Child, Preschool ; Female ; Hand, Foot and Mouth Disease ; complications ; diagnosis ; therapy ; Humans ; Infant ; Male ; Pulmonary Edema ; etiology ; Radiography, Thoracic

Immobilized penicillin acylase was used for bioconversion of penicillin G into 6-APA in aqueous two-phase systems consisted of a light-sensitive polymer PNBC and a pH-sensitive polymer PADB.Partition coefficients of 6-APA was found to be:about 5.78,in the presence of 1% NaCl.Enzyme kinetic showed that reaction reached equilibrium at 7h or so.The 6-APA mole yields were 85.3%(pH 7.8,and 20 ℃) and this value was about 20%higher than control in reaction of single aqueous phase buffer.Partition coefficient of penicillin G(Na) washardly changeable,while partition coefficient of product,6-APA and phenylacetate acid was significantly changeable.Reason is due to Donnan effect of phase systems andhydrophobicity of products.The change of partition coefficients of products also affects bioconversion yield of products.In the aqueous two-phase systems,substrate,penicillin G,products 6-APA and phenylacetate acid are biased in top phase,while immobilized penicillin acylase is completely partitioned in bottom.Substrate,penicillin G enters into bottom phase,and it is catalyzed into 6-APA and phenylacetate acid,then the products enter into top phase.Finally,inhibition of substrate and products is removed to result in improvement of products yield.Moreover,immobilized enzymehashigher efficiency than immobilized cells and occupy smaller volume.Comparing with free enzyme,immobilized enzymehashigher stability,longer use life,completely partitioned in bottom phase and recycle.Bioconversion in two-phase systems using immobilized penicillin acylase showed outstanding advantage.The light-sensitive copolymer forming aqueous two-phase systems could be recovered by laser radiation at 488 nm or filtrated 450 nm light,while pH-sensitive polymer PADB could be recovered by isoelectric point(pH 4.1).The recovery of the two copolymers was 95%~99%.

OBJECTIVETo observe the promoting consciousness effect of electroacupuncture combined with routine western medicine therapy on the patient with coma caused by craniocerebral trauma.

METHODSThirty-two cases were randomly divided into an acupuncture-medication group treated with electroacupuncture at Neiguan (PC 6) and Quze (PC 3) and routine western medicine, and a control group treated with routine western medicine, 16 cases in each group. Glasgow (GCS) scores were assessed after treatment for 7 sessions and 30 sessions respectively and the promoting consciousness rate was observed.

RESULTSAfter treatment of 7 sessions, GCS score was 6.88 +/- 1.63 in the acupuncture-medication group and 5.25-1.65 in the control group with a significant difference between the two groups (P < 0.05); after treatment of 7 sessions, the promoting consciousness rate was 25.0% in the acupuncture-medication group and 0 in the western medicine group, and after treatment for 30 sessions, the promoting conscious ness rate was 81. 3% in the acupuncture-medication group and 43.8% in the western medicine group with a signifi cant difference between the two groups (P < 0.05).

CONCLUSIONElectroacupuncture at Neiguan (PC 6) and Quze (PC 3) combined with western medicine has a good promoting consciousness effect in the patient with coma caused by craniocerebral trauma, which is better than that of simple western medicine.

Adolescent ; Adult ; Aged ; Coma ; drug therapy ; etiology ; therapy ; Combined Modality Therapy ; Craniocerebral Trauma ; complications ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo discuss the clinical epidemiology features and change trend of aortic dissection (AD).

METHODSRetrospective analysis of consecutive 339 patients with AD over 10 years in Guangdong Cardiovascular Institution. Hospital records and prognosis were compared between two five-year periods.

RESULTS339 cases with AD were hospitalized during the past 10 years. The mean age was 55.7 +/- 11.2. The male/female ratio was 4.75 to 1. Hypertension was present in 71.7% of all patients. Heavy smoking history was elicited in 52.2% of all the patients. Type I dissection were identified in 32.3% of all the cases, type II in 5.1%, and type III in 62.6%. In-hospital mortality of acute type A dissection was 35.3%, acute type B dissection 8.0%. In two five-year periods, the total number of cases increased by 165%, among which type I was the fastest, increased by 270%. Changes of mean age and male/female ratio were not significant. For acute AD, changes of prognosis in one year improved, but did not reach statistical significance.

CONCLUSIONSThis study provides insight into current regional profiles of AD. The number of hospitalized patients with AD is increasing dramatically. The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers. Limited by sample size, one year prognosis of acute AD dissection improved, but did not reach statistical significance. These data support the urgent need for further improvement in prevention and treatment of AD.

Adult ; Aged ; Aneurysm, Dissecting ; diagnosis ; epidemiology ; Aortic Diseases ; diagnosis ; epidemiology ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Analysis

OBJECTIVETo evaluate the clinical value of iodine[131I] metuximab infusion combined with transcatheter arterial chemoembolization (TACE) for treating cases of post-intervention relapse of mid or advanced stage hepatocellular carcinoma (HCC).

METHODSSixty patients who were diagnosed between March 2009 and June 2010 with relapse of mid or advanced stage HCC following previous intervention with various standard clinical methods were recruited for study. The patients were randomly and equally divided into a control treatment group (CG; receiving TACE therapy alone) and an experimental treatment group (TG; receiving TACE combined with iodine [131I] metuximab injection). For all patients, licartin was first perfused into the tumor feeding artery and then the TACE procedure was performed 20 min later. Liver function markers and routine blood parameters, including alpha-fetoprotein (AFP) and clotting time, were examined at one week and one month after the treatment. Enhanced computed tomography or magnetic resonance imaging of the liver was performed at one month after treatment and thereafter on a bi-monthly follow-up schedule. The World Health Organization's tumor evaluation standard was used to assess the therapeutic effects in each group. Results of laboratory tests (pre- and post-treatment), reported complications, and side-effects were evaluated for their contributions to time of tumor progression (TTP) and survival time.

RESULTSPatients in the TG and CG groups had similar blood cell counts at pre-operative and 1-week postoperative time points. The TG group showed a significantly reduced level of AFP following treatment, but it was not significantly different from the level in the CG group. The TG group did however show significantly different levels of liver functional parameters (all P less than 0.05) and significantly higher TTP (4.84+/-4.11 vs. CG: 2.54+/-2.08 months; t = -2.13, P less than 0.05) and average survival time (7.05 vs. 5.15 months; x2 = 4.24, P = 0.039). The rates of partial response (PR), slight remission (MR), unchanged status (SD) and progressive disease (PD) were 16.7%, 37.5%, 25.0% and 20.8% in the TG group, and 8.7%, 17.4%, 21.7% and 52.2% in the CG group. The therapeutic effect rate (CR + PR + MR) and reaction rate (CR + PR + MR + SD) was significantly different between the two groups (P = 0.048). No serious adverse effects were reported.

CONCLUSIONTACE combined with iodine [131I] metuximab injection is a safe and effective procedure for prolonging the survival and TTP of patients with HCC relapse following prior therapeutic intervention.

Aged ; Antibodies, Monoclonal ; therapeutic use ; Carcinoma, Hepatocellular ; pathology ; therapy ; Chemoembolization, Therapeutic ; methods ; Female ; Humans ; Iodine Radioisotopes ; therapeutic use ; Liver Neoplasms ; pathology ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; therapy ; Treatment Outcome

OBJECTIVETo study the effect of low- and intermediate-dose factor VIII (FVIII) for prophylactic treatment of severe hemophilia A in children by comprehensively evaluating the outcomes of the joints.

METHODSForty-seven children with severe hemophilia A (FVIII activity ≤2%) were enrolled in this study. Eighteen of the children received prophylactic treatment with low-dose FVIII (10 U/kg, 2-3 times a week), 20 received prophylactic treatment with intermediate-dose FVIII (15-30 U/kg, 3 times a week), and 9 received on-demand treatment with FVIII infusion when bleeding occurred according to the Chinese Expert Consensus on the Diagnosis and Treatment of Hemophilia. The children were followed up for 180 days to observe the changes in the indexes of clinical bleeding phenotype, joint structure, joint function, and joint mobility, and the correlation of these indexes were analyzed.

RESULTSCompared with on-demand treatment, prophylactic treatment with low- and intermediate-dose FVIII significantly improved the clinical hemorrhage phenotype (P<0.01), and the improvement was significantly more conspicuous with intermediate-dose prophylactic treatment (P<0.05). Comprehensive evaluation of the joint structure and function changes showed that compared with on-demand treatment, prophylactic treatment with low- and intermediate-dose FVIII resulted in significant improvements in the total score of Hemophilia Joint Health Score (HJHS), Functional Independence Score in Hemophilia (FISH), the single most severe target joint ultrasound and HJHS score of the target joint (P<0.05) and prophylactic treatment with intermediate-dose FVIII appeared to produce better outcomes of the joint than low-dose FVIII. No correlation was found between annual target joint bleeding rate (ATJBR) and ultrasound score, between ATJBR and HJHS change, or between annual joint bleeding rate (AJBR) and the total score of FISH (P>0.05).

CONCLUSIONCompared with on-demand treatment, prophylactic treatment with low- and intermediate-dose FVIII can significantly improve the bleeding phenotype and delay the progression of joint injury, but the clinical hemorrhagic phenotype is not sufficient to monitor the disease progression.

Objective To observe the microanatomy of the bridging veins emptying into the superior sagittal sinus (SSS) for preservation of the bridging veins in surgeries through the anterior transcallosal approach. Methods Blue latex was injected into the SSS and internal jugular veins in 20 cadaver heads (40 sides), in which the bridging veins of the frontal zone and central zone were dissociated and their positions relative to the body surface were determined. Such indexes of the lateral veins in each zone as the caliber, the number of bridging veins, and convergence angle were determined. The opposite hemisphere was manipulated in an identical manner to measure the indexes of the sagittal sinus. Results in an area posterior to the frontal region of the SSS, a "safe zone" was identified where no bridging veins drained into the SSS, covering the area 32.6 nun anterior and 7.5 mm posterior to the coronal suture. After complete dissociation of the bridging veins near the longitudinal fissure in the "safe zone", the fissure allowed an opening width of 4.48～10.86 mm. Conclusion Thorough knowledge of the venous anatomy can help avoid the bridging veins in the anterior transcallosal approach. Total dissociation of the sticking segment and arachnoid segment of the bridging veins can broaden the opening width of the longitudinal fissure without increasing the tension of the bridging veins to better preserve the bridging veins during surgery.

OBJECTIVETo analyse the cases of platelet transfusion refractoriness after received HLA-matched unrelated donor hematopoietic stem cell transplantation, to analyze and identify the phenotype and genotype of CD36 in both the patient and stem cell donor, as well as the characteristic of antibody induced platelet transfusion refractoriness, and to analyse the efficacy of matched CD36-deficiency platelets transfusions.

METHODSThe CD36 expression on platelet and monocyte was analyzed by flow cytometry (FCM) in both patient and donor. Polymerase chain reaction sequence-based typing (PCR-SBT) was used to analyze the exons sequence of CD36 and HPA. Fast monoclonal antibody-specific immobilization of platelet antigen (F-MAIPA) and FCM were used to identify platelet antibodies in the patient. Short tandem repeat polymerase chain reaction (STR-PCR) was applied to monitor engraftment evidence. The platelet level was monitored. CD36- deficiency donor's platelets were selected from CD36- deficiency donor blood bank.

RESULTSThe donor was CD36 positive and the patient was typed I CD36 deficiency. The anti-CD36 antibody was identified in patient's serum (after transplantation), while the HLA and HPA-related antibodies were excluded. Sequence analysis of CD36 exon in the patient showed Exon 6 -1G>C(Change in splicing site) homozygote, which was a novel CD36 mutation. STR, HPA and CD36 of the patient (complete chimerism) were conversed to that of donor gene types on day 18 after allo-HSCT. The positive CD36 expression on platelet and monocyte in the patient was observed on day 96 after allo-HSCT. The patient showed the platelet transfusion refractoriness which was significantly improved after platelets transfusions from CD36 deficiency donors.

CONCLUSIONStem cell transplants resulted in anti-CD36 and caused platelet transfusion refractoriness, that was first reported in China. To ensure the efficacy of platelet transfusion, the CD36-deficiency patient should receive CD36 deficiency platelets for transfusion.

Antigens, Human Platelet ; Blood Platelet Disorders ; Blood Platelets ; CD36 Antigens ; China ; Humans ; Platelet Transfusion ; Thrombocytopenia

Objective To explore the clinical effect of gamma knife treatment in intractable epilepsy patients with delayed radiation-induced cerebral edema and/or necrosis.Methods The clinical feature,EEG,MRI and treatment modality data of 20 patients,admitted to our hospital from 1995 to 2008 and treated with gamma knife,were analyzed retrospectively.In all these patients,14 received conventional medical treatment and 6 adopted surgical removals of necrosis and epileptic focus resulting from the formation of necrotizing lesion,the apparent mass effect and aggravated seizures after conservative treatment.Results Except 1 patient died of cerebral hernia after giving up surgical treatment,all the other patients achieved good results in controlling the epilepsy and headache.Five in the medical group and 2 in the surgical group still needed anti-epileptic drugs.Two patients presented epilepsy of new type because of brain necrosis after radiation therapy and followed EEG demonstrated that radiation-induced delayed cerebral edema and/or necrosis could lead to new epileptogenie focus.Conclusions Radiation-induced cerebral edema and/or necrosis is a common complication in patients with epilepsy after gamma knife treatment which is unpredicted or repeated,thus early diagnosis and treatment are extremely important.Most patients can be cured with such drugs as corticosteroid combined with mannitol or Chinese herbal medicine.However,surgical treatment is needed in controlling the seizures and improving the symptoms once the cystic necrosis lesion,apparent mass effect and new epileptogenic focus appear.

AIM:To observe the clinical effect of ranibizumab combined with 577nm micropulse laser in the treatment of severe diabetic macular edema(DME). METHODS:There were 52 eyes of 52 patients diagnosed with severe DME who admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from June 2016 to September 2019. The patients were randomly divided into the observation group(26 patients with 26 eyes, treated with ranibizumab combined with 577nm micropulse laser)and the control group(26 patients with 26 eyes, treated with ranibizumab alone). Patients in both groups received intravitreal injection of ranibizumab with “3+PRN” regimen. Followed up at 9mo after treatment to observe the central macular thickness(CMT), the best corrected visual acuity(BCVA)and the times of intravitreal injection of ranibizumab in the two groups.RESULTS:Compared with before treatment, the CMT and BCVA of the two groups were significantly improved at each time point after treatment(all P<0.001), but there was no difference between the two groups(P>0.05). During the follow-up period, the times of vitreous injection of ranibizumabin the observation group was significantly less than that in the control group(5.88±1.24 times vs 7.12±1.24 times, P=0.001). CONCLUSION:Both ranibizumab combined with 577nm micropulse laser and ranibizumab alone are effective in reducing edema and improving vision in patients with severe DME, but the combination therapy reduces the times of injection.