2018�꡶���ʶ�ͯ��ʪ��������֯��PRINTO�������ط��Թؽ����·����׼ר�ҹ�ʶ���������裩���й�ר�ҽ��

??Toward New Classification Criteria for Juvenile Idiopathic Arthritis??First Steps??Pediatric Rheumatology International Trials Organization International Consensus was published onJournal of Rheumatologyin October??2018??and then at the2018Annual Meeting of AmericanColleage of Rheumatology??ACR????the relevant experts introduced the samecontent. Although the new JIA classification criteria in the process of improvement in western countries is still??PRINTO has designed a two-step’sprospective study??which will form a mature new JIA classification criteria after itscompletion. The new trend and progress of this subject is of great significance to the diagnosis??treatment and research of JIAin the world. CCIHA has organized a group of relevant Chinese experts to interpret the international consensus??aiming at putting forward suggestions and opinions of Chinese experts on the new classification of JIA??providing a basis for future research on the real world researchof JIA in China??and putting forward the opinions of Chinese experts to be in line with the new international criteria. This paper only interprets faithfully the original English text. The formation and application of JIA’s new classification criteria in China still need further study and discussion.     

Neural networks to identify multiple sclerosis with optical coherence tomography

Purpose:  To compare axonal loss in ganglion cells detected with spectral‐domain optical coherence tomography (OCT) in eyes of patients with multiple sclerosis (MS) versus healthy control subjects using an artificial neural network (ANN). To analyse the capability of the ANN technique to improve the detection of retinal nerve fibre layer (RNFL) damage in patients with multiple sclerosis. Methods:  Patients with multiple sclerosis (n = 106) and age‐matched healthy subjects (n = 115) were enrolled. The Spectralis OCT system was used to obtain the circumpapillary RNFL thickness in both eyes. The 768 RNFL thickness measurements provided by the Spectralis OCT were performed to obtain thickness measurements from 24 uniformly divided locations around the peripapillary RNFL. The performance of the ANN technique for identifying RNFL loss in patients with multiple sclerosis was evaluated. Receiver‐operating characteristic (ROC) curves were used to display the ability of the test to discriminate between MS and healthy eyes in our population. ROC curves obtained using ANN and parameters provided by OCT (mean and 6 sector thicknesses) were compared. Results:  The capability of the ANN technique to detect RNFL loss in patients with multiple sclerosis compared with healthy subjects was good. The area under the ROC curve was 0.945. Compared with the OCT‐provided parameters, the ANN had the largest area under the ROC curve. Conclusions:  Measurements of RNFL thickness obtained with Spectralis OCT have a good ability to differentiate between healthy and individuals with multiple sclerosis. Based on the area under the ROC curve, the ANN performed better than any single OCT parameter.     

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??OBJECTIVE To discuss the effect and mechanism of cinepazide maleate (CM) on myocardial injured rats induced by isoproterenol (Iso). METHODS Fifty male and female rats were divided into normal group, model group, the low and the high dose group of the CM, and captopril (Cap)positive control group. The rat model of myocardial injury was established by subcutaneous injection of Iso (5 mg??kg^-1??d^-1)for 7 d, rats in treatment group were given intraperitoneal injection of CM on the second day (1.5,3 mg??kg^-1??d^-1), rats in positive control group were given intragastric administration of Cap(10 mg??kg^-1??d^-1), and rats in normal group and model group were given intraperitoneal injection of normal saline in the same volume, for 14 d. The rats in each group were tested before and after treatment by three times of running endurance test. After stopping drug all rats were anesthetized for measuring the electrocardiogram (ECG), then taken blood for measuring the activities of serum SOD, LDH and CK, and taken hearts for measuring heart weight index (HWI), left ventricular mass index (LHWI), the contents of myocardial hydroxyproline (Hyp)and MDA, and observing the morphological changes of myocardial tissue by HE staining. RESULTS Compared with rats in normal group, rats in model group showed endurance value decrease, ECG abnormalities (arrhythmia and myocardial ischemia in waveform), increased HWI, LHWI (P<0.01), myocardial Hyp content, myocardial MDA level, and the level of serum LDH and CK, and reduced the serum SOD activity (P<0.05 or P<0.01). Compared with model group, CM could significantly increase endurance value, improve abnormal phenomenon of ECG, lower the HWI, LHWI, myocardial Hyp content, myocardial MDA level, and serum LDH and CK levels were lower, and serum SOD activity increased, especially in high dose group of CM (P<0.01). HE staining showed in the model group rat ventricular remodeling, myocardial rupture, a large number of collagen fibers, in the treatment group, ventricular remodeling and myocardial fibrosis were significantly improved. CONCLUSION Cinepazide maleate has protective effect on myocardial injury of rats induced by Iso.     

Mechanical pulmonic valve thrombosis: expanding role of cardiac CT and multimodality imaging

We report a case of a 44-year-old man with a clinical history of Tetralogy of Fallot status post staged surgical correction with mechanical pulmonic valve replacement who presented with progressive exertional dyspnea in the setting of non-compliance with anticoagulation. In the context of this suggestive clinical presentation, the diagnosis of mechanical pulmonic valve thrombosis (MPVT) was made possible via multimodality imaging, including transthoracic echocardiogram and cardiac computed tomography angiography. Due to the uncommon nature of the condition, the patient was treated with systemic thrombolysis and anticoagulation using evidence-based guidelines, largely extrapolated from left-sided mechanical valve thrombosis. Our case underscores the importance of anticoagulation in MPVT and recognizing the features of MPVT on clinical history, physical examination, and multimodality imaging. It is essential to understand the pivotal role of multimodality imaging in the assessment of MPVT and realize the limitations of available data regarding the management of MPVT in the current era.     

Everything that is not given is lost

A small health center is located in Velingara,Senegal.It is approximately 7 o'clock in the morning.In the old,dusty room that constitutes the operating room,a s...     

Organophosphorus pesticide exposure decreases sperm quality: association between sperm parameters and urinary pesticide levels

Several studies have suggested that human semen quality has declined over the past decades and some of them have associated it with occupational exposure to pesticides. However, most of these studies have not been associated with a reliable exposure level and have been designed mostly as cross-sectional studies. The present work evaluates, in a longitudinal follow-up study, the effect of organophosphate pesticides (OP) at three occupational exposure levels on semen quality. In addition, the study examined the association between OP urinary levels and sperm parameters in exposed and unexposed workers. A total of 139 semen samples from 52 volunteers were assessed. Urinary OP levels were measured by gas-liquid chromatography.The results revealed that the poorest semen quality was found among the subjects with the highest OP exposure and the highest urinary OP levels. Seasonal variations in sperm concentration and sperm count were registered.The results showed a significant decrease in total sperm count among subjects with the highest exposure to OP. Further studies assessing the effects of OP on male reproductive health should be controlled by the variability in human sperm parameters, sperm seasonality, spermatogenesis time and the changing OP exposure level in men highly exposed to OP.     

玻璃体腔内注射曲安奈德联合光动力疗法治疗脉络膜新生血管所致的黄斑萎缩

目的:报道经玻璃体腔内注射高剂量曲安奈德(triamcinolone acetonide,TA)联合光动力学疗法(photodynamic therapy,PDT)治疗老年性黄斑变性( age related macular degeneration, AMD)的脉络膜新生血管(choroidal neovascularization,CNV)后发生的脉络膜毛细血管萎缩。方法:我们采用非随机回顾性干涉治疗病例。在阿利坎特学院眼科,连续观察51眼(实验组)玻璃体腔内的注射(19.4±2.1)mg/0.1mL TA联合PDT治疗AMD的全部中心凹下型CNV患者,经过2a的随访,检查黄斑部脉络膜毛细血管和视网膜色素上皮细胞(RPE)萎缩情况。同时,采用单独PDT治疗的连续30眼患者作为对照组,其年龄,性别和AMD的CNV类型及大小与实验组相匹配。结果:随访24mo后,在治疗区域21/47眼(45%,实验组)和7/30眼(23%,对照组)发展成黄斑部RPE和脉络膜毛细血管萎缩(P=0.04,卡方检验)。实验组平均最大萎缩区域的直径为(5044±1666)μm,而对照组为(4345±1550)μm。在实验组中,RPE萎缩患者的平均最佳矫正视力为(0.87±0.33),而非RPE萎缩患者的平均最佳矫正视力为(0.66±0.26) (P=0.11,秩和U检验)。结论:玻璃体腔内注射大剂量TA联合PDT治疗可能会增加RPE和脉络膜毛细血管萎缩的风险。     

Leitlinie zur Betreuung von Neugeborenen diabetischer M��tter

All diabetic women are advised to give birth in a hospital with a pediatric service that allows for continuous intravenous glucose administration, precluding the need for out-of-house transfer of the infant. Women with pre-pregnancy diabetes or on insulin treatment during pregnancy should give birth in a hospital offering round-the-clock neonatal care. Early (breast) feeding is of paramount importance and should be started 30?min after birth, subsequently every 2?C3?h. A mandatory preprandial blood glucose measurement should be taken 2?C3?h after birth and again immediately before the infant is transferred out of the delivery room; subsequent preprandial measurements at 6, 12, and possibly 24?h of age. In the event of three consecutive values of >2.5?mmol/l (45?mg/dl), further controls may be dispensed with. Simultaneously, infants should be checked for symptoms of hypoglycemia by a midwife or nurse on the maternity unit. Clinical findings suspicious for hypoglycemia should prompt immediate blood glucose determinations. Blood glucose concentrations below 2?mmol/l (36?mg/dl; in infants without symptoms) or 2.5?mmol/l (45?mg/dl; in infants with hypoglycemia-related symptoms, prior hypoglycemia, or following asphyxia) require immediate intervention in the form of feeding (preferably breast milk, otherwise hydrolyzed formula, or hydrolyzed starch solution only temporarily), by gavage if necessary. Intravenous glucose administration if blood glucose falls below 1.7?mmol/l (30?mg/dl). Routine echocardiography or laboratory tests (Ca2+, Mg2+, hematocrit, bilirubin) are not necessary unless otherwise indicated. Breast feeding should be consistently encouraged before and after delivery.     

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??Abstracts?? Objective To study the T2* magnetic resonance imaging for evaluation of iron deposition of liver?? pancreas and heart in β- thalassemia major ??β-TM?? patients and the relationship of the serum ferritin with iron overload. Methods Measurement of hepatic?? pancreatic and cardiac MRI T2* was performed in 153 patients with β-TM from May 1?? 2010 to December 31?? 2010??The demographics and serum ferritin ??SF?? were collected. The rate of the iron overload in liver?? pancreas and heart was analyzed. The rates of combined pancreatic and cardiac iron overload in different hepatic iron overload groups were compared. Results According to MRI T2*?? there was serious hepatic iron overload in 85 cases?? moderate in 39?? mild in 21?? no iron overload in 8. Similarly?? there was pancreatic iron overload in 134?? no iron overload in 19. In terms of cardiac iron overload?? there was serious cardiac iron overload in 37 cases?? mild in 21?? no iron overload in 95. No correlation was found between hepatic?? pancreatic and cardiac MRI T2* and age or SF?? but hepatic MRI T2* correlated with pancreatic and cardiac MRI T2*??P = 0.000?? r = 0.529?? r = 0.369???? and pancreatic MRI T2* correlated with cardiac MRI T2* well ??P = 0.000?? r = 0.715??. As grade of hepatic iron overload increases?? the patients demonstrated higher rate of combination of pancreatic and cardiac iron overload simultaneously ??χ2 = 20.78??P = 0.000??.