Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.Results A man complained of fever with a sore throat,and examination found an enlarged left tonsil with prominent exudate,normal blood routine test and chest radiograph.Although the patient received the treatment of penicillin G and azithromycin,his condition worsened.Blood test showed white blood cell count 13.59 × 109/L (neutrophils 0.933),platelet count 7.4 × 109/L,TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,serum albumin 19.3 g/L with the development of the conditions.Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled.In addition,anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein.Two follow-up clinic visits over the following 4 months were unremarkable.Besides three similar cases reported,four patients were male,and the ages ranged from 19 to 54 years.The chief complaints were sore throat and fever (4/4),with neck pain (4/4).Physical examinations found pharyngitis (2/4),exudate or abscess in the tonsillar crypt (2/4),maculopapular rashes (2/4).Laboratory results showed leukocytosis and thrombocytopaenia (4/4),acute cholestatic liver dysfunction (3/4),acute renal failure (2/4),acute respiratory failure (1/4).The first chest radiographs were normal at the onset,but chest radiography features included peripheral nodules and cavitation (3/4),focal or wedge-shaped lesions (1/4),pleural effusion (1/4) with the development of the conditions.Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4),both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4).Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4).Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4).All patients recovered and no one died.Conclusions The characters of Lemierre syndrome include primary oropharynx infection,septicaemia,septic or embolic phlebitis of jugular vein,and metastatic abscess.Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.

From ethyl acetate fraction of Chinese Anthopleura xanthogrammica B, collected from Qingdao beach, three new glycerolipids named 1-O-hexadecanoyl-2-O (9-oc-tadecenoyl )-3-O-( 9, 12-octadecadienoyl ) glycerol (3)'1-O-hexadecahoyl-3-O-(14-eiosyle-cenoyl)glycerol (4)and l-O-(9,12-octadecadienoyl)-2-O-(9,12-octadecadienoyl)glycerol (5) as well as two lipidic acids named 9,12-octadecadienoic acidd) and 9,14-docosandienoic acid (2) were isolated. Their structures were identified by various spectrial(IR,PNMR ,CNMR, MS,et al)analysis and chemical conversion.

Objective To conduct a systematic review with evidence collected from randomized controlled trials (RCTs) of domestic and overseas acupuncture for nervous tinnitus. Methods RCTs were searched in several databases i.e. CNKI, VIP, CBM and PubMed, using the keywords of acupuncture and tinnitus. The efficacy and methodologies were evaluated using meta-analysis by RevMan5.0. Efficacy indexes i.e. recovery rate, significant efficiency rate, total effective rate of acupuncture in treating nervous tinnitus were assessed using odds ratio (OR). Funnel plot was drawn to analyze publication bias. Begg’s rank test and Egger’s linear regression test were conducted to measure symmetry in funnel plot by using Stata 11.0. Results Fifteen RCTs involving 1082 patients met the inclusive criteria. The results of meta-analyses showed that recovery rate (OR=2.82, 95%CI 1.89 to 4.20), significant efficiency rate (OR=1.75, 95%CI 1.26 to 2.44), total effective rate (OR=3.68, 95%CI 2.62 to 5.16) were significantly higher in acupuncture group than control group. Begg’s rank test (P=0.350) and Egger’s linear regression test (P=0.887) showed partly symmetry in funnel plot with unfilled corner, which indicated that some degree of bias existed in the included studies. Conclusion According to the analysis results, acupuncture or acupuncture combining other therapies were superior to pure medication or non-acupuncture treatments. However, high-quality, large-sample, randomized, controlled trials seem to be needed to further confirm the efficacy of acupuncture, owing to the different standards and research methods, limited qualities of the included studies.

Objective To characterize the spectrum of adult choledochal cyst and to determine suitable surgical procedures for this disorder.Methods The medical records of 169 patients who were treated for choledochal cyst from July 1977 to October 2008 in our Department were retrospectively reviewed.The cysts were classified using Todani's classification as type Ⅰ in 110 patients (65.1％),type Ⅱ in one patient (0.6％),and type Ⅳ in 56 patients (33.1％).The choledochal cysts in two patients could not be classified because of the lack of clinical data.163 patients received surgical treatment,which included cystectomy (n=119),cystenterosotmy (n=33),T-tube drainage following bile duct exploration (n=5),surgical exploration/biopsy (n =5),and endoscopic sphincterotomy (n =1).Results There was an increase in the number of patients in the 1980s which became stable at round 30 patients per every four years since the late 1990s.The proportion of patients presenting with a history of biliary surgery decreased and accounted for about 25％ of patients in the past decades.The rate of cyst malignancy dropped from 16.5％ in 1977=1995 to 9.7％ in 1996=2008.Of the 163 patients who received surgical treatment,long-term complications included anastomotic strictures and intrahepatic bile ductal stones presenting with repeated cholangitis.Conclusions The incidence of adult congenital choledochal cysts had become stable following years of rapid increase.The rate of cancer progression had gradually decreased.The use of different surgical treatments based on the condition of the proximal bile duct helped to prevent postoperative stenosis of biliary anastomosis.

To study the chemical constituents of sea anemone, Anthopleura stell Verrill.Methods　The chemical constituents were isolated and purified by chromatographic methods and their structures elucidated by chemical evidences and spectra data.Results　5 nucleosides were obtained and identified from the ethanolic extract as 2-hydroxy purine (Ⅰ); deoxyinosine (Ⅱ); 1-methylxanthosine (Ⅲ); deoxyguanosine (Ⅳ), and deoxyribo-thymidine (Ⅴ).Conclusion　Compound Ⅲ was a new natural product， while the others were found from sea anemone for the first time.

Objective To study the pathway of miR-221/222 in enhancing radiation resistance of glioblastoma.Methods After 2 Gy of X-ray irradiation,the expressions of miR-221/222 in U251,U87 and LN229 glioblastma cells were detected with real-time PCR.Clonogenic assay was used to measure the radiosensitivity of glioblastoma after knocking down miR-221/222.ChIP assay was used to identify the combination situation of c-jun and miR-221/222.Luciferase assay was applied to check whether PTEN was a target of miR-221/222.Western blot was used to detect the expression of relevant proteins in the glioblastoma cells after knocking down miR-221/222.The effect of miR-221/222 and irradiation on growth of glioblastoma in nude mice was also observed.Results The expression of miR-221/222 was increased by irradiation(t =5.48 ～29.21,P ＜ 0.05) and the radiosensitivity of anti-miR-221/222-transfected cells was alsoincreased(F=1 202.22,1 789.12,1 012.32,P＜0.05).MiR-221/ 222 was transcriptionally regulated by c-jun with a target of PTEN (t =13.16,P ＜ 0.05).When miR-221/222 was knocked-down,the expression of pAkt and DNA-PKcs were down-regulated while PTEN and GSK-3β were up-regulated,and the expression of Akt were not changed.Moreover,the growth of xenograft tumor was significantly inhibited by the combination treatment of anti-miR-221/222 and irradiation(F =56.36,P ＜ 0.05).Conclusions The expression of miR-221/222 in glioblastoma cells can be increased by irradiation,and the activation of Akt pathway downstream miR-221/222 could enhance the radiation resistance of glioblastoma.

Objective To evaluate the correlation between sonographic features of papillary thyroid microcarcinoma(PTMC) and cervical lymph node metastasis.Methods Preoperative sonographic features of 379 papillary thyroid microcarcinoma in 341 patients were retrospectively reviewed,and were divided into two groups,lymph node metastasis and lymph node non-metastasis according to pathology.Univariate and multivariate analyses were performed to analyze the sonographic features relevant to lymph node metastasis.Results Univariate analysis revealed that unclear border,microcalcification and multifocal PTMC were statistically significant(all P ＜0.05).Multivariate analysis revealed that microcalcification and multifocal PTMC were statistically significant (both P ＜0.05).Conclusions Microcalcification and multifocal PTMC are closely relevant to cervical lymph node metastasis.

Objective To analyze the distribution characteristics and risk factors of extended stay over 30 days at tertiary comprehensive hospitals, and explore methods of shortening average length of stay(LOS).Methods Homepage of all inpatients discharged from October 2014 to October 2015 of 31 tertiary comprehensive hospitals in Shanxi province were collected.39 234 cases of these inpatients stayed over 30 days and their case information was complete.A generalized linear model was used for risk factors analysis.Results With the extension of LOS, most of the inpatients with extended stay were found during their 30th-40th days, accounting for 50.21% of all and constituting the highest daily costs as well.The ratio of inpatients decreases with their LOS, and its distribution presents a positive skew in entirety.Distribution of inpatients over 30 days identified urban employees under medical insurance accounting for the highest ratio among all payment categories,and those from the department of orthopedics for the highest ratio among all departments, while those of diseases from injury and poisoning accounting for the highest ratio among all disease categories.The findings indicated ten important factors for extended stay, namely gender, medical payment category, ICD, inter-department transfer, nosocomial infection, and clinical pathway.Conclusions To strengthen management of specific departments and inpatients, focus on key process of medical quality, and accelerate medical insurance payment reform can effectively control extended stay.

Objective To evaluate the relationship between polymorphisms in surfactant protein (SP) genes and susceptibility to chronic obstructive pulmonary disease (COPD). Methods An extensive literature search for relevant studies was conducted in databases of Wanfang Data, VIP, Google Scholar, PubMed, CNKI, CBM, EMBASE and Web of Science and so on from inception to Sep., 2013. A meta-analysis was then performed using Stata 12.0 software. Results 7 case-control studies were included with a total of 1,279 COPD cases and 1,482 healthy controls. This meta-analysis revealed that polymorphisms of the SP-A gene might be associated with an increased risk of COPD (allele model: OR=1.53, 95%CI: 1.14~2.05, P=0.005; dominant model: OR=1.65, 95%CI: 1.02~2.69, P=0.043; recessive model: OR=1.66,95%CI: 1.17~2.35, P=0.005: homozygous model: OR=2.06, 95%CI: 1.24~3.41, P=0.005; eterozygous model: OR =1.59, 95%CI: 1.13~2.22, P=0.007; respectively). However, there was no evidence for any association between polymorphisms of the SP-B and SP-D genes and COPD risk (all P>0.05). Further subgroup analysis by ethnicity suggested that SP-A genetic polymorphisms were associated with an increased risk of COPD among Asians, but not among Caucasians. Conclusion SP-A genetic polymorphisms may contribute to increasing susceptibility to COPD, especially among Asians.

Objective To identify the critical indicators of nursing practice environment in China, as a reference for related studies. Methods Descriptive systematic review was used to retrieve literature of nursing practice environment, collect all potential indicators and design questionnaires based on those indicators. In the end, 39 potential indicators were identified, for a questionnaire survey of nurses from cooperating medical institutions in 30 provinces in China, with the data subject to statistical analysis in multiple linear regression model. Results Questionnaire items of higher mean score were usually found with a smaller 95% confidence interval, while coefficient of variation tended to be lower. Seventeen indicators were recommended as key indicators for nursing practice environment in China, including proper working hours and intensity, opportunities for nurses to participate in hospital management, good working relationship with doctors within a department,nursing managers′support for nurses′right decisions. The remaining components turned out to be insignificant in the analysis. Conclusions The influencing factors for the nursing practice environment in China are different from other countries. In this consideration, nursing managers should further explore and focus on such special indicators, and proactively improve the quality of nursing practice environment for better nursing service.