2nd Affiliated Hospital Research Articles

Association of M-Type Phospholipase A2 Receptor Deposition in Kidney Tissue with Treatment Outcomes in Patients with Idiopathic Membranous Nephropathy.

The purpose of this study was to investigate the correlation between the deposition of M-type phospholipase A2 receptor (PLA2R) in the kidney tissues of patients with idiopathic membranous nephropathy (IMN). We enrolled a total of 61 patients diagnosed with IMN in the past 8 years who were admitted at the Jinjiang Municipal Hospital and the 2nd Affiliated Hospital of Fujian Medical University. PLA2R immunofluorescence was used to stain kidney tissues, and all patients were treated with steroid combined with immunosuppressive agents or conservative regimens. The duration of follow-up was more than 48 weeks. Based on the deposition of PLA2R in kidney tissues, we divided the patients into the PLA2R Positive group and the PLA2R Negative group. Further, patients with PLA2R-positive kidney tissues were divided into "1+", "2+", and "3+" groups based on the extent of their PLA2R deposition, and we compared the therapeutic outcomes of the various groups. At week 12 of follow-up, the partial remission rate of kidney tissues in the PLA2R Negative group was significantly higher than that in the Positive group (P = 0.004). Among the various deposition groups with PLA2R-positive kidney tissues, the complete remission rate of the "2+" group was higher than that of the "3+" group at weeks 24, 36, and 48 of follow-up (P < 0.05). In IMN patients treated with a combination regimen of steroid and tacrolimus, the complete remission rate in kidney tissues of the PLA2R Negative group was higher than that of the Positive group at weeks 24 and 48 of follow-up (P < 0.05). The overall effective rate of treatment in kidney tissues of PLA2R-negative patients was higher than that in the kidney tissues of PLA2R-positive patients. The varied levels of PLA2R deposition in kidney tissues were related to the treatment outcomes of IMN, and those with lower PLA2R deposition levels had better outcomes.

A novel missense mutation in the CRYBA2 caused autosomal dominant presenile cataract in a Chinese family.

Presenile cataract is a relatively rare type of cataract, but its genetic mechanisms are currently not well understood. The precise identification of these causative genes is crucial for effective genetic counseling for patients and their families. The aim of our study was to identify the causative gene associated with presenile cataract in a Chinese family. In February 2020, a four-generation pedigree of presenile cataract patients was recruited at the 2nd Affiliated Hospital of Kunming Medical University. One patient and her healthy husbandfrom the family underwent whole exome sequencing. The variant was validated through sanger sequencing, and co-segregation analysis was conducted in all family members to assess its pathogenicity. Molecular dynamics simulation (MDS) was used to analyze the conformation of both the wild type and pathogenic mutant loci p.Y153H of CRYBA2. We identified presenile cataract in the pedigree, which follows an autosomal-dominant pattern of inheritance. The family includes five clinically affected patients who all developed presenile cataract between the ages from 24 to 30. We confirmed the pathogenicity of a heterozygous missense variant (NM_057093:c.457T >C) in CRYBA2 within this family. The affected amino acid demonstrates high conservation across species. Subsequent sanger sequencing confirmed co-segregation of the disease in all family members. MDS analysis revealed that the p.Y153H mutant disrupted hydrogen bond formation between Y153 and R193 within the two β-strands of the fourth Greek key domain, leading to destabilization of the βA2-crystallin. In conclusion, a novel causative mutation (NM_057093:c.457T>C) in CRYBA2 might contribute to autosomal dominant presenile cataract.

Racial and Ethnic Disparities in Pregnancy-related Complications: Findings at Mansa General Hospital and 2nd Affiliated Hospital of Nanjing Medical University

Background: 800 women die and 2.6 million stillbirths occur worldwide related to pregnancy complications. Racial/ethnic disparities in pregnancy-related mortality have continued to be significantly higher among black than whites due to various factors. We sought to investigate complications among pregnant women of different race/ethnicity. Methods: Cross-sectional observational study of 2030 obstetric cases randomly selected for the period January 1 to December 31, 2021. Data was collected from the hard copy and electronic inpatients’ records. Analysis was performed using SPSS version 23. Descriptive statistics analyzed the pregnancy complication frequencies, standard deviations, range, minimum and maximum values. Maternal characteristics were analyzed using an independent samples t-test. Maternal characteristics were evaluated using the two samples t-test. The odds ratios and confidence intervals were calculated as measures of association between ethnicity/race and pregnancy complications using a binary logistic regression model. Confidence interval was set at 95% and p &lt; 0.05 (2-tailed) was considered statistically significant. Results: 76.25% of Chinese and 67.86% of Zambians were affected by one or more complications. The mean ± standard deviation for MGH [age (26.69 ± 7.33), gravidity (3.35 ± 2.08), and parity (2.07 ± 1.68)] and for 2nd affiliated hospital was [age (30.04 ± 4.29), gravidity (2.19 ± 1.38) and parity (0.45 ± 0.55)]. Prevalence of top five pregnancy complications in the Chinese group was gestational diabetes mellitus at 18.41%, hypothyroidism at 15.91%, oligohydramnios at 14.39%, premature rupture of membranes at 12.17%, and anemia at 5.73%. The prevalence of the top five pregnancy complications in the Zambian group was preeclampsia at 13.80%, PIH at 12.74%, PROM at 12.45%, eclampsia at 7.53%, and placenta abruption at 7.43%. Statistical significance findings were noted as follows: Oligohydramnios [OR 0.02, CI (0.01 - 0.05), p = 0.000], placenta praevia [OR 0.08, CI (0.01 - 0.61), p = 0.015], preeclampsia [OR 13.10, CI (7.22 - 23.78), p = 0.000], placenta abruptio [OR 79.73, CI (11.07 - 574.38), p = 0.000], PIH [OR 11.95, CI (6.57 - 21.73), p = 0.005], eclampsia [OR 162.90, CI (10.08 - 2631, p = 0.000), PPROM [OR 0.03, CI (0.00 - 0.45), p = 0.012], GDM [OR 0.11, CI (0.07 - 0.17), p = 0.000], hypothyroidism [OR 0.01(0.00-0.03), p = 0.000], anemia [OR 0.18, CI (0.92-0.34), p = 0.000], ICP [OR 0.03, CI (0.00 - 0.48), p = 0.013], syphilis [OR 7.17, CI (2.14 - 24.02), p = 0.001], UTI [OR 22.55, CI (3.04 - 17.26), p = 0.002], HBV [OR 0.05, CI (0.00 - 0.86), p = 0.039] and GBS [OR 0.06, CI (0.00 - 1.11), p = 0.059]. Conclusion: Highest odds for obstetrical and infection-related pregnancy complications were associated with Zambian cases. The highest odds for medical complications were associated with Chinese cases.

The Correlation Between Aldosterone and Leukocyte-Related Inflammation: A Comparison Between Patients with Primary Aldosteronism and Essential Hypertension.

Hypertension patients with primary aldosteronism (PA) have a higher risk of cardiovascular complications than blood pressure-matched essential hypertension (EH) patients. The cause may be closely related to inflammation. We explored the correlations between leukocyte-related inflammation parameters and plasma aldosterone concentration (PAC) in PA patients and clinical characteristics-matched EH patients. A total of 346 PA and 346 sex, age and 24-h blood pressure-matched EH patients at the 2nd Affiliated Hospital of Nanchang University from January 2020 to June 2021 were enrolled in this study. The differences and correlations of aldosterone and leukocyte parameters between the two groups were analyzed. Compared with EH patients, the lymphocyte count was significantly lower (P = 0.004), the neutrophil-lymphocyte ratio (NLR) (P = 0.023) and the monocyte-lymphocyte ratio (MLR) (P = 0.037) were significantly higher in PA patients. Linear regression analysis and multivariate regression analysis identified that lymphocyte count, NLR and MLR were significantly and independently correlated with PAC in PA patients, and the correlations were stronger with increasing levels of aldosterone. However, in EH patients, only NLR maintained an independent correlation with PAC. Leukocyte-related inflammation parameters, including lymphocyte count, NLR, and MLR, were significantly and independently correlated with PAC in PA patients. The correlations were stronger with increasing levels of aldosterone. However, the above correlations were not always present in patients with EH matched for clinical characteristics.

Ligation versus stapling in video-assisted thoracoscopic (VATS) bullectomy; early outcome of a low cost technqiue

BackgroundSpontaneous pneumothorax is thoracic condition, with annual incidence of 7 to 9 cases per 100,000 people. Most of thoracic surgeons prefer minimally invasive method that uses staplers to resect bullous parenchyma, but this technique is costly. Now, the problem of rising health care costs is faced by all countries all over the world. As result, preventing use of disposable consumables in video-assisted thoracic surgery (VATS) will aid in cost control.In our study, we described a new cheap technique which was VATS ligation of bullae by silk ligature and we compared it to standard technique of using staplers in VATS bullectomy.Aim of WorkWe aimed to investigate the results of VATS ligation of bullae by silk ligature in comparison to using staplers in VATS bullectomy.Patient & techniquesThis was retrospective research done on 120 studied cases at cardiothoracic surgery, 2nd Affiliated Hospital, Harbin Medical University, China and Assiut University Hospital, Egypt from March 2020 to December 2021.ResultsWe retrospectively investigate data of 120 patients and there was no variation in patient characteristics among VATS bullectomy using staplers and VATS bullae ligation. Air leak duration and post-operative drainage were statistically significant higher in VATS bullectomy using staplers than bullae ligation.Hospital stay duration (mean = 3.800 ± 1.070 vs 4.917 ± 2.794) and complications were statistically significant higher in VATS bullectomy using staplers than thoracoscopic bullae ligation.ConclusionTreatment of spontaneous pneumothorax by thoracoscopic ligation of bullae by silk ligature is comparable to VATS bullectomy using staplers in short-term results and offers less complications and better economic results.

Sequential therapy for pancreatic cancer patients with synchronous oligo-hepatic metastatic lesions.

Treatments for patients suffering from pancreatic cancer with oligo-hepatic metastasis have always been a cause of certain controversy. Herein, we reported 15 pancreatic cancer patients with oligo-hepatic metastasis who accepted sequential therapy of chemotherapy, radiofrequency ablation (RFA), and radical resection of the primary tumor. A total of 87 pancreatic cancer patients with synchronous oligo-metastatic hepatic lesions who received treatments in the 2nd Affiliated Hospital of Zhejiang University between January 2017 and July 2020 were enrolled. The chemotherapy regimens included modified folfirinox (54/87) and gemcitabine plus nab-paclitaxel (33/87). Test of blood tumor markers and contrast-enhanced computed tomography (CT) or magnetic resonance (MR) scan was performed at diagnosis and after eight weeks of chemotherapy. Thirty-five patients received just chemotherapy because of poor reaction to the first round of chemotherapy(Overall survival (OS), 6.47±1.80 months); 15 patients reassessed as stable disease (SD)/partial response (PR) continued chemotherapy (OS, 10.35±3.15); nine patients reassessed as progressive disease (PD) after RFA and continued chemotherapy (OS, 10.90±2.60). The primary tumors in 13 patients were unresectable after chemotherapy and RFA (OS, 12.92±2.47), while 15 patients completed the sequential therapy of chemotherapy, radio-frequency ablation, and radical resection (OS, 16.76±6.55). Sequential chemotherapy and RFA is a good treatment strategy to select the best candidates for surgical treatment among patients with pancreatic cancer with oligo-hepatic metastasis.

Relationship of Microchannels and Plaque Erosion in Patients with ST-Segment Elevation Myocardial Infarction: An Optical Coherence Tomography Study

Abstract Objective: Microchannels are associated with the progression of atherosclerotic vulnerable plaques. However, in patients with culprit optical coherence tomography (OCT)-defined plaque erosion, the knowledge of microchannels and culprit lesion vulnerability is limited. The aim of this study was to investigate culprit lesion characteristics in patients with ST-segment elevated myocardial infarction (STEMI) caused by plaque erosion with and without microchannels using OCT. Methods: In all, 348 STEMI patients with plaque erosion who underwent OCT of the culprit lesion at the 2nd Affiliated Hospital of Harbin Medical University (Harbin, China) from August 2014 to December 2017 were included and divided into the microchannel group (n = 116, 33.3%) and no-microchannel group (n = 232, 66.7%). The clinical characteristics and OCT-derived plaque features were compared between both groups. Results: Among the 348 STEMI patients with plaque erosion, culprit lesions with microchannels had higher incidence of lipid plaque (59.5% vs. 45.3%, P = 0.012); calcification (41.4% vs. 24.6%, P = 0.002); spotty calcification (30.2% vs. 18.1%, P = 0.014); macrophages accumulation (72.4% vs. 45.7%, P &lt; 0.001); and cholesterol crystals (32.8% vs. 14.2%, P &lt; 0.001) than those without microchannels. In addition, minimal lumen area was smaller ((1.9 ± 0.9) mm2 vs. (2.8 ± 2.3) mm2, P &lt; 0.001) and lumen area stenosis was greater ((71.3% ± 13.4%) vs. (65.3% ± 19.3%), P = 0.001) in the microchannel group than in the no-microchannel group. Conclusion: In patients with STEMI caused by plaque erosion, one-third manifested typical microchannel characteristics, and those with microchannels were associated with more severe luminal stenosis and more vulnerable plaque features than those without microchannels.

Influence of Lymphangio vascular (V) and perineural (N) invasion on survival of patients with resected esophageal squamous cell carcinoma (ESCC): a single-center retrospective study.

BackgroundLymphangio vascular invasion (LVI) and perineural invasion (PNI) are associated with survival following resection for gastrointestinal cancer. But the relationship between LVI/PNI and survival of esophageal squamous cell carcinoma (ESCC) is still unclear. We aim to demonstrate the prognostic significance of LVI/PNI in ESCC.MethodsA total of 195 ESCC patients underwent curative surgery from 2012 to 2018 was collected in the 2nd Affiliated Hospital of Fujian Medical University. All the patients were divided into four groups based on the status of the neurovascular invasion: (1) neither LVI nor PNI (V0N0); (2) LVI alone (V1N0); (3) PNI alone (V0N1); (4) combined LVI and PNI (V1N1). First, the analysis included the Kaplan-Meier survival estimates with the Log rank test were performed to determine median overall survival (OS) in different groups divided according to the clinical factor, respectively. And the association between OS with multi clinical factors was examined using Cox regression analysis. Next, the risk factors for recurrence in patients with V1N1 were analyzed with univariate and multivariate logistic regression analyses, respectively.ResultsThe cases in V0N0, V1N0, V0N1, and V1N1 groups were 91 (46.7%), 62 (31.8%), 9 (4.6%) and 33 (16.9%), respectively. The OS in the four groups was different (P < 0.001). The 1-, 3- and 5-year OS in V0N0 group was higher than that in V1N1 group, respectively (1-year OS: 93.4% vs 75.8%, 3-year OS: 53.8 % vs 24.2%, 5-year OS: 48.1% vs 10.5%). The OS in stage I-II for patients with V1N1 was significantly lower than that in the other groups (V0N0, V1N0, V0N1) (P < 0.001). The postoperative adjuvant chemotherapy was a significant impact factor of OS for ESCC patients with V1N1 (P = 0.004). Lymphatic invasion and LVI were significantly prognosis factors associated (P = 0.036, P = 0.030, respectively). The ulcerative type is a risk factor for V1N1 occurance (P = 0.040).ConclusionsThe LVI and PNI are important prognosis factors for ESCC patients. ESCC patients with simultaneous lymphangio vascular and perineural invasion (V1N1) showed worse OS than patients with either lymphangio vascular or perineural invasion alone (V1N0 or V0N1) or none (V0N0). In addition, adjuvant chemotherapy may prolong the OS for ESCC patients with V1N1.

Pulmonary Neuroendocrine Tumor with Pancreatic Metastasis: A Case Report

Weihua Wang BS1 and Yuling Tong MS2* Author Affiliations 1Department of Internal Medicine, The People’S Hospital of Suichang County, Lishui, China 2Department of General Practice/Health Management Center, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China Received: July 22, 2021 | Published: August 02, 2021 Corresponding author: Yuling Tong MS, Department of General Practice/Health Management Center, The 2nd affiliated hospital of Zhejiang university, school of medicine, China DOI: 10.26717/BJSTR.2021.37.006036

The factors affecting the physical development of neonates in pregnant women with or without gestational diabetes mellitus.

ObjectivesTo explore the factors affecting neonatal physical development in pregnant women with or without gestational diabetes mellitus (GDM).MethodsThe subjects were selected from the pregnant woman giving birth in 2nd Affiliated Hospital of Zhengzhou University, from November 2015 to May 2016. The age, occupation, education level, gestational age, body weight before pregnancy, body weight at delivery, body height, delivery pattern, GDM status of pregnant women and neonatal gender, birth weight (BW), chest circumference (CC), head circumference (HC) and birth length (BL) were collected through medical records and questionnaires. The clinical data were retrospectively analyzed and studied.ResultsThe significant differences were found between women with GDM and without GDM in following neonatal variables (P<0.05): BW, CC, and HC. GDM status increased the incidence of macrosomia (OR = 2.241, 95% CI: 1.406–3.573), large CC (OR = 2.470, 95% CI: 1.687–3.6153). Gestational weight gain (GWG) above IOM guideline was risk factor for macrosomia (OR = 1.763, 95% CI:1.098–2.833), large HC (OR = 1,584, 95% CI: 1.093–2.296) and large CC (OR = 1.707, 95% CI:1.163–2.506). Underweight was risk factor for short BL (OR = 2.543, 95% CI:1.161–5.571) and small CC (OR = 1.901, 95% CI:1.064–3.394). Female neonate was prone to appear short BL(OR = 2.831, 95% CI: 1.478–5.422) and small HC (OR = 2.750, 95% CI: 1.413–5.350), and not likely to macrosomia (OR = 0.538, 95% CI: 0.343–0.843), longer BL (OR = 0.584, 95% CI: 0.401–0.850), large HC (OR = 0.501, 95% CI: 0.352–0.713), and (OR = 0.640, 95% CI: 0.446–0.917). For women with GDM, gestational age was an risk factor of neonatal BW (low BW: OR = 0.207, 95% CI: 0.085–0.503; macrosomia: OR = 1.637, 95% CI: 1.177–2.276), BL (short BL: OR = 0.376, 95% CI: 0.241–0.585; long BL: OR = 1.422, 95% CI: 1.054–1.919), HC (small HC: OR = 0.343, 95% CI: 0.202–0.583; large HC: OR = 1.399, 95% CI: 1.063–1.842) and CC (small CC: OR = 0.524, 95% CI: 0.374–0.733; large CC: OR = 1.485, 95% CI: 1.138–1.936).ConclusionsIn our study, gestational age, GDM status, neonatal gender, GWG and pre-pregnancy body mass index (BMI) are associated the abnormal physical development of neonates. In women with GDM, gestational age was correlate with neonatal abnormal physical developments.

Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

BACKGROUNDHemorrhoidal prolapse is a common benign disease with a high incidence. The treatment procedure for prolapse and hemorrhoids (PPH) remains an operative method used for internal hemorrhoid prolapse. Although it is related to less pos-operative pain, faster recovery and shorter hospital stays, the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy (MMH). We have considered that recurrence could be due to shortage of the pulling-up effect. This issue may be overcome by using lower purse-string sutures [modified-PPH (M-PPH)]. AIMTo compare the therapeutic effects and the patients’ satisfaction after M-PPH, PPH and MMH.METHODSThis retrospective cohort study included 1163 patients (M-PPH, 461; original PPH, 321; MMH, 381) with severe hemorrhoids (stage III/IV) who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014. Early postoperative complications, efficacy, postoperative anal dysfunction and patient satisfaction were compared among the three groups. Established criteria were used to assess short- and long-term postoperative complications. A visual analog scale was used to evaluate postoperative pain. Follow-up was conducted 5 years postoperatively.RESULTLength of hospital stay and operating time were significantly longer in the MMH group (8.05 ± 2.50 d, 19.98 ± 4.21 min; P < 0.0001) than in other groups. The incidence of postoperative anastomotic bleeding was significantly lower after M-PPH than after PPH or MMH (1.9%, 5.1% and 3.7%; n = 9, 16 and 14; respectively). There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH (15%, 8% and 10%; n = 69, 30 and 32; respectively). There was a significantly lower rate of recurrence after M-PPH than after PPH (8.7% and 18.8%, n = 40 and 61; P < 0.0001). The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups (1.3% and 4.3%, n = 5 and 20; P = 0.04). Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSIONM-PPH has many advantages for severe hemorrhoids (Goligher stage III/IV), with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.M-PPH

DDAH2 (-449 G/C) G allele is positively associated with leukoaraiosis in northeastern China: a double-blind, intergroup comparison, case-control study.

Cerebrovascular endothelial dysfunction is involved in the progression of leukoaraiosis. Asymmetric dimethylarginine is a competitive inhibitor of nitric oxide, which is highly expressed in patients with leukoaraiosis. Dimethylarginine dimethylaminohydrolase (DDAH) is a hydrolytic enzyme that is primarily responsible for eliminating asymmetric dimethylarginine, and it plays a role in the pathogenesis of cardiovascular and cerebrovascular diseases. The DDAH2 subtype is expressed in organs rich in induced nitric oxide synthase, including the heart, the placenta, and the cerebral endothelium during cerebral ischemia, in the stress state, or under neurotoxicity. Overexpression of the DDAH2 gene can inhibit asymmetric dimethylarginine-induced peripheral circulating endothelial cell dysfunction. However, it is unknown whether this polymorphism regulates plasma asymmetric dimethylarginine levels in patients with leukoaraiosis. In this double-blind study, we recruited 46 patients with leukoaraiosis and 46 healthy, matched controls. Plasma asymmetric dimethylarginine levels were determined using enzyme-linked immunoassays. Genomic DNA was isolated from whole blood samples, and polymerase chain reaction, SmaI restriction enzyme digestion, restriction fragment length polymorphisms, and agarose electrophoresis were used to detect DDAH2 (-449 G/C) gene polymorphisms. The results revealed that 95.65% of leukoaraiosis patients had recessive genetic models (GG and CG), while 89.13% of healthy control subjects had dominant genetic models (CC and CG). There was a significant difference in the genotype composition ratio between leukoaraiosis patients and healthy controls (P = 0.0002). The frequency of G alleles in the leukoaraiosis patients (71.74%) was significantly higher than in healthy controls, whereas the frequency of C alleles was lower (χ2 = 13.9580, P = 0.0002). Furthermore, asymmetric dimethylarginine concentrations in subjects with the GG genotype were significantly higher than in subjects with the CG and CC genotypes (Kruskal-Wallis H = 24.5955, P < 0.0001). In addition, the GG genotype of DDAH2 (-449 G/C) was more common in patients with leukoaraiosis. These findings suggest that the G allele of DDAH2 (-449 G/C) is a risk factor for leukoaraiosis morbidity and is correlated with high levels of asymmetric dimethylarginine. This study was approved by the Institutional Ethics Committee of The 2nd Affiliated Hospital of Harbin Medical University of China (approval No. KY2016-177) on July 28, 2016.

Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy

Objective: Functional connectivity density (FCD) mapping was used to investigate abnormalities and factors related to brain functional connectivity in cortical regions of patients with dysthyroid optic neuropathy (DON) and to analyze the pathogenesis of DON further. Methods: Patients diagnosed with thyroid-associated opthalmology (TAO) in the Eye Hospital were enrolled. All patients underwent comprehensive eye examinations and best-corrected visual acuity, visual field (VF) test. MRI data collection and analysis were completed in the 2nd Affiliated Hospital of Wenzhou Medical University. The patients were divided into 2 groups: the DON group, with an average VF, mean deviation (MD) of both eyes < −5 dB, and the non-DON group (nDON group), with an average VF MD of both eyes ≥ −2 dB. Results: A total of 30 TAO patients (14 men, 16 women) with complete data who met the experimental requirements were enrolled. The average age was 48.79 (40–57) years. There were 16 patients in the DON group and 14 patients in the nDON group. No significant differences in age, gender, education level, and the maximum horizontal diameter of either medial rectus muscle were found between the 2 groups. The difference of brain FCD between the 2 groups showed significant abnormal connectivity in the right orbital gyri of the frontal lobe (Frontal_Inf_Orb_R) and the left precuneus in the DON group compared with the nDON group. As demonstrated by decreased FCD values in the right inferior frontal gyrus/orbital part, the relevant brain regions were the left middle temporal gyrus, left precuneus, left middle frontal gyrus, right postcentral gyrus, and brain gyri (excluding the supramarginal gyrus and angular gyrus) below the left parietal bone. The FCD associated with the left precuneus was increased, and the relevant brain areas were the left middle temporal gyrus, right cuneus, superior occipital gyrus, and right fusiform gyrus. A significant correlation was identified between the MD of the binocular VF and brain FCD. Conclusion: The abnormal FCD in the cortex of DON patients suggests that a central nervous system mechanism may be related to the pathogenesis of the DON.

Expression Level and Target Gene Prediction of miR-181b in Patients with Chronic Lymphocytic Leukemia

To analyze the diagnostic value of multiple reverse transcription-polymerase chain reaction (RT-PCR) for detecting different fusion genes in children with primary acute lymphoblastic leukemia (ALL). The clinical data of 80 children with ALL treated in the 2nd affiliated hospital of Xi'an Medical College from September 2012 to September 2017 were collected and retrospectively analyzed. Immunophenotype, chromosome karyotype and fusion gene were analyzed. Immunophenotyping showed that there were 2 cases of mixed expression of myeloid + B system, 2 cases with pre- B expression, 58 cases with former B expression, 11 cases with CD13 combined with pre- B expression, 4 cases with CD5 combined with pre- B expression, and 3 cases with CD2 combined with pre- B expression. The results of chromosome karyotype analysis showed that among 72 cases of karyotype analysts 5 cases could not be analyzed, 27 cases were determined to be normal karyotype, 11 cases with abnormal karyotype and 29 cases without mitotic phase. Six fusion genes were expressed in 30 cases (37.50%) of 80 ALL children, including MLL/AF9, CBF/MYH 11, BCR/ABL, TLS/ERG, MLL/ENL and TEL/AML1. Among the 3 cases with MLL/AF9 fusion gene expression [t(9;11)], 2 cases showed a poor response to early treatment, but achieved complete remission after intensive chemotherapy, and 1 case accepted bone marrow transplantation; in 1 case with CBF/MYH 11 fusion gene expression, treatment was abandoned by family members, and 4 cases with BCR/ABL fusion gene expression [t (9;22) (q34; q11)] were all showed poor response to early treatment, and achieved complete remission after intensive chemotherapy. All the fusion genes were positive during remission, including 2 cases of bone marrow transplantation; 1 case with TLS/ERG fusion gene expression [t (16;21)] displayed poor response to early treatment, and completely remitted after intensive chemotherapy; 2 cases with MLL/ENL fusion gene expression [t (11;19)] recurred during chemotherapy; 19 cases with TEL/AML1 fusion gene expression [t (12;21)] also achieved complete remission. 4 cases achieved a partial remission. Genotyping can make up for the insufficiency of MICM typing, and multiplex RT-PCR can be used to rapidly detect the fusion genes caused by chromosomal aberration in children with ALL.

Construction and clinical effects of ICU nursing subspecialty group

Objective To explore the construction and clinical effects of ICU nursing subspecialty group. Methods From January 2018 to January 2019, we selected 60 ICU nurses in the 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University as the subjects by convenient sampling, set up a nursing subspecialty group, selected a staff plan for the group, and defined the work responsibilities of the group; we also determined the organizational management structure, drafted an operation project proposal for the subspecialty group, established the group work system and training program, implemented a performance management mechanism, and formulated an evaluation operation mechanism. Nursing quality, patients' satisfaction, doctors' satisfaction 1 year before and after the ICU nursing subspecialty group was launched were compared and analyzed. Results After the ICU nursing subspecialty group was constructed, the basic nursing, specialized nursing, high-quality nursing, sterilization and isolation, patient satisfaction, and doctor's satisfaction with the nurse were significantly higher than those before the construction, and the differences were statistically significant (P<0.05) . Conclusions The construction of the ICU nursing subspecialty group can comprehensively improve the quality of care, the satisfaction of patients and doctors, which proves an effective discipline and talent management model. Key words: Intensive care unit; Nursing quality; Subspecialty; Satisfaction

Fiber-Specific White Matter Alterations in Parkinson's Disease

Background: Disruption of brain circuits, including the basal ganglia network, is one of the core mechanisms of Parkinson’s disease(PD). Understanding the structural connection alterations in PD is the key for relevant treatment. Although, due to methodological limitations, most previous studies suffered from the difficulty of locating white matter damages to specific fiber tracts. In the present study, we aimed to demonstrate tract-specific white matter structural changes and its relationship with clinical symptoms. Methods: Nighty-eight PD patients(41 patients were at early stage and 57 were at middle stage) and 76 healthy controls were enrolled and underwent brain magnetic resonance imaging and neuropsychological tests. We implemented the fixel-based analysis method to investigate both micro- and macro-structural changes in the white matter fibers of PD patients, and to investigate their correlation with clinical symptoms. Findings: We found decreased fiber density(FD) of the corpus callosum and increased FD of the cortical spinal tract in PD patients comparing to healthy controls. We also found increased fiber-bundle cross-section(FC) of the superior cerebellar peduncle of PD patients. Further region-of-interest analysis showed that FD values of the corpus callosum in PD patients were negatively correlated with UPDRS-III scores(r=0.001, p=-0.334), HAMD-17 scores(r=0.043, p=-0.205) and HAMA scores(r=0.02, p=-0.234). Also, log transformed FC values of superior cerebellar peduncle were negatively correlated with HAMD-17 scores(r=0.013, p=-0.251) and positively correlated with MMSE scores(r=0.002, p=0.312). Interpretation: PD patients had both decreased and increased white matter integrity within specific fiber bundles. Additionally, these white matter alterations were different across disease stages, suggesting complex pathological and compensatory changes during the development of PD. Funding Statement: This study was supported by the 13th Five-year Plan for National Key Research and Development Program of China (Grant No. 2016YFC1306600), the Health Foundation for Creative Talents in Zhejiang Province (2016). Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: All the subjects had signed written informed consent forms before participating in the study. This research was approved by the Medical Ethics Committee of 2nd Affiliated Hospital, Zhejiang University.

Correlation between perceived vulnerability and parenting stress in mothers of children with congenital heart disease

Objective To explore the current perceived vulnerability and parenting stress (PS) in mothers of children with congenital heart disease (CHD) and to analyze the correlation between the two. Methods The mothers of 176 children with congenital heart disease admitted in the 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from September 2017 to September 2018 were selected using convenient sampling and investigated with the General Information Questionnaire, Child Vulnerability Scale (CVS) and Parenting Stress Index-Short Form (PSI-SF) . Results Totally 176 questionnaires were distributed and collected, including 168 valid questionnaires, accounting for a recovery rate of 95.45%. The CVS score of the mothers of CHD children averaged (8.77±3.59) ; their PSI-SF scores saveraged (100.74±10.55) ; there was statistically significant difference in PSI-SF scores between mothers with different educational background and single child or not (P<0.05) ; the total CVS score was positively correlated with the total PSI-SF score and the scores of its various dimensions (r=0.262-0.569) ; multivariate stepwise regression analysis showed that mothers with different educational background, single child, and the total score of CVS were factors of parenting stress, except the effect of general information, the total score of CVS can explain 17% of the total variation. Conclusions The perceived vulnerability and PS of the mothers of CHD children stand at high levels. Their perceived vulnerability is positively correlated with their PS. Medical and nursing workers may improve their PS by reducing their perceived vulnerability, thus providing better family care for CHD children. Key words: Heart defects, congenital; Mother; Perceived vulnerability; Parenting stress

HF-SENSE: an improved partially parallel imaging using a high-pass filter

BackgroundOne of the major limitations of MRI is its slow acquisition speed. To accelerate data acquisition, partially parallel imaging (PPI) methods have been widely used in clinical applications such as sensitivity encoding (SENSE) and generalized autocalibrating partially parallel acquisitions (GRAPPA). SENSE is a popular image-domain partially parallel imaging method, which suffers from residual aliasing artifacts when the reduction factor goes higher. Undersampling the k-space data and then reconstruct images with artificial sparsity is an efficient way to accelerate data acquisition. By exploiting artificial sparsity with a high-pass filter, an improved SENSE method is proposed in this work, termed high-pass filtered SENSE (HF-SENSE).MethodsFirst, a high-pass filter was applied to the raw k-space data, the result of which was used as the inputs of sensitivity estimation and undersampling process. Second, the adaptive array coil combination method was adopted to calculate sensitivity maps on a block-by-block basis. Third, Tikhonov regularized SENSE was then used to reconstruct magnetic resonance images. Fourth, the reconstructed images were transformed into k-space data, which was filtered with the corresponding inverse filter.ResultsBoth simulation and in vivo experiments demonstrate that HF-SENSE method significantly reduces noise level of the reconstructed images compared with SENSE. Furthermore, it is found that HF-SENSE can achieve lower normalized root-mean-square error value than SENSE.ConclusionsThe proposed method explores artificial sparsity with a high-pass filter. Experiments demonstrate that the proposed HF-SENSE method can improve the image quality of SENSE reconstruction. The high-pass filter parameters can be predefined. With this image reconstruction method, high acceleration factors can be achieved, which will improve the clinical applicability of SENSE.This retrospective study (HF-SENSE: an improved partially parallel imaging using a high-pass filter) was approved by Institute Review Board of 2nd Affiliated Hospital of Zhejiang University (ethical approval number 2018–314). Participant for all images have informed consent that he knew the risks and agreed to participate in the research.

Effects of logotherapy on self-perceived burden and hope in cervical cancer patients after surgery

Objective To explore the effects of logotherapy on self-perceived burden and hope in cervical cancer patients after surgery and to provide reference for improving the quality of life in cervical cancer patients after surgery. Methods A total of 164 patients receiving surgery for cervical cancer in the 2nd Affiliated Hospital of Wenzhou Medical University between October 2016 and January 2018 were selected by convenient sampling and randomly divided into the observation group (n=81) and the control group (n=83) according to the random number table. Patients in the control group received conventional nursing care, while patients in the observation group received logotherapy on the basis of conventional nursing care. The Self-Perceived Burden Scale (SPBS) and Hope Level Scale were used to evaluate the self-perceived burden and hope in the patients in the two groups. Results There was statistical difference in the self-perceived burden and hope scores between the two groups (P<0.05) , and the self-perceived burden of the observation group was lower than that of the control group, the total score and scores in different dimensions of the observation group were higher than those of the control group, the differences were statistically significant (P<0.05) . Conclusions Logotherapy can help cervical cancer patients to experience and discover the meaning of life in different contexts of disease, reduce the self-perceived burden and improve the hope level, which is worth promoting in clinical practice. Key words: Cervical neoplasms; Meaning of life; Self-perceived burden; Hope level

Effects of motivational care on self-care ability and quality of life in patients receiving permanent enterostomy

Objective To explore the effects of motivational care on the self-care ability and quality of life in patients receiving permanent enterostomy. Methods Totally 96 patients receiving permanent enterostomy in the 2nd Affiliated Hospital of Harbin Medical University from February 2017 to February 2018 were selected and randomized into the treatment group (n=47) and the control group (n=49) . Patients in the control group received conventional nursing care, while patients in the treatment group received motivational care on the basis of conventional care. The intervention effects were compared between the two groups with the Exercise of Self-care Agency (ESCA) and Quality of Life Scale (QLS) . Results The total ESCA score of the treatment group was (137.84±16.23) , and that of the control group was (126.53±15.87) post intervention (P<0.05) . The total QLS score of the treatment group was (77.98±16.83) , and that of the control group was (53.27±19.78) post intervention (P<0.05) . Conclusions Motivational care can improve the self-care ability and quality of life in patients receiving permanent enterostomy. Key words: Enterostomy; Intestinal neoplasms; Quality of life; Self-care; Permanent enterostomy; Motivational care