Objective: To observe the impact of vascular calcification on kidney injury rats with the expressions of β-Klotho, fibroblast growth factor receptor 1 (FGFR1) in kidney tissue in order to find the predictor for early chronic kidney disease (CKD), to provide the prevention and investigation basis of vascular calcification and CKD. Methods: Vascular calcification model was induced by vitamin D3 and nicotine injection in experimental rats and the animals were divided into 2 groups: Normal control group and Calcification group. n=6 in each group. Serum levels of creatinine and urea nitrogen were examined by sarcosine oxidase method and UV-glutamate dehydrogenase method respectively; blood levels of calcium and phosphorus were detected by biochemistry method; kidney tissue alkaline phosphatases (ALP) activity was measured by ALP detection kit, protein expressions of β-Klotho and FGFR1 were assessed by ELISA.Results: Compared with Normal control group, Calcification group showed increased serum levels of creatinine (35.200±4.087) umol/L vs (26.000±5.0990) umol/L and urea nitrogen (6.900±0.623) mmol/L vs (5.400±0.803) mmol/L, both P<0.05; elevated kidney tissue ALP activity (60.510±31.090) U/g vs (26.590±8.664) U/g and β-Klotho protein expression (9.052±1.238) ng/mg vs (6.860±1.036) ng/mg, both P<0.05. Blood levels of calcium, phosphorus and kidney tissue FGFR1 protein content were similar between 2 groups. Conclusion: Large dose vitamin D3 and nicotine injection may induce vascular calcification and early CKD symptom in experimental rats; β-Klotho protein expression was significantly increased suggesting that β-Klotho had been involved in the early regulation of vascular calcification and it could be used for the early diagnosis of CKD at certain point.

Objective To summarize the evaluation standard of cardiac death organ donation from Chinese first category donor heart application and experience of donor heart function maintenance.Method From Jan.2013 to Jan.2015,donor hearts for heart transplantation were obtained in 18 cases of Chinese first category cardiac death organ donors from 109 cases of organ donation donors through rigorous assessment and effective donor heart function maintenance.The diagnosis of brain death was based on the diagnosis of brain death criteria (adult) by the neurological department of internal medicine,department of neurosurgery,and intensive care unit with brain death qualification.Organ donation work followed the basic principles of voluntary,free,fair,equitable and technical access.Result Eighteen case of heart transplantations were all operated with double lumen venous anastornosis.The cold ischemia time was (125.5+ 18.7) min (61-60 min),and cardiopulmonary bypass time was (130.4+ 12.5) min (99-193 min).In 18 heart transplantations,16 cases survived,and 2 eases died of acute right heart failure.During the follow-u period,the quality of life in the survival recipients was satisfactory.Conclusion Using cardiac death organ donation from Chinese first category donor heart transplantation has achieved good results.The accurate assessment of donor hearts and effective donor heart function maintenance are the key factors to guarantee the success of heart transplantation.

Cerebral arteriovenous malformation (AVM) is a common cerebrovascular disease in clinical practice. Although the treatment of AVMs has been w idely studied, the prognosis of the patients does not get significantly improvement. The main therapeutic purpose of AVMs is to reduce the risk of bleeding. This article review s the risk of bleeding and treatment modalities of AVMs.

OBJECTIVETo investigate the effect of rapamycin, an mTOR inhibitor, on learning and memory ability of mice with pilocarpine (PILO)-induced seizure.

METHODSOne hundred and sixty male adult ICR mice were randomly grouped as vehicle control (n=20), rapamycin control (n=20), PILO model (n=40), rapamycin pre-treatment (n=40) and rapamycin post-treatment (n=40). PILO model and rapamycin treatment groups were injected with PILO to induce temporal lobe seizure. Rapamycin was administrated for 3 days before or after seizure. Morris water maze, Y maze and open field were used for the assessment of learning and memory, and FJB and Timm staining were conducted to detect the neuronal cell death and mossy fiber sprouting, respectively.

RESULTSNo significant cell death was observed in the mice with PILO-induced seizure. The learning and memory were impaired in mice 7 to 10 days after PILO-induced seizure, which was evident by prolongation of avoiding latency (P<0.05), decrease in number of correct reaction (P<0.01) and number of crossing (P<0.05). Treatment with rapamycin both pre-and post- PILO injection reversed seizure-induced cognitive impairment. In addition, rapamycin inhibited the mossy fiber sprouting after seizure (P<0.001).

CONCLUSIONRapamycin improves learning and memory ability in ICR mice after PILO-induced seizure, and its mechanism needs to be further studied.

Animals ; Cell Death ; drug effects ; Disease Models, Animal ; Epilepsy ; chemically induced ; drug therapy ; Learning ; drug effects ; Memory ; drug effects ; Mice ; Mice, Inbred ICR ; Neurons ; drug effects ; pathology ; Pilocarpine ; toxicity ; Sirolimus ; pharmacology

OBJECTIVE: To analyze the genotype and clinical phenotype of a 3-month-old female infant featuring unresponsiveness. METHODS: The infant was subjected to genetic testing, and her clinical features were compared with syndromes associated with variants of the candidate gene. RESULTS: The patient has featured long fingers, long and overlapped toes, musk-like face, blepharophimosis, ptosis, and lacrimal duct anomaly. She was found to harbor a heterozygous de novo variant NM_012330.3: c.3040C>T (p.Gln1014*) in exon 16 of the KAT6B gene. Her clinical phenotype and genotype have both conformed to Say-Barber-Biesecker-Young-Simpson syndrome (SBBYSS). CONCLUSION The child was diagnosed with SBBYSS syndrome due to the c.3040C>T (p.Gln1014*) variant of the the KAT6B gene. Discovery of the unique features has expanded the phenotypic spectrum of this syndrome.
Female ; Humans ; Blepharophimosis/genetics* ; Blepharoptosis ; Genotype ; Histone Acetyltransferases ; Infant

Objective To investigate the effect of temperature on cell proliferation and osteogenic differentiation inhibition of preosteoblast induced by hydrogen peroxide(H2 O2).Methods The MC3T3-E1 cells in the logarithmic phase were randomly divided into 0,450,500,550,600,650 μmol·L-1 H2O2 intervention groups and incubated with 0,450,500,550,600,650 μmol·L-1 H2O2 for 2 h,respectively.Other MC3T3-E1 cells in the logarithmic phase were selected and randomly divided into the control group,model group,low-temperature group,and high-temperature group.Cells in the control group were cul-tured in an incubator with 5％CO2 for 24 h at 37 ℃;cells in the model group were incubated with H2O2 for 2 h and cultured in an incubator with 5％CO2 for 24 h at 37 ℃;cells in the low-temperature group were incubated with H2O2 for 2 h and cultured in an incubator with 5％CO2 for 24 h at 32 ℃;cells in the high-temperature group were incubated with H2O2 for 2 h and cultured in an incubator with 5％CO2 for 24 h at 40 ℃.The cell proliferation in all groups was detected by cell counting kit-8.The expression levels of Runt-related transcription factor 2(RUNX2),osteopontin(OPN)and osteocalcin(OC)mRNA were detected by real-time fluorescence quantitave polymerase chain reaction;and the expression levels of RUNX2,OPN and OC protein were detected by Western blot.Results There was no statistically significant difference in cell proliferation among the 0,450 and 500 μmol·L-1 H2O2 intervention groups(P＞0.05);the cell proliferation rate in the 550,600 and 650 μmol·L-1 H2O2 intervention groups was significantly lower than that in the 0,450 and 500 μmol·L-1 H2O2 intervention groups,showing a significant decrease in cell proliferation with the increase of H2O2 concentrations(P＜0.05).In order to ensure that there were enough cells to perform the following experiments,550 μmol·L-1 H2 O2 was chosen.The cell proliferation rate in the model group and the low-temperature group was significantly lower than that in the control group and high-temperature group(P＜0.05);there was no significant difference in the cell proliferation rate between the control group and high-temperature group(P＞0.05).The relative expression of RUNX2 mRNA in the model group and high-temperature group were significantly higher than that in the control group and low-temperature group(P＜0.05);the relative expression of RUNX2 mRNA in the low-temperature group was significantly lower than that in the control group(P＜0.05);there was no significant difference in the relative expression of RUNX2 mRNA between the model group and high-temperature group(P＞0.05).The relative expression of OPN mRNA in the model group,low-temperature group and high-temperature group was significantly higher than that in the control group(P＜0.05);the relative expression of OPN mRNA in the low-temperature group and high-temperature group was significantly higher than that in the model group(P＜0.05);the relative expression of OPN mRNA in the low-tem-perature group was significantly higher than that in the high-temperature group(P＜0.05).The relative expression of OC mRNA in the model group,low-temperature group and high-temperature group was significantly than that in the control group(P＜0.05);the relative expression of OC mRNA in the low-temperature group and high-temperature group was significantly higher than that in the model group(P＜0.05);there was no significant difference in the relative expression of OC mRNA between the low-temperature group and high-temperature group(P＞0.05).The relative expressions of RUNX2,OPN and OC protein the model group,low-temperature group and high-temperature group were significantly lower than those in the control group(P＜0.05);the relative expressions of RUNX2 and OPN protein in the low-temperature group were significantly lower than those in the model group and high-temperature group(P＜0.05);the relative expression of OC protein was significantly lower than that in the high-temperature group(P＜0.05);and there was no siqnificantly difference in the relatiwe experesson of OC protein between the low-temperature group and model group(P＞0.05);the relative expressions of RUNX2,OPN and OC protein in the high-temperature group were significantly higher than those in the model group(P＜0.05).Conclusion The inhibitory effects of H2O2 on cell proliferation and osteogenic differentiation are observed in MC3T3-E1 cells;low-tempera-ture incubation can enhance the inhibition of H2O2 on cell proliferation and osteogenic differentiation in MC3T3-E1 cells,while high-temperature incubation can relieve its inhibitory effect on cell proliferation and osteogenic differentiation.RUNX2,OPN and OC protein might play an important role in cell proliferation and osteogenic differentiation mediated by temperature.

Objective: To identify the risk factors for early fluid overload(FO)following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF]<50%) and evaluate the effect on clinical outcomes. Methods: Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction, aged 2-128 months, weighing 4.5-34.5 kg, with New York Heart Association Ⅲ or Ⅳ, undergoing ALCAPA repair, were enrolled in this study.The pediatric patients were divided into FO≥5% group (n=14) and FO<5% group (n=29) according to the FO developed within 24 h after operation. The pediatric Risk, Injury, Failure, Loss, and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation. Factors including age, height, weight, preoperative LVEF, preoperative biomarkers, operative data, postoperative ventilation time, duration of intensive care unit(ICU)stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO≥5% developed within 24 h after operation.The effect of FO≥5% on postoperative severe acute kidney injury (Injury and Failure), ventilation time, duration of ICU stay and etc. was assessed. Results: Fourteen cases developed early postoperative FO≥5%, and the incidence was 33%.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO≥5% (P<0.05). Compared with FO<5% group, the postoperative ventilation time and duration of ICU stay were significantly prolonged, the number of pediatric patients who developed pulmonary infection and required reintubation was increased, the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P<0.05), and no significant change was found in the other parameters of clinical outcomes in FO≥5% group (P>0.05). Conclusion Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair, and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5% occurs.

Objective: To explore the feasibility of assessing complications registration through medical information. Methods: A descriptive case series study was performed to retrospectively collect medical information and complication registration information of gastric cancer patients at Department of Gastrointestinal Cancer Center Ward I, Peking University Cancer Hospital from November 1, 2016 to March 1, 2017 (the first period), and from November 1, 2018 to March 1, 2019 (the second period). Case inclusion criteria: (1) adenocarcinoma confirmed by gastroscopy and biopsy; (2) patients undergoing open surgery or laparoscopic radical gastrectomy; (3) complete postoperative medical information and complication information. Patients who were directly transferred to ICU after surgery and underwent emergency surgery were excluded. Because difference of the complication registration procedure at our department existed before and after 2018, so the above two periods were selected to be used for analysis on enrolled patients. The prescription information during hospitalization, including nursing, medication, laboratory examination, transference, surgical advice, etc. were compared with the current Standard Operating Procedure (SOP, including preoperative routine examinations, inspection, perioperative preventive antibiotic use, postoperative observational tests, inspection, routine nutritional support, prophylactic anticoagulation, and prophylactic inhibition of pancreatic enzymes, etc.) for gastric cancer at our department. Medical order beyond SOP was defined as medical order variation. Postoperative complication was diagnosed using the Clavien-Dindo classification criteria, which was divided into I, II, IIIa, IIIb, IVa, IVb, and V. Medical order variation and complication registration information were compared between the two periods, including consistence between medical order variation and complication registration, missing report, underestimation or overestimation of medical order variation, and registration rate of medical order variation [registration rate = (total number of patients–number of missing report patients)/total number of patients], severe complications (Clavien-Dindo classification ≥ III), medical order variation deviating from SOP and the corresponding inferred grading of complication. The data was organized using Microsoft Office Excel 2010. Results: A total of 177 gastric cancer patients were included in the analysis. The first period group and the second period group comprised 89 and 88 cases, respectively. The registrated complication rate was 23.6% (21/89) and 36.4% (32/88), and the incidence of severe complication was 2.2% (2/89) and 4.5% (4/88) in the first and the second period, respectively. The complication rate inferred from medical order variation was 74.2% (66/89) and 78.4% (69/88), and the incidence of severe complication was 7.9% (7/89) and 4.5% (4/88) in the first and second period, respectively. In the first and second period, the proportions of medical order variation in accordance with registered complication were 36.0% and 45.5% respectively; the proportion of underestimation, overestimation and missing report were 5.6% and 4.5%, 4.5% and 4.5%, 53.9% and 45.5%, respectively; the registration rate of medical order variation was 46.1% and 54.5%; the number of case with grade I complications inferred from medical order variation was 34 (38.2%) and 25 (28.4%), respectively; and the number of grade II was 12 (13.5%) and 15 cases (17.0%), respectively. The reason of the missing report of medical order variation corresponding to grade I complication was mainly the single use of analgesic drugs outside SOP, accounting for 76.5% (26/34) and 64.0% (16/25) in the first and second period respectively, and that corresponding to grade II complication was mainly the use of non-prophylactic antibiotics, accounting for 9/12 cases and 5/15 cases, respectively. Conclusions Medical information can evaluate the morbidity of complication feasibly and effectively. Attention should be paid to routine registration to avoid specific missing report.

Objective:To evaluate the effect of deep learning based on DWI and fluid attenuated inversion recovery (FLAIR) to construct a prediction model of the onset time in acute stroke.Methods:A total of 324 cases of acute stroke with clear onset time, from January 2017 to May 2020 in Nanjing First Hospital, were retrospectively enrolled and analyzed. The patients were divided into a training set of 226 patients and a test set of 98 patients according to the complete randomization method using a 7∶3 ratio, and the patients were divided into ≤ 4.5 h and >4.5 h according to symptom onset time in each group. The acute infarction areas on DWI and the corresponding high signal area on FLAIR were manually outlined by physician. Using the InceptionV3 model as the basic model for image features extraction, the deep learning prediction model based on single sequence (DWI, FLAIR) and multi sequences (DWI+FLAIR) were established and verified. Then the area under curve (AUC), accuracy of human readings, single sequence model and multi sequence model in predicting the acute stroke onset time from imaging were compared.Results:DWI-FLAIR mismatch was found in 94 cases (94/207) of patients with symptom onset time from imaging ≤ 4.5 h, while in 28 cases (28/117) of patients with symptom onset time from imaging >4.5 h. ROC analysis showed that the AUC of DWI-FLAIR mismatch in predicting acute stroke onset time from imaging was 0.607, and the accuracy was 60.2%. The prediction model of deep learning based on single sequence showed that the AUC of FLAIR was 0.761 and the accuracy was 71.4%; the AUC of DWI was 0.836 and the accuracy was 81.6%. The AUC of predicting stroke onset time based on the multi-sequence (DWI+FLAIR) deep learning model was 0.852, which was significantly better than that of manual identification ( Z = 0.617, P = 0.002), FLAIR sequence deep learning model ( Z = 2.133, P = 0.006) and DWI sequence deep learning model ( Z = 1.846, P = 0.012). Conclusion:The deep learning model based on DWI and FLAIR is superior to human readings in predicting acute stroke onset time from imaging, which could provide guidance for intravenous thrombolytic therapy for acute stroke patients with unknown onset time.

Objective:To investigate the ultrasonographic features and evolution of thyroid shrinking nodules in order to improve the differential diagnosis and management strategy and avoid unnecessary biopsy.Methods:A total of 245 patients with old bleeding of benign thyroid nodules diagnosed via fine needle aspiration cytology (FNAC) from May 2015 to July 2020 in the southern part of the Shanghai General Hospital Affiliated to the Medical College of Shanghai Jiaotong University, including 263 nodules. The sonographic parameters such as size, shape, aspect ratio, echo, edge, boundary, periphery, halo, calcification, posterior echo enhancement and posterior acoustic attenuation of nodules were analyzed retrospectively, and the ultrasonic appearances of nodules were classified; 41 nodules from 40 patients, who did ultrasound examinations more than twice and had both complete ultrasonographic data, were compared and then classified in order to explore the evolution rules of the nodules.Results:Two hundred and sixty-three thyroid shrinking nodules in 245 cases were classified into 4 types: "cystic wall shrinkage sign" type(71.48%, 188/263), "carcinoma-like" type (22.05%, 58/263), "inflammation-like" type(3.04%, 8/263) and "undefined atypical solid nodules" type(3.42%, 9/263). Of the 41 consecutive follow-up nodules, 37 cases showed obvious cystic wall shrinkage sign, and 7 of them developed into "carcinoma-like" type and 6 cases into "inflammation-like" type.Conclusions:The ultrasonographic appearance of thyroid shrinking nodules is a dynamic process, which can be divided into 4 types: "cystic wall shrinkage sign" , "carcinoma-like" , "inflammation-like" and "undefined atypical solid nodules" types. The "cystic wall shrinkage sign" type is typical and common. The "cystic wall shrinkage sign" type can develope into the "carcinoma-like" type or the "inflammation-like" type.