Pyriform sinus fistula,owing to rare disease incidence and lacking of awareness,is always a puzzle to neck illness. At the mean time,The frequent delay in accurate diagnosis was reported in the literature. Pyriform sinus fistula should be considered in any children with repeated neck or thyroid infection/mass( mainly on the left side) . The combination of barium esophagography,CT scan and ultrasound is useful to establish the diagnosis. Intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide can facilitate identification of the tract during dissection,and it can effectively reduce the relapse rate.

Objective To study the regulatory effect of interleukin-17 on the production of inflammation and bone erosion related factors of fibroblast-like synoviocytes (FLSs) from rheumatoid arthritis (RA) patients and to investigate whether signal transducer and activator of transcription 3 (STAT3) is implicated in this regulatory effect.Methods FLSs were acquired through primary culture from RA patients.Receptor activator for nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) expression in FLSs were determined using western blot analysis.The level of IL-6,granulocyte-mac rop hage colony stimulating fac tor (GM-CSF)and IL-8 were determined by enzyme linked immunosorbent assay (ELISA) assay.Statistical product and service solutions (SPSS) 17.0 statistical software was used for single factor analysis of variance and LSD-t comparison between each two groups.Results IL-17 stimulated FLSs and promoted the release of IL-6,GM-CSF and IL-8 (t=2.135,P＜0.01) and increased the production of RANKL (t=2.105,P＜0.01) and reduced the production of OPG (t=2.502,P＜0.01).However,targeted silencing of STAT3 could inhibit the effect of IL-17 on FLSs [control group:IL-6 (512±18) pg/ml;GM-CSF (591±25) pg/ml;IL-8 (473±10) pg/ml;RANKL (2.310±0.096);OPG (0.614±0.311);IL-17 group:IL-6 (1 630±39) pg/ml;GM-CSF (1 825±18) pg/ml;IL-8 (2 804±41) pg/ml;RANKL (4.010±0.256);OPG (0.131±0.101);STAT3 silent group:IL-6 (405±21) pg/ml;GM-CSF (451±12) pg/ml;IL-8 (370±9) pg/ml;RANKL (0.850±0.298);OPG (1.120±0.342)].Conclusion STAT3 pathway is critical to IL-17-induced regulatory effect on the release of inflammation and bone erosion related factors of FLSs.IL-17 can induce the inflammation and bone erosion of RA via STAT3.

Neonatal bacterial meningitis may lead to severe neurological sequelaes,with a high mortality rate.It shows different etiology characteristics in different regions and different days of age.The lack of specific clinical manifestations of the disease,easily lead to delays in diagnosis and treatment.Diagnosis needs to realize cerebrospinal fluid (CSF) culture and biochemical parameters by lumbar puncture,however,the rate of positive in CSF culture is extremely low,and the sensitivity in biochemical parameters in the early days and after treatment with antibiotics may be decreased.The reverse transcription-PCR technique may improve the early diagnosis of specificity and sensitivity,but which is expensive and restricted by technical conditions,therefore,clinicians should be alert to the suspicious children and to check in time even repeated lumbar puncture.The third generation of cephalosporins antibiotics are the choices for gram-negative bacilli,gram-positive coccus preferred vancomycin,hormone application is still not advocate.Because of greater incidence of neurological complications of bacterial meningitis in neonates,head imaging examination timely in treatment process is an important means of assessing prognosis.

Objective To investigate anti-inflammatory effect of recombinant human erythropoietin(rhEPO) on bronchopulmonary dysplasia in newborn rats exposed to hyperoxia.Methods Ninety-six Wistar newborn rats were randomly divided into 4 groups after birth:room air-exposed control group,room air-exposed rhEPO treated group,hyperoxia-exposed group,and the hyperoxia-exposed rhEPO treated group.The last two groups were exposed to oxygen,FiO2 =850 mL/L,room air-exposed rhEPO treated and hyperoxia-exposed rhEPO treated group received rhEPO 2 400 IU/kg subcutaneously at birth,30 minutes' before oxygen exposure and 2 d after birth.The isodose of 9 g/L saline was given in the same way in room air-exposed controls and hyperoxia-exposed pups.Rats from each group were sacrificed on day 3,7 and 10.Lung histology was observed under microscope,and mRNA expression of monocyte chemoattractant protein-1 (MCP-1) and cytokine-induced neutrophil hemoattractant-1 (CINC-1) were determined with reverse transcriotion-polymerase chain reaction(RT-PCR).Results Under microscope,in the hyperoxia-exposed group,inflammatory cell influx was detected in the lungs on the 3rd day and there was marked neutrophlic infiltrate on the 7th day.Alveolar enlargement and fibrosis were evident on the 10th day.At the same time,the histopathological changes were improved greatly in the lungs of hyperoxia-exposed rhEPO treated pups compared with the hyperoxia-exposed pups.MCP-1 and CINC-1 mRNA expression increased in hyperoxia-exposed pups,compared with room air-exposed controls especially on the 7th day [(0.94 ± 0.45) vs (0.21 ± 0.03),P ＜ 0.001 ; (1.26 ± 0.29) vs (0.26 ± 0.06),P ＜ 0.001].MCP-1 and CINC-1 mRNA expression were greatly depressed in the hyperoxia-exposed rhEPO treated pups compared with the hyperoxia-exposed pups especially on the 7th day.[(0.65 ± 0.07) vs (0.94 ± 0.45),P＜0.05;(0.83±0.07) vs (1.26±0.29),P＜0.05].Conclusions The therapy of rhEPO (2 400 IU/kg) therapy can reduce lung inflammatory cell infiltration and alveolar fibrin deposition in newborn rats with hyperoxic lung injury,and it can restrain MCP-1 and CINC-1 mRNA expression.The anti-inflammatory mechanism of rhEPO is related to inhibition of MCP-l and CINC-1 mRNA expression.

Objective To investigate the association between diet during pregnancy and hypertensive dis-order complicating pregnancy ( HDCP ) , so as to provide a theoretical basis guiding appropriate diet during pregnancy.Methods Using 1∶2 matched case-control study method, we selected pregnant women delivered in Anhui Women and Child Health Care Hospital from January to December 2014, and interviewed them with food frequency questionnaire.The relationship between intake frequency of various food and HDCP was analyzed. Results A total of 543 women were included in this study, including 181 cases and 362 controls.Mann-Whit-ney U test results showed that the frequencies of meat and fish, eggs, beans, nuts, milk, and pickled food con-sumption were significantly different between the cases and the controls (all P<0.05);while the differences in cereals, vegetables, and fruits consumption frequency between cases and controls were not statistically signifi-cant (all P>0.05).Multivariate Logistic regression analysis showed that higher intake frequencies of beans (OR=0.746, 95%CI:0.645-0.862), eggs (OR=0.789, 95%CI:0.693-0.898), and milk (OR=0.822, 95% CI:0.725-0.931) were associated with lower risk of HDCP; in contrast, higher intake fre-quency of pickled food was associated with higher risk of HDCP (OR=1.190, 95% CI:1.054-1.344). Conclusions Beans, eggs, and milk may be protective factors for HDCP, while pickled food may be risk fac-tor of HDCP.Diet during pregnancy should be appropriate and following scientific guidelines.

Objective To investigate the relationship between the detection of serological antibodies of Helicobacter pylori(HP) infection and the pathological features of gastric ulcer.Methods 228 cases of patients with gastric ulcer diagnosed by endoscopic biopsy(180 cases of benign ulcer and 48 cases of malignant ulcer) were enrolled in this study from January 2015 to October 2016.All subjects were given 14C-urea breath test.The positive rates of cytotoxin associated gene A(CagA),urease A(UreA),urease B(UreB),vacuolating toxin A(VacA) and flagellin antibodies in serum were determined by immunoblotting.The relationship between serum antibody level of Hp infection and pathologic features of gastric ulcer patients were analyzed.Results HP positive rate and type Ⅰ HP positive rate in malignant gastric ulcer group were significantly higher than those in benign gastric ulcer group(P<0.05).The positive rates of CagA,UreA,UreB,VacA and flagellin antibodies were significantly higher in patients with malignant gastric ulcer than those in benign gastric ulcer group(P<0.05).The positive rates of UreA,UreB,VacA and flagellin antibodies in patients with gastric ulcer area>2.0 cm2,severe mucosal inflammatory reaction and severe inflammatory reaction activity were higher(P<0.05).Conclusion The occurrence of gastric ulcer and progression of the disease could be related to the interaction of HP virulence factors.HP serological antibodies detection could help to classify patients with HP-positive gastric ulcer and formulate targeted prevention and treatment plan.

Next-generation sequencing has boosted the development and application of non-invasive prenatal testing.Non-invasive prenatal screening of fetal aneuploidies (T21/T18/T13) has been widely applied around the world as the well-recognized best screening method because of its high sensitivity, low false-positive rate and false-negative rate.Non-invasive prenatal testing of fetal sex chromosome aneuploidies, common chromosome deletion-duplication syndromes and several monogenic disorders has also become technically feasible.It can be expected that primary challenges in the future would be the issues of clinical services and proper managements.

Objective To discuss the effectiveness between arthroscope cleaning combined with exercise therapy and exercise therapy in senile osteoarthritis patients.Methods Two hundred and ten senile osteoarthritis patients were divided into operation group and non-operation group by random digits table method with 105 cases each.Patients in operation group received the arthroscope cleaning and exercise therapy,and patients in non-operation group received the exercise therapy alone.The visual analogue score (VAS) and international knee documentation committee knee evaluation form (IKDC) score before treatment and 1,6 and 12 months after treatment were compared.Results A total of 210 patients received the analysis of result without drop-out.There were no statistical differences in VAS and IKDC scores before treatment and 6 and 12 months after treatment between operation group and non-operation group (P ＞ 0.05).The VAS and IKDC scores 1,6,12 months after treatment were significantly improved compared with those before treatment in operation group,and there were statistical differences (P ＜ 0.05).The VAS and IKDC scores 6,12 months after treatment were significantly improved compared with those before treatment in non-operation group,and there were statistical differences (P ＜ 0.05).According to the IKDC score,in operation group 15 patients were excellent,61 patients were fine,19 patients were general and 10 patients were bad after treatment,and good effectiveness rate was 72.38％ (76/105).In non-operation group,14 patients were excellent,59 patients were fine,20 patients were general and 12 patients were bad after treatment,and good effectiveness rate was 69.52％ (73/105).There was no statistical difference in the good effectiveness rate between 2 groups (P ＞ 0.05).Conclusions Exercise therapy with guidance can significantly improve the function of senile knee joint osteoarthritis,and ease joint pain symptoms.Arthroscope cleaning combined with exercise therapy can relieve the joint acute inflammatory symptoms,but it has no significant clinical effectiveness in long-term treatment of osteoarthritis.

Moyamoya disease (MMD) is a chronic and progressive cerebrovascular disease which is characterized by the bilateral internal carotid artery ends and (or) stenosis or occlusion of anterior cerebral artery and middle cerebral artery initial segments,compensatory proliferation of small blood vessels in the skull base and formation of abnormal vascular network.Its etiology and pathogenesis remains unclear.The present studies speculate that MMD may be a polygenic disease,inflammation,immune response,abnormal cytokine secretion,endothelial progenitor cell change and nitric oxide level change are associated with the occurrence and development of MMD.This article reviews the advances in research on the genetics and pathophysiological mechanism of MMD.

Objective To develop a simple high-resolution melting ( HRM) analysis method for differentiation of Pc and P2 variants in class 1 integron.Methods DNA fragments containing Pc and P2 variants were amplified from plasmids pACW ( PcW ) and pACWP2 ( PcW-P2 ) respectively , then these purified PCR products and P 2 promoters were analyed full-length amplicon by HRM .Eight DNA fragments containing different Pc promoters were amplified and site-specific mutated from plasmids pACS ( PcS ) , pACH2 ( PcH2 ) , pACH1 ( PcH1 ) , pACW ( PcW ) , genomic DNA of Klebsiellar pneumonia HS07-68 (PcWTGN-10)and HS05-1792(PcH2TGN-10)respectively.The purified PCR products and eight Pc variants were characterized by HRM analyses of an unlabeled probe and full-length amplicon.This assay was applied to the differentiate Pc and P2 variants in 109 class 1 integrons from 95 urine clinical Escherichia coli isolates in Huashan Hospital during 2004 -2007.The differentiation results were compared with that determined by direct sequencing .Results P2 promoter with a significant higher melting temperature ( Tm ) can be identified by HRM analysis clearly .P2 promoters were identified in 2 class 1 integrons and consistent with direct sequencing results .Eight Pc variants were classified into three groups: PcS, PcSTGN-10 , PcW, PcWTGN-10, PcH1, PcH1TGN-10.Using direct HRM analysis.PcH2, PcH2TGN-10 were classified into four groups:PcS, PcH1, PcH2, PcW, PcSTGN-10 , PcH1TGN-10 , PcH2TGN-10 , PcWTGN-10 according to the melting curves of the unlabeled probe .Combined the HRM analyses of the whole amplicon and unlabeled probe , the eight Pc variants can be differentiated from each other .Five different Pc variants, PcS, PcW, PcH1, PcH2TGN-10 and PcWTGN-10 , were identified and consistent with direct sequencing results .Conclusions This developed a simple Pc and P 2 variants differentiation method via simultaneous HRM analyses of an unlabeled probe and full-length amplicon .This method is cost-effective and accurate , could be used in differentiation of Pc and P2 variants of class 1 integrons in clinical isolates .