BACKGROUND: As the selective susceptible region following cerebral injury, hippocampus was found to be more sensitive to the extrinsic stimulation which would stimulate hippocampus region, then result in post-traumatic excessive expression of some immediate early genes, over release of excitatory amino acid and delayed death of nerve cells.OBJECTIVE: To study the relationship between the expression of nitrogen monoxide (NO) and endothelin and the apoptosis of nerve cell in cerebral hippocampus region following brain laceration.DESIGN: A comparative study based on paired t test and multiple linear correlative analysis.SETTING:Neurosurgery Department of Kailuan Hospital Affiliated to Northern China Coal Medical College.MATERIALS:This study was carried out at Molecular Biological Laboratory of Northern China Coal Medical College, from February to June 2003. Totally 126 healthy male Wistar rats, grade two, with body mass of 250-350 g,were randomly divided into three groups: experimental group and control group of 60 rats, normal group of 6 rats, moreover the experimental group and control group were subdivided into 0.5 hour, 1 hour, 3 hours, 6 hours,12 hours, 24 hours, 72 hours, 120 hours, 168 hours, 240 hours time point subgroups with 6 rats in each subgroup.METHODS: Left parietal lobe laceration model was established on experimental rats by modified Feeney's free-drop traumatic method; rats in control group were only subjected to parietal skull opening without injury; rats in normal group were received no treatment. The level of Serum NO and endothelin, as well as the number of apoptosis nerve cell at hippocampus region were detected at each time point by using nitric acid deoxidase method, ELISA and in situ terminal labeled technique(TUNEL).MAIN OUTCOME MEASURES: Level of serum NO and endothelin,apoptosis of nerve cells in hippocampus region following brain laceration.RESULTS: Data of 126 rats were statistically analyzed without loss. ① The expression of serum NO, endothelin and apoptosis of nerve cells in hippocampus region of experimental rats: All amounted to the peak level at post-Iaceration 6 hours [(81.45±2.41) mmol/L, (20.29 ±1.63) ng/L], which began to decline from onset of 12 hours [(66.11±1.97) mmol/L, (20.14±1.63)ng/L]. The level of NO at each time point from post-laceration 0.5 hour to 120 hours, and the level of endothelin of from 0.5 hour to 168 hour were significantly higher in experimental group in contrast with normal group and control group (t=3.33-27.91, P ＜ 0.01). ② The apoptosis of nerve cells in hippocampus region of experimental rats: The apoptosis reached to the top at post-laceration 168 hours (27.33±l.86)x102/mm2, which began to decline at 240 hours (21.67±2.07) ×l02/mm2. No apoptosis cells could be observed in normal hippocampus, and less in control group. ③ The correlation of the level of NO and endothelin with the number of apoptosis of nerve cells in hippocampus region: There was obviously positive correlation (r=0.838, P ＜ 0.01; r=0.281, P ＜ 0.05).CONCLUSION: There are definite correlation between the level of NO and endothelin and the number of nerve cells of apoptosis at hippocampus following cerebral laceration. NO and endothelin interacted each other,which involved in the pathophysiological process of cerebral laceration, and consequently resulted in the apoptosis of nerve cells in hippocampus region.

Objective:To discuss mice cellular immune response to the hepatitis C viral nucleic acid vaccine.Methods:Hepatitis C viral nucleic acid vaccine pSVL HCV/C+E 1 was inoculated BALB/C mice by subcutaneous injection.To detect the CTL activity of immune mice,Made the standard 4 hours lysis test by labeling the target cells with (Na) 2 51 CrO 4,which was prepared from the syngentic BALB/C mouse myeloma derived cell strain SP2/0 transfected by the eukaryotic expression recombinant plasmid pEGFP N 1 HCV/C+E 1.Results:The kill ratio of CTL is up to 40.7%.Conclusion:The result suggested hepatitis C viral nucleic acid vaccine could induce strong cellular immune response

Objective To summarize the experience of unilateral endonasal transsphenoidal pituitary adeno-ma resection under neuroendoscopy. Methods 48 patients with pituitary adenoma were treated by unilateral en-donasal transsphenoid under neuroendoscopy. During the dissection of the adenoma, attention should be paid to pro-tect pituitary stalk and gland. Results The postoperative MRI detection revealed that the tumor was totally removed in 40(83.3%) cases,subtotally in 6(12.5%) ,and partially in 2(4.2%). All patients were followed up for 10 -36 months. Among the 38 patients with increased hormone level ,24 recovered to normal hormone level postoperatively; 14 were improved evidently;pituitary insufficiency was not found in 38 cases;7 patients have temporary diabetes in-sipidus but the symptom was released in three weeks. Conclusion The surgical treatment of pituitary adenoma by neuroendoscopic unilateral endonasal transsphenoid has its advantage in achieving both complete resection of tumor and sound protection of pituitary stalk and gland. Neuroendoscopic operation offers greater help in improving the pa-tients' quality of survival.

The subjects were all Chinese male adults. The average age, body weight and height were 37.9 (24-44) yr, 64.3 (51.5-74.0) kg and 173 (157-180) cm respectively in the first group, and 30.2 (24-41) yr, 67.7 (56.5-70.0) kg and 171 (170-176) cm respectively in the second group.The subjects in the first group were studied for 70 days for the N balance response at graded protein intakes of 0.42, 0.60, 0.73, 0.90 and 1.05 g/kg /day on Chinese mixed diet, during 5 experimental periods respectively. Each period took ten days preceded by one day of low protein diet, and was followed by three days of free choice diet The sequence of protein intakes during the study was 0.60, 0.73, 0.42, 0.90 and 1.05 g/kg/day. Six subjects in the second group were given a mixed diet ata protein level of 0.93 (0.91-0.94) g/kg/day for three months.In the N balance data of the first group, all subjects were in negative balance at protein intake of 0.42, 0.60 and 0.73 g/kg/day and all in positive N balance at 1.05 g/kg/day. Most of the subjects were in positive N balance at 0.90 g/kg/day. The linear regression analysis of N balance response of individual subject is that the intercept at zero balance of individuals ranged from 129.4-192.5 mg N/kg/day with the mean of the group of 147.7? 18.6mg N/kg/day or 0.92?0.12 g protein/kg/day. The five of the six subjects in the second group were in positive N balance, when on a mixed diet of 0.93 ?0.02 g protein/kg/day for three months.The results obtained indicated the mean protein requirement of these subjects based on the linear regression analysis of N balance response of individuals was 147.7 ? 18.6 mg N/kg/day or 0.92?0.12 g protein/kg/day. If 97.5% is to be covered, the safe level of protein intake should be 1.16 g protein/ kg/day.

Objective To evaluate the therapeutic effects of Lumber continued drainage of cerebrospinal fluid after Key-hole approach operation and craniotomic hematoma elimination on the prognosis of hypertensive in-tracerebral hemorrhage patients. Methods Lumber continued drainage of cerebrospinal fluid after Key-hole ap-proach operation was conducted on 38 hypertensive intracerebral hemorrhage patients. At the 1st month and 6th month after operation, Glasgow coma scale (GCS), Glasgow outcome scale (GOS), Barthel index, language barrier degree evaluation and sports function barrier degree evaluation were measured. The therapeutic effects were observed and compared with 34 patients who were operated by craniotomic hematoma elimination. Results GCS was 6.8± 2.1,6.6±2.3 before operation and 10.5±2.5,8.7±2.2 one week after operation in experimental group and con-trol group respectively; GOS was 3.4±0.3,2.8±0.2 one month after operation and 4.1±0.6,3.2±0.4 six month after operation in experimental group and control group respectively; Bartherl index, language barrier degree and sports function barrier degree were 63.15±11.64,51.76±12.81 and 1.7±0.3,2.3±0.2,2.0±0.3, and 2.6± 0.4 (P<0.05 or P<0.01). Conclusion Lumber continued drainage of cerebrospinal fluid after Key-hole approach operation offers greater help in improving the patients' quality of existence, by which the neurological function recov-ers faster and the patients recover well.

2019 novel coronavirus(2019-nCoV) outbreak is one of the public health emergency of international concern.Since the 2019-nCoV outbreak, China has been adopting strict prevention and control measures, and has achieved remarkable results in the initial stage of prevention and control.However, some imported cases and sporadic regional cases have been found, and even short-term regional epidemics have occurred, indicating that the preventing and control against the epidemic remains grim.With the change of the incidence proportion and the number of cases in children under 18 years old, some new special symptoms and complications have appeared in children patients.In addition, with the occurrence of virus mutation, it has not only attracted attention from all parties, but also proposed a new topic for the prevention and treatment of 2019-nCoV infection in children of China.Based on the second edition, the present consensus further summarizes the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of treatment of 2019-nCoV infection in children.

Objective:To evaluate the application of metagenomic next-generation sequencing (mNGS) in the diagnosis of osteoarticular infection.Methods:The clinical data of 37 inpatients aged 32-90 year with osteoarticular infection admitted in the Department of Spine Surgery of Qingdao Chest Hospital from January to December 2019 were retrospectively analyzed. There were 31 cases of spine infection and 6 cases of other joint infection. The tissue samples were obtained from the infected sites through puncture or surgical approach in all patients. The tissue samples were subjected to routine culture of mycobacteria, aerobic bacteria and anaerobic bacteria, respectively. The gene amplification and mNGS were performed for detection of mycobacterium tuberculosis DNA (MTB-DNA). The chi-square test or Fisher’s exact test were used to compare the detection rates of pathogen and simple bacterial infection between mNGS and conventional culture. The conventional culture, mNGS and MTB-DNA amplification detection were performed for all samples; with clinical diagnosis as the gold standard, the diagnostic values of 3 methods were evaluated with receiver operating characteristic curve (ROC). Paired sample t test was used to compare white blood cell(WBC) count, erythrocyte sedimentation rate, C-reactive protein of patients before and after treatment. P<0.05 was considered statistically significant. Results:The pathogens were detected by mNGS for 42 times: bacteria for 39 times (92.8%), fungi for twice (4.8%) and Kirks body for once (2.4%). Among 37 patients there were 29 cases of pure bacterial infection (78.4%), 2 cases of pure fungi infection (5.4%), 1 case of pure Kirks body infection (2.7%), and 5 cases of mixed infection of two or more pathogens (13.5%). The detection rates of mNGS and conventional culture were 100.0% (37/37) and 67.6% (25/37), respectively ( χ2=13.987, P<0.05). The detection rates of mNGS and conventional culture in 29 patients with pure bacterial infection were 100.0% (29/29) and 69.0% (20/29), respectively ( χ2=16.913, P<0.05). The area under the ROC curve (AUC) of conventional culture, mNGS, and MTB-DNA in the diagnosis of osteoarticular tuberculosis infection was 0.958 (95% CI: 0.866-1.000, P<0.05), 1.000 (95% CI: 1.000-1.000, P<0.05) and 0.958 (95% CI: 0.866-1.000, P<0.05). All the 37 patients were treated with anti-infective drugs according to the results of mNGS and conventional culture. Among them, 28 patients received surgical intervention. The patients were followed up until April 30, 2020, 1 patient died. After 3 months of follow-up, the WBC count, erythrocyte sedimentation rate and C-reactive protein were (5.5±1.5)×10 9/L, (41±38)mm/h and (5.0±4.6) mg/L, respectively, which were lower than those before anti-infection treatment [(8.0±2.9)×10 9/L, (79±42)mm/h and(63±52)mg/L] ( t=6.536, 8.302 and 6.373, all P<0.05). Conclusion:The metagenomic next-generation sequencing may have important clinical value in the differential diagnosis of osteoarticular infection.

At present, severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still rampant worldwide.As of September 10, 2021, there were about 222 million confirmed cases of corona virus disease 2019(COVID-19)and more than 4.6 million deaths worldwide.With the development of COVID-19 vaccines and the gradual vaccination worldwide, the increasing number of cases in children and unvaccinated young people has drawn attention.According to World Health Organization surveillance data, the proportion of COVID-19 infection cases in children gradually increased, and the proportion of cases in the age groups of under 5 years and 5-14 years increased from 1.0% and 2.5% in January 2020 to 2.0% and 8.7% in July 2021, respectively.At present, billions of adults have been vaccinated with various COVID-19 vaccines worldwide, and their protective effects including reducing infection and transmission, reducing severe disease and hospitalization, and reducing death, as well as high safety have been confirmed.Canada, the United States, Europe and other countries have approved the emergency COVID-19 vaccination in children and adolescents aged 12 to 17 years, and China has also approved the phased vaccination of COVID-19 vaccination in children and adolescents aged 3 to 17 years. For smooth advancement and implementation of COVID-19 vaccination in children, academic institutions, including National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health, and The Society of Pediatrics, Chinese Medical Association organized relevant experts to reach this consensus on COVID-19 vaccination in children.

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.