Objective To investigate the etiology, pathogenesis and treatment of erythromelalgia.MethodsRetrospective analysis of clinical features and respective treatment options of 8 cases of erythromelalgia patients in Ruijin Hospital.ResultsThe major clinical characteristics of EM cases included burning, sharp, tingling and/or stinging pain in toes, soles and/or dorsum of feet, increased temperature, erythema and swelling.One case reported burning pain in both fingers and feet.These symptoms were more severe during the night, walking, standing, exercising and when the individual was near a heater.Patients could relieve their pains by rest, using cold packs, walking on cold floors or immersing feet in cold water.Combined treatment, topical therapies and management of underlying disorders were necessary for erythromelalgia.ConclusionErythromelalgia is a rare cutaneous vascular disease with characteristics of recurrent redness, burning pain, and warmth of the extremities which could be induced by heat and exercise.Combined treatment, topical therapies and management of underlying disorders were necessary for erythromelalgia.

Background Insulin can promote the occurrence of myopia.It has been proven that insulin receptor exists in human retinal pigment epithelial (RPE) cells and can promote RPE cells to secrete transforming growth factor-β2(TGF-β2),which is one of the most important myopic signal molecules.Objective This study was to investigate if PI3K/Akt mediates the promotive effects of insulin on proliferation of human RPE cells and secretion of TGF-β2.Methods Human RPE cell line,ARPE-19 cells,were regularly cultured using DMEM containing 10％ fetal bovine serum,and 10× 103 U/ml insulin,LY294002,10× 103 U/ml insulin+LY294002,Wortmanin,10× 103 U/ml insulin+Wortmanin were added into the medium respectively for 48 hours,and the regularly cultured cells served as blank controls.The proliferation value (absorbance,A) of the cells was evaluated by MTS,and the TGF-β2 level in the cell supernatant was detected by ELISA.The relative expression of TGF-β2 mRNA in the cells was assayed using reverse transcription PCR (RT-PCT) 1 hour and 2 hours after the addition of reagents.Results MTS showed that the proliferation value of the cells in the insulin+LY294002 group was 0.75±0.03,which was significantly lower than that in the insulin group (0.98± 0.04).No significant difference was seen in the proliferative value between the insulin+Wortmanin group and the insulin group (0.97±0.07 versus 0.98± 0.04,P＞0.05).ELISA revealed that the content of TGF-β2 in the the cell supernatant was (11.59±2.85) pg/ml and (49.16± 10.94) pg/ml in the insulin + LY294002 group and the insulin + Wortmanin group,respectively,showing a significant decline in comparison with (548.50±35.18) pg/ml in the insulin group (both at P＜0.05).A significant difference was found in the TGF-β2 content between the insulin+LY294002 group and the insulin+Wortmanin group (t =8.131,P =0.000).The RT-PCR showed that 1 hour and 2 hours after addition of the reagents,the expression levels of TGF-β2 mRNA in the cells were lower in both insulin+LY294002 group and insulin+Wortmanin group than those in the insulin group (P＜0.05).The decline range of TGF-β2 mRNA expression level was more significant in the insulin+LY294002 group than that in the insulin+Wortmanin group at 1 hour (t=4.176,P=0.014) rather than at 2 hours (t=0.756,P=0.492).Conclusions Insulin can promote the proliferation of human RPE cells and secretion of TGF-β2 through PI3K/Akt pathway.This may be one of the mechanisms of insulin causes myopia.

Objective To evaluate the clinical effect of the facial soft tissue defect treated with platelet-rich plasma (PRP) mixed with purified fat.Methods 35 patients with facial soft-tissue defects were treated by PRP mixed with centrifuged fat tissue.Using Fuzzy judgment method the clinical effectiveness of therapeutic outcomes were evaluated on fullness,injection of frequency and satisfaction during 3 to 6 months of follow-up.Results The therapeutic outcomes showed that the reconstructed face became a relative symmetrical and natural appearance with not evidently fat resorption and stable after operation.Both patients and surgeons were satisfied with the results.The score of effectiveness was highest in Fuzzy judgment.Conclusions The efficacy of PRP is significant in enhancing fat graft,reducing fat necrosis and resorption.The fat tissue mixed with PRP is a reliable reconstruction option for the facial soft tissue defect.

Objective To evaluate left ventricular(LV) twist and untwist using velocity vector imaging(VVI) in patients with apical hypertrophic cardiomyopathy (ApHCM). Methods Twenty-three patients diagnosed with ApHCM were consecutively enrolled and compared with normal controls. After a standard echocardiographic examination, parasternal basal and apical short-axis planes were scanned to quantify LV rotations,twist and LV untwist using VVI. Results Compared with the normal controls, the rotation and rotaional velocity of apical subendocardial myocardium were markedly decreased in ApHCM patients during the period of systole ( P＜0.05) ,but the decreases in basal planes were not significant. As a consequence,LV twist was significantly lower in ApHCM patients (P＜ 0.05). Compared to normal controls,the velocity of LV untwisting was also significantly decreased in ApHCM patients ( P＜0.05).Conclusions The twist and untwist of LV subendocardial myocardium were decreased in ApHCM patients.VVI is a useful method to assess the characteristics of LV twist and untwist in ApHCM patients.

In this paper, taking Shijiazhuang city, Hebei province as an example, a random sampling of 30 streets in three districts were investigated the use of tactile ground surface indicator. The survey showed that 69% of the existing tactile ground surface indicator were used normally, while 8%were laid unreasonable, 11%were occupied and 12%were damaged. Suggestions were set from three aspects:sci-entific and reasonable laying, strengthening supervision and maintenance, and strengthening publicity and education, so as to improve the current situation of tactile ground surface indicator, improve the utilization rate, promote the participation of visually impaired persons in so-cial life and improve their quality of life.

To introduce the biological properties and functions of individual blood-brain barrier components,and summarize the most widely used in vitro blood-brain barrier models,compare their strengths and weaknesses,and provide suggestions on model selection in blood-brain barrier research and new-drug research and development.

Objective:To investigate the molecular epidemiological characteristics of norovirus (NoV) in hospitalized children with sporadic acute gastroenteritis in Tianjin in 2019.Methods:Fecal specimens and clinical data were collected from 3 116 hospitalized children with sporadic acute gastroenteritis possibly caused by viral infection in Tianjin Children′ Hospital between January and December, 2019. Real-time quantitative PCR was used to detect NoV. Partial sequences of RNA-dependent RNA polymerase (RdRp) and capsid genes of NoV were amplified by RT-PCR. Sequence alignment and phylogenetic analysis were performed for further analysis.Results:Among the 3 116 specimens, 809 (26.0%) were positive for NoV. There were significant differences in NoV detection rate between different age groups ( P=0.000), and the highest NoV detection rate (31.6%) was observed in the age group of 7-12 months. Moreover, the detection rate of NoV varied with seasons ( P=0.000), and the NoV detection rate was highest in winter (39.0%). Based on the sequence analysis of RdRp and capsid genes, 286 identified NoV strains belonged to six genotypes, which were GⅡ.P12-GⅡ.3, GⅡ.P16-GⅡ.2, GⅡ.P17-GⅡ.17, GⅡ.Pe-GⅡ.2, GⅡ.Pe-GⅡ.3 and GⅡ.Pe-GⅡ.4. The predominant genotype was GⅡ.Pe-GⅡ.4 Sydney 2012 (61.2%), followed by GⅡ.P12-GⅡ.3 (33.6%, 96/286), GⅡ.Pe-GⅡ.3 (2.4%, 7/286), GⅡ.P16-GⅡ.2 (2.1%, 6/286), GⅡ.Pe-GⅡ.2 (0.3%, 1/286) and GⅡ.P17-GⅡ.17 (0.3%, 1/286). Patients carrying the NoV of GⅡ.Pe-GⅡ.4 Sydney 2012 genotype were likely to suffer from vomiting than those positive for NoV of GⅡ.P12-GⅡ.3 genotype. Conclusions:NoV was an important pathogen causing acute gastroenteritis in children. GⅡ.Pe-GⅡ.4 Sydney 2012 and GⅡ.P12-GⅡ.3 were the major genotypes of NoV in hospitalized children with sporadic acute gastroenteritis in Tianjin in 2019.

Objective:To evaluate the prevalence of human rhinovirus (HRV) infection in hospitalized children in Tianjin and investigate the clinical impact of HRV infections.Methods:From July 2017 to December 2019, 2 945 nasopharyngeal secretion specimens were screened for HRV using polymerase chain reaction (PCR). VP4/VP2 sequences of HRV were further characterized. The clinical characteristics of the HRV infection were analyzed. The detection results of HRV for different groups and different months were compared using SPSS 19.0.Results:HRV-positive specimens accounted for 8.15% (240/2 945), of which 74.78% (86/115) were diagnosed with pneumonia, 40.83%(98/240) had co-infections with other common pathogens. HRV infections could be detected throughout the year with peaks in spring (11.00%, 66/660) and autumn (9.29%, 81/872). The positive rate of HRV was 4.14%(29/700) in winter. By VP4/VP2 sequence analysis, HRV-A was the most frequently detected strain(50.00%, 78/156), followed by HRV-C (41.67%, 65/156).46.15% (30/65) of HRV-C infections occurred in October and November. There were several different HRV-A types and HRV-C types. The most commonly detected HRV-A types were A12(11.54%, 9/78), A49(6.41%, 5/78), A22, A101, and A66(5.13%, 4/78), etc. The most common HRV-C types were C2(20.00%, 13/65), C22(9.23%, 6/65), C26, C43, C54 and C53(4.62%,3/65). Patients with HRV-A infections are more likely to show fever symptoms than HRV-C (χ2=5.411, P<0.05). No significant difference in other symptoms were found between the two types. Conclusions:HRV was a commonly detected virus among infants and had a clear seasonal distribution. It′s also possible for the HRV patients to have co-infections with other pathogens.HRV showed high genetic diversity.

Objective To evaluate the effect of limb remote ischaemic preconditioning on pul-monary function in patients undergoing cardiac valve replacement surgery with cardiopulmonary by-pass.Methods Seventy patients,32 males and 38 females,aged 18-70 years,weighing 45-90 kg, ASA physical status Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement surgery with cardiopul-monary bypass,were divided into 2 groups using a random number table,35 in each group.Patients in group R received three cycles of right upper-limb 5 min ischemia (blood-pressure cuff inflation to≥ 200 mm Hg)and 5 min reperfusion (blood-pressure cuff deflation to 0 mm Hg)at 10 min after in-tubation.In group C,the cuff was placed around the arm but not inflated.At 10 min after intubation (T0),at 1 h after aortic declamping (T1)and at 6 h (T2),12 h (T3),24 h (T4)after surgery,arte-rial blood was sampled to conduct gas analysis,PaO2/FiO2ratio and alveolar-arterial oxygen gradient (A-aDO2)were calculated,and the dynamic lung compliance (Cd)and static lung compliance (Cs) were also recorded.The occurrence of pulmonary adverse events was recorded until discharge. Results Compared with T0,PaO2/FiO2was decreased in the two groups at T1-T4,A-aDO2was de-creased at T2-T4,Cs and Cd were increased in group C at T3,and were increased in group R at T2, T3(P<0.05).Compared with group C,the Cs and Cd at T2,T3were increased in group R.There were no significant differences between the two groups in the PaO2/FiO2,A-aDO2at T0-T4.The oc-currence of the pulmonary adverse events was decreased significantly in group R than in group C (P<0.05).The occurrence of pulmonary adverse events was declined significantly in group R than in group C (P<0.05).Conclusion Limb remote ischemic preconditioning can improve the lung compli-ance and reduce the occurrence of the pulmonary adverse events in patients undergoing cardiac valve replacement surgery.

Objective:To investigate the prevalence and clinical characteristics of Mycoplasma pneumoniae( Mp) genotypes and subtypes in children in Tianjin. Methods:Children with pneumonia admitted to Tianjin Children′s Hospital from December 2017 to December 2019 were selected as the research objects. Bronchoalveolar lavage fluid was collected by fiberoptic bronchoscopy. The positive samples were detected by real-time fluorescent quantitative PCR and Mp culture. PCR-restriction fragment length polymorphism(RFLP) and multiple variable number tandem repeats were used for genotyping. Detailed clinical and laboratory data were collected for all cases. Results:The results of RFLP showed that there were 138 cases (78.9%) of typeⅠand 37 cases (21.1%) of type Ⅱ; 37 cases of type M3-5-6-2, including six subtypes B, G, M, S, V and Y; 138 cases of M4-5-7-2 were detected, including seven subtypes of E, J, P, U, X, Z and a. In M3-5-6-2 type, there were 1 case of P1-Ⅰtype (2.7%), 36 cases of P1-Ⅱtype (97.3%), 137 cases of P1-Ⅰ type (99.2%) and 1 case of P1-Ⅱ type (0.7%) in M4-5-7-2 type. There was no significant difference in genotype distribution among different age groups. There were statistical differences in the distribution of four seasons among the 13 genotypes of B, G, M, S, V, Y and E, J, P, U, X, Z, a. All Mp infected children had symptoms of fever and cough. The hospitalization time, fever duration, high fever (>39℃), cough duration, skin changes, digestive system symptoms and liver function injury rate of P1-Ⅰ/M4-5-7-2 pneumonia children were higher than those of P1-Ⅱ/M3-5-6-2 pneumonia children, but the difference was not statistically significant. The WBC count of P1-Ⅱ/M3-5-6-2 types was higher than that of typeⅠand M4-5-7-2; the LDH of P1-Ⅰ/M4-5-7-2 was higher than that of Ⅱ and M3-5-6-2, with statistical difference. There was no significant difference in the incidence of inflammatory consolidation, atelectasis, pleural thickening and pleural effusion among different genotypes. Conclusions:Mp infection in children with pneumonia in Tianjin is mainly P1-Ⅰ/ M4-5-7-2, and P1-Ⅱ is on the rise. P1-Ⅰ and M4-5-7-2 were associated with fever and severe symptoms.