Objective To study the anatomic characteristics of Zuckerkandl's tubercle (ZT) and its clinical relevance as an anatomic landmark of the recurrent laryngeal nerve (RLN) in thyroid surgery.Methods This study involved 147 (106 with benign thyroid diseases and 41 with malignancies) patients who underwent thyroidectomy.ZT was measured and classified based on the Pelizzo classification.The relationship between ZT and the RLN and the relationship between the RLN and the inferior thyroid artery were recognized and classified.Results 233 (107 left and 126 right) thyroid gland lobes were dissected and ZT was identified in most patients (left in 93.5％ and right in 96.0％).The distribution of ZT according to grade was as follows:Grade 0,left 16.0％ and right 13.2％ ; Grade Ⅰ,left 32.0％ and right 27.3％ ; Grade Ⅱ,left 46.0％ and right 44.6％ ; Grade Ⅲ,left 6.0％ and right 14.9％.There was no significant difference on classification between the left-sided and right-sided ZTs.In terms of the relationship between the ZT and the RLN,it was classified as follows:Type A,left 92.9％ and right 93.3％ ; Type B:left 0 and right 0; Type C:left 7.1％ and right 6.7％.Similarly,there was no significant difference between the left sided and the right sided.The ZT grade was correlated with the course of the RLN:the higher the ZT grade was (that is,the greater the size of the ZT),the more often was the course of RLN behind the back of the ZT; the lower the ZT grade (that is,the smaller the size of the ZT),the more often was the course of RLN running by the lateral of the ZT.Considering the incidence of being dangerous type of RLN,the right sided (19.0％) was higher than the left sided (8.3％).The relationship between the ZT and the RLN does not relate to RLN course across the inferior thyroid artery.Conclusions As an important anatomic landmark,the ZT is essential for locating and dissecting the RLN during thyroid surgery,and its classification is a guide to RLN dissection and preservation.

Objective To analyze the epidemiological characteristics of Mycoplasma pneumoniae(MP)infection in children with acute respiratory tract infection in Haikou area and surrounding area to provide a scientific evidence for the prevention and treatment of MP infection in children.Methods A total of 1 699 children inpatients with acute respiratory tract infection in our hospital from 1 January to 1 December,2014 were collected.The serum MP antibody was detected.The MP infection status of different sites,genders,ages and months was retrospectively analyzed.Results Among 1 699 children patients with acute respiratory tract infection,the total positive rate of MP infection was 17.60％,in which male was 15.73％ and female was 21.59％,the positive rate of female was higher than that of male with statistical difference(P＜0.01).The lower respiratory infection rate was 18.75％ and upper respiratory tract infection was 13.70％,the difference was statistically significant(P＜0.05).The MP infection rates was common in children aged >1-4 years old,in which children aged >3-4 years old had the highest infection rate.MP infection was sporadic in the whole year and was highly epidemic in March and April.Conclusion MP was an important pathogen of acute respiratory tract infection for children in Haikou during 2014,and its epidemic characteristics were manifested by higher incidence in female than that in male.Children aged within 4 years old are a high onset group and MP infection occurs all year round,March and April are the relatively high onset period of MP infecting.

Objective To investigate the relationship of programmed cell death 4(PDCD4) with the invasion of astrocytic glio-mas .Methods Using the immunohistochemical method to detect the expression of PDCD4 in astrocytic gliomas in different grades . Measuring the peritumoral low-density area on MRI scan ,then compared with the results of immunohistochemical expression .Re-sults The downregulation of PDCD4 was with the increasing of the malignant grade of astrocytic gliomas .The tumor grade malig-nancy was positively correlated with the grade of the peritumoral low-density area on MRI scan(P<0 .05) ,while the expression of PDCD4 was negatively correlated with the grade of astrocytic gliomas (P<0 .01) .Conclusion PDCD4 might serve as one of the in-dicators of invasion and malignant phenotype for astrocytic gliomas .

ObjectiveTo evaluate the efficacy of sphenopalatine ganglion stimulation with acupuncture for moderate-to-severe perennial allergic rhinitis.MethodsA total of 50 patients were recruited into a sphenopalatine ganglion stimulation group and a routine acupuncture group according to order of presentation, with 25 in each group. The sphenopalatine ganglion stimulation group received sphenopalatine ganglion stimulation with filiform needle, 1-2 sessions/week for 4 weeks. The routine acupuncture group received traditional acupuncture, withyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the maln points, andyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the adjunct points, 1-2 points from both the maln and adjunct points in each session, 2 sessions/week for 4 weeks. The nasal symptom score (2004 version), the total nasal symptom score (TNSS) and the total non-nasal symptom score (TNNSS) were used to evaluate symptom improvement. The Rhinoconjunctivitis Quality of Life Questionnalre (RQLQ) was used to assess the patients’ quality of life. The time to symptom alleviation, duration of symptom alleviation in every session and the recurrence duration during 1 month after the treatment were compared between the two groups.Results After the treatment, the score of the nasal symptom score (99.74 ± 31.89vs.196.83 ± 31.22;t=-4.912,P=0.001), TNSS (33.63 ± 12.37vs.71.82 ± 19.21;t=-3.463,P=0.003), TNNSS (33.63 ± 12.37vs.71.82 ± 19.21,t=-3.463,P=0.003) in the sphenopalatine ganglion stimulation were significant lower than those in the routine acupuncture group. Compared with the routine acupuncture group, the time to symptom alleviation was significant shorter (13.85 ± 4.21 minvs.45.63 ± 7.87 min;t=-1.763,P=0.008), while the duration of symptom alleviation was significant longer (37.92 ± 9.94 hvs.3.35 ± 1.23 h;t=7.637,P<0.01) after each session in the sphenopalatine ganglion stimulation group. Four weeks after the treatment, RQLQ score in the sphenopalatine ganglion stimulation group was significant lower than that in the routine acupuncture group (8.48 ± 3.71vs.37.68 ± 12.46;F=-7.312,P<0.01). The recurrence duration during 1 month after the treatment in the sphenopalatine ganglion stimulation group was significant longer than that in the routine acupuncture group (4.12 ± 2.15 dvs.23.53 ± 4.63 d;t=-8.879,P=0.003).ConclusionSphenopalatine Ganglion stimulation is superior to routine acupuncture in treatment of patients with moderate-to-severe perennial allergic rhinitis.

OBJECTIVETo obtain geranylgeranyl diphosphate synthase gene of Salvia miltiorrhiza, and conduct bioinformatic and transcript expression analysis of the cloned SmGGPS1 gene.

METHODThe degenerate primers were designed based on the conservative regions of GGPS protein sequences from public databases. The target gene was obtained from root of S. miltiorrhiza by use of homologous cDNA amplification and RACE technologies. The sequence alignment was performed using BLAST. The open reading frame was identified by use of the ORF Finder. The protein domains were defined by use of Prosite software and the signal peptide sequence was predicted by Target P1.1. MEGA4.0 was used to conduct multiple amino acid sequence alignment and construct the phylogenetic tree. Roots and leaves at the seedlings stage and roots, stems, leaves, buds and flowers in the flowering stage were sampled for transcript analysis. Semi-quantitative RT-PCR was used to detect the gene expression level. The complete gene of GGPS was obtained from S. miltiorrhiza genomic DNA by PCR using the cDNA-derived specific primer. The gene structure of GGPS was analyzed by comparison of the genomic DNA and its cDNA.

RESULTThe obtained 1 298 bp SmGGPS1 cDNA sequence contains an 1095 bp ORF, encoding 364 amino acids. It is predicted that it has a plastid targeting signal peptide of approximately 52 amino acid at the N-terminal end. It is to believe that this is the polyprenyl synthetase signature, and nucleic acid sequence comparison revealed that SmGGPS1 ORF has more than 60% identity to the reported GGPS. RT-PCR semi-quantitative analysis showed that the gene expresses in the all tested tissues, and with much higher level of expression in the leaves in the flowering stage. SmGGPS1 has a 397 bp intron.

CONCLUSIONFor the first time the cloning of geranylgeranyl diphosphate synthase gene from S. miltiorrhiza was reported, and it provides a good basis for further functional study of SmGGPS1.

Amino Acid Sequence ; Base Sequence ; Cloning, Molecular ; Farnesyltranstransferase ; chemistry ; genetics ; metabolism ; Gene Expression Regulation, Enzymologic ; Molecular Sequence Data ; Open Reading Frames ; Phylogeny ; Plant Proteins ; genetics ; metabolism ; Plants ; classification ; enzymology ; genetics ; Salvia miltiorrhiza ; classification ; enzymology ; genetics

Objective To explore the value of MRI in differential diagnosis of primary central nervous system lymphoma (PCNSL) and high grade glioma (HGG) in deep brain.Methods Features of routine MRI and DWI of 28 PCNSL (PCNSL group) and 30 HGG patients (HGG group) with single lesion in deep brain confirmed clinically and pathologically were analyzed,then apparent diffusion coefficient (ADC) and relative ADC (rADC) were measured.The optimal diagnostic threshold (OT) and diagnostic performance of ADC and rADC values were calculated according to the ROC curve.Results The incidence of capsule,necrosis,hemorrhage,enhancement heterogeneity and DWI signal strength were significantly different between the two groups (all P＜0.05).ADC values were statistically different between lesions and the control side of the brain white matter in PCNSL and HGG patients (both P＜0.001).ADC values and rADC values of PCNSL lesions were significantly lower than those of HGG lesions (all P＜0.001).Taking ADC=0.86 × 10-3 mm2/s as a threshold,the sensitivity,specificity and accuracy in differential diagnosis of PCNSL and HGG was 92.9％,80.0％ and 86.2％,respectively,and the area under curve was 0.946 (P＜ 0.001).Taking rADC =1.02 as a threshold,the sensitivity,specificity and accuracy in differential diagnosis of PCNSL and HGG was 92.9％,86.7％ and 89.7％,respectively,and the area under curve was 0.957 (P＜0.001).Conclusion MRI differential diagnosis can provide reliable information for clinical treatment of PCNSL and HGG in deep brain.

Objective To investigate the clinical characteristics and risk factors of the occurrence of hypoxic hepatitis(HH)in children with shock.Methods Clinical data(general situation,clinical situation and prognosis)of 234 children with different types of shock admitted to the pediatrics department of Hainan Women and Children's Medical Center from January 2016 to December 2023 were collected.Serum biochemical indexes on day 1(d1),day 2(d2),day 3(d3),day 5(d5),day 7(d7)of children with shock were collected,including serum alanine aminotransferase(ALT),glutamate aminotransferase(AST),lactate dehydrogenase(LDH),alkaline phosphatase(ALP),albumin(ALB),total bilirubin(TBIL),urea nitrogen(BUN),C reactive protein(CRP),international standardized time(INR)and lactate.And the clinical characteristics and risk factors of the occurrence of HH in children with shock were analyzed.Results A total of 234 cases(150 cases of males)of different types of shock in children were enrolled,ages ranged from 1 month to 16 years old.According to whether developed HH,the children with shock were divided into HH group(32 cases)and non-HH group(202 cases).The total incidence of HH was 13.7%(32/234).Septic shock was the main disease of the occurrence of HH in children with shock,accounting for 65.63%(21/32).According to the prognosis,children with shock combined HH were divided into survival group(17 cases)and death group(15 cases).The case fatality rate of children with shock combined HH was 46.9%.The ALT and AST values in children with shock combined HH were more than 20 times of the upper limits of normal ranges.The peak values of enzymatic indexes in the survival group appeared at the onset time d 1 to d 2,they were close to the normal ranges at the onset time d7,while the enzymatic indexes in the death group were higher than the normal ranges during the whole disease stage.Compared with the survival group,the peak values of ALT,AST,ALP,TBIL,CRP,BUN,and INR in the death group were obviously higher(P<0.05,both).The lowest value of ALB in the death group was lower than that in the survival group(P<0.05).The results of multivariate Logistic regression analysis showed that pediatric critical illness score(PCIS),lactate,multiple organ dysfunction syndrome(MODS),decompensated shock and cardiogenic shock were the risk factors for the occurrence of HH in children with shock(P<0.05 or 0.01),and left ventricular ejection fraction(LVEF)and mean arterial pressure(MAP)were the risk factors of the death of HH in children with shock(P<0.01).Conclusions Children with shock who have the risk factors as decreased PCIS,increased lactate level,MODS,decompensated shock and cardiogenic shock are apt to suffer from HH.Poor prognosis in the chil-dren with shock combined HH is associated with worse condition and lower LVEF.There is a high fatality rate of shock combined HH in children,so that liver function indicators should be closely monitored to early detect HH,and reasonable treatment should be given.

Hemorrhage/etiology* ; Humans ; Image-Guided Biopsy ; Lung/diagnostic imaging* ; Lung Diseases/etiology* ; Lung Neoplasms ; Retrospective Studies ; Risk Factors ; Ultrasonography, Interventional

Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.