Objective:To observe any effect of using a lower limb exoskeleton robot during ankle rehabilitation training on the walking ability of stroke survivors.Methods:Forty-five persons with cerebral apoplexy were randomly divided into a control group, a robot group and a combination group, each of 15. In addition to routine rehabilitation training 5 days a week for 3 weeks, the robot group additionally trained for 10 minutes assisted by a lower limb exoskeleton. The combined group joined that training and additionally undertook 10 minutes of ankle rehabilitation training. Before and after the experiment all of the participants were evaluated using the Fugl-Meyer lower extremity scale (FMA-LE), the Holden functional walking scale (FAC), and for walking speed and step frequency.Results:After treatment, significant improvement was observed in the average FMA-LE score, FAC grade, walking speed and step frequency in all 3 groups. The robot group′s average FMA-LE score, walking speed and step frequency were then significantly better than those of the control group ( P<0.05). Moreover, the average FMA-LE score, step speed and step frequency of the combined group after treatment were (22.67±1.63) min, (0.65±0.05) m/s and (80.80±4.28) steps /min, respectively, significantly better than the other two groups ( P<0.05). Conclusion:Using an exoskeleton robot combined with ankle rehabilitation training can significantly improve the walking of stroke survivors.

Objective:To investigate the clinical characteristics and risk factors of critical burn patients complicated with invasive fungal infection.Methods:A retrospective case series study was conducted. From January 2017 to December 2022, 88 critical burn patients combined with invasive fungal infection who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 61 males and 27 females, aged 26-74 years. Data on invasive fungal infection sites and the detection of pathogens in patients were recorded. According to the survival outcome within 28 days after admission, the patients were divided into survival group (63 cases) and death group (25 cases). The following data of patients were compared between the two groups, including the basic data and injuries of patients at admission such as age, sex, body weight, total burn area, combination of inhalation injury, combination of hypertension and diabetes, acute physiology and chronic health status evaluation Ⅱ (APACHE Ⅱ) score, and admission time after burns, the levels of blood biochemical indexes within 24 h after admission such as white blood cell count, platelet count, red blood cell count, monocyte count, neutrophil count, lymphocyte count, alanine transaminase, aspartate transaminase, glucose, creatinine, urea nitrogen, D-dimer, galactomannan (GM), 1,3-β-D glucan, and creatine kinase, the application of invasive procedures and vasoactive drugs during the treatment such as continuous renal replacement therapy, ventilator-assisted breathing, tracheotomy, deep vein catheterization, skin grafting >2 times, the levels of infection indicators on post admission day (PAD) 1, 3, 7, and 14 including C-reactive protein (CRP), procalcitonin, lactic acid, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and the detection of pathogens in the process of treatment. Data were statistically analyzed with independent sample t test, analysis of variance for repeated measurement, chi-square test, Mann-Whitney U test, and Bonferroni correction. Multivariate logistic regression analysis was performed to screen the independent risk factors that affected death of critical burn patients complicated with invasive fungal infection. Results:The main sites of invasive fungal infection were the wounds (67 cases) and blood stream (46 cases), with Candida fungi (58 strains) as the main strain for fungi infection, and there were a total of 30 cases of infection with mixed pathogenic bacteria. Compared with those in survival group, the APACHE Ⅱ score, proportions of combination with inhalation injury and hypertension of patients in death group were significantly increased ( t=2.11, with χ2 values of 6.26 and 9.48, respectively, P<0.05), while the other basic data and injury condition had no significant changes ( P>0.05). Compared with those in survival group, the levels of D-dimer, GM, and 1,3-β-D glucan of patients in death group were significantly increased within 24 h after admission (with t values of 2.42, 2.05, and 2.21, respectively, P<0.05), while the other blood biochemical indexes within 24 h after admission, as well as the proportions of applying invasive procedures and application of vasoactive drugs during the treatment process were not significantly changed ( P>0.05). The levels of infection indicators of patients on PAD 1 and 3 were similar between the two groups ( P>0.05). The procalcitonin level on PAD 7 and the levels of CRP, procalcitonin, lactic acid, IL-6, and TNF-α on PAD 14, as well as the proportion of infection with mixed pathogenic bacteria of patients in death group were significantly higher than those in survival group (with t values of 4.69, 3.89, 6.70, 6.14, 4.65, and 3.26, respectively, χ2=12.67, P<0.05). Multivariate logistic regression analysis showed that combination with inhalation injury, combination with hypertension, and infection with mixed pathogenic bacteria were independent risk factors for death of critical burn patients complicated with invasive fungal infection (with odds ratios of 5.98, 4.67, and 6.19, respectively, 95% confidence intervals of 1.42-15.39, 1.41-25.28, and 1.86-20.58, respectively, P<0.05). Conclusions:The main sites of infection in critical burn patients complicated with invasive fungal infection are the wounds and blood stream, with Candida fungi as the main strain for fungi infection, and a large proportion of infection with mixed pathogenic bacteria. The combined inhalation injury, combined hypertension, and infection with mixed pathogenic bacteria are the independent risk factors for the death of those patients.

In this study, we aimed to construct a non-replication mRNA platform and explore the side effects of electroporation-mediated delivery of mRNA on the mice as well as the expression features of the mRNA. With luciferase gene as a marker, in vitro transcription with T7 RNA polymerase was carried out for the synthesis of luciferase-expressed mRNA, followed by enzymatic capping and tailing. The mRNA was delivered in vivo by electroporation via an in vivo gene delivery system, and the expression intensity and duration of luciferase in mice were observed via an in vivo imaging system. The results demonstrated that the mRNA transcripts were successfully expressed both in vitro and in vivo. The electroporation-mediated delivery of mRNA had no obvious side effects on the mice. Luciferase was expressed successfully in all the mRNA-transduced mice, while the expression intensity and duration varied among individuals. Overall, the expression level peaked on the first day after electroporation and rapidly declined on the fourth day. This study is of great importance for the construction of non-replication mRNAs and their application in vaccine or antitumor drug development.
Animals ; Electroporation/methods* ; Gene Transfer Techniques ; Luciferases/metabolism* ; Mice ; RNA, Messenger/genetics*

On March 14, 2017, a thirty years old male severe burn patient accompanied by asphyxia, sudden cardiac arrest, and acute respiratory distress syndrome was admitted to Zhengzhou First People′s Hospital. During the shock stage, the pulse contour cardiac output was monitored for the restrictive rehydration, tracheotomy was performed, and fibrobronchoscope lavage was performed for the treatment of inhalation injury and pulmonary infection. An alternate application of suspended bed and turning bed was conducted to balance the treatment of cerebral edema and pulmonary infection; targeted antibiotics were used for anti-infective treatment; multiple operations were performed for eschar excision and skin grafting. At last, the wounds were all healed, the lung infection was cured, and the patient was discharged with severe disturbance of consciousness. Asphyxia and acute respiratory distress syndrome post-cardiopulmonary resuscitation are serious complications in severe burn patients. The clinical treatment of such patients is very difficult and should be highly alerted.

Objective To explore the value of ultra-high b-value diffusion-weighted imaging(DWI) in diagnosis of prostate cancer. Methods According to inclusion and exclusion criteria, 73 consecutive examinees in Chinese PLA General Hospital from June 2014 to May 2015 were screened. Written informed consent was obtained from all patients. T2WI, conventional DWI with b-value of 1 000 s/mm2and ultra-high b-value DWI with 2 000 s/mm2and 3 000 s/mm2were performed in each examinee. Images were interpreted and were corresponding to histological results conducted by ultrasound guided prostate systematic biopsy. Reference biopsy as the gold standard,the sensitivity,specificity, positive predictive value(PPV) and negative predictive value (NPV) were calculated for each image. Sensitivity and specificity differences between ultra-high b-value DWI and conventional DWI were analyzed. The areas under the curves (AUCs) between ultra-high b-value DWI and other modalities were compared. Results The sensitivity and specificity for ultra-high b-value DWI were 92.5 % and 68.8 % with b-value of 3 000 s/mm2, and they were 88.1 % and 53.1 % for 2 000 s/mm2in peripheral zone. The sensitivity and specificity for ultra-high b-value DWI were 88.0 % and 88.2 % with a b-value of 3 000 s/mm2, and they were 80.0 % and 52.9 % for 2 000 s/mm2in transition zone. The values of sensitivity for ultra-high b-value DWI were significantly higher than those for conventional DWI both in peripheral zone and transition zone (all P <0.000 1). The detection of lesions was comparable with ultra-high b-value DWI at 2 000 s/mm2and 3 000 s/mm2in peripheral zone (P >0.05), whereas the value of specificity for 3 000 s/mm2were significantly higher than that for 2 000 s/mm2in transition zone (P<0.000 1). PPV and NPV for 3 000 s/mm2were significantly higher than those for the other three modalities both in peripheral zone(86.1 % and 81.5 %) and transition zone (91.7 % and 83.3 %). In peripheral zone, the AUCs were 0.591, 0.553, 0.698 and 0.806 in T2WI, conventional DWI and ultra-high b-value DWI at 2 000 s/mm2 and 3 000 s/mm2respectively, for the diagnosis of transition zone cancer were 0.693, 0.506, 0.665 and 0.881 respectively, and the AUCs for the ultra-high b-value with 3 000 s/mm2were the largest. Conclusion Ultra-high b-value DWI is an accurate and reliable method in the diagnosis of prostate cancer.

Objective To observe the effect of injecting botulinum toxin type A ( BTX-A) into the tibialis anterior muscle on spasm and the walking function of stroke survivors with spastic foot drop and strephenopodia. Methods Fifty-six stroke survivors with spastic foot drop and strephenopodia were randomly divided into a tibialis anterior injection group ( Group TA) and a conventional injection group ( Group CG) , each of 28. Both groups had 50 U of BTX-A injected into the medial-lateral heads of the affected gastrocnemius and soleus muscles, and 35 U in-jected into each of two sites in the tibialis posterior. Group TA was additionally injected with 30 U in the tibialis ante-rior. Before the injection, as well as 2, 4 and 12 weeks afterward, both groups were evaluated using the modified Ashworth scale (MAS) for the plantar flexors and varus muscle groups, a 10-minute walking test (10 m-WT), a simple Fugl-Meyer assessment ( FMA) of the lower limb and a timed up and go test ( TUG) . Results Before the injection, there were no statistically significant differences in the average MAS, 10 m-WT, FMA or TUG results be-tween the two groups. After 2 weeks, however, the average MAS score of both groups had decreased significantly, and that improvement was maintained at 4 and 12 weeks after the injection. Moreover, 2, 4 and 12 weeks after the injec-tion, significant differences in the average MAS score were observed between the two groups. The average 10m-WT re-sults, FMA scores and TUG times of both groups also improved significantly, but there were significant differences between the two groups′10m-WT times and FMA scores after 2 and 4 weeks. Conclusions Injecting a small dose of BTX-A into the tibialis anterior can further relieve spasm in the tibialis anterior muscle and improve the walking a-bility of stroke survivors with spastic foot drop and strephenopodia.

OBJECTIVETo assess clinical and pathological features of ovarian transitional cell tumors.

METHODSFourteen cases of ovarian transitional cell carcinoma (TCC) were selected and investigated for their clinical and pathological features. Their immunohistochemical profiles were compared with 12 cases of serous adenocarcinoma (SC) admixed with TCC and 4 cases of EC admixed with TCC 20 cases of pure high-grade serous adenocarcinoma (HG-SC), 15 cases of endometrioid adenocarcinoma (EC), 6 cases of Brenner tumor (BT, 2 cases of malignant BT and 4 cases of benign BT).

RESULTSThe patients' age ranged from 36-63 years (mean, 56 years). All cases underwent surgery and postoperative chemotherapy with TP or CAP program. Clinical follow-up was available in 9 cases, of which 2 patients died. Histologically, all cases showed features of transitional cell carcinoma without BT component. Immunohistochemically, 13 of 14 TCCs were positive for WT-1 and all were positive for CK7, ER, PR and CA125, but negative for Uroplakin III and CK20.Similar immunohistochemical staining patterns were seen in SC admixed with TCC and pure HG-SC. Percentage of the 14 TCC cases were also diffusely positive for BRCA1. All SCs admixed with TCC and pure HG-SCs were diffusely or heterogeneously positive for WT-1, with a sharp contrast and mottled distribution pattern in the heterogeneous cases. All TCCs were diffusely and strongly positive for p53, while 16 of 20 cases of pure HG-SC were positive. The positive ratio of p53 in SCs admixed with TCC cases was 11/12.WT-1 expression in TCCs was significantly higher than BTs, ECs and ECs admixed with TCC (P < 0.01), while no obvious difference was seen when compared with SCs admixed with TCC and pure HG-SCs.SCs admixed with TCC, TCCs and EC were positive for BRCA1 except pure ECs and BTs. The positive rate of Ki-67 of BTs was low, while it was higher in TCCs, SCs admixed with TCC and pure HG-SCs. Only BTs expressed Uroplakin III.

CONCLUSIONSOvarian TCC has characteristic morphological and immunohistochemical features, similar to SC but different from BT. Therefore, TCC should be considered as a morphological variant of HG-SC.

Adult ; Brenner Tumor ; metabolism ; pathology ; CA-125 Antigen ; metabolism ; Carcinoma, Endometrioid ; pathology ; Carcinoma, Transitional Cell ; pathology ; Cystadenocarcinoma, Serous ; pathology ; Female ; Humans ; Middle Aged ; Neoplasm Proteins ; metabolism ; Neoplasms, Glandular and Epithelial ; pathology ; Ovarian Neoplasms ; metabolism ; pathology ; Uroplakin III ; metabolism

The author described the experience at Kennedy Institute of Ethics during her visit and learning as a senior visiting scholar .The author also introduced Kennedy Institute of Ethics to China .In that institute , they not only have the largest library of bioethics in the world but also have a group of research experts and professors who love bioethics and treat their work diligently , show their enthusiasm and warm care to new learning scholars , etc.

BACKGROUND: There is no study addressing transplantation of umbilical cord mesenchymal stem cells for the treatment of spinocerebellar ataxia.OBJECTIVE: To study the clinical effect of human umbilical cord stem cells transplantation in the treatment of autosomal dominant spinocerebellar ataxias. METHODS: Spinocerebellar ataxias patients selected from Stem Transplantation Center of the 455 Hospital of Chinese PLA were treated with umbilical cord mesenchymal stem cells transplantation via intrathecal injection. The number of umbilical cord mesenchymal stem cells was 107 per transplantation, once per week, for 4 weeks.RESULTS AND CONCLUSION: Both the total score of the International Cooperative Ataxia Rating Scale and Activities of Daily Living score were significantly decreased at 1 month after transplantation compared with before treatment (P < 0.05). The nerve function was significantly improved and the total effective rate was up to 16.7%. Experimental findings indicate that, transplantation of umbilical cord mesenchymal stem cells via intrathecal injection is a feasible and effective treatment to ameliorate the clinical efficacy of spinocerebellar ataxias patients and improve their quality of life.

Objective To evaluate the efficacy of moxifloxacin-based triple therapy combined with rebamipide for Helicobacter pylori (Hp) eradication in type 2 diabetic patients.Methods Two-hundred age and sex matched type 2 diabetic patients with Hp infection and accompanied by gastrointestinal symptoms were assigned into rebamipide group (n =100) and placebo group (n =100).Both groups received moxifloxacin-based triple therapy for 10 d to eradicate Hp.Rebamipide was administrated in rebamipide group and placebo was administrated in placebo group for 30 d.All patients proceeded 14C-urea breath test (14C-UBT) hefore and 7-8 weeks after eradication therapy.The blood sugar indices,gastrointestinal symptom scores and Hp eradication rates were measured and compared.Those who had gained successful Hp eradication in both groups proceeded 14 C-UBT again 12 months after eradication therapy,and the re-infection rates of both groups were compared.Results There were no significant differences in the average fasting glucose,postprandial glucose and HbAlc levels between the rebamipide group and the placebo group before and after therapy (P ＞ 0.05),the gastrointestinal symptoms of the rebamipide group were improved more markedly than those of the placebo group after therapy (Rome Ⅲ Criteria,2.1 ± 0.9 vs.4.4 ± 0.7,P ＜ 0.01).The Hp eradication rate with both intention-to-treat (ITT) and per protocol (PP) analysis of the rebamipide group were higher than that of the placebo group [86.0％ (86/100) vs.73.0％ (73/100),P ＜ 0.05 and 92.5％ (86/93) vs.76.8％ (73/95),P ＜ 0.01].The re-infection rates with both ITT and PP analysis of those who had successful eradication in rebamipide group were lower than that in placebo group [19.8％ (17/86) vs.35.6％ (26/73),P＜0.05and20.5％ (17/83) vs.36.6％ (26/71),P＜0.05].Conclusions Moxifloxacin-based triple therapy combined with rebamipide has a more beneficial effect on Hp related symptoms,a higher Hp eradication rate and a lower Hp re-infection rate for type 2 diabetic patients.