Objective:To explore the differences in the standardized z-score amplitude of low-frequency fluctuations (zALFFs) across different brain regions between children with global developmental delay (GDD) and healthy children (HC) using functional near-infrared spectroscopy (fNIRS), and correlating zALFF values with the subjects′ Gesell Developmental Scale (GDS) scores.Methods:Thirty-one children aged 2-4 years with GDD and 29 HC of the same age were studied. fNIRS was used to record both groups′ brain activity in response to natural stimuli and to measure any changes in oxygenated hemoglobin (HbO) levels in cerebral blood flow. zALFF values were calculated and the values of 44 channels were compared between the two groups. The correlations between zALFF values and GDS scores were computed.Results:The zALFF values of the children with GDD were significantly lower than those of the HC in the right frontal pole (channel 10) and the right pre-motor and supplementary motor areas (channel 43). In contrast, the zALFF values in the left pre-motor and supplementary motor areas (channels 24 and 26) were significantly higher in the children with GDD compared to the HC. Spearman ranked correlation analysis revealed that the zALFF values in the right pre-motor and supplementary motor areas (channel 43) were positively correlated with socialization scores on the GDS ( r=0.37, P≤0.05). Conclusions:The delays in cognitive and motor development in children with GDD may be associated with functional abnormalities in the right frontal polar region and the bilateral premotor and supplementary motor areas. zALFF values from the right premotor and supplementary motor areas are positively correlated with social skills.

Objective:To explore the differences in the standardized z-score amplitude of low-frequency fluctuations (zALFFs) across different brain regions between children with global developmental delay (GDD) and healthy children (HC) using functional near-infrared spectroscopy (fNIRS), and correlating zALFF values with the subjects′ Gesell Developmental Scale (GDS) scores.Methods:Thirty-one children aged 2-4 years with GDD and 29 HC of the same age were studied. fNIRS was used to record both groups′ brain activity in response to natural stimuli and to measure any changes in oxygenated hemoglobin (HbO) levels in cerebral blood flow. zALFF values were calculated and the values of 44 channels were compared between the two groups. The correlations between zALFF values and GDS scores were computed.Results:The zALFF values of the children with GDD were significantly lower than those of the HC in the right frontal pole (channel 10) and the right pre-motor and supplementary motor areas (channel 43). In contrast, the zALFF values in the left pre-motor and supplementary motor areas (channels 24 and 26) were significantly higher in the children with GDD compared to the HC. Spearman ranked correlation analysis revealed that the zALFF values in the right pre-motor and supplementary motor areas (channel 43) were positively correlated with socialization scores on the GDS ( r=0.37, P≤0.05). Conclusions:The delays in cognitive and motor development in children with GDD may be associated with functional abnormalities in the right frontal polar region and the bilateral premotor and supplementary motor areas. zALFF values from the right premotor and supplementary motor areas are positively correlated with social skills.

Objective:To compare the effectiveness of two types of robotic training in improving the lower extremity motor functioning of children with spastic cerebral palsy (SCP).Methods:Twenty-eight children with SCP were randomly divided into a control group and an experimental group, each of 14. Both groups received conventional exercise therapy, paraffin therapy, neuromuscular electrical stimulation, and massage. Both also performed 30 minutes of gait training five days a week for eight weeks assisted by either a Lokomat or a Relink lower limb rehabilitation robot. Before and after the treatment, both groups were evaluated using the Gross Motor Function Measure (GMFM), the Pediatric Balance Scale (PBS), the Modified Tardieu Scale (MTS), the six-minute walk test (6MWT), the Physiological Cost Index (PCI) and their self-selected walking speed (SWS).Results:Significant improvement in all of the measurements were observed in both groups. After the treatment, there were no significant differences between the two group in the average GMFM (section D and E) or PBS scores. The average MTS R1 and R2, SWS, 6MWT and PCI results of the experimental group were, however, significantly better than those of the control group.Conclusion:Applying either the Lokomat or Relink robot in lower extremity rehabilitation improves the lower extremity motor function of children with grade II-III SCP. The Relink robot is the more effective in improving triceps surae spasm and walking ability.

Objective:To investigate the relationship between red blood cell distribution width (RDW) and activity of Crohn′s disease (CD), and explore the diagnostic value of RDW for CD activity.Methods:A cross-sectional study was conducted. Clinical data of CD patients treated continuously at the Sixth Affiliated Hospital of Sun Yat-sen University from November 2012 to October 2014 (CD group) were collected, including the first results of routine hematological examinations and C-reactive protein (CRP) levels after admission. Routine hematological examination results were also collected from healthy peoples undergoing regular health check-ups at the same time, who served as the normal control group. CD patients were divided into remission, mild activity, and moderate-severe activity groups based on the Crohn′s disease activity index (CDAI). The levels of routine hematological indicators including RDW and platelet-to-lymphocyte ratio (PLR) were compared between the CD group and the normal control group, as well as among different subgroups of CD patients. The correlations between RDW, PLR and CD activity or CRP were analyzed, and the diagnostic value of RDW for CD activity was evaluated by using ROC curve. Logistic univariate and multivariate regressions were performed to analyze the influencing factors of the activity of CD. Logistic regression equation was constructed to calculate the diagnostic efficacy of the influencing factors.Results:A total of 303 CD patients (216 males, 87 females; mean age 28.6 ± 11.7 years) were assigned to CD group and 293 healthy peoples (190 males, 103 females; mean age 30.1 ± 12.3 years) were assigned to normal control group. There was no significant differences in age and gender between the two groups (both P>0.05), indicating comparability. Among the CD patients, 109 were in remission group, 106 in mild activity group, and 88 in moderate-severe activity group. There was no significant differences in age and gender among the three subgroups (all P>0.05), indicating comparability. Compared with the normal control group, RDW (15.26% ± 2.51% vs. 13.10% ± 1.13%, P<0.001), PLR (245.09 ± 158.69 vs. 119.07 ± 36.52, P<0.001), neutrophil-to-lymphocyte ratio (NLR) [3.22 (2.06, 4.75) vs. 1.76 (1.39, 2.32), P<0.001], white blood cell count [ (7.68 ± 3.30) ×10 9/L vs. (6.52 ± 1.68) × 10 9/L, P<0.001] and platelet count [ (320.69 ± 116.10) × 10 12/L vs. (230.10 ± 51.08) × 10 12/L, P<0.001] were significantly higher in the CD group, while hemoglobin [ (112.8 ± 21.0) g/L vs. (137.1 ± 13.5) g/L, P<0.001] and platelet distribution width (PDW) [ (10.70 ± 1.91) fl vs. (11.89 ± 1.75) fl, P<0.001] were significantly lower. Compared with patients in remission group, the patients in mild activity group had higher RDW and platelet count, and lower hemoglobin (all P<0.05). Compared with the patients in remission and mild activity groups, the patients in moderate-severe activity group had higher RDW, PLR and NLR, and lower hemoglobin (all P<0.05). Correlation analysis showed the positive correlations between RDW, PLR and CD activity ( r = 0.423, P<0.001; r = 0.295, P<0.001), and RDW was positively correlated with CRP ( r = 0.438, P<0.001). The cut-off value of RDW for predicting CD activity was 13.85%, while the area under curve (AUC) was 0.723 (95% CI: 0.664-0.782, P<0.001), sensitivity was 0.784 and specificity was 0.550. Logistic multivariable regression analysis showed that RDW ( OR = 1.532, 95% CI: 1.291-1.818, P<0.001) and PLR ( OR = 1.003, 95% CI: 1.001-1.006, P = 0.013) were independent risk factors. The combination of RDW and PLR in diagnosing CD activity yielded an AUC of 0.730 (95% CI: 0.673-0.787, P<0.001), sensitivity of 0.407, and specificity of 0.927. Conclusions:CD patients with high RDW have more severe activity. RDW is a simple and practical indicator for diagnosing the activity of CD.

Objective:To investigate the relationship between red blood cell distribution width (RDW) and activity of Crohn′s disease (CD), and explore the diagnostic value of RDW for CD activity.Methods:A cross-sectional study was conducted. Clinical data of CD patients treated continuously at the Sixth Affiliated Hospital of Sun Yat-sen University from November 2012 to October 2014 (CD group) were collected, including the first results of routine hematological examinations and C-reactive protein (CRP) levels after admission. Routine hematological examination results were also collected from healthy peoples undergoing regular health check-ups at the same time, who served as the normal control group. CD patients were divided into remission, mild activity, and moderate-severe activity groups based on the Crohn′s disease activity index (CDAI). The levels of routine hematological indicators including RDW and platelet-to-lymphocyte ratio (PLR) were compared between the CD group and the normal control group, as well as among different subgroups of CD patients. The correlations between RDW, PLR and CD activity or CRP were analyzed, and the diagnostic value of RDW for CD activity was evaluated by using ROC curve. Logistic univariate and multivariate regressions were performed to analyze the influencing factors of the activity of CD. Logistic regression equation was constructed to calculate the diagnostic efficacy of the influencing factors.Results:A total of 303 CD patients (216 males, 87 females; mean age 28.6 ± 11.7 years) were assigned to CD group and 293 healthy peoples (190 males, 103 females; mean age 30.1 ± 12.3 years) were assigned to normal control group. There was no significant differences in age and gender between the two groups (both P>0.05), indicating comparability. Among the CD patients, 109 were in remission group, 106 in mild activity group, and 88 in moderate-severe activity group. There was no significant differences in age and gender among the three subgroups (all P>0.05), indicating comparability. Compared with the normal control group, RDW (15.26% ± 2.51% vs. 13.10% ± 1.13%, P<0.001), PLR (245.09 ± 158.69 vs. 119.07 ± 36.52, P<0.001), neutrophil-to-lymphocyte ratio (NLR) [3.22 (2.06, 4.75) vs. 1.76 (1.39, 2.32), P<0.001], white blood cell count [ (7.68 ± 3.30) ×10 9/L vs. (6.52 ± 1.68) × 10 9/L, P<0.001] and platelet count [ (320.69 ± 116.10) × 10 12/L vs. (230.10 ± 51.08) × 10 12/L, P<0.001] were significantly higher in the CD group, while hemoglobin [ (112.8 ± 21.0) g/L vs. (137.1 ± 13.5) g/L, P<0.001] and platelet distribution width (PDW) [ (10.70 ± 1.91) fl vs. (11.89 ± 1.75) fl, P<0.001] were significantly lower. Compared with patients in remission group, the patients in mild activity group had higher RDW and platelet count, and lower hemoglobin (all P<0.05). Compared with the patients in remission and mild activity groups, the patients in moderate-severe activity group had higher RDW, PLR and NLR, and lower hemoglobin (all P<0.05). Correlation analysis showed the positive correlations between RDW, PLR and CD activity ( r = 0.423, P<0.001; r = 0.295, P<0.001), and RDW was positively correlated with CRP ( r = 0.438, P<0.001). The cut-off value of RDW for predicting CD activity was 13.85%, while the area under curve (AUC) was 0.723 (95% CI: 0.664-0.782, P<0.001), sensitivity was 0.784 and specificity was 0.550. Logistic multivariable regression analysis showed that RDW ( OR = 1.532, 95% CI: 1.291-1.818, P<0.001) and PLR ( OR = 1.003, 95% CI: 1.001-1.006, P = 0.013) were independent risk factors. The combination of RDW and PLR in diagnosing CD activity yielded an AUC of 0.730 (95% CI: 0.673-0.787, P<0.001), sensitivity of 0.407, and specificity of 0.927. Conclusions:CD patients with high RDW have more severe activity. RDW is a simple and practical indicator for diagnosing the activity of CD.

Objective:To provide the risk stratification method of hepatoblastoma (HB) suitable for implementation in China and explore the new treatment method for high-risk HB patients.Methods:A total of 100 cases of children and adolescents under 18 years old with newly diagnosed HB in Sun Yat-sen University Cancer Center and Sun Yat-sen University First Affiliated Hospital from September 2014 to September 2018 were included. According to the clinical stage, AFP level, pathological subtype and other factors, patients were stratified into four groups: extremely low-, low-, intermediate- and high-risk. The patients at very low risk were treated with surgery only and followed-up. The patients at very low risk were treated with C5V(Cisplatin+ 5-Fluroracil+ Vincristine) regimen for 4 courses. The patients at intermediate risk were treated with C5VD(Cisplatin+ 5-Fluroracil+ Vincristine+ Doxorubicin)regimen before and after surgery for 6-8 courses. The patients at high risk were treated with C5VD and IIV (ifoshamide+ irinotecan+ vincristine) alternately before and after surgery for 8 courses.Results:One hundred patients were stratified into extremely low-risk, low-risk, medium-risk and high-risk groups for 2, 10, 51 and 37 cases, respectively. Eighty three cases had evaluable lesions before chemotherapy. Among them, 65 patients achieved partial remission, stable disease and progressive disease were observed in 10, and 8 cases, respectively, with a response rate of 78.3%. During a median follow-up of 20 months, 30 patients experienced tumor relapse or progression, and 27 of them died. The 2-years progression-free survival (PFS) and overall survival (OS) rates were 69.2% and 72.0%, respectively. The 2-years PFS rates of patients with extremely low risk, low risk, medium risk and high risk were 100%, 88.9%, 75.3% and 43.2%, respectively. The 2-years OS rates were 100%, 100%, 81.0% and 44.8%, respectively.Conclusions:The novel HB risk classification is simple and feasible. With active comprehensive treatment, patients at extremely low-, low- and medium-risk have excellent outcomes. The survival rate of high-risk HB patients remains to be improved, and new treatment strategies need to be explored.

Objective:To provide the risk stratification method of hepatoblastoma (HB) suitable for implementation in China and explore the new treatment method for high-risk HB patients.Methods:A total of 100 cases of children and adolescents under 18 years old with newly diagnosed HB in Sun Yat-sen University Cancer Center and Sun Yat-sen University First Affiliated Hospital from September 2014 to September 2018 were included. According to the clinical stage, AFP level, pathological subtype and other factors, patients were stratified into four groups: extremely low-, low-, intermediate- and high-risk. The patients at very low risk were treated with surgery only and followed-up. The patients at very low risk were treated with C5V(Cisplatin+ 5-Fluroracil+ Vincristine) regimen for 4 courses. The patients at intermediate risk were treated with C5VD(Cisplatin+ 5-Fluroracil+ Vincristine+ Doxorubicin)regimen before and after surgery for 6-8 courses. The patients at high risk were treated with C5VD and IIV (ifoshamide+ irinotecan+ vincristine) alternately before and after surgery for 8 courses.Results:One hundred patients were stratified into extremely low-risk, low-risk, medium-risk and high-risk groups for 2, 10, 51 and 37 cases, respectively. Eighty three cases had evaluable lesions before chemotherapy. Among them, 65 patients achieved partial remission, stable disease and progressive disease were observed in 10, and 8 cases, respectively, with a response rate of 78.3%. During a median follow-up of 20 months, 30 patients experienced tumor relapse or progression, and 27 of them died. The 2-years progression-free survival (PFS) and overall survival (OS) rates were 69.2% and 72.0%, respectively. The 2-years PFS rates of patients with extremely low risk, low risk, medium risk and high risk were 100%, 88.9%, 75.3% and 43.2%, respectively. The 2-years OS rates were 100%, 100%, 81.0% and 44.8%, respectively.Conclusions:The novel HB risk classification is simple and feasible. With active comprehensive treatment, patients at extremely low-, low- and medium-risk have excellent outcomes. The survival rate of high-risk HB patients remains to be improved, and new treatment strategies need to be explored.

BACKGROUND: Postoperative cholangitis is a common but severe complication after Kasai portoenterostomy for biliary atresia (BA). This study aimed to identify its prognostic factors. METHODS: Two sets of liver paraffin-embedded tissue samples were collected from BA patients who received Kasai portoenterostomy (n = 25 and n = 31, respectively). Patients were divided into non-cholangitis and cholangitis groups. The infiltration of CD4+, CD8+, CD45RO+, CD68+ cells and expression of Beclin1 were quantitatively evaluated in immunohistochemical analysis. RESULTS: Cholangitis group had a significantly lower CD8+ T cell infiltration but a higher CD45RO+ cell infiltration, and a lower Beclin1 level than non-cholangitis group (all P < 0.01). Multivariate logistic regression analysis indicated that infiltration of CD8+ cells (odds ratio [OR], 0.112; 95% confidence interval [CI], 0.022–0.577) and CD45RO+ cells (OR, 3.88; 95% CI, 1.37–11.03), and Beclin1 level (OR, 0.088; 95% CI, 0.018–0.452) were independent influence factors for early postoperative cholangitis. Receiver operating characteristic (ROC) analysis showed that area under ROC curve (AUROC) values for CD8+ cells, CD45RO+ cells and Beclin1 were 0.857, 0.738 and 0.900, respectively. CONCLUSION: Our findings demonstrated the CD8+ cells, CD45RO+ cells and Beclin1 level possessed the prognostic value for early postoperative cholangitis following Kasai operation, which may be helpful to develop new prevention and treatment strategies for postoperative cholangitis.
Biliary Atresia* ; Cholangitis* ; Humans ; Liver ; Logistic Models ; ROC Curve ; T-Lymphocytes*

Objective To observe what changes the brown adipose tissue (BAT) of T2DM rat models would have,including morphology,function and specially expressed uncoupling protein (UCP1) after the gastric bypass (Roux-en-Y,RYGB) and to explore the effects of RYGB on BAT of T2DM rat models and its related mechanism in order to provide a theoretical and experimental basis for treatment of T2DM patients with RYGB.Methods SD rats were given a high-fat and high-sugar diet for two weeks,by injecting streptozotocin (STZ) 30 mg/kg intraperitoneally to build models.Blood glucose was measured after 72 h and 1 week by the fast blood glucose meter.The models were built successfully if blood glucose at both times were ≥ 16.7 mmol/L.Feeding environment:individually caged,standard rat feed,natural circadian cycle,indoor temperature (18±2)℃,indoor humidity (50±2)％.50 rats were randomly selected and dividing into four groups according to intervention methods:diabetes operation group (group A,n=10),undergoing RYGB surgery with the whole stomach kept;diabetes sham operation group (group B,n=10),the same anesthesia and incision as the previous RYGB group.The operation mode was anterior gastric wall incision and suture,jejunum transection in corresponding position and in situ anastomosis with the same suture method as group A;diabetes control group (group C,n=10),normally feeding after building models;and the last one was the healthy control group (group D,n=10):no special treatment,adequate water feeding ensured.The rest of rats remained to be used.The body mass (BM),fasting blood glucose (FBG),fasting serum insulin(Fins)before and at the 1st,2nd,4th and 8th week after surgery were measured.The number of transversal ceils was calculated by IPP6.0 image software and the average radius of fat cells was calculated.UCP1 expression was tested with western blot.Results ① The fasting blood glucose,fasting serum insulin level and the body weight of dia betic rats were higher than those of the control group,but the insulin sensitivity index was significantly lower.② HE Staining showed:diabetes operation group (group A) rats,compared with diabetes control group and diabetes sham operation group(group B),had obviously higher brown fat cell counts transversally and average radius,and the difference was statistically significant (P＜0.01).Diabetes operation group (group A) rats had no significant difference from the healthy control group(group D) rats,and the diabetes control group (group C) rats had no significant difference from sham operation group (group B) rats as well.③ Western blot showed that after the gastric bypass surgery,compared with the diabetes sham operation group (group B) and the diabetes control group (group C),UCP1 expression of brown adipose tissue of the diabetes operation group (group A) increased significantly (P＜0.05).The diabetes sham operation group (group B) had no significant difference from the diabetes control group (group C),and the diabetes operation group(Group A) had no significant difference from the healthy control group (Group D) as well (P＞0.05).Conclusion RYGB can reduce the body mass and insulin resistance (IR) of diabetic rats and,at the same time,promote the expression of UCP1 of brown adipose tissue.RYGB might increase the activity of brown adipose tissue by regulating the UCP1 signaling pathway to improve body's insulin resistance.