OBJECTIVETo provide evidence for Chinese medical treatment of children with EB virus infection by exploring its clinical efficacy from multiple angles.

METHODSTotally 81 children patients were randomly assigned to the treatment group (46 cases) and the control group (35 cases). Patients in the treatment group took Chinese medical decoction, while those in the control received intravenous dripping of Ganciclovir and oral administration of pidotimod. The treatment period for the two groups was 2 weeks. Patients were followed-up till the 12th week. Clinical symptoms such as fever, lymphadenopathy and hepatosplenomegaly, as well as lab indices such as abnormal lymphocyte percentage, EB virus antibody, virus DNA load, T cell subsets, immunoglobulin, and so on were observed before and after treatment, at week 4 and 12 of follow-ups.

RESULTS(1) The total effective rate at week 2 was 95.6% in the treatment group, higher than that of the control group (94.3%), but there was no statistical difference between the two groups. (2) The time for defervescence, duration of pharyngeal hyperemia, duration of swollen tonsils was shorter in the treatment group than in the control group (P<0.05). The subsidence of lymphadenopathy, hepatomegaly, and abnormal lymphocytes was better in the treatment group than in the control group (P < 0.05). (3) The positive cases of peripheral blood hetero-lymphocyte was significantly reduced after treatment, at week 4 and 12 of follow-ups both in the treatment group and the control group (P < 0.01). The expression of IgA and IgM decreased after treatment in the two groups when compared with before treatment in the same group (P < 0.05, P < 0.01). IgG in the treatment group also obviously decreased after treatment, at week 4 and 12 of follow-ups (P < 0.05, P < 0.01), while it decreased only after treatment in the control group (P < 0.05). Activities of AST and ALT in the treatment group and the AST activity in the control group were markedly improved when compared with those before treatment (P < 0.05). Compared with the control group, the abnormal lymphocyte positive case number obviously decreased in the treatment group after treatment, at week 4 and 12 of follow-ups (P < 0.05). (4) After treatment, at week 4 and 12 of follow-ups, CD3+ and CD8+ significantly decreased; CD4+, CD4/CD8, and B cells significantly increased in the two groups, when compared with before treatment (P < 0.05). NK cells significantly increased more in the treatment group after treatment, at week 4 and 12 of follow-ups, higher than before treatment as well as the control group (P < 0.05). (5) EB viral DNA and EB viral CA-IgM negative conversion case numbers significantly increased in the two groups after treatment, at week 4 and 12 of follow-ups (P < 0.05). Compared with the control group, EB viral DNA and EB viral CA-IgM negative conversion case numbers significantly increased in the treatment group after treatment and at week 4 of follow-ups (P < 0.05).

CONCLUSIONSTreatment of EB virus infection by Chinese medical treatment was effective. It could promote the recovery of EB viral infection, and reduce the risk of vicious disease after EB viral infection.

Adolescent ; Child ; Child, Preschool ; Drugs, Chinese Herbal ; therapeutic use ; Epstein-Barr Virus Infections ; drug therapy ; immunology ; Female ; Herpesvirus 4, Human ; Humans ; Infant ; Male ; Phytotherapy ; T-Lymphocyte Subsets ; immunology

AlM: To observe the effect of dacryocystorhinostomy for the treatment of chronic dacryocystitis using nasal endoscope and discuss the operation technique. METHODS: A retrospective clinical analysis was performed on the clinical data followed up for 6 ~12mo from 140 patients (169 eyes) with dacryocystorhinostomy for the treatment of chronic dacryocystitis using nasal endoscope. The effect of the treatment was evaluated and the operation technique for the treatment of chronic dacryocystitis using nasal endoscope was discussed.RESULTS: ln all of cases 155 eyes ( 91. 7%) were recovery, 3 eyes ( 1. 8%) were improved, and 11 eyes (6. 5%) were failure. The total efficiency was 93. 5%, there was no significant difference compared with traditional dacryocystorhinostomy group (χ2=3. 743, P>0. 05). CONCLUSlON: Dacryocystorhinostomy using nasal endoscope for treatment of chronic dacryocystitis has a good curative effect. Techniques including lacrimal sac location and size, colostomy position and size, treatment of colostomy mucosal flap and nasal disease, postoperative follow - up and physical condition of patients are likely to affect the operation curative effect.

Objective To investigate the long-term prognosis an d recorery of children with juvenile rheumatoid arthritis(JRA).Methods The cases diagnosed JRA in our hospital over the period of 1988～1992 we re followed up for the conditions of disease,the deteriorated joints,the treatme nt and the living conditions of patients.Results Ninty-six ca ses were followed up(involving male 66 cases,female 29 cases,the mean age of on set 8.21?3.17 years )except for a case who died of lymphoma.There were 44 cases with systemic JRA ,2 cases of them died after 7-years onset and 23 cases developed severe destructive arthritis.There were 38 oligoarthritis cases,27 cases of them stiu had active disease during 10-year following-up and 9 cases were diagnosed sacroiliitis.There were 13 polyarthritis and 3 cases of them were RF positive, who had developed severe destructive arthritis.Conclusions The prognosis of juvenile rheumatoid arthritis is not desirable,especially in systemic JRA,whose prognostic factors are related to age of onset,the lasting of fever,the markers of phlegmasia activity and the condition of systemic involvement and treatment.Oligoarthritis about 30 % may develop into ankylosing spondylitis.The probability of destructive arthritis is hi gher in polyarthritis with more RF positive and poor prognosis.

Objective To assess the influence of length of the alanine tract of forkhead box E1 (FOXE1) gene on genetic susceptibility to idiopathic premature ovarian failure (POF). Methods Totally 110 patients with idiopathic POF were recruited between February 2009 and December 2012 at the Affiliated Shenzhen City Maternity and Child Healthcare Hospital of Southern Medical University. Controls (n=110) were individuals with normal menstrual cycles, normal FSH concentrations. The polyalanine tract and flanking sequence of FOXE1 were screened using the multiplex ligation-dependent probe amplification (MLPA) technique and direct sequence technique. Results The most frequent of FOXE1 polyalanine stretch length was 14 residues in both groups. The length of FOXE1 polyalanine reported in this study varied from 12 to 16 alanines, and three variants of FOXE1-polyalanine length, containing 12, 14, or 16 alanine residues, and 5 different genotypes were identified. The most common genotypes were 14/14 homozygote, occurring with the frequency of 81.8% (90/110) in the POF group, while 96.4% (106/110) in control subjects, respectively. The incidence of 14/14 genotypes of FOXE1-polyalanine was significantly lower in patients with POF (χ2=119.730, P=0.001) in comparison to the controls. There were significantly higher frequencies of the 16/16 genotypes in cases with POF [10.0% (11/110) versus 0; χ2=3.403, P=0.001], as compared with the controls. The FOXE1 14 alanine allele was significantly less common in the POF patient group than the controls [84.5% (186/220) versus 98.2% (216/220); χ2=25.923, P=0.001]. The FOXE1 16 alanine allele was significantly more common in the POF patient group than the controls [12.7% (28/220) versus 1.8% (4/220); χ2=19.412, P=0.001]. Conclusions The polymorphism of the polyalanine tract of FOXE1 gene have a certain relevance for the genetic aetiology of idiopathic POF.

Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis,and the effect and safety of assistant cannulation methods.Methods The clinical data were retrospectively analyzed in 372 patients,who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014.The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis.The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with doubleguide wire technique (DGT) and precut sphincterotomy (PS),which were used when standard biliary cannulation failed.Results The univariate analysis showed that floppy and long duodenal papilla (P=0.000),angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000,OR=0.131,95％CI:0.056-0.307),angulated common bile duct (P =0.003,OR =0.378,95 ％ CI:0.197-0.726) were independent risk factors for standard biliary cannulation.The success rate of standard biliary cannulation was 83.3％ (310/372),62 cases undergone DGT or PS after standard biliary cannulation failure,and the total success rate of cannulation was 99.7％ (371/372).There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation,including 18 cases (5.8％,18/310) of standard biliary cannulation,8 cases (16.3％,8/49) of DGT,and 3 cases (25.0％,3/12) of PS.The incidence of PEP by DGT (x2 =5.532,P =0.019) and PS (x2 =6.994,P=0.008) was significantly higher than that of standard biliary cannulation,but there was no statistical difference on the incidence of PEP between DGT and PS (x2 =0.079,P =0.778).Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis.DGT and PS are effective assistant cannulation methods when the standard cannulation fails.

The ABCD2 score is validated for evaluating short-term stroke risk after transient ischemic attack (TIA); however, whether it is able to predict the long-term risk of vascular outcome remains uncertain. Recently a new tissue-based definition of TIA has been proposed. The ABCD2 scores of 145 TIA patients admitted to our hospital were retrospectively calculated and stratified into two categories: ≤ 3 points (low risk); 4-7 points (moderate-high risk). At a median follow-up of 81 months, new vascular events were recorded. Follow-up data were available in 107 patients. Seventy one patients had a moderate-high ABCD2 score. Sixty six patients experienced a cerebral ischemic event; 8 a myocardial infarction; 7 died of cerebrovascular or cardiovascular cause. Moderate-high ABCD2 score was significantly associated with the further cerebral ischemic events (hazard ratio [HR], 1.755; 95% confidence interval [CI], 1.019 to 3.024) and with the combined endpoint (HR, 1.818; 95% CI, 1.079 to 3.063). Our study shows that the ABCD2 score may also be used to predict long-term vascular outcome after tissue-based definition of TIA. Moderate-high ABCD2 score is associated with an increased general vascular risk in the long-term follow-up after TIA.
Stroke

Objective To identify the genotypes of ESBLs-producing Klebsiella pneumoniae isolates from the First Affiliated Hospital,Shantou University Medical College.Methods The MICs of 10 antibiotics were determined by agar-dilution against the clinical isolates of ESBLs-producing K.pneumoniae.PCR were performed with specific primers for blaTEM,blaSHV, blaCTX-M and blaOXA respectively.PCR products were cloned and sequenced.Results The results of PCR showed that a- mong the 83 strains of ESBLs-producing K.pneumoniae,75 were positive for blaTEM,41 positive for blaSHV,25 poitive for blaCTX-M,9 positive for hlaOXA.Three genotypes were found in 13 strains(15.7%),2 genotypes in 59 strains (71.1%) and single genotype in only 11 strains(13.2%).The genes of CTX-M-3,TEM-1 and SHV were found co-existent in 9 strains. The strains carrying 2 or 3 ESBL genes were more resistant to antibiotics than those carrying only 1 ESBL gene.Conclusions The genotypes of ESBLs-producing Klebsiella pneumoniae in this hospital are blaTEM,blaSHV,blaCTX-M and blaOXA. Most strains carry 2 or 3 ESBL genes.

Objective To analyze the clinical and histopathologic characteristics in children with subcutaneous panniculitis-like T-cell lymphoma(SPTCL),and explore the pathological diagnosis and differential diagnosis,in order to boost paediatricians to better understanding the disease.Methods One case was diagnosed SPTCL with over 2 years protracted course of fever and multiple skin lesions.The evolvement of clinical presentation,the misdiagnosed experience,the histopathological features,the immunohistochemical results and T cell receptor(TCR)gene cloning rearrangement were observed.The related literatures published were reviewed.Results Skin biopsy showed that the histopathologic findings were limited within subcutaneous fatty tissue,the atypical lymphocytes characteristically rimmed individual fat cells in a lace-like pattern.Immunophenotypic studies showed CD45,CD45RO,CD3,CD5,T cell intracellular antigen-1(TIA-1)and perforin usually expressed possitive,while CD10,CD20,CD56,CD68,epithelial membrane antigen(EMA)and cytokeratin(CK)were negative,implying tumor cells derived from T-cell.The results of TCR gene rearrangement as following:IgH FR2(+),FR3A(-);TCR ? JVI(-),JVII(+);TCR? JD1(-),JD2(-).Although the protocol of children's T-cell Non-Hodgkin lymphoma was administrated,the treatment outcome was poor.Conclusion SPTCL is a special primary cutaneous lymphoma with poor prognosis,skin biopsy of suffered lesion is an important method for the diagnosis of SPTCL children with unclear recurrent fever and multiple skin lesions.

Objective To evaluate clinical value of denaturing high performance liquid chromatography (DHPLC) used in detecting transforming growth factor beta receptor 3 (TGFBR-3) exons 11 and 12 polymorphism in women with idiopathic premature ovarian failure (POF).Methods From Feb.2009 to Dec.2011,110 patients with idiopathic POF undergoing treatment at Shenzhen Maternal & Child Health Institute affiliated to Southern Medical University were enrolled as POF group in this study.In the mean time,110 women under 40 years old with normal hormonal level and menstrual cycles as control group.The exons 11 and 12 of TGFBR-3 gene polymorphism were screened by using DHPLC,and results of DNA sequencing was as golden standard.Some related indexes were calculated,such as sensitivity,specificity,false negative value,false positive value,Youden index,positive predictive value,and negative predictive value.At the same time,20％ of the tested specimens were chosen randomly and detected by DHPLC again.The value of Kappa index were calculated by comparing the results between the first and second DHPLC analysis.Results The exon 11 of TGFBR-3 were not identified gene polymorphism and two nucleotide polymorphisms were identified in exon 12.For 2022 T/C polymorphism,the frequencies of CC with 0.9％ (1/110),TC with 22.7％ (25/110),TT with 76.4％ (84/110),Cwith12.3％ (27/220) and T with 87.7％ (193/220) in POF group were significantly different from CC with 0,TC with 9.1％ (10/110)and TT with 90.9％ (100/110),C with 4.5％ (10/220) and T with 95.5％ (210/220) in control group (all P ＜ 0.05).Allelic and genotypic frequencies of 2161-75 C/T were not differed significantly between the two groups (all P ＞ 0.05).As DNA sequencing as golden standard,DHPLC showed that the sensitivity was 100％,specificity was 97.9％,Youden index was 97.9％,positive predictive value was 96.3％,negative predictive value was 100％,and Kappa index was 0.888 (P ＜ 0.05).Conclusion DHPLC analysis is higher validity,reliability and practicability method in detecting TGFBR-3 polymorphism in idiopathic premature ovarian failure.

Objective To find out the current situation of brucellosis infection and exposure status of family members of sheep farmers in the western pastoral areas of Jilin Province,and to provide a reference for control of human brucellosis spreading among family members.Methods On November 2012,Qianguo County was randomly selected using a multi-stage sampling method,and two townships,Chaganhua and Wulantala,were randomly selected in the county; half of the villages were selected from each township; all family members of the sheep farmers in these villages were investigated about their demographic characteristics (sex,age,education),high-risk behavior and information about brucellosis infection by using a questionnaire survey.Based on the principle of informed consent,respondents venous blood samples were collected.Brucellosis was confirmed with serum agglutination test (SAT).The effects of gender,age,education and other demographic data,high-risk behavior and high-risk behavior protection on the prevalence of brucellosis were studied.Results Out of the 403 copies of qualified questionnaires collected,84 people were found infected with brucellosis,and the infection rate was 20.84％ (84/403).Men infection [24.78％ (57/230)] was higher than that of women [15.61％ (27/173),x2 =5.038,P ＜ 0.05].The rates of eight kinds of high-risk behaviors were:helping feeding 86.85％ (350/403),cleaning sheepfold 80.40％ (324/403),holding lamp 71.71％ (289/403),delivering sheep 61.54％ (248/403),vaccinating sheep 53.85％ (217/403),apoblema 47.39％ (191/403),milking 22.08％ (89/403) and slaughtering sheep 14.89％ (60/403).The highest risk behavior was vaccinating sheep[24.40％(53/217)],and the lowest was milking [16.90％ (15/89)].The highest rate of basic protection was delivering a sheep [31.85％ (79/248)],the next was apoblema[27.23％ (52/191)],and the lowest was slaughtering sheep [8.33％ (5/60)].There was no statistical significant difference between brucellosis infection and the eight kinds of high-risk behaviors as well as the basic protective behaviors.Conclusions The prevalence of brucellosis infection among sheep farmers' family members is higher than others.Brucellosis infection-related contact manner is ubiquitous and the level of basic protection is low.We should carry out targeted health education on sheep farming household members to improve their level of protection,so as to reduce the risk of brucellosis infection.