The patient,a 11-year-old boy,presented with a 4-year history of erythema and vesicles on the face and arms as well as a 4-month history of tumor and ulcer on the extremities,accompanied by progressive fatigue and intermittent fever.The patient had a body temperature of 37.7℃.No lymph node involvement was observed.Cutaneous examination revealed minimally indurated pink-red patches on the face and nose and dusky red firm nodules and tumors of varying sizes on the extremities.The nodules ranged from 2.0 cm to 18 cm in diameter,some had necrosis and black crusts on the surface.Ulcers were observed in some of the larger nodules;many of the ulcers extended into the muscle layer.White purulent discharge was seen on the surface of many of the nodules.The lesions were sharply demarcated,firm,tender, and surrounded by small satelite nodules.Histologically,there were large quantities of irregularly shaped, middle-sized tumor cells with clear cytoplasm,large twisted nuclei and prominent chromatin,infiltrating from the epidermis to subcutaneous tissue.The tumor cells infiltrating the follicles and eccrine sweat glands were either distributed perivascularly in a nest shape,or dispersed.There were broken nuclei and reactive histio- cytic infiltration in the dermis and subcutaneous tissue.Immunohistologically,the tumor cells were positive for cytoplasmic CD3 around the nuclei,for CD56,CD45RO and T cell intracellular antigen-l,and partly for CD30,CD8 and Ki67.Epstein-Barr virus-encoded nuclear RNA was positive with in situ hybridization. TCR?-2 gene rearrangement was positive in these tumor cells.A diagnosis of hydroa vacciniforme-like primary cutaneous NK/T-cell lymphoma was made.Therefore,this is a case report of hydroa vaccini- forme-like primary cutaneous NK/T-cell lymphoma with primary involvement in the skin;the condition was slowly progressive over 51 months.

Purpose: Nurses’ musculoskeletal diseases (MSDs) are worldwide prevalent and are considered to be a costly occupational injury. This study aims to investigate the relationship between exposure to occupation-related psychosocial factors, physical workload, and upper body musculoskeletal diseases among hospital nurses. Methods: An electronic search was implemented using nine databases with June 2019 as the latest search date. English and Chinese studies were chosen, and data were independently and separately extracted by two investigators. Pooled odds ratio (OR) and its 95% confidence interval (CI) were estimated for each subset, using the fixed or random-effects model, following heterogeneity between studies for research synthesis. The source of heterogeneity was explored through subgroup, sensitivity, and meta-analyses. Results: Eighteen studies were included in the meta-analysis. Most participants were women (51.4%–100.0%), aged between 20 and 60. A correlation was found between high job demand and the prevalence of low back pain (OR = 1.41; 95% CI = 1.23-1.62). Total job strain was related to the risk of low back pain (OR = 1.71; 95% CI = 1.15-2.55), neck pain (OR = 1.67; 95% CI = 1.26-2.20), shoulder pain (OR = 1.62; 95% CI = 1.06-2.48) and back pain (OR = 1.45; 95% CI = 1.10-1.91). Furthermore, the physical workload was significantly associated with the prevalence of low back pain (OR = 1.76; 95% CI = 1.32-2.35), neck pain (OR = 1.17; 95% CI = 1.08-1.27), shoulder pain (OR = 1.59; 95% CI = 1.37-1.85) and back pain (OR = 1.66; 95% CI = 1.45-1.90). Conclusion There were significant associations between occupational strain, more physical workload and upper body MSDs, but the evidence advocating a growth risk in MSDs due to low levels of social support is quite weak.

Objective: To observe the effects of acupoint thread-embedding therapy on serum apelin and glucagon-like peptide-1 (GLP-1) in type 2 diabetes mellitus patients with obesity due to dampness-heat encumbering spleen.Methods: Sixty-six patients were randomly divided into a control group and an observation group according to the random number table method, with 33 cases in each group. Patients in the control group were treated with exenatide and metformin, while patients in the observation group were treated with additional acupoint thread-embedding. After 12-week treatment, the obesity-related indicators, including body mass index (BMI), waist circumference and body fat rate, the glycometabolism indicators, including fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin, and the lipid metabolism indicators, including total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C), as well as serum apelin and GLP-1 levels were observed in patients of the two groups. Results: After treatment, the BMI, waist circumference and body fat rate of patients in the two groups were all reduced (all P<0.05), and were lower in the observation group than in the control group (all P<0.05); the fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin levels of patients in both groups were all decreased (all P<0.05), and were significantly lower in the observation group than in the control group (all P<0.05); the TC level was decreased (P<0.05), while the TG and LDL-C levels did not change significantly in the control group (both P>0.05); the TC, TG and LDL-C levels were all significantly reduced in the observation group (all P<0.05), lower than those in the control group (all P<0.05); the serum apelin level was decreased (P<0.05) and the serum GLP-1 level was increased (P<0.05) in the observation group, statistically different from those in the control group (both P<0.05). Conclusion: Combined with the conventional medication, acupoint thread-embedding therapy can significantly improve the obesity-related indicators, glycometabolism and lipid metabolism in type 2 diabetes mellitus patients with obesity due to dampness-heat encumbering spleen. This may be achieved by regulating the serum apelin and GLP-1 levels.

Purpose: Nurses’ musculoskeletal diseases (MSDs) are worldwide prevalent and are considered to be a costly occupational injury. This study aims to investigate the relationship between exposure to occupation-related psychosocial factors, physical workload, and upper body musculoskeletal diseases among hospital nurses. Methods: An electronic search was implemented using nine databases with June 2019 as the latest search date. English and Chinese studies were chosen, and data were independently and separately extracted by two investigators. Pooled odds ratio (OR) and its 95% confidence interval (CI) were estimated for each subset, using the fixed or random-effects model, following heterogeneity between studies for research synthesis. The source of heterogeneity was explored through subgroup, sensitivity, and meta-analyses. Results: Eighteen studies were included in the meta-analysis. Most participants were women (51.4%–100.0%), aged between 20 and 60. A correlation was found between high job demand and the prevalence of low back pain (OR = 1.41; 95% CI = 1.23-1.62). Total job strain was related to the risk of low back pain (OR = 1.71; 95% CI = 1.15-2.55), neck pain (OR = 1.67; 95% CI = 1.26-2.20), shoulder pain (OR = 1.62; 95% CI = 1.06-2.48) and back pain (OR = 1.45; 95% CI = 1.10-1.91). Furthermore, the physical workload was significantly associated with the prevalence of low back pain (OR = 1.76; 95% CI = 1.32-2.35), neck pain (OR = 1.17; 95% CI = 1.08-1.27), shoulder pain (OR = 1.59; 95% CI = 1.37-1.85) and back pain (OR = 1.66; 95% CI = 1.45-1.90). Conclusion There were significant associations between occupational strain, more physical workload and upper body MSDs, but the evidence advocating a growth risk in MSDs due to low levels of social support is quite weak.

OBJECTIVETo investigate the spectrum of pathogens for community-acquired pneumonia (CAP) in children, and to provide a basis for the diagnosis and treatment of CAP.

METHODSRespiratory secretions and venous blood samples were collected from 1560 children with CAP aged from one month to 9 years within 2 hours after admission, for detection of multiple pathogens. Respiratory virus antigens in nasopharyngeal swab specimens were detected by immunofluorescence. Sputum was used for bacterial culture. Levels of Mycoplasma pneumoniae (MP)-IgM and Chlamydia pneumoniae (CP)-IgM in venous blood were measured by enzyme-linked immunosorbent assay.

RESULTSA total of 579 strains of bacteria were isolated from all respiratory secretions, including 213 (36.8%) Gram-positive strains and 366 (63.2%) Gram-negative strains. The five most common strains were Haemophilus influenzae (7.50%), Streptococcus pneumoniae (6.73%), Staphylococcus aureus (6.35%), Moraxella catarrhalis (5.19%), and Escherichia coli (3.46%), wherein the beta-lactamase-producing strains accounted for 3.3% of all strains. The non-bacterial pathogens mainly included respiratory syncytial virus (12.88%), MP (7.88%), and CP (8.91%). Mixed infection of pathogens was serious, and the mixed infection of respiratory syncytial virus with Haemophilus influenzae infections were the most common. For most pathogens, the infection rate was higher in children aged under one year than in those aged over one year.

CONCLUSIONSHaemophilus influenzae, respiratory syncytial virus, MP and CP are the main pathogens for children with CAP. For most pathogens, the infection rate is higher in children aged under one year than in those aged over one year. Mixed infection rate of pathogens is high.

Child ; Child, Preschool ; Coinfection ; etiology ; microbiology ; Community-Acquired Infections ; etiology ; microbiology ; Female ; Humans ; Infant ; Male ; Pneumonia ; etiology ; microbiology

Animals ; Athletic Performance ; Drugs, Chinese Herbal ; pharmacology ; Free Radicals ; metabolism ; Male ; Mice ; Mice, Inbred Strains ; Morinda ; Myocardium ; metabolism ; Physical Conditioning, Animal

Objective To establish rat models of polycystic ovary syndrome(PCOS) induced by different methods,to assess the serum levels of several related hormones,to examine the morphological changes in the ovaries,and to discuss their significance.Methods Letrozol,sodium prasterone sulfate,or sodium prasterone sulfate combined with human chorionic gonadotropin were used to establish rat models of PCOS.Radioimmunoassay was used to measure the serum levels of hteinizing hormone(LH),follicle-stimulating hormone(FSH),estrogen(E_2),progesterone(P),testosterone(T),prolactin(PRL),and insulin(INS).HE staining was used to examine the morphological changes of the ovaries.Results Comparing with the normal group A,the serum FSH was increased and the serum progesterone was reduced in the group B,with a statistically significant difference(P<0.05).The serum testosterone was significantly higher in the group B than in the group A(P<0.01).The levels of serum sex hormones and insulin were not significantly different in the group D and C(P>0.05).In comparison with the group C,the levels of serum testosterone and LH/FSH ratio was significantly increased in the group E.(P<0.05).Comparing with the group D,the serum levels of progesterone and testosterone were significantly increased in the group E(P<0.05).The ovaries in the rats of groups A and C showed almost a normal histyology,with mature follicles and dominant follicles.Polycystic changes were observed only in the ovaries of groups B,D and E.Conclusion At the aspect of affecting the level of sex hormones in serum and changing the ovarian morphology.adopting letrozol tablets or sodium prasterone sulfate combined with HCG to induce rat PCO model is more close to clinic manifestations and meets the criteria of PCO animals.In the rat PCOS models induced with letrozol or with sodium prasterone sulfate combined with HCG,either the serum levels of sex hormones and ovarian histology are quite similar to those of human clinical appearance,and may well meet the modeling requirements for future experimental studies of polycystic ovary syndrome.

Objective To explore the value of thyroid-stimulating antibody(TSAb) and degree of goiter in predicting the outcome of Graves'disease after antithyroid drug treatment. Methods Seventy-one patients with Graves'disease were given antithyroid drugs for (2. 8±1. 4)years and then followed up for(22±6.0)months.Finally,age,gender,thyroid function,TSAb and goiter size at the time of drug withdrawal were compared between the relapsed and relieved groups. TSAb was measured in all patients by using HEK-hTSHR cells. Results Eleven of 71 patients relapsed during the follow-up after drug withdrawal. The relapse rate (42. 9% ,6/14)in patients with positive TSAb was significantly higher than that (8.8%, 5/57) in patient with negative TSAb (X2 = 9.97, P<0.01). The relapse rates in patients with normal size thyroid, Ⅰ degree goiter,Ⅱ degree goiter were 6.25%, 12.2%,35.7% respectively. TSAb activity, positive rate and goiter size of the relapsed patients at the time of drug withdrawal were significantly higher than those of relieved patients (P<0.05 or P<0. 01). Conclusion TSAb activity and goiter size at the time of drug withdrawal are two effective prognostic markers of relapse in Graves' disease treated with antithyroid drugs.

Objective To investigate the feasibility of complicate myomectomy.Methods Six- seven patients with complicated uterine myomas undergoing laparoscopic myomectomy were retrospectively analyzed.The myomectomy was done using ureteral infravision imaging system or/and with self-made myoma segregate-stick.Among the total,there are 29 cases of multiple myomas(the number of myomas≥5)and 23 cases of single myoma(the diameter of myoma≥7cm,including 19 cases of intramural myoma,4 cases of subserous myoma),6 cases of myoma of broad ligament of uterus and 9 cases of cervical myoma.Results All cases were performed successfully laparoscopically.No intra-operative laparotomy or complications occurred.The average operating time and blood loss were(114?32)min and(114?78)ml respectively. The average time of hospital stay was 5.1 d.The average operating time and blood loss in the group (including multiple myoma group,intramural myoma group and cervical myoma)were significantly exceeded the other groups(including myoma of broad ligament of uterus group and subserous myoma group). Conclusions Laparoscopic complicate myomectomy can be performed and the operation indication is enlarged using Ureteral Infravision Imaging System.Advancement in surgical instruments and expert operating skills are the key to operation success.

Based on the outpatient interview and literature review,the initial framework of the outpatient experience of human caring scale was formed with 9 dimensions of outpatient process.The research aim was to improve the scale by Delphi method.Sixteen experts in medical management,human caring or medical education were invited to evaluate the importance of the dimensions and items of the scale and provided some expertise via filling out the Delphi consultation questionnaires twice in the consulting round.In the first round,the recovery rate showing the experts' positivity was 80％;the coefficient of reliability (Cr) ascertaining the authority of the evaluation was 0.92;the mean and full mark ratios responding the concentration of the evaluation were 2.88-4.94 and 6.25％-93.75％ respectively;the coefficients of variation (CV) and the Kendall's W determining the concordance of the evaluation were 5.06％-52.15％ and 0.21-0.24 respectively.In the second round,the recovery rate was 93.75％;the Cr was 0.93;the mean was 3.93-4.93;the full mark ratios were 26.67％-93.33％;the Kendall's W was 0.14-0.31,the CV was 5.25％-23.61％.Via the two-round Delphi study,the scale that included 10 dimensions and 61 items has been improved.Ten dimensions are pre-hospital medical service,guidance,registration,waiting,diagnosis & treatment,paying,inspection & assay,medicine receiving,therapy/injection/transfusion and global evaluation.It was concluded that Chinese scholars have paid high attention to human caring and outpatient experience.The experts have given high agreements about the dimensions which were established with Chinese outpatient process.The dimensions are different from the similar researches about outpatient experience study.In the future,it is necessary to survey the outpatients to test the construct validity,internal consistency reliability and others of the scale to improve the scale.