Objective The paper discussed the clinical value of differential diagnosis of pleural effusion by combined examination of exfoliative cytology and tumor markers,such as Carcinoembryonic-antigen(CEA),Carbohydrate-antigen1 9-9 (CA1 9-9),Cytoker-antin-1 9-fragment 21-1 (CYFRA21-1)and carbohydrate antigen 125 (CA125).Methods A total of 21 6 patients with pleural effu-sion were divided into malignant group containing 1 96 patients and benign group consisting of remaining patients.Aside from the conventional exfoliative cytology examination,by electrochemical luminescence immunoassay technology,the contents of tumor markers of CEA,CA1 9-9,CYFRA21-1,CA125 in the pleural effusion were measured.Finally,the data were statistically analyzed. Results In malignant group,the positive rate of exfoliative cytologic examination was 82.7%,in which adenocarcinoma accounted for 87.7%.The tumor markers in malignant group was significantly higher than that of benign group.The difference was statisti-cally significant (P < 0.05 ).The sensitivity of CEA is 52.0%,CA1 9-9 48.5%,CA125 41.9%,and the four tumor markers is 74.5%,respectively.For the combined examination of exfoliative cytology and tumor marke,the sensitivity is 96.4%,and specifici-ty is 80%,accuracy is 96.8%.Conclusion The exfoliative cytologic examination is one of the best ways to diagnose malignant pleu-ral effusion.The tumor marker detection is a useful auxiliary method for correct diagnosis and treatment.The sensitivity and accura-cy of the diagnosis of benign and malignant pleural effusion can be improved by the exfoliative cytologic examination combined with tumor marker detection.

Objective To analyze the clinical effect of brevisapine injection on high sensitivity C-reaction protein level in the treatment of acute myocardial infarction.Methods The patients were randomly divided into treatment group(n=80)and control group(n=80).Both groups were treated with routine midication,but treatment group were given intravenous drip of 100 mg brevisapine once a day.for 14 days.80 paients who came for diagnosis were selected for healthy control group.The selqlm high sensitivity C-reaction protein levels were measured at 2 d,7 d,and 14 d by ELLSA in treatment group,control group and healthy control group.Mortality,heart function status (Killip class),revaseularization and clinical adverse cardic events including postinfartion angina,new arrhythmia,reinfarction and bleeding complication at 4 weeks were observed.Results Treatment group had a significantly high level of hs-CRP compared with healthy subjects[(6.37±1.43)vs.(2.17±1.12)mmol/L,P＜0.01]at the second day.The serum hs-CRP content of treatment group was obviously lower than that of control group(3.21±1.31)and(2.25±0.34)mmol/L vs.(5.87±1.16)、(3.97±1.21)mmol/L,(P＜0.01)]on the 7th,14th days;The revascularization rate of treatment group was obviously higher than that of control group[62.50%(50/80)vs.51.25% (45/80),P ＜0.01];There was no difference between the two groups in mortality(3.75% vs.4.10%,P ＞0.05).No difference was found in the rate of bleeding between the two groups(6.25% vs.7.50%,P ＞0.05);Patients with Killip class＜Ⅱ of treatment group was obviously higher than that of control group (83.75% vs 61.25%,P ＜ 0.05 );Clinical adverse cardic events rates at 4 weeks of treatment group were obviously lower than those of control group (P ＜ 0.01 ).No obvious adverse reactions related to the treatment group were observed.Condusion The serum hs-CRP level is in close relation with acute myocardial infarction,which is the risk factor.It is effective and safe of brevisapine injection in the treatment of acute myocardial infarction.The effects of brevisapine on acute myocardial infarction might be involved in decreasing the level of hs-CRP and inhibiting the vascular inflammatory reaction.

Objective:To study the clinical outcome of lamellar keratoplasty combined with autogenous corneal stromal padding for treatment of corneal perforation.Methods:An observational case series study was conducted.A total of 14 patients (14 eyes) with corneal perforation underwent lamellar keratoplasty in Henan Provincial People's Hospital from January 2017 to August 2018 were collected.During the operation, the corneal stromal autograft was taken to pad the corneal perforation.Visual acuity, intraocular pressure, corneal epithelial healing time, infection recurrence, and the status of corneal graft and anterior chamber were recorded on the 1st, 7th, 14th day, 1st, 3rd, 6th, 9th and 12th month after operation.OCT examination of anterior segment was performed at 1 month, 6 and 12 months postoperatively to observe the interlamellar structure of corneal implantation bed and stromal graft, anterior chamber and iris.The safety and effectiveness of the operation were evaluated according to the 1-year follow-up.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[18]). Written informed consent was obtained from each patient prior to entering the study cohort.Results:The healing time of corneal epithelium was 2-4 days after operation, (3.01±0.59) days on average.At one day after surgery, all patients had normal anterior chamber depth without aqueous leak and no double chamber was observed.The corneal grafts attached to the implantation bed well and showed mild to moderate edema.There was no recurrence of corneal infection ulcer two weeks after operation, and the corneal ulcer was healed and anterior chamber was well formed in 14 patients.The corneal graft was transparent, and the anterior segment OCT image showed corneal implant bed and graft were well attached, and the anterior chamber depth was normal three months after operation.The best corrected visual acuity of 9 eyes was more than 0.3 one year after operation, and the vision acuity of the 14 patients improved obviously, and no refractory glaucoma occurred after operation.Conclusions:Lamellar keratoplasty combined with autogenous corneal stromal padding is a safe and effective surgical procedure for treating corneal perforation.

Background and purpose:Hepatocellular carcinoma(HCC) is one of the most common malignancies in the world,It has a poor prognosis due to its rapid infiltrating growth and complicating liver cirrhosis.Surgical resection is considered the best curative option,the 5-year survival rate could reach 50%,especially in the patients with lesions less than 5 cm in diameter and good residual liver function.However curative surgery is feasible for only about 20% of patients.Transcatheter arterial chemoembolization(TACE) has been demonstrated that its short-term curative effect is better than the other nonsurgical treatments.However,it has not provided any survival benefit.Many studies have been done to improve the overall therapeutic effects of HCC with multi-modality approaches.The purpose of our trial was to evaluate the effects of TACE combined with 3-dimensional conformal radiation therapy(3-DCRT) for primary hepatic carcinoma.Methods:90 patients with primary hepatic carcinoma were randomly divided into two groups :45 were treated with 3-DCRT plus TACE and the others were treated with TACE alone.For TACE,80-120 mg cisplatin and 1 000 mg 5-Fluorouracil or 30 mg hydroxycamptothecine)were perfused into the hepatic arteries,then 50-100 mg adriamycin(or epirubicin) or 16 mg mitomycin C and iodized oil 10-30 ml were given to embolize the hepatic arteries,and followed by 1-2 mm gel form particles.TACE of 1-3 sessions was given to both groups.For the combined group,3-DCRT was given by 6MV X-ray.The patients with planned target volume(PTV) lesser than 512 cm~(3) received a total dose of 45-56 Gy,4.5-7 Gy per fraction,and the patients with PTV larger than 512 cm~(3) received a total dose of 45-56 Gy,2.5-4.5 Gy per fraction,5 times every week.Results:The response rates (CR+PR)of 3-DCRT plus TACE group and TACE alone group were 91.1% and 60%,respectively(?~(2)=11.79,P

Objective To apply iTRAQ technology to observe changes in protein expression group in the process of inducing C2C12 cells differentiation towards osteoblast by BMP-2.Methods The myoblast C2C12 cells were seeded in BMP-2 induced differentiation system for differentiation induction.In the 7th day,differentiation protein was extracted and labeled with iTRAQ reagent.Then,mass spectrometric detection,data analysis of differentially expressed proteins,and analysis of biological information were carried out.Results 23 significantly differentially expressed protein spots were screened by BMP-2-induced myoblast C2C12 differentiated cell protein expression profile analysis,where the protein was labeled with iTRAQ reagent.8 protein points were up-regulated,and 15 protein points were down-regulated.Trend classification found that the above differential protein had differential expression in each period of C2C12 cell osteogenic differentiation (1-7 days).Part of up-regulated protein in the early differentiation period showed high expression level;part of up-regulated protein in the late differentiation period showed high expression level;similarly,part of down-regulated protein in the early differentiation period presented low expression level;part of down-regulated protein in the late differentiation period showed low expression level.Preliminary identification showed SERCA3,Cytochrome bS,S100A4,ATPase inhibitor and ATPIF1 presented dynamic changes,which suggests that these proteins may be related to inducing osteogenic differentiation mechanism.Conclusion The results of differential protein expression trend show the necessity of full monitoring of C2C 12 cells osteogenic differentiation and indicate that iTRAQ technology is an effective method of studying protein changes of cellular molecule.Five proteins including SERCA3,Cytochrome b5,S100A4,ATPase inhibitor and ATPIF1 can be used as candidate targets for osteogenic differentiation mechanism research.

Objective:To explore the epidemiological characteristics of Streptococcus pyogenes, namely β-hemolytic Group A Streptococcus (GAS) in children in Shenzhen. Methods:Multilocus sequence typing (MLST) data on the epidemic clonal population of GAS infection in children in Shenzhen Children′s Hospital from January 2016 to December 2018 were retrospectively analyzed.In the present study, 32 GAS strains belonging to 7 different emm types were from 32 children′s with impetigo, cellulitis, scarlet fever, sepsis, pneumonia, obstructive sleep apnea hypopnea syndrome, bronchitis, allergy with rhinitis, buttock abscess, allergic purpura or pharyngeal tonsillitis, which were isolated from 23 throat swabs, 5 sputum samples, 3 pus and 1 blood.Using polymerase chain reaction technology, 7 pairs of allelic housekeeping genes ( gki, gtr, murI, mutS, recP, xpt and yqiL) of 32 GAS isolates were analyzed, and the target gene products were subjected to sequencing.Then the obtained gene sequences of each allele were submitted to the MLST database to obtain the allele profile.Finally, the allele profiles were introduced in the MLST database again to confirm the sequence typing (ST). Results:The GAS clone groups of emm 1.00 and its subtypes, emm 4.00, emm 12.00 and its subtypes, emm 22.00, emm 28.00, emm 75.00, and emm 89.00 belonged to the sequence typing ST28, ST39, ST36, ST46, ST52, ST49, and ST921, respectively. Conclusions:From 2016 to 2018, the MLST clone populations of GAS isolates causing infections in children in Shenzhen are classified as ST28, ST39, ST36, ST46, ST52, ST49 and ST921.

Objective:To explore the method and effect of free thining anterolateral thigh perforator flap (ALTP) in repairing soft tissue defect of scar contracture deformity after hand trauma.Methods:From March, 2015 to August, 2019, 12 patients who suffered scar contracture after hand trauma were repaired with thin ALTP. First, completely resected the scar contracture tissue from the hands and restored the normal bone structure and force line of the hand. The area of hand wound defects were 5.0 cm×6.0 cm-8.0 cm×10.0 cm. The wound was repaired by free ALTP, and the flap was micro-thinned for the first time. The flaps did not carry broad fascia, and the donor sites were directly sutured. The wound healing, the flap appearance, texture, sensation, scarring of the donor area, and functional recovery of the affected hand were observed regularly after surgery. The patients were followed-up by outpatient review and WeChat.Results:All the flaps survived well after the operation. Two cases suffered crisis because hematoma entraps vein cause by bleeding from perforator branch. After surgical exploration, the flaps survived successfully. All 12 flaps were followed-up successfully, including 6 cases reviewed in outpatient clinic, 4 cases followed by WeChat video and 2 cases by telephone consultation. The follow-up time was 3-20 months, with an average of 11 months. The flaps were not bloated, soft, non-pigmented, and beautiful in appearance. Only linear scars remained in the donor sites. The gripp function, palm function, thumb opposition function and finger function of the affected hand were largely restored. According to the TAM method of Upper Limb Function Evaluation of the Chinese Medical Association: 7 cases were excellent, 4 cases were good, and 1 case was fair.Conclusion:The thinning ALTP can be used to repair the scar contracture deformity after hand trauma. It can carry different tissues for 3-dimensional repair. After operation, the flap has a beautiful appearance, the donor site can be closed directly, and the damage of donor site can be reduced. It is an effective method to repair the hand contracture deformity.

【Objective】 To analyze the effect of extensively hydrolyzed formula(eHF) in the treatment of feeding intolerance in preterm infants and the effect on hospital infection, in order to provide reference for the clinical treatment of feeding intolerance in preterm infants. 【Methods】 A total of 208 cases of preterm infants with feeding intolerance diagnosed and treated in Shandong Heze Municipal Hospital from April 2017 to February 2020 were selected into the clinical trial for eligibility assessment, then were randomly assigned into study group(n=100) and control group(n=100) after screening and exclusion. Children in the control group were fed with standard preterm formula, while children in the study group were fed with eHF. Feeding tolerance indicators, including daily milk intake, time to meconium evacuation, time to full gastrointestinal nutrition, total gastric residual counts(GRV1) in the 7-d period after resumption of breastfeeding, ratio of all-day gastric residual counts/all-day estimated milk intake after resumption of breastfeeding(GRV2) were compared between the two groups, and growth indicators(body weight growth rate, head dimension growth rate), complication incidence [necrotizing enterocolitis(NEC), pathological jaundice, positive fecal occult blood or blood in stool] and incidence of hospital-acquired infections. 【Results】 The daily milk intake(t=5.037) of the study group was higher than that of the control group, and the time of foetal excretion(t=9.217), the time to reach full gastrointestinal nutrition(t=15.833), GRV1(t=6.737), GRV2(t=9.956) were lower than those of the control group, and the differences were all statistically significant(P<0.05). The rate of weight gain(t=2.454) and head dimension growth(t=5.469) in the study group was significantly higher than those of the control group(P<0.05). The incidence of the three complications of NEC, pathological jaundice and positive fecal occult blood or blood in stool(χ²=4.310) and the incidence of hospital infections(χ²=4.688) were significantly lower in the study group than in the control group(P<0.05). 【Conclusions】 Compared with the standard formula milk for preterm infants, eHF can significantly improve the feeding intolerance of preterm infants, promote growth and development, and reduce the occurrence of hospital-acquired infections. Therefore, eHF can be widely used in clinic for preterm infants with feeding intolerance.

Objective: To analyze the antimicrobial resistance profile in Chinese children. Methods: This was a prevalence survey. From January 1 through December 31, 2016, the isolates were collected from 10 tertiary children hospitals in China. Antimicrobial susceptibility testing was carried out by routine laboratory methods. The penicillin susceptibility of streptococcus pneumonia and Meropenem susceptibility of gram-negative bacteria were detected by E-test and disk diffusion method respectively. Antimicrobial susceptibility results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) Guideline 2016. The data of antimicrobial susceptibility testing of isolates from either the different patients (neonatal group and non-neonatal group) or various sources were analyzed by WHONET 5.6 software. Results: A total of 56 241 isolates were collected, of which 41.5% (23 328 isolates) were gram-positive organisms and 58.5% (32 886 isolates) gram-negative organisms. The five leading pathogens were Escherichia coli (7 995/56 214, 14.2%), Straphylococcus aureus (6 468/56 214, 11.5%), Streptococcus pneumonia (6 225/56 214, 11.1%), Haemophilus influenza (5 435/56 214, 9.7%) and Klebsiella pneumonia (4 523/56 214, 8.0%). The Meropenem resistance rates of Klebsiella pneumonia, Enterobacter cloacae, Escherichia coil, Pseudomonas aeruginosa, Acinetobacter baumonia isolates were 27.4% (326/1 189) , 8.1% (29/358) , 2.0% (27/1 362) , 19.5% (34/174) , 49.7% (230/463) in neonatal group and 15.4% (512/3 327) , 4.8% (40/841) , 2.3% (151/6 564) , 13.7% (252/1 840) , and 53.4% (860/1 611) in non-neonatal group. The Methicillin-resistant Staphylococcus aureus (MRSA) rates of neonatal group and non-neonatal group were 46.2% (649/1 404) and 33.3% (1 668/5 010) . The penicillin non-susceptible rates of Streptococcus pneumonia in the two groups were 17.6% (6/34) and 18.2% (1 121/6 158) respectively. The β-lactamase positive rates of Haemophilus pneumonia isolates in the neonatal group and non-neonatal groups were 33.8% (47/139) and 44.4% (2 345/5 282) respectively. Conclusion This investigation highlights the worrisome trend of antimicrobial resistance in children, especially among neonatal patients in China.

Objective: To describe the clinical characteristics of pneumococcal infections and drug resistance of Streptococcus pneumoniae isolates from children's hospitals, which would provide reference for preventing and treating pneumococcal diseases. Methods: This was a prevalence survey. In this study, the age, specimen type, monthly distribution characteristics, and antimicrobial resistance of Streptococcus pneumoniae isolates from 9 children's hospitals in China were investigated between January 1, 2016 and December 31, 2016. The WHONET 5.6 software was used to analyze the antibiotic susceptibility of Streptococcus pneumoniae. The comparison of rates was performed by Chi-square test. Results: A total of 6 200 isolates of streptococcus pneumoniae were obtained, namely, 95.1% (5 876/6 177) from the respiratory tract specimens, 2.2% (136/6 177) from blood specimens and 0.4% (24/6 177) from cerebrospinal fluid specimens. The isolates were mainly from children older than 1 and younger than 5 years (54.7%, 3 381/6 185) . Most of strains (33.2%, 1 184/3 563) were isolated in November, December and January. Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 6 189/6 189) , linezolid (100.0%, 6 030/6 030) , moxifloxacin (100.0%, 3 064/3 064) , highly sensitive to levofloxacin (99.8%, 5 528/5 540), ertapenem (98.8%, 3 024/3 061) and lowly sensitive to erythromycin (1.7%, 102/6 016), clindamycin (3.7%, 116/3 136), and tetracycline (5%, 244/4 877), respectively. According to the parenteral susceptibility breakpoints for non-meningitis isolates, the sensitivity of Streptocococus pneumoniae to penicillin from children's hospital of Chongqing Medical University (49.3%, 892/1 809) was significantly lower than those of other hospitals (χ²=1 268.161, P<0.05) . Conclusions Streptococcus pneumoniae is mainly isolated from respiratory tract, from children older than 1 and younger than 5 years and during November to January in tertiary children's hospital of China. The Streptococcus pneumoniae from children is highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin. There are also significant differences in the sensitivity of penicillin for Streptococcus pneumoniae from different hospitals.