Abstract: This retrospective analysis examines the diagnosis and treatment of a case of chronic liver disease infected with Vibrio vulnificus, admitted to the First Affiliated Hospital of Hainan Medical University on August 8, 2023. The patient, a 34-year-old male fisherman, had chronic viral hepatitis B. He sustained a leg abrasion while fishing on August 3, and developed fever and continuous swelling pain in both lower limbs, more severe in the left limb, on the night of the injury. On the fourth day of the disease, he went to the local hospital where he received antibiotic treatment and was transferred to the First Affiliated Hospital of Hainan Medical College on August 8. Upon admission, the patient exhibited low blood pressure, high lower limb skin temperature, poor peripheral blood transport, visible scab, and signs of infectious shock. Within 12 hours of admission, an abscess incision and drainage procedure was performed on his left calf, along with negative pressure wound therapy, and tissue samples from the infected left lower limb were sent for microbial culture.The pathogen culture indicated a Vibrio vulnificus infection, and the histopathology results confirmed necrotizing fasciitis. Treatment included meropenem combined with vancomycin for infection control, maintenance of blood pressure and electrolyte balance, tenofovir disoproxil fumarate for antiviral therapy, and polyene phosphatidylcholine capsules for liver protection based on the drug sensitivity results. Additionally, levofloxacin and cefotaxime were administered for infection control and debridement was performed based on wound conditions. After 17 days of hospitalization, the infection was substantially controlled, but the liver function enzyme was still higher than the normal level, and the wound still had blood and exudation. The patient and his family members requested discharge; however, due to poor wound healing, he was readmitted on September 11, 2023, receiving antiviral and liver preservation treatment. On the fifth day,the secretion culture identified a co-infection with Corynebacterium striatum and Providencia stuartii infection. Corynebacterium striatum was subsequently reported as multidrug-resistant, prompting an immediate switch to sensitive antibiotics and supportive care. Sixteen days after readmission, the patient's general condition improved, but the liver function enzyme levels were still higher than normal, so he was discharged. Four months after discharge, a follow-up phone call revealed that the patient had actively pursued antiviral treatment and abstained from alcohol, showing reasonable wound recovery. The patient's case, with a typical exposure history and clinical manifestations, matches the characteristics of septic shock and necrotizing fasciitis caused by V. vulnificus. Clinically, it is crucial todiagnose and treat V. vulnificus infection early according to its pathological characteristics and clinical characteristics to improve the prognosis of patients.

Objective To investigate changes in plasma levels of D-dimer in patients with prostate hyperplasia(BPH)complicat-ed with acute urinary retention(AUR),and to explore its clinical significance.Methods 102 cases of patients with prostate hyper-plasia complicated with acute urinary retention,treated in this hospital from July 2013 to December 2014,were selected and divided into the simple BPH group(56 cases)and BPH complicated with AUR(BPH+AUR)group.The plasma levels of D-dimer of these patients were detected and comparatively analysed.Results Compared with the simple BPH group,the plasma levels of D-dimer of patients in the BPH+AUR group was increased,had statistically significant difference.(P <0.01).Conclusion The plasma levels of D-dimer in patients with BPH complicated with AUR increase significantly,which indicates that patients are with secondary in-creased fibrinolytic activity.Measures should be taken to relieve urinary retention as soon as possible,so as to protect the vascular endothelial function of patients and reduce the incidence of complications.

BACKGROUND: Panel reaction antibody (PRA) plays an important role in rejection of recipients undergoing solid organ transplantation, which has a positive effect on nonfunction of implant. OBJECTIVE: To evaluate the effect of thalassemic serum-specific PRA on the proliferation and differentiation of umbilical cord blood hernatopoetic stem/progenitor cells (HSC/HPCs) in children patients with thalassemia. DESIGN, TIME AND SETTING: The in vitro cytology experiment was performed at the Experimental Research Center, Second Affiliated Hospital, Zhongshan University from January 2006 to August 2007. MATERIALS: Five samples of umbilical cord blood from healthy full-term birth puerperants (each 80 100 mL) were used in this study. PRA serum samples of children patients with thalassemia after repetitive blood transfusion, five samples of AB blood grouping serum, and six samples of positive anticoagulation vein blood (10 mL) were used in the study. METHODS: Mononuclear cells were harvested from umbilical cord blood by Ficoll-Hypaque gradient centrifugation. 1 × 105 rnononuclear cells from umbilical cord blood were incubated with different levels of experimental or AB control serum (0, 50, 100 μ L) from healthy children. The mixture mentioned above was incubated with rabbit complement for semisolid colony culture.MAIN OUTCOME MEASURES: Colony-forming units (CFU) were counted and observed after 7 days and 14 days of culture under an inverted microscope.RESULTS: After incubation with HSC/HPCs PRA serum, total number of CFUs and varied CFUs decreased to different extents, of which the total number of CFUs and CFU- granulocyte-rnacrophages (CFU-GM) had significant differences (P < 0.01). Moreover, there were negative correlations between different levels of serum PRA and the followings: number of total colonies, CFU- GM, CFU- granulocyte-erythrocyte-monocyte-megakaryocytes, CFU-erythroids, burst forming unit-megakaryocytes, and CFU-megakaryocytes (P < 0.05).CONCLUSION: The thalassemic serum PRA has an apparent inhibitory effect on the proliferation and differentiation of cord blood HSC/HPCs in vitro, an effect that may be pronounced with increasing serum PRA.

OBJECTIVETo study the clinicopathologic characteristics of atypical fibrous histiocytoma (AFH), with emphasis on differential diagnosis.

METHODSThe clinical and pathologic features were reviewed in 24 cases of AFH (from 2007 to 2012). The follow-up data were analyzed. Immunohistochemical study using EnVision method was carried out.

RESULTSThere were 10 males and 14 females with age at presentation ranging from 8 to 67 years (mean = 41 years and median = 39 years). The tumor occurred in the extremities (number = 14), trunk (number = 8) or head and neck region (number = 2). Apart from one case, all were located in the dermis. The clinical appearance was similar to those of classic fibrous histiocytoma. Histologically, the tumor was characterized by various number of hyperchromatic bizarre cells scattered in the background. Mitotic figures including atypical ones were noted, especially in the more cellular areas. Immunohistochemical study showed that the tumor cells expressed vimentin. Focal positivity for alpha-smooth muscle actin was demonstrated in some cases. Follow-up information was available in 14 cases. Three of them suffered local recurrence. None of these cases had distant metastasis.

CONCLUSIONSAtypical fibrous histiocytoma represents a pleomorphic variant of fibrous histiocytoma. Although the tumor exhibits worrisome features, it usually pursuits a relatively benign course. Nevertheless, rare cases may recur, especially after incomplete excision. AFH is sometimes mistaken as atypical fibroxanthoma. A distinction between the two entities is warranted as they represent two different entities.

Actins ; metabolism ; Adolescent ; Adult ; Aged ; Back ; pathology ; Child ; Diagnosis, Differential ; Extremities ; pathology ; Female ; Follow-Up Studies ; Histiocytoma, Benign Fibrous ; metabolism ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Skin Neoplasms ; metabolism ; pathology ; surgery ; Vimentin ; metabolism ; Xanthomatosis ; pathology ; Young Adult

Adult ; Aged ; Bone Screws ; Female ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Intramedullary ; Humans ; Internal Fixators ; Male ; Middle Aged

OBJECTIVETo observe the biological changes of primary human nasopharyngeal epithelial cells in the early stage of immortalization.

METHODSThe morphological changes of nasopharyngeal epithelial cells were observed by phase contrast microscopy, and the activity profile of senescence-associated beta-galactosidase (SA-beta-Gal) was detected by SA-beta-Gal staining. The expression of p16(INK4a) protein was tested by immunochemical assay, and the life span in vitro of nasopharyngeal epithelial cells was calculated as population doublings. In addition, the expression of Epstein-Barr (EB) virus latent membrane protein 1 (LMP1) was also detected by immunofluorescence staining.

RESULTSMorphologically, cells treated with EB virus and 12-o-tetradecanoyl-phorbol-13-acetate (TPA) formed multi-layer foci, and their cellular life span in vitro was extended (about 155 days of culture). A low percentage of cells (about 4.8%) expressed SA-beta-Gal activity at late primary culture, and did not always express p16(INK4a) protein in the progression of culture.

CONCLUSIONSNasopharyngeal epithelial cells treated with EB virus in cooperation with TPA can pass through the stage of senescence and enter the early stage of immortalization. Some changes of phenotype occur in these cells. Our results provide data for further studying the mechanism of immortalization and the establishment of a human nasopharyngeal epithelial cell line.

Cell Transformation, Viral ; Cellular Senescence ; Cyclin-Dependent Kinase Inhibitor p16 ; analysis ; Epithelial Cells ; physiology ; virology ; Herpesvirus 4, Human ; physiology ; Humans ; Nasopharynx ; cytology ; virology ; Tetradecanoylphorbol Acetate ; pharmacology

With the development of molecular pathology,many types of epidermal growth factor receptor (EGFR) mutations have been identified.The efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) in non-small cell lung cancer (NSCLC) patients with different types of EGFR mutations,especially in patients with single rare mutations or complex mutations (co-occurrence of two or more different mutations),has not been fully understood.This study aimed to examine the efficacy of EGFR-TKIs in NSCLC patients with different types of EGFR mutations.Clinical data of 809 NSCLC patients who harbored different types of EGFR mutations and treated from January 2012 to October 2016 at Renmin Hospital and Zhongnan Hospital,Wuhan,were retrospectively reviewed.The clinical characteristics of these patients and the efficacy of EGFR-TKIs were analyzed.Among these patients,377 patients had only the EGFR del-19 mutation,362 patients the EGFR L858R mutation in exon 21,33 patients single rare mutations and 37 patients complex mutations.Among these 809 patients,239 patients were treated with EGFR-TKIs.In all the 239 patients,the disease control rate (DCR) was 93.7％ with two patients (0.2％) achieving complete response (CR),the median progression free survival (PFS) was 13.0 months (95％ confidence interval [CI],11.6-14.4 months),and the median overall survival (OS) was 55.0 months (95％ CI,26.3-83.7 months).Subgroup analysis revealed that the DCR in patients harboring single rare or complex mutations of EGFR was significantly lower than in those with del-19 or L858R mutation (P＜0.001).Patients with classic mutations (del-19 and/or L858R mutations) demonstrated longer PFS (P＜0.001) and OS (P=0.017) than those with uncommon mutations (single rare and/or complex mutations).Furthermore,the patients with single rare mutations had shorter median OS than in those with other mutations.Multivariate Cox regression analysis identified that the type of EGFR mutations was an independent risk factor for PFS (hazard ratio [HR]=0.308,95％ CI,0.191-0.494,P＜0.001) and OS (HR=0.221,95％ CI,0.101-0.480,P＜0.001).The results suggest that the single rare or complex EGFR mutations confer inferior efficacy of EGFR-TKIs treatment to the classic mutations.The prognosis of the single rare EGFR mutations is depressing.EGFR-TKIs may be not a good choice for NSCLC patients with single rare mutations of EGFR.Further studies in these patients with uncommon mutations (especially for the patients with single rare mutations) are needed to determine a better precision treatment.

"Internet + Nursing Services" can provide convenient and high-quality nursing services for elderly patients with chronic diseases and other people who are inconvenient to travel. Actively promoting "Internet + Nursing Services" is of great significance for accelerating healthy aging and facilitating the implementation of the healthy China strategy. This article analyzes the problems existing in the implementation of "Internet + Nursing Services", and finds that: related laws and regulations are lacking, and supporting systems urgently need to be improved; nurses have limited time and energy, and there are concerns about personal safety and practice safety; the actual service utilization rate of patients needs to be improved; the service mode is relatively sporadic and single; there are isolated islands of information and risks of data leakage. This article puts forward corresponding development countermeasures and suggestions in order to provide a reference for the healthy and sustainable development of "Internet + Nursing Services".

Objective:To explore the mechanism of herb-partitioned moxibustion in relieving rat intestinal inflammation by focusing on the neutrophil extracellular traps(NETs)in Crohn disease(CD)development. Methods:Rats were randomly divided into a normal group,a model group,a herb-partitioned moxibustion group,and a mesalazine group.The CD rat model was prepared with 2,4,6-trinitrobenzene sulfonic acid except for rats in the normal group.Rats in the normal group and model group did not receive any treatment but had the same fixation as the other groups.Rats in the herb-partitioned moxibustion group received herb-partitioned moxibustion at Qihai(CV6)and bilateral Tianshu(ST25).Rats in the mesalazine group received intragastric administration of mesalazine enteric-coated tablets.The general situation of rats in each group was recorded,and the histopathological changes in the colon were observed and scored by hematoxylin-eosin staining.The serum concentrations of NETs DNA(NETs-DNA),neutrophil elastase(NE)-DNA,and myeloperoxidase(MPO)-DNA were detected by ABC enzyme-linked immunosorbent assay,and the citrullinated histone 3(citH3),MPO,and NE protein and mRNA expression levels in rat colon tissue were observed by immunofluorescence and real-time quantitative polymerase chain reaction. Results:Compared with the normal group,the mucosal ulcer reached the muscularis,the epithelium was incomplete,the goblet cells decreased obviously with significant inflammatory cell infiltration in the colon;the colonic mucosa damage index(CMDI)score increased significantly(P<0.01);the serum NETs-DNA,NE-DNA,and MPO-DNA concentrations increased(P<0.05);the NE,citH3,and MPO protein and mRNA expression in the colonic tissue increased significantly in the model group(P<0.01 or P<0.05).Compared with the model group,the mucosal epithelium in the herb-partitioned moxibustion group and the mesalazine group was repaired and the goblet cells increased with a few infiltrating inflammatory cells in the colon;the CMDI score decreased(P<0.01);the serum NETs-DNA,NE-DNA,and MPO-DNA concentrations decreased(P<0.05);the NE,citH3,and MPO protein and mRNA expression in the colonic tissue was down-regulated(P<0.01 or P<0.05). Conclusion:Herb-partitioned moxibustion reduced the serum NETs complex and inhibited the protein and mRNA expression of NETs complex in the colon tissue,which may be one mechanism of herb-partitioned moxibustion in relieving colon mucosal inflammation in CD.

Objective:To investigate the role of serotonin reuptake transporter(SERT)and P2X3 receptor of dorsal root ganglion(DRG)in regulating visceral hypersensitivity of rats with irritable bowel syndrome(IBS)by electroacupuncture(EA). Methods:Male Sprague-Dawley and SERT-/-rats were subjected to preparing IBS visceral hypersensitivity models with 2,4,6-trinitrobenzene sulfonic acid(TNBS)enema.Three weeks post-modeling,interventions including EA,intrathecal injection,and EA plus intrathecal injection were applied,respectively.Hematoxylin-eosin staining and abdominal withdrawal reflex(AWR)score were used to confirm the successful establishment of the IBS model.AWR score,whole-cell patch clamp technique,and Western blotting assay were used to evaluate the changes in visceral pain sensitivity,electrophysiological properties of DRG neurons,and the expression of DRG P2X3 receptor and SERT in IBS rats. Results:Compared to the model group,the AWR score in the EA group decreased significantly(P<0.05),the resting membrane potential(P<0.05)and the number of action potentials(P<0.05)of DRG neurons reduced,and the baseline intensity increased(P<0.05);additionally,the expression of P2X3 receptor in DRG decreased(P<0.01),and the SERT expression increased(P<0.05).Compared to the P2X3 receptor agonist group,the SERT protein expression in DRG was higher in the EA group.In SERT-/-rats,the P2X3 receptor expression in DRG increased in the EA group compared to the model group(P<0.01). Conclusion:EA modulates the electrophysiological characteristics of intestinal primary sensory neurons by regulating the expression of SERT and P2X3 receptor in DRG of IBS rats.This modulation may contribute to the mechanism by which EA alleviates peripheral sensitization of visceral pain in IBS rats.