Adult onset Still's disease is a rare inflammatory disease characterized by spiking fevers, arthritis/ arthralgias, typical salmon-colored bumpy rash, pharyngalgia, myalgia and possible involvement of visceral organs. The diagnosis is exclusively based on clinical symptoms, according to the criteria, after the exclusion of well-known infectious, neoplastic, or other autoimmune/autoinflammatory disorders. This report includes one case of adult onset Still's disease with the initial symptom of pharyngalgia.
Adult ; Humans ; Pharyngitis ; Rare Diseases ; Still's Disease, Adult-Onset ; diagnosis

OBJECTIVETo observe the impact of electroacupuncture (EA) on the quality of life in the patients of female mixed urinary incontinence (MUI) and evaluate its clinical efficacy.

METHODSEA was adopted in 25 cases of MUI at Zhongliao (BL 33) and Huiyang (BL 35), needle retaining for 30 min each time. The treatment was given once every two days, three treatments a week, totally for 12 weeks of treatment. The incontinence quality of life questionnaire (I-QOL), the incontinence impact questionnaire-7 (IIQ-7), the urogenital distress inventory short form (UDI-SF) and the visual analogue scale (VAS) were adopted in the comparison before and after treatment. The efficacy was evaluated.

RESULTSThe curative rate was 52.0% (13/25) and the total effective rate was 96.0% (24/25) in 25 cases. In comparison before and after treatment, in I-QOL, the score of limiting behaviors was increased up to (30.32 ± 3.39) from (11.52 ± 2.45), the score of psychosocial impacts was up to (36.48 ± 2.90) from (13.52 ± 2.25) and the score of social isolation was up to (21.52 ± 1.61) from (9.84 ± 2.23). The score of IIQ-7 was decreased, down to (2.48 ± 1.36) from (11.96 ± 3.45), the score of UDI-SF was down to (2.92 ± 0.95) from (8.84 ± 2.58) and VAS score was down to (1.40 ± 0.91) from (6.96 ± 1.65). The differences were all significant statistically in comparison (all P < 0.05).

CONCLUSIONEA improves effectively the quality of life in MUI patients and the clinical efficacy is apparent.

Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Middle Aged ; Quality of Life ; Treatment Outcome ; Urinary Incontinence ; physiopathology ; therapy ; Urination

OBJECTIVETo verify the effect of electroacupuncture (EA) for female stress urinary incontinence (SU).

METHODSForty-two patients were randomly divided into an observation group(20 cases) and a control group (22 cases). EA at Zhongliao (BL 33) and Huiyang (BL 35) was used in the observation group. Sham acupuncture at non meridian points, one can beside Zhongliao (BL 33) and Huiyang (BL 35), was applied, and placebo EA was adopted in the control group. Treatment with needle retained for 30 min a time was given once every other day and three times a week for continuous six weeks in the two groups. Urinary and reproductive simple score (UDI),visual analogue scale (VAS) and the frequency of nocturnal enuresis were observed before treatment, at the second, forth and sixth week of treatment in the two groups, and the efficacy was compared.

RESULTSThe effective rates of the observation group were 80.0% (16/20), 95.0% (19/20) and 95.0% (19/20), which were better than 40.9% (9/22), 31.8% (7/22) and 27.3% (6/22) of the control group at the second, forth and sixth week of treatment. The differences were statistically significant between the two groups (all P < 0.05). After treatment in the observation group, the results of UDI, VAS and frequency of nocturnal enuresis were improved compared with those before treatment (all P < 0.05). Along with treatment, all indices were gradually improved, and the change at the sixth week was the most obvious in observation group. The results of the observation group were better than those of the control group at all times (all P < 0.05).

CONCLUSIONEA achieves obvious effect for female SUI, and effectively improves the lower urinary trace symptoms, the degree of urinary incontinence and the frequency of nocturnal enuresis. The effect becomes increasingly better along with treatment within six weeks.

Acupuncture Points ; Electroacupuncture ; Female ; Humans ; Treatment Outcome ; Urinary Incontinence, Stress ; physiopathology ; therapy ; Urination

We investigated the epidemiological characteristics of diarrheagenic Escherichia coli (E.coli) infection in Fujian Province,providing reference for the prevention and control of diarrhea epidemic and outbreak.Yanping and Yongan areas were selected as surveillance sites from year 2010 to 2015,where 1 950 samples were collected from the sentinel hospitals,and then samples were isolated and cultured on MacConkey agar plates.Suspected strains were identified by routine and molecular diag nosis technique methods.Results were analyzed by SPSS 17.0 software package.A total of 129 strains of diarrheagenic E.coli were isolated with a total detection rate of 6.62％.The detection rates of enteropathogenic E.coli(EPEC),enterotoxigenic E.coli(ETEC) and enteroadhesive E.coli(EAEC) were 3.33％,1.64％ and 1.64％ respectively (including 61 strains of atypical EPEC,4 strains of typical EPEC,and 32 strains of ETEC and EAEC for each),while EHEC and EIEC were not found.There was no significant difference between the detection rates of male and female.All the patients were divided into five groups according to the age,and there were no significant differences between the detection rates of EPEC,EAEC and ETEC in the 5 groups.The detection rates were the highest in August and September.There was no significant difference between the detection rates of rural area and uban area.There was also no significant difference between the composition ratio of diarrheagenic E.coli (DEC) in the two surveillance sites.In conclusion,there were three kinds of DEC in Fujian Province,and EPEC was the dominant.August and September were the months with the highest detection rates.Children age less than five and adult aged 20 59 years were the high risk groups with DEC infection.More attention should be attached on the rational treatment by antibiotic for DEC.

Objective To evaluate the efficacy of caudal block with dexmedetomidine mixed with lidocaine for management of perioperative analgesia in children. Methods Thirty pediatric patients, aged 2-6 yr, weighing 8-23 kg, scheduled for elective unilateral high ligation of hernial sac, were equally and randomly assigned into either lidocaine group ( group L ) or dexmedetomidine mixed with lidocaine group ( group DL) using a random number table. Each patient received a single caudal dose of 1% lidocaine 1 ml∕kg in group L. Each patient received a single caudal dose of 1% lidocaine 1 ml∕kg mixed with dexmedetomidine 1 μg∕kg in group DL. Postoperative analgesia was assessed using FLACC scale. When FLACC score ≥4, ibuprofen suspension 10 mg∕kg was given orally. The consumption of ibuprofen was recorded within 8 h after operation. The onset time of caudal block and duration of analgesia were recorded, and adverse effects were observed. Results Compared with group L, the onset time of caudal block was significantly shortened, the duration of analgesia was prolonged, and the requirement for ibuprofen was decreased in group L. There was no significant difference in adverse effects between the two groups. Conclusion Addition of dexmedetomidine 1 μg∕kg to caudal lidocaine can significantly optimize the efficacy of caudal block with lidocaine alone for the management of perioperative analgesia in children.

Objective To observe the effect of one-lung ventilation (OLV) on cerebral oxygen balance and energy metabolism during total intravenous anesthesia for thoracoscopic surgery.Methods Thirty patients scheduled for thoracoscopic surgery were selected.After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol by target controlled infusion in order to maintain a bispectral index(BIS) between 40 and 60,and end-tidal partial pressure of carbon dioxide (PETCO2) between 30mmHg and 35mmHg.Mean arterial pressure (MAP),heart rate (HR),SpO2,PetCO2,cerebral blood flow velocity (CBFv),BIS value and nasopharyngeal temperature(NPT) were measured,always with the patients in the lateral position,in four phases:10min after beginning twolung ventilation (TLV),15 min after beginning OLV (OLV + 15),30min after beginning OLV (OLV + 30) and 60 min after beginning OLV(OLV + 60).Blood samples were drawn simultaneously and analyzed within 5min.The Da-jvO2,CERO2,CMRO2,Da-jvLac and Da-jvGlu at each phase were calculated.Results In all patients,a decrease in PaO2 [(172±85) vs (428±42);(162±54) vs (428±42);(185±61) vs (428±42)] and MAP [(70±10) vs (81 ±11) ; (71 ± 12) vs (81 ± 11)] occurred during OLV (t =15.02,13.14,23.25,20.16,18.02,all P ＜ 0.05).SjvO2 at the phase:OLV + 15 and OLV + 30 were significantly lower than those at TLV [(54.0 ± 1.2) ％ vs (65.0 ± 0.8) ％ ;(55.0±1.5)％ vs (65.0 ±0.8)％] (t =3.12,2.14,all P＜0.05).Ca-jvO2[(50 ± 12)％ vs(40 ± 12)％ ;(54±11)％ vs (40 ± 12)％],CMRO2 [(186 ±40) vs (162 ± 35);(191 ±24) vs (162 ±35)]and CERO2 [(36 ± 12) vs (30 ± 1 1) ; (35 ± 10) vs (30 ± 11)] atthephase:OLV + 15 andOLV + 30weresignificantlyhigher than those at TLV (t =5.23,4.28,1.86,2.01,8.21,10.11,all P ＜ 0.05).After OLV,Da-jvGlu [(0.45 ± 0.10) vs (0.22 ± 0.30) ; (0.52 ± 0.20) vs (0.22 ± 0.30) ; (0.40 ± 0.20) vs (0.22 ± 0.30)] significantly increased (t =6.45,12.03,15.10,all P ＜ 0.05).The differences of Da-jvLac and CBFv at every phase were not significant (P ＞0.05).Conclusion During total intravenous anesthesia,OLV resulted in an increase of consumption of cerebral oxygen and energy.It may be not good for cerebral oxygen balance and energy metabolism.The efficient prevention is necessary clinically.

The emergence of atypical El Tor strains from V .cholerae in South Asia and Africa has been attributed to several outbreaks in recent decades ,however ,backgrounds of such strains in China remain exclusive .In this study ,PCR am-plification of both El Tor and classical alleles for ctxB ,tcpA ,rstR and hlyA genes was attempted in sixty-nine El Tor isolates from Fujian between 1962 to 2005 ,in addition ,some amplicons were sequence-analyzed .Thus ,the time point of atypical EVC strains in Fujian was determined ,genetic diversities of such strains were investigated .It was revealed that ctxB-Cl ,tcpA-Cl and hlyA genes were detected in O1 serogroup EVC isolates from Fujian since 1962 .Although rstR-Cl gene was solely detected in isolates between 1994 to 2000 .It was indicated by sequence analysis that atypical EVC strains from Fujian possessed a novel T→G mutation at residual 204 of the ctxB gene .Remarkably ,two novel ctxB genotypes (ctxB-10 and ctxB-11) were identified in one strain .The residual 115-C of ctxB in ctxB-11 showed characteristics of ctxB-Cl ,however ,its residual 203-T demonstra-ted characteristics of ctxB-El .This observation implied that it was common in O1 serogroup EVC strains from Fujian hybrid-ized with classical alleles since 1962 ,which would be the earliest time-point for the emergence of atypical El Tor strains hitherto in literature .Emergence of atypical El Tor strains harboring rstR-Cl in Fujian occurred since 1994 .Meanwhile ,novel mutation sites and ctxB genotypes were observed in Fujian isolates ,including diverse combination of ctxB genotypes in one strain and combination of biotype-specific sites in ctxB sequences .In summary ,molecular characterization of O 1 serogroup EVC strains from Fujian was unique and geography-associated .

Single-docking robot-assisted laparoscopic radical nephroureterectomy is difficult to deal with the distal ureter and bladder. Thirty-two patients with ureter carcinoma underwent single-docking robot-assisted nephroureterectomy in rectus rectilinear cannula placement in our hospital. The advantages include lower surgical difficulty, shorter operation time, less surgical bleeding and damage. This surgical method is a safe and effective minimally invasive treatment for ureter carcinoma.

The occurrence of the clinical manifestations of myocardial ischemia shows clear circadian rhythmicity ,and they are unevenly distributed during the 24 h with higher morbidity during the initial hours of the daily activity span and in the late afternoon or early evening .Such temporal patterns result from circadian rhythms in pathophysiological mechanisms plus cyclic environmental stressors that trigger these clinical events .β‐receptor antagonist medications ,oral nitrate ,and calcium channel blocker have been shown to be influenced by the circadian time of their administration .Here we briefly review the char‐acteristics of circadian rhythmicity in MI ,the pathophysiological mechanisms as well as the current chronotherapy ,and then discuss the future treatment strategies .

Purpose To explore the value of CT-based radiomics in the preoperative prediction of lymphatic invasion of node-negative gastric cancer,and to construct a nomogram combined with clinical variables.Materials and Methods The clinical and CT imaging data of 173 gastric cancer patients with lymph node negative and pathologically confirmed gastric cancer in the Sir Run Run Shaw Hospital from January 2019 to June 2021 were retrospectively analyzed.A total of 60 cases with lymphovascular invasion(LVI)positive patients and 113 cases with LVI negative patients were included,and randomly divided into train cohort(n=121)and test cohort(n=52)at 7∶3.Based on the train cohort,the clinical model,the radiomics model,the fusion model were constructed and verified in the test cohort.Clinical data and conventional CT features included age,gender,tumor marker,tumor location,tumor morphology,enhancement range,etc.The clinical significant variables were selected through univariate and multivariate analysis to establish the clinical model.The tumor regions of interest were segmented and radiomics features were extracted by using the 3D-Slicer software.Key features were screened through least absolute shrinkage and selection operator regression analysis,and then the radiomics model was constructed with random forest algorithm,and converted to random forest score(RF score).The fusion model was constructed via combining clinical significant variables and RF score,and visualized as a nomogram.The receiver operator characteristic curve and area under curve(AUC)were used to evaluate the prediction performance of the models.Decision curve analysis was used to calculate the clinical practicability.Results The radiomics model was superior to the clinical model.The radiomics model AUC of the train cohort and the test cohort were 0.872(0.810 to 0.935)and 0.827(0.707 to 0.947),the clinical model AUC were 0.767(0.682 to 0.852)and 0.761(0.610 to 0.913).The nomogram further improved the predictive efficiency,the AUC in train cohort and test cohort reached 0.898(0.842 to 0.953)and 0.844(0.717 to 0.971),respectively.Decision curve analysis demonstrated clinical benefits of nomogram.Conclusion The radiomics model can be used to preoperatively predict LVI of node-negative gastric cancer.The nomogram can further improve the prediction efficiency.