Brugada syndrome presents mainly in adulthood,and sudden death occurs mainly at rest or during sleep.It is uncommon in childhood,especially with atrial flutter as the first manifestation.In this article,we report a case of a 13-year-old child with atrial flutter as the first manifestation,without underlying cardiac disease,who developed Brugada-like electrocardiographic changes during the treatment of propafenone,and genetic testing revealed the suspected mutant genes SCN5A(c.2834A＞G[p.D945G]).Present case and related literature review might improve the awareness of clinicians on the inducing factors of Brugada syndrome and related a variety of cardiac arrhythmias,the importance of electrocardiogram monitoring during the application of antiarrhythmic drugs,and provide guidance and close follow-up strategies to this high-risk group,so as to avoid the occurrence of adverse events in these patients.

Objective:To investigate the effects of salt induced kinase 1(SIK1)in the effects of aerobic exercise on neu-roinflammatory response and spatial learning and memory function in aging mice. Method:Fifty-four male C57BL/6 mice were divided into three groups:the young group(group C,n=18),the aging control group(group A,n=18),and the aging exercise group(group E,n=18).Mice in groups C and A were fed naturally,while the mice in group E were subjected to aerobic treadmill exercise intervention for 8 weeks.Morris water maze training and testing were used to evaluate mice's spatial learning and memory abili-ties.Transcriptome sequencing was used to screen the differential genes.Immunofluorescence was used to detect the fluorescence intensity of ionized calcium-binding adaptor molecule 1(Iba-1).The mRNA and protein expres-sion levels of SIK1,nuclear factor kappa-B(NF-κB)and interleukin 1β(IL-1β)were detected by real-time PCR and Western Blot. Result:The mean escape latency was prolonged and the number of crossings of the original platform was re-duced(P＜0.01)for learning and memory function-related indicators in aging mice;hippocampal neurons were significantly disrupted and microglia(MG)activation-related gene Iba-1 fluorescence intensity was increased(P＜0.01);transcriptome levels were disturbed,with 175 genes upregulated and 66 genes were downregulated;inflammation-related genes SIK1,NF-κB mRNA(P＜0.05,P＜0.01)and protein(P＜0.01,P＜0.01)expression was elevated and IL-1β mRNA expression was increased(P＜0.05).After exercise intervention,the mean es-cape latency was reduced and the number of crossing the original platform was increased in aging mice(P＜0.01),attenuated neuronal damage,reduced Iba-1 fluorescence intensity(P＜0.01),upregulation of 19 genes,downregulation of 12 genes,reduced expression of SIK1,NF-κB mRNA(P＜0.01,P＜0.05)and protein(P＜0.05,P＜0.05),and IL-1β protein expression was reduced(P＜0.05). Conclusion:Eight weeks of aerobic exercise can reduce the expression of hippocampal SIK1 and its down-stream NF-κB and IL-1β in aging mice,inhibit MG activation,reduce neuroinflammation,and ultimately im-prove spatial learning and memory function.

We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
Animals ; Chromoblastomycosis ; Humans ; Laser Therapy ; Lasers, Solid-State ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Terbinafine ; Treatment Outcome

Objective To screen the glycoproteins as biomarkers for intracranial aneurysm (ⅠA) in cerebrospinal fluid (CSF) and evaluate the specificity and sensitivity of the biomarker candidates.Methods A complementary proteomic approach integrated with multidimensional chromatography was employed to simultaneously measure relative changes in the gylcoproteins of cerebrospinal fluid (CSF) obtained from patients with ruptured ⅠA (RIA) and unruptured ⅠA (UIA) compared to the healthy controls (HC) and disease controls (DC).One protein-receptor tyrosine kinase Axl with a unique change in RIA was validated in CSF and plasma.The sensitivity at 95％ specificity of Axl in CSF and plasma was evaluated with receiver operating characteristic curve (ROC curve).Results Firstly,a total of 294 glycoproteins were identified in human CSF with believable evidence.Secondly,the proteomic findings showed the quantitative changes in RIA and UIA as compared to HC and DC.Of 294 identified CSF proteins,59,24 and 33 proteins displayed quantitative changes unique to RIA,UIA or IA,respectively.At last,one of these unique proteins-receptor tyrosine kinase Axl with unique increase in RIA was confirmed both in CSF and plasma.ROC curve analysis showed that the sensitivity at 95％ specificity of Axl in CSF to differentiate RIA from UIA was 60％.When compared to CSF,the sensitivity at above setting in plasma to differentiate RIA from HC was 40％ and to differentiate RIA from UIA was 25％.Conclusions A glycoprotein biomarker Axl might be used as a promising biomarker to predict the rupture of ⅠA.The further investigation of the relations between Axl and IA formation as well as rupture might help to elucidate the underlying pathogenesis and find new therapeutic targets.

Objective To investigate the risk factors of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and evaluate the effect of lumbar drainage of cerebrospinal fluid on vasospasm.Methods In this retrospective controlled-cohort study, 175 patients with aneurysmal subarachnoid hemorrhage met our study criteria between January 2012 and December 2013.By multi-factor regression analysis, gender, age, Hunt-Hess grade, modified Fisher grade and lumbar drainage were analyzed.The outcomes were assessed by the presence or absence of symptomatic cerebral vasospasm and vasospasm-related infarction, and the mean days of hospital stay and score of Glasgow Outcome Scale at 1-month follow-up.Results Several factors affected the prognosis of subarachnoid hemorrhage.Lumbar drainage was a protective factor of symptomatic cerebral vasospasm (OR =0.243, 95％ CI: 0.119-0.497) and vasospasm-related infarction (OR =0.305, 95％ CI: 0.154-0.604).The patients with lumbar drainage had higher score of Glasgow Outcome Scale (P ＜ 0.05).But the patients with lumbar drainage had longer hospital stay (P ＜ 0.05).Conclusions Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage markedly reduced the risk of symptomatic cerebral vasospasm and improved outcome.

ObjectiveTo investigate the relationship between the change of circulating endothelial cell (CEC) level and coronary artery lesion (CAL) of Kawasaki disease (KD),and to further explore the method for early diagnosis of KD.MethodsThirty KD children were recruited for study,including 23 children with complete type of KD and seven children with incomplete KD.According to the results of echocardiography,the KD group was divided into CAL group (9 cases) and non-coronary artery lesion (NCAL)group (21 cases).Ten healthy children were enrolled as control group.Double-blind and controlled trial was conducted,and Hladovec method was applied for CEC counting.Results The CEC level was ( 1.09 ±0.60) × 107/L in KD group,which was higher than that of control group [ (0.38 ±0.14) × 107/L],and the difference was statistically significant ( t =2.85,P ＜ 0.01 ).The CEC level in the CAL group [ ( 1.84 ± 0.24) × 107/L] was higher than that of the NCAL group[ (2.01 ±0.38) × 107/L],and the difference was statistically significant ( t =2.24,P ＜ 0.05 ).The CEC level was ( 1.16 ± 0.63 ) × 107/L in the complete type of KD group and (0.83 ± 0.45 ) × 107/L in the incomplete KD group,which showed no significant difference between the two groups ( t =1.86,P ＞ 0.05 ).CondusionCEC level was elevated significantly in the acute phase of KD.The CEC level in CAL group was higher than that of NCAL group in acute phase.CEC level detection may be helpful for the early diagnosis of KD.

We report a case of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation in Guangdong. A 66-year-old man who had a renal transplantation 6 years ago was admitted in October 2011 for the presence of 16 nodules (0.5-1.5 cm) found on his right middle finger, wrist and forearm for 5 months. Microscopic examination of the purulent exudate showed segmented and branched brown mycelium, and tissue biopsy and PAS staining showed fungal hyphae. The isolate was processed for morphological identification and molecular sequence analysis. A black colony was found after culture of the isolate on SDA at 26 degrees Celsius;, and small culture identified the isolate as Exophiala jeanselmei. ITS sequence analysis of the isolate showed a 100% homology with Exophiala jeanselmei. E-test strip was used in drug sensitivity test, and the isolate was sensitive to amphotericin B, voriconazole, itraconazole and fluconazole, but resistant to 5-flucytosine and caspofungin. Good response was obtained with surgical intervention, local injection and systemic antifungal treatment.
Aged ; Exophiala ; pathogenicity ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Phaeohyphomycosis ; etiology ; Postoperative Complications

Kawasaki disease is far more frequent in children than in adults. The pathogenesis of Kawasaki disease is unknown, but it involves changes to the coronary artery and other diverse clinical manifestations. There are currently no specific laboratory diagnostic indexes, and especially since the disease is rare in adults, so it is extremely easy to misdiagnose or to overlook entirely. Our retrospective analysis of an diagnosis of and treatment for Kawasaki disease in an adult provides a guide to clinical doctors in terms of understanding Kawasaki disease, early diagnosis of it, and improved prognosis.
Adult ; Aspirin ; therapeutic use ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; diagnosis ; therapy ; gamma-Globulins ; therapeutic use

Objective To analyze the incidence of the disease, clinical features, diagnostic criteria, therapy and prognosis of Penicilliosis marneffei found in Guangdong province. Methods To analyze patients data, clinical features, laboratory findings, response to therapy, and prognosis of 15 cases Penicilliosis marneffei found in Guangdong province of China. Results The male was predominant compared with the female (ratio 2 to 1) and without occupational preference, but the patients with AIDS as underlying disease were mostly drivers and the unemployed. Thirteen patients were immunocompromised such as AIDS, connective tissue disease, and kidney transplant. Clinical features showed different manifestations, such as high fever, loss of weight, skin lesion, and respiratory system symptoms. Biopsy of the skin lesion showed PAS stain positive yeast-like, or sausage-form spores. Four patients were localized infection of the skin, eleven patients were systemic infection. Nine patients died, five recovered, 1 patient refused to be treated. Fifteen isolates from different anatomic sites of the patients were identified to be Penicillium marneffei by morphology and dimorphism in the culture, and eleven isolates among these 15 isolates were also confirmed by DNA sequence analysis. Conclusion The incidence rate of Penicilliosis marneffei become higher in the recent years and many patients were accompanied with AIDS in Guangdong province. Attention should be paid to the disease.

Objective To further know the Reiter′s syndrome of venerel type.Methods Two patients with Reiter′s syndrome of venereal type were reported and the related literature was reviewed.Results Features of the disease were described in detail,including its etiology,pathogenesis,clinical feature,diagnosis and differential diagnosis.Conclusion Reiter′s syndrome of venereal type is caused by C.trachmatis and U.urealyticum ,etc,infection.It is featured with urethritis,arthritis and conjunctivitis.In addition,the other related clinical features include mucocutaneous,genital system,cardiovascular system and nervous system damages.Its pathogenesis is associated with hereditary susceptibility and HLA B27 antigen.Therefore,the Reiter′s syndrome of venereal type should be considered when urethra,joint,conjunctiva and mucocutaneous damages were expressed after sexually transmitted disease.