Objective To discuss the clinical features of immunocompetent patients with Penicilliosis marneffei.Methods To analyze and summarize the clinical data of 4 immunocompetent patients with Penicilliosis marneffei.Results Clinical manifestation of patients centered on intermittent slight or mild fever,lymphadenectasis,skin eruptions,osteolytic destruction,anaemia,and leukocytosis.The cultural Penicillium marneffei in specimen such as blood,pus showed a higher positive rate.Amphotericin B and itraconazole was available in treatment.Conclusion Immunocompetent people can be infected by Penicillium marneffei,and they appear nonspecific in clinical manifestation after infection.A timely and effective antifungal therapy can improve the prognosis of patients.

Respiratory dysfunction is a significant part of disorders associated with stroke. Stroke could impair respiratory center or motor pathway, leading to alter breath pattern or reduced respiratory muscle strength. Pneumonia secondary to stroke and stroke-associated sleep apnea are common respiratory disorder, which are adverse to the prognosis of stroke. Clinical routine physical examination is basic evaluation of respiratory function. Attention should be paid especially in breath pattern, respiratory muscle volume and muscle tone. Multiple quantitative assessments include arterial blood gas analysis, sleep apnea monitoring, dynamical, imaging and electrophysiological tests. Rehabilitation can be used to improve the inspiratory muscle strength, endurance and cough effectiveness, reduce sleep apnea hypoventilation, enhance the cardiorespiratory fitness, finally improve the quality of life in stroke patients.

OBJECTIVETo investigate the therapeutic effect of reconstruction of facial defects with frontal expanded flaps bipedicled by superficial temple vessels and supraorbital/supratrochlear neurovascular bundles.

METHODSFrom June 2006 to Mar. 2013, the patients with mostly unilateral facial defects which affected temple area and crossed the facial midline, were treated with frontal expanded flaps. The expanders were implanted at first stage and the expanded frontal flaps were transferred at second stage. At third stage, pedicle division was performed and the pedicle skin tissue was used to repair the residue defect.

RESULTAll the 18 flaps survived completely with satisfactory color and texture. Good results were achieved during the follow-up period of one year.

CONCLUSIONThe bipedicled frontal expanded flap has a reliable blood supply which is very suitable for large facial defect.

Adolescent ; Adult ; Child ; Face ; surgery ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Treatment Outcome ; Young Adult

OBJECTIVE:To provide reference for rational use of antidepressive drugs. METHODS:In retrospective study,the utilization of antidepressive drugs in 31 hospitals of Nanjing area during 2013-2015 was analyzed statistically in respects of consump-tion sum,DDDs,DDC,B/A,etc. RESULTS:There were a total of 20 kinds of antidepressive drugs in 31 hospitals of Nanjing ar-ea,and total consumption sum increased year by year,increasing from 76 085 200 yuan in 2013 to 100 812 500 yuan in 2015,in-creased by 17.43% compared to 2014 and by 12.83% compared to 2015. The top 4 drugs in the list of consumption sum and DDDs were paroxetine,escitalopram,sertraline and venlafaxine. The sum of their consumption sum accounted for more than 60% of total consumption sum. The consumption sum of plant antidepressive drugs increased rapidly. B/A and DDC of antidepressive drugs kept sta-ble each year compared to last year,among which DDC of doxepin,clomipramine and amitriptyline was less than 2 yuan,B/A val-ues of sertraline,fluvoxamine,flupentixol and melitracen,doxepin,clomipramine and amitriptyline were all more than 1.00. CON-CLUSIONS:Of antidepressive drugs in 31 hospitals of Nanjing area during 2013-2015,selective serotonin reuptake inhibitors and se-lective serotonin-norepinephrine reuptake inhibitors took up dominant place,and plant antidepressive drugs is promising in the future.

Objective To explore the correlation between postoperative cognitive dysfunction (POCD)and serum level of S100βand NSE in patients undergoing on-pump heart valve replacement. Methods Ninety-eight patients underwent elective heart valve replacement were enrolled and divided into two groups:POCD group (group P)and none POCD group(group NP)by the result of neurocog-nitive testing with MMSE performed preoperatively and on the first postoperative day.Serum S-100βprotein and NSE were measured before operation(T0 ),at the end of operation(T1 ),24 h(T2 )and 48 h(T3 ) postoperatively.Results The incidence of POCD on the first postoperative day was 45 (45.9%).Compared with T0 ,the S100βincreased at T1 in both groups (P <0.05),NSE increased at T1 and T2 in both groups,and NSE increased in group NP at T3 (P <0.05).There was no signifi-cant difference of NSE between groups P and NP.The prolonged recovery time(OR = 1.222,P =0.004)and increased concentration of S100βat the end of operation(OR=1.85,P =0.009)were pre-dictors of POCD on the first postoperative day.Conclusion There was a higher incidence of POCD af-ter on-pump heart valve replacement surgery.The prolonged recovery time and increased concentra-tion of S100βat the end of operation might be predictors of POCD.

PurposeSpinal cord is one of the most frequently involved sites of multiple sclerosis (MS), which seriously affects the life quality of patients. In this paper, we investigate the application value of voxel-based morphology (VBM) and resting-state magnetic resonance imaging (RS-fMRI) in multiple sclerosis patients with single spinal cord involvement (MS-SSCI).Materials and Methods Three-dimensional T1WI data and RS-fMRI data were acquired from 20 patients with MS-SSCI and 20 normal controls, grey matter volume (GMV), changes of white matter volume (WMV), total intracranial volume (TIV) and local nuclei volume were compared between the two groups using VBM, posterior cingulate cortex (PCC) was regarded as the seed point and the functional connectivity about whole brain was compared between the two groups by using resting-state functional connectivity analysis, the relationships between MS-SSCI structure, function change parameters and expanded disability states scale (EDSS) scores were further explored.Results①Compared with the control group, GMV, WMV, TIV of MS-SSCI group were not significantly reduced, only the volume of some regions (bilateral middle temporal gyrus, left inferior temporal gyrus) showed significant atrophy (P<0.01); MS-SSCI exhibited increased functional connectivity (FC) in the left medial prefrontal cortex, left inferior temporal gyrus, left caudate nucleus and right supplementary motor area (two-sample t test, after AlphaSim correction,P<0.01, voxel size >40).②There was no significant correlation (P>0.05) between MS-SSCI structure change parameters and EDSS; while a significant correlation between EDSS scores and FC was noted in the left inferior temporal gyrus (r=0.633,P<0.05).Conclusion Both structural abnormalities and altered FC with PCC can be detected in MS-SSCI, but only functional parameters are associated with clinical abnormalities, which are more sensitive than microstructural changes.

Objective To construct a extracellular matrix-like collagen mimetic peptide-PEG hybrid hydrogel and to study the usage of this hydrogel in 3D culture of rabbit bone marrow mesenchymal stem cells (rBMSCs).Methods The hybrid hydrogel was synthesised by conjugating the cysteine at the end of the collagen mimetic peptide with the maleimine-modified multi-arm PEG.The circular dichroism spectra were used to characterize the triple helix structure and thermal stability of the collagen mimetic peptides.The rheology test and scanning electron microscopy were used to study the gelation process,mechanical strength and internal structure of the hydrogel.The rBMSCs were embedded in the hybrid hydrogel for 3D culture.The cell compatibility of the hydrogel and its effect on differentiation of the cells was studied.Results Collagen mimetic peptides could promote spontaneous formation of triple helix structure in the natural collagen,and the thermal transition temperature was 49.4 ℃.The formation process of the collagen mimetic peptides-PEG hybrid hydrogel was rapid,in which the porous network-like fibrous structure was formed.After the encapsulation of rBMSCs within the hydrogel for 24 h,most of the cells remained viable.Gene expression analysis showed that the hybrid hydrogel could affect the differentiation of rBMSCs.Conclusions The collagen mimetic peptide-PEG hybrid hydrogel possesses the characteristics of mild preparation condition,good mechanical strength and good cell compatibility,and is favorable to chondrocyte differentiation of rBMSCs.

An analysis method for requirement of medical consumptive materials on Kalman filter is put forward.An analysis mathematical model is established at first,its solution process is carried out at same time,and then an example using this solution is given according to the working practice.At last,the shortcomings using classical Kalman filter were discussed and a new method using adaptive Kalman filter was proposed.

Objective:To study the effect of glucosamine combined with sodium hyaluronate on serum interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels in patients with Kashin-Beck disease (KBD).Methods:In a prospective design, patients with KBD admitted to South Hospital of Yantaishan Hospital from January 2017 to January 2019 were selected and divided into control, observation, and replacement groups. The control group was treated with glucosamine sulfate, the observation group was treated with intra-articular injection of sodium hyaluronate on the basis of the control group, and the replacement group was treated with artificial knee arthroplasty. The clinical efficacy, visual analogue scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) of the three groups were compared before treatment, 6 weeks and 6 months after treatment. Blood samples were collected from the patients, and the serum levels of IL-1β and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA) to compare the serum levels of IL-1β and TNF-α in the three groups before treatment, 6 weeks and 6 months after treatment.Results:The age of patients in the control group was (53.76 ± 7.33) years old, including 19 males and 23 females. The age of patients in the observation group was (54.18 ± 7.06) years old, including 20 males and 22 females. The age of the replacement group was (55.17 ± 6.43) years old, including 17 males and 13 females. The total effective rate in observation group (92.86%, 39/42) was significantly higher than that of the control group (76.19%, 32/42, χ 2 = 4.459, P < 0.05). At 6 weeks and 6 months after treatment, the VAS scores in the observation group [(4.10 ± 1.21), (3.16 ± 0.95) points] were significantly lower than those in the control group [(5.48 ± 1.17), (4.06 ± 0.74) points, P < 0.05]; at 6 weeks after treatment, the VAS score in the replacement group [(3.28 ± 0.89) points] was significantly lower than that in the observation group ( P < 0.05). At 6 weeks and 6 months after treatment, the WOMAC scores in the observation group [(40.72 ± 4.19, 25.86 ± 3.02) points] were significantly lower than those in the control group [(48.29 ± 2.16), (36.81 ± 3.13) points, P < 0.05]; the WOMAC scores in the replacement group [(29.68 ± 4.22), (23.57 ± 3.86) points] were significantly lower than those of the observation group ( P < 0.05). The serum levels of IL-1β [(9.28 ± 2.74), (6.85 ± 2.27) pg/ml] and TNF-α [(12.66 ± 4.54), (10.34 ± 3.48) pg/ml] in the observation group were significantly lower than those in the control group [(12.78 ± 2.79), (10.36 ± 2.63), (15.51 ± 4.63), (14.64 ± 4.27) pg/ml, P < 0.05], the serum levels of IL-1β [(6.12 ± 3.55), (5.39 ± 2.23) pg/ml], TNF-α [(10.42 ± 3.13) , (8.19 ± 3.15) pg/ml] in the replacement group were significantly lower than those in the observation group at 6 weeks and 6 months after treatment ( P < 0.05). Conclusion:Glucosamine combined with intra-articular injection of sodium hyaluronate can relieve inflammation, improve pain and promote joint function recovery in patients with KBD, but there is still a certain gap compared with knee arthroplasty.