Objective To explore the efficacy of sequential or combined amphotericin B (AmB) and fluconazole (FCZ) therapy on a 5 flucytosine based regimen in non-acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis.Methods A tatal of 117 cases of non-AIDS-related cryptococcal meningitis treated with 5-flurocytosine-based regimens were retrospectively divided into five groups:AmBgroup (n=38),FCZ group (n=25),FCZ and AmB sequential group (n=18),AmB and FCZ sequential group (n=15),AmB and FCZ combination group (n=21).The number in cerebrospinal fluid (CSF) of the five groups were compared.Statistical analyses included t test,oneway analysis of variance,K-independent samples test and chi-square test.Results Intracranial pressure of AmB group,FCZ group,FCZ and AmB sequential group,AmB and FCZ sequential group,AmBandFCZ combination group were (208.6±75.1),(191.5±94.5),(185.0±76.3),(201.9±69.7) and (223.1±89.3) mm H2O (1 mm H2O=0.0098 kPa),respectively,and the differences were not statistically significant (F=0.611,P =0.656).Median cryptococcus counts in CSF of the five groups were 0,10,0,3 and 0/mL,respectively,with no statistical significance (x2 =7.638,P-0.090).CSF protein levels of the five groups were 0.55,0.69,0.67,0.53 and 0.96 g/L,respectively,with no significant differences among groups (F=7.063,P=0.133).The cure rates of the five groups were 55.3％ (21/38),32.0％ (8/25),9/18,6/15 and 47.6％ (10/21),respectively;progression rates or mortality of the five groups were 28.9％ (11/38),44.4％ (11/25),5/18,4/15and 23.8％ (5/21),respectively; and the differences among cure rates (x2 =3.638,P=0.457) and progression rates or mortality (x2-2.785,P =0.604) were not statistically significant.Conclusion FCZ or AmB alone,sequential or combined therapy were all effective in the treatment of cryptococcal meningitis.

Objective To explore the reliability and validity of poly ether ether ketone (PEEK) rods and pedicle screw system for lumbar degenerative diseases.Methods Sixty-three patients,including 23 men and 40 women with the mean age of 56.2±5.1 years (range,35-75 years),treated by PEEK rods pedicle screw system from September 2012 to March 2013 were retrospectively recruited.Fusion procedure were performed in 10 patients,with 2 cases at L3,4,5 cases at L4,5,3 cases at L5S1; nonfusion procedure were performed in 17 patients,with 4 cases at L3,4,10 cases at L4,5,3 cases at L5S1; hybrid procedure were performed in 36 patients,with 22 case fusion at L4,5 and nonfusion at L3,4,with 2 cases fusion at L3,4 and nonfusion at L4,5,with 12 cases fusion at L5S1 and nonfusion at L4,5.Clinical effects were evaluated via Japanese Orthopedics Association (JOA) score and Oswestry disfunction index (ODI) at 3 months,6 months and 24 months postoperatively.Disc heights were measured by disc height index on lateral lumbar radiograph.Range of motion (ROM) was measured by extension-flexion lumbar X-ray.Three-dimensional CT reconstruction was achieved to observe the integrity of PEEK rods at the final follow-up.Results The mean follow-up were 23.4±3.3 months.The mean operation time were 110±17 min in the fusion group,98±22 min in the non-fusion group and 121±25 min in the hybrid group.The mean blood loss were 270±85 ml in the fusion group,255±72 ml in the non-fusion group and 316±80 ml in the hybrid group.The JOA score improved from 10.5±2.6 preoperatively to 24.0±3.1 at the final follow-up in the fusion group,from 10.3±2.2 to 24.3±3.4 in the non-fusion group and from 11.1±2.3 to 23.9±3.3 in the hybrid group (P＜0.05).The ODI decreased from 51.8％±10.3％ preoperatively to 14.1％±3.7％ at the final follow-up in the fusion group,from 52.2％±11.1％ to 13.2％±3.2％ in the non-fusion group and from 53.4％±9.2％ to 13.8％±2.5％ in the hybrid group.There was no significantly statistical difference in the disc height index at 3 months,6 months and 24 months postoperatively compared with that at preoperative.The ROM decreased from 8.8°±1.8° preoperatively to 2.2°±0.3° at the final follow-up (P＜0.05).One case demonstrated cage migration at one month follow-up,bony fusion in situ at 3 months follow-up,and the patient had no related symptoms during the follow-up.No screw loosening or breakage and rods breakage was observed during the follow-up.Conclusion PEEK rods and pedicle screw system for lumbar degenerative diseases by fusion,non-fusion and hybrid procedure can achieve considerable clinical outcome with low complication rate.

Objective To assess the application of a new scoring system for severity evaluation of acute-on-chronic liver failure induced by hepatitis B.Methods A total of 399 patients (203 survivals and 196 deaths) with acute-on-chronic liver failure induced by hepatitis B were collected from the Third Affiliated Hospital of Sun Yat-sen University during January 2003 and June 2008.All patients were graded with the new scoring system and model for end-stage liver disease (MELD) at critical stage (survivals) or terminal stage (deaths).The survival rates and fatality rates of patients who were graded by two scoring systems were analyzed and compared.Results With MELD system,the fatality rate was 11.89％ (17/143) in patients with scores of 15-26,64.68％ (141/218) with scores of 27-48,and 100％ (38/38) with scores of 49-69.No score range with fatality rate of 0 was found.While with the new scoring system,the survival rate was 99.2％ (126/127) when the severity scores were between 2 to 8,and patients with scores 2,3,4,5,6 and 8 were all survived; the fatality rates were gradually raised from 4.2％ (1/24) with scores of 9-17 to 100％ (82/82) with scores of 18 and above.Conclusion The new scoring system is more objective,simple and sensitive than MELD system,which can be used for severity evaluation of acute-onchronic liver failure induced by hepatitis B.

Objective To establish a scoring system for evaluating the severity of hepatitis B patients with acute-on-chronic liver failure and to compare the validity of this system with model for end-stage liver disease (MELD). Methods MELD score was used in hepatitis B patients with acuteon-chronic liver failure who were divided into survival group (203 cases) and death group (196 cases).Seven clinical relative indices, including prothrombin activity, serum creatinine, hepatic encephalopathy, accompanying infections, serum total bilirubin, the dimension of liver, the amount of ascites, were selected for evaluating the severity. Each index was graded with 1 to 4 points based on the severity. Then the total score was counted by adding up scores of each index. T test and area under receiver operating characteristic (ROC) were used to evaluate the difference and similarity of the two systems. Results According to the new scoring system, the total score was 8. 07±3. 14 in the survival group and 16. 91 ±3. 54 in the death group. There was a statistically significant difference between these two groups (t = 26.125. P<0.01). In 81.32% of survival patients, their scores ranged from 3.91 to 12.23, while in 81.32% of dead patients, their scores ranged from 12.23 to 21.60. The two ranges overlapped at 12.23. According to the MELD system, the total score was 26. 43 ±5. 58 in the survival group and 40. 16 ±10. 22 in the death group. The difference between the two groups was statistically different (t = 16. 566, P<0. 01). In 61.02% of survival patients, the MELD scores ranged from 21. 49 to 31. 19, while in 61. 02% of the dead patients, the MELD scores ranged from 31. 19 to 48. 94. The two ranges overlapped at 31.19. The areas under ROC of the new scoring system and MELD system were 0.960 (95% CI: 0. 944-0. 977) and 0.886 (95% C/;0. 852 - 0. 920). No overlap was found in these two 95%CJ and there was a statistically significant difference. Conclusions The new scoring system is applicable for evaluating the severity and prognosis of acute-on-chronic liver failure in hepatitis B patients. The sensitivity of this new scoring system is approximate to the MELD system.

Objective To evaluate the short-term efficacy of lamivudine versus entecavir for patients with HBeAg-negative acute-on-chronic liver failure (ACLF) with different pretreatment liver failure degrees.MethodsA total of patients with HBeAg-negative ACLF were enrolled into this retrospective study.Seventy-two cases were treated with lamivudine 100 mg daily,while 93 cases were treated with entecavir 0.5 mg daily.Biochemical items,model for end-stage liver disease (MELD)score,hepatitis B virus (HBV) DNA level and mortality were observed.The efficacies of the two drugs were analyzed in patients with different degrees of liver failure.The comparison of rates was done using chi-square test and the measurement data were compared by t test.ResultsAmong the patients with pretreatment MELD scores above 30,the post-treatment HBV DNA levels in lamivudine group and entecavir group were (3.6 ± 1.1) lg copy/mL and (3.7 ± 1.4) lg copy/mL,respectively (t=0.181,P=0.859) and the mortalities were 92.0％ and 91.8％,respectively (χ2 =0.002,P=0.680).For the patients with pretreatment MELD scores from 23 to 30,the post-treatment HBV DNA levels in two groups were (3.2± 1.1) lg copy/mL and (3.2±2.3) lg copy/mL,respectively (t=0.760,P=0.455) and the mortalities were 42.9％,54.1％,respectively (χ2 =0.799,P=0.455).In patients with pretreatment MELD scores below 23,the post-treatment HBV DNA levels in two groups were (3.1±1.0) lg copy/mL and (2.8±1.5) lg copy/mL,respectively (t=-0.740,P=0.464) and the mortalities were 3/19 and 6.3％,respectively (χ2=1.227,P=0.455).In lamivudine group,the mortalities were significantly different among patients with three different ranges of pretreatment MELD scores (χ2 =26.967,P =0.000).The similar differences were also found in entecavir group (χ2 =41.260,P=0.000).ConclusionsAmong treatment na?ve patients with HBeAg-negative ACLF,the short-term efficacy of lamivudine versus entecavir is equal if the degree of pretreatment liver failure is similar.Meanwhile,the degrees of pretreatment liver failure significantly affects the outcome of the treatment.

Objective To investigate the relationship between serum levels of alanine aminotransferase (ALT)or aspartate aminotransferase (AST)apportioned by the same hepatic parenchyma cell volume and liver histological necroinflammation grades in HBeAg-negative chronic hepatitis B (CHB)patients.Methods A total of 145 CHB patients were divided into four groups:Gl,G2,G3 and G4 based on the liver histological necroinflammation grade.The serum ALT and AST levels were determined by automatic biochemical instrument in these four groups.Furthermore,serum ALT and AST levels were then apportioned by the same hepatic parenchyma cell volume.The data were analyzed by ANOVA.Results Mean serum ALT levels in G1,G2,G3 and G4 groups were (35.3±29.1),(91.6±120.4),(111.6± 116.1)and (118.0±122.1)U/L,respectively,and the serum ALT levels apportioned by same hepatic parenchyma cell volume were ( 54.0 ± 45.1 ),( 144.2 ± 184.9 ),(191.3± 204.8)and (215.1 ± 226.5)U/L,respectively.The pairwise comparison between G1 and other three groups all showed statistically significant difference (P＜0.05).Meanwhile,AST levels in G1 to G4 groups were (35.5± 29.0),(64.9±71.7),(96.0±81.9)and (102.8±77.0)U/L,respectively and the serum AST levels apportioned by the same hepatic parenchyma cell volume were (54.3±44.6),(102.3± 107.9),(165.2±148.7)and (189.4±145.4)U/L,respectively.The pairwise comparison between G1 and G3,G1 and G4,G2 and G3,G2 and G4 all showed statistically significant difference (P＜0.05).Conclusion Both AST and ALT levels are sensitive indicators for liver inflammation grading in HBeAg-negative CHB patients during the natural history of the disease.

To investigate the genetic character and origin of the first imported infection case of middle East respiratory syndrome coronavirus (named as MERS-CoV_China GD01), RNA was extracted from swabs of this patient followed by RT-PCR amplification. All coding gene of structural (S, E, M, E) and accessory (ORF3, ORF4a, ORF4b, ORF5, ORF8b) proteins were sequenced and analyzed. Phylogenetic analyses of structural protein coding genes of MERS-CoV_ China GD01 indicates that several substitutes exists in S coding gene and its origin belong group 5 of MERS-CoV, which were recent circulated in Saudi Arabia area, while other three structural genes (N, E, M) were very conserved. Phylogenetic analyses of accessory protein coding genes of MERS-CoV China GD01 indicates that several substitutes exists among ORF3, ORF4a, ORF4b and ORF5, while ORF8b was conserved. In conclusion, genome of MERS-CoV_ China GD01 was general conserved although several genetic variations were found among structural and accessory protein coding genes. This is the first report on sequencing and phylogenetic analyses of the first imported MERS case in China, which may pay the way for prevention and control of imported MERS-CoV infection.
China ; Conserved Sequence ; Coronavirus Infections ; transmission ; virology ; Evolution, Molecular ; Genomics ; Humans ; Middle East Respiratory Syndrome Coronavirus ; genetics ; physiology ; Phylogeny ; Sequence Analysis ; Viral Proteins ; genetics

BACKGROUND: Treatment methods for defects of fingertip skin or soft tissue combined with partial deletion bed include the phalanx shortening or flap coverage of wounds, each with shortcomings.OBJECTIVE: To investigate the efficacy of repairing finger nail bed defects by different treatments in one stage, and to evaluate the functional recovery of nail beds comprehensively.METHODS: From December 2002 to February 2009, 51 fingers with nail bed defects in 40 patients (11 thumbs, 22 index fingers, 14 middle fingers, 4 ring fingers) were repaired. Under the situation that the periosteum exist, when the area of nail bed defect area was less than one third of the nail, the graft was taken from the same finger. If the area of nail bed defects were larger than one third of the nail or two nail bed defects, the grafts were taken from the nail beds of 1st or 2nd toes. Under the situation that the periosteum nonexist, when the area of nail bed defect area was less than one half and more than one third of the nail, the split tissue flap was transferred from the same finger. The finger appearance and functions were observed in the follow-up. RESULTS AND CONCLUSION: All patients were followed up from 1 month to 2 years with an average of 6 months, 86.3% grafts survived very well, no pain, no infection and obvious deformed growth of nail were found. It revealed that using different treatment to repair nail bed defect is available. The grafted nail can grow in good appearance, and finger can act in good function.

Objective To establish an inactivated viral particle-based ELISA for the detection of antibodies against Middle East respiratory syndrome coronavirus (MERS-CoV) in serum samples collected from a MERS-CoV associated case. Methods Serum samples were collected from 10 newborns and 40 healthy adults. A viral particle-based ELISA was established by using the inactivated MERS-CoV virions as antigen. The levels of IgM and IgG antibodies in the serum samples were detected by the established ELISA and the cut-off values for positive detection were determined. Then the inactivated MERS-CoV virion-based ELISA was used to detect the antibodies against MERS-CoV in 5 serum samples collected from the first im-ported MERS case in China. Results The cut-off values of IgM and IgG antibodies in serum samples for ELISA were determined to be A450 readings of 0. 32 and 0. 42, respectively. The titers of IgM and IgG anti-bodies in serum samples collected at early admission to hospital from the first imported MERS case in China were both 1 ︰ 40. Seroconversion occurred 2 weeks after his admission to hospital with the titers of IgM and IgG reaching to 1 ︰ 320. Conclusion The inactivated MERS-CoV virion-based ELISA was established successfully and could be used for the detection of serum antibodies (IgG and IgM) in MERS associated cases.

OBJECTIVETo investigate the dynamic changes in serum levels of hepatitis B surface antigen (HBsAg) and their relation to hepatic parenchyma cell volume (hepatic cell quantity) at different grades of liver inflammation and stages of hepatic fibrosis in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B.

METHODSSerum HBsAg levels were detected by electrochemilumineseence. Serum HBsAg levels were apportioned according to the hepatic parenchyma cell volume and compared among liver histological inflammation grade (1, 2, 3 and 4) and hepatic fibrosis stage ( I, II, III and IV), respectively.

RESULTSThe levels of serum HBsAg among the four liver histological inflammation grades were:1:6,036.4+/-2,729.4 COI/ml; 2:6,704.6+/-2,457.5 COI/ml; 3:6,332.2+/-2,409.0 COI/ml; 4:6,226.2+/-2,716.0 COI/ml. There were no differences among the groups before apportion (Fbefore apportion=0.564, P=0.640).Serum HBsAg levels apportioned by the hepatic parenchyma cell volume among liver histological inflammation grades were:1:9,174.8+/-4,142.0 COI/ml; 2:10,743.1+/-3,950.3 COI/ml; 3:11,078.0+/-4 230.0COI/ml; 4:11,540.5+/-5,058.8 COI/ml. There were significant differences among the groups after apportion (Fafter apportion =27.354, P<0.001). Serum HBsAg levels among hepatic fibrosis stages were: I: 6,222.1+/-2,665.4 COI/mL; II: 6,706.8+/-2,623.8 COI/ml; III:6 004.5+/-2,625.5 COI/ml; IV:6,455.6+/-2,344.4 COI/ml. There were no differences among groups before apportion (Fbefore apportion=0.768, P=0.513).Serum HBsAg levels apportioned by the hepatic parenchyma cell volume (hepatic cell quantity) among hepatic fibrosis stages were: I :9 417.5+/-4,034.2 COI/ml; II :10,093.3+/-4,183.4 COI/ml; III:10,177.1+/-4,445.0 COI/ml; IV:12,166.6+/-4,418.5 COI/ml. There were significant differences among the groups after apportion (Fafter apportion=57.077, P<0.001).

CONCLUSIONSerum HBsAg levels apportioned by the same hepatic parenchyma cell volume (hepatic cell quantity), rather than serum HBsAg levels, increased with hepatic pathological progress.