7 (3.6-3.8) ng/ml in young patients. Fifty percent of patients lost consciousness at a BIS value of 57.3 (56.4-58.1), was similar with that of young group, which was 55.2 (54.0-56.3).

CONCLUSIONIn elderly patients, the predicted blood and effect-site concentrations of propofol at LOC were lower than that of young patients. At same sedation status, predicted blood and effect-site concentrations of remifentanil required at LOS were similar in elderly and young patients. BIS were not affected by age. Low-propofol/high-opioid may be optional TCI strategy for elderly patients.

Adolescent ; Adult ; Age Factors ; Aged ; Anesthetics, Intravenous ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Piperidines ; administration & dosage ; therapeutic use ; Propofol ; administration & dosage ; therapeutic use ; Prospective Studies ; Unconsciousness ; chemically induced ; Young Adult

BACKGROUND: Clinical value of the nerve root sedimentation sign in patients with lumbar spinal stenosis (LSS) is still uncertain.OBJECTIVE: To investigate the positive rate and correlation of the nerve root sedimentation sign in patients with LSS.METHODS: Totally 281 patients complaining lumbago or low back pain underwent MRI examination in the Orthopedic Clinic or Ward of Jinshan Hospital of Fudan University, including 119 males and 162 females. The cross-sectional area and sagittal diameter of the spinal canal were measured, and the patients were then divided into two groups according to the presence and absence of LSS. Finally, the positive rate of nerve root sedimentation sign was compared.RESULTS AND CONCLUSION: (1) Grouping based on the presence and absence dural sac cross-sectional area stenosis: the positive rate of nerve root sedimentation sign in sever, non, and mild LSS patients was 91.4%, 39.6%,and 53.5%, respectively, and the difference was significant (P < 0.05), but the positive rate showed no significant difference between mild and moderate as well as moderate and severe LSS patients. (2) Grouping according to the presence and absence spinal canal sagittal diameter stenosis: there was a significant difference in the positive rate of nerve root sedimentation sign between non-LSS and LSS patients (44.3% vs. 76.1%, χ2=21.469, P=0.000). (3) Grouping based on the dural sac cross-sectional area combined with spinal canal sagittal diameter: the dural sac cross-sectional area < 120 mm2 or the spinal canal sagittal diameter < 10 mm indicating LSS, there was a significant difference in the positive rate of nerve root sedimentation sign between non-LSS and LSS patients (40.6% vs.80.6%,χ2=30.539, P=0.000). (4) These results indicate that the diagnosis value of nerve root sedimentation sign in LSS is still under discussion. Although a positive sedimentation sign exclusively and reliably occurs in patients with severe LSS, it is also higher in patients without LSS. It may be inappropriate to take nerve root sedimentation sign as a diagnostic tool, but when combined with dural sac cross-sectional area and sagittal canal subsidence, it will be of great significance for the diagnosis of LSS.

OBJECTIVE: To investigate the effect of overexpression of glycosylphosphatidyl-inositol-specific phospholipase D (GPI-PLD) on the biological character of hepatocellular carcinoma cell line HepG2. METHODS: The GPI-PLD gene eukaryon expression vector pcDNA3.1(+)/ GPI-PLD was transiently transfected into HepG2 cell by lipid-media transfection. The untransfected HepG2 and HepG2 transfected with pcDNA3.1(+) were used as controls. After screening with G418, the single clone was obtained. The expression level of GPI-PLD mRNA in HepG2 was identified by reverse transcription polymerase chain reaction (RT-PCR). GPI-PLD activities were analyzed quantitatively by triton-X-114 partition with GPI anchored placental alkaline phosphatase (PLAP) as a substrate. Cell count was used to detect the proliferation of the 3 groups, and complement dependent cytotoxicity (CDC) effects were observed by the staining of trypan blue. Apoptosis cells were analyzed by flow cytometry. Carcinoembryonic antigen (CEA)was detected by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with HepG2 and pcDNA3.1(+)/HepG2 cell, the levels of GPI-PLD activities and its mRNA from pcDNA3.1(+)/GPI-PLD/HepG2 were increased with almost 2 to 5 times,respectively. The GPI anchored PLAP and CEA released into the medium by GPI-PLD, and the rate of CDC killing on the cells were significantly increased. However, the proliferative capacity was obviously decreased, and the typical apoptosis cells were presented in positive clones and its apoptosis rates were increased significantly. CONCLUSION The stable cell line with overexpression of GPI-PLD has been constructed. The overexpression of GPI-PLD in these cells increases the sensitivity of these cells to CDC killing and impairs the proliferative capacity of cells, and promotes the apoptosis.
Apoptosis ; genetics ; Carcinoma, Hepatocellular ; genetics ; pathology ; Complement Activation ; genetics ; Cytotoxicity, Immunologic ; genetics ; Eukaryotic Cells ; metabolism ; Genetic Vectors ; genetics ; metabolism ; Humans ; Liver Neoplasms ; genetics ; pathology ; Phospholipase D ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Transfection ; Tumor Cells, Cultured ; Up-Regulation

OBJECTIVETo investigate the role of Pediatric Critical Illness Score (PCIS) in evaluating the prognosis and severity of severe hand-foot-mouth disease (HFMD).

METHODSThis study included 424 children with severe HFMD, consisting of 390 survivors and 34 deceased patients. Related physiological parameters and clinical data were collected for calculating PCIS scores. The area under receiver operating characteristic curve (AUC) was employed to assess the performance of PCIS in evaluating the complications and outcomes.

RESULTSThe median of PCIS scores for survivors was higher than that for deceased patients (P<0.01). Of the 424 children with severe HFMD, only 26 (6.1%) had critical illness according to the severity assessment using PCIS. The AUC (95%CI) of PCIS was 0.74 (0.66, 0.82) in predicting pulmonary edema, 0.82 (0.74, 0.90) in predicting pulmonary hemorrhage, and 0.83 (0.75, 0.92) in predicting death.

CONCLUSIONSPCIS can predict the complications and prognosis in children with severe HFMD. However, the existing scoring system of PCIS cannot fully assess the severity of HFMD.

Child, Preschool ; Critical Illness ; Female ; Hand, Foot and Mouth Disease ; diagnosis ; Humans ; Infant ; Male ; Prognosis

OBJECTIVEThis paper presents a new method of individual prefabricated titanium implant for the reconstruction of the skull bone defect.

METHODA computer-based 3D model of the cranial bone defect is created from helical CT-data and serves as the basis for the computer aided design and manufacturing (CAD/CAM) of the individual prefabricated titanium implant for the cranial bone defect reconstruction.

RESULTSince 2001, a total of nine patients suffering from the cranial bone defect have been operated on by this method with satisfied result. The fallow-up is 3 to 12 months.

CONCLUSIONThese individual prefabricated titanium implants have won a high precision, a good biomechanics and a excellent biocompatibility. It is a quite ideal and very simple method with much less complication for the surgical treatment of the cranial bone defect.

Adolescent ; Adult ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Prostheses and Implants ; Reconstructive Surgical Procedures ; methods ; Skull ; surgery ; Skull Fractures ; surgery ; Titanium ; Treatment Outcome

OBJECTIVETo analyze the phenotype-genotype correlation of MYH7-V878A mutation.

METHODSExonic amplification and high-throughput sequencing of 96-cardiovascular disease-related genes were carried out on probands from 210 pedigrees affected with hypertrophic cardiomyopathy (HCM). For the probands, their family members, and 300 healthy volunteers, the identified MYH7-V878A mutation was verified by Sanger sequencing. Information of the HCM patients and their family members, including clinical data, physical examination, echocardiography (UCG), electrocardiography (ECG), and conserved sequence of the mutation among various species were analyzed.

RESULTSA MYH7-V878A mutation was detected in five HCM pedigrees containing 31 family members. Fourteen members have carried the mutation, among whom 11 were diagnosed with HCM, while 3 did not meet the diagnostic criteria. Some of the fourteen members also carried other mutations. Family members not carrying the mutation had normal UCG and ECG. No MYH7-V878A mutation was found among the 300 healthy volunteers. Analysis of sequence conservation showed that the amino acid is located in highly conserved regions among various species.

CONCLUSIONMYH7-V878A is a hot spot among ethnic Han Chinese with a high penetrance. Functional analysis of the conserved sequences suggested that the mutation may cause significant alteration of the function. MYH7-V878A has a significant value for the early diagnosis of HCM.

Adult ; Amino Acid Sequence ; Asian Continental Ancestry Group ; genetics ; Cardiac Myosins ; genetics ; Cardiomyopathy, Hypertrophic ; genetics ; Female ; Genetic Association Studies ; methods ; Genotype ; Humans ; Male ; Middle Aged ; Mutation ; genetics ; Myosin Heavy Chains ; genetics ; Pedigree ; Phenotype ; Young Adult

BACKGROUNDBispectral index (BIS) is considered very useful to guide anesthesia care in elderly patients, but its use is controversial for the evaluation of the adequacy of analgesia. This study compared the BIS changes in response to loss of consciousness (LOC) and loss of somatic response (LOS) to nociceptive stimuli between elderly and young patients receiving intravenous target-controlled infusion (TCI) of propofol and remifentanil.

METHODSThis study was performed on 52 elderly patients (aged 65-78 years) and 52 young patients (aged 25-58 years), American Society of Anesthesiologists physical status I or II. Anesthesia was induced with propofol administered by TCI. A standardized noxious electrical stimulus (transcutaneous electrical nerve stimulation, [TENS]) was applied (50 Hz, 80 mA, 0.25 ms pulses for 4 s) to the ulnar nerve at increasing remifentanil predicted effective-site concentration (Ce) until patients lost somatic response to TENS. Changes in awake, prestimulus, poststimulus BIS, heart rate, mean arterial pressure, pulse oxygen saturation, predicted plasma concentration, Ce of propofol, and remifentanil at both LOC and LOS clinical points were investigated.

RESULTSBISLOCin elderly group was higher than that in young patient group (65.4 ± 9.7 vs. 57.6 ± 12.3) (t = 21.58, P < 0.0001) after TCI propofol, and the propofol Ce at LOC was 1.6 ± 0.3 μg/ml in elderly patients, which was significantly lower than that in young patients (2.3 ± 0.5 μg/ml) (t = 7.474, P < 0.0001). As nociceptive stimulation induced BIS to increase, the mean of BIS maximum values after TENS was significantly higher than that before TENS in both age groups (t = 8.902 and t = 8.019, P < 0.0001). With increasing Ce of remifentanil until patients lost somatic response to TENS, BISLOSwas the same as the BISLOCin elderly patients (65.6 ± 10.7 vs. 65.4 ± 9.7), and there were no marked differences between elderly and young patient groups in BISawake, BISLOS, and Ce of remifentanil required for LOS.

CONCLUSIONIn elderly patients, BIS can be used as an indicator for hypnotic-analgesic balance and be helpful to guide the optimal administration of propofol and remifentanil individually.

TRIAL REGISTRATIONCTRI Reg. No: ChiCTR-OOC-14005629; http://www.chictr.org.cn/showproj.aspx?proj=9875.

Adult ; Aged ; Electroencephalography ; drug effects ; Female ; Humans ; Male ; Middle Aged ; Movement Disorders ; physiopathology ; Pain ; physiopathology ; Piperidines ; pharmacology ; Propofol ; pharmacology ; Transcutaneous Electric Nerve Stimulation ; Unconsciousness ; physiopathology

OBJECTIVESTo establish a method for screening neonatal tetanus (NT) in high risk areas in China using multi-sources data.

METHODSWe adopted six NT-related indicators from National Notifiable Disease Report System (NNDRS) and National Maternal and Child Health Annual Report System, to calculate weighted high-risk score at prefecture level in 2010 and 2011. And we selected the top 30 high risk cities, and compared the scores with the actual NT incidence ranking and WHO scoring.

RESULTSThe highest areas distributed in the Southwest of China with poor and minority population, and the Southeast part with high density of migrants. In the leading 30 prefectures with high score between the methods of weighted high-risk scoring and reported NT incidence ranking, there were 8 different. In comparison of the results of the methods of weighed high-risk scoring and WHO scoring, 276 prefectures in 340 distributed were divided into the same ranking groups, with Kappa coefficient 0.56 (P < 0.01). The Chi-Square association coefficient was 0.74 (P < 0.01), which showed a high correlation. But there were 10 different prefectures in the leading 36 prefectures between the two methods.

CONCLUSIONThe weighted scoring method included several possible factors influencing NT incidence and took their weights into consideration. Thereby, compared with WHO scoring method, this method could be more appropriate for the reality in China.

China ; epidemiology ; Humans ; Infant, Newborn ; Neonatal Screening ; Tetanus ; epidemiology ; prevention & control

OBJECTIVEThe aim of this study was to investigate the feasibility and accuracy of delayed enhancement magnetic resonance imaging (DE-MRI) for the assessment of myocardial viability in patients with myocardial infarction in comparison with (99)Tc(m)-sestamibi (MIBI) single photon emission computed tomography (SPECT) and (18)F-fluorodeoxyglucose (FDG) SPECT. Scar was defined as regionally increased MRI signal intensity 15 minutes after injection of 0.2 mmol/kg gadolinium-diethylenetriamine pentaacetic acid or reduced perfusion and glucose metabolism defined by SPECT.

METHODSA total of 34 patients with myocardial infarction (29 males, 58.0 +/- 9.8 years) were imaged with MRI and SPECT.

RESULTSA total of 578 segments were analyzed. DE-MRI and SPECT identified 431 and 336 viable segments respectively and SPECT also identified 30 ischemic segments. Necrotic segments identified by DE-MRI and SPECT were 147 and 212 respectively. Sensitivity and specificity of DE-MRI in identifying segments with matched flow/metabolism defects (scar tissues) was 61.3% and 95.4%, respectively. Quantitatively assessed relative MRI infarct area correlated well with SPECT infarct size. The value of Kappa was 0.51.

CONCLUSIONDE-MRI provides a good tool for differentiating viable myocardium from scar tissues and the detection accuracy is comparable between DE-MRI and SPECT.

Aged ; Cell Survival ; Female ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Myocardial Infarction ; diagnostic imaging ; Myocytes, Cardiac ; diagnostic imaging ; metabolism ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; methods