Objective:To investigate reflectance confocal microscopic features of childhood scabies, and to analyze clinical significance of reflectance confocal microscopy (RCM) in the diagnosis and treatment of childhood scabies.Methods:A retrospective analysis was performed in 77 children with confirmed scabies at Department of Dermatology, Tianjin Children′s Hospital from April 2018 to October 2019. These patients were divided into negative treatment history group (61 cases) and positive treatment history group (16 cases) . All the patients underwent RCM and microscopic examination of skin scrapings.Results:Among the 77 children with scabies, positive microscopic examination results were found in 33 (42.86%) , including 28 in the negative treatment history group and 5 in the positive treatment history group. Burrows, sarcoptid mites or their eggs and fecal pellets were observed in 56 cases (72.73%) by RCM, including 49 (80.33%) in the negative treatment history group and 7 in the positive treatment history group. RCM showed a significantly increased overall positive rate compared with microscopy of skin scrapings ( χ2=14.08, P<0.05) . In the negative treatment history group, RCM also showed a significantly increased positive rate compared with microscopy of skin scrapings ( χ2=15.53, P < 0.05) . Conclusion:RCM is of high clinical value to the diagnosis and treatment of childhood scabies.

To promote acupuncture practice, the general situation of acupuncture in treating leucopenia between 1949-2004 were analyzed on the basis of Chinese Modern Acupuncture Database. From 1981, references of acupuncture treating leucopenia increased annually and steadily.In clinic, hydroacupuncture, needling, and moxibustion are widely used, and the selected acupoints are those of Bladder Meridian of Foot Taiyang and Governor Vessel. Acupuncture-moxibustion have a good therapeutic effects on leucopenia.

Objective To explore the cellular localization of chemokine (C-X-C motif) ligand 1 (CXCL1) in brain tissue and its expres-sion in brain tissue and blood in patients with severe traumatic brain injury (TBI), as well as its correlation with the injury severity. Methods From September, 2013 to October, 2015, 78 cases of TBI with craniotomy admitted to our hospital were involved as TBI group. A total of 78 peripheral blood samples and 19 brain tissue samples were studied. According to the scores of Glasgow Coma Scale (GCS) at admission, the TBI group was classified as severe TBI group (6~8, n=35) and particularly severe TBI group (3~5, n=43). Ten cases of control brain tissue were taken from patients with cerebral aneurysms or benign tumor and also undergoing craniotomy during the same time. Peripheral blood from ten healthy people were involved as the healthy control group. Immunofluorescent double staining was used to detect the cellular local-ization of CXCL1 in brain tissues, and ELISA was used to detect the expression of CXCL1 in brain tissue and blood. The relationship be-tween the level of CXCL1 in peripheral blood at different time and the score of Glasgow Outcome Scale (GOS) was analyzed with Spear-man correlation analysis. Results In normal brain tissue, CXCL1 mainly localized in astrocytes. For severe TBI, CXCL1 mainly expressed in neurons and astrocytes. The level of CXCL1 was higher in brain tissue in the particularly severe TBI group than in the severe TBI group (t=-12.58, P<0.05). In the severe TBI group, the level of CXCL1 in blood reached a peak before surgery, then gradually decreased, and was still higher than that in the healthy control group 14 days after surgery (P<0.05), however, no significant difference was found 30 days after surgery compared to the healthy control group (P>0.05). In the particularly severe TBI group, the level of CXCL1 in blood reached a peak before and one day after surgery, then gradually decreased, and was still higher than that in the healthy control group 30 days after surgery (P<0.05). The level of CXCL1 in blood was higher in the particularly severe TBI group than in the severe TBI group at all time points (P<0.05), and the level before surgery was negatively correlated with the score of GOS in the particularly severe TBI group (r=-0.351, P<0.05). Conclusion The CXCL1 protein of injury brain tissue was mainly colocalized in neurons and astrocytes in severe TBI patients, and the ex-pression was associated with injury severity and outcome.

A 16-year-old male presented with a 11-year history of progressively enlarging erythema and crusting on the right cheek.Physical examination revealed an irregularly shaped,sharply marginated,dark erythematous patch sized 6 cm x 10 cm and plaques with mild verrucous proliferation.There were strip-like scar at the margin of lesions and multiple ulcers measuring 0.5 to 1 cm in diameter with firm crusts.No small jellycolored nodules were observed.Direct microscopy of multiple scrapings under the crusts showed many light brown,septate,branching and irregular hyphae.Olivaceous-black woolly colonies grew at 25 C and 35 C on Sabouraud's dextrose agar and potato dextrose agar; flask-shaped conidiogenous cells with funnel-shaped collarettes and ellipsoidal conidia arranged in flower-like shape were observed microscopically.PAS staining showed numerous septate and branching hyphae,pseudohyphae and yeast-like cells.There was a 99.73％ similarity in the species-specific rDNA sequence between the isolate and phialophora verrucosa standard strain CDC-B2152.The patient was diagnosed with cutaneous phaeohyphomycosis caused by Phialophora verrucosa.The lesion subsided after treatment with amphotericin B and itraconazole,but recurred after drug withdrawal.Itraconazole and terbinafine were administered for the retreatment of this patient.

Objective To explore the application value of high frequency ultrasound and MRI in knee osteoarthritis.Methods 94 patients with knee pain as the main clinical manifestations in our hospital from January to December 2017 were retrospectively analyzed. All patients underwent high-frequency ultrasound, MRI, and arthroscopy. The results of arthroscopy were used as the gold standard, and the signs of high-frequency ultrasound and MRI examinations were summarized and compared with the results of arthroscopy. The sensitivity and specificity between high-frequency ultrasound and MRI in the diagnosis of knee osteoarthritis were compared. Results Consistency analysis showed that highfrequency ultrasound, MRI examination with arthroscopy consistent results were good (Kappa=0.63, 0.61, P<0.05). The sensitivity and specificity of high-frequency ultrasonography for knee osteoarthritis were 86.5％ and 85.0％, respectively, and the sensitivity and specificity of MRI was 89.2％ and 75.0％, respectively.The difference between high-frequency ultrasound and MRI was not statistically significant (P>0.05). Conclusion High-frequency ultrasound and MRI have good application value in the diagnosis of knee osteoarthritis, and the results are consistent with that of arthroscopy.Compared with MRI, high-frequency ultrasound diagnosis of knee osteoarthritis has no difference in sensitivity and specificity, and can be used for routine screening of knee osteoarthritis.

Objective To establish a predictive model and to find the preoperative predictors for the nature of lesion in the setting of chronic pancreatitis. Methods The 121 patients from 7 tertiary medical centers in Shanghai from July 1998 to April 2007 with focal mass lesions in the setting of chronic pancreatitis were selected as the study population. The final diagnosis had to be confirmed histologically by surgical specimens (n =97) or by follow-up (n = 24). A case control study was conducted; the patients were divided into pancreatic cancer group and chronic pancreatitis group. The age, sex, past history, initial clinical presentations, lab results and imaging exams were collected by reviewing the medical records of these patients. χ~2 test and t test was used for univariate analysis, then the factors with P≤0. 25 were selected for further multivariate analysis, and multivariate logistic regression model was used to estimate odds ratio and 95% CI. Results Of 121 , 21 patients had a final diagnosis of pancreatic cancer and other 90 patients had a final diagnosis of chronic pancreatitis. Abdominal tenderness, direct bilirubin, CA19-9 and CEA were independent predictors of cancer in patients with focal mass lesions. Their odds ratios (95% CI) were 5. 691 (1.468, 22.070) , 1.011 (1.001 , 1.021) , 1.003 (1.001, 1.005) , 101.9 (0.988, 1.051) , respectively. Their P values were 0. 012, 0. 030, 0.003 and 0. 23 , respectively. Conclusions The logistic regression model may accurately predict the nature of lesion in the setting of chronic pancreatitis and may have certain clinical implication.

Objective To study the effectsof rehabilitative training on neural function and the expression of glial fibrillary acidic protein (GFAP) and ionized calcium binding adaptor molecule-1 (Iba-1) in rats after traumatic brain injury.Methods A left hemisphere traumatic brain injury model was established in ninety Sprague-Dawley rats.They were then randomly divided into a rehabilitation training group,an immobilization group and a free-running group,with 30 rats in each group.Another thirty rats received sham injury as the shamoperated group.Beginning 4 days post-operation the rats of the rehabilitation training group were given balancing,rotating and walking exercises three times daily,15 min/time,6 d/week.The immobilization group was fixed in mesh cages.The rats of the free-running and sham-operated groups were reared in normal cages without any special training exercise.The rats of all 4 groups were given neural and motor function tests to assess the functional outcome.Immunofluorescence staining was used to evaluate the expressions of GFAP (the marker of astrocytes) and Iba-1 (the marker of microglia) in the cortex close to the iujured region at 3 days,1 week,2 weeks,3 weeks and 4 weeks after injury.Results The average neural and motor function test scores in the rehabilitation training group were significantly better than those in the immobilization and free-running groups at the 2nd week and thereafter.The average scores in the free-running group were significantly better than those in the immobilization group at the 4th week after injury.The immunofluorescence staining showed that the expression of GFAP was lowest in the rehabilitation group at the 2nd week and thereafter.Iba-1 expression was significantly lower only at the 3rd week and beyond.Conclusion Rehabilitative training can improve nerve function recovery in rats after traumatic brain injury,and the functional enhancement may be partially attributed to the downregulation of activated astrocytes and microglia.

Objective To analyze the changes and characteristics of respiratory tract bacteria in Hebei 3A Hospital, and to provide new rationale for clinical diagnosis and treatment.Methods A single-center retrospective analysis was conducted. 7497 patients with respiratory tract infection admitted to Hebei Chest Hospital from January 2013 to December 2016 were enrolled. Deep sputum was collected, and the bacterial cultures and susceptibility analysis was conducted in sputum and upper respiratory secretions were collected by fiberoptic bronchoscopy.Results A total of 7497 patients with respiratory tract infection were enrolled in the study, and 11909 strains of 13 kinds of dominant pathogens were isolated. The dominant pathogens for respiratory tract infection wereMonilia albican (23.7%),Klebsiella pneumoniae (12.9%),Pseudomonas aeruginosa (11.6%),Escherichia coli (9.5%),Candida glabrata (9.1%),Acinetobacter baumanii (7.9%),Aspergillus (6.7%),Stenotrophomonas maltophilia (4.5%), coagulase negativeStaphylococcus(3.7%) and some species ofPseudomonas (3.7%),Staphylococcus aureus (3.0%),Aerobacter cloacae (1.9%), andCandida tropicalis (1.8%). A total of 6198 strains of 7 kinds of Gram negative (G-) bacilli infection dominant pathogens accounts for 52.0% of all infections,Klebsiella pneumonia (24.8%),Pseudomonas aeruginosa (22.3%),Escherichia coli (18.2%) andAcinetobacter baumanii (15.3%) were the main pathogens, and increased year by year. Susceptibility analysis showed that the preferred antibiotics for G- bacteria were carbapenems, followed by risperidone, sulbactam, cefepime, amikacin, and the third generation of cephalosporins. A total of 798 strains of 2 kinds of Gram positive (G+) bacilli infection dominant pathogens accounted for 6.7% of all infections, were coagulase negativeStaphylococcus(54.8%) and Staphylococcus aureus (45.2%), each had changed little by year. Susceptibility analysis showed that G+ bacteria were sensitive to glycopeptides, followed by cefoxitin, cotrimoxazole, the tetracyclines, quinolones, azithromycin, erythromycin and so on. The advantages of 4 species of fungi were 4913 strains, accounted for all of the 41.3% strains, with 57.5% of Candida albicans, and the trend was increasing year by year. Susceptibility analysis results showed that the antifungal susceptibility of dominant fungi were higher.Conclusions G- bacilli is still the main source of infection, and showed an upward trend year by year. Fungal infection rate cannot be ignored, and we must pay attention to fungal infection incentives. We should strengthen the rational use of antibiotics.

Objective To explore the correlations of vascular endothelial growth factor (VEGF) and paraoxonase 1 (PON1) gene polymorphism with diabetic retinopathy. Methods A total of 168 patients with diabetes mellitus(DM) in the Second People's Hospital of Xining City were selected from January 2013 to December 2015, and were divided into the DM group (48 cases), proliferative diabetic retinopathy (PDR) group (66 cases) and non-proliferative diabetic retinopathy (NPDR) group (54 cases). A total of 104 healthy subjects were selected as the control group (NC group). The VEGF and PON1 gene polymorphisms were detected by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and levels of superoxide dismutase (SOD) and malondialdehyde (MDA) of all subjects were detected by using UV spectrophotometer. Results Compared with the NC group, the systolic blood pressures and glycated hemoglobin levels in the DM group, NPDR group and PDR group were significantly increased,there were statistically significant differences (P<0.05). No statistically significant difference was found in diastolic blood pressure and levels of cholesterol,triglyceride, high density lipoprotein among these groups (P>0.05). There was statistically significant difference in systolic blood pressure between PDR group and NPDR group (P< 0. 05), while no statistically significant difference was found in diastolic blood pressure and levels of cholesterol, triglyceride,high density lipoprotein and glycated hemoglobin between the two groups (P>0.05). The incidence rate of DR in the patients with CC,CT and TT genotype was 71.05%, 56.27 % and 38.64 %, respectively. The incidence rate of DR in the patients with CCgenotype was significantly higher than that in the patients with CT or TT genotype (P< 0.05). No statistically significant difference was found in SOD and MDA levels of healthy subjects with different PON1 192 genotypes (P>0.05). The SOD level of DR patients with QQ genotype was lower than that of patients with QR or RR genotype,and the MDA level of DR patients with QQ genotype was higher than that of patients with QR or RR genotype,the difference was statistically significant (P<0.05). Conclusion The expression of VEGF and PON1 genes could affect the development and progression of DR. PON1 gene might control the progression of DR by affecting the expression of oxidative kinase in DR patients.

A 87-day-old female patient presented with patchy erythema on the right body and ipsilateral limb deformity after birth, and visited the hospital in January 2012. Skin examination showed obvious red plaques on the right lower abdomen, right buttock, right perineum, right leg and right foot, with yellow scales on the surface and clear boundaries, and there was no obvious exudation or odor; pale yellow verrucous hyperplasia was observed on the right lower jaw, right neck, right axilla, and on the back of the first to fourth fingers of the right hand; only 1 interphalangeal joint and no nail plate was observed on the second, third and fourth toes of the right foot. The X-ray of the right foot showed deformity and bone defects. The patient was diagnosed with CHILD syndrome, and treated with intermittent oral acitretin capsules, and topical vaseline ointment, tacalcitol ointment and weak-potency glucocorticoid ointment for more than 6 years. The skin lesions regressed during treatment, but occurred repeatedly after withdrawal. Thereafter, the patient was switched to simvastatin ointment for 2 years. The skin lesions increased proportionally with the increase of age, and the affected limb grew a little more rapidly than the healthy limb. By January 2020, the skin lesions on the right lower jaw, right neck, and the first to fourth fingers of the right hand had subsided, but new band-like hypertrophic verrucous plaques occurred on the fifth finger of the right hand; the skin lesions on the right leg were slightly improved, and no involvement of other systems was observed.