Abstract:Preterm birth is one of the most common obstetric complications. In recent decades, the incidence of premature birth remains high throughout the world, and even shows a rising trend in some countries and areas. Therefore, understanding the mechanisms of human parturition and developing the effective prevention and treatment strategies of premature delivery are urgent to improve maternal and fetal health and overall quality of population. Due to the limitation of ethics and testing methods, the prediction and early diagnosis of premature birth have been the primary problem that perplexes obstetricians. Various body fluids, including amniotic fluid, cervicovaginal fluid, urine, saliva and blood, provide rich sources of putative biomarkers that may be causative or reflective of preterm labor. In recent years, the exploration of novel biomarkers for noninvasive detection is in the ascendant, which sheds new lights for the prediction and early diagnosis of preterm labor. This review compares the biomarkers for the detection of preterm birth, and discusses the future prospect.

Abstract:Objective To explore the expression of costimulators in mice after allogenetic hematopoietic stem cell transplantation and its relationship with acute graft versus host disease (aGVHD). Methods Five C57BL/6J (H2KD^-H2KB⁺) male mice were selected as donors. Thirty CB6F1 (H2KD⁺H2KB⁺) female mice were selected as recipients and randomized into three groups:total body irradiation (TBI), bone marrow transplantation (BM) and aGVHD groups, with 10 mice in each group. The mice in the TBI group received radiation only without injecting any cells. The mice in the BM group were injected with 5×10⁶ bone marrow cells without T lymphocytes from donors after radiation. The mice in the aGVHD group were simultaneously injected with 5×10⁶ bone marrow cells without T lymphocytes and 3×10⁷ spleen cells from donors after radiation. The survival rates of mice in the three groups were evaluated using log-rank survival curve. The expression levels of costimulators, including cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed death 1 (PD-1), inducible costimulator (ICOS) and CD28, on CD4⁺ and CD8⁺ T lymphocytes, were detected using flow cytometry at 7, 14, 21 and 28 d after transplantation. At 21 d after transplantation, the expression levels of interleukin (IL)-17, interferon γ (IFN-γ) and IL-4 in CD4⁺ T lymphocytes, and the costimulator ligands in the colon tissues, were detected with flow cytometry and 3,3'-diaminobenzidine (DAB) staining, respectively. Results The mice in the TBI group all died within 19 d after irradiation. The mice in the BM group survived 30 d after irradiation without aGVHD. The median onset time of aGVHD symptoms and survival of mice in the aGVHD group were 14 (11-18) d and 22 (13-30) d, respectively. The expression levels of CTLA-4 and PD-1 on CD4⁺ and CD8⁺ T lymphocytes were decreased after transplantation, while the expression levels of ICOS and CD28 were on the rise. At 28 d after transplantation, the expression levels of CTLA-4 and PD-1 on CD4⁺ and CD8⁺ T lymphocytes were significantly lower in the aGVHD group than those in the BM group (all P<0.05), and the expression levels of ICOS and CD28 were significantly higher (all P<0.05). DAB staining showed that CD80, ICOS ligand (ICOSL), and PD-1 ligand (PD-L1) were negative in the colon tissues of mice in the BM group, and the positive expression rates of CD80, ICOSL, and PD-L1 in the aGVHD group were 40%, 80% and 80%, respectively. Compared with the BM group, the expression levels of IL-17 and IFN-γ in CD4⁺ T lymphocytes in the aGVHD group were significantly increased, while the expression level of IL-4 was significantly decreased (all P<0.05). Conclusion In aGVHD mice after allogeneic hematopoietic stem cell transplantation, the expression of costimulator CTLA-4 is gradually decreased over time. CTLA-4, ICOS and PD-1 may participate in the development and progression of aGVHD by regulating the distribution of T lymphocyte subgroups such as T-helper cell (Th)1, Th2 and Th17.

Abstract:Objective To investigate serum p75 neurotrophin receptor-extracellular domain (p75NTR-ECD) level in patients with chronic cerebral hypoperfusion-vascular cognitive impairment (CCH-VCI) and its relationship with tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6. Methods The clinical data of patients with CCH-VCI (n=34) were collected from Changhai Hospital, Naval Medical University (Second Military Medical University) from Aug. to Dec. 2018. Enzyme linked immunosorbent assay was applied for detection of serum levels of p75NTR-ECD, TNF-α, IL-1β and IL-6; and the results were then compared with those of ischemic stroke participants (n=34) and healthy controls (n=36), who were all in the same age range. Spearman correlation analysis was used to analyze the relationship between serum p75NTR-ECD level and the above-mentioned inflammatory factors in CCH-VCI patients. Results The serum p75NTR-ECD level in the CCH-VCI group was significantly higher than those in the healthy control group and the ischemic stroke group (544.36[440.88, 628.50] pg/mL vs 276.49[262.59, 313.87] pg/mL and 366.87[337.09, 450.43] pg/mL, U=87.500 and 335.500, both P<0.05). The serum levels of TNF-α, IL-1β and IL-6 were 196.02 (141.20, 280.35) pg/mL, 68.23 (60.79, 91.94) pg/mL and 51.04 (40.24, 65.26) pg/mL in the CCH-VCI group, respectively, and 218.67 (143.76, 281.28) pg/mL, 76.87 (59.10, 99.91) pg/mL and 64.45 (43.13, 86.76) pg/mL in the ischemic stroke group, respectively, which were all significantly higher than those in the healthy control group (73.71[56.94, 79.81] pg/mL, 42.98[34.52, 51.34] pg/mL and 14.97[11.76, 21.19] pg/mL, respectively; U=31.000 and 4.000, 106.000 and 132.000, and 48.000 and 13.000; all P<0.05). Serum p75NTR-ECD level in the CCH-VCI patients was correlated with TNF-α level (r=0.391, P=0.022), but not with IL-1β or IL-6 levels (r=0.032 and 0.164, P=0.855 and 0.355). Conclusion Serum p75NTR level may be related to inflammatory factors (TNF-α) after chronic cerebral hypoperfusion, and they may jointly participate in the pathogenesis of CCH-VCI.

Abstract:Objective To investigate the clinical features of Takayasu arteritis patients with different genders and ages. Methods The medical charts of 397 patients diagnosed with Takayasu arteritis in Changhai Hospital, Naval Medical University (Second Military Medical University) between Jan. 2001 and Dec. 2017 were retrospectively reviewed. The clinical manifestations, complications, laboratory parameters and imaging findings were compared between male and female patients, and between the groups subdivided by the ages of onset (≤ 40 years vs >40 years). Results There were 64 males and 333 females, with a male to female ratio of 1:5.2. The age of disease onset was 2-67 years. Seventeen (26.6%) male patients and 53 (15.9%) female patients had disease onset after 40 (χ²=4.190, P=0.041). Compared with female patients, male patients had their onset more frequently with hypertension (31.2%[20/64] vs 16.5%[55/333], χ²=7.605, P<0.01) and less frequently with dizziness, headache and syncope (28.1%[18/64] vs 46.5%[155/333], χ²=7.409, P<0.01). During the course of disease, hypertension was more prevalent (70.3%[45/64] vs 56.8%[189/333], χ²=4.076, P<0.05) and diminished or absent pulse was less common (51.6%[33/64] vs 76.0%[253/333], χ²=15.885, P<0.01) in male patients. Male patients with onset age ≤ 40 years (versus >40 years) had a higher incidence of hypertension (78.7%[37/47] vs 47.1%[8/17], χ²=5.997, P<0.05) and a lower incidence of diminished or absent pulse (40.4%[19/47] vs 82.4%[14/17], χ²=8.787, P<0.01). The complication rates of aneurysm and aortic regurgitation were significantly higher in male patients versus female patients (39.1%[25/64] vs 17.4%[58/333], 23.4%[15/64] vs 10.8%[36/333]; χ²=15.210, 7.644; both P<0.01). The prevalence rates of elevated erythrocyte sedimentation rate or C-reactive protein were similar between different gender and onset age groups (all P>0.05). Angiographically, male patients had more renal artery involvement and type Ⅳ (54.7%[35/64] vs 32.7%[109/333], 32.8%[21/64] vs 18.9%[63/333]; χ²=11.194, 6.212; both P<0.05) and less carotid artery and subclavian artery lesions and type Ⅰ (37.5%[24/64] vs 64.3%[214/333], 37.5%[24/64] vs 56.5%[188/333], 21.9%[14/64] vs 42.3%[141/333]; χ²=16.016, 8.416, 9.449; all P<0.01) compared with female patients. Male patients with onset age ≤ 40 years (versus >40 years) had a higher proportion of type Ⅳ (44.7%[21/47] vs 0[0/17], χ²=11.305, P<0.01) and lower proportions of carotid artery and subclavian artery lesions and type Ⅰ (29.8%[14/47] vs 58.8%[10/17], 25.5%[12/47] vs 70.6%[12/17], 14.9%[7/47] vs 41.2%[7/17]; χ²=4.491, 10.814, 5.046; all P<0.05). Conclusion Male Takayasu arteritis patients have a later onset age compared with female patients. Hypertension and renal artery involvement (type Ⅳ) are commonly seen in male patients with onset age ≤ 40 years; female patients and male patients with onset age >40 years often have diminished or absent pulse and carotid artery and subclavian artery lesions (type Ⅰ). The complications such as hypertension, aneurysm and aortic regurgitation are more common in male patients compared with female patients.

Abstract:Objective To evaluate the curative effect of selective screw placement of posterior three-dimensional correction for LenkeⅠadolescent idiopathic scoliosis (AIS), and to compare the effects of different screw densities on the orthopedic parameters. Methods We retrospectively analyzed the clinical data of LenkeⅠAIS patients undergoing posterior correction of scoliosis+selective fusion and internal fixation surgery in Department of Spine Surgery of Changhai Hospital of Naval Medical University (Second Military Medical University) between Jan. 2013 and Jan. 2017. According to the references, the screw density was defined as the number of nails/(fusion segment×2). The patients were divided into high density group (screw density>0.7) and low density group (screw density ≤ 0.7). The general characteristics, surgical correction rates 2 weeks and 2 years after operation, loss of correction rate after 2 years and correction ratio were compared between the two groups. Results A total of 36 eligible patients (11 males and 25 females) with LenkeⅠAIS were included in this study, with an average age of (13.97±1.89) years old. There were 23 cases in the high density group and 13 cases in the low density group, with the screw densities being 0.80±0.04 and 0.64±0.06, respectively, and the difference was significant (t=10.799,P<0.01). There were no significant differences in gender, age, brand of pedicle screw, preoperation coronal main curve Cobb angle, preoperation bending Cobb angle or preoperation scoliosis flexibility between the two groups (all P>0.05). Compared with the high density group, the low density group had no significant disadvantages in coronal main curve Cobb angles 2 weeks and 2 years after operation, surgical correction rate 2 weeks after operation, or loss of correction rate 2 years after operation (all P>0.05). Pearson correlation analysis showed that there were no significant correlations between screw density and surgical correction rate 2 weeks after operation, correction ratio and the loss of correction rate (r=0.149, 0.348, 0.217; P=0.387, 0.874, 0.177). Conclusion For LenkeⅠAIS patients with better flexibility, appropriate reduction of the nail number in selective screw placement surgery may not adversely affect the short-term and mid-term outcomes.

Abstract:Objective To evaluate the mental health status of patients with adolescent idiopathic scoliosis (AIS) after bracing treatment, and to observe the severity of depressive symptoms and analyze the influencing factors. Methods We collected the general data and imaging data of AIS patients who underwent bracing treatment in the outpatient clinic of Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2015. The data included age, gender, body mass index, coronal main curve Cobb angle at the initial treatment and the last follow-up, and duration of bracing treatment. The Center for Epidemiological Studies depression scale for children (CES-DC) and the strengths and difficulties questionnaire (SDQ) were used to assess the severity of depression and the mental health status before bracing treatment and at the last follow-up. Multivariate linear regression model was used to analyze the factors influencing the severity of depression during the bracing treatment. Results A total of 112 patients (16 males and 96 females) were enrolled in our study. We found that the CES-DC score was significantly higher at the last follow-up than that at the beginning (38.4±3.0 vs 26.1±4.2); the scores of the emotional problems (7.7±1.5 vs 5.3±2.2) and peer problems (7.6±1.4 vs 5.0±1.6) in the SDQ were significantly increased and the score of the prosocial behavior was significantly decreased (2.7±0.5 vs 4.2±0.3) at the last follow-up (t=25.22, -27.22, 9.54 and 12.94; all P<0.01). Multivariate linear regression analysis suggested that the depression severity of AIS patients was positively correlated with the pre-treatment coronal main curve Cobb angle, duration of bracing treatment, and pre-treatment SDQ emotional symptom and peer problem scores (all P<0.05), but were negatively correlated with the score of the prosocial behavioral subscale of SDQ. Conclusion The mental health status of patients with AIS is changed after bracing treatment, with increased severity of depression. Active psychological intervention shall be given to patients with large pre-treatment coronal main curve Cobb angle, longer treatment time of bracing, and higher pre-treatment SDQ's emotional symptom scores and peer problem scores, which may improve the post-treatment quality of life of patients.

Abstract:Objective To compare the mid-term outcomes of valved bovine jugular vein conduit and autologous pericardium conduit in reconstruction of right ventricular outflow tract. Methods Eighteen congenital heart disease patients were implanted with external conduits (included 11 valved bovine jugular vein conduits and 7 autologous pericardium conduits) for right ventricular outflow tract reconstruction between May 2013 and Jul. 2016. There were 11 males and 7 females at age of 2-16 (5.22±4.12) years. Preoperative clinical diagnoses included pulmonary artery atresia with ventricular septal defect (n=7), double outlet of right ventricle with pulmonary stenosis (n=4), persistent truncus arteriosus (n=3), persistent truncus arteriosus with absence of right pulmonary artery (n=1), corrected transposition of great arteries with pulmonary stenosis (n=1), and transposition of great arteries with pulmonary stenosis (n=2). The perioperative status was recorded. The cardiac ultrasound and computed tomography angiography (CTA) were used to evaluate the efficacy during 4-56 months of follow-up. Results There were no perioperative deaths in the bovine jugular vein conduit group, and 2 deaths in the autologous pericardium conduit group. One died of pulmonary hypertension crisis and the other died of low cardiac output syndrome. The ratio of right ventricular pressure to radial arterial pressure, duration of mechanical ventilation and intensive care unit (ICU) stay after surgery were significantly lower in the bovine jugular vein conduit group than those in the autologous pericardium conduit group (all P<0.05). There were no significant differences in extracorporeal circulation time, aortic cross-clamping time, transvalvular gradient in right ventricular outflow tract, blood consumption or total hospitalization costs between the two groups (all P>0.05). During follow-up, there were no deaths in the two groups, no reoperations in the bovine jugular vein conduit group, and 1 case received reoperation 2 years after surgery due to severe right ventricular dysfunction in the autologous pericardium conduit group. In the bovine jugular vein conduit group, the transvalvular gradients in right ventricular outflow tract at the last follow-up and before discharge were (22.91±7.31) mmHg (1 mmHg=0.133 kPa) and (20.45±6.70) mmHg, respectively, and the difference was not significant (P>0.05). In the autologous pericardium conduit group, the transvalvular gradient in right ventricular outflow tract was (29.20±18.09) mmHg at the last follow-up and (16.14±4.02) mmHg before discharge, and the difference was significant (P<0.05). At the last follow-up after surgery, there were 8 cases of mild reflux and 3 cases of moderate reflux in the bovine jugular vein conduit group, and 1 case of mild reflux, 2 cases of moderate reflux and 2 cases of severe reflux in the autologous pericardium conduit group, and the difference between the two groups was significant (P<0.05). Postoperative ultrasonography showed the thickened valve leaflets with good valve movement in the bovine jugular vein conduit. No calcification, thrombosis and infective endocarditis were found in the two groups. Postoperative cardiac CTA found that there was aneurysmal dilatation in 1 middle segment and 1 proximal anastomotic stoma of the bovine jugular vein conduit group, and no dilatation in the autologous pericardium conduit group. Conclusion Domestic valved bovine jugular vein conduit is suitable for right ventricular outflow tract reconstruction in patients with complex congenital heart malformations. Mid-term follow-up shows that bovine jugular vein conduit has good anti-reflux performance and no severe obstruction or calcification. It is obviously superior to autologous pericardium conduit. However, some bovine jugular vein conduits have aneurysmal dilatation in mid-term follow-up, which needs to be further improved.

Abstract:Objective To study the adverse effect of mirror artifacts generated from the specular reflection of trachea wall on microwave ablation (MWA) treatment of thyroid nodules and the causes. Methods Perioperative ultrasound imaging data of 304 patients who received MWA of thyroid nodules in Shanghai International Medical Center from Jan. 2018 to Oct. 2018 were systemically studied. The occurrence rate, sources, acoustic characteristics of the mirror artifacts and the adverse effects of mirror artifacts on MWA were summarized. The factors contributing to specular reflection of trachea were analyzed. Results A total of 169 cases (55.59%) presented tracheal mirror reflection artifacts in this study. The sources of mirror artifacts included thyroid nodules (20 cases, 11.83%), injection needle (133 cases, 78.70%), ablation electrode (16 cases, 9.47%), hydro-dissection zone (137 cases, 81.07%), and remote ablated area of thyroid nodule (8 cases, 4.73%). We also found that 88.17% (149/169) of mirror artifacts were during the MWA operative period. Conclusion Mirror artifacts generated from the specular reflection of trachea wall are commonly seen in the perioperative period of thyroid nodule MWA. Lesion close to the trachea, flattened tracheal wall, and flat interface linearity larger than the real source dimension are the important causes of mirror artifacts. Direct compression on the tracheal wall caused by thyroid nodules, ablated areas and hydro-dissection zone are the main causes of flattened tracheal wall.

Abstract:Objective To investigate the prevalence and risk factors of thyroid nodules in physical examination population of Hotan County People's Hospital, so as to provide a basis for the prevention and treatment of thyroid diseases. Methods A retrospective analysis was conducted on the data of population over 18 years old who underwent physical examination in the Health Examination Center of Hotan County People's Hospital from May 2016 to Jan. 2018. All enrolled subjects underwent thyroid ultrasonography and had complete ultrasonographic information. The subjects were divided into thyroid nodule group and non-thyroid nodule group. Univariate analysis and multivariate logistic regression analysis were performed to analyze the risk factors of thyroid nodules. Results A total of 2 752 subjects were enrolled in this study, including 1 631 males and 1 121 females. The total prevalence rate of thyroid nodules was 35.6% (980/2 752), and the prevalence rate of thyroid nodules in males was significantly lower than that in females (32.5%[530/1 631] vs 40.1%[450/1 121], P<0.01). The prevalence rate of thyroid nodules increased gradually with age (P<0.01). Multivariate logistic regression analysis showed that age, obesity, fasting plasma glucose and triglyceride were independent risk factors of thyroid nodules (all P<0.05). Conclusion The prevalence of thyroid nodules maintains at a higher level in the physical examination population of Hetian County People's Hospital, and gradually increases with age. The prevalence rate in females is higher than that in males. Age, obesity, fasting plasma glucose and triglyceride are independent risk factors of thyroid nodules, and may help the early detection of thyroid nodules.

Abstract:Objective To develop a method combining surface-enhanced Raman scattering (SERS) spectrum and electrostatic adsorption for detecting circulating tumor cells. Methods Graphene oxide was non-covalently functionalized by poly(sodium-p-styrenesulfonate) (PSS), and graphene oxide/gold nanorod (GO/GNR) hybrids were in situ synthesized via gold seeding growth approach. Then, GO/GNR hybrids were non-covalently functionalized by poly dimethyl diallyl ammonium chloride (PDDAC) to make the surface of GO/GNR positively charged. GO/GNR hybrids would target the tumor cells by electrostatic interaction. SERS technology was used to detect the composites of GO/GNR-tumor cells. The blood samples of healthy volunteers were collected, and the tumor cells of different densities were added to the blood samples to make simulated blood samples. The tumor cells in simulated blood samples were detected using the above methods. Results Positively charged GO/GNR hybrids could efficiently target the tumor cells. SERS spectroscopy could detect tumor cells within 50 to 10 000 cells. However, white blood cells might interfere the detection of tumor cells. Conclusion GO/GNR hybrids may serve as SERS probes for detection of circulating tumor cells via Raman spectroscopy.

Abstract:Nipple inversion is a common female disease which can be caused by congenital factors or acquired factors. According to the severity, nipple inversion can be divided into 3 levels. It can not only affect the shape and function of the breast, but also induce serous mastitis. Scholars have conducted many basic and clinical studies to correct the inverted nipple, and the current main methods included surgical and nonsurgical treatment. Due to the individual differences of patients and different surgical operation habits of surgeons, although many methods have been reported, there has been no single operation method which can correct all types of nipple retraction. This paper summarizes the progress of surgical treatment of nipple retraction in recent years, with emphasis on the pros and cons of three surgical methods:dermal flap, traction, minimally invasive and endoscopic fibrous tissue release.

Abstract:Fallopian tube factors and decreased ovarian function are the main causes of female infertility. Decreased ovarian function includes premature ovarian failure, diminished ovarian reserve, premature ovarian insufficiency and poor ovarian response. The main feature of ovarian function decline is the decrease in the number and/or the low quality of ova, manifested as ovulation disorders, infertility and reproductive endocrine disorders. This article summarizes the progress in different evaluation criteria and treatment of decreased ovarian function, hoping to provide reference for future diagnosis and treatment.

Abstract:Ticagrelor is a novel oral antiplatelet agent. It can inhibit platelet aggregation mediated by adenosine diphosphate (ADP) by directly acting on ADP receptor P2Y12, exerting its antiplatelet function. In addition, ticagrelor showed bioavailability like increasing coronary blood flow, reducing myocardial infarction size and inducing dyspnea. These effects were thought to be closely related to adenosine. However, recent publications about the effect of ticagrelor on plasma adenosine concentration were inconsistent, which may be caused by different determination methods, especially various compositions of stop solution, and different sampling time points. Standardized determination method of plasma adenosine concentration and dynamically monitoring the changes of plasma adenosine after taking ticagrelor may help to further illustrate the influence of ticagrelor on plasma adenosine concentration.

Abstract:Focusing on the diversified training environment of the Chinese navy and the peculiar injuries of the soldiers, we created a navy military medical geography information system based on ArcGIS two-dimensional development platform by using the large sample survey data of a certain naval medical support unit. This established system can link the naval injury data, civilian and military health resources and spatial geographic data, contributing to the monitoring and early warning of the navy injury, information management of medical resources, and decision-making in medical support.

Abstract:Objective To conduct normative analysis of the definition of psychological mobilization. Methods Normative analysis, text analysis and logic induction and deduction were used to analyze the definition of psychological mobilization. Results Psychological mobilization was included in political mobilization in law. Different methods were used in theoretical research of psychological mobilization. Psychological mobilization had been applied in wars in the past. Conclusion Psychological mobilization refers to a mobilization form that applies psychological theories and methods to influence people's psychology in a planned, organized and step by step way, so that the mental state of the military and civilian can be changed from the normal state to the wartime state, improving the psychological adaptability of the battlefield.

Abstract:Objective To report a case of Kennedy disease confirmed by gene diagnosis and to retrospectively reviewed the clinical features of genetically-confirmed patients with Kennedy disease in China. Methods The clinical data of this patient from our hospital were collected. Two electronic databases (Wanfang Data and CNKI) were searched using keywords "Kennedy disease" and "X-linked recessive hereditary amyotrophy of spinal cord and medulla oblongata" from Jan. 2007 to Dec. 2017. And a total of 63 articles (170 cases) were finally identified, including one case reported by us. The clinical data and biochemical indicators of Kennedy disease in China were summarized and analyzed. Results All the 170 patients were male. The average age of onset was (39.12±10.21) years old in 164 patients with described age of onset, mainly ranging 30-50 years old, and the average age of treatment was (48.04±8.94) years. We also noticed that the age of onset was negatively correlated with the number of CAG repeats in 161 patients (r=-0.272, P=0.001). In 170 Kennedy disease patients, the most common symptoms were proximal weakness of the lower extremities (93 cases, 54.71%), followed by weakness of limbs (38 cases, 22.35%). With the progression of the disease, 93 (54.71%) patients had breast development and/or decreased sexual function; and 143 (84.12%) patients had atrophy and fibrillation of tongue muscles, but no obvious drinking water choking was found in the literature. The main signs of lower motor neuron were mild muscle atrophy, fascicular fibrillation, mild muscle degeneration, especially the proximal limb, with diminished or disappeared tendon reflex. We also noticed that 91.18% (155/170) of the patients had increased creatine kinase. Some patients had diabetes, elevated blood lipids, thyroid dysfunction and/or mild liver dysfunction. Conclusion The diagnosis of suspected Kennedy disease patients can be confirmed by genetic tests with the deep understanding of the disease by physicians and the popularization of genetic examination, although there have been no effective methods for treatment of Kennedy disease.

Abstract:Objective To explore the feasibility of fractional exhaled nitric oxide (FeNO) dynamic changes in guiding stepped treatment of patients with chronic persistent asthma. Methods From Jan. 2016 to Dec. 2017, chronic persistent asthma patients, who were admitted to Shanghai Dahua Hospital of Xuhui District, were enrolled and randomly divided into study and control groups. All patients were given standardized treatment according to Global Initiative for Asthma in 2014 (GINA 2014) and evaluated every 3 months to adjust their medications. The control group was adjusted according to the recommended protocol from GINA 2014, while the study group was adjusted according to the results of FeNO on the basis of the recommended protocol from GINA 2014. All patients were followed for 1 year. The complete control rate, failure rate of de-escalation treatment, Asthma Control Questionnaire (ACQ) score and lung function were compared between the two groups. Results Atotal of 207 patients were enrolled in this study, including 103 cases in the control group and 104 cases in the study group. The condition of the patients was effectively controlled in both study and control groups. There were no significant differences in total control rate, ACQ score or lung function between the two groups (all P>0.05), while the failure rate of de-escalation therapy was significantly lower in the study group than that in the control group (7.28%[11/151] vs 13.66%[25/183], P<0.05). In addition, the doses of controlled drugs and short-acting on-demand remission drugs in 4-6 months, 7-9 months and 10-12 months were significantly less in the study group than those in the control group (all P<0.05). Conclusion In the treatment of chronic persistent asthma, the dynamic monitoring of FeNO can effectively guide the medication, decrease the failure rate of treatment, and reduce the doses of controlled drugs and short-acting on-demand remission drugs.

Abstract:Objective To investigate the pathogenic bacterium distribution in bacterial liver abscess and sensitivity characteristics and utilization of antibiotics. Methods The clinical data of 125 patients with bacterial liver abscess, who were admitted to anting branch of our hospital from Oct. 2015 to Apr. 2017, were collected and analyzed retrospectively. The results of bacterial culture, drug resistance and use of antibiotics were investigated. Results Totally 94 patients were examined for pathogens, and 62 samples from 51 patients were positive to bacterial culture. A total of 62 strains of bacteria were detected, including 53 (85.48%) strains of Gram-negative bacteria, of which the most common bacteria were Klebsiella pneumoniae (33 strains) and Escherichia coli (10 strains), and 9 (14.52%) strains of Gram-positive bacteria, of which Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were rather common (2 strains in each). Extended-spectrum β-lactamase (ESBL)-producing strains accounted for 6.06% (2/33) and 60.0% (6/10) in Klebsiella pneumonia and Escherichia coli, respectively. Ceftriaxone sodium, cefoperazone/sulbactam sodium, and imipenem/cilastatin sodium had higher defined daily dose system resulting in drug utilization index >1. Conclusion The most common pathogens causing bacterial liver abscess are Gram-negative bacteria, mainly Klebsiella pneumoniae and Escherichia coli. Clinically, we should strengthen the management of antibiotics use, identify the pathogens as soon as possible, and select optimum drugs based on drug-susceptibility test results to reduce drug resistance rate.

Abstract:Objective To explore the main factors influencing the attention of the military drivers working at high altitude environment by comparing the attention status of the drivers at different altitudes, so as to provide evidence for objective evaluation of military drivers' attention at high altitude. Methods A total of 196 military drivers at high altitude (2 900 m) and 190 at moderate altitude (2 200 m) were included in study groups, and 192 at low altitude (below 100 m) were taken as controls. Attention concentration instrument (EP701C) and attention distribution instrument (EP708A) produced by Scientific & Teaching Instruments Factory of East China Normal University were used to evaluate the attention status of the drivers. The data were analyzed by chi-square test, variance analysis, LSD-t and nonparametric test. Results Finally 578 of the 600 surveyed military drivers finished the survey, with a recovery rate of 96.33%. The 578 drivers included 196 in the high altitude group, 190 in the moderate altitude group, and 192 in the control group. For reaction to the 3 kinds of sounds, the correct response time of the high altitude group was significantly less than those of the moderate altitude group (P<0.01) and control group (P<0.01), the reaction period of the high altitude group was significantly longer than those of the moderate altitude group (P<0.05) and control group (P<0.01), and that of the moderate altitude group was significantly longer than the control group (P<0.05). For attention distribution test, the accuracy times of sound attention in the high altitude group and the moderate altitude group were significantly lower than that in the control group (P<0.01, P<0.05). The high altitude group also had a significantly longer reaction time to the sound compared with the moderate altitude group (P<0.05) and control group (P<0.01), and that of the moderate altitude group was significantly longer than the control group (P<0.05); and the same was true also for the light response period in the three groups. For attention concentration ability test, the high altitude group had significantly longer orbit period than the control group (P<0.01), and there was no significant difference in the time of target missing among the three groups (P>0.05). Conclusion High altitude environment has an adverse effect on selecting response time and attention distribution ability of military drivers, and the effect increases with altitude. Long-term high-altitude environmental training can promote the attention concentration ability of military drivers.

Abstract:Objective To investigate the physicochemical properties and pharmacokinetics of L-asparaginase loaded hydroxypropyl-β-cyclodextrin liposome (AHL) in rats. Methods AHL was prepared by reverse evaporation method, and the entrapment rate, particle size, zeta potential and morphology of AHL were observed. Twelve SD rats were randomly divided into two groups. One group was injected with AHL, and the other group was injected with L-asparaginase (L-ASN). The blood samples were taken from infraorbital venous plexus, and the activity of L-ASN in the samples were determined and the activity-time curve was plotted. Main pharmacokinetic parameters were calculated by software DAS2.1.1. Results The average entrapment efficiency of AHL was (53.53±0.58)%, with an average particle size of (388.99±2.02) nm and an average zeta potential of (-8.56±0.75) mV. The pharmacokinetic parameters for AHL and L-ASN were:0-48 h area under curve (198.79±9.15) U/(mL·h), (57.78±2.90) U/(mL·h); 0-48 h mean resident time (4.61±0.09) h, (2.09±0.05) h; peak concentration (32.32±1.33) U/mL, (26.82±1.38) U/mL; and time to peak (1.08±0.20) h, (0.10±0.04) h, respectively. The relative bioavailability of AHL was 344.05%. Conclusion AHL can improve the pharmacokinetics and enhance the bioavailability of L-ASN.

Abstract: