Objective To explore the clinical characteristics of epidural hematoma in children. Methods A total of 120 children with epidural hematomas within recent three years were reviewed. Results The main cause of injury in infants and preschool children was falling or sliping, but traffic accident was the predominant cause in children over seven years old. About 65.8% children were complicated by skull fractures, with average Glasgow Coma Scale (GCS) score of 13.6. Except for acute hematoma treated with emergency surgical operation, the other hematoma was rechecked with CT scan at days 1 and 3 or so after it was found for the first time. Patients receiving operation accounted for 57.5% and those with hematoma due to diploe bleeding for 43.9%. Conclusions The primary cerebral injury is not severe relatively in children with epidural hematoma, in which the incidence of skull fracture is lower than that in adults. The main cause for hematoma formation is diploe bleeding. Sound prognosis can be obtained through recheck of CT scan and suitable therapy.

Objective:To provide scientific evidence for infection prevention and control by analyzing the risk factors of surgical site infection, which can move forward the gateway of infection prevention and control.Methods:The surgery-related information of patients admitted to the Department of General Surgery and Department of Orthopedics, People's Hospital of Guangnan Hospital of Yunnan province from November 2016 to August 2019 was retrospectively analyzed. According to whether postoperative surgical site infection occurred, the patients were divided into an infection group and a non-infection group. Logistic regression model was used to analyze the risk factors of surgical site infection.Results:A total of 9 346 patients, consisting of 117 patients in the infection group and 9 229 patients in the non-infection group, were included for final analysis. In the infection group, the incidence of surgical site infection was 1.25%. Multivariate analysis showed that hypoproteinemia ( OR = 2.585), unclean incision ( OR = 3.243 and 5.125), and operation duration more than 3 hours ( OR = 2.315), blood transfusion ( OR = 2.239), drainage tube placement ( OR = 2.133) and indwelling catheter placement ( OR = 1.973) were the independent risk factors for surgical site infection, while prophylactic use of antibiotics was a protective factor ( OR = 0.383). Conclusion:Individual factors, operation-related factors, and treatment-related factors are closely related to the occurrence of surgical site infection. Much attention should be paid to the clinical issues like preoperative hypoproteinemia, perioperative prophylactic use of antibiotics and postoperative drainage tube and indwelling catheter placement.

Objective:To examine the correlations of microRNA-34c(miR-34c) expression in the peripheral blood with the onset of diabetic foot ulcer(DFU)and diabetic foot osteomyelitis(DFO)in patients with type 2 diabetes mellitus(T2DM).Methods:Sixty newly-diagnosed T2DM patients without DFU(T2DM group), 112 T2DM patients with DFU(DFU group), and 60 healthy controls with normal glucose tolerance(NC group)were included. The 112 T2DM patients with DFU were further divided into DFO( n=64)and NDFO( n=48)groups. The levels of miR-34c were determined by quantitative real-time PCR, while clinical features and risk factors of DFU and DFO were explored. Results:A significant increase in the expression level of miR-34c in peripheral blood was observed in T2DM group compared with NC group[2.99(1.45-6.22) vs 1.01(0.89-1.52), P<0.05], and a markedly increased miR-34c expression level was noted in DFU group compared with T2DM group [9.65(6.15-18.63) vs 2.99(1.45-6.22), P<0.01]. Additionally, the expression level of miR-34c in peripheral blood significantly increased in DFO group compared to NDFO group [13.46(8.89-19.11) vs 6.02(5.93-14.72), P<0.01]. Moreover, there was a positive correlation between the expression level of miR-34c in peripheral blood and the amputation rate in patients in DFU group( P=0.030), and a negative correlation in the expression level of miR-34c( P=0.025)with healing rate of DFU after eight weeks. The multivariate logistic regression analysis confirmed that a high expression of miR-34c was an independent risk factor for DFU and DFO( OR=3.52, 4.13; both P<0.01). Conclusion:An increased expression of miR-34c in peripheral blood of T2DM patients might be closely related to the occurrence, development, and prognosis of DFU and DFO.

Objective:To screen the kinase genes related to radioresistance by high-throughput method and provide a theoretical basis for clinical treatment strategy of oral squamous cell carcinoma.Methods:The tongue squamous carcinoma cell line Cal-27 was infected with lentivirus shRNA kinase library that contains 4 675 different shRNAs regulating 709 human kinase genes. The uninfected cells were removed by puromycin screening. Then, the cells were irradiated with different doses (0, 10, 15 cGy) and continued to culture for 3 d to enrich the differences among groups. Afterwards, the cell genomic DNA was extracted and the complete shRNA sequences were obtained by PCR.Different tags were labeled in shRNAs of each group. An illumina platform was used for next generation sequencing to acquire the shRNA abundance, and then the differentiated expressed genes among different groups were identified.Results:A total of 5 kinase genes (PKLR, IPMK, AURKB, ITPKB and DLG2) were screened out from irradiated cells. Knockdown of PKLR and IPMK increased radiation resistance, while knockdown of AURKB, ITPKB and DLG2 increased radiation sensitivity, and the high expression of these genes would lead to radiotherapy tolerance.Conclusions:In this study, 3 genes relative to radioresistance of oral squamous cell carcinoma were identified by using shRNA lentivirus library combined with next generation sequencing, but the underlying mechanism requires further exploration.

Objective To describe common dermoscopic features of primary cutaneous amyloidosis (PCA),and to explore the application value of dermoscopy in assisting the diagnosis of PCA.Methods Seventeen patients with PCA were collected from Department of Dermatology of Peking Union Medical College Hospital between April 2014 and December 2016.A total of 45 skin lesions were subjected to dermoscopy,and their dermoscopic features were analyzed.Results The common dermoscopic features of PCA included central hubs,which could be white,brown or scar-like areas,various pigment structures and shiny white streaks.Dermoscopy showed that central hubs could be observed in all the lesions (100％),while white center hubs alone were observed in 14 (31％) lichenoid lesions,both white center hubs and scar -like areas in 5 (11％) lichenoid lesions,brown center hubs alone in 8 (18％) macular lesions,both white and brown center hubs in 6 (13％) lichenoid lesions and 17 (38％) macular lesions.All the lesions showed various pigment structures.Shiny white streaks were observed in 4 (9％) lichenoid lesions.Conclusion Dermoscopy has good application value in assisting the diagnosis of PCA.

Angiostrongylus cantonensis invades the central nervous system (CNS) of humans to induce eosinophilic meningitis and meningoencephalitis and leads to persistent headache, cognitive dysfunction, and ataxic gait. Infected mice (nonpermissive host), admittedly, suffer more serious pathological injuries than rats (permissive host). However, the pathological basis of these manifestations is incompletely elucidated. In this study, the behavioral test, histological and immunohistochemical techniques, and analysis of apoptotic gene expression, especially caspase-3, were conducted. The movement and motor coordination were investigated at week 2 post infection (PI) and week 3 PI in mice and rats, respectively. The cognitive impairs could be found in mice at week 2 PI but not in rats. The plaque-like lesion, perivascular cuffing of inflammatory cells, and dilated vessels within the cerebral cortex and hippocampus were more serious in mice than in rats at week 3 PI. Transcriptomic analysis showed activated extrinsic apoptotic pathway through increased expression of TNFR1 and caspase-8 in mice CNS. Immunohistochemical and double-labeling for NeuN and caspase-3 indicated the dramatically increased expression of caspase-3 in neuron of the cerebral cortex and hippocampus in mice but not in rats. Furthermore, western-blotting results showed high expression of cleaved caspase-3 proteins in mice but relatively low expression in rats. Thus, extrinsic apoptotic pathway participated in neuronal apoptosis might be the pathological basis of distinct behavioral dysfunctions in rodents with A. cantonensis infection. It provides the evidences of a primary molecular mechanism for the behavioral dysfunction and paves the ways to clinical diagnosis and therapy for A. cantonensis infection.
Angiostrongylus cantonensis* ; Angiostrongylus* ; Animals ; Apoptosis* ; Behavior Rating Scale ; Caspase 3 ; Caspase 8 ; Central Nervous System ; Cerebral Cortex ; Diagnosis ; Eosinophils ; Gait ; Gene Expression ; Headache ; Hippocampus ; Humans ; Meningitis ; Meningoencephalitis ; Mice ; Neurons* ; Rats ; Receptors, Tumor Necrosis Factor, Type I ; Rodentia*

Objective To investigate the clinical efficacy of magnetic compression anastomosis for congenital esophageal atresia and stenosis.Methods The retrospective and descriptive study was conducted.The clinical data of 4 children who underwent magnetic compression anastomosis for congenital esophageal atresia and stenosis in the Northwest Women and Children's Hospital from December 2017 and February 2019 were collected.There were 2 males and 2 females.The children were aged 11 days,7 days,5 days,and 3 years,respectively.The children underwent magnetic compression anastomosis.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect food intake and complications of children up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M (range).Results (1) Surgical and postoperative situations:four children underwent magnetic compression anastomosis successfully.Of the 4 children,3 with esophageal atresia underwent open tracheoesophageal fistula repair and endoscopeassisted magnetic compression anastomosis,and 1 with congenital esophageal stenosis underwent endoscopic gastrostomy combined with magnetic compression anastomosis.The operation time of 4 children was (2.3±0.9) hours.The length of esophageal blind ending in the 3 children with esophageal atresia and length of esophageal stenosis were in the children with esophageal stenosis 30-35 mm and 8 mm.Four children has good magnet apposition,and time of postoperative magnet removal was (29± 10)days.Three children with esophageal atresia had oral removal of magnet,and 1 with esophageal stenosis had magnet removed by gastrostomy.One child complicated with postoperative fistula and anastomotic stenosis was cured by unobstructed drainage and nutritional support treatment.The duration of postoperative hospital stay was (39± 10)days.(2) Follow-up:4 patients were followed up for 3-17 months,with a median time of 10 months,and restored to oral intake after oral removal of magnet and removal of magnet by gastrostomy on the days 14-36 postoperatively.One child was detected anastomotic stenosis by esophagography at the postoperative 3 months,and was improved after esophageal dilatation.The other 3 children recovered to normal connectivity of esophagus postoperatively and maintain unobstructed.Four children had normal eating,without dysphagia or other serious complications.Conclusion Magnetic compression anastomosis is safe and feasible for congenital esophageal atresia and stenosis,with good short-term efficacy.

Objective To investigate the dermoscopic features of vulvar lichen sclerosus (VLS).Methods Seventeen patients with VLS,who visited the Department of Dermatology of Peking Union Medical College Hospital between August 2015 and June 2017 and underwent dermoscopy and skin histopathological examination,were enrolled into this study.The dermoscopic images of 75 skin lesions were collected and analyzed retrospectively.Results The common dermoscopic features in these VLS lesions included yellowish-white structureless areas (89.3％,67/75),reddish-violet globules or patches (77.3％,58/75),brownish or bluish-gray pigment structures (49％,37/75),shiny white streaks (40％,30/75),dotted vessels with irregular arrangement (28％,21/75),linear vessels (58.7％,44/75),hairpin-like vessels (6.7％,5/75),comma-like vessels (13％,10/75)and branching vessels (20％,15/75).Under dermoscopy,rosette sign could be observed in 3 (4％) lesions,comedo-like openings in 3 (4％) lesions,and keratotic plugs in 1 (1％) lesions.Conclusion Under dermoscopy,VLS is characterized by yellowishwhite structureless areas,reddish-violet globules or patches,pigment structures and vessels with various vessels.

Objective:To investigate the relationship between triglyceride glucos (TyG), C-reaction protein/albumin (CRP/Alb), 25-hydroxy vitamin D[25(OH)D] and the prognosis of patients with continous ambulatory peritoneal dialysis (CAPD).Methods:A total of 220 CAPD patients in the Affiliated Hospital of Jining Medical University from January 2017 to March 2020 were prospectively selected and divided into death group and survival group according to the 6-month prognosis. The peritoneal urea clearance index (Kt/V urea), TyG, CRP/Alb, 25(OH)D were compared between the two groups. Logistic regression was used to analyze the prognostic factors of CAPD patients. The predictive value of TyG, CRP/Alb and 25(OH)D on the prognosis of CAPD patients was analyzed by receiver operating characteristic (ROC) curve. Results:After 3 months and 6 months of dialysis, the peritoneal Kt/V urea in the death group [(1.21±0.18)ml/(s·1.73 m 2), (1.02±0.14)ml/(s·1.73 m 2)] was significantly lower than that in the survival group [(1.57±0.40)ml/(s·1.73 m 2), (1.49±0.42)ml/(s·1.73 m 2)] (all P<0.05). After 3 months and 6 months of dialysis, the TyG [(8.79±0.86), (9.24±1.03)] and CRP/Alb [(4.98±0.94)×10 -4, (5.14±1.39)×10 -4] in the death group were higher than those in the survival group [(8.03±0.60), (7.26±0.93), (3.57±1.19)×10 -4, (3.07±0.88)×10 -4], while the 25(OH)D [(19.14±2.29)ng/ml, (17.79±3.17)ng/ml] was lower than that of survival group [(22.67±3.03)ng/ml, (24.31±2.51)ng/ml] (all P<0.05). TyG and CRP/Alb at 3 months and 6 months of dialysis were negatively correlated with Kt/V urea, while the 25(OH)D was positively correlated with Kt/V urea (all P<0.05). Logistic regression analysis showed that Kt/Vurea, TyG, CRP/Alb and 25(OH)D were associated with prognosis in the two groups after 3 and 6 months of dialysis (all P<0.05). The AUC of TyG, CRP/Alb and 25(OH)D at 6 months of dialysis combined to predict the prognosis of CAPD patients was the highest, which was 0.911. Conclusions:TyG, CRP/Alb and 25(OH)D are associated with all-cause mortality in CAPD patients. High TyG and CRP/Alb and low 25(OH)D suggest a higher risk of all-cause mortality. Combined detection of all indicators can effectively predict the prognosis of CAPD, which is convenient for early clinical intervention.