Objective To discuss the anatomic features, clinical presentations, diagnosis,differentiations and treatments of congenital fourth branchial anomaly(CFBA). Methods The clinical data of 8 patients with CFBA were retrospectively analyzed. Results Of the 8 patients aging from 27 to 300 months(median age: 114 months), 4 male and 4 female; 3 untreated previously and 5 recurrent. All lesions, including 1 cyst, 3 sinus (with internal opening) and 4 fistula, located in the left necks. Three patients presented acute suppurative thyroiditis, 4 deep neck abscesses, and 1 neck lump. Preoperative examinations included barium esophagogram, direct laryngoscopy, ultrasonography, CT, MRI, and so on.The principles of managements were adequate drainage, infection control during acute period and radical surgery during quiescent period. Classic surgical approach consisted of complete excision of branchial lesions, dissection of recurrent laryngeal nerve and partial thyroidectomy. Selective neck dissection was applied in recurrent cases to extirpate branchial lesions, scarrings and inflammatory granuloma.Postoperatively, 1 case was with local incision infection which healed by wound care; 1 case was with temporary vocal cord paralysis which completely recovered 1 month after operation. No recurrence was found in all of 8 cases with follow-up of 13 to 42 months (median: 21 months). Conclusions CFBA relates closely anatomically with recurrent laryngeal nerve and thyroid grand. The barium esophagogram and direct laryngoscopy are the most useful diagnostic tools. CT and MRI are all beneficial to the diagnosis of CFBA.The treatment key to CFBA is the complete excision of lesion during a quiescent period after inflammatory control, together with the dissection of recurrent laryngeal nerve ,partial thyroidectomy and partial resection of lamina of thyroid cartilage (if necessary), which all can decrease the risk of complications and recurrence.For recurrent cases, selective neck dissection is a safe and effective surgical procedure.

Heart failure (HF) is the end stage of various kinds of cardiovascular diseases and leads to a high mortality worldwide.Numerous studies have demonstrated that frequencies of CD4+CD25+Foxp3+ regulatory T cells (Tregs) are reduced in HF patients and properly expanding Tregs attenuates HF progression.Histone deacetylase (HDAC) 9 has been revealed to contribute to several cardiovascular and cerebrovascular diseases.Plenty of studies showed that HDAC9 negatively regulated the number and function of Tregs.Thus,we aim to investigate the expression of HDAC 9 in patients with chronic heart failure (CHF) and the relationship among HDAC9,Tregs and CHF.Our research showed a reduced number of Tregs and an increased expression of HDAC9 mRNA in CHF patients.Patients with CHF were divided into two groups by heart function grade of New York Heart Association (NYHA),we found that the HDAC9 mRNA expression level in NYHA grade Ⅱ-Ⅲ group were lower than that in NYHA grade Ⅳ group.More importantly,the correlation study suggested that the expression of HDAC9 mRNA was negatively correlated to Tregs frequency and left ventricular ejection fraction (LVEF),whereas positively correlated to larger left ventricular end-diastolic dimension (LVEDD) and B-type natriuretic peptide (BNP) in patients with CHF.The correlation studies also showed a positive correlation between HDAC9 and the severity of CHF.Our research suggests that HDAC9 may be a new indicator for assessing CHF and it may offer a new direction for research of CHF.

OBJECTIVETo investigate the long-term outcome of CO₂ laser microsurgery for laryngeal cancer.

METHODSSeventy patients with laryngeal cancer were treated with CO₂ laser microsurgery. All patients were followed up for at least 36 months (36 - 108 months).

RESULTSDuring the 36-108 months follow-up, 64 patients were alive, and 6 patients died of recurrence. The total 5-year survival rate was 91.4%, 5-year local control rate was 81.4%, 5-year local recurrence rate was 18.6%, and the neck metastasis rate was 4.3%. All survivals had normal breathing and good phonation.

CONCLUSIONSThe long-term outcomes of CO₂ laser microsurgery for laryngeal cancer are good, with rapid recovery and few complications, well protected laryngeal function and quite good quality of life. Laser surgery should be the priority of treatment for early stage laryngeal cancer. However, laser surgery for advanced laryngeal cancers and supraglottic laryngeal cancers should be carefully chosen.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Lasers, Gas ; therapeutic use ; Lymphatic Metastasis ; Male ; Microsurgery ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Quality of Life ; Recovery of Function ; Survival Rate ; Treatment Outcome

OBJECTIVETo collect background information on drug-resistant HIV-1 strains in various regions before the start of nation-wide antiretroviral therapy in China.

METHODSTwenty percent of the 2,000 blood samples from antiretroviral therapy naive patients collected for the 2nd national HIV molecular epidemiology survey (NHMES) in 2002 were randomly sampled for this study. The entire protease gene and 20-230 amino acids of the reverse transcriptase gene were amplified by PCR from provirus DNA and sequenced. The results were analyzed with HIV db-Drug Resistance Algorithm and genotypic resistance mutations were determined to particular anti-HIV drugs.

RESULTSTotally 164 protease gene sequences and 138 reverse transcriptase gene sequences were obtained from patients; 0.61% of 164 sequences displayed primary resistance mutations in the protease gene, whereas 99.39% carried 1 or more secondary mutations. Genotypic resistance to at least one nucleoside reverse transcriptase inhibitors (NRTI) was present in 5.80%,and resistance to at least one non-nucleo side reverse transcriptase inhibitors (NNRTI) was present in 1.45% of samples.

CONCLUSIONThe prevalence of genotypic drug resistance is very low in drug-naive HIV infected patients from 21 provinces of China tested in this study. Laboratories participated in the NHMES have organized a network to provide drug resistance monitoring service in the current nation-wide antiviral treatment program in China.

Anti-HIV Agents ; therapeutic use ; China ; epidemiology ; Drug Resistance, Viral ; Genotype ; HIV Infections ; drug therapy ; epidemiology ; virology ; HIV Protease ; genetics ; HIV Protease Inhibitors ; therapeutic use ; HIV Reverse Transcriptase ; genetics ; HIV-1 ; genetics ; Humans ; Mutation ; Reverse Transcriptase Inhibitors ; therapeutic use ; Sentinel Surveillance

Amino Acid Sequence ; Blood Donors ; Gene Deletion ; Gene Products, nef ; chemistry ; genetics ; Humans ; Molecular Sequence Data ; nef Gene Products, Human Immunodeficiency Virus

OBJECTIVETo investigate HIV-1 co-receptor usage in patients experienced anti-retroviral therapy (ART) in Anhui and Henan province of China.

METHODSA total of 45 HIV-1 infected individuals who have experienced ART and 109 un-experienced ART patients from Anhui and Henan province, which were called as treatment group and treatment-negative group, were selected as study subjects. HIV-1 strains were isolated from peripheral blood mononuclear cells of whole blood from patients. HIV-1 p24 in the culture supernatant was measured using a commercial enzyme-linked immunosorbent assay (ELISA) kit. HIV-1 co-receptor usage was identified using Ghost cell lines expressing CD4 and the chemokine receptor CCR5 or CXCR4.

RESULTSAmong 45 HIV strains from the treatment group, 22 (48.9%) strains used CCR5 as a co-receptor (R5 tropic strain), 21 (46.7%) strains used CXCR4/CCR5 as a co-receptor (X4/R5 duel tropic strain), and 2 (4.4%) used only CXCR4 as a co-receptor (X4 tropic strain). In 109 strains from treatment-negative group, 96 (88.1%) strains used CCR5 as a co-receptor (R5 tropic strain), 13 (11.9%) strains used CCR5/CXCR4 as a co-receptor use (X4/R5 strain). A significant difference was found between two groups in X4 co-receptor usages (χ(2) = 27.30, P < 0.05). Furthermore, after treated with AZT + DDI + NVP, the HIV-1 CXC4/CCR5 utilization was 59.09% (13/22), meanwhile after treated with D4T + DDI + NVP, the HIV-1 CXC4/CCR5 utilization was 43.48% (10/23), which the difference was not statistical significant (χ(2) = 1.10, P = 0.30).

CONCLUSIONHIV-1 CXCR4/CCR5 co-receptor utilization was higher in ART patients than treatment-negative patients.

Acquired Immunodeficiency Syndrome ; drug therapy ; metabolism ; Adult ; Aged ; Antiviral Agents ; therapeutic use ; Cells, Cultured ; Female ; HIV-1 ; isolation & purification ; Humans ; Male ; Middle Aged ; Receptors, CCR5 ; metabolism ; Receptors, CXCR4 ; metabolism ; Receptors, HIV ; metabolism

To investigate the prevalence of drug-resistance mutations, resistance to antiretroviral drugs, and the subsequent virological response to therapy in treatment-naive and antiretroviral-treated patients infected with HIV/AIDS in Henan, China, a total of 431 plasma samples were collected in Queshan county between 2003 and 2004, from patients undergoing the antiretroviral regimen Zidovudine + Didanosine + Nevirapine (Azt+Ddi+Nvp). Personal information was collected by face to face interview. Viral load and genotypic drug resistance were tested. Drug resistance mutation data were obtained by analyzing patient-derived sequences through the HIVdb Program (http://hivdb.stanford.edu). Overall, 38.5% of treatment-naive patients had undetectable plasma viral load (VL), the rate significantly increased to 61.9% in 0 to 6 months treatment patients (mean 3 months) (P＜0.005) but again significantly decrease to 38.6% in 6 to 12 months treatment patients (mean 9 months) (P＜0.001) and 40.0% in patients receiving more than 12 months treatment (mean 16 months) (P＜0.005). The prevalence of drug resistance in patients who had a detectable VL and available sequences were 7.0%, 48.6%, 70.8%, 72.3% in treatment-na(1)ve, 0 to 6 months treatment, 6 to 12 months treatment, and treatment for greater than 12 months patients, respectively. No mutation associated with resistance to Protease inhibitor (PI) was detected in this study. Nucleoside RT inhibitor (NRTI) mutations always emerged after non-nucleoside RT inhibitor (NNRTI) mutations, and were only found in patients treated for more than 6 months, with a frequency less than 5%, with the exception of mutation T215Y (12.8%, 6/47) which occurred in patients treated for more than 12 months. NNRTI mutations emerged quickly after therapy begun, and increased significantly in patients treated for more than 6 months (P＜0.005), and the most frequent mutations were K103N, V106A, Y181C, G190A. There had been optimal viral suppression in patients undergoing treatment for less than 6 months in Queshan,Henan. The drug resistance strains were highly prevalent in antiretroviral-treated patients, and increased with the continuation of therapy, with many patients encountering virological failure after 6 months therapy.

Objective To observe the clinical efficacy and safety of naloxone injection in the treatment of acute left heart failure.Methods A total of 60 patients with acute left heart failure were randomly divided into control group and the treatment group with 30 cases per group.Control group received cardiotonic,diuretic,oxygen inhalation and anti-infective therapy.Treatment group was given naloxone treatment with intravenous infusion,on the basis of the control group.The first dose of naloxone was 0.8 mg,followed by naloxone 1.2 mg qd,if necessary,increasing the naloxone 0.8 mg after the first intravenous infusion 2-4 h for 3 d.Two groups were treated until thesymptoms of left ventricular failure was relieved.The clinical efficacy,beta endorphin (β-EP),brain natriuretic peptide(BNP),cardiac troponin Ⅰ (cTn-Ⅰ),stroke volume (SV),left ventricular ejection fraction (LVEF),and adverse drug reactions were compared between two groups.Results After treatment,the effective rates of treatment and control groups were 90.00％ (27/30 cases) and 63.33％ (19/30 cases) with significant difference (P ＜ 0.05).24,48,72 h after treatment,β-EP in treatment group were (40.07 ± 7.25),(31.31 ±6.57),(25.82 ± 5.44)ng · L-1,which in control group were (53.78 ± 5.98),(48.74 ± 5.94),(41.68 ±6.65)ng · L-1,the differences were statistically significant (P ＜ 0.05).24 h after treatment,BNP in treatment and control groups were (216.68 ± 39.40),(312.20 ± 51.47) ng · L-1;eTn-Ⅰ were (0.09 ± 0.04),(0.19 ±0.03) μg · L-1;SV were (83.58 ±5.66),(74.63 ±6.61) mL;LVEF were (50.04 ±6.36)％,(41.02 ± 5.81) ％,with significant differences (P ＜ 0.05).There was 1 case of vomiting in the treatment group and no adverse drug reaction in the control group,the incidences of adverse drug reactions in treatment and control groups were 3.33％ and 0 respectively without significant difference (P ＞ 0.05).Conclusion Naloxone injection has a definitive clinical efficacy in the treatment of acute left heart failure,which can significantly reduce the level of patients' β-EP and improve myocardial injury and cardiac function,without increasing the incidence of adverse drug reactions.

Objective To explore the role of protein kinase C (PKC) in the mechanism of central sensitization of migraine.Methods Sixty healthy adult male SD rats,weighting from 200 to 250 g,were randomly divided into five groups:normal group,sham-operated group,migraine model group,chloroform treatment group and H-7 (the inhibitor of PKC) treatment group (n=12).Dural blood flow monitor was performed by laser Doppler blood flow imager and extracellular discharge frequency in the spinal trigeminal nucleus was observed by multi-conductive polygraph; the dural blood flow and discharge frequency changes were analyzed and compared.Results Two hours after the success of model making,the dural blood flow in the migraine model group increased obviously as compared with that in the sham-operated group (P＜0.05); as compared with that in the migraine model group,the dural blood flow in the H-7 treatment group decreased obviously (P＜0.05); as compared with sham operation group,blood flow decreased obviously in H-7 group (P＜0.05).Extracellular discharge frequency in the spinal trigeminal nucleus increased 2 h after the success of model making; 2 hours after model making,the extracellular discharge frequency was (323.82±11.00) ％ of baseline level; as compared with that in the migraine model group,discharge frequency in the H-7 treatment group decreased obviously (P＜0.05); as compared with that in the sham-operated group,discharge frequency in the H-7 treatment group had no obvious changes (P＞0.05).Conclusion PKC may play an important role in the mechanism of central sensitization of migraine.

OBJECTIVETo assess the feasibility of the 10 microg recombination yeast hepatitis B vaccine in the expanded applicable population group aged 5 - 18.

METHODSPeople with both HBsAg and anti-HBs negative were selected to take two-stage clinical experiment and the safety and immunogenicity were observed. Safety observation was conducted in 925 subjects, while 568 for immunogenicity. The observation group (aged 5 - 18) included 493 subjects, and (age > 18) 75 enrolled in control group. For the observation group, there were three sub-groups including a child group (141, aged 5 - 6), early youth group (177, aged 12 - 13), and youth group (175, aged 16 - 18). Both groups were administered with 10 microg recombination yeast hepatitis B vaccines with 3 doses at 0 month, 1st month, 6th month. To assess the immunogenicity, the vaccination reactions were observed during the following 4 weeks in order to assess the vaccine safety. The blood samples were taken during 4 - 6 weeks after fully vaccinated, and then anti-HBs were tested with RIA and analyzed by comparing the positive rate of anti-HBs, the geometric mean titer (GMT) and the protective rate between the two groups.

RESULTSBoth observation and control group didn't show any general reactions, adverse events following immunization (AEFI) or coincidental cases when observed at 0.5 h, 6 h, 24 h, 48 h, 72 h, 1 week, 2 weeks, 3 weeks, 4 weeks after being vaccinated. The result of serum test showed, the positive rates of child group, early youth group, youth group and control group were respectively 100.00% (141/141), 97.18% (172/177), 98.29% (172/175) and 89.33% (67/75); the GMTs of anti-HBs were respectively 440.28, 875.38, 467.80, 131.06 U/L; the protective rates were respectively 100.00% (141/141), 97.18% (172/177), 97.14% (170/175) and 86.67% (65/75). The positive rate, GMT and protective rate of the experimental group were all higher than that of control group (chi(2)(positive rate) = 12.77, 5.12, 7.99; t(GMT) = 3.89, 4.13, 5.91; chi(2)(protective rate) = 16.81, 8.60, 8.44; P < 0.05).

CONCLUSIONThis vaccine could be expanded to 5 - 18 year-old population with safety and effectiveness, the positive rate and protective rate of anti-HBs were both higher than that of control group.

Adolescent ; Child ; Child, Preschool ; Female ; Hepatitis B Antibodies ; blood ; immunology ; Hepatitis B Surface Antigens ; blood ; immunology ; Hepatitis B Vaccines ; administration & dosage ; adverse effects ; immunology ; Humans ; Male ; Vaccines, Synthetic ; administration & dosage ; adverse effects ; immunology