Objective To evaluate the curative effect of ultra-early microtrauma drainage in the treatment of hypertensive cerebral hemorrhage. Methods Sixty-one cases of hypertensive cerebral hemorrhage were divided into two groups: the ultra-early group (31 cases; received surgery within 6 hours after the onset) and the control group (30 cases; received surgery between 24 hours and 1 week after the onset).All these cases underwent microtrauma drainage for cleaning the hematoma. Results The effective rate and the marked effective rate in the ultra-early group were 83 9% (26/31) and 67 7% (21/31),respectively,both of which were higher than those in the control group (60% and 40%; ? 2=4 322,4 725;P =0 038, 0 030).The death rate in the ultra-early group (16 1%,5/31) was lower than that in the control group (40%,12/30; ? 2=4 322,P =0 038).Of the life quality of survivors,the values of ADL Ⅰ～Ⅲ accounted for 84 6% (22/26) in the ultra-early group and 55 6% (10/18) in the control group ( ? 2=3 182;P =0 074). Conclusions Ultra-early microtrauma drainage for hypertensive cerebral hemorrhage provides better curative effect and lower death rate than postponed operation.

Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.

detection of HIV-1 quasispecies in HIV-1 infected populations with low level viral load.

Objective To investigate the characteristics of V3 loop amino acid sequences of human immunodeficiency virus type 1 (HIV-1) quasi-species in long-term non-progressors (LTNP)infected with HIV. Methods End-point limiting dilution polymerase chain reaction (EPLD PCR) was used to amplify the env gene c2-v3-c3 region of single HIV-1 provirus from five LTNPs at sequential time points. The PCR products were then sequenced and the amino acid sequences of V3 loop were analyzed by sequence confirm analysis technology. Results The results showed that there were one to ten kinds of polymorphisms in the V3 region of HIV-1 quasi-species which were found from the serial samples of the five LTNP. However, the sequences of the predominant strains were either completely consistent or at most changed at one or two residues in the serial samples of individual patient. The tetramer compositions of the tip of V3 loop were consistent in each patient. It was GPGR in four patients and GPGK in one patient. It was speculated the co-receptor of HIV-1 was CC chemokine receptor (CCR)-5 based on the amino acids at the residue 11 and residue 25 of V3 loop and the net charge of V3 loop. Conclusions There are various polymorphisms at the HIV V3 loop in LTNP. However, the tetramer composition of the tip part of V3 loop is stable. The LTNP are very likely infected with non-syncytium inducing (NSI) strain.

Objective To identify the pathogens that cause hand, foot and mouth disease (HFMD) in adults and analyze the nucleotide sequences characteristics of enterovirus 71 (EV71). Methods The reverse transcription-polymerase chain reaction (RT-PCR) method was used to detect the enterovirus from the samples of four adult HFMD patients. The 227 bp amplified segments of EVT1 were then sequenced and compared with the sequences of previously isolated EVT1 strains available from GenBank by homogeneity and phylogenetic tree analyses. Results All the results of RT-PCR with enterovirus universal primers and EVT1 specific primers were positive. The EV71 sequences analysis showed that the four new sequences (named as GZ19610, GZ99310, GZ99355 and GZ46477) shared 96.0% to 99.1% nucleotide identify themselves and shared 96.9% to 100.0% homology with the strain Fuyang/17.08/3 isolated in 2008 from Fuyang, Anhui Province. Phylogenetic tree analysis showed that the genotype of the four new sequences was all subtype C4, they were the same sub-genotype as those strains isolated from Chinese mainland and Chinese Taiwan in 2004, and the genetic distance between them was most closely. Conclusions EV71 can cause adult HFMD. Compared with the nucleotide sequences of EV71 strains that isolated now and formerly in China, there is no large variation of the EV71 sequences isolated from four adult HFMD patients in Guangzhou this time. The adult HFMD patients should be isolated for treatment to avoid them transmitting the virus and causing disease spreading.

Objective:To correlate N-terminal pro-B-type natriuretic peptide (NT-proBNP) and heart type fatty acid binding protein (H-FABP) levels with the prognosis of patients with heart failure.Methods:Forty-nine patients with severe heart failure who received treatment in Tongde Hospital from December 2017 to June 2019 were included in the observation group. Forty-nine healthy subjects who concurrently received health examination were included in the control group. The heart function of the 49 patients was graded by the New York Heat Association (NYHA) classification. The levels of NT-proBNP and H-FABP were measured in different NYHA grades of patients and the healthy controls. The value of NT-proBNP and H-FABP levels in the diagnosis of heart failure was investigated and NT-proBNP and H-FABP levels were correlated with prognosis of heart failure.Results:In the observation group, NT-proBNP and H-FABP levels were (341.52 ± 12.74) pg/mL and (69.01 ± 11.45) ng/mL, respectively, which were significantly higher than (189.60 ± 12.73) pg/mL and (37.25 ± 11.44) ng/mL, respectively, in the control group ( t = 59.047 and 13.735, both P < 0.001). In patients with NYHA III grade severe heart failure, NT-proBNP and H-FABP levels were (295.62 ± 42.38) pg/mL and (75.09 ± 19.15) ng/mL, respectively, which were significantly higher than (120.43 ± 21.69) pg/mL and (21.76 ± 5.22) ng/mL, respectively in patients with NYHA I grade severe heart failure, (203.51 ± 42.77) pg/mL and (44.92 ± 10.85) ng/mL in patients with NYHA Ⅱ grade severe heart failure ( F = 55.100, 46.040, both P < 0.001). NT-proBNP and H-FABP levels in patients with NYHA I grade severe heart failure were significantly lower than those in patients with NYHA Ⅱ grade severe heart failure ( t = 7.231, 8.130, both P < 0.001). The sensitivity and accuracy of detecting NT-proBNP and H-FABP levels alone in the diagnosis of heart failure (76.92%, 78.85%, 84.69%, 86.73%) were significantly lower than those of detecting NT-proBNP and H-FABP levels in combination (98.08%, 97.96%, χ2 = 75.760, 10.913, both P < 0.001). NT-proBNP and H-FABP levels were positively correlated with the prognosis of heart failure ( r = 0.362, 0.611, both P < 0.05). Conclusion:NT-proBNP and H-FABP levels are positively correlated with the prognosis of severe heart failure in older adult patients. Detecting NT-proBNP and H-FABP levels in combination can increase the sensitivity and accuracy in the diagnosis of severe heart failure.

Objective To identify the sequence of hepatitis B virus S gene"a"determinant in patients with positive HBsAg and anti-HBs.Methods Nested-PCR Was used to amplify the HBV S gene in 4 patients with positive HBsAg and anti-HBs,and the PCR products were sequenced directly or after cloning.The sequences of"a" determinants were then analyzed by sequence alignment.Results Direct sequencing of PCR products showed that there was one amino acid (aa)residue in"a"determinant less conserved region emerging polymorphism in all 4 patients.Clone sequencing showed that aa residue at 126 of "a"determinant in patient 1 miSht be Thr,Ile and Set,at 134 might be Phe and Set;the aa at 126 in patient 2 misht be Ala and Thr.and in patient 3 might be Ile and Asn;aa polymorphism was not found in patient 4.Conclusion The polymorphism of"a"determinant in HBV S gene might be associated with positivity of both HBsAg and anti-HBs in hepatitis B patients.

Objective In critically ill elderly patients with "heat fecaloma with watery discharge", deficiency syndrome occupies its eighty to ninety percent, while "heat accumulation" occupies its ten to twenty percent; in fact, it is "dry feces accumulation stagnation and manure water side stream". Factors of Qi deficiency, blood deficiency, Yin deficiency, Yang deficiency, etc. are the main causes of dry stool accumulating in the intestine and manure water flows to side stream. The therapeutic principles of this disease should be removing stasis by purgation, in the mean time supplementing Qi and moistening intestine, or moisturizing dryness by nourishing blood, or supplementing Yin and increasing fluids, or warming yang for relaxing bowels in order to solve the root causes of the disease. The mechanism of heat fecaloma with watery discharge in critically ill elderly patients is different from that of general patients; clinically it is necessary to interrogate the disease history in detail, synthesize the four diagnostic methods, and differentiate manifestations from root cause, deficiency from sthenia, mildness from severity and amelioration from urgency. Casually using attack should be avoided, and aiming to treat its root cause is the proper therapeutic method.

BACKGROUND:At present, biological agent-involved immunologic induction therapy gradual y became a key component in immunosuppression therapy of kidney transplantation. It can effectively prevent acute rejection and avoid the appearance of complications. OBJECTIVE:To evaluate the effect of different biological agents on immune state and functional status of transplanted kidney in immunologic induction therapy. METHODS:Clinical data of 110 recipients with kidney transplantation were retrospectively analyzed. In accordance with the conditions of immunologic induction therapy, recipients in the monoclonal antibody group (n=35) received basiliximab. Recipients in the polyclonal antibody group (n=43) underwent rabbit anti-human antithymocyteglobulin. Recipients in the control group (n=32) did not receive immunologic induction therapy. Absolute value of lymphocytes and the number of CD4+T lymphocyte subsets in peripheral blood were comparatively analyzed among three groups at 1, 4 and 12 weeks after kidney transplantation. Functional status of the transplanted kidney and complications of infection were evaluated at 12 weeks after transplantation.RESULTS AND CONCLUSION:The incidence of acute rejection was lower in the monoclonal antibody group and polyclonal antibody group than in the control group (P<0.05). The incidence of infectious complications was higher in the polyclonal antibody group than in the monoclonal antibody group and control group (P<0.05). The absolute value of lymphocytes was lower in the monoclonal antibody group and polyclonal antibody group at 1, 4 and 12 weeks after transplantation than in the control group (P<0.05). The number of CD4+T lymphocyte subsets in peripheral blood was lower in the polyclonal antibody group than in the monoclonal antibody group and control group at 1, 4 and 12 weeks after transplantation (P<0.05). These results suggested that biological agents participate in immunologic induction therapy of kidney transplantation, can effectively suppress the functional status of activated T lymphocytes, and decrease the occurrence of early acute rejection of the transplanted kidney. However, the incidence of infectious complications was higher after the use of rabbit anti-human antithymocyteglobulin.

Objective To evaluate the projection marking which was designed to improve the surgical efficiency of antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures.Methods A total of 198 patients (158 femoral intertrochanteric fractures and 40 femoral shaft fractures) were analyzed retrospectively who had been treated at Department of Orthopedics,The First Affiliated Hospital to Wenzhou University from January 2012 to January 2016.They were 61 males and 137 females,aged from 13 to 95 years (mean,65.4 ± 14.6).By AO classification,there were 55 cases of type 31-A1,103 cases of type 31-A2,21 cases of type 32-A2 and 19 cases of type 32-A3.The intertrochanteric fractures which had been treated from January 2012 to May 2013 with no projection marking were assigned into group A1 (n =61) while the shaft fractures which had been treated in the same period with no projection marking into group B1 (n =12);the intertrochanteric fractures which had been treated from May 2013 to January 2016 with projection marking were assigned into group A2 (n =97) while the shaft fractures which had been treated in the same period with projection marking into group B2 (n =28).Comparisons were made between groups A1 and A2,and between groups B1 and B2 in terms of total operative time,total number of fluoroscopy,complications,Harris hip score (HHS),and pain and symptoms scores in Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months after operation.Results The 198 patients were followed up for 3 to 18 months (average,7.0 months).The total operative time (56.5 ±6.6 min) and the total number of fluoroscopy (26.6 ±6.2 times) in group A2 were significantly less than those in group A1 (59.2 ±9.2 min and 31.4 ±9.9 times) (P ＜ 0.05).The total operative time (84.6 ± 16.1 min) in group B2 was significantly less than that in group B1 (97.8 ± 17.9 min) (P ＜0.05) but the total number of fluoroscopy (49.4 ± 12.7 times) in group B2 was insignificantly less than that in group B1 (50.6 ± 10.1 times) (P ＞ 0.05).Conclusion The self-designed designed method of projection marking can reduce operative time and number of intraoperative fluoroscopy in the antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures.