Objective To evaluate the value of serum granulocyte colony-stimulating factor(G-CSF),interlukin-8(IL-8)and white blood cell count(WBC)in detecting acute surgical bacterial infections.Methods A total of 36 patients with infections and 32 with traumatic diseases admitted in Beijing Tongren Hospital without use of antibiotics before admission were recruited,as well as 30 normal healthy controls.Three milliliters of peripheral blood were collected from each of them.Serum G-CSF and IL-8 were measured by enzyme-linked immunosorbent assay(ELISA).Results Of all the 68 patients,serum G-CSF Was(82±71)ng/L in average in those with infections,significantly higher than that in those with trauma(15±7)ng/L(P＜0.01)and controls(7±4)ng/L(P＜0.01).Conclusions Serum G-CSF may be used as a sensitive indicator for acute surgical bacterial infections.

Objective To study the efficacy of disodium pamidronate in the treatment of patients with primary hyperparathyroidism (PHPT) complicated by hypercalcemic crisis.Methods A total of 9 patients (12 cases) admitted into our hospital were diagnosed as PHPT complicated by hypercalcemic crisis.Of them,4 patients had parathyroid carcinoma,3 patients had parathyroid adenoma,2 patients had parathyroid hyperplasia.The intravenous disodium pamidronate was given for 12 times in all 9 patients.Serum calcium were monitored before and after treatment.Results Before the treatment,the serum calcium levels was 3.75 (3.66,3.99) mmol/L.On the second and third day after the treatment with disodium pamidronate,the serum calcium levels were 3.44 (2.95,3.78) mmol/L and 2.79 (2.50,3.14) mmol/L.The lowest level of serum calcium after treatment was 2.25 (2.00,2.55) mmoL/L.There were significant differences in the level of serum calcium of different days (P ＜ 0.05).On the second and third day,the change of serum calcium were 0.46 (0.10,0.88) mmol/L,0.60 (0.25,0.75) mmol/L,there were no differences.After intravenous disodium pamidronate,the serum calcium level decreased below 3.5 mmol/L in (2.27 ± 0.65) days,and were kept below 3.5mmol/L for 18.45 ± 12.30 days.Conclusions Disodium pamidronate can decrease serum calcium levels in hypercalcemic crisis caused by primary hyperparathyroidism effectively with mild adverse events.

Objective To evaluate the value of real time continuous blood glucose monitoring system (RT-CGMS) versus intermittent blood glucose monitoring (IGM) in the critically ill patients under intensive insulin therapy (IIT).Methods A systematic searching randomized and controlled trials (RCT) in databases was performed for meta-analysis by Review Manager 5.2 software.Outcomes were hypoglycemia episode,alteration of mean blood glucose level,the percentage of time at a blood glucose level within optimal target range,and the early mortalities.Results Six studies,totally 531 patients,were included in this meta-analysis.The pooled SMD of mean blood glucose level was =-0.21 (95％ SMD:-0.43-0.01,P=0.07).The pooled SMD of percentage of time at a blood glucose level within optimal target range was 0.20 (95％ SMD:-0.09-0.49,P =0.18).The pooled OR of hypoglycemia episode frequency was 0.20 (95％ CI:0.09-0.43,P ＜ 0.01).The pooled OR of early mortalities was 0.35 (95％ CI:0.14-0.89,P =O.03).Conclusions In critically ill patients under the intensive insulin therapy,RT-CGMS had obvious beneficial effect on reducing hypoglycemic events.RT-CGMS had no obvious beneficial effect on keeping blood glucose level within optimal target range.

Objective To investigate the potential and early effect of hypertonic saline resuscitation on Tlymphocyte subpopulations in patients with traumatically hemorrhagic shock.Method Eighty-two patients with acute traumatically hemorrhagic shock admitted from Department of Emergency，Beijing Tongren Hospital，from De cember 2006 to July 2008 were randomly divided into：hypotonic saline(HS)group(n=43)and Lactated Ringer's solution(LR)group(n=39).The criteria of eligible patients were systolic blood pressure＜90mm Hg at admission with definite evidence of blood loss.Patients with immune system diseases and those who died within 24 hours of admission were excluded.Patients in HS group received intravenous administration of 200 mL of 7.5% sodium chloride withhin 15～20 minutes，and LR group received routine therapy with Lactated Ringer's solution.Blood pressure and heart rate were recorded 10，20，and 60 minutes after the start of resuscitation and compared between two groups.Before and 24 hours after treatment，peripheral blood levels of T-lymphocyte subpopulations including CD3+，CD4+，and CD8+ were measured by using direct immunofluorescence test and compared between two groups.The inter-group comparison was carried out by using independent sample t-lest and intragroup comparison using paired t-test.The numabers of operation，complication cases and death cases were conducted by using X2 test.SPAS version 11.0 software was used for statistical analysis.Results The volume of solution infused in HS group was(3820±623)mL and in LR group was(5430±1254)mL(P＜0.05).At 10 and 20 minutes after the sdministration of solution.the mean blood pressures in HS group were both significantly higher than those in LR group(P＜0.01).The levels of CD3+and CD4+lymphocytes in peripheral blood in HS group 24 hours after treatment were sinificantly higher than those in LR group(P＜0.01).Totally，63(76.8%)patients were cured and 19(23.2%)patients died.ARDS occurred in 10 patients and MODS occurred in 14 patiellts.The mortality，and the rates of ARDS and MODS in HS group were sinificantly higher than those in LP group(P＜0.05).Conclusiom In patients with acute traumatically hemorrhagic shock.HS can increase the effective circulating vol. ume，ameliorate the perfusion of tissues and organs，improve the immune fuction of T-lymphocytes，decrease the rats of ABDS and MODS，mad decrease the morality.HS is more effective than routine solution used for resuscitation.

Objective To investigate the changes of electrode impedance,threshold(THR),maximum comfortable level(MCL),and dynamic range(DR),providing the basis for debugging after operation in congenital deaf children. Methods A respective study was carried out on 20 cases of congenital deaf children who were implanted with cochlear Med?EL SONATAti100. The measurements and changing ranges of electrode imped?ances,THR,MCL and dynamic range during the operation and at postoperative one month,three months,and six months were statistically analyzed. Results Electrode impedances were the lowest during the operation and the highest at one month after operation(P<0.01). The electrode imped?ance for the apical cochlear group was statistically different from that for other groups at one month(P<0.05). After three and six months,there were statistically significant differences between groups(P<0.01). THR at six months was lower than that at three months(P<0.05). MCL at three months was higher than that at one month(P<0.01). DR showed an increasing trend(P<0.05). There was no correlation of perioperative and post?operative electrode impedance with THR,MCL,and DR(P>0.05). Conclusion The electrode impedances varied due to different electrode posi?tion. The vales of THR,MCL and DR were unrelated with electrode impedance. DR was gradually increasing,MCL reached steady state earlier than THR. It is important that THR should be debugged at three months after operation and MCL should be debugged at six months.

OBJECTIVE: To evaluate the instructional effect of Multi-slice (MSCT) in the cochlear implantation pre- and post-operatively, and to contrast the image feature between the X-ray and the MSCT three-dimensional reconstruction of inner ear with implanted electrode. METHOD: Twenty-four cochlear implant (MEDEL Combi 40+) recipients,in No. 1 Hospital of China Medical University from January to October 2014, were involved in this study. Among them, 18 were male and 6 female,with an average age of 4 years. MSCT and three dimensional reconstruction of inner ear were performed in all of the 24 implanted inner ears pre- and post-operatively. And X-ray plain film were examined by using 60° lateral oblique position postoperatively. All data of the spiral CT scan with axial 1 mm image slices were transferred to workstation for three-dimensional reconstruction (direct volume rendering) of the inner ear. RESULT: In 1 of the 24 cases, preoperative three-dimensional reconstruction CT scan reveal that the length of the cochlear was shorter than the electrode. And this was confirmed by MSCT postoperatively that the electrode couldn't be inserted by full length. The insertion depth of the electrode can be evaluated directly by MSCT. Moreover, each of the electrode pairs can be identified clearly. CONCLUSION MSCT plays an indispensable role in the preoperative evaluation of cochlear implantation. Postoperative evaluation by three-dimensional reconstruction of inner ear provide more accurate image to show the electrode insertion depth in the cochlea. MSCT combined with curved planar reformation to measure cochlear length could provide guidance in choosing the more adaptive electrode. And MSCT is superior to DR in demonstration of electrode postoperatively.
Child, Preschool ; China ; Cochlea ; anatomy & histology ; Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Female ; Humans ; Male ; Postoperative Period ; Preoperative Care ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

Objective:To investigate the prevalence of carotid artery plaque (CP) in the population undergoing health examinations and to assess the association between CP and Helicobacter pylori (Hp) infection.Methods:The subjects were 3066 patients who underwent carotid ultrasonography examination and 13C urea breath test (UBT) at the health examination center of China-Japan friendship hospital from January 2019 to December 2019. The subjects were divided into CP and non-CP groups; the differences of physicochemical parameters and UBT positive rate between the two groups were analyzed by independent sample t test, Mann-Whitney U test, and Chi-squared test. The association between UBT positive and CP was analyzed by logistic regression. Results:The proportion of CP positive subjects was significantly higher in males than in females (33.4% vs 19.5%, P<0.001); the proportion of Hp positive subjects was not significant in sex composition (29.1% vs 30.9%, P=0.245); the age [(59.39±10.24) vs (46.44±9.88) years], P<0.01), BMI [(25.44±3.23) vs (24.21±3.54) kg/m 2, P<0.01], SBP [(135.91±19.07) vs (123.03±16.66) mmHg, P<0.01], DBP [(79.64±11.47) vs (75.10±11.55) mmHg, P<0.01], TC [(4.96±0.98) vs (4.86±0.98) mmol/L, P=0.004], TG [1.43 (1.03, 2.06) vs 1.20 (0.82,1.88) mmol/L, P<0.001], LDL-c [(3.21±0.93) vs (3.04±0.83) mmol/L, P<0.01)], FBG [5.55 (5.11,6.47) vs 5.16 (4.83,5.56) mmol/L, P<0.001], UA [(339.13±79.92) vs (319.85±87.62) mmol/L, P<0.01] and Hcy [13.10 (11.30,15.60) vs 11.7 (10.00,13.90) mmol/L, P<0.001] were significantly higher in the CP group than that in the non-CP group; HDL-c was significantly lower in the CP group than in the non-CP group [1.12 (0.95,1.32) vs 1.20 (1.00,1.43) mmol/L, P<0.001]. The proportion of male (62.4% vs 44.6%, P<0.01), prevalence of tobacco smoking (31.9% vs 19.6%, P<0.01), hypertension (33.8% vs 12.5%, P<0.01), and diabetes (13.45% vs 3.5%, P<0.01) were significantly higher in the CP group than that in the non-CP group. The proportion of UBT positive subjects was significantly higher in the CP group than in the non-CP group (34.5% vs 28.4%, P=0.001). Logistic regression analysis showed a significantly positive association between CP and UBT positive after adjusted confounding factors ( OR=1.270, P=0.028). Conclusions:The formation of CP is related to many risk factors; Hp infection is also an important risk factor. Controlling Hp infections might be one of the effective methods for the prevention and control of carotid plaque formation.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Coxsackievirus A16 belongs to the family Picornaviridae, and is a major agent of hand-foot-and-mouth disease that infects mostly children, and to date no vaccines or antiviral therapies are available. 2A protease of enterovirus is a nonstructural protein and possesses both self-cleavage activity and the ability to cleave the eukaryotic translation initiation factor 4G. Here we present the crystal structure of coxsackievirus A16 2A protease, which interestingly forms hexamers in crystal as well as in solution. This structure shows an open conformation, with its active site accessible, ready for substrate binding and cleavage activity. In conjunction with a previously reported "closed" state structure of human rhinovirus 2, we were able to develop a detailed hypothesis for the conformational conversion triggered by two "switcher" residues Glu88 and Tyr89 located within the bll2-cII loop. Substrate recognition assays revealed that amino acid residues P1', P2 and P4 are essential for substrate specificity, which was verified by our substrate binding model. In addition, we compared the in vitro cleavage efficiency of 2A proteases from coxsackievirus A16 and enterovirus 71 upon the same substrates by fluorescence resonance energy transfer (FRET), and observed higher protease activity of enterovirus 71 compared to that of coxsackievirus A16. In conclusion, our study shows an open conformation of coxsackievirus A16 2A protease and the underlying mechanisms for conformational conversion and substrate specificity. These new insights should facilitate the future rational design of efficient 2A protease inhibitors.
Coxsackievirus Infections ; virology ; Crystallography, X-Ray ; Cysteine Endopeptidases ; chemistry ; genetics ; Fluorescence Resonance Energy Transfer ; Hand, Foot and Mouth Disease ; enzymology ; pathology ; virology ; Humans ; Picornaviridae ; chemistry ; enzymology ; genetics ; Protein Conformation ; Structure-Activity Relationship ; Substrate Specificity ; Viral Proteins ; chemistry ; genetics

Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.