Objective:To determine the genetic causes of dystonic cerebral palsy (DCP) of unknown etiology by using whole exome and mitochondrial gene detection methods, and to analyze clues for early identification of DCP.Methods:This was a retrospective analysis of clinical data describing 21 children with unknown etiology and DCP-like phenotypes. It involved collecting a detailed medical history, biochemical testing, neuroimaging, electroencephalography and hematuria metabolic screening. Peripheral blood was collected from the children, their parents and their siblings. Genomic DNA was extracted, and whole exome and/or mitochondrial gene sequencing was performed to obtain variant sites and annotations. The candidate variants were verified by Sanger sequencing.Results:No clear perinatal risk factors were found in the 21 cases, though there was 1 case of family history. Laboratory tests found increased lactic acid in 3 and abnormal thyroid function in 2 cases. The neuroimaging showed lesions in the basal ganglia in 2 cases, delayed myelination in 6 cases, sometimes with cortical dysplasia, a wide extracerebral space and/or a thin corpus callosum. The images of 11 of the children were normal. Later follow-up showed changes in the brain magnetic resonance images (MRIs) of 2 of the children. Pathogenic or likely pathogenic candidate variants were identified in 15 of the 21 children (71%) within 12 genes: TH, SLC16 A2, RHOBTB2, FOXG1, IFIH1, WDR45, MT- ATP6, KIAA2022, GNB1, GNAO1, SLC2 A1 or NACC1. Fifteen of the children received a precise diagnosis. Genetic testing found heterozygous variants of ATP1 A2, SPR, ATP1 A3, MED13 L or NR4 A2 genes in the remaining six children, all of which were non-pathogenic variants. Conclusions:The absence of perinatal high-risk factors, a positive family history, and a normal or progressive brain MRI can be used as early clues to identify atypical DCP cases. TH, SLC16 A2, RHOBTB2, FOXG1, IFIH1, WDR45, MTATP6, KIAA2022, GNB1, GNAO1, SLC2 A1 and NACC1 variants belong to the spectrum of DCP-related pathogenic genes, and attention should be paid to the interpretation of genomic analysis results.

Objective:To analyze the clinical features，diagnosis，treatment and prognosis of children with juvenile dermatomyositis(JDM) complicated with interstitial lung disease(ILD).Methods:The clinical manifestations，laboratory examination，treatment and prognosis of 7 children with JDM-ILD who were hospitalized in the Department of Nephrology and Immunology，Women and Children's Hospital Affiliated to Qingdao University from December 2019 to December 2023 were retrospectively analyzed.Results:Among the 7 cases，4 were male and 3 were female.The age of onset was 1.8-10.0 years（mean age 5.6 years），the occurrence time of pulmonary involvement was 0.6-4.0 months（mean time 2.0 months），and the follow-up time was 1.8-4.0 years.All the 7 cases had typical rash and different degrees of myasthenia.Four cases were accompanied by skin mucosal ulceration and 4 cases had fever during the course of the disease.Of the 7 cases，2 were accompanied by macrophage activation syndrome，and 1 of them had nervous system involvement，including convulsion and coma.All the children had increased creatase of varying degrees，and only 1 case had increased creatine kinase.Five cases had positive anti- melanoma differentiation-associated gene 5（MDA5）antibody and 4 cases had positive anti- Ro-52 antibody.Interleukin-6 was increased in 5 cases，interferon-γ was increased in 3 cases，and tumor necrosis factor-α was increased in 2 cases.Electromyography showed myogenic injury，MRI showed different degrees of myositis.Chest high-resolution CT showed ground glass shadow，rope shadow，consolidation shadow，pleural thickening，mesh shadow，etc.Four cases had limited lung function or mixed ventilation function restriction.All 7 cases received methylprednisolone pulse treatment combined with immunosuppressant treatment，and 5 cases received immunoglobulin treatment.Pulmonary lesions improved in 5 cases and partially improved in 1 case.One case died due to macrophage activation and multiple organ failure.Conclusion:The respiratory symptoms of JDM-ILD are obscure，and the incidence of ILD is high in children with anti-MDA5 antibody positive.High-resolution CT contributes to early diagnosis.Reasonable early application of glucocorticoid and immunosuppressants could improve the survival rate and quality of life.

Objective:To analyze the clinical features，diagnosis，treatment and prognosis of children with juvenile dermatomyositis(JDM) complicated with interstitial lung disease(ILD).Methods:The clinical manifestations，laboratory examination，treatment and prognosis of 7 children with JDM-ILD who were hospitalized in the Department of Nephrology and Immunology，Women and Children's Hospital Affiliated to Qingdao University from December 2019 to December 2023 were retrospectively analyzed.Results:Among the 7 cases，4 were male and 3 were female.The age of onset was 1.8-10.0 years（mean age 5.6 years），the occurrence time of pulmonary involvement was 0.6-4.0 months（mean time 2.0 months），and the follow-up time was 1.8-4.0 years.All the 7 cases had typical rash and different degrees of myasthenia.Four cases were accompanied by skin mucosal ulceration and 4 cases had fever during the course of the disease.Of the 7 cases，2 were accompanied by macrophage activation syndrome，and 1 of them had nervous system involvement，including convulsion and coma.All the children had increased creatase of varying degrees，and only 1 case had increased creatine kinase.Five cases had positive anti- melanoma differentiation-associated gene 5（MDA5）antibody and 4 cases had positive anti- Ro-52 antibody.Interleukin-6 was increased in 5 cases，interferon-γ was increased in 3 cases，and tumor necrosis factor-α was increased in 2 cases.Electromyography showed myogenic injury，MRI showed different degrees of myositis.Chest high-resolution CT showed ground glass shadow，rope shadow，consolidation shadow，pleural thickening，mesh shadow，etc.Four cases had limited lung function or mixed ventilation function restriction.All 7 cases received methylprednisolone pulse treatment combined with immunosuppressant treatment，and 5 cases received immunoglobulin treatment.Pulmonary lesions improved in 5 cases and partially improved in 1 case.One case died due to macrophage activation and multiple organ failure.Conclusion:The respiratory symptoms of JDM-ILD are obscure，and the incidence of ILD is high in children with anti-MDA5 antibody positive.High-resolution CT contributes to early diagnosis.Reasonable early application of glucocorticoid and immunosuppressants could improve the survival rate and quality of life.

Objective:To determine the genetic causes of dystonic cerebral palsy (DCP) of unknown etiology by using whole exome and mitochondrial gene detection methods, and to analyze clues for early identification of DCP.Methods:This was a retrospective analysis of clinical data describing 21 children with unknown etiology and DCP-like phenotypes. It involved collecting a detailed medical history, biochemical testing, neuroimaging, electroencephalography and hematuria metabolic screening. Peripheral blood was collected from the children, their parents and their siblings. Genomic DNA was extracted, and whole exome and/or mitochondrial gene sequencing was performed to obtain variant sites and annotations. The candidate variants were verified by Sanger sequencing.Results:No clear perinatal risk factors were found in the 21 cases, though there was 1 case of family history. Laboratory tests found increased lactic acid in 3 and abnormal thyroid function in 2 cases. The neuroimaging showed lesions in the basal ganglia in 2 cases, delayed myelination in 6 cases, sometimes with cortical dysplasia, a wide extracerebral space and/or a thin corpus callosum. The images of 11 of the children were normal. Later follow-up showed changes in the brain magnetic resonance images (MRIs) of 2 of the children. Pathogenic or likely pathogenic candidate variants were identified in 15 of the 21 children (71%) within 12 genes: TH, SLC16 A2, RHOBTB2, FOXG1, IFIH1, WDR45, MT- ATP6, KIAA2022, GNB1, GNAO1, SLC2 A1 or NACC1. Fifteen of the children received a precise diagnosis. Genetic testing found heterozygous variants of ATP1 A2, SPR, ATP1 A3, MED13 L or NR4 A2 genes in the remaining six children, all of which were non-pathogenic variants. Conclusions:The absence of perinatal high-risk factors, a positive family history, and a normal or progressive brain MRI can be used as early clues to identify atypical DCP cases. TH, SLC16 A2, RHOBTB2, FOXG1, IFIH1, WDR45, MTATP6, KIAA2022, GNB1, GNAO1, SLC2 A1 and NACC1 variants belong to the spectrum of DCP-related pathogenic genes, and attention should be paid to the interpretation of genomic analysis results.

Objective To analyze the correlation between digital mammography features,lymphocyte to monocyte ratio(LMR)and prognosis in patient with invasive breast cancer,and to explore the prognostic value of digital mammography features and LMR in invasive breast cancer.Methods Ninety-six patients with invasive breast cancer were selected.The data of digital mammography features and serum LMR levels were analyzed.The patients were followed up after discharge.According to different prognosis,all patients were divided into good prognosis group(68 cases)and poor prognosis group(28 cases).Spearman was used to analyze the correlation of digital mammography features,LMR level and prognosis of patients.Receiver operating characteristic(ROC)curve was drawn to analyze the prognostic value of digital mammography features and LMR level.Results The spicule sign and proportion of calcifica-tion in the poor prognosis group was significantly higher than that in the good prognosis group,the maximum diameter of tumor was significantly larger than that in the good prognosis group,and the serum LMR level was significantly lower than that in the good prognosis group(P＜0.05).Spearman correlation analysis showed that spicule sign,proportion of calcification and maximum diame-ter of tumor were positively correlated with poor prognosis of invasive breast cancer(P＜0.05).Serum LMR level was negatively correlated with poor prognosis of invasive breast cancer(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of spicule sign,calcification and tumor maximum diameter combined with LMR level to evaluate the prognosis of invasive breast cancer was 0.927,the sensitivity was 89.71％,and the specificity was 82.14％,which were significantly higher than those of each index alone.Conclusion Digital mammography and serum LMR levels may be closely related to the prognosis of patients with invasive breast cancer,and spicule sign,calcification,tumor maximum diameter combined with serum LMR may be of significant prognostic value in invasive breast cancer.

Objective To analyze the clinical and genetic features of immunodeficiency,centromeric instability,and facial anomalies (ICF) syndrome with a case report and literature review.Methods The clinical data and genetic test of a girl diagnosed with ICF syndrome in the Department of Nephrology and Immunology in Qingdao Women and Children's Hospital in December 2016 were extracted and analyzed."ICF syndrome" "immunodeficiency,centromeric instability and facial anomalies syndrome" "ICF syndrome and DNMT3B" were used as key words to search Chinese databases and Pubmed for literature until March 2018,and the literature was reviewed.Results A female patient aged 22 months old with ocular hypertelorism and low-set ears was admitted due to recurrent infection over one year.Laboratory tests showed humoral immune deficiency with IgG＜ 1.34 g/L,IgA＜0.060 g/L,and IgM＜0.179 g/L,but normal cellular immunity (total T lymphocyte 0.503,hepler T lymphocyte 0.328,cytotoxic T lymphocyte 0.166,natural killer cell 0.184,total B lymphocyte 0.276).Whole-exome sequencing revealed a de novo heterozygous splice site mutation c.922-2A＞G in intron 8,and a de novo heterozygous missense mutation c.2477G＞A in exon 23 of DNMT3B gene.Chromosome karyotype analysis showed 46,XX,with 64 out of 100 karyotypes showing centromere instability in chromosome 1.Five papers were found which were all in English,with total of 29 patients.Forty-three mutations were reported,including 34 missense,2 deletion,1 insertion,6 splice site mutations.Eleven patients had complex heterozygosis mutations.All patients had centromere instability,humoral immune deficiency and facial dysplasia which were mainly ocular hypertelorism and low-set ears.Most patients had language and motor development delay,and a few were combined with mental retardation.Conclusions ICF syndrome is a rare autosomal recessive primary immunodeficiency with classic clinical triad manifestations.De novo mutation of DNMT3B gene is one of etiologies according to genetic test.

OBJECTIVE:To study the effects of ginsenoside CK combined with 5-fluorouracil (5-FU) on the proliferation, apoptosis and epithelial mesenchymal transition (EMT) of human pancreatic cancer PANC-1 cells. METHODS:PANC-1 cells of logarithmic growth phase were randomly divided into blank control group,ginsenoside CK group (30 mg/L),5-FU group (25 mg/L)and combination group(ginsenoside CK 30 mg/L+5-FU 25 mg/L). MTT method was used to detect the cell proliferation in-hibition rate in each group after 24,48,72 h;flow cytometry was used to detect the cell apoptosis rate after 48 h;enzyme-linked immunosorbent assay was used to detect the fibronectin expression in cells after 24,48,72,96 h;and Western blot was used to detect the expressions of vimentin,N-cadherin,E-cadherin,protein kinase(Akt)and phosphorylated Akt(p-Akt)protein in cells after 48 h. RESULTS:Compared with blank control group,the cell proliferation inhibition rate,early and late apoptotic rates,pro-tein expression level of E-cadherin in ginsenoside CK group,5-FU group and combination group were obviously increased (P<0.05),while the protein expression levels of fibronectin,vimentin,N-cadherin,and p-Akt/Akt levels were obviously decreased (P<0.05);the effects of above-mentioned indexes in combination group were superior to ginsenoside CK group and 5-FU group (P<0.05). CONCLUSIONS:Both ginsenoside CK and 5-FU can inhibit the proliferation of PANC-1 cells,induce their apoptosis and inhibit EMT,which may be associated with inhibiting phosphatidylinositol 3-kinase/Akt pathway. In addition,the combination of ginsenoside CK and 5-FU can produce a better effect.