Objective To investigate the extended-spectrum beta-lactamases ( ESBLs) producing clinical isolates of gram negative bacilli and their antibiotic resistance in Shantou and to provide suggestions on empirical treatment against the bacteria.Methods A total of 1 445 strains of gram negative bacilli (895 strains of Escherichia coli and 550 strains of Klebsiella pneumonia) were collected and examined for the production of ESBLs and antibacterial susceptibility test by Vitek-2.Results There were 69.4% of escherichia coli and 33.6% of klebsiella pneumonia producing ESBLs.The resistance rate of the ESBLs-producing strains to penicillins,cephalosporins and monocyclic beta-lactam antibiotics were very high.The ESBLs-producing strains were multidrug resistant and the resistance rates were higher than that of the non-ESBLs-producing strains.Both ESBLs-producing and non-ESBLs-producing strains were susceptible to Imipenem.Conclusion The incidence of ESBLs-producing strains was high in gram negative bacilli in Shantou.The resistance rates of the ESBLs-producing strains were higher than that of the non-ESBLs-producing strains and they expressed multiple drug resistance phenotypes.Imipenem was the best drug in the treatment of infections caused by ESBLs-producing strains.

OBJECTIVE To study and evaluate the surgical management of cervical anastomotic stricture of the esophagus and its efficiency. METHODS Cervical anastomotic stricture resulted from colon by-pass for patients with esophagus stricture due to corosive in 5 cases,and gastric pull-up in 3 with esophagus carcinoma,one patient suffered serious esophagus stricture at its upper end because of previous radiation,and failed to the anastomoticplasty RESULTS All of them failed to respond to prior dilation. Anastomoticplasty was used in 6 of them,local flap,colon by-pass and jejunal free flap interposition was chosen based on the patient's situation. The operation got succeeded at its first time in seven patients,and at its second time in two cases. Normal oral feeding was restored in seven of them,and semiliguid feeding in the other two. CONCLUSION Surgical treatment is reliable in dealing with patients with problem of anastomotic stricture of the cervical esophagus.

OJECTIVE: To analyze the cinicopathological features, treatments, and prognosis of patients with papillary TDCa. METHOD: A retrospective study was conducted of the medical records of our hospital for cases of TDCa. General clinical information including diagnostic criteria and treatments was obtained and analyzed. A literature review was also conducted. RESULT: There were 160 cases of thyroglossal duct anomalies hospitalized in Peking Union Medical College Hospital in the past 20 years, and TDCa was diagnosed in 3 (1. 88%) cases. All 3 cases underwent local radical resections, and papillary TDCa was diagnosed based on the pathology examination. Selective neck dissection was chosen in one which was confirmed with cervical lymphatic metastasis. All patients were followed up with no recurrences or metastasis. CONCLUSION The incidence of TDCa is very low and the pathology examination is the only way to confirm the diagnosis. Surgery, especially Sistrunk's procedure, is the treatment of choice, with low complications and recurrence. In the presence of cervical lymphadenopathy, selective neck dissection should be considered.
Carcinoma ; Humans ; Lymphatic Metastasis ; Lymphatic Vessels ; Neck ; Neck Dissection ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies ; Thyroglossal Cyst ; surgery ; Thyroid Neoplasms ; Thyroidectomy

Objective To evaluate the efficacy and safety of endovascular mechanical thrombectomy in patients with anterior circulation stroke. Methods PubMed, EMBASE, Cochrane database, Clinical Trials and the related supplement resources were retrieved. The randomized controled trials for comparing intravenous thrombolysis and endovascular mechanical thrombectomy in patients with anterior circulation stroke were selected. The bias risk assessment was performed. The basic characteristics of studies and the clinical outcome data at day 90, including good outcome (defined as the modified Rankin scale score 0-2), death and symptomatic intracranial hemorrhage (sICH) were extracted. Review Manager 5.3 software was used to conduct the statistical analysis. Results A total of 10 articles were enroled, including 1 557 patients in the endovascular mechanical thrombectomy group and 1 359 in the intravenous thrombolysis group. The overal quality of the included trials was higher. The risk of bias was lower. The good outcome rate in the endovascular mechanical thrombectomy group was significantly higher than that in the intravenous thrombolysis group (odds ratio [ OR] 2. 15, 95% confidence interval [ CI] 1. 34-3. 46; P < 0. 01). The death risk at day 90 was significantly lower than that in the intravenous thrombolysis group (OR 0. 86, 95% CI 0. 69-1. 06; P = 0. 16), and there was borderline statistical significance for the risk of sICH (OR 1. 35, 95% CI 1. 00- 1. 84; P = 0. 05 ). Conclusions The effectiveness of the endovascular mechanical thrombectomy is superior to the intravenous thrombolysis in patients with anterior circulation stroke;however, in terms of safety, further evaluation is needed.

Childhood obesity is an escalating public health concern，with its prevalence rising year by year.This condition can lead to a series of metabolic disorders such as type 2 diabetes mellitus，hypertension，hyperlipidemia，and hyperuricemia.While various factors contribute to obesity，genetics plays a significant role，accounting for 40% to 70% of childhood obesity cases.Most of the identified loci harbor genes are involved in pathways affecting neuro-circuits that regulate appetite and satiety，insulin secretion and action，adipogenesis，and lipid metabolism.To date，using genome-wide association studies，over 1 100 obesity susceptibility loci have been identified，with notable examples being leptin，leptin receptor，and melanocortin-4 receptor gene.In this review，the correlation between genetic factors and childhood obesity and the possible mechanisms are elaborated to provide potential directions for its clinical management.

Objective:To explore the value of traditional Chinese medicine combined with 131I in the treatment of Graves hyperthyroidism. Methods:From March 2020 to July 2021, 90 patients (39 males, 51 females, age (33.2±7.0) years) with Graves hyperthyroidism who were diagnosed and treated in Changshu No.2 People′s Hospital were retrospectively analyzed. Patients were randomly divided into 3 groups ( n=30 in each group), including group A who received treatment of antithyroid drugs (ATD), group B who received treatment of traditional Chinese medicine, and group C who received treatment of 131I combined with traditional Chinese medicine. Thyroid function indicators and inflammatory indicators before treatment and 1, 3, and 6 months after treatment were determined, including free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid stimulating hormone (TSH) and TSH receptor antibody (TRAb), and C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). One-way analysis of variance and χ2 test were used to analyze data. Results:The levels of FT 3, FT 4, TSH, TRAb, CRP, IL-6 and TNF-α in group A, B and C before treatment and 1, 3, 6 months after treatment were significantly different ( F values: 193.27-906.11, all P<0.05). The total effective rate in group C (100.0%, 30/30) was significantly higher than that in group A (86.7%, 26/30) or group B (83.3%, 25/30; χ2 values: 8.24, 9.83, P values: 0.006, 0.037), while there was no significant difference between group A and group B ( χ2=3.02, P=0.124). The incidence of adverse reactions in group B (46.7%, 14/30) was significantly higher than that in group A (30.0%, 9/30; χ2=6.59, P=0.042). And the incidence of adverse reaction in group C (13.3%, 4/30) was significantly lower than that in group A or group B ( χ2 values: 12.05, 7.20, P values: 0.004, 0.038). Conclusion:The curative effect of 131I combined with traditional Chinese medicine is effective and reliable, suggesting that clinical researches should be carried out together and perfected.

Objective To summarize the diagnostic and therapeutic experiences for multiple insulinoma. Methods Clinical data of 34 cKsefl of multiple insulinoma treated in Peking Union Medical College Hospital between 1984 and 2007 were analyzed retrospectively. Results Multiple insulinoma was identified in these 34 cases for 37 instances.Malignant insulinoma was found in 2 cases.Three cases suffered from postoperative recurrent multipie tumors.35.3% cases belonged to MEN1;13.5% cases were of insulinoma combined with islet hyperplasia;43.2% cases had 3 or more than 3 insulinomas;Fifteen cases (40.5%)had had a misdiagnosis.45.2%tumors were smaller than 1 cm in diameter:88.9%multiple insulinonla located at the body and tail of the pancreas.Enucleation of multiple tumors was performed for 48.7 percent of cases. Conclusions Most multiple insulinomas were small,it was difficult for preoperative examination to locate all the tumors therefore.Being on the alert against multiple insulinoma and such measures as careful exploration,intraoperative blood glucose determination.fine needle aspiration biopsy,frozen sections helps to avoid missing multiple imuhnoma.

Objective To study the distribution characteristics of peripheral blood stem cell-like memory T cells ( TSCM) in patients with gastric cancer and to analyze their relationship to clinicopathologi-cal characteristics and clinical application value. Methods Thirty-two patients hospitalized with gastric cancer in our hospital from July to December, 2018 were selected as the case group. Twenty-three healthy volunteers recruited during the same period served as the control group. The percentages of TSCM, naive T cells ( TN) and memory T cells ( TM) were detected by flow cytometry and the differences between the two groups were compared. The relationship of clinicopathological features to TN, TSCM, TSCM/TN ratio and TM was analyzed. Results The percentages of TN and TSCM in peripheral blood of the patients were signif-icantly lower than those of the healthy control group, while the ratio of TSCM to TN was significantly in-creased in the case group (all P<0. 05). The proportion of TN was negatively correlated with tumor TNM stage and invasion depth, and positively correlated with the degree of tissue differentiation. The ratio of TSCM to TN was positively correlated with TNM stage, invasion depth and lymph node metastasis. Conclu-sions TN and the ratio of TSCM to TN in peripheral blood of patients with gastric cancer are closely related to clinical and pathological characteristics such as tumor stage and invasion depth, which could be used as a new way to evaluate the immune status of patients. TSCM might have important clinical application value in adoptive cellular immunotherapy of gastric cancer, but large-scale multi-center clinical studies are needed for further evaluation.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy(CADASIL)is a common hereditary disease caused by NOTCH3 gene. The major clinical manifestations includerecurrent small-vessel ischaemic events, migraine, dementia and mood disturbance. Herein, wereport a 32-years-old male presented with right leg weakness and persistent migraine. We carried outneurological exams, genetic testing, blood and cerebrospinal fluid analysis (CSF) as well as magneticresonance imaging (MRI) for the brain and spinal cord. There were no anti-aquaporin-4 antibodiesand oligoclonal bands in the CSF and blood investigations were within the normal range. MRI scansrevealed multiple hyperintense regions in the brain and longitudinally hyperintense signal in spinal cord.Further, we identified a c.383G>A(p.Cys128Tyr) mutation in NOTCH3 gene. Therefore, the patientwas diagnosed with CADASIL concurrent with spinal cord lesion. The patient’s condition slightlyimproved after two weeks treatment with daily dosage of 0.5 g citicoline and 75 mg clopidogrel.

Dynamic magnetic resonance (MR) imaging has generated great research interest, because it can provide both spatial and temporal information for clinical diagnosis.However, slow imaging speed or long scanning time is still a challenge for dynamic MR imaging. Most existing methods reconstruct dynamic MR images from incomplete k-space data under the guidance of compressed sensing (CS) or lowrank theory, which suffer from long iterative reconstruction time. Recently, deep learning has shown great potential in accelerating dynamic MR. Our previous work proposed a dynamic MR imaging method with both k-space and spatial prior knowledge integrated via multi-supervised network training. Nevertheless, there was still some smoothing needed in the reconstructed images at high acceleration. In this work, we propose cascaded residual dense networks for dynamic MR imaging with edge-enhanced loss constraint, dubbed cascaded residual dense networks (CRDN).Specifically, the cascaded residual dense networks fully exploit the hierarchical features from all the convolutional layers with both local and global feature fusion.We further use the higher-degree total variation loss function, which has the edge enhancement properties, for training the networks.