Objective To investigate the expression level and clinical significance of cyclic citrullinated peptide antigen-specific T cells(CCP/AST)in synovial fluid and synovial tissue of rheumatoid arthritis(RA)patients.Methods A total of 128 RA patients in Shijiazhuang Hospital of Traditional Chinese Medicine from January to December 2021 were selected as the RA group,and 50 patients who needed arthroscopy for joint pain in the hospital during the same period were selected as the control group.Among the RA group,there were 46 cases in the mild group,52 cases in the moderate group,and 30 cases in the severe group.The protein expression levels of rheumatoid factors(RF)and anticitrullinated protein antibodies(ACPA)in synovial tissues of the subjects in each group were analyzed by Western blot.The frequency of CCP/AST in the synovial fluid of the subjects was analyzed by flow cytometry.The intensity of the staining of CCP/AST in synovial tissues was observed by double immunofluorescence staining/laser confocal scanning.Pearson correlation analysis was used to assess the correlation between the CCP/AST expression of synovial fluid and synovial tissue and RF and ACPA.Logistic regression was used to analyze the risk factors for the development of rheumatoid arthritis.Results In the order of control,mild,moderate and severe groups,RF(1.01±0.01,1.53±0.03,2.01±0.08,2.66±0.12 kDa)and ACPA proteins(1.03±0.01,1.61±0.03,2.04±0.10,2.59±0.13 kDa)in synovial tissues of patients were sequentially elevated,and the differences were all statistically significant(F=14.207,12.446,all P＜0.05).The expression of CCP/AST in synovial fluid of patients in the control,mild,moderate and severe groups was increased sequentially(8.26%±1.68%,22.46%±3.28%,33.58%±4.37%,46.15%±5.44%),and the difference was statistically significant(F=25.306,P＜0.05).Meanwhile,the intensity of CCP/AST staining in synovial tissues of patients in the control,mild,moderate and severe groups was also increased sequentially(1.05±0.26,1.35±0.89,2.04±0.56,2.78±0.15 score),and the difference was statistically significant(F=70.67,P＜0.05).The expression of CCP/AST in the synovial fluid and synovial tissues of patients with RA was positively correlated with RF(r=0.861,0.934,all P＜0.05)and ACPA in synovial fluid and synovial tissue(r=0.854,0.913,all P＜0.05).Logistic regression analysis showed that hypertension(OR=3.241,95%CI:1.491～6.752),diabetes mellitus(OR=2.565,95%CI:1.126～5.813),synovial fluid(OR=4.450,95%CI:1.652～11.622),and CCP/AST expression in synovial tissues(OR=5.629,95%CI:2.474～12.390)were independent risk factors for the development of RA(P＜0.05).Conclusion CCP/AST showed high expression in synovial fluid and synovial tissue of RA patients and related to disease activity and joint destruction,which can be used to assess the clinical joint mobility and bone destruction degree in such patients.

Objective:To explore the clinical effect of Intensive Care Unit (ICU) catheter whole life cycle management system.Methods:An ICU catheter whole life cycle management system was constructed and applied in clinical practice. This study collected data on catheter management and hospital infection of patients in ICU of Zhejiang Hospital before the application of the catheter whole life cycle management system from April to December 2019 and after the application of the catheter whole life cycle management system from April to December 2020. The accuracy of catheter recording, the compliance rate of daily catheter nursing quality, and the incidence of major catheter-associated infections were compared before and after the application of the ICU catheter whole life cycle management system. The time-consuming of catheter information recording under the two methods of applying the ICU catheter whole life cycle management system and computer manual input was analyzed, and the nurses' experience of using the ICU catheter whole life cycle management system was investigated through semi-structured interviews.Results:After the application of the ICU catheter whole life cycle management system, the accuracy rate of catheter recording increased from 89.96% (22 491/25 001) to 96.09% (30 897/32 155) , and the difference was statistically significant ( P<0.05) . The compliance rate of daily catheter nursing quality increased from 89.81% (22 453/25 001) to 95.94% (30 849/32 155) , and the difference was statistically significant ( P<0.05) . There was no significant difference in the incidence of major catheter-associated infections before and after system application ( P>0.05) . In addition, the time-consuming of catheter recording by nurses using the ICU catheter whole life cycle management system was less than that of manual input by computer, and the difference was statistically significant [ (0.98±0.28) min vs. (1.78±0.50) min, P<0.05] . The semi-structured interview results showed that nurses had a good experience in using the ICU catheter whole life cycle management system. Conclusions:The ICU catheter whole life cycle management system provides nurses with a systematic, convenient and standardized catheter management method. The system has a good user experience, can improve the accuracy of nurse catheter recording and the catheter nursing quality, and shorten catheter recording time. However, further studies are needed to confirm whether it helps to reduce the incidence of major catheter-associated infections.

OBJECTIVE: By introducing the Medical Device Reporting (MDR) system and related inspection practice of the US, this paper puts forward some suggestions on implementing reporting responsibility of manufactures in China. METHODS: The MDR system and the related inspection system in the US were systematically analyzed. RESULTS: The US had established a sound system for discovering and reporting MDR, and a mechanism for inspecting the implementing of manufactures, forming an effective post-market surveillance system. CONCLUSIONS By learning from the experience of the US, we can carry out the post-market surveillance of medical devices adverse events in China from the aspects of implementing the existing system, strengthening the reporting ability and perfecting the inspection mechanism.
China ; Equipment and Supplies/standards* ; Product Surveillance, Postmarketing

Humans ; Pedigree ; Rosacea ; pathology

Objective To explore the safety and efficacy of Solitaire AB double stents in acute occlusions in bifurcation of cerebral artery (including the ends of internal carotid artery and middle cerebral artery M1 segment).Methods The clinical and imaging data of six cases treated with the double stent retriever technique using the Solitaire AB system in Wuhan No.1 Hospital from January to November 2017 were retrospectively analyzed.And the therapeutic effect and postoperative complications of them were analyzed.Results One patient took the double stents directly,whereas five patients were treated with double stent-retriever thrombectomy after the failure of single stent thrombectomy.All of the six patients achieved recanalization successfully (modified thrombolysis in cerebral infarction (mTICI) 3 in five patients,mTICI 2b in one).All patients had no intracranial hemorrhage immediately after thrombectomy.In the 24 hours,7 days and 2 weeks,the median NIHSS score was 10 (3-17),3 (1-15) and 1 (0-15),respectively.During perioperative period,one patient had asymptomatic cerebral hemorrhage,one died of symptomatic cerebral hemorrhage within 48 hours,and one was complicated with pulmonary infection.Five patients were followed up by outpatient visit,and four patients showed good outcome (modified Rankin Scale score ≤2).Conclusion In the emergency revascularization of acute cerebral artery occlusion at arterial bifurcation,double stent-retriever is better at increasing the efficacy of thrombectomy and is safe compared with single stent mechanical thrombectomy.

Objective:To explore the relationship between unexplained palpitation in children and head-up tilt test (HUTT).Methods:A total of 142 children with the main symptom of unexplained palpitation were admitted to the Specialist Out-Patient Clinic of Children's Cardiovascular Disease from Sept.2008 to Feb.2017 in the Second Xiangya Hospital,Central South University.Among them,63 cases were male,79 cases were female,with the mean age of (10.12±2.88) years old.The detailed history,physical examinations,conventional 12 electrocardiogram,chest X-ray,echocardiography,myocardial enzymes and thyroid function were all examined.The disorders of heart disease,systemic disease and drug effect were ruled out.The HUTT inspection was then given to them.Results:Among the 142 palpitation cases,79 cases were HUTT positive (55.6％) and 63 cases were HUTT negative (44.4％).The age in HUTT positive patients was older than that in HUTT negative patients (P＜0.05),with no significant difference in gender (P＞0.05).There were three types of hemodynamic changes in HUTT positive patients.Among them,38 cases were postural orthostatic tachycardia syndrome (48.1％),36 cases were the vasovagal syncope vasodepressive type (45.6％) and 5 cases were the vasovagal syncope mixed type (6.3％).There were no hemodynamic types for vasovagal syncope cardioinhibitory type,orthostatic hypotension and orthostatic hypertension.Conclusion:Among the clinically unexplained palpitations children,more than half are caused by unbalanced autonomic nervous function.HUTT can help clear the cause of unexplained palpitations.

Objective To design an effective,inexpensive and handy scoring system of preliminary screening for the diagnosis of orthostatic intolerance (OI)in children and adolescents. Methods Two hundred and seventy -four children or adolescents diagnosed or hospitalized in Children′s Syncope Specialist Clinic or Inpatient Department of the Second Xiangya Hospital of Central South University from July 2016 to March 2017,who were complaining about the following symptoms like unexplained syncope,dizziness,headache,chest tightness,chest pain,etc. The 274 cases in-cluded 141 males and 133 females aging from 5 to 18 years old with a mean age of (11. 8 ± 2. 7)years. Each patient was asked to finish OI questionnaire and head - up tilt test (HUTT). The scores of the eight symptoms,including palpi-tation,headache,profuse perspiration,blurred vision or amaurosis,chest tightness,dizziness,gastrointestinal symptoms and syncope,were added as OI symptom scores. The data were analyzed by SPSS 18. 0 software. Results All the pa-tients were divided into HUTT negative group (n = 151)and positive group (n = 123). The positive group was com-posed of vasovagal syncope (VVS)(n = 88),postural orthostatic tachycardia syndrome (POTS)(n = 33)and ortho-static hypertension (OHT)(n = 2). Among them,31 cases were positive in baseline HUTT (BHUT)and 92 cases were negative in sublingual nitroglycerin - provocated HUTT (SNHUT). The mean OI symptom scores of HUTT positive group were distinctly higher than those of negative group [(6. 4 ± 4. 6)scores vs. (3. 5 ± 3. 4)scores,P = 0. 000]with significant difference. Taking score ≥2. 5 as the borderline,the sensitivity and specificity of HUTT result prediction were 79. 2％ and 50. 3％,respectively. Since the score was supposed to be integer number,HUTT result should be con-sidered as positive when the score was ≥3. In the HUTT positive group,the scores of POTS children group were signifi-cantly higher than those of VVS group [(8. 8 ± 5. 2)scores vs. (5. 5 ± 4. 1)scores,P < 0. 01]and the mixed syncope had the lowest score in the VVS group;The scores of BHUT positive group were obviously higher than those of SNHUT positive group [(7. 8 ± 4. 6)scores vs. (5. 6 ± 4. 4)scores,P < 0. 05]and all the difference were significant. Conclusions OI symptom score has some predictive value on the results of HUTT and can be served as a preliminary screening of OI in children and adolescents.

OBJECTIVETo analyze mutations of SLC26A4 gene and explore their origins for a patient with enlarge vestibuar aqueduct syndrome.

METHODSClinical data and peripheral venous blood samples were collected from the patient and her parents. Genome DNA was extracted from the peripheral blood. All of the 21 exons of the SLC26A4 gene were amplified with PCR and subjected to directly sequencing.

RESULTSThe patient was found to have carried two mutant alleles of the SLC26A4 gene, namely c.1522A to G and c.1229C to T, which were inherited from her father and mother, respectively.

CONCLUSIONSLC26A4 c.1522A to G is likely to be a pathogenic mutation. Above results may facilitate genetic counseling and prenatal diagnosis for this family.

Adult ; Amino Acid Sequence ; Child ; Exons ; Female ; Hearing Loss, Sensorineural ; genetics ; Humans ; Male ; Membrane Transport Proteins ; genetics ; Molecular Sequence Data ; Pedigree ; Vestibular Aqueduct ; abnormalities

Objective To explore the effects of oral rehydration salts [Ⅰ] (ORS Ⅰ) for autonomic nerve mediated syncope(NMS) in children with different hemodynamic patterns.Methods A total of 105 patients with unexplained syncope and prodromal symptoms of syncope who were confirmed as NMS by head-up tilt table test(HUTY) and treated in the Department of Pediatric Cardiovasology,Children's Medical Center,the Second Xiangya Hospital,Central South University,from March 2012 to February 2015.Their ages were from 4 to 18 years old,the average age was (11.96 ± 2.86) years old.Totally 73 cases were diagnosed as vasovagal syncope (VVS) (46 cases were vasodepressor type,27 cases were VVS mixed type or cardioinhibitory type),while 32 cases were diagnosed as postural orthostatic tachycardia syndrome(POTS).Simple random method was used to divide them into conventional therapy (health education and tilt training) plus ORS Ⅰ group (55 cases),and conventional therapy group (50 cases).Patients were followed up for 6-25 (14.82 ± 6.13) months.The recurrence of syncope and review of HUTT outcome assessment in 6 months,treatment was studied to evaluate short-term efficacy of 2 different therapies for NMS in children with different hemodynamic patterns.Taking recurrence of syncope as outcome events,Kaplan-Meier curves were drawn to compare long-term efficacy of different therapies in treating NMS children.Results There was no statistical difference in the short-term efficacy among the different hemodynamic patterns when treated with conventional therapy plus ORS I,or conventional therapy(all P ＞ 0.05).The cumulative efficiency of the conventional therapy plus ORS Ⅰ was superior to that of the conventional therapy for NMS children through the long-term follow-up study (74.5％ vs.52.0％,x2 =14.424,P ＜ 0.01).Patients with vasodepressor patterns had a better response than those with mixed or cardioinhibitory patterns to conventional therapy plus ORS I (90.0％ vs.61.1％,x2 =4.435,P ＜ 0.05).Conclusions Compared with VVS mixed type or cardioinhibitory type,children with VVS vasodepressor patterns are more appropriate to take ORS I as initial treatment.

OBJECTIVE To evaluate the clinical value of contrast-enhanced ultrasonography (CEUS) in diagnosing thyroid carcinoma.METHODS The clinical data of 129 patients with thyroid nodules,who were examined by CEUS and were operated in Xinhua Hospital between Jan 2014 and Aug 2015,were analyzed in order to compare the diagnostic results of CEUS to the postoperative pathologic findings,and to summarize its imaging features.RESULTS A total of 132 thyroid nodules in 129 patients were examined by CEUS.Among them,103 nodules were diagnosed as thyroid carcinoma,24 nodules were benign thyroid tumor and 5 nodules were thyroiditis.Compared with pathology results,the diagnostic accuracy,sensitivity and specificity of contrast-enhanced ultrasound is 88.6％,92.2％ and of 75.9％ respectively.The diagnosis of the CEUS in 31 cases was not consistent with the pathological results,in which 8 cases of thyroid carcinoma were misdiagnosed as benign tumor,3 cases of thyroiditis were misdiagnosed as thyroid carcinoma,and 20 cases of benign tumors were misdiagnosed as thyroid carcinoma.The malignant thyroid nodules mainly were papillary carcinoma,which was characterized by'low enhanced'and'slow in fast out'performance in the contrast-enhanced ultrasound examination.CONCLUSION The contrast-enhanced ultrasound examination in diagnosing thyroid carcinoma has much more specificity and sensitivity,the'low-enhanced'and'slow in fast out'signs of the CEUS were the important features of malignant thyroid nodules.