Objective:To investigate clinical and dermoscopic manifestations of nail damage secondary to hand, foot and mouth disease.Methods:Clinical data were collected from 12 patients with nail damage secondary to hand, foot and mouth disease in Department of Dermatology, Shandong Provincial Hospital from June to November 2015, and characteristics of nail damage were analyzed.Results:The clinical manifestations of nail damage following hand, foot and mouth disease included dryness of periungual skin (12 cases) , nail plate cavities (11 cases) , nail fractures (11cases) and Beau′s lines (4 cases) . Dermoscopy showed nail discoloration (12 cases) , nail delamination (12 cases) , horizontal streaks (10 cases) , longitudinal streaks (8 cases) , brown background of the nail matrix (11 cases) , telangiectasia (7 cases) , periungual desquamation (12 cases) and red background (10 cases) .Conclusion:The clinical manifestations of nail damage following hand, foot and mouth disease are mainly dryness of periungual skin, nail plate cavities and fractures, and its dermoscopic manifestations include nail discoloration, delamination, horizontal and longitudinal streaks, brown background of the nail matrix, telangiectasia, periungual desquamation and red background.

Objective:To screen for peptides that specifically bind to PreS1 antigen from a phage-displayed peptide library.Methods: The PreS1 antigen was used as the target molecule to screen the binding peptide from the Ph.D.-7 peptide library with phage display technique,and the positive clones were identified by ELISA.Results: After three rounds of biopanning,the binding peptides were screened from the peptide library by ELISA and competitive inhibiting ELISA.Sequencing result showed that the binding peptides had high affinity and specificity.Conclusion: A peptide binding PreS1 antigen has been successfully obtained by screening the phage display library,which paves a way for the diagnosis and treatment of hepatitis B infection.

Objective To investigate the feasibility of internal mammary sentinel node(SN) biopsy and internal mammary lymph chain excision under thoracoscope. Methods Six small pigs were used for the experiment.The small pigs were intubated using a double lumen endotracheal tube and kept anesthetized with ketamine.Methylene blue(4 ml) was injected subdermally into both of the first pair of breast.The sentinel node biopsy and internal mammary lymph chain dissection was performed thoracoscopically using a harmonic scalpel.Time of the appearance of the first blue-stained node and the dissection procedure were recorded respectively.Results Thoracoscopic internal mammary sentinel node dissection and internal mammary lymph chain excision was performed successfully in all the 6 pigs(12 sides).The time of the appearance of the first blue-stained sentinel node was 5~15 min(mean,8.9 min),the time of thoracoscopic biopsy was 15~50 min(mean,30.4 min),and the time of internal mammary lymph chain excision was 30~56 min on the left side and 22~48 min on the right side(mean,38.2 min),respectively.No bleeding,lung injuries,and other surgical complications occurred. Conclusions Thoracoscopic internal mammary sentinel node dissection and internal mammary lymph chain excision is feasible,easy to perform,and minimally invasive.

Objective:To explore the correlation among serum cardiac troponin I (cTnI),N terminal pro brain natri-uretic peptide (NT-proBNP)and main endpoint events of heart in patients with chronic stable heart failure.Meth-ods:The present study enrolled 95 patients with NYHA cardiac function class III~IV from Feb 2010 to Feb 2011.According to levels of cTnI and NT-proBNP,the patients were divided into cTnI negative group (n=60)and cTnI positive group (n=35);NT-proBNP negative group (n=40)and NT-proBNP positive group (n=55),all patients were followed up for two years,and the main endpoint events were cardiogenic sudden death and rehospitalization caused by acute aggravation of heart failure.Results:Compared with negative group,the hazard ratio (HR)of end-point events was 2.69 and confidence interval (CI)was 1.54~ 4.72,P = 0.002 in cTnI positive group;HR was 2.54 and CI was 1.35~4.78,P =0.003 in NT-proBNP positive group;further interclass crossover analysis found that,when patients'cTnI and NT-proBNP were both positive,the hazard ratio of cardiac endpoint events was the highest (HR=6.34,CI 2.26~17.9,P <0.001).Conclusion:In patients with chronic stable heart failure,serum elevated levels of cardiac troponin I and N terminal pro brain natriuretic peptide are important predictors reflecting prognosis of patients with heart failure.

Objective:To screen for simulation peptide binding specifically to the first and the second extra-cellular domain of CC chemokine receptor 5(CCR5),and to observe their therapeutic effect on mice with experimental autoimmune encephalomyelitis(EAE).Methods:Phage display peptide library was used to screen for peptide sequence binding specifically to CCR5;ELISA was used to identify its binding activity and analyze its DNA sequence.The simulation peptide was synthesized and was injected into abdominal cavity of the EAE mice.Spinal cord tissues were obtained and the pathologic changes were studied by H-E staining in EAE control group and simulation peptide group.Results:Twenty phage clones were randomly chosen for identification and ELISA showed that there were eighteen clones had a strong binding activity with CCR5.The positive clones were sequenced and four peptides of high frequency were obtained:STFTTTL,TPIPQLL,SLPLPKP,and QTSSAAL.Mean clinical score of mice in the EAE model group was 3 and that of the simulation peptide group was 1.H-E staining found that the spinal cord tissues in EAE model group had great number of inflammatory cells and evident demyelination changes;the simulation peptide group had less inflammatory cells and no demyelination changes.The four short peptides had an effect of suppressing and delaying the development of EAE,with the average inhibition rate being 43%(P

Objective To analyze the features of dynamic contrast-enhanced CT of blunt hepatic injury in rabbits. Methods The model of blunt hepatic injury was established in 40 New Zealand white rabbits with a steel ball falling down to the xiphoid process of the animals. Plain CT scan and dynamic contrast-enhanced CT scan (Hispeed spiral CT/2i, GE, America) of the liver were performed. Arterial,portal and balanced phases were respectively at 8-10 s, 35-40 s and 120-150 s after initiation of the contrast medium injection. The non-enhanced and enhanced images were compared in aspects of location and range of injury, tear of the liver capsule, active bleeding, involvement of the main hepatic veins and CT features of abdominal hemorrhage, which was further compared with the results of gross anatomy. Results The rate of plain CT scan was obviously lower than that of dynamic contrast-enhanced CT scan,which defined single tear in 13 patients, multiple lacerations in 18, liver subcapsular hematoma in seven,liver hematoma in nine, liver coated gap in 17, active bleeding in nine and main hepatic vein injury in five, with coincidence rates with the results of gross observation for 13/13,18/18,7/9,9/9,25/30,9/5and 5/4 respectively. According to Moore' s classification, CT/Laparotomy performed from grade Ⅰ to grade Ⅵ were 5/4 patients at grade Ⅰ , 15/13 at grade Ⅱ, 9/11 at grade, 5/6 at grade Ⅳ, 1/2 at grade Ⅴ, O at grade respectively. Conclusion Dynamic contrast-enhanced CT scan, especially at portal and balanced phases, is of great value for diagnoses of liver injuries and determination of injury severity.

Objective To understand the status of tobacco epidemic among adults in Zhejiang province in 2013.Methods A total of 2 779 residents aged 15-69 years from 15 counties were selected using stratified multi-stage cluster sampling method and surveyed by face to face interview to complete questionnaire.Results The current smoking prevalence was 25.62％ among the adults 15-69 years old in Zhejiang province,50.88％ among males and 0.78％ among females.The daily smoking prevalence was 21.85％;40.56％ of the current daily smokers smoked within 30 minutes after waking;95.19％ of current smokers were not willing to quit;64.04％ of all respondents reported someone smoked in their own homes;67.48％ smokers thought they would continue to smoke even if the price of tobacco rises;21.09％ of all respondents saw tobacco AD at shops and on TV;42.00％ of people were aware that smoking could cause stroke,heart attack and lung cancer;89.69％ smokers still believed that low-tar cigarettes were less harmful than regular cigarettes;73.92％ of people agreed with completely no-smoking in public places.Conclusions Male smoking prevalence in Zhejiang remains at a high level,coupled with low rate of quitting,second hand smoke exposure remains a serious issue in household,low awareness of the harms of smoking for people,suggesting that the task of controlling smoking needs to be strengthened.

Objective To evaluate the therapeutic effect of PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel interstitial chemotherapy for pancreatic cancer by using endoscopic ultrasonography.Methods PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel in vitro release experiments were performed in the following procedures:determination of lixivium drug concentration and calculation of its emission.Fifty nude mice with the pancreatic cancer cell line SW1990 were randomly divided into 5 groups,10 in each group.Group A was intratumorally injected with PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel at 4mg/kg ; group B with PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel at lmg/kg; Group C was intratumorally injected with 5-fluorouracil at 4 mg/kg ; Group D with PLGAPEG-PLGA matrix at 4mg/kg ;and group E was the control group.Tumor growth and audio-visual images of the nude mice tumor nodules were observed before administration,and 3,7,10,14 days after.Tumor growth curve was also drawn.Animals were sacrificed at 14 days Tumors were weighed to calculate the inhibitory rate and stained for pathological study.Results 1,3,5,8,10,and 14-day release of 5-fluorouracil temperature-sensitive hydrogel were 21.6％,33.8 ％,44.3％,63.6％,76.3％ and 91.8％.Tumor sizes of group A and group B were significantly different from those of other groups (P ＜ 0.05).Ultrasound endoscopic image characteristics were correlated with pathological findings.Conclusion PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel is able to release for 14 days in vitro,which constantly inhibits human pancreatic cancer cell line SW1990.Intratumoral injection of the agent can significantly inhibit the growth of pancreatic cancer of nude mice.Additionally,gelatinous preparations fixes better than liquid and is of clinical value.Therefore,monitoring temperature-sensitive 5-fluorouracil hydrogel interstitial chemotherapy for pancreatic cancer with endoscopic ultrasound is convenient and safe.

Objective To explore the clinical characteristics of the neuromyelitis optica spectrum disorders (NMOSD) with the area postrema syndrome as the initial symptom.Methods A total of 14 cases were enrolled in the study with the diagnose of NMOSD and the area postrema syndrome as the initial symptom.All the clinical data and imaging profiles by the contrasted magnetic resonance imaging (MRI) of the head and spinal cord were collected and analyzed.Results The median age of onset was (38.1 ± 17.0)years old and the gender ratio of female to male was 10:4.The serum aquaporin-4 (AQP4)-IgG was positive in 11 subjects and several autoimmune antibodies was positive in 7 subjects.The lesions revealed by MRI of the head mainly located in the area postrema and ependymal periphery which often presented as the linear medullary lesion,while linear lesions over three pieces of vertebra were shown by MRI of the spinal cord which mainly in the grey matter and with aH shape around the spinal central canal.Misdiagnose happened in 11 subjects with seven of gastroesophageal reflux disease,two of neurogenic vomiting,one of spinal cord tuberculosis and one of stroke.Conclusions NMOSD should be considered in patients with unexplained intractable nausea,vomiting and/or hiccups lasted for 48 hours or above,especially in those with positive nervous signs.Contrasted MRI and serum AQP4-IgG need to be performed in the suspected patients.Early detection is crucial for patients with NMOSD.

Objective To explore surgical approach for internal mammary node biopsy in patients with breast cancer. Methods Modified radical mastectomy and incised intercostal muscles for internal mammary node biopsy was performed on 113 patients. The distance from the internal mammary artery to the lateral sternal border, and the intercostal distance between the two costal cartilage were measured. Anatomical location and maximal diameter of the excised nodes were recorded. Results The internal mammary artery runs through intercostal space along the lateral sternal border. The distance from the internal mammary artery to the lateral sternal border was (10. 9?4. 5) mm, (11.6?2.9) mm, (9.6?3.6) mm and (4.5?3.5) mm in the first, second, third and fourth intercostal space, respectively. The distance between the two costal cartilage was (14. 2?4. 1) mm, (16. 2?4. 2) mm, (13. 9?4. 3) mm and (9.9?3. 6) mm in the first,second, third and fourth intercostal space, respectively. Two hundred and seventy-nine internal mammary nodes were excised from 113 patients. The anatomical location of the internal mammary nodes which embedded in the fatty tissue surrounding internal mammary artery were 41. 2% at the medial side, 51. 6% at the lateral side and 7. 2% in an anterior plane to the internal mammary artery. Metastases in the internal mammary node were detected in 26 patients. The lymph nodes metastasis were detected only in the internal mammary nodes in 5 cases. Conclusion Internal mammary node biopsy via intercostal space is a feasible, minimally traumatic, low-risk procedure.