Disorders of sex development (DSD) is a complex disease that involves multiple traditional professional disciplines.Multidisciplinary team(MDT) mode is a particularly advantageous treatment mode that has been developed in recent years for the diagnosis and treatment of complex diseases.This article is based on the analysis of research progress at home and abroad about DSD and MDT,and the latest advances application of MDT treatment try for DSD,probe into how to establish a DSD-MDT treatment mode in theory preliminarily.

Objective To investigate the reliability and validity of the Chinese version of the schizophrenia cognition rating scale ( SCoRS) . Methods 112 cases of schizophrenia or schizophreniform disorder inpatients were recruited and assessed using the SCoRS( Chinese version) ,the brief assessment of cognition in schizophrenia (BACS) and personal and social performance scale(PSP). The principle component analysis,reliability analysis and correlation analysis were used to analyze the data. Results Standardized Cronbach α = 0.964. All the 20 i-tems were significantly correlated. Except item 1 ,9,18,19 ( r=0. 830,0. 890,0. 871,0. 890) ,the interrater correlation coefficiency (ICC) of the rest of the items was over 0.9. The ICC of global rating scores between two raters was 0. 921. Factor analysis procedure identified three factors. Factor 1 reflected the neurocognitive state; factor 2 reflected the social cognitive state;and factor 3 mainly reflected the daily life function. The SCoRS rating scores were significantly correlated with the BACS and PSP scores. Conclusion The validity and reliability of SCoRS are acceptable. SCoRS is a useful tool for assessing the deficits of the cognitive function for Chinese schizophrenia patients.

Objective To study the changes of bone mineral density(BMD)and bone turnover in postmenopausal osteoporotic patients treated with salmon calcitonin nasal spray. Methods Sixty-seven postmenopausal osteoporotic patients were enrolled in our trial. All of them received calcium and vitamin D; 37patients were treated with salmon calcitonin nasal spray for 12 months and the other 30 patients received calcium and vitamin D only. Dual-energy X-ray absorptiometry(DEXA)and measurements of a series of bone turnover indices were performed before and after medication for 6 and 12 months. Results After treatment with salmon calcitonin nasal spray for6 months, BMD in lumbar spine 2-4 increased but no change occurred in femoral neck. However, after treatment for 12 months, BMD in both lumbar spine 2-4 and femoral neck increased. In the control group, BMD in lumbar spine 2-4 decreased after treatment for 6 and 12 months, but BMD in femoral neck decreased only after 12months. Comparing with the control group, after treatment with salmon calcitonin nasal spray, BMD in lumbar spine 2-4 and femoral neck were increased obviously. The level of TRACP-5b and NTX/Cr decreased after treatment with salmon calcitonin nasal spray for6 months and 12 months, while BALP increased only after treatment for 12 months. In the control group, BALP decreased after treatment for 12 months. The level of 25-(OH)vitamin D increased after treatment for 6 months and 12 months in both groups. Conclusions Long-term treatment with salmon calcitonin nasal spray prevents bone loss and may increase bone mass.

Objective To explore the effects of upper limb robot-assisted therapy on motor function and activities of daily living in con-valescent stroke patients. Methods From June to September, 2016, 12 chronic stroke patients at their first-ever stroke were enrolled and ran-domized into experimental group (n=6) and control group (n=6). Both groups received routine rehabilitation. Additional robot-assisted thera-py was provided to the experimental group, and additional repetitive movement training was provided to the control group, 20 minutes a day, five days a week for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Ashworth Scale (MAS) and Func-tional Independent Measure (FIM) were used to assess the motor function of the upper limbs and hands, the muscular tension of shoulder and elbow, and activities of daily living (ADL) before and after treatment. Results After treatment, the scores of FMA-UE and FIM were bet-ter in both groups (Z>2.032, P<0.05), and no significant difference was found between two groups (t<0.723, P>0.05), however, the scores were a little bit higher in the experimental group than in the control group. After treatment, for the experimental group, the MAS scores of shoulder abduction/adduction and elbow flexion/extension improved (Z>2.121, P<0.05);for the control group, the MAS scores of shoulder abduction/adduction improved (Z>2.000, P<0.05), but the MAS scores of elbow flexion/extension were not significantly different (Z<1.890,P>0.05). There was no significant difference in the MAS scores of shoulder abduction/adduction and elbow flexion/extension between two group (Z<1.734, P>0.05). The moving trail recorded by the computer, gradually became a regular pattern from the mass, saying the motor control ability became better. Conclusion Upper limb robot-assisted therapy can promote the recovery of the motor function of upper limbs and ADL in convalescent stroke patient, similar to the repetitive movement training.

Objective To investigate the effects of 1,25-dihydroxyvitamin D3 [1,25 (OH)2D3] on PCNA expression and cell proliferation in human glomerular mesangial cells. Methods The cultured human mesangial cells, which was subcul?tured 3-8 generations, were randomly divided into four groups: normal control group (plus the DMEM medium containing 5%fetal bovine serum), proliferation in the control group (EGF group, plus 10μg/L of EGF), general intervention group [VD group, plus 10-8 mol/L of 1,25(OH)2D3], proliferation in the intervention group [EGF+VD group, plus 10μg/L EGF and 10-8 mol/L 1,25(OH)2D3] for treatment of 48 h. The cell cycle was detected by flow cytometry,and the expression of PCNA was detected by Western blot assay in four groups. Results (1) Compared with normal control group, G1 phase cells were signifi?cantly reduced, S, G2/M phase cells were increased and PI index was higher in EGF group. And G1 phase cells were signifi?cantly increased, S and G2/M phase cells were significantly decreased, and PI index was lower in VD group. Compared with the EGF group, G1 phase cells were significantly increased in VD group and EGF+VD group, and S, G2/M phase cells de?creased, PI index was lower. (2) Compared with normal control group, the expression of PCNA was higher in EGF group, and lower in VD group. Compared with EGF group, the expression of PCNA was lower in VD group and EGF+VD group. Conclu?sion 1,25 (OH) 2D3 inhibits the proliferation of human glomerular mesangial cells by arresting cell cycle and inhibiting the expression of PCNA protein.

Objective To identify the disease-causing gene mutation in families with anterior segment dysgenesis (ASD).Methods Two ASD families coming from Henan and Hebei provinces were enrolled in this study.Ocular examinations were performed,and periphery blood specimens were collected from each family member under the informed consent.The blood samples of 2 patients and 1 normal person in family 1 and 1 patient and 1 normal person in family 2 were analyzed by the whole exome sequences.The candidate genes were verified by Sanger sequence and predicted damages by PolyPhen-2 and SIFT Human Splicing Finder software.Results Family 1 including 9 patients were examined in serial 3 passages,which conformed to autosomal dominant inheritance pattern.Clinical examination revealed binocular anterior segment dysgenesis in the 9 patients.There were 13 SNV and 55 InDel candidate mutations.And missense mutation c.T2A(p.M1K)on PAX6 gene was found.Family 2 included 8 members,and 2 patients were examined.The splicing mutation c.357 + 1g ＞ c on the same gene was found.Conclusion T2A(p.M1 K) and c.357 + 1 g ＞ c mutations in PAX6 gene are responsible for ASD.Whole exome sequence provides a new approach to detect diseasecausing mutation of ASD with diversity clinical phenotypes.

Objective To determine the effectiveness of preoperative sedation with rectal midazolam and atropine alone or combined with ketamine in infants and young children.Methods One-hundred and six ASA Ⅰ or Ⅱ infants and young children aged 2 months-2 years scheduled for elective general surgical operation were studied in a double blind fashion.The patients were randomly divided into 3 groups:group M received rectal atropine 0.02 mg?kg~(-1) and midazolam 0.5 mg?kg~(-1)(n=39);group MK and MKK received rectal atropine 0.02 mg?kg~(-1), midazolam 0.5 mg?kg~(-1) and ketamine 4 mg?kg~(-1)(MK,n=34)or 8 mg?kg~(-1)(MKK,n=33).The patients were transferred from the ward to the operating room(OR)30 min after rectal administration.Depth of sedation was evaluated before and 15 min after rectal administration; when the patients were separated from their parents and on arrival in OR using De Jong's sedation score system.SpO_2 and HR were monitored in OR.Results The patients were better sedated in group MK and MKK than in group M after rectal administration.Significantly more patients were asleep on seperation from their parents and on arrival in OR in group MK and MKK than in group M. Significantly more patients were calm and not crying at venepuncture in group MKK(63%)and group MK(32%) than in group M(18%).Conclusion Rectal midazolam combined with ketamine and atropine results in better preoperative sedation than rectal midazolam alone in infants and young children.

Objective To investigate whether miR-122 is a target of oxymatrine against HBV. Methods HepG2.2.15 cells were incubated with culture medium containing different concentrations of oxymatrine. The cyto-toxicity of oxymatrine was determined by cck-8 assay. The surface antigen of HBV (HBsAg),antigenof HBV (HBeAg)and HBV DNA in supernatant and intracellular miR-122 were determined in HepG2.2.15 cells after incu-bation with culture medium containing oxymatrine for 72 h. Results The survival percentage of HepG2.2.15 cells under different concentrations of oxymatrine was higher than 95% when the concentration of oxymatrine was lower than 4 mg/mL. After treatment with oxymatrine for 72 h,the secretion of HBsAg and HBeAg,the level of HBV DNA in the supernatant were reduced. The intracellular miR-122 in oxymatrine experience group was 3.5 times higher than that in the negative control group. Conclusions Oxymatrine might be used to inhibit viral replication and antigen expression by enhancing the expression of miR-122 in HepG2.2.15 cells.

Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.

Objective: To explore the relationship between blood levels of cyclophilin A (CyPA) and chronic heart failure (CHF).
Methods: A total of 166 CHF patients were enrolled as CHF group, according to NYHA classiifcation, it was further divided into 4 sub-groups: Class I,n=37, Class II,n=39, Class III,n=46 and Class IV,n=44. In addition, there was a Normal control group,n=52. Blood levels of CyPA, B-type natriuretic peptide (BNP) and high sensitivity C-reactive protein (hs-CRP) were examined and compared among different groups.
Results: Compared with Normal control group, CHF group had elevated CyPA (5.11 ± 2.43) ng/ml vs (2.28 ± 0.61) ng/ml, BNP (385.65 ± 184.06) pg/ml vs (90.37 ± 18.44) pg/ml and hs-CRP (11.74 ± 5.44) mg/L vs (5.99 ± 1.14) mg/L, all P<0.05. As increased severity of NYHA classiifcation, blood levels of CyPA, BNP and hs-CRP between 2 subgroups had the increasing trend accordingly, allP<0.05; while there was an exception: blood levels of CyPA and hs-CRP were similar between Class I subgroup and Normal control group, allP>0.05. Pearson correlation analysis indicated that blood levels of CyPA were positively related to BNP and hs-CRP in CHF patients (r=0.838,P<0.01 and r=0.755,P<0.01).
Conclusion: Blood levels of CyPA were elevated in CHF patients and it’s obviously related to NYHA classiifcation, which might have certain effects on CHF diagnosis and evaluation.