Child ; Humans ; Respiratory Syncytial Virus Infections ; immunology ; virology ; Respiratory Syncytial Virus, Human ; immunology ; pathogenicity

Introduction: Gallstones disease is a common disorder and symptomatic disease is usually managed with surgery while those with common bile duct stones are usually managed with endoscopic intervention before proceeding to surgery. This study was intended to assess the rate of cholecystectomy among patients who had undergone ERC interventions, the reasons for not proceeding to cholecystectomy and related complications. Materials and Methods: Patients who had intact gallbladder and had undergone ERC for stones related complications over a two year period were retrospectively identified from the Endoscopic Unit Registry. Detailed case note reviews were conducted. Results: The overall cholecystectomy rate post-ERC interventions was 36.9% (48/130). Cholecystectomy was offered to 59.2% (n=77) and the uptake was only 58.4% (n=45/77). Among those who agreed for cholecystectomy, 11.1% (n=5/45) failed to turn up for their scheduled surgery. Three patients (6.7%) had symptoms recurrence before their scheduled surgery: two subsequently underwent cholecystectomy without ERC intervention and one who was pregnant was managed conservatively with holecystectomy. Among the patients who had declined cholecystectomy, 18.8% (n=6/32) had symptoms recurrence. Four patients required repeat ERC interventions and eventually all had cholecystectomy subsequently. The most common reason for declining cholecystectomy was 'not keen' and already asymptomatic (46.9%, n=15/32). Among patients who were not offerred cholecystectomy (n=53/130), symptoms recurrence occurred in 15.2% (n=7/53). Four patients required repeat ERC interventions and three subsequently underwent cholecystectomy. Conclusions: The cholecystectomy rate remains low after ERC interventions. Recurrence of symptoms necessating re-interventions occurred in patients offerred and not offerred cholecystectomy. The uptake rate should be improved and delay to cholecystectomy should be reduced to avoid symptoms recurrence. Patients not undergoing interventions should be advised regarding symptoms recurrence and should be monitored.
Choledocholithiasis ; Cholecystectomy ; Cholangiopancreatography, Endoscopic Retrograde ; CHOLELITHIASIS

Objective To study the clinical application of laparoscopy in the treatment of closed abdominal trauma. Methods Emergent laparoscopic exploration and treatment was conducted in 21 patients with closed abdominal trauma, who had stable hemodynamic parameters,from July 2000 to December 2003. Results Diagnosis was clarified laparoscopically in all the 21 patients. There were 4 cases of open liver repair, 2 cases of laparoscopic liver repair, 5 cases of open splenectomy, 3 cases of hand-assisted laparoscopic splenectomy, 2 cases of video-assisted small incisional intestinal repair, 4 cases of partial intestinal resection and 1 case of laparoscopic greater omentum hemostasis. Conclusions Laparoscopy in the diagnosis and treatment of closed abdominal trauma is accurate, safe and effective.

Abstract: To report the diagnosis and treatment of Mucor infection in two cases of renal transplantation, and to provide reference for diagnosis and treatment of Mucor infection. Case 1, a male patient, who underwent allogeneic kidney transplantation due to increased creatinine for more than 8 years. The renal function had partially recovered 25 days after the operation, but then the patient suddenly got worse epigastric pain. Pathogen culture, smear microscopy, mass spectrometry identification and next-generation metagenomic sequencing (mNGS) were performed on the peritoneal drainage, with the result pointing to Rhizopus microsporus. The patient's condition improved after antifungal treatment using amphotericin B lipid complex (ABLC) and was discharged. Case 2, a male patient with hypertension and increased creatinine for more than 7 years was admitted to the hospital. After allograft kidney transplantation, tissue culture smear and histopathological examination suggested Mucor infection. The patient then underwent a "hand muscle debridement surgery + closed negative pressure drainage (VSD)" procedure, and amphotericin B was given postoperative treatment against Mucor infection and debridement. Subsequent retesting with mNGS showed no signs of Mucor infection. In the course of treatment, two patients developed abdominal pain after treatment with tegacycline, which was immediately diagnosed as pancreatitis and recovered after withdrawal. Both patients being male, with one case associated with hypertension. After initially guiding the diagnosis with traditional smear tests, final confirmation was done using histopathological examination, mNGS and mass spectrometry. One case was infected by Rhizopus microspora, and the other was infected by Rhizopus oryzae and Cunninghamia microbicans. The causes leading to Mucor infection in patients post renal transplantation varied greatly. Early diagnosis is the key to treatment of patients with Mucor infection after renal transplantation. Treatment with amphoteric B and its liposome is an effective means to improve mucormycosis patients after renal transplantation. The use of amphotericin B lipid complex treatment proved to be an effective treatment method for patients with Mucor infection after renal transplantation.

0.05).The death rate of cases with pneumonia combined with ascites was higher than that of cases with ascites only(?2=4.894,P=0.027) and cases without ascites and infections(?2=9.260,P=0.002).Unfavorable prognosis was found in cases with Enterococcus faecium isolated before OLT.CONCLUSIONS Severe lung infection before OLT is one of the main reasons of death.It is important to grasp characteristics of infection,evaluate risk fully,control infections and screen cases strictly before OLT to improve survival rate.

Objective To define a suitable threshold setting for gross tumor volume (GTV)when using 18F-fluoro-deoxyglucose positron emission tomography and computed tomogram (PET/CT) for radiotherapy planning in Nasopharyngeal carcinoma(NPC).Methods Sixteen NPC patients respectively received PET/CT and MRI scan before their radiation treatment.All of the images were transferred to the radiotherapy planning system (TPS).MRI/CT-based primary GTV was defined as GTVf.Biological target volumes (BTVs) were derived from PET/CT-based GTVs of primary tumors.The BTVs were defined as the volumes when adjusting different percentage of the maximal standardized uptake value (SUVmax).GTVfs were compared with BTVs.The suitable threshold level (sTL) could be determined when BTV value and its morphology using a certain threshold level were observed to be the fittest GTVf.The suitable standardized uptake value (sSUV) was calculated as the sTL multiplied by the SUVmax.Results Our result demonstrated no single sTL or sSUV method could achieve an optimized volumetric match with the GTVf.The sTL was [20.93％±6.51％(15％-40％)],whereas the sSUV was [2.27±0.48(1.56-3.25)].The sTL was inversely correlated with the SUVmax sTL =-0.144ln(SUVmax) + 0.5548 (R2 =0.85,F =78.57,P＜0.01.The sSUV showed a linear correlation with the SUVmax sSUV =0.104(SUVmax) + 1.0398,(R2=0.75,F=41.88,P＜0.01).The sTL was not associated with the value of GTVf.Conclusions In PET/CT-based BTV for NPC,SUVmax threshold method is feasible.sTL is not a fixed value,which is correlated with the SUVmax instead of the value of tumor.

Objective To evaluate different expressions of high mobility group box 1(HMGB1)and receptor for advanced glycation end products(RAGE)in placentas and their relationship with preeclampsia.Methods Fifteen early-onset pre-eclaraptic women(early-onset pre-eclampsia group),22 late-onset pre-eclamptic women(late-onset pre-eclampsia group)and 12 normotensive women(control group)in the third trimester were recruited at the Shengjing Hospital of China Medical University from March 2006 to March 2007.The localization and levels of HMGB1 and RAGE in placentas of the three groups were detected by the strept avidin biotin-peroxidose method.Results (1)Immunoreactivities to HMGB1:positive immnnostaining for HMGB1 was observed in trophoblast,macrophages,decidual cells,vascular muscle cells,endothelial cells and placental mesenchymal cells in the placentas from the pre-eclamptic women,while a low level of immunoreactivities was observed in the placentas from healthy pregnancies;the staining was observed within both the nuclei and the cytoplasm,mainly in the cytoplasm.The cytotrophoblast,especially the nuclei was extensively positive for HMGB1 in early-onset pre-eclampsia. (2)Immunoreactivities to RAGE:positive immunostaining for HMGB1 was observed in syncytiotrophoblast,macrophages and endothelial cells in the placentas from the preeclamptic women,while a low level of immunoreactivities was observed in the placentas from healthy pregnancies:the staining was in the cytoplasm and(or)cell membrane.The trophoblast was extensively positive for RAGE in early-onset pre-eclampsia.(3)Positive rate of HMGB1 expression:the expression of HMGB1 in early-onset group(73%,11/15)and late-onset group(64%,14/22)was significantly higher than that in normal group(17%,2/12;P<0.05),but no significant difference was found in early-onset group and late-onset group(P>0.05).(4)Positive rate of RAGE expression:the expression of RAGE in early-onset group(80%,12/15)and late-onset group (82%,18/22)was significantly higher than that in normal group(25%,3/12;P<0.05),but no significant difference was found in early-onset group and late-onset group(P>0.05).Conclusions The increased expression of HMGB1 and RACE in the placenta may play an important role in the pathogenesis of pre-eclampsis.The different locations may be associated with the occurrence of different onset types of pre-eclampsia.

Objective To observe the efficacy of pregabalin in the treatment of painful diabeticperipheral neuropathy.Methods In a 8-week study,50 patients were randomly assigned into two groups:the therapy group and the control group.The patients in the therapy group were treated with pregabalin 150 mg/d,and the patients in the control group were treated with carbamazepine 200 mg/d.The dose of pregabalin was increased to 300 mg/d till pain was alleviated in the therapy group,and the dose of carbamazepine was increased to 600 mg/d till pain was alleviated in the control group.The therapeutic effect and VAS score in the two groups were observed and evaluated.Results After 1 and 8 weeks' treatment,the therapeutic effect of therapy group were significantly superior to the control group ( At 1 week:U =2.028,P =0.046 ; At 8 week:U =3.540,P ＜0.001 ).After 1 and 8 weeks' treatment,the VAS scores of therapy group were significantly lower than the control group ( At 1 week:5.13 ± 1.76 vs.6.74 ± 1.52,P ＜ 0.05 ; At 8 week:1.13 ± 0.45 vs 3.27 ± 1.04,P ＜ 0.05).There were 5 patients (20％) and 10 patients (40％) had adverse reaction in the therapy and the control groups respectively.Conclusion Pregabalin is effective and safe for the treatment of painful diabetic peripheral neuropathy.

Objective To explore the pathological changes of the livers from hepatic failure (HF)patients and its association with clinical disease stages.Methods Thirty-nine patients with liver failure caused by HBV infections were investigated,and none accompanied with hepatocellular carci- noma.The sections of tissue were taken from the liver after liver transplantation and stained with he- matoxylin eosin(H&E)or RT(reticular fiber)staining.The pathological features were analyzed and compared between the clinical and pathological diagnosis.Results 1.The range and the grade of the pathological changes were all well-proportioned in the whole liver but quite asymmetrical in the same spicemen.2.4 cases with clinical diagnosis of cirrhosis(active stage)were in accordance with the pathological diagnosis.Only 17 in 35cases can be pathologically diagnosed as chronic severe hepatitis (SH),while the other 18 cases were pathologically diagnosed as cirrhosis(active stage).Conclu- sion There were a great inconsistency between the clinical and pathological diagnosis.