Objective:To improve the understanding of adult primary hemophagocytic syndrome (HPS) with aggressive natural killer cell leukemia (ANKL).Methods:The clinicopathological data of one adult patient with suspected primary HPS complicated with ANKL in Huiqiao Medical Center, Nanfang Hospital of Southern Medical University in October 2017 were retrospectively analyzed, and literatures were reviewed.Results:A 21-year-old male patient presented with persistent fever, hemocytopenia, splenomegaly, low fibrinogen, a significant increase in ferritin, hemophagocytes in bone marrow, decreased natural killer (NK) cell activity, and increased soluble CD25. Flow cytometry detection showed that the expression of NK cells was abnormal, and there were familial lysosomal trafficking regulator (LYST) and UNC13D gene defects. He was suspected of primary HPS complicated with ANKL. The patient was given 4 courses of EPOCH+PEG-Asp (etoposide, dexamethasone, vindesine, cyclophosphamide, doxorubicin hydrochloride liposome, pegaspargase) regimen chemotherapy, 20 mg of citalopidine twice a week maintenance therapy and matched unrelated hematopoietic stem cell transplantation. After 35 months of follow-up, he got sustained remission.Conclusions:Even if there are secondary causes of adult HPS, it is necessary to screen out related genes to avoid misdiagnosis. HPS patients with ANKL progress rapidly, and the early mortality is high. EPOCH+ PEG-Asp regimen induction therapy and allogeneic hematopoietic stem cell transplantation should be used as early as possible after diagnosis.

Objective:To build a medical service experience system based on role play of hospital staff, and explore its contribution to upgrading medical service, elevating medical service quality, and improving patients′ satisfaction.Methods:An indicator system for medical service experience was developed via literature review. 20 newly recruited hospital employees in 2019 were sampled randomly to form a service experience team, who were arranged to experience the full medical service process of outpatients and inpatients based on role play. The questionnaire for service quality based on patient perception and expectation was used to survey the expectation and perception values of those role players on their medical service experiences, and summarize the defects found on such six dimensions as hospital reliability, responsiveness, tangibility, assurance, empathy and cost-effectiveness. After due corrections of these defects, further experiences and patient satisfaction survey were made to assess the effects of such actions taken. Paired t test was used respectively in statistical analysis of service experience value and actual perception value, as well as the perception values before and after the actions taken, and χ2 test was used for a statistical analysis of patient satisfaction. Results:Role players experienced respectively at the emergency, outpatient and inpatient departments of the hospital for a week in August 2019. Statistics of their experiences indicated≥0.50 points difference between the mean expectation and perception values on doctor-patient communication, patient help responsiveness, outpatient process, examination report delivery duration, service attitude, patient trust on medical workers, medical environment and patient privacy protection.Following a 3-month reform, role players found improvements in such aspects as hospital reliability, responsiveness, tangibility, assurance, empathy and cost-effectiveness; patient satisfaction improved sizably in December 2019 over January of the same year( P<0.05). Conclusions:The construction and application of the medical service experience system based on role play of hospital staff prove highly useful in upgrading medical service actions, improving medical service quality, and improving patient satisfaction.

Objective To analyze the application of intraoperative neurophysiological monitoring combined with neuronavigation multi-modal fusion technology in the brainstem glioma resection. Methods One hundred twenty patients with brainstem glioma were divided into observation group and control group. The control group was treated by traditional operation, while the observation group was treated by intraoperative nerve electrophysiological monitoring combined with neuronavigation multimodal fusion technology. The general condition, clinical efficacy, KPS score, complications and survival rate of the two groups were compared. Results The effect was significantly better in the observation group(76.66%)than in control group(53.33%)( x2=11.962,P=0.001).KPS scores were significantly higher in the observation group (27.91 ±1.98) than in the control group (12.11 ±2.13)(t=32.669, P<0.001). Conclusions Intraoperative nerve electrophysiological monitoring plus neuronavigation multimodality fusion technology can improve clinical efficacy and quality of life in patients with brainstem glioma.

Brown adipose tissue (BAT) holds great promise for the prevention and treatment of metabolism diseases through thermoregulation. Polycystic ovary syndrome (PCOS) is a complex condition with anovulation, hyperandrogenism, and polycystic ovaries, and also manifests glucolipid metabolic disorders. Recent researches have shown that transplantation of BAT into a PCOS rat could significantly alleviate the phenotypes. This article reviews the role of BAT in pathogenesis of PCOS, which may provide information for prevention and treatment of PCOS.

Aim To investigate the protective effects of MANF on human neuroblastoma SH-SY5 Y cells suf-fering from oxygen-glucose deprivation/reperfusion ( OGD/R) and the underlying mechanism. Methods SH-SY5Y cells were treated with OGD for 6 h, fol-lowed by reperfusion for 12 h. Meanwhile, the cells were incubated with 2 μmol · L-1 recombinant human protein MANF for 12 h during reperfusion. The cell morphology was observed under an optical microscope. The cell viability was determined by MTT assay. PI
staining was performed to detect the number of dead cells. Western blot was performed to determine the protein levels of endogenous MANF, glucose-related protein 78 ( GRP78/BiP) , phosphorylated inositol re-quiring enzyme 1 ( p-IRE1 ) , phosphorylated eukaryot-ic translation initiator factor 2α ( p-eIF2α) , cleaved caspase-3, and C/EBP-homologous protein (CHOP). Results The cells exposed to OGD/R became smaller and round, and the neurites of the cells were shortened or disappeared . Recombinant human protein MANF
improved the survival rate ( P <0. 05 ) and decreased the death rate ( P <0. 05 ) of SH-SY5 Y cells treated with by OGD/R. Western blot assay showed that the endoplasmic reticulum ( ER) stress-associated proteins GRP78/BiP, p-IRE1, p-eIF2α, and MANF were in-creased significantly after OGD/R treatment, compared with the untreated controls. However, the increases of secretion levels of apoptosis-associated proteins CHOP
and cleaved caspase-3 in SH-SY5 Y cells induced by OGD/R were significantly suppressed by MANF. Con-clusion OGD/R up-regulates the ER stress-associated proteins and causes apoptosis. MANF inhibits OGD/R-induced cell death, which may be related to attenua-ting ER stress-induced apoptosis.

Objective To identify the configuration of the fascial sheath of the sciatic nerve in the adult pelvis . Methods A total of 14 cadaveric pelvic specimens and 20 living subjects were used for cadaveric examination and magnetic resonance imaging ( MRI) observation , respectively .The cadaveric specimens were investigated by the local latex injection method ( n =10 ) sectional anatomy ( n=2 ) or histological staining methods ( n =2 ) .The MR images were collected and analyzed from twenty patients without pelvic disorders .Results The injected latex did not diffuse along the pelvic segment of the sciatic nerve .Sectional anatomical and histological data showed that the architecture of the fascial sheath of the sciatic nerve varied at different levels .An intact circular sheath around the nerve was rarely observed .There was no fascia barrier between the obturator and sciatic nerves .Appearance on MRI was consistent with the cadaveric observation.Conclusion No intact fascial sheath exists along the pelvic segment of the sciatic nerve , thus sciatic anesthesia may block the obturator nerve .

Objective To explore the practice teaching model of human anatomy through re-forming the practice teaching of system anatomy and regional anatomy. Methods Three classes of clinical medicine (5-year program) were randomly selected as reform experimental classes and the other 3 classes of the same grade were used as control classes. The teaching content of practice teach-ing was reformed in the experimental classes. In the system anatomy practice teaching, the teacher controlled the teaching process and developed the theme and requirements of each experimental class while the student completed the experiment developed by the teacher. In the regional anatomy practice teaching, students' interest in learning was stimulated by the content , which was related with the surgery, and the teacher guided students to complete the operation. In control classes, the forms of student observation as well as teacher answering questions and helping students were adopted. The student grading was divided into theoretical knowledge examination and specimen assessment and the achievement was analyzed by using a Simple Analysis of Variance (ANOVA) in SPSS 16.0. Results Compared with those of control classes, the scores of system anatomy and regional anatomy in experi-mental classes were significantly increased (80.7±5.8) vs. (67.4±17.4), (85.1±4.6) vs. (62.6± 12.4) and the theoretical scores of system anatomy were also improved significantly. But no significant difference in theoretical scores of regional anatomy was observed. Conclusions The teaching mode based on the practice teaching highlights the academic characteristics of the human anatomy, increas-es students' interest in learning and improves the effectiveness of practice teaching in human anatomy.

Objective To investigate the effect of 12-lipoxygenase(12-LO) on the p27Kip1 expression in diabetic glomeruli. Methods Mesangial cells were exposed to 12-LO product 12 (S)-HETE (10-7 mmol/L) with or without p38 MAPK (p38) inhibitor (SB203580, 1 μmol/L) for 24 hours. Rats fed with high fat diet received low dose streptozotoein (ST-Z, 35 mg/kg, IP injection) to develop type 2 diabetes and were divided into 2 groups: low dose STZ, low dose STZ+12-LO inhibitor cinnamyl-3,4-dihydroxy-α-cynanocinnamate (CDC, 8 mg/kg) treatment. Rats fed with regular chow were divided into two groups: controls, CDC treatment. The rats received injection of CDC or vehicle subcutaneously in the hind leg. CDC or vehicle injection was performed three times weekly on alternate days. All the rats were sacrificed after 4 weeks, Wild type and 12-LO knockout C57BL/6 mice were divided into 4 groups: wild type control, 12-LO knockout, STZ-induced wild type type 1 diabetes and STZ-induced 12-LO knockout type 1 diabetes. All the mice were sacrificed after 16 weeks. Urine, blood, kidney cortical tissue and isolated glomeruli by sieving method were collected at the end of study respectively. Western blot and immunohistochemistry for target protein were performed respectively. Results Inhibition of p38 activation could significantly reduce p27Kip1 expression induced by 12 (S)-HETE in mesangial cells (P<0.01). Increased glomerular volume, microalbuminuria, elevated glomeluli p38 activation, p27Kip1 expresssion in type 2 diabetic glomeruli was decreased after CDC treatment (P<0.01). Compared with wild type diabetic mice, glomerular p38 activation, p27Kip1 exprcsssion and extracellular matrix accumulation in the 12-LO knockout diabetic mice were significantly decreased (P <0.01, respectively). Conclusions 12-LO induces p27kipl expression via p38 pathway in diabetic glomeruli.

OBJECTIVE: To provide the anatomic data for operation on the middle ear through the observation and measurement of related anatomic structure. METHOD: Forty human temporal bones of 20 voluntary bone donors were dissected, relative anatomical data of operation were observed and measured under operating microscope through posterior tympanum approach entering posterior tympanum. RESULT: The average distances from suprameatal spine to short crus of incus, pyramid segment of facial canal were 19.14 mm, 16.30 mm, respectively. The average distances from pyramid segment of facial canal to the surface of mastoid, crotch of chorda tympani nerve, posterior wall of auditory meatus were 20.84 mm, 11.28 mm, 4.40 mm, respectively. The average length of facial nerve in the horizontal segment, the perpendicular paragraph was about 11.60 mm, 15.30 mm, respectively. The average distance from pyramidal eminence to the anterior lip of round window niche, from oval window to round window niche, from incudostapedial joint to round window niche was 4.46 mm, 3.74 mm, 3.80 mm, respectively. The included angle of facial nerve in the horizontal segment and chorda tympani nerve with facial nerve in the perpendicular paragraph was 110.4 degrees, 24.8 degrees, respectively. Horizontal semicircular canal and facial nerve in the level paragraph was 17.5 degrees, long process of incus and incus buttress was 46.0 degrees. CONCLUSION The position of anatomic structure in middle ear was constant and the relationship including distance and angle between anatomic structures changed in limited region. The anatomical parameters provide a reference value for avoiding the injury during the operation.
Adult ; Chorda Tympani Nerve ; anatomy & histology ; Ear, Middle ; anatomy & histology ; surgery ; Facial Nerve ; anatomy & histology ; Female ; Humans ; Male ; Round Window, Ear ; anatomy & histology ; surgery ; Temporal Bone ; anatomy & histology ; innervation

OBJECTIVE: To provide the clinical anatomy data in physiological condition of the lingual artery in 64-slices spiral computed tomography angiography (CTA) for clinical treatment concerning the lingual artery. METHOD: CTA examination of the carotid artery were performed on 80 adult volunteers. The 3D reconstruction images of the carotid artery with hyoid bone were obtained by using 64-slices spiral CT and image postprocessing workstation. The origin, pathway, and anatomic relations of the lingual artery in CTA were studied. The distance from the origin of the lingual artery to the bifurcation of the common carotid artery and tip of the greater horn of hyoid bone were separately measured, and the distance between the segment of the greater horn of hyoid bone of lingual artery and the middle of greater horn of hyoid bone were also measured. RESULT: The pathway of the lingual artery had high variation, but the relative position between the segment of the greater horn of hyoid bone of lingual artery and the greater horn of hyoid bone were relatively constant. The lingual artery run forward approximately parallel to the greater horn of hyoid bone into tongue (2.32 +/- 1.29) mm in the superior to the greater horn of hyoid bone or (2.00 +/- 1.68) mm in the inferior to the greater horn of hyoid bone The distances from the origin of the lingual artery to the bifurcation of the common carotid artery and tip of the greater horn of hyoid bone were (12.93 +/- 7.36) mm and (10.40 +/- 5.75) mm separately. CONCLUSION The lingual artery could be clearly shown in CTA and the anatomy data in physiological condition of the lingual artery could be obtained by CTA. There was important instructive significance for clinical treatment concerning about the lingual artery.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography ; Arteries ; anatomy & histology ; Female ; Humans ; Male ; Middle Aged ; Tomography, Spiral Computed ; Tongue ; anatomy & histology ; blood supply ; Young Adult