Objective To provide an experimental evidence for the clinical applications of glyceryl trinatrate(GTN)and isosorbide dinitrate(ISDN)against Coxsackievirus B(CVB)-related myocarditis.Methods Coxsackievirus B3 was propagated in HeLa cells.Virus yields were determinded by 50% tissue culture infective dosage(TCID50).BALB/c mice were attacked with 5000 TCID50 of CVB3,meanwhile,the mice were administrated with GTN and ISDN.All mice were killed at the 14th day.The myocardial tissues were harvested for histologic evaluation.Results The infection plaques in the myocardial tissues obtained from CVB3-infected BALB/c mice treated with GTN were siginificantly reduced(0.89?0.18 in GTN group and 1.25?0.22 in ISDN group)compared with that of the untreated CVB3-infected mice(P

Objective To analyze the clinicopathologic features of mucinous cervical adenocarcinoma (ADC) and supply some reference for its diagnosis,treatment and prognosis.Methods Totally 88 cases with primary mucinous ADC diagnosed between January 2003 and December 2007 in Jiangxi Maternal and Child Health Hospital were retrieved.Their clinical and pathological data were reviewed and analyzed.Results Among 88 patients,70 cases of them were endocervical ADC,11 cases were minimal deviation adenocarcinoma (MDA),2 cases were intestinal subtype and 5 cases were villoglandular ADC.The positive rate of cervical Pap smear cytology was only 28％ (10/36).There were 10 cases were performed several times of cervical Pap smear cytology test and biopsies,while still no abnormality was found.Finally,7 cases of them were diagnosed by cervical excisional biopsy and endocervical curettage,including 5 cases with endocervical ADC and 2 cases with MDA; 2 cases (1 case with stage Ⅰ b1 endocervical ADC and 1 case with Ⅰ b1 MDA) were diagnosed by cold knife conization,and 1 case with stage Ⅰ b1 endocervical were diagnosed by uteroscopically directed biopsy.The overall 5-year survival rate was 60.0％.Using univariate analysis results showed that age (P =0.046),stage (P =0.007),tumor size (P =0.007) and therapeutic methods (P =0.009) were significant prognostic factors.Multivariate analysis showed that therapeutic methods was an independent predictor for survival (P =0.013).Stage Ⅱ b-Ⅲ b MDA patients occupied 7/11 of all MDA patient,while there was only one such patient of 5 cases with villoglandular ADC.The overall HPV infection rate was 65％ (57/88),and there was no obvious differences about the HPV infection rates among different types of mucinous ADC.Conclusions Cervical smear cytology is of little significance to the diagnosis of mucinous cervical adenocarcinoma.Early stage mucinous ADC is difficult to be detected,especially for MDA.Cervical excisional biopsy,endocervical curettage,cold knife conization,uteroscope are beneficial to its diagnosis.Therapeutic methods is an important prognostic factor for mucinous ADC and comprehensive treatment should be given to those patients with risky postsurgical factors.

Objective To investigate the effect of pre-treatment of ginkgo biloba extract from portal vein on oxidative stress in liver surgery.Methods Sixty cases of hepatic portal occlusion for hepatectomy surgery in patients (38 males, 22 females, ASA grade Ⅰ or Ⅱ, cardiac function Ⅰ or Ⅱ, Child-Pugh class A), were randomly divided into three groups (n=20 each): portal vein injection group (group P), jugular vein injection group (group J) and control group (group C).Patients in group P were injected with ginkgo biloba extract injection 5 ml slowly from portal vein after freeing the portal vein, patients in group J were injected with ginkgo biloba extract injection 5 ml slowly from the jugular vein after freeing the portal vein, while patients in group C were injected with normal saline 5 ml slowly from the jugular vein after freeing the portal vein.Venous blood samples were drawn from jugular vein at the following time points: pre-occlusion ten minutes (T0), 1 h (T1), 6 h (T2), 24 h (T3) after reperfusion respectively, and then detected the levels of ALT, AST, tumor necrosis factor(TNF-α), manlondialdehyde (MDA) and the activity of superoxide dismutase (SOD).Results Compared with T0, the serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly increased,the activity of SOD was significantly decreased in all groups (P＜0.05).Compared with group C, serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly decreased, the activity of SOD was significantly increased in groups J and P (P＜0.05).Compared with group J, serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly decreased, the activity of SOD was significantly increased in group P (P＜0.05).Conclusion The pre-treatment of ginkgo biloba extract from portal vein can increase the SOD activity, inhibit the activation of Kupffer cells, reduce the release of TNF-α, enhance the ability of anti-oxidative stress and produce significant protective effect on liver ischemia-reperfusion injury.

BACKGROUNDTo investigate the clinical possibility of detection of lung cancer cells in the peripheral blood with cytokeratin and 2F7/S5A monoclonal antibody by flow cytometry (FCM) in patients with lung cancer.

METHODSFive mililiter peripheral blood was collected. The mononuclear cells were isolated by Ficoll-Hypaquegradient centrifugation. Then the cells were labeled with lung specific antibody (2F7/S5A) and antibodies against CD45, cytokeratin (CK). The quantitation of CD45 -CK +2F7/S5A + cells were performed by FCM.

RESULTSA total of 151 people were studied, including 20 healthy controls, 116 patients with lung cancer and 15 patients with benign pulmonary diseases. The phenotype of monocytes of peripheral blood was CD45 +CK -2F7/S5A -, while the phenotype of lung cancer cells was CD45 -CK +2F7/S5A +. No cancer cell was found in peripheral blood of all the healthy controls. One out of 15 cases of benign pulmonary diseases was found to have CD45 +CK -2F7/S5A - cells in peripheral blood. And 39 out of 116 patients with lung cancer were found to have circulating lung cancer cells. The sensitivity, specificity, positive predictive value and negative predictive value of detection was 33.62% , 93.33%, 97.50% and 15.38%, respectively. The average quantitation of circulating cancer cell detected was 0.12×10⁶/L.

CONCLUSIONSThere is high specificity and positive predictive value of the examination of circulating cancer cells in patients with lung cancer by FCM, which could detect trace cancer cell in peripheral blood of lung cancer. It may be valuable in diagnosis and treatment of lung cancer.

BACKGROUND: Peanut allergy is an increasing problem in Singapore and strict avoidance is difficult as peanut is ubiquitous in Asian cuisine. OBJECTIVE: We aimed to assess the efficacy and safety of peanut oral immunotherapy (OIT) in children with obvious peanut allergy in Singapore. METHODS: This was an open-label study of peanut OIT in children living in Singapore, with 2 weekly dose escalation until final maintenance dose of 3,000 mg of peanut protein and a maintenance phase of 12 months. An oral food challenge was performed at 6 months to assess for desensitisation and at 4 weeks after discontinuation of OIT having completed 12 months of maintenance therapy to assess for possible sustained unresponsiveness. The adverse events were monitored using the symptom diaries. RESULTS: Nine subjects were started on OIT, with 7 managing to complete maintenance phase of therapy. Of these 7, all were able to tolerate at least 3,000 mg of peanut protein by 6 months of maintenance therapy, showing that the OIT was effective. Of these 7, 3 patients complied with the 4-week abstinence period after completion of OIT before another peanut challenge; 2 of the 3 subjects showed a significant decrease from the initial ability to tolerate 3,000 mg of peanut protein. Side effects were mainly gastrointestinal in nature and were more common during the updosing phase than the maintenance phase. No episodes of anaphylaxis were observed in this study. CONCLUSION: Peanut OIT seemed to be effective and safe in our cohort of Singaporean children.
Anaphylaxis ; Arachis ; Asian Continental Ancestry Group ; Child ; Cohort Studies ; Humans ; Hypersensitivity ; Immunotherapy ; Peanut Hypersensitivity ; Pilot Projects ; Probiotics ; Singapore

Objective:To explore the experience of teachers from Guangdong and Macao in nursing teaching cooperation, the existing problems in current teaching cooperation and suggestions for improvement.Methods:From January to April 2021, using descriptive qualitative method to conduct in-depth among eight clinical tutors from The Third Affiliated Hospital of Guangzhou Medical University who teach Macao nursing students, and four teachers from Kiang Wu Nursing College of Macao using the purposive sampling method. And adopted content analysis for data analysis.Results:A total of 4 themes and 2 sub-themes were analyzed: the positive impact of cross-border teaching cooperation projects including developed the nursing business of the two places and deepened the cooperative relationship between the two places; limiting the depth and breadth of knowledge transfer because of the short cross-border learning time; the imbalance between students′ abilities and teachers′ expectations; expectations for homogeneous internships for heterogeneous groups.Conclusions:Cross-border nursing teaching cooperation is an important promoter for the development of nursing education between Guangdong and Macao, but there are still deficiencies in cooperation, and it is necessary for the two places to strengthen the construction of a sharing platform for teaching resources to promote the development of nursing education in the Guangdong-Hong Kong-Macao Greater Bay Area.

Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective To make genetic diagnosis of Alagille syndrome (ALGS) patients using target gene sequence capture and next generation sequencing technology.Method Target gene sequence capture and next generation sequencing were used to detect ALGS gene of 4 patients.They were hospitalized at the Affiliated Hospital,Capital Institute of Pediatrics between January 2014 and December 2015,referred to clinical diagnosis of ALGS typical and atypical respectively in 2 cases.Blood samples were collected from patients and their parents and genomic DNA was extracted from lymphocytes.Target gene sequence capture and next generation sequencing was detected.Sanger sequencing was used to confirm the results of the patients and their parents.Result Cholestasis,heart defects,inverted triangular face and butterfly vertebrae were presented as main clinical features in 4 male patients.The first hospital visiting ages ranged from 3 months and 14 days to 3 years and 1 month.The age of onset ranged from 3 days to 42 days (median 23 days).According to the clinical diagnostic criteria of ALGS,patient 1 and patient 2 were considered as typical ALGS.The other 2 patients were considered as atypical ALGS.Four Jagged 1 (JAG1) pathogenic mutations were detected.Three different missense mutations were detected in patient 1 to patient 3 with ALGS(c.839C ＞T(p.W280X),c.703G ＞A(p.R235X),c.1720C ＞T(p.V574M)).The JAG1 mutation of patient 3 was first reported.Patient 4 had one novel insertion mutation (c.1779_1780insA(p.Ile594AsnfsTer23)).Parental analysis verified that the JAG1 missense mutation of 3 patients were de novo.The results of sanger sequencing was consistent with the results of the next generation sequencing.Conclusion Target gene sequence capture combined with next generation sequencing can detect two pathogenic genes in ALGS and test genes of other related diseases in infantile cholestatic diseases simultaneously and presents a high throughput,high efficiency and low cost.It may provide molecular diagnosis and treatment for clinicians with good clinical application prospects.

Objective:To assess the significance of counting the number of caudal vertebral ossification centers (OCN) below fetal terminal conus medullaris in the screening for closed spina bifida and tethered cord syndrome (TCS).Methods:The OCN was counted in 961 normal fetuses(normal group) between 17 and 41 gestational weeks and in 140 fetuses with closed spina bifida or tethered cord syndrome(abnormal group) from Jan.2013 to Dec.2020 in Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Women and Children′s Hospital, School of Medicine, Xiamen University and Maternity and Child Health Care of Guangxi Zhuang Autonomous Region. The OCN was counted in the dorsal mid-sagittal section of fetal caudal spine.The reliability and agreement test were evaluated by intraclass correlation coefficients in another 50 normal fetuses. The OCN was compared between two groups. ROC curve and the cut-off value were constructed and calculated.Results:In normal group, the N increased with the growing of gestational age.In the subgroup of 17-20 weeks, the OCN ranged from 5 to 7 in most fetuses. In the others subgroups, the OCN was equal to or greater than 6 in 99.9% cases and more than 6 in 97.1% cases. In abnormal group, OCN was less than 7 in 93.0% fetuses and less than 6 in 82.8% cases. There were statistical differences between the two groups except for the subgroup of 17-20 gestational weeks( P<0.05). With the cut-off value of 6.5, the specificity and sensitivity were 93.0% and 94.3% respectively for predicting the presence of closed spinal dysraphism or TCS. Conclusions:OCN is a simple way to evaluate the position of conus medullaris and to screen for the skin-covered spine dysraphism or TSC. OCN is more than 6 in most normal fetuses. Further evaluation of spine is required in fetuses with N less than or equal to 6.