Objective:To explore therapeutic effect of noninvasive bilevel positive airway pressure ventilation (Bi- PAP)on aged patients with acute left heart failure (ALHF)and evaluation value of NT-proBNP for therapeutic effect in these patients.Methods:A total of 80 aged ALHF patients treated in our hospital were selected.According to random number table,they were equally divided into routine treatment group and BiPAP group (received BiPAP therapy based on routine treatment group ).NT-proBNP level,heart rate (HR),systolic blood pressure (SBP),di- astolic blood pressure (DBP),respiratory rate (RR)and arterial blood gas were compared between two groups be- fore and after treatment.Linear correlation analysis was used to evaluate the correlation among plasma NT-proBNP level and above indexes.Results:There were no significant difference in all indexes between two groups before treatment (P>0.05 all).Compared with before treatment,on 4h after treatment,there were significant reductions in levels of HR,SBP,DBP,RR and NT-proBNP,and significant rise in partial pressure of oxygen in artery (PaO2 ) in both groups (P<0.05 or<0.01),and compared with routine treatment group,there was significant rise in PaO2 [(75.13±19.93)mmHg vs.(85.88±18.47)mmHg],and significant reduction in NT-proBNP level [(3786.71± 1270.38)pg/ml vs.(2658.65±1222.08)pg/ml]in BiPAP group (P<0.05 both).Linear correlation analysis indi- cated that NT-proBNP level was significant positively correlated with HR (r=0.383),SBP (r=0.360),RR (r=0.345)and PaCO2 (r=0.413),and significant inversely correlated with PaO2 (r=-0.471),P<0.05 or<0.01. Conclusion:BiPAP ventilation therapy can improve clinical therapeutic effect in aged ALHF patients,and NT-proB- NP is help to evaluating its therapeutic effects.

Objective To investigate the statistical.method for analyzing nurse job burnout Data. Methods Hotelling T2 test and multivariate analysis of variance(MANOVA)were used to analyze nurse job burnout datum. Results There was statistical significance between different cities,different ethnieities in the personal achievements,hut from three dimensions of the whole job burnout,there are no statistical sig-nificant differences among different cities, different ethnicities and different ages. Conclusions The use of Hotelling T2 test and multivariate analysis of variance to analyzing nurse job burnout data, not only ob-tain overall conclusion, and further use of single-variable analysis may also gain comparative results of each dimensions.

Objective To explore MR perfusion imaging characteristics of rabbit liver.Methods MR perfusion imaging was performed in 10 New Zealand rabbits)weight:2.5～3.0 kg)respectively.The MR perfusion imaging protocol consisted of T1-weighted fast field echo(FFE)sequences with a field of view of 355 mm×75 mm,matrix 89×256,TR/TE of 4.3/1.4 millisecond,slice thickness of 5 mm,intersection gap of 1 mm,NSA of 1.This sequence was repeated 65 times,in 4 slices(in total,80 seconds).The original data were transmitted to PHILIPS workstation and formed MR perfusion images automatically.The MR perfusion images in different liver tissues were observed and analyzed.Results The rabbit liver profiles were depicted on hepatic blood flow(HBF)and hepatic blood volume(HBV)images.Time-intensity curves derived from ROIs drawn in abdominal aorta appeared as a type of rapid increase and decrease,gradually increase in hepatic vein and slowly increase and decrease in normal liver tissues.The peak of MR signal intensity of abdominal aorta,hepatic vein and normal liver tissues were 496±131,323±92,194±58 separately.Conclusion MR perfusion imaging can be performed for rabbit liver successfully by using MR TFE series.The rabbit liver profiles are depicted by HBF and HBV images.The hemodynamics of different liver tissues can be responded by time-intensity curves preliminarily.

Objective: To study the correlation between MR perfusion imaging and pathology after transcatheter arterial chemoembolization (TACE) using VX2 liver cancer model and to provide a theoretical basis to evaluate the curative effect of TACE. Methods; Fifteen New Zealand white rabbits (weight: 2.5-3.0kg) were randomly divided into three groups, with 5 in each group (group 1, pre-TACE; group2, 3 days after TACE; group 3,1 week after TACE). The rabbit VX2 hepatic carcinoma models were presented in all rabbits. All of the three groups received TACE at three weeks after the tumor was implanted. The MR perfusion imaging was performed before chemoembolization, at 3 days and 1 week after chemoembolization respectively for group 1, 2 and 3. Each animal was then sacrificed for pathology observation after MR examination. Results: The lesions assessed before TACE were hyperintense compared with the surrounding liver parenchyma on DWI images. The volume of neoplastic cells became large. Nucleus was hypertrophic with different size and shape. Phase of nucleous mitosis showed in many cells and necrosis was hardly seen. No obvious difference was found between the peripheral area and the core area. At 3 days after TACE, the heterogeneous hypo-intense was observed on DWI images. Many nuclear fragmentation and caryolysis appeared on pathology. Neoplasm necrosis was seen. At 1 week after TACE, the heterogeneous hypo-intense areas became larger. Light microscopy showed incomplete necrosis. There were increased karyopycnosis and nuclear fragmentation. Conclusion: MR perfusion imaging of VX2 liver cancer corresponds well with pathology and can reflect the outcome of liver cancer after TACE.

AIM:To investigate the alleviating effect of ethyl acetate extract from Platycladus orientalis leaves(EAEPOL)on diabetic cardiomyopathy(DCM)and its mechanisms.METHODS:Healthy adult C57BL/6 mice were ran-domly divided into normal control group,DCM group,and EAEPOL group.Cardiac structure and function of the mice were assessed by echocardiography.Myocardial fibrosis was evaluated though myocardial hydroxyproline content determi-nation,myocardial Masson and Sirius red staining,and collagen type I(Col I)and collagen type Ⅲ(Col Ⅲ)immunohis-tochemistry.The degree of myocardial oxidative stress was assessed by measuring malondialdehyde(MDA),superoxide dismutase(SOD)and total antioxidative capacity(T-AOC)levels using kits,as well as detection of nuclear factor E2-re-lated factor-2(Nrf-2)and heme oxygenase-1(HO-1)expression by qRT-PCR and Western blot.Endothelial-mesenchy-mal transition(EndMT)was evaluated by detecting CD31 and α-smooth muscle actin(α-SMA)protein expression by Western blot,and cadherin 5(CDH5)and fibroblast specific protein 1(FSP1)mRNA expression by qRT-PCR,as well as α-SMA immunofluorescence staining.RESULTS:(1)Mouse echocardiography revealed that compared with normal control group,heart rate(HR)and ejection fraction(EF)were significantly reduced in DCM group(P<0.05 or P<0.01),while left ventricular anterior wall thickness at systole and diastole(LVAWs and LVAWd)and left ventricular pos-terior wall thickness at systole and diastole(LVPWs and LVPWd)were significantly increased(P<0.05).Compared with DCM group,the mice in EAEPOL group showed significant increases in HR and EF(P<0.01),and marked decreases in LVAWs,LVAWd,LVPWs and LVPWd(P<0.05).(2)Compared with normal control group,the content of hydroxypro-line in mouse myocardium,the collagen area ratio shown by Sirius red and Masson staining,and the immunohistochemical positive area ratio of Col I and Col Ⅲ in DCM group were significantly increased(P<0.01).Compared with DCM group,the above myocardial fibrosis indicators in EAEPOL group were significantly reduced(P<0.05 or P<0.01).(3)Com-pared with normal control group,the myocardial MDA content and the expression of Nrf-2 in DCM group were significantly increased,while the SOD activity,the T-AOC and the expression of HO-1 was significantly decreased(P<0.01).Com-pared with DCM group,the myocardial MDA content in EAEPOL group was significantly reduced,while the SOD activity,the T-AOC,and the HO-1 and Nrf-2 expression were significantly enhanced(P<0.05 or P<0.01).(4)Compared with normal control group,the myocardial expression of CD31 and CDH5 in DCM group was significantly reduced,the expres-sion of α-SMA and FSP1 was significantly enhanced(P<0.05 or P<0.01),and the α-SMA positive area ratio by immuno-fluorescence staining was also increased(P<0.01).Compared with DCM group,EAEPOL significantly up-regulated the expression of CD31 and CDH5 and down-regulated the expression of α-SMA and FSP1,and the α-SMA positive area ratio by immunofluorescence staining was evidently decreased(P<0.05 or P<0.01).CONCLUSION:EAEPOL may attenuate myocardial fibrosis and improve cardiac function in DCM mice by suppressing oxidative stress and alleviating EndMT.

Objective:To explore the diagnosis and treatment of adolescence-onset methylenetetrahydrofolate reductase (MTHFR) deficiency.Methods:This was a retrospective case study. Nine patients with adolescence-onset MTHFR deficiency were diagnosed at Peking University First Hospital from January 2016 to December 2022, and followed up for more than 1 year. Their general information, clinical manifestations, laboratory tests, cranial images, MTHFR gene variants, diagnosis, treatment, and outcome were analyzed retrospectively.Results:The 9 patients came from 8 families. They had symptoms at age of 8.0 years to 17.0 years and diagnosed at 9.0 years to 17.5 years. Eight were male and 1 was female. Two patients were brothers, the elder brother developed abnormal gait at 17.0 years; and the younger brother was then diagnosed at 15.0 years of age and treated at the asymptomatic stage, who was 18.0 years old with normal condition during this study. The main manifestations of the 8 symptomatic patients included progressive dyskinesia and spastic paralysis of the lower limbs, with or without intellectual decline, cognitive impairment and behavioral abnormalities. Totally, 15 variants of MTHFR gene were identified in the 9 patients, including 8 novel variants. Five patients had brain image abnormalities. Increased plasma total homocysteine level (65-221 μmol/L) was found in all patients, and decreased to 20-70 μmol/L after treatment with betaine and calcium folinate. Besides, the 8 symptomatic patients had their behavior and cognitive problems significantly improved, with a legacy of lower limb motor disorders.Conclusions:Late-onset MTHFR deficiency can occur in adolescence. The diagnosis is usually delayed because of non-specific clinical symptoms. The test of blood total homocysteine could be used as a selective screening test. Eight novel varients of MTHFR gene were identified. Timely treatment can improve clinical condition significantly, and pre-symptomatic treatment may prevent brain damage.

Objective:To analyze the clinical features, genetic characteristics, treatment and follow-up results of patients with hydrocephalus caused by methylmalonic acidemia combined with homocysteinuria, and to discuss the optimal strategies for assessing and treating such patients.Methods:From January 1998 to December 2020, 76 patients with hydrocephalus due to methylmalonic acidemia combined with homocysteinuria in the Department of Pediatrics in 11 hospitals including Peking University First Hospital were diagnosed by biochemical, genetic analysis and brain imaging examination. The patients were divided into operation-group and non-operation-group according to whether they underwent ventriculoperitoneal shunt. The clinical features, laboratory examinations, genotype, and follow-up data were retrospectively analyzed. Data were compared between the two groups using rank sum test, and categorical data were compared using χ 2 test. Results:Among the 76 patients (51 male, 25 female), 5 were detected by newborn screening, while 71 were diagnosed after clinical onset, 68 cases (96%) had early-onset, 3 cases (4%) had late-onset. The most common clinical manifestations of 74 cases with complete data were psychomotor retardation in 74 cases (100%), visual impairment in 74 cases (100%), epilepsy in 44 cases (59%), anemia in 31 cases (42%), hypotonia or hypertonia in 21 cases (28%), feeding difficulties in 19 cases (26%) and disturbance of consciousness in 17 cases (23%). Genetic analysis was performed in 76 cases, all of whom had MMACHC gene variations, including 30 homozygous variations of MMACHC c.609G>A. The most common variations were c.609G>A (94, 62.7%), followed by c.658_660del (18, 12.0%), c.567dupT (9, 6.0%) and c.217C>T (8, 5.3%). Therapy including cobalamin intramuscular injection, L-carnitine and betaine were initiated immediately after diagnosis. A ventriculoperitoneal shunt operation was performed in 41 cases (operation group), and 31 patients improved after metabolic intervention (non-operation group). There was no significant difference in the age of onset, the age of diagnosis, the blood total homocysteine, methionine, and urinary methylmalonic acid concentration between the two groups (all P>0.05). The symptoms of psychomotor development, epilepsy, and visual impairments improved gradually after a long-term follow-up in the operation group. Conclusions:Hydrocephalus is a severe complication of methylmalonic acidemia combined with homocysteinuria. The most common clinical manifestations are psychomotor retardation, visual impairment, and epilepsy. It usually occurs in early-onset patients. Early diagnosis and etiological treatment are very important. Hydrocephalus may improve after metabolic intervention in some patients. For patients with severe ventricular dilatation, prompt surgical intervention can improve the prognosis.

Objective: To explore the effect of Huangqi-Baoxin decoction combined with conventional western medicine on the cardiac function of the patients with diabetic cardiomyopathy (DCM). Methods: A total of 103 DCM patients who met the inclusion criteria were divided into the control group (51 cases) and the research group (52 cases) by random number table method. The control group was treated with conventional therapy, while the study group was treated with Huangqi-Baoxin decoction on the basis of the control group. Both groups were treated for 3 months. TCM syndromes were scored before and after treatment. The serum GSH-Px, SOD and CRP levels were measured by ELISA. Left ventricular ejection fraction (LVEF) and E/A ratio of early diastolic peak velocity to late diastolic peak velocity (E/A) were measured by echocardiography and then evaluate the clinical efficacy. Results: The total effective rate was 92.3% (48/52) in the study group and 76.5% (39/51) in the control group. There was significant difference between the two groups (χ²=4.922, P=0.027). After treatment, the scores of palpitation, shortness of breath, chest tightness and chest pain, fatigue, hypochondriac mass, spontaneous sweating, edema and total scores in the study group were significantly lower than those in the control group (t values were 10.603, 9.997, 10.546, 10.074, 5.211, 3.981, 6.438, 13.502, P<0.01). After treatment, LVEF (46.03% ± 1.70% vs. 42.33% ± 1.63%, t=11.271) and E/A (1.02 ± 0.17 vs. 0.90 ± 0.16, t=3.796) in the study group were significantly higher than those in the control group (P<0.01). After treatment, the serum GSH-Px and SOD levels in the study group were significantly higher than those in the control group (t values were 7.585, 6.816, P<0.01), and CRP level was significantly lower than the control group (t=10.854, P<0.01). Conclusions The Huangqi-Baoxin decoction combined with routine western medicine therapy can improve the clinical symptoms and cardiac function of DCM patients, reduce oxidative stress injury and inhibit inflammation.

OBJECTIVE: To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program. METHODS: A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed. RESULTS: NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035. CONCLUSION NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Aneuploidy ; Cost-Benefit Analysis ; Female ; Humans ; Noninvasive Prenatal Testing ; Pregnancy ; Retrospective Studies ; Trisomy 18 Syndrome/genetics*

Objective·To explore the association between high myopia and life quality among children.Methods·Cross-sectional study method was adopted in this study.Highly myopic children aged 4-10 from 16 districts in Shanghai were enrolled through Shanghai Child and Adolescent Large-scale Eye Study-High Myopia Registration Study.Baseline data for spherical equivalent after cycloplegia and questionnaire data in 2020 were collected.Emmetropic children aged 4-10 from 16 kindergartens and elementary schools in Jing'an District and Pudong New Area were enrolled.The uncorrected visual acuity,corrected visual acuity and spherical equivalent without cycloplegia were measured through myopia screening in schools,and the questionnaire on quality of life was filled out.Quality of life was measured by the Strengths and Difficulties Questionnaire(SDQ)and EuroQol Five Dimensions Questionnaire Visual Analogue Scale(EQ-VAS).After describing and testing the differences in variable distributions between the highly myopic children group and the emmetropic children group,the differences in life quality between the two groups,and the association between spherical equivalent and life quality scores of the highly myopic children were examined by a linear regression model.Results·A total of 193 children with high myopia and 209 children with emmetropia were enrolled.There were statistically significant differences in age[(9.58±0.94)years vs(7.63±1.50)years,P＜0.001]and gender distribution(46.6％males vs 62.7％males,P=0.00l)between the highly myopic children and emmetropic children.After adjusting for age and gender,it was found that there was no statistically significant difference in SDQ score between the highly myopic children and emmetropic children(β=0.313,95％CI-0.723-1.349,P=0.553),but the EQ-VAS score in the highly myopic children was lower than that in the emmetropic children(β=-3.805,95％CI-6.593--1.017,P=0.008).There was no significant relationship between spherical equivalent and SDQ score(β=0.297,95％CI-0.035-0.628,P=0.079)and EQ-VAS score(β=0.579,95％CI-0.330-1.489,P=0.21 1)in the highly myopic children.Conclusion·In children with high myopia,self-evaluated overall health status reflected by EQ-VAS score is poorer compared with that in children with emmetropia.However,the EQ-VAS score is not associated with the degree of high myopia.