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Zhao H.-J.,Jingan District Central Hospital | Zhang J.-Q.,Shanghai University | Song J.-L.,Shanghai University | Fu J.,Shanghai University
Chinese Journal of Medical Imaging Technology | Year: 2015

Objective: To evaluate the value of retraction phenomenon on CDFI in diagnosis of benign and malignant thyroid masses. Methods: Totally 65 patients with 102 thyroid masses were divided into malignant group (36 patients with 54 thyroid masses) and benign group (29 patients with 48 thyroid masses) according to histopathologic results. Some sonographic features of thyroid masses were observed in B-mode such as shapes, margins, microcalcifications and retraction phenomenon on CDFI mode. Size and anteroposterior diameter/transverse diameter (A/T) ratio of all masses were measured. The difference of the distribution of the features between the benign and malignant groups was statistically analyzed and compared. Results: The retraction phenomenon on CDFI could be found in 40.74% (22/54) thyroid malignant nodules; 95.65% (22/23) nodules of thyroid with retraction phenomenon were malignancy. Four features were significantly more frequent in malignant than that in benign nodules: (1)Solid appearance, (2)microcalcification, (3)posterior attenuation, (4)retraction phenomenon. The diagnostic sensitivity and specificity of (1)+(2)+(3) and (1)+(2)+(3)+(4) were 79.63% (43/54), 93.75% (45/48) and 87.04% (47/54), 93.75% (45/48), respectively. Conclusion: Retraction phenomenon on CDFI is useful for diagnosis of thyroid cancer. Copyright © 2015 by the Press of Chinese Journal of Medical Imaging and Technology.


Gao H.-N.,Zhejiang University | Lu H.-Z.,Fudan University | Cao B.,Capital Medical University | Du B.,Peking Union Medical College | And 38 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: During the spring of 2013, a novel avian-origin influenza A (H7N9) virus emerged and spread among humans in China. Data were lacking on the clinical characteristics of the infections caused by this virus. METHODS: Using medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin influenza A (H7N9) infection through May 10, 2013. RESULTS: Of the 111 patients we studied, 76.6% were admitted to an intensive care unit (ICU), and 27.0% died. The median age was 61 years, and 42.3% were 65 years of age or older; 31.5% were female. A total of 61.3% of the patients had at least one underlying medical condition. Fever and cough were the most common presenting symptoms. On admission, 108 patients (97.3%) had findings consistent with pneumonia. Bilateral ground-glass opacities and consolidation were the typical radiologic findings. Lymphocytopenia was observed in 88.3% of patients, and thrombocytopenia in 73.0%. Treatment with antiviral drugs was initiated in 108 patients (97.3%) at a median of 7 days after the onset of illness. The median times from the onset of illness and from the initiation of antiviral therapy to a negative viral test result on real-time reverse-transcriptase-polymerase- chain-reaction assay were 11 days (interquartile range, 9 to 16) and 6 days (interquartile range, 4 to 7), respectively. Multivariate analysis revealed that the presence of a coexisting medical condition was the only independent risk factor for the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95% confidence interval, 1.21 to 9.70; P = 0.02). CONCLUSIONS: During the evaluation period, the novel H7N9 virus caused severe illness, including pneumonia and ARDS, with high rates of ICU admission and death. (Funded by the National Natural Science Foundation of China and others.) Copyright © 2013 Massachusetts Medical Society.


PubMed | Chinese Academy of Sciences, Jingan District Central Hospital, Beijing Normal University, University of Chinese Academy of Sciences and 3 more.
Type: Journal Article | Journal: Biomedical optics express | Year: 2016

We introduce a more flexible optogenetics-based mapping system attached on a stereo microscope, which offers automatic light stimulation to individual regions of interest in the cortex that expresses light-activated channelrhodopsin-2


Zhu Z.,Shanghai JiaoTong University | Zhang L.,Shanghai JiaoTong University | Jiang J.,Shanghai JiaoTong University | Li W.,Shanghai JiaoTong University | And 4 more authors.
Shanghai Archives of Psychiatry | Year: 2014

Background: There is ongoing debate about the efficacy of placebos in the treatment of mental disorders. In randomized control trials (RCTs) about the treatment of generalized anxiety disorder, the administration of a psychological placebo or placement on a waiting list are the two most common control conditions. But there has never been a systematic comparison of the clinical effect of these different strategies. Aim: Compare the change in symptom severity among individuals treated with cognitive behavioral therapy, provided a psychological placebo, or placed on a waiting list using data from RCTs on generalized anxiety disorder. Methods: The following databases were searched for RCTs on generalized anxiety disorder: PubMed, PsycInfo, EMBASE, The Cochrane Library, CNKI, Chongqing VIP, Wanfang, Chinese Biological Medical Literature Database, and Taiwan Electronic Periodical Services. Studies were selected based on pre-defined inclusion and exclusion criteria and the quality of each included study - based on the risk of bias and the level of evidence - was formally assessed. Meta-analysis was conducted using RevMan5.3 and network meta-analyses comparing the three groups were conducted using R. Results: Twelve studies with a combined sample size of 531 were included in the analysis. Compared to either control method (placebo or waiting list), cognitive behavioral therapy was more effective for generalized anxiety disorder. Provision of a psychological placebo was associated with a significantly greater reduction of symptoms than placement on a waiting list. Eight of the studies were classified as 'high risk of bias', and the overall level of evidence was classified as 'moderate', indicating that further research could change the overall results of the meta-analysis. Conclusions: RCTs about the treatment of generalized anxiety disorders are generally of moderate quality; they indicate the superiority of CBT but the results cannot, as yet, be considered robust. There is evidence of a non-negligible treatment effect of psychological placebos used as control conditions in research studies. This effect should be considered when designing and interpreting the results of randomized controlled trials about the effectiveness of psychotherapeutic interventions. Copyright © 2014 by Shanghai Municipal Bureau of Publishing.


PubMed | Shanghai JiaoTong University and Jingan District Central Hospital
Type: Journal Article | Journal: G3 (Bethesda, Md.) | Year: 2016

Congenital heart disease (CHD) is the most common developmental abnormality, and is the leading noninfectious cause of mortality in neonates. Increasing evidence demonstrates that genetic defects play an important role in the pathogenesis of CHD. However, CHD exhibits substantial heterogeneity, and the genetic determinants for CHD remain unknown in the overwhelming majority of cases. In the current study, the coding exons and flanking introns of the HAND2 gene, which encodes a basic helix-loop-helix transcription factor essential for normal cardiovascular development, were sequenced in 192 unrelated patients with CHD, and a novel heterozygous mutation, p.S65I, was identified in a patient with congenital ventricular septal defect (VSD). Genetic analysis of the index patients pedigree revealed that the mutation was present in all seven affected family members available, but absent in the 13 unaffected family members examined. Besides, in addition to VSD, five of the probands close relatives also had pulmonary stenosis (PS), and the probands son also had double outlet right ventricle (DORV). The missense mutation, which altered an evolutionarily conserved amino acid, was absent in 300 unrelated, ethnically matched healthy individuals. Biological analyses using a dual-luciferase reporter assay system showed that the mutant HAND2 was associated with significantly diminished transcriptional activity. Furthermore, the mutation abolished the synergistic activation between HAND2 and GATA4, as well as NKX2.5-two other cardiac core transcriptional factors that have been causally linked to CHD. These findings indicate that HAND2 loss-of-function mutation contributes to human CHD, perhaps via its interaction with GATA4 and NKX2.5.


Zhang T.-S.,Jingan District Central Hospital
Chinese Journal of Evidence-Based Medicine | Year: 2015

Network meta-regression model can be used to account for important effect modifiers that might have impact on the treatment effects, and it can be performed within a frequentist or Bayesian framework. This study introduces how to use the mvmeta command in Stata software to implement network meta-regression within frequentist framework and briefly introduces the application of network meta-regression. © 2015 Editorial Board of Chin J Evid-based Med.


Zhang T.-S.,Jingan District Central Hospital
Chinese Journal of Evidence-Based Medicine | Year: 2015

Network meta-analysis may be performed by fitting multivariate meta-analysis models with Stata software mvmeta command; however, there are various challenges such as preprocessing the data, parameterising the model, and making good graphical displays of results. A suite of Stata programs, network, may meet these challenges. In this article, we introduce how to use the network commands to implement network meta-analysis by the example of continuous data. © 2015 Editorial Board of Chin J Evid-based Med.


Hua X.-Y.,Huashan Hospital | Liu B.,Fudan University | Qiu Y.-Q.,Jingan District Central Hospital | Tang W.-J.,Fudan University | And 6 more authors.
Journal of Neurosurgery | Year: 2013

Object. Contralateral C-7 nerve transfer was developed for the treatment of patients with brachial plexus avulsion injury (BPAI). In the surgical procedure the affected recipient nerve is connected to the ipsilateral motor cortex, and the dramatic peripheral alteration may trigger extensive cortical reorganization. However, little is known about the long-term results after such specific nerve transfers. The purpose of this study was to investigate the long-term cortical adaptive plasticity after BPAI and contralateral C-7 nerve transfer. Methods. In this study, 9 healthy male volunteers and 5 male patients who suffered from right-sided BPAI and had undergone contralateral C-7- transfer more than 5 years earlier were included. Functional MRI studies were used for the investigation of long-term cerebral plasticity. Results. The neuroimaging results suggested that the ongoing cortical remodeling process after contralateral C-7 nerve transfer could last for a long period; at least for 5 years. The motor control of the reinnervated limb may finally transfer from the ipsilateral to the contralateral hemisphere exclusively, instead of the bilateral neural network activation. Conclusions. The authors believe that the cortical remodeling may last for a long period after peripheral rearrangement and that the successful cortical transfer is the foundation of the independent motor recovery. © 2013 AANS.


Feng J.-T.,Fudan University | Zhu Y.,Fudan University | Hua X.-Y.,Fudan University | Gu Y.-D.,Fudan University | And 3 more authors.
Clinical Neurophysiology | Year: 2016

Objective: We assessed the diagnostic value of triple stimulation technique (TST) in eight patients with neurogenic thoracic outlet syndrome (TOS) by revealing the conduction block of the proximal lower trunk of the brachial plexus and locating the compression site. Methods: Eight patients fulfilling the conventional criteria of the lower-trunk neurogenic TOS were enrolled in our study. TST along with the central motor-conduction time was evaluated. The parameters including the TST amplitude ratio and the TST area ratio were compared between patients and controls. Results: The amplitude ratio was significantly lower in the patient group than in the control group (patients: 0.518 ± 0.113; control: 0.954 ± 0.020, P < 0.01), so was the area ratio (patients: 0.453 ± 0.194; control group: 0.955 ± 0.192, P < 0.01). No significant difference of central motor-conduction time (CMCT) was seen between the patient group and the control group (patients: 6.62 ± 0.36 ms; control: 6.54 ± 0.36 ms; P = 0.528). Surgical procedures proved the compression of the lower trunk in all patients. Conclusion: Our results indicated that there was conduction block besides axon loss in neurogenic TOS patients, and the conduction block was located between the nerve root emerging site and the supraclavicular stimulation site. Significance: We first applied TST in diagnosing neurogenic TOS, and we showed that the patient's TST ratio was significantly lower than normal. Combined with clinical manifestations, TOS can be more precisely diagnosed. © 2015 International Federation of Clinical Neurophysiology.


PubMed | Jingan District Central Hospital and Zhejiang University
Type: Journal Article | Journal: PloS one | Year: 2014

DNA methyltransferase 3A (DNMT3A) mutations were considered to be independently associated with unfavorable prognosis in adults with de novo acute myeloid leukemia (AML), however, there are still debates on this topic. Here, we aim to further investigate the association between DNMT3A mutations and prognosis of patients with AML.Eligible studies were identified from several data bases including PubMed, Embase, Web of Science, ClinicalTrials and the Cochrane Library (up to June 2013). The primary endpoint was overall survival (OS), while relapse-free survival (RFS) and event-free survival (EFS) were chosen as secondary endpoints. If possible, we would pool estimate effects (hazard ratio [HR] with 95% confidence interval[CI]) of outcomes in random and fixed effects models respectively.That twelve cohort studies with 6377 patients exploring the potential significance of DNMT3A mutations on prognosis were included. Patients with DNMT3A mutations had slightly shorter OS (HR=1.60; 95% CI, 1.31-1.95; P<0.001), as compared to wild-type carriers. Among the patients younger than 60 years of age, DNMT3A mutations predicted a worse OS (HR=1.84; 95% CI, 1.36-2.50; P<0.001). In addition, mutant DNMT3A predicted inferior OS (HR=2.30; 95% CI, 1.78-2.97; P=0.862) in patients with unfavorable genotype abnormalities. Similar results were also found in some other subgroups. However, no significant prognostic value was found on OS (HR=1.40; 95% CI, 0.98-1.99; P=0.798) in the favorable genotype subgroup. Similar results were found on RFS and EFS under different conditions.DNMT3A mutations have slightly but significantly poor prognostic impact on OS, RFS and EFS of adults with de novo AML in total population and some specific subgroups.

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