[Summary] Pectus excavatum ( PE ) is a posterior intrusion of the chest wall into the thoracic cavity . Although the physiological and psychological consequences vary , for a large number of patients the lesions are troublesome enough that they need corrective surgery .The minimally invasive repair of pectus excavatum ( Nuss procedure ) has been performed safely , effectively , and extensively .The current situations and progresses associated with the Nuss procedure were reviewed .

Objective To study the value of detection of C- reactive protein(CRP), serum glucose concen-tration and APACHE Ⅱ grade for estimating inflammation, pathogenetic condition and prognosis of systemic inflam-matory response syndrome (SIRS) patients.Methods 50 SIRS patients in ICU were selected and were divided into S1 and S2 subgroup according to SIRS diagnosis standard, and 18 patients developed MOBS.30 patients without SIRS, were selected as control group.Detection of CRP, serum glucose concentration and APACHE Ⅱ grade were per-formed.Results CRP(76.19±11.98 mg/L vs.14.04±5.70 mg/L) ,serum glucose concentration(7.10±1.30 mmol/L vs.5.32±1.09 mmol/L) and APACHE Ⅱ grade (20.06±6.39 vs.7.90±3.54) of SIRS group were higher than that of non-SIRs group (P<0.01).CRP, serum glucose concentration and APACHE Ⅱ grade all are higher in group S2 than that of group S1 (91.25±9.89 mg/L vs.62.29±10.38 mg/L,8.32±2.40 mmol/L vs.7.10±1.69 mmol/L,26.72±5.14 vs.18.37±5.70).MOBS incidence and case fatality in S2 subgroup (12/15 and 6/35) were higher than that of S1 subgroup(10/15 and 3/35 ) (P<0.01 ).Conclusion CRP, serum glucose concentration and APACHE Ⅱ grade are increased in SIRS patients and with their increasing, MOBS incidence and case fatality were also increasing.CRP, serum glucose concentration and APACHE Ⅱ grade are significant factors in estimating SIRS patients pathogenetic condition and their prognosis.

Objective To detect the serum IgG4 and autoantibodies levels in patients with orbital disease of unknown reasons,and to investigate their values in patients with orbital disease.Methods A total of 366 patients with orbital disease of unknown reasons recruited in the Department of Ophthalmology,Beijing Tongren Hospital Affiliated to Capital Medical University from October 2013 to October 2016 were retrospectively enrolled as orbital disease group,and 266 patients with autoimmune disease in the same period from the Department of Rheumatology of the hospital were selected as controls.The serum IgG4 was detected by rate scattering method,antinuclear antibody(ANA),anti-double-stranded DNA(dsDNA)antibody as well as anti-extractable nuclear antigen(ENA)antibody were measured by indirect immunofluorescence assay,and anti-neutrophil cytoplasmic antibody(ANCA)was detected by enzyme linked immunosorbent assay,all of which were compared between the orbital disease patients and the controls using chi-square test.Results The positive rate of the serum IgG4 in the patients with orbital disease was 36.1％(132/366),obviously higher than that in the controls(27.1％,72/266),the difference being statistically significant(x2 =5.705,P=0.017).And the positive rate of serum IgG4≥1 350 mg/L(29.0％,106/366)in the patients with orbital disease was higher than that in the controls(21.8％,58/266; x2 =4.107,P=0.043).The positive rate of ANA in the patients with orbital disease was 17.8％(65/366),obviously lower than that in the controls(28.6％,76/266),the difference also being statistically significant(x2 =10.389,P=0.001).The positive rate of anti-ENA antibody in the patients with orbital disease was 4.6％(17/366),also obviously lower that that in the controls(9.0％,24/266),with statistically significant difference as well(x2 =4.866,P=0.027).No anti-dsDNA antibody was detected in the patients with orbital disease.Only three patients with orbital disease(0.8％,3/366)were found ANCA positive,and no statistically significant difference was found in comparison with the controls(3.0％,8/266; x2 =3.127,P=0.077).Conclusions Elevated IgG4 level was commonly seen in the patients with orbital disease,where as autoantibodies were negative in the most of the patients,indicating that IgG4 might correlate with orbital disease,and part of orbital disease may belong to the IgG4-related orbital disease.

Objective: To investigate the factors associated with the patient's adherence to screening in the five years before the diagnosis of hepatocellular carcinoma (HCC) related to chronic hepatitis B ( CHB ), so as to provide reference for improving the screening rate. Methods: From June 2016 to April 2018, the patients with newly diagnosed HCC and a history of CHB for more than five years in Southwest Hospital in Chongqing were interviewed. The information about socio-demographic characteristics, health status, medical care and HCC screening in the past five years were collected. A multivariate logistic regression model was used to analyze the factors associated with adherence to screening. Results: Among 420 participants, 140 ( 33.33% ) adhered to HCC screening, 124 ( 29.53% ) had irregular/incomplete screening, while 156 ( 37.14% ) never had screening. The proportion of early-stage HCC at diagnosis was significantly higher in patients who adhered to screening ( 77.14% ) than that in patients who had irregular/incomplete screening (35.48%) or no screening ( 12.82% ) and the differences were statistically significant ( P<0.05 ). The multivariate analysis demonstrated that five factors were significantly associated with patient's adherence to screening, including education level of high school and above ( OR=2.346, 95%CI: 1.370-4.017), family history of HCC ( OR=2.795, 95%CI: 1.457-5.362 ), history of chronic diseases ( OR=3.860, 95%CI: 2.052-7.262), acceptance of antiviral therapy ( OR=17.816, 95%CI: 9.702-32.716 ) and specialized clinic visits ( OR=8.332, 95%CI: 1.588-43.710 ). Conclusions Adherence to screening is conducive to the early detection of HCC, but the screening rate is low in the patients with CHB. Education level, history of HCC, health status and medical status are significantly related to screening adherence.

Objective To investigate the clinicopathological features,diagnosis,treatment,prognosis and causative agent of a case of eumycetoma on the submaxilla.Methods A case of eumycetoma diagnosed in our department was assessed for its clinical and pathological features as well as mycologic and molecular identification.Related literature was reviewed.Results The patient was primarily characterized by swelling of the submaxilla,with multiple sinuses draining many black granules.Pathologic examination revealed a pyogenic granulomatous inflammation,and a number of lotus rhizome node-like hypha were observed in tissue samples through PAS staining.Sequence analysis of multiple loci of the isolates,including ITS 1,ITS2 and D1/D2,showed that it was mostly similar to Madurella mycetomatis with a homology of 97%.Conclusion This is a case ofeumycetoma on the submaxilla induced by a novel species of Madurella.

Objective To investigate the effects of diclofenac sodium suppositories on emergence agitation after sevoflurane maintenance in children undergoing adenotonsilleetomy. Methods Forty-five patients selected for adenotonsillectomy were randomly divided into three groups (n=15). Patients in group 1 were given diclofenac sodium suppositories 12.5 mg right after intubation, those in group 2 were given diclofenac sodium suppositories 12.5 mg immediately after operation, while those in control group were not treated with diclofenac sodium suppositories before or after operation. The extubation time and time spent in post-anesthctic ICU (PACU) were recorded, the modified Aldrete score and pain score were assessed after entrance into PACU, and pediatric anesthesia emergence delirium (PAED) scale was administered 10, 20 and 30 rain after entrance into PACU. Results There was no significant difference in extubation time and time spent in PACU among three groups(P>0.05). Ten minutes after entrance into PACU, the PAED score of group 1 was significantly lower than those of group 2 and control group(P<0.05), while there was no significant difference between the latter two groups(P>0.05). Twenty and thirty minutes after entrance into PACU, the PAED scores of group 1 and group 2 were significantly lower than that of control group(P<0.05). There was no significant difference in the modified Aldrete score right after entrance into PACU among three groups. The pain scores of group 1 and group 2 were signifiantly lower than that of control group(P< 0.05). Conclusion Diclofenac sodium suppositories can decrease the incidence and severity of emergence agitation after sevoflurane maintenance in children undergoing adenotonsillectomy.

Objective To study the polymorphisms of short tandem repeat (STR) loci in intron 1, 24, 13 and 22 (STR 1,24, 13, 22) of factor Ⅷ (FⅧ) gene in Chinese population, and establish single tube multiple fluorescent PCR method for rapid diagnosis of haemophilina A(HA). Methods Four STRs from genomie DNA of 220 females without blood relationship were amplified in a single tube using quadri-fluorescence PCR. Capillary electrophoresis was analyzed in ABI PRISM 310 Genetic Analyzer. DNA sequencing was used to assay the number of dinueleotide repeats. Gene diagnosis were performed in 96 HA families. Results It was observed that 7, 9, 10 and 7 different alleles were found in STR1, 24, 13 and 22, respectively. The PIC (polymorphism information contents) were 0. 3789, 0. 4055, 0. 5239 and 0. 4713 in STR1,24, 13 and 22, respectively, and the HR (heterozygesity rate) were 34. 55% (76/220), 38. 18% (84/220), 49. 55% (109/220) and 43.64% (96/220). In 96 HA families, the diagnosis rate of STR1, 24, 13 and 22 were 38. 54% (37/96), 38. 54% (37/96), 54. 17% (52/96), 42. 71% (41/96), respectively. Whereas it achieved 79. 17% (76/96) when combining the four STR markers. Conciusion The single tube multiple fluorescent PCR of four STR loci is an effective, simple, quick method for linkage analysis and gene diagnosis of haemophilia A.

Diagnosis, Differential ; Humans ; Parathyroid Glands

OBJECTIVETo construct the prokaryotic expression systems of tpnl7 and tpn47 genes and tpn17-tpn47 fusion of Treponema pallidum, and to establish ELISAs based on rTpN17, rTpN47 and rTpN17-TpN47 as antigens to evaluate the sensitivity and specificity of the ELISAs for detection of serological diagnosed syphilis.

METHODStpn17 and tpn47 genes were amplified and cloned by routine molecular biological methods. PCR with linking primers was used to construct artificial fusion gene tpn17-tpn47. The prokaryotic expression systems of the genes were then constructed. SDS-PAGE was used to measure the expression of the target recombinant proteins rTpN17, rTpN47 and rTpN17-TpN47. Ni-NTA affinity chromatography was applied to extract the three recombinant proteins, while Western blot was performed to determine their immunity. Using rTpN17, rTpN47 and rTpN17-TpN47 as the coated antigens, ELISAs (rTpN17-ELISA, rTpN47-ELISA and rTpN17-TpN47- ELISA) were established to detect serum samples from 200 healthy individuals, 25 RA patients, 17 SLE patients and 419 syphilis patients. Results of the ELISAs were compared to those with TRUST and TPHA.

RESULTSThe sequence similarities of the cloned tpnl7 and tpn47 genes and the constructed tpn17-tpn47 fusion gene were 100%, compared with the corresponding sequences in GenBank. The expression outputs of rTpN17, rTpN47 and rTpN17-TpN47 were 37.2%, 23.3% and 29.8% of the total bacterial proteins, respectively. Each of the three purified recombinant proteins showed a single fragment in gel after electrophoresis, and could take place remarkable conjugation reactions to the positive sera from syphilis patients. The detection results of rTpN17-ELISA, rTpN47-ELISA and rTpN17-TpN47-ELISA were negative for the serum samples from healthy individuals, RA and SLE patients, while presented 84.4%, 82.3% and 98.1% positive detection rates for the serum samples from syphilis patients. The positive detection rates of rTpN17-ELISA and rTpN47-ELISA were lower than that of TPHA (P<0.01), while the positive detection rate of rTpN17-TpN47-ELISA was similar to that of TPHA (P>0.05). All the positive detection rates from ELISA tests were higher than that of TRUST (71.4%).

CONCLUSIONrTpN17-ELISA, rTpN47-ELISA and especially rTpN17-TpN47-ELISA established in this study were of great hope as it was rapid, simple, convenient, safe, with high sensitivity and specificity for serological screening and detection of syphilis.

Bacterial Proteins ; biosynthesis ; genetics ; Cloning, Molecular ; Enzyme-Linked Immunosorbent Assay ; methods ; Genes, Bacterial ; Humans ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; Sensitivity and Specificity ; Syphilis ; diagnosis ; Syphilis Serodiagnosis ; methods ; Treponema pallidum ; genetics

Objective To explore the distribution of inflam m atory cells and positive expression of P-se-lectin glycoprotein ligand-1 (PSG L-1) in infant brainstem tissue from hand-foot-m outh disease related fatal brainstem encephalitis. Methods Tw enty brainstem sam ples from infants suffered from brainstem en-cephalitis w ere collected as the experim ental group. Ten brainstem sam ples from infants died of non-brain diseases and injuries w ere collected as the control group. The distribution of inflam m atory cells and the expression of PSG L-1 in the tw o groups w ere exam ined by im m unohistochem ical m ethod. The characteristics of the positive cells w ere observed. Results In brainstem tissue of the experim ental group, there w ere sleeve infiltrations of inflam m atory cells around the vessels and in the glial nodule. Microglia was the m ost and following was neutrophils around the vessels and in the glial nodule. There was a significant statistical difference am ong m icroglias, neutrophils and lym phocytes (P<0.05). There was no sleeve infiltration in the control group. PSG L-1 protein was expressed w idely in inflam m atory cells in the experim ental group, especially in the inflam m atory cells around the vessels and in the glial nodule. B ut PSG L-1 positive staining could be observed significantly less in the control group com paring with the experim ental group (P<0.05). Conclusion Microglia is the m ain type of inflam m atory cells involved in the progress of the fatal disease. Moreover, PSG L-1 could participate in the pathogenesis of hand-foot-m outh disease related fatal brainstem encephalitis.