Objective To analyze the expression of microRNA(miR)-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis(TBM)and their predictive value for disease severity and prognosis.Methods A total of 187 patients with tuberculous meningitis who visited Qingdao Chest Hospital from January 2018 to December 2022 were regarded and separated into stage Ⅰ(n=62),stage Ⅱ(n=76)and stage Ⅲ(n=49)according to the severity of the condition.There were 131 cases in the good prognosis group and 56 cases in the poor prognosis group according to the prognosis.The qRT-PCR method was applied to detect the expression levels of miR-200a and miR-4652-3p in cerebrospinal fluid.Spearman method was used to analyze correlation among miR-200a,miR-4652-3p and clinical data.ROC curve was applied to analyze the predictive value of cerebrospinal fluid miR-200a and miR-4652-3p levels in evaluating the severity and prognosis of tuberculosis meningitis patients.Multivariate logistic regression was applied to analyze the influencing factors of poor prognosis in patients.Results The expression levels of miR-200a(1.05±0.14,0.91±0.14,0.76±0.13)and miR-4652-3p(0.92±0.11,0.78±0.11,0.65±0.10)in the cerebrospinal fluid of patients with stage Ⅰ,Ⅱ,and Ⅲ tuberculous meningitis were decreased sequentially,and the differences were significant(F=61.079,87.203,all P＜0.05).The expression levels of miR-200a(0.95±0.14)and miR-4652-3p(0.82±0.11)in cerebrospinal fluid of patients with good prognosis tuberculous meningitis were higher than those of patients with poor rognosis(0.84±0.13,0.73±0.10),and the differences were statistically significant(t=5.025,5.262,all P＜0.05),while the levels of cerebrospinal fluid adenosine deaminase,TNF-α,IL-23,LTB4,CRP and mRS scores in patients with good prognosis were lower than those in patients with poor prognosis(t=5.649,7.721,11.150,9.455,11.314,14.407,all P＜0.05).There was a positive correlation between the levels of miR-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis(r=0.405,P＜0.001).The levels of miR-200a and miR-4652-3p in cerebrospinal fluid were negatively correlated with LTB4,TNF-ot,CRP,mRS scores,IL-23 and adenosine deaminase(r=-0.472,-0.466,-0.461,-0.435,-0.422,-0.419;-0.459,-0.531,-0.471,-0.417,-0.513,-0.408,all P＜0.05).The AUC(95％CI)of miR-200a and miR-4652-3p to assess disease severity were 0.881(0.825～0.923)and 0.878(0.822～0.921),respectively.The AUC(95％CI)of both combination in assessing the severity of patients was 0.945(0.902～0.973),which was higher than the single detection,and the differences were significant(Z=3.008,2.960,all P=0.003).The AUC(95％CI)of poor prognosis patients evaluated by cerebrospinal fluid miR-200a and miR-4652-3p levels were 0.749(0.681～0.809)and 0.756(0.688～0.816),and the AUC of poor prognosis patients evaluated by both combination was 0.839(0.778～0.889),which was higher than that measured separately,and the differences were significant(Z=2.994,2.697,P=0.003,0.007).Adenosine deaminase[OR(95％CI):1.106(1.033～1.185)],miR-200a[OR(95％CI):0.529(0.369～0.744)],miR-4652-3p[OR(95％CI):0.471(0.310～0.715)],C-reactive protein[OR(95％CI):4.423(1.459～13.412)],TNF-α[OR(95％CI):1.196(1.061～1.348)],IL-23[OR(95％CI):4.809(1.086～3.013)],and LTB4[OR(95％CI):1.327(1.064～1.655)]were influencing factors for poor prognosis in patients with tuberculous meningitis(all P＜0.05).Conclusion The expressions of miR-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis were down-regulated,and they were closely related to the severity and prognosis of the disease.The combination of the miR-200a and miR-4652-3p could better predict the severity and prognosis of tuberculous meningitis,which may have a certain clinical value.

Objective To observe the clinical effect of "palace bone-setting" Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi fixation in the treatment of acute ankle sprain.Methods A total of 60 patients with acute ankle sprain were collected and randomly divided into observation group and control group according to the random number table method,with 30 cases in each group.The observation group was treated with "Palace Bone-setting" Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi for fixation.The control group was treated with external application of diclofenac diethylamine emulsion and fixation of elastic bandage.Two groups were treated for 14 days.The patients pain disappeared time and the swelling subsided,the VAS scale for assessment of ankle pain observed.The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-after scoring system was used to assess the Ankle function,evaluation of clinical curative effect.Results The pain disappear time (9.7 ± 1.6 d vs.13.4 ± 3.5 d,t=5.638),regression and time (3.5 ± 1.3 d vs.6.7 ± 1.1 d,t=10.292) in the observation group were significantly earlier than those in the control group (P＜0.01).After treatment,VAS score (1.9 ± 1.1 vs.3.3 ± 1.3,t=4.503) of the observation group significantly lower than that of the control group (P＜0.01);AOFAS score (93.6 ± 3.9 vs.84.2 ± 5.1,t=8.019) significantly higher than the control group (P＜0.01).Total effective rate in the observation group was 96.7％ (29/30),and the control group was 80.0％ (24/30),which the difference was statistically significant (x2=4.043,P=0.044).Conclusions The "Palace Bone-setting" Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi fixation has definite curative effect on acute ankle sprain,relieve pain,swelling and promote the ankle function.

Objective To investigate the clinical diagnostic evidences of pleural tuberculosis (PT).Methods One hundred and eighty patients with pleural effussion, whom were admited into our hospital from December 2007 to December 2009 ,were enrolled into this study. The clinical data of patients confirmed with PT ( n = 90) or Non-PT ( n = 90) were analyzed retrospectively. The likelihood ratios( LR), sensitivity, specificity,positive predictive value,and nagative predictive value of six indices including pleural ADA, IFN-γ, sIL-2R ,TB-antibody in blood and pleural effusion, age and fever status were calculated. Results The variable with the hightest LR+ was ADA optimal threshold, followed by TB-antibody, IFN-γ, age, sIL-2R, fever status, If all six variables reached the optimal threshold,the probabilities of PT exceeded 99.9%. However,if all variables didn't reached the optimal threshold, the probabilities of PT were less than 1%. Among all the six variables, any four or over four variables reached the optimal threshold, the probabilities of PT exceeded 97%. Conclusion The combination use of these six variables can aid the clinical analysis, early detection, and therapy instruction,complication prevention of PT.

Objective To explore the influence of computed tomography (CT) and magnetic resonance imaging (MRI) fusing technique on target volume and dosimetrics of normal tissues in intensity modulated radiotherapy (IMRT) for prostate carcinoma.Methods Ten patients with pathologically diagnosed moderate-high risk localized prostate carcinoma were enrolled in this study.CT and MRI images were collected.Same image slices of the prostate, seminal vesicles, rectum and bladder were anatomically delineated using image fusing software.Clinical target volume (CTV) was defined as the prostate plus seminal vesicles.IMRT treatment planning was designed basing on CT and MRI images, respectively.Differences of CTV volume and dose volume histogram of rectum and bladder between the two image groups were analyzed.Results The mean volume of CTV on CT and MRI images was 84.03 cm3 and 53.53 cm3,respectively (t =2.47,P=0.024).The V50, V60 and V70 of rectum were 30.28%, 19.13%, 9.53% on MRI and 37.03%, 24.99% and 14.55% on CT images, respectively, with significent difference (t =2.71,P=0.014 for V50; t =2.83,P=0.011 for V60; t=3.19,P=0.005 for V70).The maximal dose of bladder was 81.10 Gy on MRI and 82.45 Gy on CT, respectively(t=2.41,P=0.027).Conclusions By using image fusing technique, the mean volume of the prostate plus seminal vesicles delineated on MRI image is smaller as compared to CT image.The volume of the rectum receiving high irradiation dose can be reduced when MRI was used to delineate CTV compared to CT image.

Intra-atrial re-entrant tachycardias (IARTs) are common late after heart surgery. Conventional mapping and ablation is relatively difficult because of the complicated anatomy and multiple potential re-entry loops. In this study we aimed to evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) induced by myocardial scar or incision. Methods In 6 patients (three male and three female, aged 33.3+ 11.8 years) who had AT related to myocardial scar or incision,electrophysiological study and radiofrequency catheter ablation (RFCA) were performed. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results Re-entry related to the lateral atriotomy scar was inducible in 5 of6 patients. With entrainment mapping, the PPI (post-pacing interval)-TCL (tachycardia cycle length) difference was ＜30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 3 patients had successful linear ablation between scar area to inferior vena cava, and 2 patients between scar area to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 6 patients. PPI-TCL differences ＜30 ms were observed when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of AT related to incision was observed during follow-up except for the failed patient. Conclusion Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation can be obtained in patients with IRATs related to myocardial scar or incision.

Objective: To evaluate the biocompatibility of self made nitinol alloy ventricular septal defect occluder. Methods: Six nitinol alloy ventricular septal defect occluder were implanted in the ventricular septum by catheter in 6 normal anaesthetized open chest pigs, and the animals were observed for 45 to 120 d(2 animals). Results: One deaths resulted from hemorrhage and another from embolization of occluder in abdominal aorta during the placement procedure. Successful placement of the occluder was achieved in 4 animals. Four animals were killed at 45, 60 and 120 d. Postmortem gross and microscopic examination of 4 devices 45 to 120 d after placement showed that both the right and left ventricular discs of the occluder were completely covered by a smooth, shiny, glistening thin layer of neoendocardium, and the surface of neoendocardium was covered by a monolayer of endothelium like cells. The inflammatory infiltrate around the occluder was found at 45 d, and disappeared and fibrosis formed at 120 d. These appeared as a repair process of the injury. Embolization in lung,liver, spleen, kidney, intestinal and colon were not found. Conclusion: These suggest that the self made nitinol alloy ventricular septal defect occluder has good biocompatibility. [

AIM: To investigate the effects of internal change of serum insulin and plasma glucose levels on serum free fatty acid (FFA) concentrations after glucose loading. METHODS: Serum insulin, plasma glucose and FFA concentrations were measured simultaneously in 234 essential hypertension patients who were undergoing oral glucose tolerance test (OGTT) [ including 20 cases with 2 type diabetes mellitus (DM), 74 impaired glucose tolerance (IGT), 140 normal glucose tolerance (NGT); 98 males, 136 females]. RESULTS: Fasting serum FFA concentration (?mol/L) in DM ((1 048.47)?481.6) was higher than that in IGT (760.1?332.1) (P

0 05), but there were no relationship between collagen type Ⅰ/Ⅲ ratios in IZ and +P'max or - P'max in IZ.CONCLUSION: Collagen deposition in IZ after myocardial infarction was of benefit to improvement of systolic function. Collagen deposition in NIZ was harmful to systolic and diastolic function.

Objective: To investigate the findings of coronary artery angiography in coronary artery disease patients with diabetes mellitus. Methods: The angiographic fingings of 153 coronary artery disease patients from 1995 to 1997 were reviewed. Among them, 33 were diabetic,23 were impaired glucose tolerance(IGT) and 97 were nondiabetic patients. Results: The age, sex, hypertension, hypercholesterolemia, smoking and the rate of myocardial infarction were the same among 3 groups. But the 2 vessel and 3 vessel disease were more frequent in diabetic group(66.7% ,30.3%) than in nondiabetic group (26.8%,19 6%). Two vessel disease were more frequent in diabetic group(66.7%) than in IGT group (13.1%). Single vessel disease were less frequent in diabetic group(3.0%) than in IGT group(52.2%)and nondiabetic group(53.6%)( P

Objective To evaluate the correlation between the Waters classification based on shoulder CT or MRI scan and passive shoulder external rotational angle before operation in the glenohumeral joint deformity caused by shoulder internal rotational contracture secondary brachial plexus birth palsy.Methods 33 patients suffered the shoulder internal rotational contracture secondary brachial plexus birth palsy (Tassin classification Ⅱ 19, Ⅲ 13, Ⅳ 1) including 12 girls and 21 boys, ranging from 10 months to 16 years old with an average of 4.5 years old, underwent either CT or MR examination in shoulder joint. The retroversion of the glenoid (glenoscapular angle) and the ratio of humeral head posterior subluxation were measured on the CT or MRI images according to the method described by Friedman. The deformity of glenohumeral joint was classificated according to the Waters criteria, while the passive shoulder external rotational angle was measured at neutral position in involved shoulder joint. The correlation between the external rotation and the deformity was analysed. Results 33 cases with shoulder internal rotational contracture secondary brachial plexus birth palsy were evaluated according to the Waters criteria. 4 cases were classified as typeⅠdeformity, 4 cases as typeⅡ, 7 cases as type Ⅲ, 6 cases as type Ⅳ; 5 cases as typeⅤ; 7 case as type Ⅵ. The type of glenohumeral deformity was significantly associated with the limited range of passive external rotation of the shoulder joint. Conclusion The Waters classification of the glenohumeral deformity according to the Waters criteria can accurately demonstrated the deformity of the glenohumeral joint caused by shoulder internal rotational contracture secondary to brachial plexus birth palsy.