Objective To evaluate extracellular and intracellular IFNγ and IL-4 levels in assessing Th1/Th2 balance in children with chronic hepatitis B (CHB) and asymptomatic carriers.Methods Fiftyfour hospitalized children including 23 CHB patients and 31 asymptomatic carriers were collected from May 2007 to February 2009.Thirty-four healthy children were served as control.Serum IFNγ and IL-4 levels were measured by enzyme-linked immunosorbent assay (ELISA) and intracellular IFNγand IL-4 levels were detected by flow cytometer.Analysis of variance (for homogenous variance) and Kruskal-Wallis test (for non-homogenous variance) were performed.Results The differences on extracellular IFNγ, IL-4 and Th1/Th2 among CHB, asymptomatic carriers and control groups were not statistically significant (F=0.342, 0.020 and 0.507, P ＞ 0.05); while the intracellular IFNγlevels were (7.68 ± 4.62), (11.71 ±4.36) and (13.61 ±6.71) μg/mL, and Th1/Th2 ratios were 0.96 ±0.30, 1.67 ±0.76 and 2.11 ± 1.12in three groups respectively (F=0.255 and 0.140, P ＜ 0.05 or ＜ 0.01).The differences in intracellular IL-4 levels among three groups were not significant (F=0.425, P ＞ 0.05).Conclusions Cytokine balance is affected in CHB children and asymptomatic carriers, and flow cytometry analysis is considered as a better method in evaluating the status of Th1/Th2 balance.

Objective To investigate the optimal technology of blind needle synovial biopsy.Methotis Blind needle synovial biopsy was performed on 81 knees with pain and swelling.Twenty patients with rheumatoid arthritis (RA) received uhrasonographic (US) examination before biopsies.Results Synovium were obtained in all patients and the successful rate was (71±21)%,while the area of synovium was (1.8±0.8)mm2.The time for accomplishing the procedure was (26±6) min and the depth of trocar insertion Was (3.1±0.7) cm.The successful rate in patients with RA (80±6)% was much higher than that in non-RA patients (54±10)%.The successful rate with US guidance (85±5)% was much higher than that without US guidance (78±6)%.The positive predictive value of synovium evaluation by naked eye Was 95.0%,while the negative predictive value was 81.1%.Conclusion Blind needle synovial biopsy should be spread because it is simple and safe to perfonn and it can obtain sufficient synovium for all purposes.

ObjectiveTo investigate the relationship of the polymorphism of endothelial nitric oxide synthase (eNOS), the 27-bp variable number of tandem repeats (VNTR) in intron 4 with essential hypertension (EH) of the northern Han nationality in China.MethodsGenotypes, the level of plasma nitric oxide metabolites (NOx) and the activity of nitric oxide synthase (NOS) of 207 EH subjects and 231 healthy subjects were measured by polymerase chain-reaction (PCR).ResultsThe frequencies of ecNOS4a/a,ecNOS4b/a, and ecNOS4 b/b in the healthy group were 0.43%, 13.42% and 86.15% respectively. The frequency of the b allele was 92.86%, and the frequency of the a allele was 7.14%. While the frequencies of ecNOS4 a/a, ecNOS4 a/b,and ecNOS4 b/b in the EH group were 0.49%, 19.32% and 80.19% respectively. The frequency of the a allele in EH group (n=42, 10.15%) was significantly higher than that in the healthy group (n=33, 7.14%)(P<0.05). The plasma NOx level of the EH group was 70.04±14.68 mol/L, and significantly lower than that 84.09±27.27 mol/L in the healthy group (P<0.05). Similarly, both the plasma TNOS and iNOS activities of the EH group were 35.49±12.8 U/ml and 14.92±7.93 U/ml, and markedly lower than that 41.47±13.2 U/ml and 10.11±6.21U/ml in the healthy group (P<0.05). But the activities of eNOS in the EH group and healthy group were not significantly different (P>0.05).ConclusionThe variations of ecNOS4 gene locus may be responsible for the decrement of plasma NOx, both plasma NOx level and activity of NOS decreases in EH patients, so it may be a genetic susceptibility marker for EH of the Han nationality in China.

Objective To explore the clinical features of hepatocellular carcinoma (HCC) during pregnancy. Methods Clinical data of 4 patients with HCC in pregnancy were retrospectively analyzed.Results All 4 patients were positive for hepatitis B surface antigen. A marked increase in maternal serum a-fetoprotein (AFP) was found in 3 patients (310.1-5630.0 ng/ml ). Three patients were diagnosed at their advanced stages and died of disease in the 4th, 6th and 7th months, respectively. One patient diagnosed as having early HCC underwent curative surgery and has been without recurrence for 26 months. Conclusion The overall survival of patients with HCC in pregnancy is grim because most patients are diagnosed in the advanced stage. Surveillance with AFP and ultrasonography should be recommended for pregnant woman for the detection of early HCC, especially in hepatitis B virus carriers from high endemic areas, to improve patient survival.

Objective To evaluate the safety and efficacy of mesohepatectomy for treating centrally located liver tumors. Methods The clinical data of 9 cases of centrally located liver tumor treated in our hospital with mesohepatectomy were retrospectively analyzed. Meanwhile, previous reports in Chinese and English on mesohepatectomy for treating centrally located liver tumors were reviewed.Results In the current series, perioperative mortality and morbidity rates were 0 and 66.6%, respectively. Eight patients were alive during a follow-up of 3-38 months. Twenty clinical trials were included in our systematic review. Four were retrospective non-randomized trials comparing central hepatectomy with lobar or extended hepatectomy. The surgical mortality rate of mesohepatectomy was 0% ～7. 4 %. Frequent complications were bile leakage (0. 4% ～ 18. 5 % ), pleural effusion (5. 7 % ～ 23.5 % ), ascites ( 1.9 % ～ 11.6 % ) and pneumonia ( 1.7 % ～ 12.5 % ). No differences in perioperative morbidity and early complication rate were found between the mesohepatectomy group and lobar or extended hepatectomy group in all four non-randomized studies. Two studies revealed that the overall survival rate and disease-free survival of patients with hepatocellular carcinoma were similar between the 2 groups. Conclusion Mesohepatectomy is a safe and effective operative procedure for the treatment of centrally located liver tumors.

Melioidosis is a endemic infectious disease caused by Burkholderia pseudomallei, and is considered one of the major causes of fatal pneumonia and sepsis.This paper reports diagnosis and treatment course of one case pulmonary melioidosis, and reviews the related literatures, so to improve clinical workers'' understanding towards melioidosis, avoid misdiagnosis and missed diagnosis.

[ ABSTRACT] AIM:To compare the differences of the genome-wide methylation levels and methylated regions be-tween nasopharyngeal carcinoma ( NPC) cells in the same genetic background but different radiation resistance ( CNE-2 cells and CNE-2R cells).METHODS:Using the method which was developed by Doctor Zhao Cun-you, based on using methyl-sensitive restriction enzyme to measure the genome-wide methylation levels.In addition, MeDIP-Seq was used to analyze the methylated regions in 6 gene functional elements, including the upstream 2k sequence, 5’ UTR, coding se-quence, intron, 3’UTR and downstream 2k sequence, between CNE-2 cells and CNE-2R cells.RESULTS:The genome-wide methylation level was approximately 30%lower in CNE-2R cells than that in CNE-2 cells.No obvious difference on the amount of genes and the coverage of the peak in the 6 gene functional elements was observed.However, the methylation pattern of plentiful genes had altered in the gene function elements.CONCLUSION:The genome-wide methylation levels and methylated regions between NPC cells in the same genetic background but different radiation resistance were quite dif-ferent, indicating that the DNA methylation may be associated with NPC radioresistance.

Objective In order to prevent the infection of Acinetobacter baumannii and use antibiotics rationally,the clinical infection and drug resistant data of multi-drug resistance Acinetobacter baumannii (MRAB)detected in intensive care unit (ICU)of Beijing Friendship Hospital from 2011 to 2013were analyzed.Methods This study is a retrospective study.One hundred and eighty five strains of MRAB were collected from the patients in ICU from January 2011 to December 2013.Identificationand antibiotic susceptibility of strains were determined with Vitek-2 Compact automatic bacteria identification system.The annual infection rate of MRAB was counted.PCR was used to detect the resistance genes.The clinical features of the patients with MRAB were analyzed.The average age,acute physiology and chronic health evaluation (APACHE) Ⅱ score,duration in ICU and mortality ratio of the MRAB patients were compared with the patients without MRAB.Rank-sum test was used to analyze the average age,APACHE Ⅱ score and duration in ICU.Chi-squared test was used to analyze the mortality ratio and annual infection rate.Results The average age [(67 ± 17)vs (59-± 19) years old,Z =-5.365,P =0],APACHE Ⅱ score [(25.68±7.93) vs (17.62±8.39),Z=-14.821,P=0],duration in ICU [(27 ±29) vs (5 ±8) d,Z =-4.342,P =0] and mortality ratio [10.82％ (53/185) vs 28.65％ (147/1 359),x2 =45.92,P =0] of the patients infected by MRAB were significantly higher than those without the infection.The MRAB was found mostly in sputum and bronchial precipitates (83.78％,155/185).Though detection rate reduced yearly and there was a significant reduction in 2013 compared with 2011 [11.07％ (69/469) vs 8.37％ (52/621),x2 =8.755,P =0.003],the drug resistant rate was in high level and did not show any change in the 3 years.OXA-23 and OXA-51 were detected in all MRAB.Conclusions The main drug resistant mechanism of MRAB in ICU is related to OXA-23.More active methods of coutrol and prevention of MRAB should be used in elderly aud severely pneumonic patients.Intensive disinfection and isolation measures can decrease MRAB detection rate.Combined antibiotics should be used in patients with MRAB infection.

Objective:To prepare a 177Lu labeled human epidermal growth factor receptor 2 (HER2) affibody 177Lu-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-maleimide (Mal)-cysteine (Cys)-ZHER 2: 342 ( 177Lu-NOTA-MZHER2 for short), and investigate its labeling process and anti-tumor properties. Methods:Two kinds of buffer systems (sodium acetate buffer system and sodium ascorbate buffer system) were investigated. The effects of pH value, precursor mass and reaction temperature on 177Lu labeling NOTA-MZHER2 were compared to obtain optimal labeling conditions. The radiochemical purity of labeled product was determined by instant thin-layer chromatography (ITLC), and its stabilities in PBS and plasma were observed. Human ovarian cancer cell line SKOV-3 was selected for cell internalization and cytotoxicity test to evaluate cell uptake and killing effect of 177Lu-NOTA-MZHER2. SKOV-3 tumor-bearing mice( n=3) were injected with 177Lu-NOTA-MZHER2, and microSPECT/CT imaging was performed. Another 40 tumor-bearing mice were divided into 22.2 MBq group (tail vein injection with probe of 22.2 MBq), control group (tail vein injection with PBS), low-dose group (tumor injection with probe of 3.7 MBq) and high-dose group (tumor injection with probe of 7.4 MBq). Tumor volume and mass of tumor-bearing mice were monitored after injection, and the anti-tumor effect and toxicity of probe were evaluated. Repeated measurement analysis of variance (Bonferroni method) was used to analyze the data. Results:The optimal labeling condition was 70-80 ℃ for 30 min in the system of sodium acetate buffer solution with pH=4 and precursor mass of 50 μg. Under these conditions, the labeling rate of 177Lu-NOTA-MZHER2 was (99.3±0.4)% and radiochemical purity was >99%. After 12 d in PBS and plasma, the radiochemical purities were (95.0±1.5)% and (95.0±2.1)%. Results of cell experiment showed that the internalization of 177Lu-NOTA-MZHER2 accounted for (29.02±3.50)% of the total uptake, and the survival rate of SKOV-3 cells was (48±6)% with the probe concerntration of 6×10 -3 Bq/L. SPECT imaging showed that 177Lu-NOTA-MZHER2 was still concentrated at the tumor site 96 h after injection with a dose of 18.5 MBq. Relative tumor volume (RTV) of tumor-bearing mice in 22.2 MBq group, high-dose group and low-dose group was significantly different from that in control group ( F=21.75, P<0.001). Twenty days after injection, RTV and relative body mass of the tumor-bearing mice in high-dose group were (140±7)% and (80±9)%, respectively. Compared with control group, high-dose group had obvious anti-tumor effect (both P<0.001). Conclusion:177Lu-NOTA-MZHER2 is successfully prepared, which is simple and efficient, and the probe has good anti-tumor effect.

Objective To evaluate the change of clinicopathological features and prognosis of papillary thyroid cancer over a 15-year period.Methods The clinicopathological features and outcomes of papillary thyroid cancer patients were analyzed in three groups according to the time of diagnosis:group Ⅰ (1997-2001),group Ⅱ (2002-2006),and group Ⅲ (2007-2011).Results As time advanced,the average age of papillary thyroid cancer patients increased,tumor stage,like size,extrathyroid invasion and lymph node metastasis decreased dramatically (P ＜ 0.01).The percentage of multifocality and bilaterality increased.The long-term follow up data (median follow up time was 6.6 years),indicated that the 15-year over all survival was 97.8％ and the 15-year disease-free survival was 90.2％.Tumor ≥3 cm,bilaterality,extrathyroid invasion,lymph node metastasis and AJCC stage were correlated with tumor recurrence.By multivariate COX-regression analysis only lymph node metastasis and bilaterality were independent risk factors.Conclusion The clinicopathological features of papillary thyroid cancer changed over 15 years,with the percentage of early-staged patients increased.Lymph node metastasis and bilaterality are two risk factors for tumor recurrence.