Table of Content

21 April 2016, Volume 37 Issue 2

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Application of low concentration contrast media for enhanced CT scan in children with congenital heart disease

Liu Zhimin, Song Lei, Yu Tong, Gao Jun, Jiang Ling, Liu Yong, Peng Yun

2016, 37(2):  109-113.  doi:10.3969/j.issn.1006-7795.2016.02.001

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Objective To explore the feasibility of low concentration contrast media 270 mgI/mL iodixanol for enhanced computed tomography (CT) examination of congenital heart disease in children. Methods Sixty patients with congenital heart disease were randomly divided into two groups with 30 cases in each. Groups A and B were scanned with prospective ECG gated scanning scheme. In Group A 270 mgI/mL iodixanol and in group B 320 mgI/mL iodixanol was used. All the cases were scanned on a CT750 HD Discovery (Healthcare GE) with the same parameters of injection of the contrast media. The scanning data were reconstructed by the 30% ASIR, and the two groups of cases were compared with subjective and objective quality evaluation, the dosage of contrast media, and the diagnostic accordance rate. Results All images in two groups met the diagnostic requirements; diagnostic coincidence rate showed no significant difference. Ventricular enhanced degree and contrast to noise ratio of group B were better than those of group A. Comparison of the objective noise and signal to noise ratio and subjective image quality score of the two groups have no significant difference. Conclusion The image of enhanced CT scan with low concentration contrast media can meet the diagnostic requirements for children with congenital heart disease, and can reduce the risk of contrast induced nephropathy.

Five years follow-up study of isolated premature thelarche in female infants

Li Yuchuan, Gong Chunxiu, Liu Boya, Wu Di

2016, 37(2):  114-119.  doi:10.3969/j.issn.1006-7795.2016.02.002

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Objective To observe the clinical course of isolated premature thelarche (IPT) in female infants under two years of age.Methods A total of 74 female infants with IPT, who visited the Department of Endocrinology in Beijing Children's Hospital from Feb. 2011 to Dec. 2011, were followed up for 5 years. Results Twelve cases were lost to follow-up, 83.78% (62/74) cases completed the 5 years follow-up. For total 74 cases, the median age was 63.50 months (38.86, 70.33), the median duration of follow-up was 54.9 months (21.75, 56.33). The median age of premature thelarche was 9.02 months (5.67, 14.07). Within the duration of 25 months, the velocity of relief was faster. At the end of the last visit, 96.77% (60/62) premature thelarche was relieved to Tanner I, the median relief age was 30.72 months (24.54, 35.89); According to the age of onset, all cases were divided into two groups: classical and non-classical IPT, compared with their relief rate of premature thelarche, there was no significant difference. During 5 years follow-up, 2 cases had persistent thelarche and there was no evidence of developing into central precocious puberty. Conclusion Most isolated premature thelarche have a benign prognosis among female infants under 2 years old. A longitudinal follow-up study is necessary for isolated premature thelarche cases.

Clinical analysis of head and neck lipoblastoma in childhood

Wang Shengcai, Guan Lejing, Zhang Jie, Ni Xin, Zhang Yamei, Liu Yuanhu, Ge Wentong, Li Xiaodan, Tai Jun

2016, 37(2):  120-124.  doi:10.3969/j.issn.1006-7795.2016.02.003

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Objective To investigate the diagnosis, treatment and prognosis of lipoblastoma of head and neck and analyze the clinical manifestations, imaging and pathologic features. Methods Nine cases of histopathologically proven lipoblastoma presented to Beijing Children's Hospital from December 2012 to April 2015 were reviewed. The clinical characteristics, imaging findings, surgical management and follow-up results were analyzed. Results There were 4 males and 5 females subjects aged from 4 months to 3 years in our series. The chief complaints were snoring, respiratory distress and painless superficial soft tissue masses. Tumors occurred in pharynx (n=5) and neck (n=4). One case of cervical tumors involving the spinal canal underwent surgical resections twice and others with once complete surgical resection. Complete surgical resection was performed in 4 cases of pharyngeal tumor and another one underwent conservative surgical resection. The pathological results of 3 cases were lipoblastomatosis and others were lipoblastoma. The follow-up periods ranged from 10 months to 3 years. Recurrence occurred in 2 cases of pharyngeal tumor 3 months after the operation. One case lives with residual tumor and all patients with cervical tumors had no recurrence. Conclusion Pediatric lipoblastoma is a rare benign tumor, especially in the head and neck, which presents some different clinical characteristics from the lipoblastoma of other regions. Surgical resection is the only effective treatment up to now. Although complete surgical resection is more curative, subtotal resection may be an effective alternative for those extensive lesions in the head and neck which are too difficult to get radical treatments. Pharyngeal lipoblastoma may have more potency of recurrence.

Prognostic significance of energy and protein adequacy provided by enteral nutrition in children with sepsis or severe sepsis in pediatric intensive care unit

Fang Boliang, Qian Suyun

2016, 37(2):  125-129.  doi:10.3969/j.issn.1006-7795.2016.02.004

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Objective To examine the prognostic implications of the adequacy of energy and protein intake provided by enteral nutrition (EN) in children with sepsis or severe sepsis in pediatric intensive care unit (PICU). Methods We conducted a prospective observational study of consecutive children with sepsis or severe sepsis in PICU of Beijing Children's Hospital from Nov. 2012 to April 2013. Children's energy and protein intake by EN were daily recorded and their adequacy was calculated according to 64 kcal·kg^-1·d^-1 and 1.5 g·kg^-1·d^-1 respectively. The prognosis variables were compared between children with adequate EN and inadequate EN. Results Totally 62 children aged 9.37 months were included. The adequacy of energy by EN was 0.84±0.38, while the adequacy of protein was 0.94±0.46. Children reached adequate energy and protein intake by EN during observational periods were 25 (40.32%) and 29 (46.8%) cases, respectively. Children with inadequate energy intake by EN were older (P=0.02), with lower pediatric critical illness score (PCIS) (77.12±10.21 vs 82.88±7.03, P=0.02) and longer invasive mechanical ventilation duration (P=0.03). Children with inadequate protein intake by EN had higher weight (P=0.00), higher percent of children with severe sepsis (42.4% vs 17.2%, P=0.03) and more dysfunctional organs (P=0.01). Children with inadequate energy (16.2% vs 4.0%) and protein (15.2% vs 6.9%) intake by EN also had higher mortality at 28th hospital day. Conclusion Majority of children with sepsis or severe sepsis in PICU suffered from inadequate energy and protein intake by EN, and most with older age and higher weight. Inadequate energy intake by EN may associate with longer invasive mechanical ventilation and higher hospital fees, while inadequate protein intake by EN may be associated with increased risk of organ dysfunction. Inadequate energy or protein intake by EN may increase mortality of children with sepsis or severe sepsis in PICU.

Clinical analysis of 148 cases of juvenile enthesitis related arthritis

Tan Xiaohua, Li Caifeng, Han Tongxin, Kuang Weiying, Wang Jiang

2016, 37(2):  130-135.  doi:10.3969/j.issn.1006-7795.2016.02.005

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Objective To investigate the early clinical characteristics, diagnosis and treatments of enthesitis related arthritis (ERA), and to improve the prognosis through early diagnosis. Methods A retrospective analysis was performed on 148 ERA patients who were hospitalized in Beijing Children's Hospital during the period from Jan. 1st 2006 to Dec. 31st 2010. The clinical and laboratory data of the patients were collected for analysis of characteristics.Chi-square test and t test were used for comparisons of variables. Results In this study a total of 148 cases were included, and 124 cases were boys, 24 were girls. All patients had peripheral arthritis with or without tendon enthesitis as first manifestation. Early ERA patients usually had nonspecific symptoms. Parameters of inflammation had mild to moderate increase, and the positive rate of HLA-B27 was 12.76%. Uveitis occurred in 2.03% children. Conclusion (1) ERA usually occurs in older children, the incidence among male is higher than that among female; (2) The serious radiological changes of ERA are consistent with the patients age of onset; (3) The trunk axial joint is less frequently involved than werethe adults; (4) Laboratory examination: HLA-B27 negative ERA is more common in children, Laboratory markers of Inflammation had a mild to moderate increase; (5) Complications: uveitis occur less frequently than adults.

Effect of exchange transfusion on internal environment in neonatal jaundice

Wang Xiaojiao, Wang Yajuan, Shao Fang, Yang Xuefang, He Jianping, Wang Huixin, Gu Song, Yang Caiyun, Zhong Yan, Lin Ying, Liu Ying

2016, 37(2):  136-140.  doi:10.3969/j.issn.1006-7795.2016.02.006

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Objective To summarize the changes of relevant parameters before and after exchange transfusion, and to provide basis for clinical application.Methods Newborns with complete clinical data who underwent exchange transfusion therapy because of jaundice, hospitalized in neonatal ward from 1996 to 2013, were enrolled as the research subjects. A retrospective analysis of clinical data was performed using paired t-test and χ² test. Results From 1996 to 2013, 111 cases were treated with exchange transfusion in the neonatal ward, data of 85 cases treated with exchange transfusion were collected and analyzed. In this 85 cases treated with exchange transfusion, 81 cases (95.3%) had hemolytic disease, including 71 cases (87.7%) of Rh incompatibility, 9 cases (11.1%) of ABO incompatibility, one case (1.2%) of Rh and ABO hemolytic disease; one case (1.2%) had glucose-6-phosphate dehydrogenase (G6PD) deficiency and 3 cases (3.5%) had unknown hyperbilirubinemia. Exchange transfusion removed 48.0% of total body bilirubin, 47.8% of unconjugated bilirubin. After exchange transfusion, the total serum bilirubin, indirect bilirubin, direct bilirubin and albumin ratio (B/A) was decreased as compared with those of pre-exchange levels, the difference was statistically significant. The red blood cell counts and hemoglobin increased, the difference was statistically significant. Analysis of the one-hour-bilirubin, all of the hour-bilirubin was located in P95 region (100%) before exchange transfusion, which is high risk of bilirubin encephalopathy. After the exchange transfusion, 33 cases (38.8%) located in low risk area, 22 cases (25.9%) in low intermediate risk, 16 cases (18.8%) in high intermediate risk area, and 14 cases (16.5%) still located in P95 region. It suggested that the exchange transfusion can effectively decrease the risk of bilirubin encephalopathy. In this study, 77 cases (90.6%) developed adverse events after exchange transfusion. Among them, the most common adverse event was hyperglycemia in 61 cases (79.2%), hypocalcemia in 46 cases (59.7%), hypokalemia in 33 cases (42.9%), thrombocytopenia in 28 cases (36.4%), and metabolic acidosis in 15 cases (19.5%). Conclusion Exchange transfusion show definite effect in treatment of neonatal jaundice. It can reduce the risk of bilirubin encephalopathy and hemolytic reaction at the same time, and can correct anemia. Exchange transfusion changes the environment of blood. After the exchange transfusion, there is a high incidence of adverse reactions, the indications should be strictly controlled and the parameters should be carefully monitored.

Clinical characteristics of 26 children with Burkitt's leukemia and outcome of treatment with revised LMB 89 protocol

Duan Yanlong, Jin Ling, Yang Jing, Huang Shuang, Zhang Meng, Lai Rui, Zhou Chunju, Zhang Yonghong

2016, 37(2):  141-147.  doi:10.3969/j.issn.1006-7795.2016.02.007

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Objective To summarize the clinical features and to evaluate outcomes and to assess therapeutic effects in 26 children and adolescents with Burkitt's leukemia treated with revised LMB 89 protocol in China.Methods From January 2010 to April 2015, 26 hospitalized children and adolescents with Burkitt's leukemia were enrolled into this study. Staging was based on clinical evaluation and was defined by the St. Jude staging system. All patients were confirmed to have Burkitt's leukemia and mature B blast > 25% in marrow that diagnosed by MICM system and biopsy of marrow. The 26 patients were treated with C group of the revised LMB 89 protocol.All analyses were performed by the statistical program SPSS.Results Of the 26 Burkitt's leukemia patients, 24 were male and 2 were female.The median age was 7.8 years (range from 3 years to 13 years) at the time of diagnosis.In terms of clinical presentation, 88% had abdominal bulky lymphoma involvement; in 62% of the patients maxillofacial region was involved, 27% had testis involvement, 69% had severe tumor lysis syndrome. All patients were followed up. The overall survival (OS) and the 2-year event-free survival was 76.9% respectively at a median follow-up of 35 months.All patients suffered from IV degree marrow suppression and sever infection. Two patients died from sepsis in the early 2 course of chemotherapy because of severe marrow suppression, and no child died from TLS. Three patients had early relapse after treatment was finished.Conclusion Childhood Burkitt's leukemia in our study was more frequently seen in male school aged children.Revised LMB 89 protocol used for Burkitt's leukemia is effective and well tolerated if the early TLS could be controlled.The overall prognosis is worse than that of other group Burkitt's lymphoma because of early severe persistent marrow suppression complicated with sepsis.The early relapse is still a challenge.

Clinical analysis of 27 cases of neonatal respiratory distress syndrome complicated with pneumothorax

Xin Yue, Zheng Rongxiu

2016, 37(2):  148-152.  doi:10.3969/j.issn.1006-7795.2016.02.008

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Objective To study the clinical features and key points of prevention and treatment of neonatal respiratory distress syndrome (NRDS) complicated with pneumothorax.Methods A retrospective analysis was conducted on clinical data of 27 neonates with NRDS complicated with pneumothorax, who were admitted to the neonatal intensive care unit from October 2010 to October 2015.Results All 27 cases were preterm infants, of whom 24 cases were delivered by cesarean section, 13 cases were complicated with asphyxia, 11 cases were complicated with meconium aspiration syndrome, 9 cases were treated with positive pressure ventilation, in 3 of the cases the pneumothorax occurred during mechanical ventilation. Pneumothorax happened to 25 cases within 72 hours after birth, and the number of the patients who got pneumothorax within 24-48 hours after birth was 12. Most cases showed that respiratory distress was suddenly worsened or recurred again; 19 cases got increased heart rate. Only 3 cases developed signs of pneumothorax. For 24 cases conservative management was applied to have gas absorbed gradually, 3 cases underwent thoracic close drainage; 1 case gave up treatment, other cases had good prognosis. Conclusion NRDS is the leading cause of pneumothorax in preterm infants. Well understanding pathogenesis of NRDS complicated with pneumothorax, minimizing or eliminating potential risk factors are keys of effective prevention of pneumothorax. In order to diagnose and treat pneumothorax as early as possible and appropriately, it is necessary to improve awareness of this disease so that disease exacerbation could be controlled and preterm infants management could be improved.

Audiologic analysis of patients with Turner syndrome

Hao Jinsheng, Zhang Jie

2016, 37(2):  153-157.  doi:10.3969/j.issn.1006-7795.2016.02.009

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Tuner syndrome (TS) is one of the most frequently encountered sex chromosomal abnormalities. The features of the syndrome include infertility due to lack of ovaries and low or absent estrogen production, short stature and hearing problems. The association between auditory phenotype and karyotype remains inconsistent among TS patients. The purpose of the present study is to review the otologic and audiologic features among TS patients and to identify probable associated causative factors for hearing loss.

Effect of treatment with different mood stabilizers on glycogen synthase kinase-3 activity in the peripheral blood mononuclear cells of patients with bipolar mania

Li Xiaohong, Cai Zhuoji, Liu Min, Wang Gang

2016, 37(2):  158-163.  doi:10.3969/j.issn.1006-7795.2016.02.010

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Objective To explore the therapeutic effects of of different mood stabilizers single or combined atypical antipsychotics on glycogen synthase kinase 3 (GSK3) activity in the peripheral blood mononuclear cells (PBMCs) of patients with bipolar mania. Methods Thirty-six patients with bipolar I mania were enrolled for treatment with mood stabilizers single or combined atypical antipsychotics for eight weeks. Twenty mL of blood was collected from each patient by venipuncture at week 0, week 4 and week 8. The level of pSer21-GSK3α;pSer9-GSK3β, total GSK3α and GSK3β in PBMCs of patients were measured by Western blotting. Clinical symptoms were assessed with the Young mania ratings scale (YMRS) and other clinical rating scales at the same time. Results The average scores of YMRS, and CGI-S significantly reduced at week 8 compared with those at week 0 (P<0.001); meanwhile, the level of pSer21-GSK3α and pSer9-GSK3β increased at week 8; Compared with valproate group, the relative ratio of pSer-GSK3β/total-GSK3β was higher than that of lithium group (P=0.020). There was a positive correlation between ratio of pSer9-GSK3β to toal-GSK3β at baseline and the average score of YMRS reduction from baseline to week 0 (P=0.043). Excluding patients with manic episodes more than 3 times, there was a significant trend of increase (P=0.020). The correlation was significant in lithium group. However, it did not appear in valproate group. Conclusion Mood stabilizers single or combined atypical antipsychotics could decrease glycogen synthase kinase 3 (GSK3) activity in the peripheral blood mononuclear cells (PBMCs) of patients with bipolar mania. Compared with valproate treatment, lithium single or combined treatment could significantly reduce the activity of GSK3 of patients with bipolar mania.

Predictive factors for efficacy and adverse reactions of ziprasidone in schizophrenia patients

Zhu Hong, Jia Hongxiao, Yan Aiguo, Zhi Lihua

2016, 37(2):  164-167.  doi:10.3969/j.issn.1006-7795.2016.02.011

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Objective To analyze factors related to efficacy of ziprasidone and extrapyramidal symptom (EPS) in 70 schizophrenia patients treated with ziprasidone. Methods Multi linear Logistic regression was used to analyze factors related to efficacy of the treatment and extrapyramidal symptom in 70 schizophrenia patients treated with ziprasidone.Results Significant episodes of the disease were the predictor for the good effect of ziprasidone(β=-0.496, P=0.000). Previous history with acute dysmyotonia and Parkinson syndrome, prominent positive symptom, were the predictor for acute dysmyotonia and Parkinson syndrome(β=-0.634, 0.332 respectively, P=0.000 for both). Previous history of akathisia, prominent positive symptom, and relapse time of disease were the predictor for akathisia(β=0.633, 0.136 respectively, P=0.000, 0.034 respectively), prominent negative symptom and duration of disease were the protective factors for akathisia(β=-0.310, -0.181 respectively, P=0.000, 0.024 respectively).Conclusion Schizophrenia patients with few relapses of disease will demonstrate good therapeutic effect when treated with ziprasidone. Schizophrenia patients with previous history of extrapyramidal symptom, or with fewer relapses of disease may show higher occurrence of EPS; patients with prominent negative symptom, long duration of disease may predict lower occurrence of akathisia. Patients with prominent positive symptom may predict higher occurrence of acute dysmyotonia and Parkinson syndrome.

Changes of duration of untreated psychosis and its influential factors in patients with first-episode schizophrenia

Liu Hui, Liu Shanshan, Jia Hongxiao

2016, 37(2):  168-171.  doi:10.3969/j.issn.1006-7795.2016.02.012

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Objective To explore the trends of change and related factors in duration of untreated psychosis (DUP) at first-episode of schizophrenia. Methods Retrospective investigation was employed on relieved patients with first-episode of schizophrenia in Beijing Anding Hospital, Capital Medical University from different years (1994, 2004 and 2014) to explore DUP changes.Results Statistical analyses showed that DUP in patients with first-episode of schizophrenia in 2014 was significantly lower than that in 1994 and 2004. However, there was no significant difference between the latter two groups. Besides, there was a negative correlation between DUP and reduced score rate of Positive and Negative Syndrome Scale (PANSS) in 2014. Conclusion The DUP was significantly shortened in patients with schizophrenia, in which the proportion of students, unmarried people and well educated population increased, showing the development and progress of mental health system in our country.

Progress in the neural cognitive mechanism of familiar people recognition disorders

Jia Hongxiao, Zhou Yong, Zhu Hong

2016, 37(2):  172-175.  doi:10.3969/j.issn.1006-7795.2016.02.013

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This article describes the progress in the neural cognitive mechanism of familiar people recognition disorders: 1The anatomical structures and the cognitive processes involved in face recognition; 2the anatomical structures and the cognitive processes involved in face and voice recognition; 3 the interactions that exist among the perceptual processes subsuming face and voice recognition, but not people's faces, voices and proper names; 4the different roles of the right and left hemisphere in identifying people by face, voice and name; 5 pivotal role of anterior temporal lobe system impairment in the familiar people recognition disorders.

Effect of acupuncture on the serum brain-derived neurotrophic factor level in depressive patients with hyperactivity of “Fire” due to “Yin” deficiency

Wang Qunsong, Ji Xiangdong, Zhu Wenxian, Yu Haiyan

2016, 37(2):  176-180.  doi:10.3969/j.issn.1006-7795.2016.02.014

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Objective To evaluate the effect of acupuncture on the serum brain-derived neurotrophic factor (BDNF) level and the clinical efficacy in patients with depressive disorder of hyperactivity of "fire" due to "yin" deficiency type. Methods Sixty-four depressive patients with hyperactivity of fire due to yin deficiency were randomly allocated into two groups. The trial group (n=32) were treated with acupuncture and the control group (n=32) were treated with mirtazapine for 8 weeks, respectively. The serum BDNF concentration was tested for every subject before and after the treatment; meanwhile, the HAMD-24 was assessed at the baseline, 4-week and 8-week after treatment. The between-group differences were analyzed, and the side effects were evaluated using the Asberg Rating Scale for Side Effects (SERS). Results The total HAMD scores were comparable between the two groups before treatment. Repeated measures analysis of variance revealed a significant main effect of time (F=381.87, P=0.000), and the post-hoc analysis (least-significant difference test) indicated that the HAMD scores after 4-week treatment were lower than those of the baseline, and the HAMD scores further decreased after 8-week treatment (All P<0.05), in both groups; whereas there was no significant difference between the two groups at any time point (All P>0.05). Neither the interactive effect of time × group nor the between-group effect was significant (F=0.063, P=0.939, and F=0.008, P=0.931, respectively). The reduction rate of HAMD at 8-weekend of the trial group was comparable to that of the control group (71.88% vs 75.00%, P>0.05). The serum BDNF levels of both groups increased significantly (both P<0.05) after treatment but there was no significant between-group difference either at the baseline or at the follow-up (both P>0.05). After 8-week treatment, the SERS score of the trial group was significantly lower than that of the control group (P<0.05). Conclusion Acupuncture could significantly improve the serum BDNF levels in depressive patients with hyperactivity of "Fire" due to "Yin" deficiency, and it has comparable anti-depressive effects to mirtazapine without causing obvious side effects.

A short-term risk assessment for cardiovascular diseases among the elderly in Beijing based on competing risk model

Liu Long, Tang Zhe, Li Xia, Luo Yanxia, Guo Jin, Li Haibin, Liu Xiangtong, Tao Lixin, Yan Aoshuang, Guo Xiuhua

2016, 37(2):  181-187.  doi:10.3969/j.issn.1006-7795.2016.02.015

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Objective The study aimed at developing a 5-year risk prediction model of cardiovascular disease (CVD) based on competing risk model, and developing a user-friendly risk score tool for risk assessment of cardiovascular disease.Methods We used competing risks model to evaluate the risks of developing a first CVD event. Sub-distribution hazard ratios (SHR) and 95% confidence intervals (95%CI) were computed for the associations between each risk factor and CVD.Time-dependent receiver operating characteristic (ROC) curve and time-dependent areas under the ROC curves (AUC) were used to evaluate the discrimination ability of the models, calibration plot was applied to assess the calibration of the models. Internal validation of predictive accuracy was performed via 1 000 times of bootstrap resampling.Results Of the 1 775 subjects without CVD at baseline, 473 incident cases of CVD were documented for a median 8-year follow-up. The participants were 886 men and 889 women between the ages of 55 and 96 years old without cardiovascular disease at baseline with 20 years of follow-up.Multivariable risk functions were derived that incorporated age, total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), blood pressure, smoking, diabetes, marital status and overweight or obesity body mass index (BMI). The model showed good discrimination and calibration.Male and female cardiovascular disease risk scores were 65 points and 62 points, the best point were 34 points and 30 points. Conclusion A sex-specific multivariable risk factor algorithm based competing risk model was made. The BLSA CVD risk prediction model can be used to predicted an individual's risk of CVD and provides a useful guide to identify the groups at high risk for CVD among over 55 years old man. A user-friendly risk score tool predicting 5-year probability of cardiovascular disease was developed.

Treat severe acute kidney failure with renal replacement therapy in early or late stages-a Meta analysis

Rong Guang, Hu Jiahui, Meng Qinggang, Xie Qingyu

2016, 37(2):  188-195.  doi:10.3969/j.issn.1006-7795.2016.02.016

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Objective To explore the impact of early versus late initiation of renal replacement therapy (RRT) on critically ill patients suffered from acute kidney injury (AKI). Methods Meta-analysis including effect combination, subgroup analysis and meta-regression were used in the present study. CNKI, WANFANG, Pubmed, EMBASE, SCOPUS and Web of Science (January 1985 to May 2015) were searched. Cohort and randomized trials that assessed timing of initiation of RRT in critically ill adults with AKI were considered eligible.Results Totally 15 unique studies with 2 randomized, 4 prospective cohort and 9 retrospective cohort studies out of 1 494 retrieved citations were identified. The general methodological quality was roughly low. Early, compared with late therapy, was associated with a significant improvement in 28-day mortality [odds ratio (OR)=0.45; 95% confidence interval (CI): 0.28 to 0.72, P<0.001]. There was significant heterogeneity among the 15 pooled studies (I²=78%). In subgroup analyses, stratification was done by (intensive care unit, ICU) modality or study design, there was no impact on the overall summary estimate for mortality. Early RRT did not; however, it significantly affected the odds of kidney recovery beyond hospitalization (OR=0.62, 95% CI: 0.34 to 1.13, I²=69.6%). Conclusion 1. Earlier institution of RRT in critically ill patients with AKI may have a significant beneficial impact on survival. 2. Merged evidence indicates such beneficial effect cannot be observed for the same population on renal function; 3. Current evidences are basically derived from small sample studies with varied designs and quality. Consequently, any findings about RRT timing cannot be conclusive until new evidence from large-sample, multi-center, sound-design trials have been conducted and reported; 4. Studies focusing on a standardized, plausible division between early and late stages of RRT may be particularly necessary.

Construction of vascular depression animal model based on chronic ischemic and stress

Tan Sai, Lei Xiaoming, Wang Yanyun, Pan Juhua, Zhang Ying, Huang Shijing, Zhang Yongchao, Zheng Jun, Chen Zhao, Chen Yuxia, Li Duojiao

2016, 37(2):  196-202.  doi:10.3969/j.issn.1006-7795.2016.02.017

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Objective To build the ideal animal model for depression. Methods Forty SD rats were divided randomly into 4 groups: 1sham-operated group; 2operation group: bilateral common carotid artery ligation (LBCCA); 3depression group: chronic unpredictable mild stress (CUMS) combining with solitary, with no surgery; 4model group: LBCCA +CUMS and solitary. We observe animals continuously for 21 days to detect the variation of weight, behavioristics, cerebral blood flow and expression level of matrix metalloproteinases (MMPs), brain-derived neurotrophic factor (BDNF)/tropomyosin related kinase B (TrkB) and MMPs mRNA, BDNF/TrkB mRNA. Results Compared with the sham-operated group, model group rats and depression group rats were significantly decreased (P<0.05 or P<0.01) in weight, sucrose consumption, movement distance and the number of rearing in open-field test; the blood flow of rats of operation group and model group were significantly decreased (P<0.01); the expression level of MMP-2 and MMPs mRNA in model group and operation group were increased markedly (P<0.01), the expression level of BDNF/TrkB and BDNF/TrkB mRNA in model group and depression group were decreased significantly (P<0.01). Conclusion The method of LBCCA superposition CUMS combined with solitary simulate well the core symptoms of depression (lack of sensation, decline of movement and exploration) and the pathomechanism of unbalance of nerve vascular unit. It's an ideal model for vascular depression, and it can be used in the study of pharmacological experiment and the mechanism of curative effect.

Relationships between metabolic syndrome and its related blood indexes

Yang Kun, Tao Lixin, Cao Kai, Liu Xiangtong, Li Haibin, Yan Aoshuang, Guo Xiuhua

2016, 37(2):  203-207.  doi:10.3969/j.issn.1006-7795.2016.02.018

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Objective To evaluate the relationships between metabolic syndromes (MetS) and its related blood indexes in Beijing adults' population.Methods Subjects from Beijing three hospitals were enrolled and blood indexes record were tracked. The detection rates of MetS and its accompanying blood indexes were investigated. Generalized estimation equation model was used to estimate the relationships between MetS and its related blood indexes. Results 7 489 subjects, who attended the health check-up from 2007 to 2012, were incorporated into the final analysis. During the 5 year follow-up, 378 cases of MetS were developed. The related blood routine indexes with MetS were hematocrit value (HCT) and white blood cell (WBC) for males. Compared with Q1, the lower quartile of HCT and WBC, the RRs of Q4 were 1.861 3 (95% CI: 1.325 6-2.613 5) and 2.598 4(95% CI: 1.805 5-3.739-5), respectively. Red blood cell (RBC), WBC and lymphocyte were corresponding factors for females. Compared with Q1, the lower quartile of RBC, WBC and lymphocyte, the RRs were 3.146 3 (95% CI: 1.836 3-5.391 0), 1.897 1 (95% CI: 1.089 9-3.302 2) and 2.200 8 (95% CI: 1.221 9-3.964 0), respectively.Conclusion MetS has a certain association with its related blood routine parameters, such as HCT, WBC, RBC and Lymphocyte applied by health check-up data in Beijing adults, and such parameters may be used as the predictors of MetS.

Adenosine monophosphate-activated protein kinase involved in early hepatocarcinogenesis associated with nonalcoholic steatohepatitis in rats

Wang Yunjiao, Han Wenqi, Li Ruofei, Du Zunshu, Wang Xuejiang, Jiang Ying

2016, 37(2):  208-213.  doi:10.3969/j.issn.1006-7795.2016.02.019

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Objective To explore the role of adenosine monophosphate-activated protein kinase(AMPK) in the development of precancerosis induced by a high-fat diet and diethylnitrosamine and its molecular mechanism.Methods The low dose of diethylnitrosamine(DEN, 30mg/kg, ip) and high fat diet(16 weeks)induced liver precancerosis of rat model in vivo was established to observe the pathological changes of rat livers by HE staining.The expression levels of glutathione S-transferase-π(GST-π), sterol regulatory element binding protein-1c (SREBP-1c), fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), stearoyl-CoA desaturase 1(SCD1), AMPK, p-AMPK were detected by Western blotting, Real-time PCR and immunohistochemistry. The rat cells H4IIE were disposed by palmitic acid(PA) to mimic lipid overload in hepatocarcinoma cells and evaluate the role of AMPK in modulating fat metabolism of hepatocarcinoma.Results We found lipid droplets overload evidently in hepatocytes of rats in DEN+HFD group compared with DEN group, some of which behaving ballooning change, necrosis and inflammatory; meanwhile, GST-π and triglyceride(TG) expression were both elevated significantly in the livers of rats treated with DEN+HFD group when compared with that of DEN group, indicating the precancerosis of rat model induced by NASH was successful.Similarly, the expression of SREBP-1c and its target genes FAS, ACC, SCD1 were all elevated statistically. Furthermore, p-AMPK level was decreased. The in vitro model indicated that TG, SREBP-1c, FAS, ACC, SCD1 were all increased in PA treated cells, while treating cells with AICAR, activator of AMPK, can reverse the effect of PA. Conclusion AMPK is involved in liver precancerosis induced by high-fat diet and diethylnitrosamine, and this process may happen through the inhibition of SREBP-1c.

Expression of galanin and its receptor subtypes in human breast cancer

Zhang Shuai, Deng Jiahui, Xu Zhiqing, Qi Xiaodong

2016, 37(2):  214-218.  doi:10.3969/j.issn.1006-7795.2016.02.020

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Objective To determine the expression of galanin(GAL) and galanin receptor 1、2、3 (GALR1、2、3) in breast cancer and the paired peritumoral tissues; To analyze the relationship between the different clinical therapies and the expression of galanin and its receptor subtypes. Methods qRT-PCR was performed to detect the mRNA level of galanin and its three receptor subtypes in breast cancer and the paired peritumoral tissues. Western blotting was carried out to detect the GAL protein level in breast cancer and the paired peritumoral tissues. t-test was used to analyze the expression of galanin and its three receptor subtypes in cancer tissues of different groups; while paired t-test was performed to analyze the expression of galanin and its three receptor subtypes in breast cancer and the paired peritumoral tissues of the same group. Results The GAL mRNA and protein levels of cancer tissues were higher than the paired peritumoral tissues in the group of no preoperative treatment (P<0.05, P<0.01), whereas the mRNA levels of GALR1, GALR2 and GALR3 were lower than the paired peritumoral tissue (P<0.05, P<0.05, P<0.01). In the NAC and HIFU groups, there were no significant differences in GAL protein, GAL and its receptors mRNA levels between the cancer and the paired peritumoral tissues (P<0.05, P<0.05, P<0.01). However, the GAL protein and GAL mRNA levels were lower than the group of no preoperative treatment (P<0.05). In addition, the GALR3 mRNA level was higher than the group of no preoperative treatment in the NAC group (P<0.01). Conclusion The abnormal expression of galanin and its receptor subtypes in breast cancer was relevant to different clinical therapies, which might be used as a potential biomarker for breast cancer diagnosis, therapy and prognosis.

Therapeutic effect of the decoction of Baihuxiaochi combined with promethazine in the treatment of tardive dyskinesias

Wang Lin, Yuan Haining, Jia Hongxiao, Zhu Hong, Kang Yuchun

2016, 37(2):  219-222.  doi:10.3969/j.issn.1006-7795.2016.02.021

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Objective To observe the effect of the decoction of Baihuxiaochi combined with Promethazine in the treatment of tardive dyskinesias. Methods Totally 60 cases of tardive dyskinesias were divided into the control group or study group randomly. The control group was treated with Promethazine, while study group with Chinese medicine. The scores of Abnormal Involuntary Movement Scale(AIMS)and Positive and Negative Syndrome Scale(PANSS), Treatment Emergent Symptom Scale(TESS)were observed and compared.Results After treatment, the scores of AIMS in study group decreased significantly in contract with control group (P<0.01).The decrease of AIMS scores began in the fourth week and kept bigger till the end of study. While the scores of PANSS and TESS had not significantly changes at the ending point in contrast with contral group. Conclusion The decoction of Baihuxiaochi could treat the tardive dyskinesias.

Early experimental diagnosis for deep vein thrombosis after traumatic hip arthroplasty in old and middle-aged patients

Bai Lu, Bai Junqing, Wang Guoli

2016, 37(2):  223-227.  doi:10.3969/j.issn.1006-7795.2016.02.022

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Objective To investigate the clinical value by detecting hematology index in the early experimental diagnosis of deep vein thrombosis after traumatic hip arthroplasty in old and middle-aged patients. Methods Totally 150 cases of traumatic hip arthroplasty combined with deep vein thrombosis in lower limb were selected as a study group (thrombus group) while 150 cases without deep vein thrombosis in lower limb were chosen as a control group. All those patients are from Tangshan Orthopedics Hospital during January 2011 to February 2015. To conduct¹²⁵IFIB and DD detection of collected fasting venous blood by radioimmunoassay and to detect FIB, DD, AT-Ⅲ, TpP, TAT of plasma by ELISA. Results Postoperative¹²⁵IFIB and DD of plasma testing results show that 125IFIB and DD in plasma in thrombus group increased significantly, which is obviously higher than preoperative value, as it is statistically significant. (P<0.05) On the other hand, the results from ELISA show that the area under the curve of FIB, DD, TpP, TAT and AT-Ⅲ are respectively 88.1%, 86.4%, P<0.01; 67.4%, 70.0%, P<0.05 and 64.1%, P>0.05. The results of Logistic regression analysis showed that the OR values of fibrinogen and D-two were 13.294 and 7.784 respectively(P<0.05).Conclusion fibrinogen and D-dimer in plasma have certain clinical significance in the early diagnosis of deep vein thrombosis patients after hip arthroplasty.

Effects of lowering dialysate calcium concentration on mineral metabolism and bone turnover in patients with low level of parathyroid hormone on hemodialysis

Ma Lijie, Li Zhongxin, Liu Jing, Zhao Sumei

2016, 37(2):  228-232.  doi:10.3969/j.issn.1006-7795.2016.02.023

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Objective To observe the effect of dialysate with lowering calcium concentration on mineral metabolism and bone turnover in patients with low level of parathyroid hormone on hemodialysis.Methods Total 70 patients with iPTH<100 pg/mL were treated with DCa-1.25mmol/l dialysate for 1 year. Serum calcium, phosphorus, alkaline phosphatase(ALP) levels were determined by standard method. Their levels of serum intact parathyroid (iPTH), osteocalcin (OC), procollagen type I amino-terminal propeptide (PINP), β-crosslaps (β-CTX) were measured by Chemiluminescence. iPTH, OC, PINP, β-CTX, serum calcium, phosphorus, ALP were measured before and 1, 3, 6, 12 months after the change of dialysate. Results After lowering D-Ca, serum iPTH levels progressively increased at 3 months(P<0.001), and serum OC, PINP, β-CTX levels increased at 1 months(P<0.001). In correlation analyses, the changes in OC and β-CTX correlated positively with baseline iPTH (OC:r=0.673, P=0.037;β-CTX:r=0.651, P=0.020), and correlated negatively with age (OC:r=-0.816, P<0.001;β-CTX:r=-0.718, P<0.001). In Logistic regression analysis, baseline iPTH, diabetes were independent factors of the improvement of iPTH level. Conclusion Dialysate with lowering calcium concentration can improve PTH levels and stimulate bone metabolism.

Investigation of two intervention models to men who have sex with men in Dongcheng District, Beijing

Tian Fei, Wang Yuanyuan, Ma Yunfang, Wang Jing, Kong Lingkun

2016, 37(2):  233-237.  doi:10.3969/j.issn.1006-7795.2016.02.024

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Objective To evaluate the effects of combination intervention model and stationary point intervention model, which conducted by community based organization (CBO) to the men who have sex with men(MSM).Methods To implement one-year stationary point intervention model in a MSM venue(A venue) during Jan.2013 and Jan.2014. Meanwhile, another similar MSM venue(B venue) was chosen, which combination intervention model was implemented.Investigations were conducted among subjects of questions related to acquired immune deficiency syndrome (AIDS) prevention knowledge, behavior of AIDS prevention before and after intervention and will of accepting AIDS prevention. Meanwhile, the rate of HIV antibody testing and the ability of finding HIV infected person of two models were compared. 100 MSM were investigated by convenience sampling before and after two kinds of interventions. Results After one-year CBO stationary point intervention, in A venue, the awareness rate of knowledge about AIDS prevention of MSM increased from (85.25±15.63)% to (95.50±6.77)%, the proportion of condom-use with male at last intercourse increased from 74% to 95%, the proportion of condom-use with male at each intercourse increased from 52% to 79%, the numbers of fixed sexual partner in recent half year decreased from (2.88±0.08)to(1.54±0.67), Condom-accepting rate increase from 77% to 95%, AIDS consult and test-accepting rate increase from 66% to 92%. After one-year combination intervention, in B venue, the awareness rate of knowledge about AIDS prevention of MSM increased from (73.63±15.48)% to (91.38±13.73)%, the proportion of condom-use with male at last intercourse increased from 46% to 73%, the proportion of condom-use with male at each intercourse increased from 19% to 52%, the numbers of fixed sexual partner in recent half year decreased from (2.33±0.87) to (1.78±0.80). Condom-accepting rate increased from 29% to 92%, AIDS consult and test-accepting rate increased from 33% to 91%. All the above indexes show significant statistic difference before and after the intervention. In A venue, peer education-accepting rate increased from 33% to 91%, but the index shows no significant statistic difference in B venue. The rate of HIV antibody testing of MSM was 86% in A venue, the rate of HIV antibody testing of MSM was 36% in B venue, the index show significant statistic difference between A venue and B venue. The rate of finding HIV infected person was 4.65% in A venue, the rate of finding HIV infected person was 2.78% in B venue, the index show no significant statistic difference between A venue and B venue Conclusion Both CBO stationary point intervention model and combination intervention model were effective intervention models. But CBO stationary point intervention model was more effective in peer education-accepting rate and HIV infected person finding than combination intervention model. It worth be used in the fitted site.

Value of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta

Kong Lijun, Zhou Li, Yang Li, Fan Ling

2016, 37(2):  238-240.  doi:10.3969/j.issn.1006-7795.2016.02.025

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Objective The purpose of the study was to evaluate the role of ultrasound (US)and magnetic resonance imaging(MRI) in the prenatal diagnostics of placenta accreta. Methods The study includes 76 pregnant women with suspected placenta accreta. The results of ultrasound and magnetic resonance imaging were compared. Results US and MRI showed no significant difference in sensitivity and specificity in diagnosing placenta accrete(P>0.05), and the Kappa values were 0.835 and 0.863, respectively Conclusion US is an accurate imaging modality for diagnosing placenta accrete, but when the US result is negative or the placenta is posteriorly located, MRI is more sensitive for the detection of the degree of placental invasion.

Application of low-dose nalmefene in postoperative patient-controlled intravenous analgesia of elderly patients with hip fracture

Wu Dong, Cheng Bin, Gao Maolong, Zhao Jiaxun

2016, 37(2):  241-244.  doi:10.3969/j.issn.1006-7795.2016.02.026

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Objective To observe the effects of low-dose nalmefene on the postoperative analgesia and side effects of sufentanil and dezocine.Methods Eighty elder patients undergoing hip operations under spinal anesthesia (SA) and given patient-controlled intravenous analgesia(PCIA) were randomly divided into two groups (n=40 each group).Group T was given sufentanil and dezocine plus tropisetron for PCIA, group N was given sufentanil and dezocine plus low-dose nalmefene.The Visual Analogue Scale(VAS) pain scores of two groups were assessed at 2h, 4h, 8h, 12h, 24h, 48h after operation.The side effects and pressing times of PCA were observed and recorded as well.Results The VAS scores in the group N were statistically lower than that of group T postoperatively (P<0.05).The pressing times of PCA in group N was less than that in group T(P<0.05).The incidence of nausea and vomiting, dizziness in group N was significantly lower than group T (P<0.05).There was no occurrence of drowsiness and respiratory depression in group N, but no statistical significance compared with group T.Conclusion Compared with tropisetron, low-dose nalmefene can enhance the analgesic effect safely and reduce the incidence of side effects of sufentanil and dezocine to some extent in elder patients.

Study of intense pulsed light treatment for acne

Mei Xueling, Liu Juan, Li Yan, Zhao Junying

2016, 37(2):  245-247.  doi:10.3969/j.issn.1006-7795.2016.02.027

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Objective To observe the efficacy of different frequency intense pulsed light(IPL) in treatment of acne vulgaris. Methods Fifty cases were randomly divided into two groups. A group received the treatment every 2 weeks, B group received the treatment every 4 weeks, continued treatment for 4 times. Michelsons scores were compared at the 2 and 4 weeks after the treatment. Results The therapeutic effects in the A and B group were significantly better than those before treatment (P<0.05). The therapeutic effects in the A group were significantly better than those of B group (P<0.05). Conclusion IPL can get better clinical results in acne treatment. Treatment interval of 2 weeks is better than treatment interval of 4 weeks.

Development and clinical application of new-type IVCF

Chen Xin, Luo Tao, Huang Ying

2016, 37(2):  248-251.  doi:10.3969/j.issn.1006-7795.2016.02.028

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As an effective measure to prevent pulmonary thromboembosis, the inferior vena cava filters (IVCF) was widely used in clinic.To understand the clinical application of IVCF and the existing problems in its application process, will make great significance to the development of new IVCF.This paper summarized the clinical application status of IVCF and the latest advances of new-type IVCFs.