Volume 93  ·   Issue 13  ·  2013

To explore the situation and the affect factors of myopia and scientificalness and effectiveness of eye exercises about primary and middle school students.

Through the random cluster sampling method, 20 000 students of 90 schools including key and nonkey primary or junior or senior school in country and city of shandong,qinghai, yunnan,Shanghai and wenzhou were random selected.Primary students is 11 246 junior students is 3673 senior students is 4220.We surveyed related situation of eye exercises, myopia.a total of 19 139 valid questionnaires were received.By random sampling stratification method, freshmen were selected and retrospective surveyed.929 freshmen have normal vision when they graduated primary school.338 freshmen have normal vision when they graduated primary school. 2 groups are considered analysis object, and Myopic students of the former in junior school stages and the latter in senior school stages are considered case group, normal vision are considered control group, and then through the Logistic multiple stepwise regression analysis, a regression analysis model is established.

This survey show that myopia prevalence was 13.7% of primary students, 42.9% of junior students, 69.7% of senior students.According to the significant P<0.001, Rsquare=0.14, the result shows that the model has the significant statistical significance.Among the influence factors, whether to long-term excessive use eye is the most significant, and following by outdoor activities and gender.A chi-square test χ²=0.371 and P=0.543 show that doing eye exercises was not statistically significant to prevalence of myopia.

The influence factors are changed, and the preventive methods should be adjusted with the social environment.

To explore the presence of functional connectivity between anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC) during the manipulation of attentional network test (ANT) and its relationship with behavioral performance.

Functional magnetic resonance imaging was performed on 25 healthy subjects aged 17- 20 years.And ANT was used as a paradigm.Functional connectivity between ACC-DLPFC was tested and correlation analysis conducted between functional connectivity coefficients and behavioral scores of ANT.

Significant functional connectivity between the dorsal ACC (dACC) with bilateral DLPFC was found.Furthermore, event-related functional connectivity coefficients between left d ACC and left DLPFC were negatively associated with the behavioral scores of executive control (r=-0.63| P<0.01).

Our findings provide new evidence that ACC and DLPFC are functionally connected and such functional connectivity has advantageous influence on executive control function of attention so as to contribute to our understanding of the integrated role of these brain regions in attentional network.

To explore the clinical and electrophysiological characteristics of sensory neuron disease (SND).

The clinical and electrophysiological characteristics were analyzed from November 2007 to November 2012 in 57 patients with sensory neuron disease and another 95 with sensory polyneuropathy.Nerve conduction studies of median nerve, ulnar nerve, tibial nerve, peroneal nerve and sural nerve and electromyogram (EMG) of bulbar,cervical, thoracic and lumbosacral region,somaosensory evoked potential (SEP) and contact heat evoked potential (CHEP) were performed.

The amplitude of sensory nerve action potential (SNAP) decreased in 50 SND patients and disappeared in another 7.The parameters of SEP and CHEP were abnormal.The amplitude of SNAP was lower in median and ulnar nerve than in sural nerve ((0.6±0.2) μV, (0.7±0.2) μV vs (1.5±0.5) μV;t=2.42, 2.38; P<0.05).The latencies of SEPs were longer in SND patients than in those with sensory polyneuropathy (t=1.99, 1.99, 2.00, 2.07, 1.99; 1.98, 1.99, 2.02, 1.98, 1.99; P<0.05).Comparing with those with sensory polyneuropathy, the latencies of CHEP were longer in SND patients when the stimuli was applied at hand dorsum, proximal volar forearm and anticus tibialis (t=2.01, 2.00, 2.02; P<0.05).No difference existed in latencies between 2 groups when the stimuli was at the levels of C7 and T12 (t=0.97,0.68;P>0.05).

Sensory neuron diseases usually present with sensory symptoms and ataxia.The amplitude of SNAP decreases or disappears especially in upper extremities.Both SEP and CHEP are abnormal.

To evaluate the efficacy and safety of combined transarterial chemoembolization with sorafenib in patients with large hepatocellular carcinoma.

79 patients with large HCC (larger than 10 cm in diameter) were enrolled from July 2008 to June 2012 for this retrospective study.24 patients undertaken TACE combined with sorafenib as T+S group.35 patients undertaken TACE alone as T group, and other 20 patients treated with sorafenib alone as S group.

The median survival time was 15 months in T+S group,10 months in T group,and 5 months in S group, respectively (P=0.000).The median time of tumor progress was 6 months,3 months and 2.5 months, respectively (P=0.000).The most common adverse events related to sorafenib in group T+S group and S group alone were hand foot skin reaction, diarrhea and alopecia.The incidence rate of adverse events related to sorafenib was no significant difference between two groups.There was no 4 or more grade adverse event occurred in each group.The most common complications related to interventional treatment in group T+S group and T group alone were mild jaundice, ascites, inguinal region hematoma.The incidence rate of complications related to interventional treatment was no significant difference between two groups.

The combination of TACE and sorafenib in patients with large HCC is well tolerated and safe, which is available to delay tumor progression and prolong survival.

To explore the epidemic characteristics of HIV-1 recent infection among high-risk populations in Tianjin and to provide reasonable evidence for intervention strategy.

Blood samples were detected using BED-CEIA to identify recent HIV-1 infection, and HIV/AIDS cases in Tianjin 2010 were collected to analyze epidemic data.

349 of reported HIV/AIDS cases were confirmed from total 777 207 people.ALL of 87 HIV-1 recent infections were males and mainly detected from men who have sex with men (MSM),voluntary counseling and testing (VCT) and STD outpatients, the HIV-1 incidence of each group was 1.48%, 0.38%, 0.17% respectively.There were not significant difference in recent HIV-1 infection rate between other areas and locals.The homosexual transmission was 80.46% among recent HIV-1 infections.

The results of this study showed that the homosexual contact was primary route of HIV transmission in Tianjin.The infection of HIV was serious among MSM,effective interventions should be taken for HIV/AIDS control and prevention urgently.

To document the MRI features of Chromophobe cell carcinoma and to explore whether MR features vary with the tumor size.

MRI features of 34 patients (16 male, 18 female, age range from 24-61, average age is 49 years old), totally 35 focuses with histologically proved chromophobe cell carcinoma were studied retrospectively.All the patients underwent MR plain and dynamic contrast-enhanced scan before their surgery.Variation of signal intensity (3D LAVA) and ADC values of the lesions, and the analysis of images of T₁WI, T₂WI and chemical shift were all evaluated on the GE Advantage 4.4 work station.All lesions were categorized into 2 groups (tumor diameter≤4 cm, or>4 cm).The difference of imaging characteristics between these two groups was analyzed using Fisher exact test.Signal intensity variation and ADC values were analyzed by using one-way ANOVA method.

None of the 35 cases contained fat or lipid.On T₂WI 27 cases showed slightly low signal intensity (77.1%).In all cases,4 appeared local cystic change (11.4%);4 spotty hemorrhage (11.4%);5 necrosis (covering less than 20% of whole tumor)(14.2%); 30 clear pseudo capsule (85.7%); 29 round-like lesions (the difference among the length, width and height was within 0.5 cm)(82.8%); and no cases showed signs of invasiveness or metastasis.The average changes of signal intensity of all the 35 cases were 119.8% on cortex period,176.4% on medulla period and 154.5% on delayed phase.The mean ADC value of tumor was 1.08±0.28×10^-3mm²/s. 35 leasions were divided into two groups,21 in group 1 (diameter≤4 cm) and 14 in group 2 (diameter>4 cm).Cystic degeneration was seen in 0/21 in group 1 versus 4/14 in group 2 respectively, and hemorrhage 0/21 versus 4/14, necrosis 0/21 versus 5/14, central scar 2/21 versus 8/14.The difference of these findings between two groups demonstrated statistical significance (P<0.05).Variation of signal intensity and ADC values in two groups has no statistical significance.

The MR features of Chromophobe renal cell carcinoma were hypointensity on T ₂WI, clear pseudocapsule, However, cystic degeneration, hemorrhage, necrosis and central scar are more common in larger tumors.

To assess the sensitivity and specificity of anti-aquaporin 4 antibody in the diagnosis of neuromyelitis optica (NMO) and analyze the relationship between clinical features and different NMO-IgG status.

A total of 269 serum specimens were collected from the patients with NMO, high-risk for NMO, multiple sclerosis (MS) and miscellaneous diseases and analyzed with HEK-293T cells transfected by aquaporin 4 cDNA.The sensitivity and specificity of antiaquaporin 4 antibody in the diagnosis of NMO were calculated,Spearman correlation coefficients were used to examine the relationship between clinical features and antibody titer.

(1) The results of cell-based immunofluorescence assay showed 36 examples of 47 NMO patient serums (76.6%) were positive, 7/23 high-risk for NMO positive (30.4%), 3/85 multiple sclerosis (3.5%) positive, 1/48 miscellaneous neurological disorders (2.1%), 2/16 immune system diseases positive (12.5%) and negative in all 50 healthy serum specimens.Sensitivity and specificity were 76.6% and 97.0% for discriminating NMO from MS and other diseases. (2) Anti-AQP4 antibody titer had no obvious correlation to relapses, spinal lesion length and EDSS (P>0.05). (3) Anti-AQP4 antibody titer became lower after a high dose of intravenous methylpredonisolone (P<0.05).

Anti-AQP4 antibody in NMO has a high specificity and sensitivity so as to contribute to early diagnosis and optimized treatment of NMO.And its titer decreases after a high dose of intravenous methylpredonisolone.But there is no correlation between its titer and length of spinal cord lesions, relapsing frequency or expanded disability status scale (EDSS) score.

To explore the clinical efficacy of endovascular treatment for lower extremity arteriosclerosis obliterans.

A total of 34 patients (43 limbs) with lower extremity arteriosclerosis obliterans undergoing endovascular treatment from July 2010 to July 2012 were analyzed.The cohort had Fontaine stage Ⅱb (n=16), Fontaine stage Ⅲ (n=10) and Fontaine stage Ⅲ (n=8).Among them, the lesions were of TASCⅡA (n=4), TASCⅡB (n=8), TASCⅡC (n=9) and TASCⅡD (n=13).All patients underwent percutaneous transluminal angioplasty (PTA) plus stents after computed tomographic angiography (CTA) or digital subtraction angiography (DSA).And 9 patients underwent femoral endarterectomy associated with endovascular treatment.

The success rate of this technique was 100%.One iliac artery ruptured during endovascular surgery.One patient suffered intraoperatively from arterial perforation.One patient was amputated one week later.One patient had in-stent thrombosis at Week 3 post-treatment.One patient was amputated at Week 4 after endovascular treatment.Thirty patients (38 limbs) were followed up for 13.3 months.During the follow-up, 3, 4 and 4 limbs became occluded at Month 6, 12 and 24 post-treatment respectively.

Endovascular treatment has an excellent early patency rate.Special issues should be properly handled during endovascular treatment.

To explore the changes of brachial flow-mediated vasodilation (FMD), vascular endothelial growth factor (VEGF) and soluble VEGF receptor 1 (sFLT) in patients with severe sepsis and evaluate their prognostic values.

A total of 128 patients with severe sepsis were consecutively recruited from January 2009 to January 2011 at Intensive Care Unit of Zhejiang Hospital.And their general profiles and clinical characteristics were analyzed.Brachial artery FMD was measured by ultrasound upon admission after a diagnosis of severe sepsis.The plasma levels of VEGF and sFLT were measured by enzyme-linked immunosorbent assay (ELISA).

The average age was (69.0±10.1) years and the 28-day mortality rate stood at 41.4%.Compared with the survivors, the non-survivors had a lower brachial FMD (P<0.001) and a higher plasma concentration of sFLT (P=0.006).However, the survivors and non-survivors had a similar plasma level of sFLT (P=0.32).In addition, brachial FMD was inversely correlated with sFLT (r=-0.39,P<0.001), but not with plasma VEGF (r=0.07, P=0.11).Receiver operating characteristic (ROC) analysis showed that the optimal FMD (sensitivity 81%, specificity 76%) and plasma sFLT (sensitivity 77%, specificity 71%) cutoff values were 4.5% and 398 pg/ml for 28-day mortality respectively.The multiple Logistic regression analysis revealed that brachial FMD (OR=0.48,95% CI:0.22-0.81, P=0.04) and plasma sFLT (OR=1.86, 95% CI:1.21-3.08, P=0.02) were independent predictors of 28-day mortality rate.

Lower brachial FMD and higher plasma sFLT may reflect endothelial function impairment and carry a higher risk of mortality in patients with severe sepsis and have.Non-invasive ultrasonic assessment of flow-mediated dilation is recommended.

To explore the effects of a knockdown of cyclooxygenase 2 upon the growth and migration of SaOS₂cells.

We employed lentivirus mediated-RNA interference technology to knockdown the endogenous expression of gene COX-2 in human osteosarcoma cells (SaOS₂) and analyzed their phenotypical changes.The effects of COX-2 silencing on the proliferation, cell cycle and migration of SaOS₂cells were assessed by thiazoyl blue tetrazolium bromide, flow cytometry and migration assays respectively.COX-2, vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF) mRNA and protein expression were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.

A decreased expression of COX-2 in human osteosarcoma cells significantly inhibited the growth and decreased the migration ability of SaOS₂cells.Furthermore, it also reduced VEGF, EGF and bFGF mRNA and protein expression.

The COX-2 signaling pathway may provide a novel therapeutic target for the treatment of human osteosarcoma.

To investigate the effects of platelet on intercellular adhesion between leukocyte and liver sinusoidal endothelial cell (LSEC) and the transendothelial migration under the hypoxia-reoxygenation condition, as well as the role of relevant adhesion molecules.

LSEC was cultured for 24 hours under hypoxia condition and then reoxygenated for 2 hours (hypoxiareoxygenation,HR).This hypoxia-reoxygenation model was used to simulate the clinical liver ischemia-reperfusion injury process (IRI).Platelets and leukocytes were labeled with fluorescence dye, and then the adhesion was detected by fluorescence microscope, fluorescence plate reader and laser scanning confocal microscope.Antibody blockage experiment was used to analyze the relevant adhesion molecules.

The adhesion between platelets and LSEC was increased significantly after HR.The fluorescence intensity of adherent platelets increased from 142.10±7.53 to 289.17±20.00 (P<0.01).After H-R treatment and the addition of platelets, the number of adherent leukocytes increased markedly, and a significant statistical difference (360.71±23.47 and 186.39±17.96, P<0.01) was found in comparing with the platelet deficient group.These adhesion processes could be blocked respectively by anti-GPⅠb, anti-GPⅡb, anti-GPⅢa, anti-P-selectin, anti-CD31, anti-ICAM-1, anti-VCAM-1 and anti-ELAM-1.Confocal microscopy showed that platlets located between leukocytes and LSEC, and mediated their adhesion process.However, the adhesion of platelets to LSEC decreased the transendothelial migration of leukocytes (227.79±16.51 and 167.27±10.92, P<0.05).

During ischemia-reperfusion condition platelets adhere to the surface of LSEC, and then further mediate more adhesion processes between leukocytes and endothelial cells,as well as inhibit the transendothelial migration of leukocytes.The consequence is that large numbers of leukocytes were sequestrated within hepatic sinus, and deteriorate liver ischemia-reperfusion injury.

To explore the association of HLA-DM gene with childhood systemic lupus erythematosus (SLE).

DMA and DMB genes were genotyped by sequence-based typing (SBT) in 79 SLE patients at our hospital from 2003 to 2006 and 57 normal controls.

The frequency of DMB0101/0102 was lower significantly in SLE patients than that in controls (5.1% vs 21.1%).And the frequency of DMB0102/0102 in SLE patients with renal involvement was higher than that in controls (17.6% vs 1.8%, P<0.05).The frequency of all alleles and other genotypes had no significance in SLE patients, SLE patients with different organ involvements and controls.

As a protective gene, DMB0102/0102 may be a susceptible allele for SLE patients with renal involvement.

To explore the mechanism of umbilical cord mesenchymal stem cells (UCMSC) in the up-regulation of peripheral regulatory T cells in patients with systemic lupus erythematosus (SLE).

Peripheral blood mononuclear cells (PBMC) from 20 SLE patients and normal controls were co-cultured with UC-MSC at different ratios respectively for 72 hours.And the proportions of CD4⁺CD25⁺Foxp3⁺ regulatory T cells were analyzed by flow cytometry.PBMC and sera from active SLE patients and normal controls were used to stimulate UC-MSC.The expressions of transforming growth factor β1 (TGF-β1) on UC-MSC were detected by real-time fluorescence quantitative polymerase chain reaction (real-time PCR).The supernatant level of TGF-β1 was determined by enzyme-linked immunosorbent assay (ELISA).And the TGF-β1 small interfering RNA (siRNA) was used to interfere with the TGF-β1 expression on UC-MSC and determine its effect on the regulation of SLE Treg cells.TGF-β1 inhibitor was added into the culture system of UC-MSC and PBMC from active SLE patients to observe its role on the up-regulation of Treg cells by UC-MSC.

UC-MSC could dose-dependently up-regulate the peripheral CD4⁺CD25⁺Foxp3⁺ Treg proportion in SLE patients.And such an effect was not dependent on cell-cell contact.UC-MSC had no regulatory effect on Treg cells in normal controls.Compared with the non-stimulated and normal PBMC stimulated groups, PBMC from SLE patients significantly promoted TGF-β1 mRNA expression on UC-MSC (relative gene expression was 1.00±0.09,1.95±0.62, 4.20±2.34 respectively, both P<0.05).The supernatant level of TGF-β1 was significantly elevated in the presence of SLE PBMC.Sera of SLE patients (5%) enhanced TGF-β1 mRNA expression on UC-MSC and it was significantly higher than fetal bovine serum cultured group (12.19±4.49 vs 1.33±0.06,P<0.01) and normal individual sera cultured group (2.53±0.72,P<0.01).Additionally, TGF-β1 siRNA interfered UC-MSC failed to up-regulate Treg cells in SLE patients.Furthermore, TGF-β1 specific inhibitor SB431542 significantly inhibited the regulatory role of UC-MSC on Treg cells in SLE patients.

Immune microenvironment in SLE patients can significantly stimulate the TGF-β1 expression on UC-MSC and plays an important role in the up-regulation of Treg cells in patients.

To explore the correlation between labial salivary gland focus score (FS) and severity of Sjögren′s syndrome patients.

From January 2009 to December 2010, a total of 77 patients with primary Sjögren′s syndrome were recruited to undergo minor salivary gland biopsy,Schirmer′s test, unstimulated whole salivary flow,organ function and serological test.Focus score was calculated for all biopsy samples.And the correlation between focus score and serological test and organ function damage was evaluated.

Their pathological examinations revealed focal lymphocytic sialadenitis (n=62), 10 cases with non-specific or sclerosing chronic sialadenitis (n=10) and normal features (n=5).Among 62 cases with focal lymphocytic sialadenitis, 46 cases had FS≥1 and another 16 FS<1. The median FS was 2.4±2.5.FS≥1 was strongly associated with unstimulated whole salivary flow rates and ocular staining score (P<0.05), but not significantly with dry mouth or eyes.FS was significantly correlated with serum immunoglobin G (IgG), immunoglobin M (IgM) and rheumatoid factor level (P<0.05).Those with positive anti-SSA had higher FS level than those with negative anti-SSA antibody (P<0.05).In addition, FS level was not significantly associated with organ function damage.

Prior to determining FS, distinguishing focal lymphocytic sialadenitis from other types of sialadenitis is essential in assessing salivary gland biopsy.And the FS level might be associated with disease activity and positive anti-SSA.No correlation exists between FSand organ function damage.

To explore the clinical features of immunoglobin (IgG4)-related Mikulicz′s disease (MD).

Since December 2010, a prospective cohort study of IgG4 related disease (IgG4RD) was performed our hospital.A total of 42 Ig G4RD patients were recruited along with 18 MD patients.Their clinical, laboratory and histopathological features and response to treatment were analyzed.

The 18 MD patients accounted for 42.9% of IgG4RD.There were 10 males and 8 females with a mean age of (48±14) years.The mean follow-up period was 8.18 months.All of them had an involvement of salivary and lacrimal glands.Fifteen cases suffered other organs′damage, including autoimmune pancreatitis (n=7), sclerosing cholangitis (n=4) and lymph nodes (n=6).And 10 patients complained of a history of allergies.All serum levels of IgG4 subclass significantly increased.Histological examinations in 16 patients revealed massive infiltration of lymphocytes and IgG4 positive plasma cells with obvious tissue fibrosis.Glucocorticoid and immunosuppressive therapies were effective for MD.

As an IgG4-related systemic disease involving predominantly lacrimal and salivary glands without autoantibodies, MD is treated optimally with a combination therapy of glucocorticoid and immunosuppressive drugs.

To evaluate the relationship between sleep quality and nocturnal pain in ankylosing spondylitis (AS) patients.

A total of 157 AS patients were recruited.Pittsburgh sleeping quality index (PSQI) and visual analogue scale (VAS) were used to assess sleep quality and nocturnal pain respectively.Disease activity was assessed by Bath ankylosing spondylitis disease activity index (BASDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

The mean PSQIand nocturnal pain score was 6.6±3.6 and 3.7±3.0 respectively.Fifty-five of them had poor sleep.Quality of sleep was positively correlated with nocturnal pain (P<0.01).Elevated ESR/CRP was found in 47.1% (74/157) of them.Patients with elevated ESR/CRP had significantly a higher level of BASDAI than those with normal ESR/CRP (P<0.01).Logistic regression analysis revealed that nocturnal pain was most powerful risk factor of sleep disturbances (P<0.05).In hierarchical multiple regression analysis, the quality of sleep variable contributed significantly to the variance in nocturnal pain scores, adding an additional 18.2% to the overall Rsquare beyond that accounted by demographic and disease-related variables (inclusion of ESR and CRP)(R²=0.175).

Sleep quality has close relationship with nocturnal pain.And sleep disturbances should be considered in the management of AS.

To evaluate the effects of duloxetine on depression, anxiety, pain, disease activity and function in patients with ankylosing spondylitis (AS).

A total of 55 AS patients with concurrent depression disorders were randomized into treatment and control groups.Both were given conventional therapy of AS while duloxetine was administered in treatment group.Bath ankylosing spondylitis disease activity index (BASDAI), functional Index (BASFI) and metrology Index (BASMI), spinal pain, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Hamilton depression scale (HAMD) were recorded before and Weeks 4 and 8 weeks post-treatment.

(1) Spinal pain, BASDAI, BASFI and SDSscores significantly declined by repeated measurement data analysis of variance in treatment group (P<0.05).And no statistical difference existed between BASMI and SAS (P>0.05). (2) The reduced rates of spinal pain and BASDAI were positively correlated with those of SDS and SAS.And the reduced rate of BASFI was positively correlated with SDS and HAMD reduced rate.However, no relationship existed between BASMI, SDS, SAS or HAMD. (3) The remission rate of AS symptoms and depression disorders were both significantly higher in treatment group than that in control group (P<0.01, P<0.05).

The combined regimen of duloxetine and conventional therapy is significantly effective in the treatment of AS patients with depression and anxiety.