Objective To explore the clinical manifestations of toxic epidermal necrolysis(TEN) and its rare pulmonary complications.Methods Clinical symptoms,treatment and prognosis of 1 child with TEN caused by carbamazepine were analyzed.Radiological images were reviewed to evaluate the manifestations and the outcome of chronic pulmonary complications associated with TEN.Results The patient had high fever shortly after a dosage increment of carbamazepine.A confluent erythematous exanthema developed rapidly into painful blistering with skin erosion,denudation and involvement of conjunctive and oropharyngeal mucosa.The diagnosis of TEN was made.The mucocutaneous damage was gradually recovered with steroid plus intravenous immunoglobulin for 3 weeks.However,the patient presented with respiratory failure in the recovery phase of TEN.The computer tomography revealed pulmonary bullae and pneumothorax in the right lung.Lung parenchyma was squeezed and pulmonary bullae ruptured with pneumothorax and atelectasis,which were absorbed gradually through thoracic drainages.The patient′s lung function and pulmonary bullae were partly improved during a 7-month follow-up.Conclusions TEN is a severe form of blistering skin di-sease which is characterized by an extensive loss of epidermis and mucous membrane.Chronic pulmonary complications may occur in recovery phase of TEN.Pulmonary bullae,which might be caused by mucous damage and respiratory obstruction,is a rare complication of TEN.

Salmonella enterica serovar Cerro 87, which was isolated from a commercial egg-producing farm, has a phosphorothioated DNA backbone resulting DNA degradation(Dnd) during the pulsed field gel electrophoresis (PFGE) process. In this research, a gene deletion mutant XTG103 was engineered with the entire dnd gene cluster knocked out by double crossover using vector pKOV-kan, and lost Dnd phenotype corre- spondingly. We regulated the DNA phosphorothioation by heterogenous expression of dnd gene cluster with an isopropyl ?-D-1-thiogalactopyranoside (IPTG) inducible promoter PlacZ.

Objective To report 6 cases of hydroa vacciniforme-like cutaneous lymphoma,and to inves- tigate the relationship between this disorder and Epstein-Barr virus(EBV)infection.Methods Pathological and immunohistochemical examinations were performed in the biopsy specimens obtained from all 6 patients. Skin lesions were subjected to EBV encoded RNA(EBER)detection by in situ hybridization.Serological assay and quantification of EBV DNA were performed.Results All the 6 patients had recurrent papules, papulovesicles,necrosis and variola-like scar with chronic intermittent fever;four of the patients also presented with edema of the face,hands and feet.Pathologically,there were multilocular vesicles in the epidermis,and large numbers of infiltrating lymphocytes through the dermis.The cells were atypical with mitotic figures. Immunohistochemical staining of the lesions of 4 patients showed large quantities of cells expressing CD56, scattered cells expressing CD3 and CD45RO,and cells expressing grazyme B and T cell intracellular antigen-1 (TIA-1);a diagnosis of hydroa vacciniforme-like cutaneous NK/T lymphoma was made in these 4 cases. In the lesions of another 2 patients,the cells expressing CD3 and CD45RO,but not CD56,were observed; the diagnosis of hydroa vacciniforme-like cutaneous T-cell lymphoma was made in them.EBER was detected in the tumor cells of all the 6 patients.The IgG titers of anti-Epstein-Barr viral capsid antigen increased in all patients(1:5120 in 2 cases,1:2560 in 2 cases,1:1280 in 2 cases).The copies of EBV DNA were increased in the peripheral blood of both the two detected cases.A chronic active EBV infection was confirmed in all patients.Conclusions Hydroa vacciniforme-like cutaneous lymphoma is clinically characterized by edema of face,hands and feet,vesicular eruptions and variola like scars;histologically,it is characterized by infiltrates of atypical cells consistent with lymphoma,and necrosis in the center of vessels.NK/T is the primary immunophenotype of this disease.There is a close association between chronic active EBV infection and hydroa vacciniforme-like cutaneous lymphoma.

ObjectiveTo observe the clinical effect of unstable femoral intertrochanteric fracture treated with DHS. Methods Summarized 37 cases of unstable femoral intertrochanteric fracture treated by DHS,all cases were commented by fracture type,operation method and clinical effect. ResultsWe have followed up 37 cases from 0.8 to 4.7 years with average of 2.5 years.Conclusions DHS is one of the best implants due to its merits of strong fixation, little complication and early rehabilitation exercise.

OBJECTIVETo explore surface roughness of bone cement and surround tissue on histological characteristic of induced membranes.

METHODSBone cements with smooth and rough surface were implanted in radius bone defect, intramuscular and subcutaneous sites of rabbits, and formed induced membranes. Membranes were obtained and stained (HE) 6 weeks later. Images of membrane tissue were obtained and analyzed with an automated image analysis system. Five histological parameters of membranes were measured with thickness,area,cell density,ECM density and microvessel density. Double factor variance analysis was used to evaluate the effect of the two factors on histological characteristics of induced membranes.

RESULTSMembranes can be induced by each kind of bone cement and at all the three tissue sites. In histological parameters of thickness,area and micro vessel,there were significant differences among the membranes induced at different tissue sites (P = 0.000, P = 0.000, P = 0.000); whereas, there were no significant differences in histological parameters of cell density and ECM density (P = 0.734, P = 0.638). In all five histological parameters of membranes, there were no significant differences between the membranes induced by bone cements with different surface roughness (P = 0.506, P = 0.185, P = 0.883, P = 0.093, P = 0.918).

CONCLUSIONSurround tissue rather than surface roughness of bone cements can affect the histological characteristics of induced membranes. The fibrocystic number, vascularity, mechanical tension and micro motion of the surround tissue may be closely correlated with the histological characteristics of induced membranes.

Animals ; Bone Cements ; Female ; Membranes ; cytology ; Rabbits ; Radius ; cytology ; Surface Properties ; Tissue Engineering ; methods ; Tissue Scaffolds

OBJECTIVETo evaluate the clinical application of intraoperative electrophysiological monitoring in lumbosacral selective posterior rhizotomy for spastic cerebral palsy.

METHODSTotal 372 dorsal roots of 89 patients underwent selective posterior rhizotomy at a single medical center. The dorsal roots from L3 to S1 were divided into rootlets and stimulated with a 1-second 50 Hz train. Motor responses were recorded by electromyography. Rootlets were assigned according to the extent of abnormal electrophysiological propagation, and grades of 3+ to 4+ were cut. If no electrical response was observed, the second criterion is the behavioral response (that is, muscle contraction in the legs or toes) assessed by the physical therapist, when rootlets were stimulated at the lowest threshold with a 1-second 50 Hz train.

RESULTSThe rootlets of 340 dorsal roots were assigned according to the extent of abnormal electrophysiological propagation, 324 (83.5%) roots were assigned the maximally abnormal response of grade 3+ (76, 22.4%) or 4+ (248, 72.9%) in EMG monitoring and were cut. For no electrical response was observed, according to the second criterion, 48 roots were partially cut. It was also be found that free running EMG occurred earlier than stimulus triggered EMG, and identified "abnormal" rootlets on free running EMG monitoring was more easily and quickly than on stimulus triggered EMG. During the postoperative 2 weeks in hospital, there was a significant decrease in lower-limb spasticity and an increase in range of movement in all patients, and no one case occurred obvious loss of muscle strength, abnormity of sensory, or deterioration of bladder/bowel control.

CONCLUSIONSThe spread of electromyography response to the contra lateral limb and/or upper extremity remains a valid criterion to define a "abnormal" posterior nerve rootlet that feeds into a disinhibited spinal circuit involved in uncontrolled spasticity. Intraoperative electrophysiological monitoring is reproducible and reliable for selection of "abnormal" rootlets.

Adolescent ; Cerebral Palsy ; surgery ; Child ; Child, Preschool ; Electromyography ; Female ; Humans ; Male ; Monitoring, Intraoperative ; Rhizotomy ; Spinal Nerve Roots ; surgery

OBJECTIVETo report the postmortem findings of a case of highly pathogenic H5N1 avian influenza virus occurring in human beings.

METHODSPostmortem examination was carried out in a deceased caused by highly pathogenic H5N1 avian influenza virus. Detailed light microscopy of major organs, including heart, lungs, liver, spleen, kidneys and brain, was performed. The lung tissue was further investigated by histochemistry, immunohistochemistry and electron microscopy.

RESULTSMajor histopathologic changes in lungs secondary to highly pathogenic H5N1 avian influenza virus included diffuse alveolar damage, hyaline membrane formation and focal hemorrhage. Some of the alveolar spaces contained lightly eosinophilic liquid, lymphocytes, macrophages, plasma cells and small number of neutrophils. Congested capillaries were commonly seen in the alveolar septa which were focally rimmed by hyaline membrane. Immunohistochemical study showed that the lymphocytes were mainly of T lineage and macrophages were also demonstrated.

CONCLUSIONSHighly pathogenic H5N1 avian influenza virus causes pathologic changes mostly in lungs, including diffuse alveolar damage and acute exudative changes (involving mainly T lymphocytes and macrophages). The resulting parenchymal destruction, consolidation, pulmonary edema and hemorrhage eventually lead to respiratory distress and death.

Adult ; Autopsy ; CD3 Complex ; analysis ; Fatal Outcome ; Female ; Humans ; Immunohistochemistry ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza, Human ; metabolism ; pathology ; virology ; Leukocyte Common Antigens ; analysis ; Lung ; pathology ; ultrastructure ; virology ; Microscopy, Electron

OBJECTIVETo summarize the clinical characteristics and treatment options of cutaneous vessel abnormalities.

METHODSThe clinical data of 384 pediatric patients with cutaneous vessel abnormalities who were treated in Beijing children's Hospital from January 2007 to December 2007 were retrospectively analyzed. Patients were classified according to International Society for the Study of Vascular Anomalies (ISSVA) classification method.

RESULTSOf the 384 patients, infantile hemangioma was confirmed in 185 patients (male : female = 1 : 1.7). Most children (78.4%) were taken to our department when they were within six months. The skin injuries were mainly located on the head and face (50.8%). Congenital hemangioma was confirmed in 132 patients (male : female = 1 : 1.9). Most children (75.0%) were taken to our department when they were within six months. The skin injuries were mainly located on the head and face (37.1%). Capillary malformation was confirmed in 27 patients (male: female = 1 : 1.3). Most children (40.7%) were taken to our department when they were within one year old. The skin injuries were mainly located on the head and face (77.8%). Venous malformation was confirmed in 16 patients (male : female = 1 : 1.3). Most children (31.3%) were taken to our department when they were within one year old. The skin injuries were mainly located on the head and face (56.3%). Of the 384 patients, 250 patients (65.1%) were treated by watching and waiting. Eighty of these 250 patients were followed up, which showed that, when these children were 1. 5-2 years old, the lesions' color lightened and their areas reduced by half and lesions almost disappeared in 34 patients.

CONCLUSIONSInfantile hemangioma and congenital hemangioma are two common cutaneous vessel abnormalities in children. Their incidences were higher in female than in male. Cutaneous vessel abnormality with endothelial cell proliferation has an earlier onset age. Skin injuries are mostly seen in face. Most pediatric patients experience good prognosis after being treated with watching and waiting.

Adolescent ; Child ; Child, Preschool ; Face ; Female ; Hemangioma ; congenital ; therapy ; Humans ; Infant ; Infant, Newborn ; Male ; Retrospective Studies ; Skin Neoplasms ; therapy

OBJECTIVETo study the changes of cardiac function following treatment with granulocyte colony stimulating factor (G-CSF) in patients with heart failure after myocardial infarction.

METHODSThirty-eight patients with heart failure after myocardial infarction were randomized into G-CSF treatment group and control group. All the patients received conventional treatment (medication and interventional therapy), and the patients in treatment group were given additional G-CSF (600 µg/day) for 7 consecutive days. The plasma level of brain-type natriuretic peptide (BNP) and the number of endothelial progenitor cells (EPCs) in the peripheral blood were detected before and at 7 days and 4 months after the treatment. The cardiac functions (LVSD, EDV, and LVEF) were evaluated by ultrasonic imaging before and at 2 weeks and 4 months after the treatment.

RESULTSThe number of EPCs was significantly higher in the treatment group than in the control group after the treatment especially at 7 days (P<0.01). In both groups, BNP level was lowered significantly after the treatment to recover the normal level (P<0.01). The cardiac functions were improved in all the patients at 7 days and 4 months after the treatment, and the improvement was more obvious in the treatment group (P<0.05), especially in terms of LVEF at 4 months after the treatment (P<0.01).

CONCLUSIONEPC mobilization by G-CSF can effectively improve the cardiac functions and lessen ventricular remodeling in patients with heart failure after myocardial infarction.

Aged ; Endothelial Cells ; cytology ; Female ; Granulocyte Colony-Stimulating Factor ; therapeutic use ; Heart Failure ; etiology ; physiopathology ; therapy ; Hematopoietic Stem Cell Mobilization ; methods ; Humans ; Male ; Middle Aged ; Myeloid Progenitor Cells ; cytology ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Natriuretic Peptide, Brain ; metabolism ; Treatment Outcome ; Ventricular Remodeling

Objective：This study was designed to explore the mechanism of inhibition of proliferation induced by arsenic trioxide (As2O3) and homoharringtonine in neuroblastoma. Method：Methy thiazoloyl tetrazolium (MTT) methods and analysis of apoptosis were used to evaluate the effect of As2O3 and homoharringtonine on the proliferation of NB cell lines and their mechanisms. Reverse-transcriptase polymerase chain reaction(RT-PCR) and immunohistochemistry techniques were used in NB cell lines treated with As2O3 and HHT to determine N-myc mRNA and protein expression. Results：Both As2O3 and HHT can significantly inhibit the proliferation of neuroblastoma cell lines and induce apoptosis of SJ-N-SH and IMR-32 cells. In As2O3 treated cell line, at transcription and protein level, N-myc expression is up-regulated at first and then down-regulated to a lower level. HHT can down-regulate N-myc protein. Conclusion：N-myc may play some roles in apoptosis induced by As2O3 and HHT, but the mechanisms initiating N-myc gene may be different.