Objective To investigate the relationship between blood lipids levels and leukoaraiosis (LA). Methods 322 cases were designed into non-LA group (n=141) and LA group (n=181) according to MRI. LA group was further designed into mild (Fazekas Ⅰ, n=57),moderate (Fazekas Ⅱ, n=52), and severe (Fazekas Ⅲ, n=72) groups according to Fazekas classification. Their blood lipids levels were compared.Results The level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) increased (P<0.05) with the level of LA,while the level of triglycerides (TG) increased in all the LA groups (P<0.05), but no significant difference among them (P>0.05). There was no significant difference among all the groups in high-density lipoprotein cholesterol (HDL-C) (P>0.05). Conclusion TC, TG, and LDL-Cincrease in those with LA, and the TC and LDL-C increase with the severity of LA. The HDL-C do not relate with LA.

Objective To investigate the clinical characteristics of multisystem impairment of Sj(o)gren's syndrome (SS) to make quick and accurate diagnose and treatment to decrease the rate of misdiagnosis and mistreatment.Methods A case of thrombotic thrombocytopenic purpura with SS was reported and the related literatures were reviewed.The clinical manifestations,laboratory examinations,diagnostic criteria and therapy of thrombotic thrombocytopenic purpura with SS were analyzed.Results Purpura haemorrhagica,hemolytic anemia,central nervous systemic symptoms,kidney impairment and fever were the representative clinical manifestations of thrombotic thrombocytopenic purpura with SS.Plasmapheresis was the most effective therapy with the background treatment with glucocorticosteroid and immunosuppressive agents.Conclusion Thrombotic thrombocytopenic purpura with SS presents a complicated clinical manifestations,so misdiagnosis and mistreatment is very frequent.More attention should be paid to this specific situation because the disease is rare and has high mortality rate.

Objective:To study the role of activin A in regulation of neutrophil function by detecting activin receptor expression and cellular activities.Methods:Peritoneal neutrophils were isolated in mouse.After the neutrophils were stimulated with activin A,the expression of ActRⅡA on neutrophils was examined by immunofluorescence and flow cytometry.Expression of Smad3 in neutrophils was analyzed by Western blot.Assays of neutrophils function were performed by detecting respiratory burst, production of NO and phagocytosis.Results:The isolated cells were composed of more than 90% peritoneal neutrophils.ActRⅡA was expressed on mouse neutrophils and Gr-1/ActRⅡA double-positive cells were 41.1%.Activin A promoted Smad3 phosphorylation in neutrophils,increased the production of ROS and O2-(P<0.05),enhanced secretion of NO and phagocytosis of mouse neutrophils(P<0.01),and promoted fluorescent microsphere phagocytosis of neutrophils by flow cytometry ( P<0.01 ) .Conclusion: Activin receptor and activin signaling protein were expressed on mouse neutrophils,activin A might play an important regulatory role in activation and function of neutrophils.

Objective To assess the diagnostic value of fiberoptic ductoscopy(FDS) on the nipple discharge. Methods The clinical data of fifty two consecutive patients with nipple discharge undergoing FDS from November 1998 to April 1999 were retrospectively analysed. Results A total of 62 ducts in 52 patients were successfully examined by FDS. Intraductal tumor of the breast was found in 14 cases(4 cancer and 10 papilloma). The diagnostic rate of FDS on intraductal tumor was 100%; and 85.7% of these patients were microlesions. Six cases were diagnosed as mastitis. Thirty two normal duct cavities presented just simple dilatation. In 73.7% of non tumor patients, the nipple discharge disappeared after irregation via FDS. Conclusions As a simple technique and a minimal traumatic endoscopy, FDS would be useful in detection of the microlesions of breast and might become a new diagnostic method of nipple discharge instead of ductography.

Objective: To investigate the effects of fluoride exposure on the thyroid hormone level and intelligence in rats and to investigate the biomarkers of intellectual impairment induced by high fluoride exposure. Methods: A total of 24 clean healthy Sprague-Dawley rats were randomly divided into control group (tap water containing 0.344 mg/L fluoride) and low-, medium-, and high-fluoride exposure groups (tap waters containing 10, 50, and 100 mg/L sodium fluoride, respectively). One male rat was cohabited with two female rats in the same group. After the offspring rats were weaned, 12 offspring rats (male/female ratio=1∶1) with a similar body weight in each group were subjected to the same treatment for the parental offspring. The offspring rats were sacrificed on the 60th day after birth. The weight of offspring rats was measured. Serum thyrotropin (TSH) , free triiodothyronine (FT₃) , and free thyroxine (FT₄) levels were measured by enzyme-linked immunosorbent assay. The learning and memory abilities of the rats were evaluated by Morris water maze test. The expression of mitochondrial fission 1 (Fis1) and mitofusin 1 (Mfn1) in blood was measured by Western blot. Results: The offspring rats in the medium-and high-fluoride exposure groups had significantly lower serum TSH and FT₄ levels than those in the control group (P<0.05). The place navigation test showed that the offspring rats in the medium-and high-fluoride exposure groups had significantly longer escape latency than those in the control group (P<0.05) , and the high-fluoride exposure group had a significantly longer escape distance than those in the control group (P<0.05). The spatial probe test showed that the offspring rats in the low-, medium-, and high-fluoride exposure groups had significantly shorter swimming time and distance in the target quadrant and total swimming time and distance than those in the control group (P<0.05). Compared with the offspring rats in the control group, those in the low-, medium-, and high-fluoride exposure groups had significantly higher expression of Fis1 (P<0.05) , and those in the low- and medium-fluoride exposure groups had significantly higher expression of Mfn1 (P<0.05) . Conclusion High fluoride exposure can reduce the secretion of thyroid hormone and the abnormality of mitochondrial dynamics in peripheral lymphocytes may provide a clue to identifying the biomarkers of intellectual impairment induced by fluoride exposure.

Objective:To investigate the relationship between intracellular calcium level and neutrophil migration dysfunction in patients with sepsis.Methods:This study retrospectively collected 21 blood samples of patients with sepsis in the First Hospital of Jilin University from December 2017 to September 2018, and 20 healthy people were included as the control group. Peripheral blood neutrophils were isolated from the healthy controls and patients with sepsis using magnetic-activated cell sorting. Multichannel microfluidic microarray technology was used to detect the chemotactic migration of neutrophils. The levels of calcium in neutrophils from healthy controls and sepsis patients as well as in neutrophils from healthy controls that were pretreated with calcium chelators BAPTA-AM and EDTA were detected by flow cytometry using the calcium indicator Fluo-4.Results:The intracellular calcium levels were lower in neutrophils from sepsis patients than in those from healthy controls ( P<0.01). BAPTA-AM and EDTA could reduce the calcium level in neutrophils of healthy controls ( P<0.01). Microfluidics revealed that the migration speed, distance and gap-passing rate of neutrophils in microfluidics were significantly reduced after the decrease of intracellular calcium ( P<0.01). Conclusions:Reduced calcium levels in neutrophils of patients with sepsis may be closely related to the decreased cell migration. This study suggests that the migration impairment of neutrophils can be improved by regulating intracellular calcium levels, which provides a new idea for further research.

Objective To evaluate the differences among five representative and useful Doppler parameters in the diagnosis of the three common types of renal artery stenosis (RAS). Methods Five Doppler parameters including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-interlobar ratio (RIR),acceleration time (AT),and resistant index (RI) were measured in 221 patients before renal arteriography. Differences between the groups of patients with various clinical causes of RAS were analyzed by Chi-Squared test. One-way ANOVA or t test were used to compare the means between different groups.The optimal cutoff value was determined with the maximum sum of sensitivity and specificity. Results Of the 442 renal arteries (main and accessory renal arteries) demonstrated at arteriography,214 were normal or stenosed less than 50 %, 204 stenoses 50% - 99 %, and 24 occlusions. RIR, RAR and RI were significantly different between the atherosclerotic and non-atherosclerotic RAS groups (P ＜0.05), while RPSV and AT were not. The optimal cutoff values of RAR,RIR and RI for detecting RAS between the atherosclerotic and non-atherosclerotic groups were much different (2.5 versus 1.9, 5. 1 versus 6.5, 0.57 versus 0.50,respectively) ,but those of RPSV and AT were similar or the same (170 cm/s versus 200 cm/s,51 ms versus 51 ms,respectively). Conclusions In the case of RAS (diameter reduction≥50%),it is advised to establish separate cutoff values of RAR, RIR and RI according to atherosclerotic and non-atherosclerotic RAS, but the same cutoff value of RPSV and AT can be applied. RIR is a good Doppler parameter in the diagnosis of RAS,especially atherosclerotic and fibromuscular dysplasia RAS.

Absdract Melanoma is characterized by high mortality and poor prognosis. The novel immunotherapy has offered a breakthrough in antitumor activity in melanoma and has offered incremental improvements over standard care. The ASCO annual meeting held on June 1, 2018 in Chicago, was conducted to present the progress of current treatment and promise of those still in clinical development. The academic event showed results of clinical trials in patients with lymph node dissection, adjuvant therapy, immunotherapy, and targeted therapy. Melanoma drugs introduced at the meeting included NIVO, Pembro, T-VEC, Encorafenib, Binimetinib, and CDk4/6i. The development of therapy is retrospected in this paper in order to provide a basis and give hope for melanoma treantment in China.

During pandemic of corona virus disease 2019 (COVID-19), emergency orthopedic trauma is commonly seen. It is particularly important to ensure the emergency treatment quality of orthopedic trauma but avoid cross-infection between doctors and patients. The double-buffered diagnosis and treatment mode refers to the model of patients first undergoing medical observation in the comprehensive buffer ward and the inpatient buffer rooms of various disciplines after admission to confirm the exclusion of COVID-19 and then receiving specialist diagnosis and treatment. The authors summarize the experiences of using the double-buffered diagnosis and treatment model in the Department of Orthopedics, Renmin Hospital of Wuhan University during the prevention and control of COVID-19 pandemic so as to provide a reference for treatment of orthopedic patients.

Objective To investigate the prenatal diagnosis and genetic counseling of fetal nuchal fold (NF) thickening.Methods This study retrospectively analyzed 17 fetuses with increased NF detected by prenatal ultrasound examination in Peking Union Medical College Hospital,Peking Union Medical College & Chinese Academy of Medical Sciences from December 1,2016 to December 1,2017.All cases were divided into isolated (isolated group) or non-isolated increased NF group (non-isolated group) according to whether the fetus had concomitant ultrasonographic abnormalities or not.Karyotype and chromosomal microarray analysis (CMA) were performed on all cases.Clinical data,prenatal genetic testing results and pregnancy outcomes were analyzed.Results Of those twelve cases in the isolated group,two were terminated due to the identification of chromosomal abnormalities and pathogenic copy number variations (CNVs) and the fetal autopsy results were consistent with the prenatal diagnosis.The rest 10 pregnancies were all continued including one fetus carrying a variant of unknown significance,which was proved to be a paternal heredity by CMA,and nine without genetic abnormalities and all-these infants were healthy during follow-up.Among the five non-isolated cases,one was diagnosed as trisomy 21 by karyotyping and CMA,and the other four were found to have structural abnormalities under ultrasound scan,but without genetic abnormalities in karyotyping and CMA.And all the five pregnancies were terminated after genetic counseling and three of them chose whole exome sequencing (WES) for further test.One homozygous mutation in CHRNA 1 gene and one de novo mutation in SETD2 gene were found in two cases,respectively,while no abnormality was identified in the other one case.Conclusions Once increased NF were indicated by ultrasound examination,prenatal genetic testing should be offered to the patients,including CMA,regardless of other ultrasonographic abnormalities,and WES should also be offered when necessary.Considering a thickened NF is associated with increased risks of structural defects,a close follow-up with fetal echocardiography and ultrasound is required even the prenatal tests are normal.