Objective    To analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. Methods    The clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. Results    A total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. Conclusion    Early surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.

Objective:To compare the tropism of different adeno-associated virus (AAV) serotypes in retinal cells.Methods:The plasmids pFastBacDual-inCap and pFastBacDual-ITR-CMV-EGFP were constructed for AAV packaging with the baculovirus expression system.Recombinant adeno-associated virus type 2(rAAV2), 6, 8 and 9 serotypes were packaged, and the infectivity of rAAV was evaluated by infecting HEK293T cells at multiplicity of infection(MOI)2000.Twenty-five C57BL/6 mice were divided into five groups, with five mice per group.In the three experimental groups, both eyes of each mouse were injected 1 μl rAAV intravitreally, and 1 μl phosphate buffered saline (PBS) for the eyes of the control group.Two weeks after injection, the retinal tissues were collected for preparing flat mounts and cryosections.Enhanced green fluorescent protein (EGFP) gene expression was observed via fluorescence microscopy and laser scanning confocal microscopy.The study protocol was approved by the Ethics Committee of Suzhou Institute of Biomedical Engineering and Technology.Results:The infection efficiency of the recombinant virus to HEK293T cells was rAAV2>rAAV6>rAAV8>rAAV9, and the transduction efficiency was 39.5%, 18.4%, 8.7% and 4.6%, respectively.In mouse retinal transduction, rAAV2 and rAAV6 were highly expressed in the ganglion cells, and rAAV8 and rAAV9 were highly expressed in the retinal pigment epithelium (RPE) and photoreceptor cells.rAAV2-mediated EGFP expression in retinas was stable within three months after injection.Conclusions:Different rAAV serotypes have varying tropism and transduction efficiencies in retinal cells through intravitreal injection, rAAV2 has a high transduction efficiency and it can be stably expressed in retinas within three months after injection.

Gallstone associated with cirrhotic portal hypertension is not uncommon in clinic, and its incidence rate increased year by year, presenting 2- 3 times of the incidence rate of non-cirrhotic patients. Cirrhotic portal hypertension can lead to a variety of local and systemic physiological changes, and it can promote the incidence of gallstones. Due to the dysfunction of the liver and the blood coagulation which are caused by cirrhotic portal hypertension, the surgical difficulty and risk increases significantly. Currently, scholars still have certain controversy in the options of surgical methods and surgical staging. Now let me review and summarize the pathogenesis and surgical treatment of gallstone associated with cirrhotic portal hypertension.

Objective To investigate the value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) based on ISHIM sequence in the grading of astrocytic tumor.Methods We collected excised tumors confirmed by histological diagnosis from 42 patients including high-grade astrocytic tumors (10 WHO grade Ⅲ,18 WHO grade Ⅳ),and 14 low-grade astrocytic tumors (1 WHO grade Ⅰ and 13 WHO grade Ⅱ).All patients underwent conventional MR imaging,ISHIM IVIM-DWI,and contrast-enhanced MR imaging.Parameters of tumor parenchyma region,peripheral edema regions and the contralateral normal brain white matter sites were measured,and the statistical analysis was conducted.Results The D value in tumor parenchyma region was significantly lower,but the D* and f values were higher in high-grade astrocytic tumor when compared with lowgrade one and all had statistical significance;in tumor peripheral edema region,D value was lower in high-grade astrocytic tumor than that in low-grade one,and the difference had statistical significance but there was no significant difference in terms of the D* and f values.There was no significant difference of the D,D* and f values in contralateral normal brain white matter sites in both high-and low-grade astrocytic tumor.Conclusion The D,D* and f values measured by ISHIM IVIM-DWI are helpful to the judgment of tumor grade and it has greatapplication value in the differential diagnosis of high-and low-grade astrocytic tumor.

Objective To investigate the value of magnetic resonance (MR)diffusion kurtosis imaging (DKI)in diagnostic classi-fication of astrocytic tumors.Methods 31 patients with astrocytic tumors confirmed by operation and pathology were collected,in-cluding low-grade tumors (WHO gradeⅠ and Ⅱ)in 14 and high-grade ones (WHO grade Ⅲ and Ⅳ)in 1 7.Routine MRI and DKI scan were preoperatively conducted using Siemens 3.0T MR scanner.Mean kurtosis (MK),radial kurtosis (RK)and axial kurtosis (AK)values were calculated in the solid portion of the tumors and the contralateral normal white matter.Results The MK,RK and AK values in tumors were lower than those in contralateral normal white matter,and were significantly higher in high-grade tumors than those in low-grade ones (P <0.05).Conclusion The MK,RK and AK values obtained by DKI reflect the histological structure changes of the astrocytic tumors.DKI is helpful for the diagnostic classification of astrocytic tumors,exhibiting more value in optimi-zing the treatment.

AAV-ITR gene expression mini vector is a double-strand or single-strand DNA that only contains inverted terminal repeats of adeno-associated virus, cis-elements and gene of interest and does not contain any other foreign DNA sequences. We prepared Bac-ITR-EGFP and Bac-inrep. Spodoptera frugiperda cells were infected with Bac-ITR-EGFP (P3) and Bac-inrep (P3). Up to 100 μg of AAV-ITR-EGFP gene expression mini vectors were extracted from 2 x 10(7) cells of Sf9 72 h after infection. The gel electrophoresis analysis shows that most forms of AAV-ITR-EGFP gene expression mini vector were monomer and dimer. The mini vector expression efficacy was examined in vitro with HEK 293T cells. The EGFP expression was observed at 24 h after transfection, and the positive ratio reached 65% at 48 h after transfection.
Animals ; Baculoviridae ; DNA, Single-Stranded ; Dependovirus ; Gene Expression ; Genetic Vectors ; HEK293 Cells ; Humans ; Sf9 Cells ; Terminal Repeat Sequences ; Transfection

Objective To evaluate the effect of ultrasound-guided vacuum-assisted minimal invasive resection(Mammotome procedure)of breast lumps through the retromammary space. Methods Seven hundred and eighty-seven patients in Obstetrics and Gynecology Hospital Affiliated to Fudan University from Jan. 2011 to May 2012 were underwent ultrasound-guided Mammotome operation through the retromammary space (retromammary space group,385 cases),or adjacent the lumps,and followed by post-operation visits regularly (Mammotome operation adjacent the lumps group,402 cases). The operation effects were compared between the two groups. Results All cases were followed up for 12 months. The period of Mmmotome operation through the retromam mary space and the rate of resection were(48 ± 6)min and(52 ± 4)min,99. 48%(383 / 385), 99. 25%(399 / 402),perspectively,in group of Mammotome operation through the retromammary space and Mammotome operation adjacent lumpsand. There was no significant difference between the two groups( P> 0. 05). The amount of procedural bleeding,the incidence of ecchymosis,local hematoma and the number of incision in group of Mammotome operation through the retromammary space were(8 ± 3)ml,2. 34%(9 / 385), 0. 52%(2 / 385),(1. 3 ± 0. 6)respectively,which were significantly lower than those in Mammotome operation adjacent the lumps group((14 ± 6)ml,8. 71%(35 / 402),2. 74%(11 / 402),(2. 4 ± 0. 3)respectively). There were statistical difference between two groups( P = 0. 003,P < 0. 001,P = 0. 001,P = 0. 006). The rate of satisfaction in group of Mammotome operation through the retro-mammary space was 98. 70%(380 / 385),which is significantly higher than in group of Mammotome operation adjacent the lumps(89. 30%(359 / 402),P< 0. 01). Conclusion The therapy approach of ultrasound-guided Mammotome operation through the retromammary space has lower hemorrhagic complication,as well as the better effect with special advantages. Therefore it has prospective clinical application.

Objective To determine whether the different pathological types of astrocytic tumours can be differentiated by diffusion tensor MR imaging. Methods In this study, diffusion tensor MR imaging was performed preoperatively in 67 patients with different pathological types of astrocytic tumours. Furthermore , T1WI, T2WI, FLAIR and T1WI enhancement scanning by GD-DTPA were performed preoperatively in all patients. The Mean diffusivity (ADC) values in the tumor parenchyma and normal white matter from different pathological types of astrocytic tumours were measured and analyzed. The ADC with the tumor parenchyma and normal white matter from the tumours were statistically analyzed by SPSS 19.0. The results were expressed as ± s and P < 0.05 was regarded as statistically significant differences. Results There were many differences with ADC (< 10-9 mm2/s) in the tumor parenchyma between fibrillary astrocytoma (1.48 ± 0.12、0.72 ± 0.05) from fat cell astrocytoma (1.31 ± 0.07, 0.69 ± 0.03), There were also many differences with ADC ( < 10-9 mm2/s) in the tumor parenchyma between fibrillary and fat cell astrocytoma from anaplastic astrocytoma (1.06 ± 0.11, 0.71 ± 0.04) and giant cell glioblastoma (0.98 ± 0.09, 0.73 ± 0.04). There were not differences with ADC in the tumor parenchyma between anaplastic astrocytoma from giant cell gliobastona. Conclusion Measurement of tumor parenchyma′s ADC values can identify different pathological types of astrocytic tumours , but not between anaplastic astrocytoma and giant cell glioblastoma. DTI is essential to preoperative evalution of astrocytic tumours.

Objective To investigate the risk factors, clinical and angiographic features of women aged 50 or less with coronary artery disease(CAD). Methods One hundred and seventy-three female CAD patients comifrmed by coronary angiographic aged 50 or less were classiifed as group A, while another 494 non-CAD women aged 50 or less as group B. The differences in CAD risk factors, clinical and angiographic features between the 2 groups were analyzed. Results There were more women with diabetes, positive CAD family history, dyslipidemia or hypertension (especially diastolic hypertension) in group A than in group B. Patient in group A had higher diastolic pressures and serum glucose level than those in group B but both groups had similar body weights, systolic pressures and menopause ages. The serum total cholesterol and triglyceride levels were higher in patients in group A than those in group B while high-density-lipoprotein (HDL) cholesterol and apolipoprotein A levels were lower in group A. The low-density-lipoprotein (LDL) and apolipoprotein B were higher in group A than in group B but without signiifcance. There were more women with positive urine protein in group A than in group B. In group A, more than 50%of patients were with single diseased artery while another 15%with slight coronary artery atherosclerosis or even normal arteries. Most of the lesions were found in left anterior descending artery (LAD) and its branches. Conclusions Risk factors of CAD included diabetes, positive CAD family history, dyslipidemia, hypertension(especially diastolic hypertension) and positive urine protein in women aged 50 or less Menopause alone, without other CAD risk factors, would not lead to CAD. Single vessel disease was more commonly found in this group of patients.

Objective To investigate the detection value of plasma brain natriuretic peptide(BNP) in patients with heart failure.Methods 90 patients with heart failure were selected as subjects of this experiment.These include left ventricular failure,left ventricular diastolic failure and normal cardiac function.The same period 100 cases of healthy people were selected as control group.Compared four groups of patients with plasma BNP.Results plasma BNP of Heart failure patients was higher than the healthy group( P ＜ 0.05 ).The level of the serum BNP of failure patients with left ventricular systolic function was higher than those of other heart failure patients ( all P ＜ 0.05 ).Conclusion Patientswith heart failure plasma BNP to aid medical diagnosis,it has high clinical value.