Objective To elucidate the clinical features, diagnosis and treatment of Aspergillus necrotizing bronchitis. Methods Medical records and investigation data from 5 eases of Aspergillus necrotizing bronchitis were retrospectively analyzed, and related literatures were reviewed. Results Five patients (3 males and 2 females) with mean age of 63.6 y were enrolled in this study. All patients had histopathologically proved necrotizing aspergillosis of the large airways. Common presentations included cough, short of breath, sputum production, fever and haemoptysis. Tracheoscopy presentations included necrosis, mucous hyperemia, focal airway constriction and neoplasm. The CT findings included bronchial wall thickening, narrowing of the bronchial lumen, which was often associated with distal obstructive pneumonia. Conclusions The clinical manifestations of Aspergillus necrotizing bronchitis are nonspecific, and histopatholagical diagnosis is essential for a definite diagnosis and can be supported by tracheoscope or imaging techniques.

Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). MethodsOne hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. ResultsThere was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P

Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor. Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection,exposure and protection of the RLN during the surgical procedures. Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact,the rest 2 nerves were resected because of tumor involving. Conclusion s NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery,especially reoperation.

ObjectiveToinvestigatethecorrelationsofmethylenetetrahydrofolatereductase(MTHFR) gene C677T polymorphism w ith ischemic stroke and hyperuricemia in Chinese Han population in Shandong, China.Methods The patients w ith acute ischemic stroke and age-and sex-matched controls in Chinese Han population in Shandong, China w ere enrol ed. Polymerase chain reaction amplification and microarray hybridization w ere used to detect the MTHFR gene C677T polymorphism, and the serum uric acid concentration w as measured. Results A total of 145 patients w ith acute ischemic stroke and 145 age-and sex-matched controls in Chinese Han population in Shandong, China were enroled. The proportion of diabetes ( 26.90%vs. 6.89%; χ2 = 20.653, P< 0.001 ) and fasting blood glucose ( 5.56 ± 1.57 mmol/L vs.5.01 ±1.11 mmol/L;t= -3.390, P=0.001), homocysteine (median, interquartile range:18.2[16.30-22.55 μmol/L] vs.15.20[12.10-17.85 μmol/L]; Z= -6.323, P<0.001), and uric acid (43.0[361.60-490.45 μmol/L] vs.285.9[267.00-346.25 μmol/L]; Z= -10.360, P<0.001) levels in the ischemia stroke group w ere significantly higher than those in the control group. The distribution frequencies of TT genotype (42.07%vs.15.17%; χ2 =25.673, P<0.001) and T alele (58.28%vs. 34.48%; χ2 =33.008, P<0.001) in the ischemia stroke group w ere significantly higher than those in the control group. Multivariate logistic regression analysis showed that the uric acid (odds ratio [OR] 1.018, 95%confidence interval [ CI] 1.013-1.024; P<0.001), TT genotype ( vs.CT genotype OR 6.774, 95%CI 1.779-25.507; P=0.005), hypertension ( OR 1.919, 95%CI 1.013-3.636; P=0.045), and homocysteine (OR 1.153, 95%CI 1.059-1.258;P=0.001) w ere the independent risk factors for ischemic stroke. The ischemic stroke group w as combined w ith the control group, a total of 101 patients had hyperuricemia, and 189 had normal uric acid. The proportion in patients w ith diabetes ( 32.67%vs. 11.64%; χ2 = 23.749, P< 0.001), as wel as total cholesterol ( 5.67 ±1.56 mmol/L vs.5.10 ± 1.33 mmol/L; t= -3.255, P< 0.001 ) and homocysteine ( 19.50[17.10-24.70 μmol/L] vs. 15.40[12.60-18.05 μmol/L ]; Z= -7.236, P< 0.001 ) levels in the hyperuricemia group w ere significantly higher than those in the normal uric acid group. The distribution frequencies of the TT genotype (55.45%vs.13.76%;χ2 =56.409, P<0.001) and T alele (71.9%vs.32.54%;χ2 =79.561, P<0.001) w ere significantly higher than those in the normal uric acid group. Multivariate logistic regression analysis show ed that the TT genotype ( vs.CC genotype, OR 6.434, 95%CI 2.334-17.736; P<0.001 ), CT genotype ( vs.CC genotype, OR 2.234, 95%CI 1.019-4.898; P= 0.045 ), homocysteine ( OR1.081, 95%CI 1.010-1.157;P=0.024), and total cholesterin ( OR 1.363, 95%CI 1.123-1.653;P=0.002) w ere the independent risk factors for high hyperuricemia. Conclusions MTHFR gene C677T TT genotype and serum uric acid level are the independent risk factors for ischemic stroke in Chinese Han population in Shandong, China. MTHFR gene C677T TT genotype is also an independent risk factor for hyperuricemia in this population. Adjusting dietary habit may have a positive significance for the prevention of ischemic stroke in Chinese Han population in Shandong, China.

BACKGROUND:In the total hip arthroplasty, intravenous and topical tranexamic acid can significantly reduce the perioperative blood loss and blood transfusion rate, but at present, the clinical application of tranexamic acid is stil controversial. OBJECTIVE:Cochrane system evaluation method is applied on the efficacy and safety of intravenous combined with topical application versus single-dose intravenous application of tranexamic acid in the total hip arthroplasty. METHODS:We searched the Cochrane Library, PubMed, Ovid, EMBASE, CBM, Wanfang, VIP and CNKI database, from inception to July 2016 and retrieval of randomized control ed trials concerning intravenous combined with topical application and single dose intravenous application of tranexamic acid during total hip arthroplasty. Total blood loss, intraoperative blood loss, postoperative blood loss, blood transfusion rate, thrombosis, operation time, and length of hospital stay were analyzed by meta-analysis. RESULTS AND CONCLUSION:(1) There were seven randomized control ed trials with 620 patients. (2) Meta-analysis results indicated that total blood loss, intraoperative blood loss, postoperative blood loss, and blood transfusion rate were significantly better in the combination group than in the single dose group (P<0.05). There were no significant differences in thrombosis, operation time, and length of hospital stay between the two methods (P>0.05). (3) These results suggested that compared with the single dose of intravenous application, intravenous combined with topical application, can significantly reduce the loss of blood volume and blood transfusion rate and did not increase the rate of thrombosis. Subject headings:Arthroplasty, Replacement, Hip;Tranexamic Acid;Venous Thrombosis;Hemorrhage;Tissue Engineering

Objective To investigate the effect of anti-inflammation-analgesic injection (AIAI) combined with extract from rabbit skin inflamed by vaccinia virus (ERSVV) on repair of the damaged sciatic nerve in rats.Methods Fifty adult SD rats of both sexes weighing 260-300 g were randomly divided into 5 gronps ( n = 10each): sham operation group (group S); sciatic nerve chronic constriction injury group (group CCI); CCI + AIAI group (group A); CCI + ERSVV group (group E) and CCI + AIAI + ERSVV group (group A + E). Right sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4/0 catgut in CCI,A,E and A + E groups. A catheter was placed around sciatic nerve, and fixed to the nearby muscle and kept unclogged by injecting 0.2 nl distilled water daily. AIAI and/or ERSVV 0.2 ml were injected via the catheter starting from the 14th day after operation. AIAI 0.2 ml contained dexamethasone palmitate (4 mg/ml) 0.05 ml, 2% lidocaine 0.05 ml and vitamin B12 (0.5 mg/ml) 0.05 ml in distilled water. Dexamethasone palmitate was omitted in AIAI starting from the 2nd of drug administration in group A and A + E. Paw withdrawal threshold to mechanical stimulation (MWT) was measured before (baseline) and at 1, 5, 7, 14, 21 and 28 days after operation. Sciatic nerves were exposed at 14 and 28 days after operation in 5 rats in each group. Conduction velocity of motor nerve (NCV) and action potential (AP) of gastrocnemius muscle were measured. Sciatic nerve at the site of CCI was examined for pathologic changes, the number of axons (NA) and thickness of myelin sheath (TMS) with light microscope. Results CCI significantly decreased MWT, AP, NA, TMS and NCV in group CCI as compared with group S (P ＜0.01). AIAI and/or ERSVV significantly attenuated CCI-induced decrease in MWT, AP, NA, TMS and NCV in A,E and A + E groups as compared with CCI group ( P ＜ 0.05). Their curative effects were potentiated by combined use. Conclusions Both AIAI and ERSVV have curative effects against CCI-induced sciatic nerve injury and their actions are potentiated by combined used.

Objective To analyze the space-time characteristics of hand-foot-mouth disease (HFMD) in Shijiazhuang by using geographic information system (GIS).Methods The data of HFMD during 2009 to 2011 in Shijiazhuang were collected and GIS database was created.Special map was drawn by PHGIS software to analyze the space-time characteristics of HFMD in Shijiazhuang.Results The epidemic situation of HFMD in Shijiazhuang appeared sporadic with local centralization.The attack ranked alternately rise year after year and high epidemic areas were geographically complimentary.Overall epidemic levels tend dropping from 2009 to 2011 and there were differences among areas.The high-attack areas of HFMD changed over time.Conclusions GIS can provide direct-viewing of the space-time characteristics of HFMD and further understand the prevalence of HFMD,which could help to provide the scientific basis of HFMD control in Shijiazhuang.

Objective To investigate the changes of chemokines related to dendritic cells in liver and spleen in rats with hepatic carcinoma treated by radiofrequency ablation (RFA),and to explore the mechanism of anti-tumor responses to RFA.Methods Forty healthy SD rats with established animal model of hepatic carcinoma were randomly divided into control group (n=10),RFA 7d group (n=16) and RFA 14d group (n=14).The rats of control group were killed without treatment.The other rats were killed in 7d and 14d after RFA treatment respectively.Spleen and liver tissue around the ablation area or around the tumor were taken out.The expressions of macrophage inflammatory protein (MIP)-1a in liver tissue and MIP-3β in spleen were analyzed by ELISA.Results The expression of MIP-1a in liver tissue was (232.92±54.5B)ng/L in control group,which enhanced to (499.38±15.14)ng/L and (495.90±9.94)ng/L in RFA 7d and 14d groups respectively.There were significant differences between control and RFA 7d group,control and RFA 14d group(P＜0.05).The expression of MIP-3βin spleen was (70.08±2.67) ng/L in control group,which enhanced to (151.57±48.48)ng/L and (154.57±18.25)ng/L in RFA 7 d and 14 d groups respectively.There were significant differences between control and RFA 7 d group,control and RFA 14 d group (P＜0.05).Conclusions The expressions of MIP-1a in liver tissue and MIP-3β in spleen increase significantly after RFA.These changes will promote recruitment and migration of dendritic cells and may contribute to the anti-tumor responses after RFA.

Objective To investigate the change of dendritic cells (DCs) in rats with hepatic carcinoma treated by radiofrequency ablation (RFA),and to explore the mechanisms of anti-tumor immune response to RFA. Methods Forty healthy SD rats with established animal model of hepatic carcinoma were randomly divided into control group (n = 10) ,RFA 7 d group (n = 16) and RFA 14 d group (n = 14). The rats of control group were killed without treatment. The other rats were killed in 7 d and 14 d after RFA treatment respectively. Peripheral blood, liver tissue around the ablation area and spleen were taken out. The OX62,OX6,CD86 of DCs were analyzed with flowcytometry. Results ①OX62 cells accounted for (0.45 ± 0.19)% of mononuelear cells in peripheral blood in control group. The account of OX62 cells increased to (0.78 ± 0.30)% and (1.53 % 0.80)% in RFA 7 d and 14 d groups respectively. There were significant differences between control and RFA 7 d group, control and RFA 14 d group (P<0.05). ②OX62 cells accounted for (18.91 ± 4.58)% of mononuclear cells in liver tissue around the tumor in control group. The account of OX62 cells increased to (24.49 ± 4.59)% in RFA 7 d group (P<0.05). The expression of OX6 on DCs in liver tissue was (15.29 ± 4.59)% and increased to (34.2 ± 11.62)% and (39.18 ± 9.14)% in RFA 7 d and RFA 14 d group respectively (P<0.05). ③OX62 cells accounted for (11.69 ± 4.39)% of mononuclear cells in spleen in control group which increased to (15.10±2.37)% in RFA 14 d group (P<0.05). Conclusions The precursor DCs in peripheral blood and DCs in liver and spleen increased significantly after RFA. The expressions of OX6 on DCs in liver and spleen increased after RFA. RFA can promote the differentiation and maturation of DC. The increased function of antigen presenting may contribute to the anti-tumor responses after RFA.

Objective To investigate the resistant mechanism of carbapenem-resistant Escherichia coli and its relationship with endogenous infection. Methods Two carbapenem-resistant Escherichia coli strains were isolated from blood and stool of a same patient, respectively. The minimal inhibition concentrations (MIC) of the two isolates against imipenem and meropenem were determined by E-test. The susceptibility against other antimicrobial agents were done by disc diffusion method. Isoelectric focusing electrophoresis (IEF), polymerase chain reaction (PCR) amplification,cloning and sequencing, conjugation, Southern blotting were carried out to analyze the encoding gene of β-lactamases. Homology analysis of the two strains was done by pulsed field gel electrophoresis (PFGE). Results MIC against imipenem and meropenem of the two strains were both≥32 mg/L.Both strains produced KPC-2 (pI 6.7) and SHV-12 (pI 8.2) β-lactamases. blaKPC2gene was located on a 54 kb transferable plasmid. PFGE showed that the two Escherichia coli strains were derived from the same clone. Conclusions The resistance and enzyme digestion map of chromosome DNA of the two Escherichia coli strains are coincident. The Escherichia coli septicemia of this patient is probably an endogenous infection caused by the immigration of Escherichia coli from the gut.