Objective:To assess the practical value of visual scores of magnetic resonance imaging(MRI)features in the diagnosis and classification of dementia with Lewy bodies(DLB).Methods:In this study, 102 DLB patients were prospectively recruited, with 102 cognitively normal elderly people as the normal control group(NC).All included subjects underwent MRI examinations and neuropsychological assessments.Based on the clinical dementia rating(CDR)scale, DLB patients were divided into a mild(CDR=1.0), a moderate(CDR=2.0)and a severe(CDR=3.0)group.The results of MRI were scored visually and the rating scales included medial temporal lobe atrophy(MTA), global cortical atrophy-frontal subscale(GCA-F), posterior cortical atrophy(PCA), white matter lesions(the Fazekas scale), cerebral microbleeds(CMBs), and the Evans Index(EI).Statistical differences were compared between the DLB and NC groups and between DLB patients with different degrees of cognitive impairment.Results:In terms of neuropsychology, the Mini-Mental State Examination(MMSE) score of the DLB group[16.0(11.0, 21.0)]was statistically significantly lower than that of the NC group[29.0(28.0, 30.0)]( Z=-12.31, P<0.001), the Montreal Cognitive Assessment(MoCA)score of the DLB group[9.5(6.0, 15.0)]was statistically significantly lower than that of the NC group[28.0(27.0, 29.0)]( Z=-12.40, P<0.001), and the Activities of Daily Living(ADL)score of the DLB group[32.0(23.8, 40.0)]was statistically significantly higher than that of the NC group[20.0(20.0, 20.0)]( Z=-11.98, P<0.001).The scores of all MRI visual assessment scales in DLB patients were statistically significantly higher than those in the NC group( P<0.001).There were significant differences in MTA scores between DLB patients with different degrees of cognitive impairment( P0<0.001).The MTA score of the mild group[1.0(1.0, 1.0)]was statistically significantly lower than that of the moderate group[2.0(1.0, 2.0)]( P1<0.001, P2<0.001); The MTA score of the moderate group[2.0(1.0, 2.0)]was statistically significantly lower than that of the severe group[2.0(2.0, 3.0)]( P1=0.003, P2=0.010). Conclusions:This study has for the first time after comprehensively evaluated the value of various visual scores in DLB diagnosis, MTA can be used to help diagnose DLB and distinguish the severity of DLB, providing a new supplemental tool for clinical diagnosis.

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common pathological type of glomerular disease. Kidney biopsy, the gold standard for IgAN diagnosis, has not been routinely applied in hospitals worldwide due to its invasion nature. Thus, we aim to establish a non-invasive diagnostic model and determine markers to evaluate disease severity by analyzing the serological parameters and pathological stages of patients with IgAN. METHODS: A total of 272 biopsy-diagnosed IgAN inpatients and 518 non-IgA nephropathy inpatients from the Department of Nephrology of Chinese People's Liberation Army General Hospital were recruited for this study. Routine blood examination, blood coagulation testing, immunoglobulin-complement testing, and clinical biochemistry testing were conducted and pathological stages were analyzed according to Lee grading system. The serological parameters and pathological stages were analyzed. The receiver operating characteristic (ROC) analysis was performed to estimate the diagnostic value of the clinical factors. Logistic regression was used to establish the diagnostic model. RESULTS: There were 15 significantly different serological parameters between the IgAN and non-IgAN groups (all P < 0.05). The ROC analysis was performed to measure the diagnostic value for IgAN of these parameters and the results showed that the area under the ROC curve (AUC) of total protein (TP), total cholesterol (TC), fibrinogen (FIB), D-dimer (D2), immunoglobulin A (IgA), and immunoglobulin G (IgG) were more than 0.70. The AUC of the "TC + FIB + D2 + IgA + age" combination was 0.86, with a sensitivity of 85.98% and a specificity of 73.85%. Pathological grades of I, II, III, IV, and V accounted for 2.21%, 17.65%, 62.50%, 11.76%, and 5.88%, respectively, with grade III being the most prevalent. The levels of urea nitrogen (UN) (13.57 ± 5.95 vs. 6.06 ± 3.63, 5.92 ± 2.97, 5.41 ± 1.73, and 8.41 ± 3.72 mmol/L, respectively) and creatinine (Cr) (292.19 ± 162.21 vs. 80.42 ± 24.75, 103.79 ± 72.72, 96.41 ± 33.79, and 163.04 ± 47.51 μmol/L, respectively) were significantly higher in grade V than in the other grades, and the levels of TP (64.45 ± 7.56, 67.16 ± 6.94, 63.22 ± 8.56, and 61.41 ± 10.86 vs. 37.47 ± 5.6 mg/d, respectively), direct bilirubin (DB) (2.34 ± 1.23, 2.58 ± 1.40, 1.91 ± 0.97, and 1.81 ± 1.44 vs. 0.74 ± 0.57 μmol/L, respectively), and IgA (310.35 ± 103.78, 318.48 ± 107.54, 292.58 ± 81.85, and 323.29 ± 181.67 vs. 227.17 ± 68.12 g/L, respectively) were significantly increased in grades II-V compared with grade I (all P < 0.05). CONCLUSIONS The established diagnostic model that combined multiple factors (TC, FIB, D2, IgA, and age) might be used for IgAN non-invasive diagnosis. TP, DB, IgA, Cr, and UN have the potential to be used to evaluate IgAN disease severity.
Adult ; Biomarkers ; blood ; Blood Urea Nitrogen ; Cholesterol ; blood ; Creatinine ; blood ; Female ; Fibrinogen ; metabolism ; Glomerulonephritis, IGA ; blood ; diagnosis ; pathology ; Humans ; Immunoglobulin A ; blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; ROC Curve

BACKGROUND: The biocompatibility of chitosan and Nafion can be improved by external factors. OBJECTIVE: To explore the effect of different weak laser irradiations (red, blue, green) on biocompatibility of porous chitosan membrane and the Nafion membrane. METHODS: (1) Porous chitosan membrane test: Forty-eight Sprague-Dawley rats were randomized into red, green, blue light groups (n=16 per group). Porous chitosan membranes (two membranes at each side) were implanted into the bilateral subcutaneous tissue of the rat back with the spine as the axis of symmetry, and then the four implanted membranes in each rat were irradiated by red light for 0, 2, 4, 6 minutes respectively. The irradiation lasted until sample collection at 7, 14, 28 and 56 days after implantation, and the samples were used for histological analysis. The same procedures were done in the blue and green light groups. (2) Nafion membrane test: Twenty-four Sprague-Dawley rats were randomized into red, blue and green light groups (n=8 per group). Nafion membranes (two membranes at each side) were implanted into the bilateral subcutaneous tissue of the rat back with the spine as the axis of symmetry, and then the four implanted membranes in each rat were irradiated by red light for 0, 2, 4, 6 minutes respectively. The irradiation lasted until sample collection at 7 and 14 days after implantation, and the samples were used for histological analysis. The same procedures were done in the blue and green light groups. RESULTS AND CONCLUSION: The content of red blood cells in blood vessels and vascular density around the membrane materials (porous chitosan membranes and Nafion membranes) increased after irradiated by red light (especially at 7 days after implantation); the red light had less influence on the inflammatory response and fibrous capsule thickness around the two kinds of membranes. The inflammatory cells percentage around the membrane materials irradiated by green light for 4 minutes was significantly reduced, and the blue light had less influence on inflammatory responses; blue and green lights showed effects on the fibrous capsule thickness and vascular density around the membrane materials, but the effect was not obvious. Thus, to a certain extent, weak lasers can improve the biocompatibility of PCSM and Nafion membrane.

BACKGROUND: Caspofungin, a novel echinocandins systemic antifungal agent, has been shown to exert broad-spectrum antibacterial effect on deep fungal infections, which is superior to or equivalent with the role of amphotericin B, but there is no report on its application for preventing fungal infection after renal transplantation.OBJECTIVE: To analyze the difference in high risk factors of fungal infection after kidney transplantation using donation after cardiac death donors and living-related donor kidney transplantations, and to explore the feasibility and safety of caspofungin to prevent fungal infection after kidney transplantation using donation after cardiac death donors.METHODS: This was a prospective, single-center, controlled trial finished at the Department of Kidney Transplantation,the First Affiliated Hospital of Zhengzhou University, Henan Province, China. Totally 188 patients undergoing primary kidney transplantation without history of fungal infection and use of antifungal drugs between January 2012 and August 2013 were enrolled, including kidney transplantation with donation after cardiac death donors (n=102, trail group), and kidney transplantation with living-related donors (n=86, control group). The CYP3A5 genotype was determined preoperatively. All patients received tacrolimus+mycophenolate mofetil+prednisone triple immunosuppression after transplantation. The trial group was subjected to caspofungin therapy for 2 weeks. The risk factors for fungal infection in the two groups were compared, and the effects of caspofungin on the tacrolimus concentration, tacrolimus concentration/dose were detected in the recipients with same CYP3A5 genotype recipients at 1 and 2 weeks, and 1, 3 and 6 months postoperatively. The liver and kidney function, adverse events and fungal infections were recorded at different time points. This trial was registered with the Chinese Clinial Trial Registry (Regitration number:ChiCTR-OON-17013342).RESULTS AND CONCLUSION: The survival rate of patient/kidney was 98.4% and 97.3% respectively, 97 cases in the trial group and 86 controls competed 6-month follow-up. Preoperative hemodialysis time, hemoglobin value, cold ischemia time, warm ischemia time, intraoperative blood transfusion volume, time of central venous catheter kept in situ,methylprednisolone usage, ATG usage, serum creatinine reduced level at 1 week, thrombocytopenia and duration of postoperative body temperature > 38 ℃ were the risk factors for fungal infection in the trail group relative to the control group. The fungal infection rate in the trial and control groups was 0% and 2.3%, respectively, at 6 months of follow-up.The serum creatinine level in the trail group was significantly higher than that in the control group at 1 month postoperatively (P < 0.05), and the level showed no significant difference between two groups at other time points (P >0.05). After 2 weeks of caspofungin treatment, the concentrations of tacrolimus and tacrolimus concentration/dosage did not differ significantly in different CYP3A5 genotype recipients (P > 0.05). Caspofungin might induce some adverse reactions, especially electrolyte disturbance with an incidence of 21.6%, but there was no significant difference between two groups (P > 0.05). These findings imply that kidney transplantation using donation after cardiac death donors presents with various risk factors for fungal infection compared with living-related donor kidney transplantation.Furthermore, caspofungin is effective and safe for preventing fungal infection and has no effect on tacrolimus concentration; therefore, it can be used as a new anti-fungal agent after kidney transplantation.

Objective To develop the method for concentration determi-nation of phenobarbital , phenytoin sodium , topiramate and levertiracetam in human plasma.Methods UPLC -MS/MS was adopted to analyze plasma with protein precipitated by methanol.Sulfamethlazole (SMZ) and pioglitazone hydrochloride were as internal standard.Plasma samples were separated on ACQUITY UPLC HSS PFP column with aqueous solution (0.1%formic acid-5 mmol· L-1 ammonium acetate buffer )-methanol as mobile phase , and at a flow rate of 0.2 mL· min-1.Multiple reaction monitoring ( MRM) mode was performed combined with the ion switching technology for quantification in three sections.Results The liner calibra-tion curve of phenobarbital , phenytoin sodium , topiramate and levertirace-tam were obtained in the concentration range of 1.15 -230.00 ( r =0.997 3 ) , 0.10-20.20 ( r=0.998 5 ) , 0.02-2.12 ( r =0.996 5 ) and 0.10-20.40μg· mL-1(r=0.996 3), respectively.The lowest detection limit were 230.0, 20.20, 5.30,20.40 ng· mL-1 , respectively.The RSD of inter-day and intra -day were less than 15%.The relative recovery was more than 75%.Conclusion The method is accurate , sensitive and suitable for blood concentration monitoring and pharmacokinetic study of phenobarbital , phenytoin sodium , topiramate and levertiracetam.

OBJECTIVETo explore the clinical effects and related factors of combined anterior and posterior surgeries in treatment of double column acetabular fracture.

METHODSFrom August 2007 to July 2009, 19 patients with double column acetabular fracture were treated. There were 13 males and 6 females, with a mean age of 39.6 years (ranged, 27 to 52 years). Among the patients, upper double column fracture was in 11 cases, lower double column fracture was in 8 cases and double column fracture involved sacroiliac joint in 1 case. The mean time from injury to operation was 5.8 days (ranged, 4 to 10 days). All patients were received combined anterior and posterior surgeries, reconstructed plate and fixed by screw.

RESULTSOne patient was death, other patients were followed up from 12 to 18 months (with a mean time of 13.6 months). According to Harris standard, 9 cases got excellent results, 7 good cases and 2 fair.

CONCLUSIONCombined anterior and posterior surgeries for double column acetabular fracture can get satisfactory effects.

Acetabulum ; injuries ; surgery ; Adult ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged

BACKGROUNDAdvances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed for repair of the neonatal esophageal atresia with tracheoesophageal fistula (EA/TEF) to be approached endoscopically. However, thoracoscopic surgery in children is still performed in only a few centers throughout the world. The aim of this study was to compare the neonatal tolerance to the thoracoscopic repair (TR) and the open repair (OR) and also to discuss anesthetic management in thoracoscopic procedure.

METHODSWe performed a prospective study enrolling newborns diagnosed with EA with distal TEF (type C) receiving the repair surgery between June 2009 and January 2012 in our institution. Data collected included the newborns' gestational age and weight at the time of the operation, operative time, parameters of intraoperative mechanical ventilation, oxygenation, end-tidal carbon dioxide (ETCO2), and analysis of blood gases. Time to extubation and length of stay were also recorded.

RESULTSIntravenous induction with muscle paralysis followed by pressure-control ventilation and tracheal intubation regardless of the position of the fistula can be performed uneventfully in EA/TEF newborns with no additional airway anomalies and large, pericarinal fistulas in our experiences. The thoracoscopic approach appeared to take longer than the open approach. During the procedure of repair, hypercarbia and acidosis developed immediately 1 hour after pneumothorax in both groups. CO2 insufflation did have additional influence on the respiratory function of the newborns in the TR group; values of PaCO2 and ETCO2 were higher in the TR group but the difference did not reach statistical significance. By the end of the procedure, values of PaCO2 and ETCO2 returned to the baseline levels while pH did not, but all parameters made no difference in the two groups. Besides, time to extubation was shorter in the TR group.

CONCLUSIONSThoracoscopic repair of EA/TEF is comparable to the open repair, and is believed to be safe and tolerable in selected patients. A wider range of neonates may be acceptable for thoracoscopic EA/TEF repair with increasing surgical experience.

Esophageal Atresia ; surgery ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Prospective Studies ; Thoracoscopy ; methods ; Tracheoesophageal Fistula ; surgery

Objective To study the acceptability of pre-exposure prophylaxis (PrEP) to prevent the transmission of HIV among men who have sex with men (MSM) in Guangxi, China.Methods Snow-balling methods were used to recruit 650 MSM in Guangxi. Questionnaires and interview were administrated to these 650 men, using a self-designed questionnaire and face to face interviews to collect information on HIV-related risk behaviors, knowledge and acceptability of PrEP.effective, safe and free of charge', 597 (91.9%) of the 650 MSM claimed that they would accept it,who refused to use it, most of them said that were afraid of the side-effect and doubted on the effectiveness of PrEP. Data from logistic regression analysis showed that those who had found partners through friends (OR=6.21, P=0.020) and those who would advise his friend to use PrEP (OR=39.32, P=0.000) were more likely to accept PrEP. Those who thought they could protect themselves from HIV infection (OR=0.32, P=0.010) or not having sex with the ones who refused to use a condom (OR=0.34, P=0.010) were less likely to accept PrEP. Conclusion Effectiveness, safety and cost seemed to be the main influential factors related to the acceptability of PrEP. Peer education might improve the acceptability of PrEP.

OBJECTIVETo observe the therapeutic effect of acupoint sticking therapy for treatment of stroke.

METHODSTwo hundred and forty-six cases were randomly divided into a non-acupoint sticking group (control group, n=122) and an acupoint sticking group (n=124). The control group was treated with routine ward treatment of stroke (acupuncture combined with routine western medicine). The acupoint sticking group was treated with basis ward treatment of stroke (similar to the control group), and acupoint sticking therapy was applicated on Shenque (CV 8). The scores of Stroke-Specific Quality of Life (SS-QOL) and WHOQOL-100BREF were adopted to evaluate the therapeutic effects and the cysteine of patients were tested before and after treatment.

RESULTSThere were significant differences in scores comparison of SS-QOL and WHOQOL-100BREF before and after treatment in both groups (both P < 0.001); there was no significant difference after treatment between two groups (P > 0.05); there was a significant difference in thinking items of SS-QOL after treatment between two groups (P < 0.05), the acupoint sticking group was superior to that of control group; SS-QOL score of patients with abnormal cysteine of acupoint sticking group was superior to that of the control group after treatment, with a significant difference between the two groups (P < 0.05).

CONCLUSIONThe acupoint sticking therapy can improve the thinking ability of stroke patients, and improve the life quality of high cysteine stroke patients.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Stroke ; psychology ; therapy ; Thinking

The N gene and genome promoter nucleotide sequence of a Chinese Peste des petits rumiants virus (PPRV) ("China/Tib/Gej/07-30") was firstly determined. The length of N gene was 1689 nucleotides with a single open reading frame (ORF). The nucleotide and deduced amino acid sequence was compared with the homologous region of other PPRV isolates. The nucleotide sequence of the "China/Tib/Gej/07-30" was 91.7%-97.6% identical to other PPRV isolates, while a homology of 94.9%-98.5% could be observed at the amino acids level. The N gene encoded a protein of 525 amino acids. Several sequence motifs were identified on the basis of conservation in the PPRVs and the morbilliviruses. The genome length of promoter region was 107 nucleotides with 91.8%-98.2% identity to other PPRV isolates. Phylogenetic analysis showed that the "China/Tib/Gej/07-30" belonged to the Asian lineage.
Amino Acid Sequence ; Animals ; Base Sequence ; China ; Female ; Genome, Viral ; Goat Diseases ; virology ; Goats ; Molecular Sequence Data ; Nucleocapsid Proteins ; chemistry ; genetics ; Peste-des-Petits-Ruminants ; virology ; Peste-des-petits-ruminants virus ; chemistry ; classification ; genetics ; isolation & purification ; Phylogeny ; Promoter Regions, Genetic ; Sequence Alignment ; Sequence Analysis