Objective To investigate the concentration of homocysteine (Hcy) and related factors of hyperhomocyste-inemia (hHcy,Hcy≥15μmol/L) among non-hypertensive people aged between 40-70 in Tianjin. Methods Non-hyperten-sive community residents aged 40-70 years were enrolled randomly from May 2011 to December 2012 in six districts in Tian-jin. Plasma Hcy was assessed by enzyme cycling method. Factors related to hHcy were analyzed in multivariate logistic re-gression models. Results Our study included 874 participants (mean age is 57 ± 6 years, 25.5%of all are males) and the con-centration of Hcy was 12.0 μmol/L. The OR (odds ratio)(95%CI; P)for hHcy were 1.048(1.015,1.083; P=0.004), 4.191 (2.359,7.448;P<0.001), 1.280(0.896,1.829;P=0.175), 0.460(0.259,0.816;P=0.008)respectively for age, male, smoking, exercise, and the odd ratio for hHcy were 0.290(0.179, 0.469;P<0.001), 0.168(0.092,0.309;P<0.001)for consumption of vegetable and fruits 250-500 g/d and>500g/d, compared with<250 g/d. Conclusion Male and age were adverse factors for hHcy, consumption of vegetable and fruits, and exercise were positive factors.

Objective: To detect the vascular paths in the lateral wall of maxillary sinus using cone beam computer tomography (CBCT), and to retrospect the surgical managements of avoiding bleeding complication during the lateral approach maxillary sinus elevation.Methods: The documents of 71 consecutive patients with 81 sides maxillary sinus elevation surgery were collected.The vascular paths in the lateral wall of maxillary sinus were detected by the preoperative CBCT, and the messages about the vascular in surgical records were analyzed.Results: The paths of the vascular could be detected in 77 (95.1%) sides maxillary sinus in the reconstruction panoramic images of CBCT.At the position of the first molar, the paths of the vascular of the lateral maxillary sinus walls could be detected in 54 sides (66.7%) in the reconstruction coronal images of CBCT, and the other 27 sides (33.3%) could not be detected.Two approximately parallel paths of the vascular were found in 3 sides (3.7%) of the lateral maxillary sinus walls.The different diagnoses occurred in 6 sinuses between two observers.The kappa of diagnostic consistency of the two observers was 0.842 (P<0.001).The mean distance between the lower border of the vascular path to the plane of the alveolar crest of 54 sides maxillary sinuses was about (13.0±4.7) mm.The mean distance between lower border of vascular path to the plane of the floor of the sinus was (9.3±4.8) mm.The vascular path was located in the floor wall in 1 sinus.During the lateral approach maxillary sinus elevation operation, intraosseous vessels were dissected in 4 sides sinus lateral wall, the vascular path was avoided consciously in 3 sides, and the sinus elevation surgery had to be given up in 1 side for the vessel was torn and bleeding.There were no vascular related messages in 73 sides of the lateral approach maxillary sinus elevation operation records.Conclusion: The vascular paths of maxillary sinus wall could be detected by CBCT in most cases.Preoperative CBCT examination was proved to be reliable.The vascular paths of maxillary sinus wall should be examined carefully.It was helpful to make the surgical design perfectible and reduce the risk of tearing the vessel in operation.

OBJECTIVETo summarize the clinical features, imaging characteristics, diagnosis and treatment of a case with central nervous system infection caused by Exophiala dermatitidis, as well as to review the related literature.

METHODAssociated literature and clinical data of an 8-year-old boy who was diagnosed as central nervous system infection caused by Exophiala dermatitidis in Beijing Children's Hospital Affiliated to Capital Medical University and hospitalized twice from 2012 to 2014 were analyzed retrospectively.

RESULTThe boy was 8 years old with the chief complaint of dizziness for 2 months, intermittent fever for 1 month accompanied with spasm twice. He was diagnosed as bile ducts space-occupying lesions 2 years ago, when the pathological diagnosis was fungal infection. The boy was treated with irregular anti-fungal therapy. Then the boy developed nervous symptoms, impaired consciousness and abnormal physical activity that developed gradually. After hospitalization the cerebral MRI of the boy showed space-occupying lesions accompanied with edema of surrounding area. Filamentous fungi was found by brain biopsy, which was culture positive for Exophiala dermatitidis. After diagnosis the boy was treated with amphotericin B (AMB), voriconazole and 5-Fu, as well as symptomatic treatment. The state of the boy was improved gradually. Two months later, the boy could communicate with others normally and move personally. The lesions and edema seen on the MRI was decreased moderately. Accordingly, the boy was treated with oral voriconazole maintenance treatment for about 1 year and 4 months after discharge. During this period, the state of him was stable without symptoms. The lesions shown by MRI did not disappear but decreased on regular examination. However, recently the disease of the boy progressed again, with dizziness, neck pain, headache and progressive nervous symptoms (intermittent spasm, inability to cough, and impaired consciousness). The boy died at last, even with the active treatment at the second hospitalization. Exophiala dermatitidis was culture-positive again in his CSF, and was confirmed by PCR successfully.

CONCLUSIONThe central nervous system infection caused by Exophiala dermatitidis is rare. Clinical features of this disease were similar to those of other fungal CNS infection, cerebral MRI of which could show the similar lumpy lesions. Diagnosis of the disease should be based on pathology and culture.

Amphotericin B ; administration & dosage ; Antifungal Agents ; administration & dosage ; Brain ; diagnostic imaging ; microbiology ; pathology ; Central Nervous System Infections ; diagnosis ; drug therapy ; microbiology ; Cerebrospinal Fluid ; microbiology ; Child ; Drug Therapy, Combination ; Exophiala ; isolation & purification ; Fatal Outcome ; Fluorouracil ; administration & dosage ; Humans ; Magnetic Resonance Imaging ; Male ; Mycoses ; diagnosis ; drug therapy ; microbiology ; Radiography ; Voriconazole ; administration & dosage

Objective:To investigate the pathogenic characteristics of viral encephalitis or meningitis in children living in Shijiazhuang city and surrounding areas, and to study the relationship between pathogenic and clinical findings.Methods:A total of 132 cerebrospinal fluid specimens were randomly collected from hospitalized children diagnosed with viral encephalitis or meningitis (January 2018 to December 2018) in the Department of Neurology of Hebei Children′s Hospital in Shijiazhuang city and surrounding areas. The nucleic acids of four viruses in cerebrospinal fluid were detected by real-time quantitative PCR. SPSS 21.0 software was used for statistical analysis.Results:Among the 132 cases, 78 were boys and 54 were girls, with a sex ratio of 1.44∶1. However, in the gender composition of children in each age group, there was no significant difference (χ 2=3.901, P=0.272). Of the 132 children, 121 had signs of fever, 109 had symptoms of headache, 92 had symptoms of vomiting, 17 had abnormal electroencephalogram(EEG), and 15 had abnormal head magnetic resonance imaging(MRI). 132 cerebrospinal fluid specimens were tested for pathogenic pathogens, and 80 of them were successfully detected. There was 1 case of human herpesvirus type I(HHV-I), 2 cases of varicella-zoster virus (VZV) and 77 cases of enterovirus(EV). The age group of 1~3 years′s EV detection rate was 66.67%, it is the highest, but overall, the EV detection rate, there was no significant difference among the four age groups (χ 2=3.147, P=0.369). The detection rate of EV in summer and autumn were 65.52% and 70.83%, respectively, which were significantly higher than those in spring and winter (33.33% and 0.00%), and there was a significant difference (χ 2=22.504, P=0.000). There was no significant difference in the positive rates of fever, headache and vomiting between EV-positive and non-EV-positive children ( P>0.05). There was no significant difference in the incidence of abnormal EEG and abnormal head MRI between EV-positive and non-EV-positive children ( P>0.05). Conclusions:In 2018, EV was the main pathogen of viral encephalitis and meningitis in children in Shijiazhuang city and surrounding areas, and EV detection rate was high in summer and autumn.