OBJECTIVETo investigate the fourth branchial abnormity and its managements.

METHODTwelve cases of the fourth branchial abnormity treated between January 2005 and April 2012 were reviewed.

RESULTSDissection of the recurrent laryngeal nerve was done in all cases. Partial thyroidectomy was performed in 10 cases, and 2 cases of them received selective neck dissection including level II, III, IV and VI. The abnormity lesions were found to pass posterior to the thyroid glands in the 10 cases and to pass through the inferior constrictor muscle into the pyriform sinus in 7 cases of them. The internal opening in the pyriform sinus demonstrated by preoperative examination couldn't be identified in the operation in one case. The abnormity tract terminated at the lateral surface of the esophagus in one case, passed into the cervical esophagus in one case, and terminated at the lateral surface of the thyroid gland in one case, and formed a cyst lateral to the thyroid gland in one case. No abnormity tract was found to loop around the hypoglossal nerve and to descend into the mediastinum. The left recurrent laryngeal nerve was cut off in one patient, although end to end anastomosis was performed immediately, the patient was still complicated with left vocal cord paralysis postoperatively. The median follow-up time of the cases was 24 months (8-88 months). One case was lost of follow up. No recurrence was found in 10 cases. Recurrence was found in one case, and no recurrence in 10 cases.

CONCLUSIONSThe presentation of congenital the fourth branchial fistula is variated significantly. Most abnormity lesions had close relations to the thyroid gland and the recurrent laryngeal nerve, thus the recurrent laryngeal nerve need to protect and partial thyroidectomy might be considered. In the recurrent cases when the abnormity couldn't be identified clearly, selective neck dissection including level II, III, IV and VI should be done long term follow up should be carried out in the cases that the internal opening couldn't be found.

Branchial Region ; abnormalities ; Branchioma ; Fistula ; Head and Neck Neoplasms ; Humans ; Neck ; Neck Dissection ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroidectomy ; Vocal Cord Paralysis

Objective To investigate and control the outbreak of infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in a gastroenterology intensive care unit (ICU), so as to provide reference for the prevention and control of clinical multidrug-resistant organisms (MDROs).Methods Epidemiological investigation was conducted on 3 patients with CRKP infection in a gastroenterology ICU on January 21-31, 2018, specimens were collected with environmental biology monitoring method, CRKP in environment was searched, homology between patients and environmental isolates were analyzed by pulsed-field gel electrophoresis (PFGE).Results Three patients were all isolated CRKP from sputum and blood specimens, all were male, with adjacent beds in the same ward, and treated by the same doctor.The number of isolated CRKP and infection rate in January 2018 were higher than those in other months, infection rate was significantly different (χ2=13.67, P＜0.01).A total of 102 environmental specimens were collected, including air and surface of objects, only 1 of which (nurse's uniform) was isolated 1 strain of KP.PFGE typing of KP isolated from patients and environment showed that there were two genotypes A and B, KP isolated from uniform of a nurse, hydrops abdominis and blood specimen of patient at bed 07, blood specimen of patient at bed 08, as well as sputum and blood specimen of patient at bed 09 were all type A, KP isolated from sputum specimen of patient at bed 07 was type B, KP isolated from hydrops abdominis in patient at bed 09 was not be typed.After comprehensive intervention, CRKP was not no longer isolated from 3 patients, and there was no new case in the ward.Conclusion Imperfect implementation of prevention and control measures for MDROs by health care workers may be an important cause for the spread of CRKP.

By using Western blot and immunofluorescence assays, the recombinant HEV capsid protein p239 was found specifically attached to the HepG2 cell surface and entered to the cytoplasm with the increase of incubation temperature. Pre-mixture of wild-type HEV with p239 blocked the infectivity of the virus on primary cultured human hepatocytes and HepG2 cells, indicating that p239 and HEV competed the same targeting site on these cells. These data provide evidence that p239 has a similar cell surface structure with wild-type HEV.
Blotting, Western ; Capsid Proteins ; genetics ; metabolism ; Cell Line, Tumor ; Fluorescent Antibody Technique ; Hepatitis E virus ; genetics ; growth & development ; metabolism ; Hepatocytes ; metabolism ; virology ; Humans ; Protein Binding ; Recombinant Proteins ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors

E2 is a recombinant hepatitis E virus capsid protein including its main antigenic determinants but lacking of the particle assembling domain. P239 was the C-terminal extending protein of E2 and could self-assemble to form virus like particles, which might serve as mimicry of virions both structurally and antigenically. We previously used yeast two-hybrid system to screen proteins interacting with E2 based on a human hepatocyte cDNA library. One candidate was identified as the segment (aa388-437) of cytochrome P450 2A6 protein, which is predominantly expressed in liver and important for metabolization. Some studies have demonstrated that hepatitis virus infection may altered cell metabolic clearance of coumrarin which were rapidly matebolised by CYP2A6. In this research, we demonstrated that the protein interaction between HEV capsid proteins and CYP2A6 by pull-down and co-immunoprecipitation. It was also found that their interaction could decrease the CYP2A6 catalytic activity when p239 was incubated within the CYP2A6-transfected Huh7 cells. These results suggested that CYP2A6 might be related to the pathological process when HEV invaded host cells.
Aryl Hydrocarbon Hydroxylases ; genetics ; metabolism ; Capsid Proteins ; genetics ; metabolism ; Cell Line, Tumor ; Coumarins ; metabolism ; Cytochrome P-450 CYP2A6 ; Hepatitis E virus ; metabolism ; Humans ; Imidazoles ; metabolism ; Immunoprecipitation ; Protein Binding ; Recombinant Proteins ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo identify the etiology of an aseptic encephalitis outbreak (ten cases) in a hospital of Xiamen city from 11 to 17 May, 2011.

METHODSA total of ten patients' throat swabs, anal swabs and cerebrospinal fluid were collected and detected by RT-PCR for pan-enterovirus. The samples containing detectable pan-enterovirus were tested by PCR with genotype-specific general primers located in VP1 region of enterovirus genotype A, B and C (HEV-A, B and C). The PCR products of VP1 segment were purified and sequenced, and phylogenetic analysis was performed. Meanwhile, the pathogens in those samples were isolated in Vero cell culture. Homologous analysis of VP1 sequences were carried out for the cultured virus samples and the original clinical samples to identify the outbreak etiology.

RESULTSAmong the ten cases, seven cases were positive for pan-enterovirus nucleic acid. When tested by genotype-specific PCR, the throat and anal swab samples from those 7 patients were positive with HEV-B VP1 primers. Meanwhile, the HEV-B VP1 segments were sequenced and phylogenetic analyzed, which indicated the seven cases were all infected by enterovirus Echo 30. The sequences from those samples had homology of 95.3% - 97.1% with the epidemic strains in Zhejiang, 2004. Out of the seven cases, the sequences of XM2, XM3, XM4, XM8 throat swab samples and XM3, XM6 throat samples showed 99.4% - 100.0% homology which were different from the sequence of XM1, and the homology was 92.8% - 93.4%. Furthermore, the viruses were isolated using Vero cells from XM1, XM2, XM3, XM4 and XM8 throat swab samples, and the VP1 sequence showed more than 99.9% homology with the original specimens.

CONCLUSIONThe local outbreak of aseptic encephalitis was caused by Echo 30 of enterovirus genotype B, and the epidemic strains may have different genetic background.

Child, Preschool ; China ; epidemiology ; Cross Infection ; epidemiology ; virology ; Disease Outbreaks ; Encephalitis ; epidemiology ; virology ; Enterovirus ; genetics ; Enterovirus B, Human ; genetics ; Female ; Genotype ; Humans ; Male ; Molecular Sequence Data

By comparing and analyzing the similarity among the international scalp acupuncture, JIAO's scalp acupuncture and ZHU's scalp acupuncture, it is believed that the international scalp acupuncture is a combination of traditional acupuncture and other scalp acupuncture on the basis of channel theory of TCM, and this combination is worthy of discussion. However JIAO's scalp acupuncture lacks scientific evidence. So, the international scalp acupuncture following most contents of JIAO's scalp acupuncture is worthy of discussion.
Acupuncture Therapy ; methods ; Humans ; Scalp ; anatomy & histology

Objective To observe the therapeutic effect of endovascular embolization for perimedullary arteriovenous fistula(PMAVF).Methods Data of 8 PMAVF patients who underwent endovascular embolization were retrospectively analyzed.Findings of digital subtraction angiography(DSA)immediately and 6 months after treatment were reviewed,and the modified Aminoff-Logue score(mALS)was compared before and 6 months after treatment.Results Among 8 cases of PMAVF,there were 2 cases of type Ⅰ,5 cases of type Ⅱand 1 case of type Ⅲ,among them 3 were treated with Onyx glue while 5 with Glubrane glue.The immediate DSA results after treatment showed complete embolization of the fistula in all 8 cases,while those 6 months after treatment showed no recurrence.One case recovered and the other 7 cases improved,and mALS(2.25±2.12)6 months after treatment was lower than that(5.50±2.39)before treatment(P＜0.05).Conclusion Endovascular embolization could safely and effectively treat PMAVF.

OBJECTIVETo compare the clinical outcomes between HLA allele matched (HLA-M) and 1 approximately 2 alleles disparity mismatched (HLA-mis) unrelated allogeneic bone marrow transplantation (URD-BMT).

METHODSThirty-nine patients received HLA-M and 21 received HLA-mis URD-BMT for the treatment of acute leukemia, chronic myeloid leukemia in chronic phase (CP) and myelodysplastic syndromes (MDS) in our hospital between November 1998 and December 2002. Conditioning regimen was Bu 16 mg/kg plus CTX 120 mg/kg, and mycophenolate mofetil (MMF), CsA and MTX were given to prevent aGVHD.

RESULTSThirty-eight of the HLA-M group and 18 of the HLA-mis group were engrafted successfully. The median follow-up duration was 11 (2.5 - 52.0) months for HLA-M group and 9 (2 - 46) months for HLA-mis group. The 3-year probabilities of disease-free survival (DFS) for HLA-M and HLA-mis group were (79.2 +/- 7.1)% and (45.8 +/- 15.5)%, respectively (P < 0.05). Grade II - IV aGVHD occurred in 10 (26.3%) patients in HLA-M group and 6 (33.3%) in HLA-mis group, respectively (P > 0.05).

CONCLUSIONURD-BMT is an effective modality for the treatment of leukemia and MDS. The outcome after URD-BMT can be optimized by matching the HLA-A, B and DR alleles between the donor and recipient.

Adolescent ; Adult ; Alleles ; Bone Marrow Transplantation ; Child ; Disease-Free Survival ; Female ; Histocompatibility Testing ; Humans ; Leukemia ; mortality ; therapy ; Male ; Middle Aged ; Myelodysplastic Syndromes ; mortality ; therapy ; Transplantation, Homologous

OBJECTIVEAllogeneic bone marrow transplantation has been established as a standard method for the treatment of a range of malignant and non-malignant hematologic diseases in children. Unfortunately, fewer than 30% of patients have a human leukocyte antigen (HLA)-matched sibling. Advances in our understanding of the HLA system and the development of large international donor registries encourage the increasing use of unrelated donors as an alternative source of stem cells. The purpose of this study was to evaluate the clinical efficacy and safety of unrelated donor allogeneic bone marrow transplantation (URD-BMT) for the treatment of childhood leukemia.

METHODSSix patients with leukemia received URD-BMT. Two of them suffered from chronic myeloid leukemia (CML), 3 suffered from acute lymphocytic leukemia (ALL) and 1 suffered from acute promyelocytic leukemia (APL) (CR2). All cases were facilitated by Tzu Chi Marrow Donor Registry (TCTMDR). The high resolution DNA test for classIand II was carried out in HLA typing of all donor-receiver pairs. HLA allele matched in three cases, mismatched with one locus in two cases and with two loci in one case. All patients were prepared with cyclophosphamide (CY) 60 mg/kg/day for 2 days (total dose 120 mg/kg) and busulfan (Bu) 1 mg/kg x 4/day for 4 days (total dose 16 mg/kg). Mycophenolate mofetil (MMF), CsA and MTX were given to prevent acute graft-versus-host-disease (aGVHD). CsA of 3 mg/kg/d was continuously given by i.v. infusion, and then 6mg/kg/d by oral. The blood CsA concentration was 200 - 300 ng/ml. MTX was given at the dosage of 15 mg/m(2) on d 1 and 10 mg/m(2) on d 3, 6,9 or 11. MMF was given at the dosage of 0.25 - 0.5 g/d from day 0 to day 120. Prostaglandin E1 was given to prevent the hepatic veno-occlusive disease (VOD), Ganciclovir was used to prevent CMV infection until the CMV antigenemia became negative.

RESULTSAnalysis of DNA short tandem repeats showed total engraftment of donor marrow after transplantation in all cases. The median time when granulocyte exceeded 0.5 x 10(9)/L was 14.5 (13 - 18) days, platelets exceeded 20 x 10(9)/L was 16 (14 - 23) days. The acute GVHD grade II-IV occurred in 2 of 6 (33.3%) patients. There were 3 cases with chronic GVHD and none of them developed with the extensive chronic GVHD. All patients were alive in disease-free situation now with median follow-up 412 (187 - 1338) days.

CONCLUSIONURD-BMT is an effective method for the treatment of childhood leukemia.

Bone Marrow Transplantation ; Child ; Humans ; Immunosuppressive Agents ; therapeutic use ; Leukemia ; therapy ; Tissue Donors ; Transplantation, Homologous ; Treatment Outcome

ObjectiveThere are few studies on the correlation between the concentration of oncoembryonic antigen associated cell adhesion molecule 1(CEACAM1) and osteonecrosis of the femoral head (ONFH). The purpose of this study was to investigate the value of CEACAM1 in the early diagnosis of ONFH and the monitoring of the disease by detecting the CEACAM1 concentration in the serum of patients with ONFH and healthy subjects respectively.Methods95 patients, who were hospitalized and diagnosed as ONFH in the Department of No.3 Orthopaedic Ward, the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2016 to November 2016, were selected as the experimental group. In addition, 56 genders and age-matched healthy subjects in our hospital were selected as the control group. The peripheral venous blood was taken and separated by a centrifuge. Their CEACAM1 concentrations were measured by enzyme linked immunosorbent assay (ELISA). The differences in CEACAM1 concentrations were analyzed between the two groups, and between patients with ONFH before (ARCO stage I or II) and after (ARCO stage III or IV) collapse as well.Results①The concentration of CEACAM1 in the experimental group was significantly lower than that in the control group [(6.11±2.07)ng/mL vs (7.21±3.76)ng/mL, P=0.022]. ②The concentration of CEACAM1 in Arco stage II[(7.33±1.90) ng/mL] was significantly higher than that in stage III [(6.08±2.26) ng/mL], P=0.037.③The difference of CEACAM1 concentration between before(stage II) and after collapse (stage III or stage IV) was statistically different [(7.33±1.90)ng/mL vs (5.86±2.02)ng/mL, P=0.007].④ROC curve analysis showed that the area under the curve was 0.710 (0.608-0.798), the sensitivity was 71.79%, the specificity was 58.82%, and the cut off value was ≤ 6.757ng/mL in the diagnosis of collapse of ONFH.ConclusionThe concentration of serum CEACAM1 can be used as a biochemical marker to assist in the diagnosis and monitoring of ONFH, which can provide reference for early diagnosis and monitoring of ONFH.