Objective: To compare the measurement accuracy of two⁃dimensional (2D) photography and three⁃di⁃mensional (3D) photography in the analysis of the asymmetric appearance of children with cleft lip and palate and the influence of the severity of asymmetric deformity on the accuracy of facial measurement to guide clinical measurement work Methods: Children with unilateral cleft lip were enrolled in this prospective study. Seven parameters⁃⁃the devia⁃tion of the pronasale, subnasale, and labrale superius, as well as the cleft/noncleft ratio of the width of nostrils, length and height of lateral lips and height of columella⁃were measured with Vernier calipers as the gold standard. Traditional 2D photography and 3D stereophotogrammetry photos were taken and measured. The extent of cleft malformation is indi⁃cated by the ratio of the cleft side to the noncleft side. The error size is represented by the ratio difference between two⁃dimensional photography or stereophotogrammetry with the ratio of the gold standard Results: Thirteen patients were eventually recruited. The measurement results of the ratio of lateral lip height by 2D photography tended to be larger (P＝0.019), and the measurement results of the ratio of columella height tended to be smaller (P＝0.008). The measure⁃ment results of the deviation of the subnasale by stereophotogrammetry tended to be smaller (P＝0.003). The pronasale deviation (P＝0.022) with two⁃dimensional photography, the deviation of the labrale superius (P＝0.025) and the ratio of lateral lip length (P＝0.036) with stereophotogrammetry had a significant negative correlation with the extent of cleft malformation Conclusion Both two⁃dimensional photography and stereophotogrammetry have errors and biases that underexaggerate or overexaggerate the extent of cleft malformation, and some errors may increase with the decrease in the extent of cleft malformation. When applying two⁃dimensional and three⁃dimensional photography to analyze cleft lip and palate deformities, these biases should be considered to evaluate the face more objectively

Objective To investigate the effect of Lactobacillus delbrueckii fermented supernatant on Candida albicans biofilm and explore its possible mechanism and effective components.Methods Lactobacillus delbrueckii was isolated from vaginal Lactobacillus capsules (Ding Junsheng) and identified by mass spectrometer and sequencing.Lactobacillus delbrueckii fermented supernatant was prepared.The effect of Lactobacillus delbrueckii fermented supernatant on Candida albicans biofilm was tested by microplate crystal violet staining method and catheterization tube modeling method.Biofilm morphological changes were analyzed by crystal violet staining and Live/ Dead fluorescent dyes.Exopolysaccharides of Candida albicans biofilm was measured by the sulphruic acid-phenol method.The effect of Lactobacillus delbrueckii fermented supernatant on the adherence of Candida albicans biofilm was tested by the method of colony counting on plate.The fermented supernatant was treated with NaOH,catalase,typsin and proteinase K respectively.Then the treated fermented supernatant's effect on Candida albicans biofilm formation was detected.One-way ANOVA or Wilcoxon Rank Sum Test was used as statistical analysis for quantitative data.Results Lactobacillus delbrueckii was successful ly isolated and identified from Ding Junsheng.Lactobacillus delbrueckii fermented supernatant could significantly and dose-dependantly inhibited the formation of Candida albicans biofilm(F=10.804,P=0.000).The morphological changes showed that the fermented supernatant could decrease the formation of biofilm.When treated with Lactobacillus delbrueckii fermented supernatant,Candida albicans biofilm expolysaccharides was significantly inhibited (F=17.140,P=0.000) and adherence ability was reduced.Compared to untreated fermented supernatant (A490=0.486±0.112),the biofilm inhibition effect of fermented supernatant treated with NaOH (A490=0.675 ± 0.095),catalase(A490=0.577 ± 0.118),typsin(A490=0.600 ± 0.044) and proteinase K (A490-0.495±0.084)only decreased slightly,but when compared to the control group (A490=1.079 ± 0.158),the treated fermented supernatant still showed significant biofilm inhibition effect (x2=26.052,P=0.000),which suggested that the effective components of fermented supernatant were organic acid and bacteriocin-like substance.Conclusions Lactobacillus delbrueckii fermented supernatant can effectively inhibit Candida albicans biofilm formation.The action mechanisms are related with expolysaccharides decreasement and adherence reduction.The function components of fermented supernatant are possibly organic acids and bacteriocin-like substance.

Objective To establish a preliminary model which can effectively predict the risk for postoperative delirium (POD) in elderly orthopedic patients and verify its effectiveness.Methods This prospective study involved 2 cohorts.For an analysis cohort,the assessment data of 148 elderly orthopedic patients were collected who had been treated at Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University from June to October 2017.The relevant risk factors for POD (gender,age,BMI,schooling ＜ 9 years,history of smoking and alcohol drinking,concomitant diseases and perioperative factors) were screened after comparing POD and non-POD patients.All the risk factors were analyzed and a predictive model was established after valuation of independent risk factors.A predictive cohort of 66 patients was included according to the same inclusion and exclusion criteria as the analysis cohort out of the patients who had been treated at our hospital from November to December 2017.The 2 cohorts were scored by the predictive model to verify the validity of the model.Results A total of 18 risk factors were identified in this study.In the analysis cohort,age (P =0.006),schooling ＜ 9 years (P =0.043),cerebrovascular disease or mental illness (P =0.004),preoperative albumin (P =0.038) and intraoperative infusion of allogeneic blood (P =0.019) were risk factors for POD.Of them,age (P =0.037),schooling ＜ 9 years (P =0.003) and intraoperative infusion of allogeneic blood (P =0.042) were independent ones.In the predictive model,age ＞ 75 years was assigned 3 points,schooling ＜ 9 years 2 points and intraoperative infusion of allogeneic blood 5 points.The validity of the ROC curve was verified for the predictive model.According to the ROC curve,the analysis cohort had AUC =0.66 and the predictive cohort AUC =0.75,indicating a certain predictive value of the model.Conclusion Our predictive model can be used to effectively screen out those with a high risk for postoperative delirium from elderly orthopedic patients.

Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.

Objective: To evaluate the efficacy and safety of steroids-free immunosuppressive therapy including tacrolimus, cyclosporin A, tripterygium glycosides or intravenous cyclophosphamide in membranous nephropathy (MN) patients combined with type 2 diabetes mellitus (T2DM). Methods: This study was a retrospective analysis of patients with T2DM complicated with biopsy proved MN in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 2009 to January 2017. The patients were divided into steroids-free group and control group. The patients in steroids-free group were treated with one or two immunosuppressive agents except glucocorticoids. The patients in control group were treated with glucocorticoid combining with immunosuppressive agents. Results: A total of 64 patients were enrolled in this study. There were 26 cases in steroids-free group and 38 cases in control group. The total remission rate was 69.24% in steroids-free group and 73.68% in control group at 12 months. In a median follow up of 33(12-106) months, two patients in control group entered hemodialysis and one of them died after 1 year of dialysis. One patient in steroids-free group died of accidental death and no patient entered dialysis. All patients in control group had elevated blood glucose level, whereas only 5 patients in steroids-free group had elevated blood glucose and all these 5 patients used tacrolimus. Conclusion Immunosuppressive regimen without glucocorticoid treatment can reduce side effects on blood glucose level in MN patients with type 2 diabetes, with a certain rate of treatment response.

Objective To investigate the application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair.Methods The retrospective cohort study was conducted.The clinical data of 281 patients with parastomal hernia of abdominal wall who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between March 2013 and April 2017 were collected.Of 281 patients undergoing laparoscopic combined with open parastomal hernia repair with artificial materials,151 using DynaMesh-IPST stoma dedicated mesh and 130 using ordinary anti-adhesive mesh were respectively allocated into the DynaMesh-lPST mesh group and ordinary mesh group.Observation indicators:(1) intra-and post-operative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and long-term complications at 1-,3-,6-month and 1 year postoperatively up to June 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Measurement data with skewed distribution were described as M (P25,P75) and M (range),and comparison between groups was done using rank sum test.Comparison of count data between groups was analyzed using the chi-square test.Results (1) Intra-and post-operative situations:281 patients underwent successfully laparoscopic combined with open parastomal hernia repair with artificial materials.The operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were 100 minutes (60 minutes,120 minutes),(34± 15)mL,17 days (13 days,24 days) in the DynaMesh-IPST mesh group and 100 minutes (85 minutes,120 minutes),(42± 36)mL and 20 days (16 days,25 days) in the ordinary mesh group,with statistically significant differences between groups (Z=2.166,t=2.654,Z=2.795,P＜0.05).The postoperative incisional infection and intestinal leakage were respectively detected in 18 and 2 patients in the DynaMesh-IPST mesh group and 36 and 7 patients in the ordinary mesh group,showing a statistically significant difference of incisional infection between groups (x2 =11.194,P＜0.05),and no statistically significant difference of intestinal leakage between groups (x2 =4.234,P＞ 0.05).Of 54 patients with postoperative incisional infection,4 were cured after removing mesh and clearing up infection,50 were cured after dressing change,local debridement and drainage.(2) Follow-up:279 of 281 patients including 149 in the DynaMesh-IPST mesh group and 130 in the ordinary mesh group were followed up for 20-44 months with a median time of 32 months.During the follow-up,10 patients had hernia recurrence including 4 in the DynaMesh-IPST mesh group and 6 in the ordinary mesh group.Six of them underwent reoperation (4 with keyhole hernia recurrence,1 with mesh bulging out because of abdominal weakness at stoma,1 with parastomal recurrence after mesh removal due to intestinal leakage) and 4 had regular reexamination after fixation with abdominal belt.There was no statistically significant difference of hernia recurrence between groups (x2 =0.318,P＞0.05).Twenty-seven patients (14 in the DynaMesh-IPST mesh group and 13 in the ordinary mesh group) with intestinal obstruction were improved by conservative treatment,showing no statistically significant difference between groups (x2 =0.043,P＞0.05).Ten patients (6 in the DynaMesh-IPST mesh group and 4 in the ordinary mesh group) with stoma stenosis were improved after local stoma remodeling,showing no statistically significant difference between groups (x2=0.007,P＞ 0.05).Ninteen patients (4 in the DynaMesh-IPST mesh group including 1 complicated with hernia recurrence and 15 in the ordinary mesh group including 2 complicated with hernia recurrence) with stoma prolapse were improved after local stoma remodeling,showing a statistically significant difference between groups (x2 =8.756,P ＜ 0.05).Conclusion Parastomal hernia repair with DynaMesh-IPST stoma dedicated mesh is safe and feasible,with satisfactory effects.

OBJECTIVE To analyze mutation of POMT1 gene in a Chinese family affected with congenital muscular dystrophy (CMD). METHODS Peripheral blood samples of the family including one affected and two unaffected individuals, in addition with chorionic villous sample from the fetus, were collected. PCR was used to amplify exons 19 and 20 of the POMT1 gene, and the products were sequenced directly. Based on the result of genetic testing, prenatal diagnosis of the fetus was attained. RESULTS The proband was found to carry a heterozygous missense mutation c.1939G>A (p.Ala647Thr) in exon 19 of the POMT1 gene inherited from the mother and a heterozygous frameshift mutation c.2141delG (p.Trp714Ter) in exon 20 inherited from the father. Prenatal diagnosis revealed that the fetus has carried the c.1939G>A (p.Ala647Thr) missense mutation. With the disease causing mutation, the fetus was predicted to have similar phenotype as its mother. CONCLUSION The compound heterozygous mutations of c.1939G>A (p.Ala647Thr) and c.2141delG (p.Trp714Ter) probably underlie the CMD in this family. Based on the result, prenatal diagnosis may be provided.

Objective To establish a rat model of Cryptococcus neoformans meningitis. Methods Sprague-Dawley rats were divided into four groups (group A to D). The load of Cryptococcus neoformans was inoculated by intracisternal injection to the animals in Group A (1×105 cfu), Group B (1×106 cfu), Group C (1×107 cfu), and 0.9％ NaCl solution to Group D. The rats were observed after inoculation for their clinical symptoms. On day 14 and day 21 after inoculation, cerebrospinal fluid was sampled and cultured for counting of bacterial colonies. The 28-day mortality of the animals was calculated. Results All the animals in group A (1×105 cfu) survived without any apparent clinical symptoms, and associated with decreasing bacteria load. The animals in group B (1×106 cfu) had mild symptoms associated with low mortality rate and slightly increased bacterial load. The animals in group C (1×107 cfu) showed a lot of symptoms and associated with high mortality rate and significantly increased bacteria load. All the animals in group D (0.9％ NaCl solution) survived with normal activity. No bacterial colony was cultured from the cerebrospinal fluid. Conclusions Intracisternal injection of 1×107 cfu Cryptococcus neoformans to rats could cause apparent clinical symptoms of meningitis. The 28-day mortality rate of such a rat model of Cryptococcus neoformans meningitis is greater than 80％. An ideal rat model of Cryptococcus neoformans meningitis is established successfully.

OBJECTIVE: To explore the characteristics of PAH gene variants among 113 phenylketonuria patients from Henan Province. METHODS: The 13 exons of the PAH gene were subjected to PCR amplification and direct sequencing. Large fragment deletion and duplication of the PAH gene were detected with a multiple ligation-dependent probe amplification (MLPA) assay. RESULTS: In total 195 point variants and 3 large fragment deletions were detected among the 226 alleles, with the detection rates being 86.28% and 1.33%, respectively. Variants of p.Arg243Gln (18.14%), p.Arg111X (6.19%), p.Arg53His (5.31%), EX6-96A>G (5.31%), p.Tyr356X (4.87%) and p.Val399Val (4.42%) were relatively common. Most of the variants were located in exons 7, 11, 3 and 6. Missense variations were most common. Four novel variations were detected, which included c.1016C>A (p.Ser339Tyr), c.1000T>C (p.Cys334Arg), c.1110G>T (p.Glu370Asp), and IVS6+1G>T. CONCLUSION The PAH gene variations in Henan Province have featured extensive allelic heterogeneity and variety.
China ; Exons ; Humans ; Mutation, Missense ; Phenylalanine Hydroxylase ; genetics ; Phenylketonurias ; genetics ; Point Mutation ; Sequence Deletion

Objective To investigate the relationship between the composition of vaginal microbiota and the course of cervical precancerous lesion.Methods A total of 64 vaginal swabs were collected from 22 healthy women, 18 CINⅠ patients and 24 CINⅡ/Ⅲ patients who visited Obstetrics and Gynecology of the Second Xiangya Hospital of Central South University during July 2014 and July 2015.The Bacterial genomic DNA was extracted and the V3 and V4 hypervariable regions of 16S rRNA were amplified and high-throughput sequenced.The abundance and composition of vaginal microbiota were analyzed by Uparse, Mothur and LefSe statistical software.Results There was no significant difference in Alpha diversity index between CINⅡ/Ⅲ group(Chao:63±32;ACE:72±38;Simpson:0.70±0.27;Shannon:0.70±0.63) and control group ( Chao:48±24;ACE:54±25;Simpson:0.71±0.27;Shannon:0.65±0.58)(W=192,P=0.11;W=189,P=0.10;W=281,P=0.72;W=241,P=0.62).The ACE(85±37) and Chao(66±25) values of CINⅠgroup were significantly different from those of the control group (ACE:54±25;Chao:48±24)(W=99,P=0.006;W=113,P=0.02).At the phylum level, 78.69%(309 020/392 722) of the vaginal microbiota in the control group was Firmicutes, 16%(62 846/392 722) was Actinobacteria.Firmicutes was reduced to 64.86%(208 422/321 318) and Actinobacteria increased to 27.71%(89 040/321 318) in CINⅠgroup.The composition of vaginal microbiotain in CINⅡ/Ⅲ group was similar to those of control group.At the genus level, the composition of vaginal microbiota were similar between CINⅡ/Ⅲ group and control group, with Lactobacillus as predominant genus[71.81%(307 658/418 424)], Gardnerella[12.91%(55 299/428 424)], others such as Prevotella, atopobium were less.In the CINⅠ group, the abundance of Lactobacillus was decreased to 56.26%(180 787/321 318), Gardnerella was increased to 19.62%(63 057/321 318), and Listeria was increased to 7.7%(24 746/321 318).The composition of vaginal microbiota in the most samples was classified as CSTⅢ and CSTⅠ, with Lactobacillus inersand and Lactobacillus crispatus were dominant respectively.There was no significant difference in the composition of vaginal microbiota between the three groups(χ2=2.72, P=0.949).LEfSe analysis showed that the abundance of bacteria in CIN group and control group were varied.At the genus level, there were significant differences in the abundance of Geobacter, Atopobium and Ureaplasma (P<0.05, P<0.05, P<0.01, respectively).At the species level, there was significant difference in the abundance of Ureaplasma urealyticum serotype 9 (P<0.01).Conclusion The diversity and the composition of vaginal microbiota were similar between CIN patients and healthy women, but the abundances of some bacteria were varied, with Ureaplasma increased in patients with CIN.