Malnutrition associated vitamin D deficiency contributes to the calcium loss from bone and results in osteoporosis and osteomalacia at final stage. Osteomalacia is characterized with softening of bone secondary to defective bone mineralization. Here, we report a case of possible osteomalacia caused by prolonged lactation and severe malnutrition in 35-year-old female. She was a housewife and her body mass index was 11.8 kg/m2. She was diagnosed with severe osteoporosis in regular health check-up 2 years ago, but did not take any medication. Nine months ago, she had been treated with anti-tuberculosis medications for 6 month due to active pulmonary tuberculosis. After complete remission of pulmonary tuberculosis, she had lost her appetite severely. Furthermore, she felt gait difficulty and suffered from generalized bone pain. On serologic examination, hypocalcemia, hypophosphatemia, high alkaline phosphatase, low vitamin D3 and high parathyroid hormone level were seen. In the bone mineral density, Z-score from her lumbar spine was -6.5. She was treated with oral calcium and vitamin D3 intramuscularly. After 1 year treatment, she felt significant improvement in bone pain and could walk alone. Also her serum calcium, phosphate and vitamin D3 level are all normalized.
Adult ; Alkaline Phosphatase ; Appetite ; Body Mass Index ; Bone Density* ; Calcification, Physiologic ; Calcium ; Cholecalciferol ; Female ; Gait ; Humans ; Hypocalcemia ; Hypophosphatemia ; Lactation* ; Malnutrition* ; Osteomalacia ; Osteoporosis ; Parathyroid Hormone ; Spine ; Tuberculosis, Pulmonary ; Vitamin D ; Vitamin D Deficiency*

The purpose of the research is to provide a new standard for matching of HLA three-dimensional structure, and summarize the major permissible mismatch and immunogenic mismatch antigens. The molecular modeling method was used to create HLA molecular structures by Swiss Model Server, and the comparison of the differences among the alleles was done by SPDV software with the function of iterative magic fit. The results were recorded by relative mean square deviation (RMSD, nm). The differences among alleles were scattered below 0.06 nm for HLA-A and -B molecules, and below 0.03 nm for HLA-DRB1 molecules. On the basis of the statistical analysis, when RMSD is greater than 0.04 nm for -A and -B molecules and 0.02 nm for -DRB1 molecules, the difference is meaningful and can be related with graft versus host disease. When RMSD is lower than 0.02 nm for -A and -B molecules and 0.01 nm for -DRB1 molecules, the difference is decided unmeaningful. From the data, the permissible mismatch and immunogenic mismatch alleles within HLA-A, HLA-B and HLA-DRB1 molecules were summarized. Three-dimensional structure matching is a new area in the transplantation field, much research should be done in the future.

Objective To analyze the clinical characteristics and the interventional effects of hysteria in leftbehind children in Chongqing rural area for early detection,early treatment and prevention of the disease.Methods One hundred and three left-behind children aged from 7 to 17 years were diagnosed as hysteria from Jun.2008 to Jun.2011.Their general information,clinical presentations were analyzed retrospectively.After comprehensive intervention,they were assessed the clinical efficacy in accordance with Brief Psychiatric Rating Scale,and some of them were tested by Eysenck Personality Questionnaire (EPQ) and Symptom Checklist (SCL-90).Results There were many clinical forms of hysteria in 103 left-behind children.Physical dysfunction accounted for 72 cases(69.90％),whose symptoms were mainly paralysis and convulsive seizure,which was significantly higher than mental disorder(5 cases,4.9％).The mixed episode of physical dysfunction and mental disorder accounted for 26 cases (25.40％).Seventy-eight cases (75.73 ％) were cured,19 cases (18.45％) improved significantly,and 6 cases (5.83％) improved respectively after intervention of 3 to 12 days.Emotional instability accounted for 12 cases(63.16％) in personality factors with EPQ test in 19 cases.Their factors of somatization,interpersonal relationship,depression,anxiety,and hostility with SCL-90 significantly decreased(all P ＜0.05) after intervention of 7 to 12 days.Conclusions The main forms of hysteria in leftbehind children in Chongqing rural area are physical dysfunction and mixed episode,which are paralysis and convulsive seizure.Emotional instability is common in personality factors for them.It can be achieved good results of hysteria in left-behind children to pay attention to the emotional exchange between the children and their parents,early detect,early treat and active prevent the disease.

BACKGROUND AND OBJECTIVES: Because most patients with Wegener's granulomatosis (WG) visit otolaryngologists complaining of head and neck symptoms, otolaryngologists may play an important role in early diagnosis. In this study, we investigated clinical features, laboratory findings and treatment outcomes of 33 patients with WG, and propose a new algorithm for the diagnosis of WG. SUBJECTS AND METHOD: Thirty-three patients with WG who visited the clinic between January 1980 and December 2007 were included. The medical records of 13 male and 20 female patients were retrospectively reviewed. The mean follow-up duration was 68 months. RESULTS: Most WG patients had ENT symptoms such as nasal obstruction, rhinorrhea, otorrhea, hearing loss, dyspnea and hoarseness. The mean duration from ENT examination to diagnosis was 6.7 months (3 days- 102 months) and tissue biopsy was performed on an average of 2.1 times to confirm the diagnosis. While 16 patients could be diagnosed by the first biopsy, the others were required to repeat the biopsy. ANCA was positive in 17 patients (50%). Twentysix patients (78.7%) had multiple organ involvements such as lung, kidney, joint and skin. Twenty-eight patients received a combination of prednisolone and cyclophosphamide with the remission rate of 87%. CONCLUSION: Based on this study, we propose a better algorithm for the diagnosis of WG to avoid unnecessary delay in the diagnosis and treatment of WG.
Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Cyclophosphamide ; Dyspnea ; Early Diagnosis ; Female ; Follow-Up Studies ; Head ; Hearing Loss ; Hoarseness ; Humans ; Joints ; Kidney ; Lung ; Male ; Medical Records ; Nasal Obstruction ; Neck ; Prednisolone ; Retrospective Studies ; Skin ; Wegener Granulomatosis

BACKGROUND AND OBJECTIVES: The aim of this study is to identify differences in polysomnographic findings according to the upper airway obstruction level in patients with obstructive sleep apnea (OSA). SUBJECTS AND METHOD: Eighty-four patients with OSA were included in this study. Every patient underwent polysomnography (PSG) and upper airway pressure measurement using a four-sensor catheter simultaneously. The catheter was positioned at the posterior nasal cavity, uvula tip, tip of the epiglottis, and mid-esophagus level, which was inserted through the nasal cavity down to the esophagus. The patients were categorized into two groups of single site obstruction and multi-site obstruction. RESULTS: Twenty-one patients showed single site obstruction and sixtythree patients showed multi-site obstruction. Apnea-hypopnea index, apnea index, and minimal oxygen saturation showed statistically significant differences between two groups. There was no difference in bony mass index (BMI). CONCLUSION: Upper airway pressure measurement can be a method to evaluate the upper airway obstruction site. This study shows that OSA patients with multisite obstruction have severer sleep apnea than those with single site obstruction.
Airway Obstruction ; Apnea ; Catheters ; Epiglottis ; Esophagus ; Humans ; Nasal Cavity ; Oxygen ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Uvula

Objective::To observe effect of addition and subtraction therapy of Huaihuasan combined with Taohuatang to ulcerative colitis with cold-heat complicated syndrome at active stage, and to study regulation effect to immune function and inflammatory response. Method::One hundred and twelve patients were randomly divided into control group and observation group by random number table. Patients with light and middle symptoms in control group got mesalazine slow release tablets, 1.0 g/time, 3 times/days, patients with severe symptoms or whose symptoms were not changed after getting for 4 weeks in control group got prednisone acetate tablets, 0.75 mg·kg^-1·d^-1 for 3 times. Based on the treatment in control group, patients in observation group added Huaihuasan combined with Taohuatang, 1 dose/day. The course of treatment was 4 weeks. At remission period, mesalazine slow release tablets were used for maintain long-term maintenance therapy, 0.5 g/times, 3 times/days. Scores of disease activities were graded by improvement mayo, and clinical remission and clinical efficacy were recorded, scores of cold-heat complicated syndrome, mucous membrane under enteroscopy and histology of mucosa belongs to Geboes were graded. And levels of tumor necrosis factor-α(TNF-α) in peripheral blood, interleukin-8 (IL-8), IL-10, T lymphocyte subsets (CD4⁺, CD8⁺), and adverse reactions, 6 months' follow-up and recurrence were also be recorded. Result::Therapeutic effect of traditional Chinese medicine syndromes were analyzed by rank sum test, which in observation group was better than that in control group (Z=1.915, P<0.05). Clinical effect in observation group was 98.04%(50/51) higher than 84.00%(42/50) in control group, clinical remission rate was 94.12%(48/51) higher than 78.00%(39/50) in control group, and mucosal healing rate was 96.08%(49/51) higher than 82.00%(41/50) in control group (P<0.05). Scores of mayo, cold-heat complicated syndrome, colonic mucosa and index scores of Geboes were all lower than those in control group (P<0.01). And levels of TNF-α, IL-8 and CD8⁺ were lower than those in control group (P<0.01), and levels of IL-10, CD4⁺ and CD4⁺ /CD8⁺ were higher than those in control group (P<0.01). Recurrence rate during 6 months in observation group was 10.42%(5/48) lower than 30.77%(12/39) in control group (χ²=5.669, P<0.05), as for adverse reactions, there was no significant difference between two groups. Conclusion::Huaihuasan combined with Taohuatang can induce UC to remission period, inhibit the activity of disease, alleviate clinical symptoms, regulate immune function and expression of inflammatory factors, alleviate inflammatory reaction, promote intestinal mucosal healing, and can maintain clinical remission and reduce recurrence. The clinical efficacy is superior to that of 5-ASA/glucocorticoid in Western medicine.