Objective Mycoplasma pneumoniae is one of the main pathogens of community-acquired pneumonia in children and teenagers , which may cause mycoplasma pneumoniae pneumonia ( MPP) .Atelectasis is one of the most common manifestations of MPP.The aim of the article was to evaluate the diagnostic and therapeutic value of fiberoptic bronchoscopy ( FB) in children with MPP associated with atelectasis . Methods Retrospective analysis were made on clinical data and FB records of 99 cases of hospitalized children with MPP associated with atelectasis from August 2010 to December 2012 . Results The positive rate of MP-DNA was 92.9%(92/99) in bronchoalveolar lavage fluid (BALF), and the positive rate of MP-Ab-IgM in serum was 68.7%(68/99).All pa-tients showed obviously bronchial mucosa congestive edema during FB examination .The results are as follows:bronchial phlegm bloc-king in 31 cases (31.3%), lumen inflammatory stenosis in 22 cases (22.2%),mucosal ulcer change in 7 cases(7.1%) and mucous nodular change in 3 cases (3.0%).4 weeks after being treated with bronchoalveolar lavage (BAL), only 3 cases remained in atelec-tasis, the partial and complete re-expansion rate reaching 96.5%(82 of 85). Conclusion The positive rate of BALF MP-DNA de-tection technology for the diagnosis of MP infection is higher than that of serum MP-Ab-IgM examination .Early interventional therapy by FB can shorten the course of disease and promote the lung re-expansion in children with MPP associated with atelectasis .

Objective To study the correlation between lactate/albumin ratio level and incidence of multiple organ dysfunction syndrome (MODS) as well as mortality in patients with severe sepsis or septic shock.Methods In January 2012-September 2013, 54 patients who were admitted to the intensive care unit(ICU) of a hospital developed severe sepsis and septic shock on the first day of admission, clinical data of patients were analyzed.Results On the first and second days of admission, 30(55.56%)and 26(53.06%)patients developed MODS;lactate/albumin ratio between MODS group and non-MODS group on the first and second days of admission were both significantly different (both P<0.05).Multivariate logistic regression analysis showed that lactate/albumin ratio, oxygenation index (PaO2/FiO2), as well as acute physiology and chronic health evaluation (APACHE Ⅱ) were independent risk factors for predicting MODS in patients with severe sepsis.Lactate/albumin ratios between MODS group and non-MODS group, death group and non-death group were both significantly different (both P<0.05);lactate/albumin ratio was correlated with APACHE Ⅱand PaO2/FiO2, the higher the APACHE Ⅱ score and the lower the PaO2/FiO2, the higher of lactate/albumin ratio.The area under the receiver operating curve (ROC curve) analysis showed that incidence and mortality of MODS on the first day of admission predicted by lactate /albumin ratio were 0.85 and 0.84 respectively;sensitivity, specificity, positive predictive value, and negative predictive value of occurrence of MODS predicted by lactate /albumin ratio>1.735 were 80.00%, 79.17%, 82.67%, and 75.92% respectively, sensitivity, specificity, positive predictive value, and negative predictive value of mortality were 100.00%, 51.02%, 17.23%, and 100.00% respectively.Conclusion Lactate/albumin ratio level is closely correlated with incidence and mortality of MODS in patients with severe sepsis or septic shock.

Objective To investigate changes in tracheal bronchus (TB) under bronchoscopy and its clinical features in children.Methods The bronchoscopy datum,clinical manifestations and treatments of 46 children with TB from Department of Respiratory Medicine,Anhui Provincial Children's Hospital,were retrospectively analyzed.Results Among 46 cases,31 patients had displaced TB,13 patients had supernumerary TB,and 2 patients had trachea diverticulum.Meanwhile,in 45 cases was located at the right tracheal wall and 1 case was located at the posterior tracheal wall.Besides,20 cases were found accompanied with one type of tracheo bronchial anomalies,and the other 3 patients had 2 types of anomalies.Luminal stenosis,mucous membrane longitudinal fold and/or mucous plug were mostly revealed by bronchoscopy.Clinically,the main symptom s included recurrent or persistent cough,wheezing,refractory pneumonia,atelectasis or hyperinflation in the right upper lobe.Some cases showed no symptoms and were found accidentally by using chest CT or bronchoscope to check other diseases.Through anti-inflammatory and bronchoalveolar lavage (BAL) treatment,symptoms were improved or disappeared in 38 cases,the efficient rate was 82.6％.Conclusions TB is not unusual in pediatric patients,and mainly be found at the right wall of the trachea.Displaced TB is the most common type and frequently accompanied with the other anomalies.TB should be considered when recurrent or persistent cough,wheezing,or refractory pneumonia,atelectasis or hyperinflation in the right upper lobe occurred.Bronchoscopic technology is an important tool in the diagnosis and treatment of children with TB and may be used widely in pediatric diseases clinically.

Objective To investigate the efficacy and safety of exsanguination band used in the lower extremity varicose vein operation.Methods A total of 158 cases of lower extremities varicose veins in this hospital served as the research subjects.All cases underwent the high ligation of great saphenous vein combined with punctate stripping operation.Among them,117 cases intraoperatively used the exsanguination band for blocking the lower limb blood flow (observation group),41 cases did not use the exsanguination band (control group).Then the intraoperative bleeding volume,operation time,pain degree and postoperative complications were observed in the two groups.Results Compared with the control group,the operation time,intraoperative blood loss,hematoma score,prothrombin time (PT) and fibrinogen (FIB) in the observation group were significantly decreased (P＜0.05),while activated partial thrombin time (APTT) and thrombin time (TT) were significantly increased(P＜0.05).The lower limb blood flow occlusion time in the observation group was 45-62 min with an average of (46.68-5.53) min.The sensory score and pain score at postoperative 2 weeks had no statistical difference between the two groups (P＞0.05).No arterial abnormalities and no obvious ischemic injury were found in the injured limbs of 2 groups.Conclusion Applying the exsanguination band for transiently blocking the blood flow can effectively shorten the operation time,reduces the intraoperative bleeding amount and decreases the subcutaneous hematoma formation risk with high safety.

Objective To analyze the correlation between herpes zoster neuralgia and the methylation status of the whole genome and GCH1 gene.Methods From June to October in 2017,patients with confirmed herpes zoster and obvious neuralgia were selected in Department of Dermatology,The Affiliated Hospital of Xuzhou Medical University,who achieved complete remission (no effect was observed on normal sleep) of neuralgia after antiviral and neurotrophic treatment.Finally,36 patients and 36 healthy controls were enrolled into this study.Peripheral blood samples were obtained from the healthy controls and patients before and after the treatment.Dot-blot hybridization assay was performed to determine the methylation status of the whole genome,methylated-DNA IP kit was used to enrich the methylation sites of the GCH1 gene,and real-time quantitative PCR was conducted to detect changes in methylation status of the GCH1 gene.Statistical analysis was carried out with GraphPad Prism v7.00 software by using paired t test for the comparison of methylation status before and after the treatment,and two-sample t test for the comparison between the patient group and control group.Results The relative methylation level of the whole genome was 135.94 ± 2.52 in the patients before treatment,significantly lower than that in the patients after treatment (144.76 ± 3.48,t =2.056,P ＜ 0.05) and healthy control group (146.84 ± 3.39,t =2.580,P ＜ 0.05).However,there was no significant difference in the methylation status of the whole genome between the patients after treatment and healthy controls (t =0.429,P ＞ 0.05).Compared with the patients after treatment (0.89 ± 0.13) and healthy control group (0.97 ± 0.07),the methylation status of the GCH1 gene significantly decreased in the patients before treatment (0.65 ± 0.17;t =3.977,4.648 respectively,P ＜ 0.05,＜ 0.01 respectively),while no significant difference between the patients after treatment and the healthy controls (t =0.506,P ＞ 0.05).Conclusion The methylation status of the whole genome and GCH 1 gene markedly decreased in the patients with herpes zoster neuralgia.

Guanosine triphosphate cyclohydrolase 1 (GTPCH1) is a protein encoded by the GCH1 gene,which catalyze GTP to tetrahydrofolinine (BH4) under physiological condition.BH4 is a coenzyme of aromatic amino acid hydroxylase and a cofactor of nitric oxide synthases.BH4 involves in the synthesis of various hormones and neurotransmitters and plays an important role in a series of pathophysiological processes in vivo.Recent studies showed that GTPCH1 is involved in the pathogenesis of neuropathic pain,doparesponsive dystonia,cancer and cardiovascular diseases.In this review,we will discuss the role of GTPCH1 in those diseases mentioned above.

Objective To understand the infected strains and prevalence of brucellosis in occupational population in Tacheng and Kashgar regions,Xinjiang Uygur Autonomous Region.Methods In September 2015,blood samples from occupational population (including herders,semi-agricultural and semi-pastoral,veterinarians) and non-occupational population (including students and cadres) were collected to detect Brucellaspecific antibody and bacterial nucleic acids by rose bengal plate test (RBPT),serological standard tube agglutination test (SAT) and PCR methods,respectively.The positive products of PCR were sent to Shanghai Sangon Biotechnology Co.,LTD.Then the sequence results were retrieved online using the basic alignment search tool (BLAST) in GenBank web page and uploaded to NCBI (National Center for Biotechnology Information).Results A total of 546 blood samples were tested,including 300 males,aged (55-± 15) years old,and 246 females,aged (54 ± 12) years old.The positive rates were 17.58％ (96/546) and 6.78％ (37/546) in 546 blood samples by serological method and genetic markers targeting omp22 and omp2,respectively.The positive rates were statistically significant (x2 =29.8,P ＜ 0.05).Additionally,based on BLAST analysis of outer membrane protein omp22 and omp2 genes,the positive products were identified as Brucella abortus,and the sequence similarity was 100.00％ (253/253,863/863 bp) to Brucella abortus strain Wisconsin genome assembly,chromosome (LT651712).Conclusions Brucellosis has a high infection rate in the occupational population of some animal husbandry-based groups in Xinjiang.The infection strain is abortive species Brucella,and health education for the occupational population and prevention of brucellosis should be strengthened to reduce the infection rate.

Obesity can not only lead to various metabolic diseases such as non-alcoholic fatty liver, hypertension, hyperlipidemia, diabetes, and cardiovascular disease, it is also closely related to the occurrence and development of heart failure. Heart transplantation is the ultimate treatment for patients with heart failure. However, heart failure patients with obesity are usually excluded from the list of heart transplants. That is to say, obesity is considered a contraindication for heart transplantation. The traditional weight loss methods, including lifestyle interventions and medications, can not effectively alleviate obesity and its comorbidities because of their limited effect and time-consuming. In addition, weight-loss drugs cannot be used in heart transplantation because they can affect the absorption of immunosuppressive drugs. At present, metabolic surgery has become the most effective method for the treatment of obesity and its comorbidities, and is now gradually applied in the field of heart transplantation most of the heart failure patients with obesity meet the standards of heart transplantation after metabolic surgery, greatly increasing the transplantation rate as well as obesity, obesity-related metabolic diseases, and cardiac function were significantly improved, even some patients with heart failure no longer need heart transplantation after their cardiac function has been significantly improved. However, the application of metabolic surgery in the field of heart transplantation has not yet reached a consensus, and only a few reviews on this topic have been published. In this article, the application status and prospects of metabolic surgery in the field of heart transplantation are reviewed so as to provided reference for clinical practice.

Objective:To investigate the consistency and correlation of the respiratory synchronization tracking and fiducial marker respiratory synchronization tracking in the Cyberknife stereotactic body radiotherapy (SBRT) with the diaphragm as the tracking target.Methods:A total of 11 patients hospitalized at Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2018 to November 2019 were enrolled, including 8 cases of lung cancer, 2 cases of liver cancer with lung metastasis and 1 case of colorectal cancer with lung metastasis. All enrolled cases used fiducial marker tracking plan (RT) and diaphragm contour tracking plan (DT), and then all received tumor visualization simulation tests. Bland-Altman method was used to make the consistency analysis of the offset in the visualization tests process of 2 tracking plans at each respiratory time point. The minimum tolerance distance, uncertainty and average standard deviation and maximum standard deviation in the optimal model state plans were compared between the both plans by using t test. Results:Compared with RT, the translational standard deviations of DT tracking were listed as follows: head-foot direction (0.4±2.9) mm, left-right direction (0.3±4.4) mm, anterior-posterior direction (-1.8±6.8) mm. The Bland-Altman method showed that the consistency between RT and DT was better in the head-foot and left-right directions, and worse in the anterior-posterior direction; the synchronization was only better in the head-foot direction, and worse in both the left-right and anterior-posterior directions. Results of the model quality comparison showed that the uncertainty of RT was higher than that of DT, and the difference was statistically significant [(23±6)% vs. (9±4)%, t=-5.24, P = 0.001], while the differences of the minimum tolerance distance, average standard deviation and maximum standard deviation were not statistically significant (all P>0.05). Conclusions:Patients who use respiratory synchronization Cyberknife SBRT with the diaphragm as the tracking target have better consistency and synchronization in the head-foot direction, but worse in the left-right and anterior-posterior directions. Under the corresponding marginal margin of the target area in the left-right direction, for tumors near the diaphragm that are not visible in the visual test, it is potentially feasible to use the diaphragm as a tracking target to implement respiratory synchronization SBRT. For larger motion amplitudes in the left-right and anterior-posterior directions, more caution is required.

Objective:To investigate the effectiveness and safety of transurethral low power green laser enucleation of prostate (VREP) after transrectal prostate puncture.Methods:The clinical data of 96 patients with VERP in the First Affiliated Hospital of Xinxiang Medical College from October 2020 to October 2021 were retrospectively analyzed. They were randomly divided into the control group ( n=41) and the observation group ( n=55). The control group did not undergo prostate biopsy before operation, and the observation group underwent transrectal prostate biopsy within 1 week before operation. The general data, perioperative indexes, maximum urinary flow rate ( Qmax), international prostate symptom score (IPSS), quality of life score (QOL) and complications of the two groups were compared before and 3, 6 and 12 months after surgery. Results:Preoperatively, the PSA was higher in the observation group compared with the control group ( P<0.05), and the differences in other general information were not statistically significant (all P>0.05). Compared with the control group, the observation group had longer operation times and heavier resected specimens, and the differences were statistically significant (all P<0.05), but there were no statistically significant differences between the two groups in the comparison of enucleation efficiency, crushing efficiency, postoperative hemoglobin (HGB) decline value, postoperative hospitalization time, and postoperative ureter removal time (all P>0.05). At 3, 6 and 12 months postoperatively, Qmax, IPSS and QOL were significantly improved in the observation group compared with the control group (all P<0.05). However, there was no statistically significant difference between the two groups in the comparison of the above-mentioned indexes in the same period after surgery (all P>0.05). There was no statistically significant difference in the complication rate comparison between the two groups ( P>0.05). Conclusions:Transurethral low-power green laser prostate enucleation after transrectal prostate puncture is efficacious and has a certain degree of safety.