AlM: To evaluate the effectiveness of Spot Vision Screener on vision screening of children without cycloplegia.METHODS:A total of 87 children (174 eyes) aged from 2~9 years old were examined with Spot Vision Screener and optometrist before cycloplegia.RESULTS: Statistical analysis demonstrated that the cylinder diopter and axis, the equivalent spherical diopter in both eyes, and the spherical diaopter in left eye had no significant change ( P>0. 05 ). However, the spherical diaopter in right eye had statistical significance. CONCLUSlON: Spot Vision Screener is a suitable instrument in vision screening of children without cycloplegia.

Animals ; Humans ; Lymph Nodes ; pathology ; Lymphangiogenesis ; physiology ; Lymphatic Metastasis ; Lymphatic Vessels ; metabolism ; pathology ; Neoplasms ; metabolism ; pathology ; Vascular Endothelial Growth Factor C ; metabolism ; physiology ; Vascular Endothelial Growth Factor D ; metabolism ; physiology

Objective To investigate the clinical manifestations and treatment regiment of children with juvenile dermatomyositis(JDM).Methods The clinical manifestation,changes of serum muscale enzyme,myopathic laboratory examination,treatment and prognosis of 15 children with JDM retrospectively admitted from Jan.1990 to Jan.2004 were analyzed.Results All of the children had symmetrical weakness of the proximal muscles.The most frequent features were heliotrope and Gottron's papules.Elevated muscle enzymes were noted in all cases.Electromyography revealed typical change of myopathic type and muscle biopsy was compalible with myositis in all cases.Most of patients achieved normal muscle enzymes within 1 month and had improved muscle strength with 2.5 monthes of the initiation of corticosteroid therapy.Conclusion It is very important to know the clinical features of JDM,and prompt diagnosis and treatment will result in an improved prognosis.

Objective To investigate the efficacy and safety as well as the effects of rituximab on B-lymphocytes and anti-platelet glycoprotein-specific antibodies,in patients with steroid-resistant idiopathic thrombocytopenic purpura(ITP).Methods Twelve steroid-resistant ITP patients,16 to 54 years old,received intravenous rituximab at the dose of 375 mg/m2 once-weekly for 4 weeks.Lab studies included CBC,serum concentrations of IgG,IgM and IgA.CD+3,CD+4,CD+8,CD+19,CD+20 cell numbers were assayed by flow cytometry and anti-platelet glycoprotein-specific antibodies(GP Ⅱ b/Ⅲ a,GP Ⅰ b/Ⅸ)were assayed by monoclonal antibody-specific immobilisation of platelet antigens prior to and following rituximab therapy.Results A complete response(platelet counts ≥100×109/L)was observed in 4 cases,a partial response (platelet counts between 50 and 100×109/L)in 3 cases,a minor response(platelet counts between 30 and 50×109/L)in 2 cases,and non response(platelet counts＜30×109/L)in 3 cases.Responses were sustained 0.5 to 12 months(median 5 months).After 4 weeks of rituximab therapy,anti-platelet glycoprotein-specific antibodies(GP Ⅱ b/Ⅲ a,GP Ⅰ b/Ⅸ)disappeared except one NR patient and CD+19/CD+20 cells were almost depleted in all patients(295.0±86.4)×106/L vs(4.1±2.2)×106/L(P＜0.01).As expected,the T cell counts,and the serum concentrations of IgG,IgM and IgA were not changed after therapy.No severe side effects were observed.Conclusion Rituximab may be an effective and safe treatment for adults with steroid-resistant ITP.

Objective To analyze Holder pasteurization,temperature and duration of frozen,duration of continuous breast milk pumping and types of pumping tube on macronutrients and total energy in breast milk and the circadian variation of macronutrients and energy content of breast milk.Methods Two hundred and two breast milk samples were collected from healthy mothers of 188 infants who were hospitalized in Department of Pediatrics,Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from April 2016 to December 2016.Fat,protein,carbohydrate and energy contents of the breast milk samples were detected both before and after various processes to analyze the influence of Holder pasteurization,frozen storage conditions (temperature and time),duration of continuous pumping and types of pumping tube and to observe the variations within a single day.Paired t-test,repeated-measures analysis of variance,one-way analysis of variance and LSD-t test were used for statistical analysis.Results The contents of fat,protein and energy in breast milk were significantly decreased [(3.69 ± 0.98) vs (4.22 ± 1.00) g/dl,t=9.405;(2.12 ± 0.34) vs (2.21 ± 0.34) g/dl,t=4.785;(69.77±9.35) vs (74.94±9.53) kcal/dl (1 kcal=4.184 kJ),t=9.470],while the carbohydrate content was increased [(6.66±0.17) vs (6.62±0.17) g/dl,t=-3.442] after Holder pasteurization comparing with those before (all P＜0.01).Breast milk frozen at =80 ℃ had higher protein content than that frozen at-20 ℃ (Ftemperature=4.990,Ptemperature=0.027).Breast milk stored at-20 ℃ for 7,15,30,60 and 90 days showed significantly decreased fat,protein and energy contents as compared with those in fresh breast milk,while the carbohydrate contents in the breast milk samples stored at-20 ℃ for 15,30 and 60 days were significantly increased and that kept for 90 days were lower than those at 30 and 60 days (LSD-t test,P＜0.05).Compared with fresh breast milk,breast milk stored at-80 ℃ showed significantly decreased fat,protein and energy contents at 60 d and 90 d,but increased carbohydrate content at 60 d (LSD-t test,P＜0.05).Compared with fresh breast milk,breast milk which was pumped at 1,2 or 3 h through gastric tube (size 6,8 or 10) or transfusion connecting pipe had lower fat content (LSD-t test,P＜0.05).Compared with fresh milk,breast milk had lower energy content on condition that it was pumped through gastric tube size 6 at 2 or 3 h or through gastric tube size 8 or 10 or transfusion connecting pipe at 1,2 or 3 h (LSD-t test,P＜0.05).Breast milk secreted from 12:01 to 15:00 had higher fat and energy contents [(5.16±0.93) g/dl and (86.96±9.35) kcal/dl] than that secreted from 00:01 to 03:00[(4.54±0.75) g/dl and (80.77±7.75) kcal/dl],from 03:01 to 06:00 [(4.61 ±0.75) g/dl and (81.44±7.69) kcal/dl] or from 21:01 to 24:00 [(4.71 ± 0.88) g/dl and (82.44± 8.82) kcal/dl].Moreover,breast milk secreted from 09:01 to 12:00 had higher fat and energy contents [(5.01 ± 0.94) g/dl and (85.31 ± 9.62) kcal/dl] than that secreted from 00:01 to 03:00,and that secreted from 09:01 to 12:00 had higher fat contents than that secreted from 03:01 to 06:00 (LSD-t test,P＜0.05).Conclusions Fresh breast milk is better than processed milk to meet the infantile need for growth and development.

Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT-3D TEE)in left atrial appendage (LAA)occlusion.Methods Consecutive 10 atrial fibrillation (AF)patients (CHADS2 ≥ 2 )with high risk bleeding underwent LAA occlusion under the guidance of TEE.The LAA orifice shape and characteristics of lobes were assessed,the size of LAA with RT-3D TEE wee measured before closer implanation,and the position of the LAA occlusion device were evaluated by RT-3D TEE.The correlational analysis between LAA diameter and occluder size was conducted.Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion.Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium.The average number of LAA lobes were 2.2±0.7. LAA ostium long diameter were larger by 3D TEE compared with 2D TEE[(21 .8±5.1)mm vs (20.8±4.1) mm],and ostium short diameter were smaller by 3D TEE compared with 2D TEE [(16.1 ± 3.0 )mm vs (1 7.0±2.6)mm],however there were no significant differences between 2D and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods.LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter (3D TEE:r =0.719,0.690,0.791 ,0.71 1 ,and P =0.029,0.040,0.01 1 , 0.032,respectively;2D TEE:r = 0.887,0.894,0.932,0.896,and P = 0.001 ,0.001 ,0.000,0.000, respectively).LAA occlusion device position assessed by RT-3D:6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition.Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA,accurately judging LAA ostium shape and size and position of the occlusion device.

Objective To assess the value of transesophageal echocardiography (TEE) in left atrial appendage (LAA) closer with Amplatzer Cardiac Plug (ACP).Methods Consecutive 32 atrial fibrillation patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE.Measurements of LAA anchoring area diameter (AAD) and LAA anatomical orifice diameter (AOD) including maximum,minimum values,and LAA depth on 2 dimentional TEE (2D TEE) were conducted before closer device implantation.The outcomes of LAA occlusion were analyzed.Results Among 32 patients,27 cases achieved successful LAA occlusion,including 2 cases with peripheral leakage ≤5 mm,and 5 cases failed occlusion.Among 5 failed closed patients,3 cases with LAA AAD≥ 30 mm,1 case with LAA of short depth,and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA.LAA AAD maximum,minimum and LAA depth were (25.9±4.9)mm,(20.0±3.8)mm,(31.0±5.6)mm,respectively,and LAA AOD maximum,minimum diameters were (26.2±6.2)mm,(19.4±4.3)mm,respectively.Among 10 cases with LAA AAD≥30 mm,7 cases achieved successful LAA occlusion,but 3 cases failed.The implanted device diameter was (26.4±3.8)mm,and device compression rate was (7.6±5.5)%.The coefficient of correlation between device diameter and large LAA AAD and AOD is 0.770 and 0.717,respectively.There was no complication but 1 case with pericardial effusion.Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder.The AAD of 2D TEE has the good correlation with ACP occluder′s size,the AADs are important factors which affect the success of LAA occlusion.

Objective To explore the characteristic and its influencing factors of resilience in Chinese recruits to provide the scientific evidence for the mental health training. Methods Resilience Scale for Adults (RSA) ,Self-report Symptom Checklist 90( SCL-90), Eysenck Personality Questionnaire(EPQ) and General SelfEfficacy Scale (GSES) were applied to 2459 recruits(2231 males and 139 females, aged ( 19 ± 1.5 ) ) within two male recruits( 101.76 ± 14.06) was significantly higher than that of males (96.65 ± 15.62) ( t=4. 13, P＜0. 0l ) ;Recruits with College and above education have significantly higher RSA scores than those with junior high school education and senior high school education (P ＜ 0. 0l ). Between the only child group and non only child group, there was no significant difference in RSA total score , but significant difference existed only in three factors higher RSA group scored significantly higher in extraversion (Z = 19.13, P = 0.000), abreaction adjustment (Z =8.67, P = 0.600 ) and self-efficacy (Z = 19.48, P = 0.000 ), while scored significantly lower in the SCL-90 (Z =Resilience had significant positive correlation with extraversion, abreaction adjustment and self-efficacy, and negative correlation with the neuroticism and inhibition adjustment. Multiple linear regression analysis revealed that extraversion, neuroticism,abreaction adjustment/inhibition adjustment and self-efficacy had predictive ability to resilience( explain 41% ). Conclusion Chinese recruits have good resilience. Emotion Regulation (abreaction adjustment/inhibition adjustment), extraversion, neuroticism and self-efficacy are important influencing factors of resilience for Chinese recruits.

OBJECTIVETo study the expressions changes of gastric mucosal hypoxia-inducible factor-1alpha (HIF-1alpha) and downstream molecules [such as vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2)] of verrucous gastritis (VG) patients of different Chinese medicine (CM) syndrome types and their clinical significance.

METHODSTotally 94 VG patients were assigned to Gan-Wei disharmony group (GWDG, 28 cases), the damp-heat in Pi-Wei group (DHPWG, 17 cases), the blood stasis in Wei-collateral group (BSWCG, 20 cases), and the insufficiency of Pi-yang group (IPYG, 29 cases). Another 30 patients with chronic mild non-active superficial gastritis patients accompanied with negative Hp infection were recruited as the control group. The Hp infection was detected using 14C-labeled urea breath test. The expressions of HIF-1alpha, VEGF, and COX-2 in the gastric mucosal tissue were detected using immunohistochemical EnVision two-step test.

RESULTSThe positive Hp infection rate in VG patients was 37.23% (35/94 cases). The positive Hp infection rate in patients of DHPWG (76. 47%) was significantly higher than the other three groups (32.14% in GWDG, 31.03% in IPYG, and 20.00% in BSWCG, P < 0.01). The expressions of HIF-1alpha and COX-2 in VG patients of different syndrome types were obviously higher than those of the control group (P < 0.01, P < 0.05). Of them, the expression of HIF-1alpha was the highest in BSWCG and the expression of COX-2 was the highest in DHPWG. The expression of VEGF was higher in DHPWG and IPYG than in the control group and the GWDG (P < 0.01, P < 0.05).

CONCLUSIONSThe expressions of HIF-1alpha, VEGF, COX-2, and Hp infection showed certain changes in VG patients of different syndrome types. The expression of HIF-1alpha was the strongest in BSWCG. The expressions of VEGF and COX-2 as well as Hp infection were the highest in DHPWG. All showed the specificity of CM syndromes.

Adult ; Aged ; Cyclooxygenase 2 ; metabolism ; Female ; Gastric Mucosa ; metabolism ; pathology ; Gastritis ; diagnosis ; metabolism ; pathology ; Helicobacter Infections ; diagnosis ; metabolism ; pathology ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Vascular Endothelial Growth Factor A ; metabolism ; Young Adult

Objective To discuss the feasibility and accuracy of left atrial appendage (LAA)ejection fraction by real-time 3 dimensional imaging (3D-EF),and tissue velocity of the LAA wall by tissue Doppler imaging (TDI)via transesophageal echocardiography (TEE)in assessing LAA functions.Methods A total number of 76 patients with atrial fibrillation (AF)were included in the study consecutively and underwent TEE for LAA investigations.3D-EF,fractional area change by 2 dimensional imaging (2D-FAC),peak emptying velocity (PEV),LAA tissue velocity by TDI at the mid-portion of lateral wall (TDI-L),mid-portion of septal wall (TDI-S)and the apical tip (TDI-A)were calculated.Results Statistic analysis showed the following results:1 )2D-FAC,3D-EF,PEV,TDI-L,TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations (all P <0.05),and significantly higher in patients without spontaneous echo contrast (SEC)than those who had SEC (all P <0.05);2)The results of 3D-EF showed a good correlation with 2D-FAC (r=0.727,P =0.000),and their correlations with PEV were similar (2D-FAC and PEV:r =0.685;3D-EF and PEV:r =0.632,both P =0.000);3)TDI-A [(14.95±4.63)cm/s]were significantly higher than TDI-L [(12.62±3.96)cm/s]and TDI-S [(12.68±3.59)cm/s](both P =0.000).The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S (with PEV:r=0.840 vs r=0.564,r=0.524;with 2D-FAC:r=0.701 vs r=0.486,r=0.504;with 3D-EF:r=0.753 vs r=0.493,r=0.522,all P <0.05). Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function.The best location for LAA tissue velocity evaluation is the apical tip.