This paper reports a cases of cervical root chylous cyst and reviews related literatures.This disease is rare in the root of neck. Clinical and imaging diagnosis of the disease is very important for treatment.Surgical excision is the main treatment,conservative treatment can be used as a aductive therapy.

Objective:To evaluate the accuracy of serum concentration of procalcitonin (PCT) in differential diagnosis of the etiology of bloodstream infections (BSI).Methods:Patients hospitalized in ICU of China-Japan Friendship Hospital from January 2015 to June 2020 with BSI and with PCT test simultaneously when blood drawing for blood culture were enrolled. Sequential Organ Failure Assessment (SOFA) were calculated based on parameters on the day of blood culture. Difference of various indicators among different pathogen infections were compared. Receiver Operating Characteristic (ROC) Curve was used to analyze the value of PCT in differential diagnosis of BSI by different pathogens.Results:Among 1 456 patients with BSI,1 261 (86.6%) patients with monobacterial infection, 80 (5.5%) patients with candidiasis and 115 (7.9%) patients with mixed infection. The 28-day mortality was 24.5% (356/1 456) and the 60-day mortality was 30.6% (446/1456). Mortality of both 28-day and 60-day in the mixed group was significantly higher than that in the bacteriacemia group and candidemia group. PCT levels was significantly higher in patients with bacteremia caused by gram-negative bacteria (GNB) than that in gram-positive bacteria (GPB) infected bacteremia and candidemia {3.4 μg/L[95% confidence interval (95% CI) 0.7-17.0 μg/L] vs 1.3 μg/L (95% CI 0.4-7.3 μg/L); 3.4μg/L (95% CI was 0.7-17.0 μg/L) vs 1.1 μg/L (95% CI was 0.4-3.4 μg/L); P<0.01} . ROC curve analysis showed that: ① the optimal cut-off value of PCT in differential diagnosis of monobacterial bacteremia and candidemia was 7.25 μg/L, with specificity of 90.0% and the area under the ROC curve (AUROC) was 0.612 (95% CI 0.533-0.691). When PCT value was greater than 0.51 μg/L, the sensitivity of diagnostic of bacteremia could reach 73.3%. ② the optimal cut-off value of PCT in differential diagnosis of bacteremia caused by GNB infection and candidemia was 7.32 μg/L, with specificity of 90.0% and AUROC was 0.695 (95% CI 0.614-0.776). When PCT value was greater than 0.51 μg/L, the sensitivity of diagnostic of bacteremia caused by GNB infection was 84.9%.③ the optimal cut-off value of PCT in differential diagnosis of bacteremia caused by GNB and GPB infection was 0.52 μg/L, with sensitivity of 84.9% and AUROC was 0.713 (95% CI 0.672-0.755). When PCT value was greater than 7.36 μg/L, the specificity of diagnostic of bacteremia caused by GNB infection could reach 80.1%. Conclusions:PCT can provide additional information about the possible etiology of patients with BSI, especially as high levels often indicate the possibility of GNB bacteremia.

Objective To identify-and study a monoclonal antibody (McAb) against pancreatic cancer stem cell in vitro,as well as to provide candidate antibody-drug for cancer stem cell-targeted therapy of pancreatic cancer.Methods Cell culture in serum-free medium and PKH26 staining were used to determine the existence of cancer stem cell in PANC-1 cell line.Flow cytometry was used to detect the expression of CD24 and CD44 in PANC-1 cells and sphere cells,Immunofluorescence was used to detect the expression of CD24 and antigen recognized by 15D2.The effects of 15D2 on self-renewal,proliferation and chemosensitivity to gemcitabine of PANC-1 parent or sphere cells were identified by serum-free suspension culture and CCK-8 assay,Immunohistochemistry was applied to detect the level of antigen recognized by 15D2 in cancer and adjacent tissues.Results PANC-1 cells could survive,proliferate and form sphere cells in serum-free medium.The sphere-forming rate was (2.5±0.5) ％.The percentage of CD44+ CD24+ cells population in sphere cells increased by 11.4 folds compared to PANC-1 cells,in which single nearly 97 ％ CD24+ cells was CD44+ CD24+ cells.Therefore,CD24+ was selected for cancer stem cell marker in PANC-1 in this study.The two-color immunofluorescence assay showed that 15D2 could recognize cells which was also stained by CD24.In vitro functional experiments demonstrated that 15D2 significantly suppressed the sphere formation of PANC-1 cells,with the inhibitory rate being 30.4 ％.Meanwhile,the combination of 15D2 and gemcitabine can significantly attenuate the growth of PANC-1 sphere cells.The IC50 was 0.10 μmol/L in 15D2+gemeitabine group,and 0.39 μmol/L in mlgM+gemcitabine group,Immunohistochemical results showed that the antigen recognized by 15D2 was greatly expressed in about 76.9 ％ (11/13) human pancreatic cancer tissues and hardly detected in adjacent normal tissues (10.0 ％,1/10).Conclusion McAb 15D2 can inhibit self-renewal and drug-resistance of pancreatic cancer stem cell in PANC-1 cell line,and it might become a candidate drug for target pancreatic cancer stem cell treatment.

Objective To evaluate the efficacy of systemic glucocorticoids and intravenous immunoglobulin (IVIG)for the treatment of toxic epidermal necrolysis (TEN). Methods Clinical data on TEN inpatients treated with systemic glucocorticoids alone or in combination with IVIG were collected from the Department of Dermatology, First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2012. Therapeutic outcomes were evaluated in these patients. Statistical analysis was carried out by using a multiple linear regression analysis, binary logistic regression analysis and Cox regression analysis with the SPSS 16.0 software. Results A total of 48 inpatients with TEN were included in this study. Multiple linear regression analysis showed that the maximum daily dose of glucocorticoids for disease control was decreased gradually over years (β=-0.461, P=0.004). However, binary logistic regression analysis revealed no obvious changes in the frequency of administration of IVIG over years. Cox regression analysis showed that both hospitalization duration (RR=0.351, 95.0%CI:0.150-0.825)and the time required for the control of skin lesions (RR=0.492, 95.0%CI:0.245-0.986)decreased with the increase in the frequency of IVIG administration. In addition, with the increase in the maximum daily dose of glucocorticoids for disease control, the time required for the control of skin lesions was also shortened (RR=0.997, 95.0%CI:0.994 -1.000), while no obvious changes were observed in hospitalization duration. Conclusions IVIG shows superiority in controlling lesions, reducing complications and improving the prognosis of TEN. Compared with systemic glucocorticoids, IVIG shows better therapeutic efficacy and less adverse effects, and may be preferentially selected.

Objective To discuss risk factors,clinical characteristics and associated prognostic factors of acute aortic dissection with different Stanford classification.Methods Retrospective analyses were conducted on clinical data of 162 patients with acute aortic dissection in China-Japan Friendship Hospital.The data was analysed according to Stanford type,risk factors,clinical manifestation,auxiliary examination.Prognostic factors of acute aortic dissection were analysed by single factor and binary logistic regression analysis.Result Of all the acute aortic dissection patients,the mean age was (53.9 ± 13.5) years (foreigners' mean age was 61.0 years),87.0％ were less than 65.0 years old,males were younger than females,77.2％ presented hypertension.Application of Latex (＜0.5 mg/L) and ELISA (0 ～400 ng/mL) methods to detect D-dimer,the sensitivities were 90.9％ and 94.7％ respectively,and the general sensitivity was 93.2％;91.5％ patients were abnormal when detected by ultrasound (echocardiography),of which the sensitivity of A type was 100％,so it can be the first choice of hemodynamic instability patients,at the same time can be used for differential diagnose between acute myocardial infarction and acute myocardial infarction caused by AAD.As to prognosis,the mortality of type A was higher than type B (30.7％ vs.3.4％,P ＜0.05).When treated with surgery (stent),the mortality was declined obviously (8.5％ vs.23.8％,P ＜ 0.05) while hospitalization.Confirmed time over 4 hours,shock caused by hypotension and (or) cardiac tamponade were independent risk factors for the prognosis of AAD.Conclusion The AAD patients' age of onset in our country is younger than foreigner'.High sensitivity of ultrasound can be a complementary diagnostic tool for critical AAD patients.Try to shorten the time of diagnosis and early operation can lower the mortality of AAD patients,type A patients might benefit from surgery.

We report a case of a 35-year-old right-handed male patient with drug-resistant mesial temporal lobe epilepsy who developed ipsilateral occipital hematoma after right temporal anterior lobectomy and amygdalohippocampectomy. Patient did not report taking any drugs with anticoagulant effect, such as aspirin or valproate. There was no past history of hypertension and the pre-operation tests were normal. Pre-operative brain magnetic resonance imaging revealed no abnormality in the right occipital lobe. Overdraining of cerebrospinal fluid may have triggered this remote cerebellar hemorrhage.

Neonatal stroke leads to cognitive deficits that may include hemispatial neglect. Hemispatial neglect is a syndrome after stroke that patients fail to be aware of stimuli on the side of space and body opposite a brain lesion. We report here a 7-year-old girl who suffered neonatal right brain stroke and underwent right hemispherectomy due to refractory epilepsy. Post-surgical observation of the child’s behavior and tests did not show any signs of hemispatial neglect. We concluded the spatial attention function of the child with neonatal stroke might be transferred to the contralateral side during early childhood.

Objective To investigate the relationship between plasma concentration of B type natri uretic peptide (BNP) and the severity and prognosis of patients with acute spontaneous intracerebral hemorrhage (ICH).Methods Review of 86 cases of patients with spontaneous intracerebral hemorrhage analysis in our hospital Department of Emergency/Surgical Intensive Care Unit (ED/S1CU) were admitted within 6 hours of admission to collect blood samples,head CT,biochemical index,Glasgow Coma Scale (GCS) score and other clinical data,and detected within 6 hours after admission,the admission of third days and 7 days of plasma BNP concentration.The blood volume of cerebral hemorrhage was computed.The GCS was used to evaluate nerve function after admission.The survival of 28 days was observed.Results The concentration of BNP detected at 3 time points increased with the increase of the amount of bleeding in patients with acute cerebral hemorrhage and increased with the decrease of GCS score at admission (P ＜0.01).The BNP concentration was mild higher in the small amount of bleeding group than that of the control group (P =0.094),while that of the other two groups were significantly higher (P ＜ 0.01).Concentration of BNP detected within 6 hours of admission was positively correlated with cerebral hemorrhage (r =0.551).The a mount of BNP in the 6 hours after admission of the GCS ＞ 8 group was significantly higher than those of the control group (P ＜ 0.05),and the GCS ≤ 8 group was significantly higher than that of the control group and GCS ＞ 8 group (P ＜ 0.01).The BNP concentration was negatively correlated with GCS score at admission (r =-0.532).The 28-day mortality was predicted by BNP ＞ 168 pg/ml for 6 hours,AUC was 0.814,the sensitivity was 75.0％ and the specificity was 81.4％.Conclusions The concentration of BNP in patients with acute spontaneous intracerebral hemorrhage increased with the increase amount of bleeding and the decrease of GCS score at admission.The concentration of BNP in the 6 hours after admission was correlated with the severity and the prognosis of the disease,which can be used as the important reference indicators for evaluating severity and prognostic prediction.

Objective To investigate the occurrence of hepatocyte autophagy and the expression of autophagy associated proteins at different time points in sepsis mice model established by cecal ligation and puncture.Methods Fifty male ICR mice aged 6-8 weeks were randomly (random number) divided into 5 groups:CLP 3 h group,CLP 6 h group,CLP 12 h group,CLP 24 h group and control group.The samples were collected at the corresponding time points after operation.Liver function was tested to obtain alanine aminotransferase (ALT) and aspartate aminotransferase (AST).The expression of TNF-α and IL-6 was detected by ELISA,the inflammation of liver tissue by HE staining while the ultrastructure of autophagosome and autolysosome in liver tissue was observed by electron microscopy.Meanwhile,the expression of LC3 and P62 was detected by Western blot.and the location and quantity of autophagosome was observed by Immunofluorescence.SPSS 21.0 was used for statistical analysis.Two independent sample t tests were performed to compare the two groups,and one-way ANOVA was used for comparison between multiple groups.Results ALT and AST increased significantly after CLP,and peaked at 12 h,respectively (137.8 ±11.94) U/L and (475.3 ±57.34) U/L.The expression of IL-6 peaked at 6 h (2589.63 ±27.96) pg/mL,and TNF-α peaked at 3 h (320.21±8.9) pg/mL.HE staining showed activation of Kupffer cells and infiltration of single granulocyte.Electron microscope showed the formation of autophagosome and autolysosome.Compared with the control group,the ratio of LC3 Ⅱ/Ⅰ increased first and then decreased,peaked at 6 h (t=13.35,P＜0.05).The content of P62 protein declined first and then went up,reaching the lowest level at 6 h (t=66.1 l,P＜0.05),contrary to the trend of LC3 Ⅱ/Ⅰ.Immunofluorescence results illustrated that the fluorescence intensity of LC3 reached its high point at 6 h (t=12.52,P＜0.05).Conclusions Autophagy occurred in the liver of sepsis mice model established by cecal ligation and puncture.The formation of autophagosome first increased and then decreased,reaching its peak at 6 h.

Objective To study the influence of obesity on outcome of rehabilitation for the hemiplegic post stroke. Methods 118 hospitalized stroke patients were divided into the normal weight, overweight and obesity groups according to the Body Mass Index. All the patients received rehabilitation for 12 weeks. They were assessed with National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI) before and after rehabilitation. Results The scores of NIHSS, FMA, BBS and MBI improved significantly after rehabilitation in all the groups (P<0.001), and improved the lest in the obesity group in the scores of NIHSS, BBS and MBI (P<0.05). There was no significant difference in FMA score among groups (P>0.05). Conclusion Obesity influences the outcome of rehabilitation, results in poor functioning.