Hepatitis C and its complications are one of the highlights in liver disease prevention and control in China,and from the clinical practice 20 years ago to a cure rate of nearly 100％ at present,standardized diagnosis and treatment of hepatitis C,a large number of scientific studies,and drug research and development are the basis for the clearance of HCV.Direct-acting antiviral agents play an important role in the clearance of HCV,and the clearance of HCV does not equal to the cure of chronic hepatitis C.For patients with hepatitis C who have achieved a high sustained virologic response rate after using direct-acting antiviral agents,their long-term prognosis should be taken seriously.Correct and reasonable application of hepatitis C treatment is still a hot issue that needs to be discussed at present.

Objective To explore the clinical characteristics,pathogens,inflammatory biomarkers,therapeutic methods and prognosis of necrotizing pneumonia (NP) in children.Methods The clinical data of children with NP who were admitted to the Department of Pediatrics of Shengjing Hospital of China Medical University from October 2010 to October 2015 were collected.The data included demographic data,laboratory test results,intrapulmonary complications,therapeutic methods and so on were analyzed,retrospectively.Results Forty-nine pediatric patients with NP were enrolled,31 cases were boys,18 cases were girls;the average age of the patients were 2.5 years (4 months-13 years).The average febrile time were (15.08 ± 5.92) d,and the hospital stay was (21.19 ± 10.83) d,respectively.The median value of peripheral blood leukocyte count was 17.7 × 109/L,the average of neutrophils ratio was (67.62 ± 18.52)％,and the median value of C-reactive protein (CRP) and procalcitonin (PCT) was 97.9 mg/L and 0.54 μg/L,respectively.Nineteen cases had Mycoplasma pneumoniae (MP) infection,16 cases with pneumonia chlamydia infection,9 cases complicated with MP and chlamydia pneumoniae infection,and 8 cases with positive bacterial culture,and 10 cases suffered from the intrapulmonary complications.Forty-seven cases got better prognosis with the treatment of antibiotics,glucocorticoids,intravenous immunoglobulin and other comprehensive therapeutic methods such as bronchoalveolar lavage with fiber bronchoscope and closed thoracic drainage.Conclusions NP is a severe complication of community-acquired pneumonia in children,and the occurrence of NP should be alerted in the children who have persistent high fever,higher inflammatory index and pleural effusion,but the great majority of patients do recover fully after comprehensive treatment.

Objective To investigate the relationship between the Schatzker types and postoperative knee function in tibial plateau fractures .Methods Totally 120 patients with tibial plateau fracture from January 2010 to December 2014 were selected and performed the Schatzker classification according to the X‐ray film ,CT and three dimensional reconstruction .They were divided into 6 groups .The postoperative knee function in each group was followed up and the statistical analysis was conducted .Results The excellent grade distribution of knee function by Kruskal‐Wallis test had statistical difference among 6 groups(P<0 .05) ,in the fur‐ther pairwise comparison ,the significant differences were found between the group 1 and 2 with the group 4 ,5 and 6(P<0 .05) . Conclusion The Schatzker types of tibial plateau fractures is closely correlated with the postoperative knee function .The knee function scores of type Ⅳ ,Ⅴ and Ⅵ are obviously poor .

Objective To investigate the relationship between obesity parameters and obstructive sleep apnea-hypopnea syndrome (OSAHS) in aircrew. Methods A questionnaire survey in aircrew members was performed. Outcome measurement included body height, body weight, neck circumference ( NC), waist circumference (WC), and body mass index (BMI). Those with snoring during sleep and/or Epworth sleepiness scale (ESS)score ≥ 9 were screened with pulse oxygen saturation test during overnight sleep. Those with oxygen saturation decrease index ≥ 10 times/h and suspected OSAHS were tested by polysomnography (PSG). The objects were then assigned to three groups: the OSAHS group,the snore group and the normal group. The relationship between obesity parameters and OSAHS was analyzed. Results There were 399 ( 37. 54% ) overweight, 36 ( 3. 39% ) obesity, 130 ( 12. 23% ) increased NC, and 354 (33.30%)increased WC in 1063 aircrew members (OSAHS group ＞ snore group ＞ normal group; P＜O. 05). The mean value of BMI, NC and WC in the three groups were dittos. Multiple logistic regression analysis showed that overweight, obesity and increased WC were significantly associated with snoring (P ＜0.05) and snoring enlarged NC was significantly correlated with OSAHS (P＜ 0.05). Conclusion Increased BMI, NC and WC may be risk factors of OSAHS among aircrew. Effective prevention and treatment of OSAHS should be needed.

Carcinoma ; diagnosis ; Carcinoma, Papillary ; Diagnostic Errors ; Female ; Humans ; Thyroglossal Cyst ; diagnosis ; Thyroid Neoplasms ; diagnosis ; Young Adult

Objective To investigate the role of serum and glucocorticoid regulated protein kinase (SGK) 1 in the inflammatory responses mediated by toll like receptors.Methods Mice were injected with lipopolysaccharide (LPS,1 mg/kg) 2 h after the pretreatment of EMD638683 (10 mg/kg) or phosphate buffered saline (PBS) as control.At the time points of 3 and 24 h,pro-inflammatory cytokines (interleukin [IL]-6,IL-12 and tumor necrosis factor [TNF]-α) in serum were measured using enzymelinked immunosorbent assay (ELISA).Livers and lung were harvested at 6 h and 24 h after the injection of LPS,embedded by optimum cutting temperature (OCT) and then stained with hematoxylin and eosin (HE).Peripheral blood mononuelear cell (PBMC) were isolated and stimulated by LPS with or without the pretreatment of EMD or LY294002.Cytokines (IL-6,IL-12 and TNF-α) were measured using ELISA.IKKα/β,IKBα and nuclear factor (NF)-κB p65 were detected by Western bolt.Data were analyzed by one way analysis of variance.Results In the model of LPS-induced endotoxin sepsis,inhibition of SGK1 induced secretion of pro-inflammatory cytokine (IL-6 [t=3.007,P＜0.05],IL-12[t=4.413,P＜0.05] and TNF-α[t=5.403,P＜0.05]),increased inflammatory cells infikration into the liver and lung within 6 h,and induced serious multiple organ damage with collapse of alveoli and fatty degeneration of liver.After 24 h,pharmacological inhibition of SGK1 with EMD638683 increased proinflammatory cytokine (IL-6 [t=18.540,P＜0.01],IL-12[t=16.520,P＜0.01] and TNF-α[t=34.880,P＜0.01]) production in human PBMC upon LPS stimulation and inhibited the phosphorylation of IKKα/ β/IKBα and nuclear factor (NF)-κB p65.Conclusions SGK1 suppresses the toll like receptor 4 mediated inflammatory responses via NF-κB.

ObjectiveTo explore the ultrasound characteristics of coronary artery fistula to improve its prenatal diagnosis.MethodsImaging data for 12 fetuses with coronary artery fistula who underwent fetal echocardiography at our hospital from June 2005 to December 2013 were retrospectively analyzed to summarize the ultrasound characteristics of coronary artery fistula.ResultsOf the 12 fetuses, 7 were confirmed with coronary artery fistula by echocardiography after birth, and the remaining 5 were aborted due to other cardiac abnormalities (since an autopsy was not performed, the diagnosis of coronary artery fistula could not be confirmed). Of the 7 confirmed cases, 1 had left coronary artery-to-right atrium fistula, 3 had left coronary artery-to-right ventricle fistula, and 3 had right coronary artery-to-right ventricle fistula; 1 had left coronary artery-to-right ventricle fistula with muscular ventricular septal defect, and 6 had simple coronary fistula. Two-dimensional ultrasound examination revealed that coronary arteries were displayed in all cases, and the diameter ranged from 1.8 to 4.0 mm. Color Doppler ultrasound clearly showed the fistula size, course and the situation fistulas drained into heart chambers. Diastolic regurgitation signal could be detected in the ascending aorta and aortic arch.ConclusionCoronary artery fistula can be diagnosed by color Doppler ultrasound combined with spectral Doppler ultrasound when the fetal coronary artery expands.

BACKGROUND:From the point of view of human anatomy, the load of the spine is more. When the body moves, the range of activities, and activity are relatively large. After screws were implanted in the spine, if biomechanical properties and stability are not up to the standard, it easily leads to lack of grip force of screw and screw loosening so as to increase the incidence of complications after treatment.
OBJECTIVE:To compare biomechanical properties and stability of the spine after insertion of pedicle screw and cervical vertebral screw into the spine.
METHODS:100 vertebrae under human cervical spine specimens were analyzed and randomly divided into cervical vertebral screw fixation group and pedicle screw fixation group. Cervical vertebral screws and pedicle screws were implanted in lower cervical spine specimens. Electro Force 3510 material testing machine was used to test axial pul-out force, axial pul-out strength after the fatigue loading, and fixed stability. The biomechanical properties and stability were compared after two kinds of screws were implanted in the spine.
RESULTS AND CONCLUSION:(1) Instantaneous pul out force and immediate pul out stiffness were significantly higher in the pedicle screw fixation group than in the cervical vertebral screw fixation group (P<0.05). (2) Fatigue pul-out strength and fatigue pul-out stiffness did not have significant differences in both groups, but statistical analysis showed significant differences (P<0.05). Fatigue pul-out strength and fatigue pul-out stiffness were significantly higher in the pedicle screw fixation group than in the cervical vertebral screw fixation group. (3) These results suggested that pedicle screw fixation after implantation in the spine provides sufficient fixation stability, has better fatigue resistance, elevates instantaneous pul-out force and fatigue pul-out strength, and presents strong stability.

Objective To describe the epidemiology and clinical characteristics of spinal infections to assist the clinical diagnosis and treatment .Methods Clinical data of all cases with spinal infections at He′nan Provincial People′s Hospital from January 2010 to December 2014 were analyzed retrospectively . The demographic characteristics , risk factors , clinical characteristics and outcomes were evaluated . Variables were compared by t‐test ,chi‐square test or Fisher exact test when appropriate .Results Totally 231 patients fulfilled the inclusion criteria and were reviewed ,of which 179 (77 .5% ) were pyogenic spinal infection (PSI) and 52 (22 .5% ) were tuberculous spinal infection (TSI) .The most common risk factor for infection was history of previous spinal surgery or procedure (43 .3% ) ,followed by diabetes mellitus (14 .7% ) .The infection site of lumbosacral spine was prominent with 114 cases (63 .7% ) in PSI and 38 cases (73 .1% ) in TSI .At initial presentation ,white cell blood count ([10 .8 ± 4 .5] × 109/L vs [7 .3 ± 3 .2]× 109/L ,t=2 .685) and C‐reactive protein levels ([79 ± 33] vs [37 ± 21] mg/L ,t=6 .241) in PSI were higher compared to TSI (both P<0 .05) .The positive rate of blood culture was significant higher than tissue culture in PSI (47 .9% vs 21 .8% ,χ2 = 6 .782 , P< 0 .05 ) .But the positive rate of blood culture was significantly lower than tissue culture in TSI (0 vs 39 .4% ,χ2 =8 .312 , P<0 .05) .Surgical treatment was performed in 30 .2% of PSI and 25 .0% of TSI .Conclusions History of spinal surgery or procedure is the most common risk factor for spinal infections , followed by diabetes mellitus . The lumbosacral spine is the common involved site in both PSI and TSI .The incidence of PSI is higher among spinal infections in our hospital .And Staphylococcus aureus is the most common pathogenic bacteria in PSI .

OBJECTIVE To study the clinical characteristics of invasive pulmonary aspergillosis(IPA).METHODS Based on the clinical data from 14 IPA cases identified by pathologic examination in the 454th Hospital,the characteristics of IPA were discussed,including the underlying diseases,symptoms,X-ray,CT,the treatment methods and the curative effect.The related literatures were also reviewed.RESULTS All of the 14 patients had underlying diseases.From them 5 were with pulmonary cancer(35.7%),3 with chronic obstructive pulmonary disease(21.4%),2 with pulmonary abscess(14.3%),2 were after chemotherapy for leukemia(14.3%),1 with pulmonary tuberculosis(7.1%)and 1 with diabetes(7.1%).The common symptoms of the 14 cases were febricity,productive cough and hemoptysis.Some of them also suffered with short of breath,night sweat,fatigue,chest pain and losing weight.The air crescent sign showed on X-ray and CT.Soft tissue masses with halo-sign on the margin,dense shadow of small masses within the alveoli,and multi-nodular shadows were also observed.Among 10 patients treated by antifungal medications,only 4 treated otherwise with operation were cured,4 patients died,and 2 patients did not complete the treatment scheme.CONCLUSIONS The patients with immunodeficiency are susceptible to IPA.The clinical manifestations of IPA are non-specific.The final diagnosis depends on the pathologic examination.The only medication is not sufficient for IPA patients.Pulmonary resection should be considered if the prolonged illness or frequent hemoptysis exist.