Objective To explore the role of flexible fiberoptic bronchoscope(FFB) in the critical patients with severe respiratory diseases of PICU.Methods One hundred and eighty-nine cases of severe respiratory diseases had undergone FFB from Jul 2010 to Jan 2011.One hundred and fifty-seven (83.06％) cases were less than 3 years.FFB examinations were made through nose (226 times) and endotracheal intubation (25 times).Bronchoscopic lavage for bacterial culture was performed by injecting normal saline solution (NSS) via a syringe into the working channel of FFB.Results Of all 189 cases,bacteria were isolated from 80 cases (42.3％) for bacterial culture of bronchoscopic lavage fluid,which included G-bacilli in 51 cases,G + cocci in 21 cases,and fungi in 8 cases.Six cases with tracheobronchial foreign bodies and 31 cases with respiratory tract anatomical abnormalities were found through FFB.Forty cases of severe pneumonia complicated with respiratory failure underwent bronchoscopic lavage,which were effective in 35 cases,and ineffective in 5 cases.In 20 cases of severe pneumonia atelectasis,pulmonary reexpansion were found in 16 cases by bronchoscopic lavage,atomization inhalation,and systemic administration,4 cases improved.Tracheobronchial foreign bodies were removed in all 6 cases by FFB.During FFB,bradycardia was found in 1 cases.There was no FFBrelated death.Conclusion FFB is safe for severe patients with respiratory diseases in PICU.FFB play important role in diagnosis and treatment for children in PICU,including feasible intervention under bronchoscopy.

Objective: To explore the potential mechanism of acupuncture and moxibustion in treating Crohn disease (CD) by evaluating the changes in histamine and inflammatory factors in the skin tissue at Tianshu (ST25) of rats.Methods: Fifty-eight Sprague-Dawley rats were randomly divided into a normal group (n=14) and a CD-modeling group (n=44). Rats in the CD-modeling group received enema with 2,4,6-trinitrobenzene sulfonic acid plus ethanol to establish CD models. The enema was repeated once every 7 d for a total of 4 times. After modeling, four modeled rats and four normal rats were randomly selected for model identification. After the CD model was successfully established, the remaining rats in the CD-modeling group were randomly divided into a model group, an acupuncture group, a moxibustion group, and a Western medication group, with ten rats in each group. The rats in the acupuncture and moxibustion groups were treated with acupuncture or moxibustion at Tianshu (ST25) and Shangjuxu (ST37); the rats in the Western medication group were treated with mesalazine enteric-coated tablets by gavage for continuous 7 d. After the intervention, the colon tissue of rats in each group was collected. After gross observation, hematoxylin-eosin (HE) staining was performed to further observe the pathological changes. The expression of histamine in the skin tissue at Tianshu (ST25) was detected by enzyme-linked immunosorbent assay. The expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-18, IL-10, and IL-6 in the skin tissue at Tianshu (ST25) was detected by Western blotting. Results: Compared with the normal group, the colonic wall of rats in the model group showed cobblestone-like changes, local ulcers, and polyps in dark red and thickening and hardening. HE staining showed local loss of mucosal epithelial layer and formation of slit-like ulcers, destruction of mucosal glands, edema, and infiltration of inflammatory cells in lamina propria and submucosa, and occasional formation of sarcoid-like granuloma. The levels of histamine and IL-6 were significantly up-regulated (P<0.01, P<0.05), and the levels of TNF-α, IL-18, and IL-10 were significantly down- regulated (P<0.01 or P<0.05) in the skin tissue at Tianshu (ST25) of rats in the model group. Compared with the model group, the pathomorphological damage of the colon tissue of rats in the acupuncture group, moxibustion group, and Western medication group was significantly improved. The levels of histamine and IL-6 were significantly down- regulated (P<0.01, P<0.05), and the level of IL-10 was significantly up-regulated (P<0.01) in the skin at Tianshu (ST25) of rats in the acupuncture group. The levels of histamine and IL-6 were significantly down-regulated (P<0.01, P<0.05), and the levels of TNF-α, IL-18, and IL-10 were significantly up-regulated (P<0.01 or P<0.05) in the skin tissue at Tianshu (ST25) of rats in the moxibustion group. The level of histamine was significantly down-regulated (P<0.01), and the levels of IL-18 and IL-10 were significantly up-regulated (P<0.05, P<0.01) in the skin tissue of rats in the Western medication group. Compared with the acupuncture group, the level of IL-10 in the skin tissue at Tianshu (ST25) of rats in the moxibustion group was significantly up-regulated (P<0.01). Conclusion: The inflammatory responses in the skin tissue at Tianshu (ST25) may be the external manifestation of CD. Significant differences in the regulation of inflammatory responses in the skin tissue at Tianshu (ST25) between acupuncture and moxibustion exist, which may be caused by the differences in the stimulation characteristics between acupuncture and moxibustion.

Interferons (IFNs) are cytokines playing an important role in immune responses. Interferons are classified into two distinct types according to specific interferon receptors(IFNR). Type I IFNs include IFN-α and IFN-β, whereas IFN-γ is type II IFN. It is well known that type I IFNs have important roles in the host defense against viruses through activation of interferon receptor A (IFNAR). However, many recent studies have also demonstrated that type I IFNs have effects on immune responses to bacterial infection. This review focuses on the immune regulation of type I IFN-mediated signal pathways in bacterial infections such as Listeria monocytogenes, Streptococcus, Mycobacterium tuberculosis, Bacillus anthracis, Legionella, Pseudomonas aeruginosa and others.
Animals ; Bacterial Infections ; immunology ; Humans ; Immunity, Innate ; Interferon Type I ; immunology ; Signal Transduction

Objective:To determine the immunological effects of a new type adjuvant CTA 1-DD/IgG.Methods:Intranasal im-munization of BALB/c mice with OVA in combination with adjuvant CTA 1-DD or CTA1-DD/IgG.Blood samples were subjected to OVA-specific IgG Abs detection and IgG subclass profiles assessment using ELISA.Splenic plasma cells secreting anti-OVA Abs were detected by ELISPOT.Results:CTA1-DD/IgG showed stronger activity in inducing OVA-specific IgG Abs and splenic Abs-secreting cells compared with CTA1-DD.The enhancement of IgG1,IgG2a and IgG2b Abs were observed,and the ratio IgG2a/IgG1 were >1 in both groups.Conclusion: CTA1-DD/IgG can exert enhanced adjuvant effects compared with CTA 1-DD.Mixed IgG subclasses are induced,indicating a more balanced Th1/Th2 response.

OBJECTIVETo explore a new access for internal rigid fixation of mandibular mid-and-low condylar fracture.

METHODS16 patients of unilateral mid-and-low condylar fractures were treated with a 2cm mini-retromandibular approach. The subcutaneous tissues superficial to the superficial muscular aponeurotic system (SMAS) were dissected forward that parallel to the masseter muscle fiber bundles, aiming to the fracture. After exposing the fracture, the fracture segments were reduced and fixed under sufficient exposure.

RESULTSCorrect anatomic reduction and occlusion were achieved in all cases. Additionally, all patients showed normal articular function and the surgical scars were barely visible.

CONCLUSIONThe transmasseter approach by retromandibular access is one of the feasible methods for curing mid-and-low condylar fracture, which minimizeing the risk of facial nerve injury and reducing the visible scars.

Adult ; Dental Occlusion ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Mandible ; Mandibular Condyle ; Mandibular Fractures ; Masseter Muscle ; Middle Aged ; Treatment Outcome

Objective: To evaluate the effects of office blood pressure(OBP)combined with ambulatory blood pressure monitoring(ABPM)on the diagnosis of hypertension. Methods: The residents aged 35-79 years without hypertension history,whose casual OBP were 120~159 mm Hg/80~99 mm Hg,were enrolled from 4 communities of Hangzhou and Zhuji from 2015 to 2018. They were performed OBP measurements on other two days in 4 weeks and ABPM in a week. There were 2 criteria of OBP as elevated OBP on the first day or in 3 different days,and 4 criteria of ABPM as elevated mean BP in 24 hours, daytime, nighttime and either of the above time. Receiver operating characteristic(ROC)curve was employed to evaluate the effects of different OBP criteria combined with ABPM criteria on the diagnosis of masked hypertension(MH)and white-coat hypertension(WCH). Results: Taking 3-day-OBP as a golden standard,the 1-day-OBP with 4 ABPM criteria had the areas under the ROC curve(AUC)of 0.79-0.81,sensitivity of 57.58%-62.77% and specificity of 100.00% in MH;had the AUC of 0.95-0.98,sensitivity of 100.00% and specificity of 88.96%-96.80% in WCH. The Kappa values were all less than 0.6,known as low consistency. Taking either time of ABPM as a golden standard,24 hours,daytime and nighttime ABPM criteria with OBP had the AUC of 0.90-0.92,sensitivity of 79.17%-83.90% and specificity of 100.00% in MH(all Kappa>0.6),when with 1-day-OBP,the Kappa values were all more than 0.8,known as high consistency;had the AUC of 0.95-1.00,sensitivity of 100.00% and specificity of 89.54%-99.37% in WCH,the Kappa values of daytime ABPM were all more than 0.6,known as high consistency. Conclusions If limited by options, 1-day-OBP could be used instead of 3-day-OBP for detection of WCH or exclusion of MH yet with less accuracy; 24 hours or daytime ABPM instead of either time of ABPM was reliable.

Group-A rotaviruses are recognized as the most common cause of acute diarrhea. Phylogenetic analyses of the VP7 genes of rotaviruses circulating in Nanjing (China) could aid in the development of rotavirus vaccines. A total of 908 stool specimens were collected from patients suffering from acute diarrhea in Nanjing between October 2012 and December 2013, and were tested further for rotaviruses. Fifty rotavirus isolates selected randomly were typed by reverse transcription-polymerase chain reaction using serotype-specific primers for G genotyping. VP7 genes of 19 G9 strains were sequenced for further genetic characterization. Among the 908 stool specimens examined during the surveillance period, 103 (11.34%) were rotavirus-positive. G9 was the most predominant genotype (78.0%), followed by G2, G1 and G3. Sequence and phylogenetic analyses of the VP7 genes of serotype G9 rotaviruses revealed these strains to comprise two lineages (G9-VI, G9-III) and to be dominated by the G9-VI lineage (which belonged to a unique subcluster of Japanese and Chinese G9 strains). Amino-acid sequences of the four antigenic regions (A, B, C or F) were variant among a portion of strains, which may have contributed to the prevalence of G9 rotaviruses in this area.
Adult ; Amino Acid Sequence ; Antigens, Viral ; chemistry ; genetics ; Capsid Proteins ; chemistry ; genetics ; China ; Evolution, Molecular ; Humans ; Infant ; Molecular Sequence Data ; Mutation ; Phylogeny ; Rotavirus ; genetics ; immunology ; physiology ; Serogroup

OBJECTIVE: To investigate the genetic polymorphism in the 5' and 3' region of TPH2 gene of Northern Chinese Han population and to explore its application value in forensic medicine. METHODS: The sequence variants and the genetic polymorphisms of 6 SNP loci (rs4570625, rs11178997, rs11178998, rs41317118, rs17110747 and rs41317114) within a 905 bp 5' flanking region and a 1,104bp 3' flanking region of TPH2 gene were analyzed by DNA sequencing in a total of 244 unrelated healthy individuals in Northern Chinese Han population. The statistical analysis was carried out by Haploview v4.2 software. RESULTS: The genotypic distributions of the 6 SNP loci in the TPH2 gene were in accordance with Hardy-Weinberg equilibrium. One C/T variant in 92922 site was found. There was a high linkage disequilibrium among the 3 SNP loci (rs4570625, rs11178997 and rs11178998) in the 5' region and the 3 SNP loci (rs41317118, rs17110747 and rs41317114) in the 3' region of TPH2 gene, respectively. The parameters of population genetics of 6 SNP loci were obtained. CONCLUSION There are great polymorphisms in the 5' and 3' region of TPH2 gene in Northern Chinese Han population, which could be used as genetic indexes for association analysis of the related diseases, as well as for forensic individual identification and paternity testing.
3' Untranslated Regions ; 5' Untranslated Regions ; Asian People/genetics* ; China/ethnology* ; Forensic Genetics ; Gene Frequency ; Genetics, Population ; Genotype ; Humans ; Linkage Disequilibrium/genetics* ; Microsatellite Repeats ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Tryptophan Hydroxylase/genetics*

OBJECTIVETo study the relationship between the patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene and hereditary susceptibility to non-alcoholic fatty liver disease (NAFLD) by detecting single nucleotide polymorphisms (SNPs).

METHODSPeripheral blood DNA from 315 patients diagnosed with NAFLD (including the spectrum of simple steatosis (SS) and non-alcoholic steatosis (NASH)) and 336 control subjects was used to determine the PNPLA3 genotype by polymerase chain reaction (PCR) and direct sequencing. The relationship of SNPs and NAFLD-related markers of liver function were assessed by correlation analysis.

RESULTSThe SNP rs738409 was identified in more of the NAFLD patients (allele variant frequencies: NAFLD, 65.40%; NASH: 71.87%; SS, 56.47%) than in the controls (33.18%). Case-control analysis revealed that carriers of the 148GG genotype were at 3.81-fold (95% CI: 3.03 ~ 4.79) higher risk of developing NAFLD and at 1.97-fold (95% CI: 1.41 ~ 2.75) higher risk of progressing from SS to NASH, compared with non-carriers. rs738409 was also found to be associated with serum levels of alanine aminotransferase (ALT) and y-glutamyltransferase (y-GT) (both P less than 0.05). Carriers of the 148GG genotype had significantly higher body mass index, ALT, and fasting insulin than carriers of the 148CC genotype (all P less than 0.05), and significantly higher level of serum HDL than carriers of either the 148CC genotype or the 148GC genotype (both P less than 0.05).

CONCLUSIONPolymorphisms in the PNPLA3 gene may play an important role in mediating susceptibility to developing NAFLD in the Chinese population. The rs738409 polymorphism, in particular, is related to development and progression of NAFLD and may play a role in the contribution of PNPLA3 to NAFLD pathogenesis.

Adolescent ; Adult ; Aged ; Alleles ; Case-Control Studies ; Fatty Liver ; genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Lipase ; genetics ; Male ; Membrane Proteins ; genetics ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; Polymorphism, Single Nucleotide ; Young Adult

BACKGROUNDCommunity-acquired pneumonia (CAP) remains one of the leading causes of death from infectious diseases around the world. Most severe CAP patients are admitted to the intensive care unit (ICU), and receive intense treatment. The present study aimed to evaluate the role of the pneumonia severity index (PSI), CURB-65, and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.

METHODSA total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated. The ability of different pneumonia severity scores to predict mortality was compared for effectiveness, while the risk factors associated with 30-day mortality rates and hospital length of stay (LOS) were evaluated. The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.

RESULTSAll three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group. As the risk level increased, the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged. The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94, 0.91 and 0.89 for the PSI, CURB-65 and sepsis score, respectively. Compared with the corresponding control groups, the mortality was markedly increased in patients with a history of smoking, prior admission to ICU, respiratory failure, or co-morbidity of heart disease. The differences were also identified in LOS between control groups and patients with ICU treatment, heart, or cerebrovascular disease. Logistic regression analysis showed that age over 65 years, a history of smoking, and respiratory failure were closely related to mortality in the overall CAP cohort, whereas age, ICU admission, respiratory failure, and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group. The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment, but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.

CONCLUSIONSEach severity score system, CURB-65, sepsis severity score and especially PSI, was capable of effectively predicting CAP mortality. Delayed ICU admission was related to higher mortality rates in severe CAP patients.

Adult ; Aged ; China ; Community-Acquired Infections ; mortality ; pathology ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia ; mortality ; pathology ; Sepsis ; mortality ; pathology ; Severity of Illness Index