Abstract: Objective　This article summarizes the clinical characteristics and diagnosis and treatment experience of an elderly patient infected with Omicron variant BA.5.1.3 of COVID-19 in Hainan Province. Methods　The clinical data and treatment of an elderly patient infected with Omicron variant BA.5.1.3 of COVID-19 admitted to Haikou designated hospital on August 15, 2022 were retrospectively analyzed. Results　A 107-year-old female patient was admitted to the hospital with "fever and cough for 1 day". Two of her family members have infected with COVID-19. The patient initially developed fever, accompanied by cough, expectoration, a little white sticky sputum, accompanied by sore throat, muscle pain, fatigue. Nucleic acid test was positive in throat swab, indicating Omicron variant BA.5.1.3 infection. The patient was diagnosed as mild COVID-19 and treated with antiviral therapy, Chinese medicine conditioning, anticoagulation, electrolyte disorder regulation and symptomatic treatment for 9 days. The patient's clinical symptoms were relieved, and she was cured and discharged after two negative nucleic acid tests. One week later, the patient recovered well. Conclusions　Omicron variant BA.5.1.3 is highly infectious, and comprehensive treatment such as antiviral treatment and traditional Chinese medicine treatment has achieved good efficacy. For elderly patients, attention should be paid to maintaining the stability of organ function and internal environment, which is helpful to improve the prognosis of patients.

Objective: To analyze the clinical characteristics, treatment and prognosis of Hashimoto's encephalopathy presenting with isolated cerebellar ataxia in children. Methods: A retrospective analysis was performed on the clinical features, laboratory tests, neuroelectrophysiological examination, imaging, treatment and outcomes of 13 patients with Hashimoto's encephalopathy presenting with isolated cerebellar ataxia, who were admitted to the Department of Pediatric Neurology of Guangzhou Women and Children's Medical Center from January 2016 to May 2021. Results: Among the 13 cases, 6 were males and 7 were females. The onset age was 2.6 (2.0,3.3) years, 9 children had precursor infection or vaccination before the first course of disease. All the 13 children had gait abnormalities or unsteady sitting, 10 had intentional tremor, 6 had dysarthria, 3 had body tremor, 2 had nystagmus, 3 had fatigue, 3 had hypotonia, 2 had vomiting and 1 had irritability. Thyroglobulin antibody (TgAb) was 500.0 (298.9,587.2) kU/L and thyroid peroxidase antibody (TPOAb) was 621.9 (449.6,869.4) kU/L in 13 cases. Autoantibodies were positive in 9 cases, and cerebrospinal fluid leukocytosis was seen in 4 cases. Regarding electroencephalography result, 4 cases had background slowing and 1 case had occasional sharp waves. Among the 3 patients who had relapses, 1 had cerebellar atrophy shown on cranial magnetic resonance imaging (MRI) during the recurrence. All the patients received intravenous immunoglobulin (IVIG) and intensive methylprednisolone therapy during the first onset, followed by the disappearance of the symptoms, 1 patient had repeated episodes which was decreased after immunosuppressive treatment with Rituximab.Followed up for 25.0 (22.5,33.3) months after the last episode, 12 achieved complete remission and 1 had a wide base gait. Conclusions: Trunk ataxia is the common symptom of Hashimoto's encephalopathy presenting with isolated cerebellar ataxia in children.Children with cerebellar ataxia should be tested for TgAb and TPOAb to detect Hashimoto's encephalopathy, avoiding missed diagnosis and treatment delays; IVIG and intensive steroid therapy is effective, and immunosuppressive therapy for patients with multiple relapses could reduce the recurrence.
Autoantibodies ; Cerebellar Ataxia ; Child ; Encephalitis ; Female ; Hashimoto Disease ; Humans ; Male ; Retrospective Studies

Objective: To analyze the impact of metabolic risk factors on the epidemiological characteristics of the reactivation of inactive HBsAg carriers (IHC) and provide effective intervention measures to standardize the management of chronic hepatitis B infections. Methods: Based on the chronic hepatitis B infection cohort established in 2010 in Jiangsu province, six follow-up visits from 2012 to 2020 were conducted to analyze the characteristics and influencing factors of the hepatitis B reactivation of IHC and the impact of metabolic risk factors, including obesity, high blood pressure, diabetes and hyperglycemia. Results: From 2012 to 2020, 2 527 IHC and 17 730 person-years were observed during a median follow-up period of 7.0 person-years. Ninety-eight cases of hepatitis B reactivation, with a cumulative reaction rate, was 3.9%, and the incidence density was 5.53/1 000 person-years. Multivariate Cox proportional risk regression analysis showed that age and baseline HBV DNA were independent risk factors of HBV reactivation. Compared with the patients ≥60 years, 40-49 age group (aHR=2.16, 95%CI:1.20-3.90) and 20-29 age group (aHR=5.48, 95%CI:2.07-14.48) were significantly associated with hepatitis B reactivation. Compared with the HBV DNA negative patients at baseline, the risk of hepatitis B reactivation was higher in the group with low HBV DNA level 100-1 999 IU/ml (aHR=1.67, 95%CI:1.11-2.52). Stratification analysis results showed that compared with those without metabolic risk factors, in the ≥50 age group, patients with ≥2 metabolic risk factors showed adjusted HR of 2.73 (95%CI:1.08-6.96). Conclusions: The risk of hepatitis B being reactive is the persistent existence of IHC in communities in Jiangsu province, especially young adults, low-level HBV DNA carriers, and IHC with ≥2 metabolic risk factors. Follow-up for these IHC should be strengthened to reduce the risk of disease progression by antiviral treatment at the right time.
Cohort Studies ; DNA, Viral ; Hepatitis B/epidemiology* ; Hepatitis B Surface Antigens ; Hepatitis B virus/genetics* ; Hepatitis B, Chronic/epidemiology* ; Humans ; Risk Factors ; Young Adult

【Objective】 To evaluate the cerebral hemodynamic changes due to interictal epileptic discharges(IEDs) and explore the associated neuroelectrophysiological factors and cognition deficits on electrical status epilepticus during sleep(ESES) through real-time transcranial Doppler ultrasound-video-electroencephalogram(TCD-vEEG) . 【Methods】 Eighteen ESES patients from August, 2017 to March, 2019 were recruited to undergo TCD-vEEG. The trend curve of mean cerebral blood flow velocity(MCBFV) was generated and analyzed. The spike wave index(SWI) and various TCD parameters during non-rapid eye movement(NREM) sleep were measured. The patients were divided into three clinical level groups based on seizures, their cognitive functions and the Activity of Daily Living Scale. According to the patterns of EEG during pre-ESES, the patients were also separately grouped to three groups: bilateral synchronous epileptogenic foci(BSEF), bilateral asynchronous epileptogenic foci(BAEF) and multiple epileptogenic foci(MEF). The patients were also separated into near-ESES and asymmetric ESES groups based on EEG patterns during ESES. We then performed Fisher's precise test, an analysis of variance(ANOVA) and Student's t-test, to determine that those parameters significantly varied according to clinical level and/or EEG pattern through SPSS 17.0. 【Results】 SWI was(85.22±10.33) % on average; MCBFV oscillations during deep sleep was(17.98±7.27) % on average(t = 7.579, P < 0.01); the mean of MCBFV(MCBFVm) was(92.81±21.53) cm/s on average(t = 6.464, P < 0.01); all increased significantly more than those of healthy children. SWI(F = 3.996, P < 0.05) revealed a statistically significant difference among three clinical level groups. ESES pattern had no obvious relation with the SWI, but Near-ESES influenced MCBFV oscillations during deep sleep significantly more(t = 2.885, P = 0.011) . 【Conclusions】 There are obvious cerebral hemodynamic changes during NREM in ESES, and IEDs frequency are the important factors of cognitive impairment due to ESES. ESES pattern is closely related to MCBFV oscillations during deep sleep.

Costal cartilage is a commonly used filling and supporting material in clinical practice, which has many advantages, but chest wall deformity frequently occurs after autologous costal cartilage harvesting. In order to effectively reduce the incidence of chest wall deformity, experts and scholars have conducted a full exploration.Theauthor reviewed the related literatures and summarized the prevention of chest wall deformity after costal cartilage harvesting. On the basis of reasonable selection of surgical site and cartilage harvesting amount, the costochondral junction(CCJ)and optional cartilage should be preserved.The costal perichondrium should be sutured and autogeneic cartilage debris should be replanted during the operation. In addition, postoperative management should also limit the degree of chest movement and breathing range, such as external fixation and restrictions on physical exercise.

Costal cartilage is a commonly used filling and supporting material in clinical practice, which has many advantages, but chest wall deformity frequently occurs after autologous costal cartilage harvesting. In order to effectively reduce the incidence of chest wall deformity, experts and scholars have conducted a full exploration.Theauthor reviewed the related literatures and summarized the prevention of chest wall deformity after costal cartilage harvesting. On the basis of reasonable selection of surgical site and cartilage harvesting amount, the costochondral junction(CCJ)and optional cartilage should be preserved.The costal perichondrium should be sutured and autogeneic cartilage debris should be replanted during the operation. In addition, postoperative management should also limit the degree of chest movement and breathing range, such as external fixation and restrictions on physical exercise.

OBJECTIVE: To investigate the genetic carrier rate of thalassemia and its gene mutation types as well as the distribution characteristics among the people in Lingshui Li autonomous county of Hainan province, so as to provide the basis for making the prevention programs of thalassemia in administrative departments. METHODS: Samples were collected from couples undergoing premarital and pregestational screenings, in which the positive ones in preliminary screening were further tested by genetic diagnoses and the genotypes were analyzed. RESULTS: The rate of thalassemia gene carriers was 19.41% （274/1412） of the couples of childbearing age in Lingshui Li autonomous County of Hainan Province. In these carriers,α-thalassemia accounted for 83.21%（228/274）, β-thalassemia for 8.03%（22/274）, and both α-and β-thalassemia gene accounted for 8.76% （28/274）. CONCLUSION The carrying rate of thalassemia gene in population Lingshui Li autonomous county of Hainan province is high, and its distribution has geographical characteristics,the major type is α-thalassemia. Blood screening and genetic diagnosis of thalassemia should be strengthened, and corresponding measures should be taken to reduce its gene frequency.
China ; Genetic Testing ; Genotype ; Heterozygote ; Humans ; alpha-Thalassemia ; beta-Thalassemia

AIM: To explore the clinical effect of Tongzhihuoluo Granules combined with compound anisodine on the acquired ophthalmoplegia in the middle-aged and elderly.

METHODS:We selected 81 patients(81 eyes)with acquired ophthalmoplegia in the middle-aged and elderly who were diagnosed and treated in our hospital from January 2015 to October 2017. All patients were divided into observation group(n=40)and control group(n=41)by treatment methods. The control group was given subcutaneous injection of compound anisodine 2mL near the superficial temporal artery of the affected side. The observation group was combined with Tongzhihuoluo Granules. The clinical efficacy and diplopia distance were compared between the two groups. The pulsatility index and blood flow velocity of the basilar artery before and after treatment were compared between the two groups.

RESULTS: The effective rate of ophthalmoplegia in the observation group was 92%(37/40), which was significantly higher than that in the control group(73%, 30/41; P<0.05). The incidence of cure time ≤ 2wk in the observation group was significantly higher than that in the control group(P<0.05). The recombination distances after treatment in both groups were significantly shortened(P<0.01), and the diplopia distance in the observation group was significantly shorter than that in the control group(P<0.01). The pulsation index of both groups were significantly lower after treatment(P<0.01), and the blood flow velocity was significantly increased(P<0.01), and those of the observation group changed more(P<0.01).

CONCLUSION: The clinical therapeutic effect of Tongzhihuoluo Granules combined with compound anisodine on the acquired ophthalmoplegia in middle-aged and elderly patients is significantly better than that of compound anisodine, which can effectively improve the blood flow of vertebral-basal artery and has high clinical efficacy.

OBJECTIVETo prepare cytochrome (CYP)2E1-silenced hepatocytes by lentivirus-mediated RNA interference technology and to investigate the hepatotoxicity of trichloroethylene (TCE) in CYP2E1-silenced hepatocytes.

METHODSShort hairpin RNA fragments were designed and synthesized and were then ligated into the lentiviral vector; single colonies were screened; the plasmid was extracted after PCR and sequence identification and then transferred into L02 hepatocytes; the CYP2E1-silenced hepatocytes were selected; real-time quantitative PCR and Western blot were used to evaluate the interference effects. The obtained CYP2E1-silenced hepatocytes, as well as normal L02 hepatocytes, were treated with TCE (0, 0.25, 0.50, 1.00, 2.00, and 4.00 mmol/L). The cell viability and half maximal inhibitory concentration (IC50) of TCE were measured; the apoptotic rate of cells was measured by flow cytometry; the mRNA expression levels of apoptosis genes and oncogenes were measured by real-time quantitative PCR.

RESULTSThe IC50s of TCE for L02 hepatocytes and CYP2E1-silenced hepatocytes were 15.1 mmol/L and 23.6 mmol/L, respectively. The apoptotic rate increased as the dose of TCE rose in the two types of cells; the CYP2E1-silenced hepatocytes hada significantly lower apoptotic rate than L02 hepatocytes when they were exposed to 2.0 and 4.0 mmol/L TCE (P < 0.05 or P < 0.01). The mRNA expression level of bcl-2 (anti-apoptosis gene) in CYP2E1-silenced hepatocytes was 15% ∼ 60% higher than that in L02 hepatocytes (P < 0.01), while the mRNA expression levels of caspase-3 and caspase-9 (apoptosis genes) in CYP2E1-silenced hepatocytes were 30% ∼ 60% lower than those in L02 hepatocytes (P < 0.01). The mRNA expression level of p53 (cancer suppressor gene) in CYP2E1-silenced hepatocytes was 81 - 278% higher than that in L02 hepatocytes (P < 0.01), while the mRNA expression levels of c-fos and k-ras (oncogenes) in CYP2E1-silenced hepatocytes were 20-68% lower than those in L02 hepatocytes (P < 0.01).

CONCLUSIONCYP2E1-silenced cells can be successfully prepared by lentivirus-mediated RNA interference technology. Silencing CYP2E1 gene can reduce the hepatotoxicity of TCE and inhibit the expression of some apoptosis genes and oncogenes, suggesting that CYP2E1 gene plays an important role in TCE metabolism and is related to the hepatotoxicity of TCE.

Apoptosis ; drug effects ; genetics ; Cell Line ; Cell Survival ; drug effects ; genetics ; Cytochrome P-450 CYP2E1 ; genetics ; metabolism ; Genetic Vectors ; Hepatocytes ; drug effects ; metabolism ; Humans ; Lentivirus ; genetics ; RNA Interference ; Trichloroethylene ; toxicity

OBJECTIVETo explore the development and prognosis of the acute flaccid paralysis (AFP) associated with enterovirus 71 (EV71) infection through clinical follow-up study for clinical and magnetic resonance imaging (MRI) features based on the research progress of virology and pathology.

METHODSixteen children with HFMD associated with AFP in hospital from May 1, 2011 to August 31, 2011 were investigated and the patients received intensive rehabilitation training. The 16 cases were divided into two groups (the recovery or the sequela) by if the muscle strength recovered to level 4 after intensive rehabilitation. The MRI findings of 15 children were analyzed and among them, 6 patients were reexamined after one month. The clinical markers were compared between groups including course of disease, WBC, WBC in cerebrospinal fluid (CSF), ventilator support, therapy, the worst muscle strength, the initial tendon reflex, the muscle atrophy, and multi-limb paralysis. The data were analyzed by t test and χ2 test with SPSS10.0.

RESULTAll the 16 children were infected with enterovirus 71 (EV71). The myodynamia of 7 children were level 0, 4 children had serious upper limbs paralysis. The neck muscle in 3 cases and the brain stem motor ruckus in 4 cases were involved. The ankle clonus of non-completely paralyzed limbs in 14 cases occurred during rehabilitation. Eight children had the better prognosis, the other 8 children had sequela. 0 level muscle strength (0 case vs. 7 cases, χ2=12.4), the initial tendon reflex (2 cases vs. 8 cases, χ2=9.6), obvious muscle atrophy (0 case vs. 8 cases, χ2=16), were significantly different in the children with the recovery when compared to the sequela (P<0.01). The severe upper limbs paralysis had the worse prognosis than the severe lower limbs paralysis. MR imaging showed signs of spinal nerve root inflammation and the bilateral hyperintense lesions, symmetrical in the posterior portions of the medulla, pons, and asymmetrical in the ventral horns of cervical spinal cord. Signal enhancement occurred only in the early MRI examination.

CONCLUSIONIn the evolution of AFP due to EV71 infection, the upper motor neuron damage is common, the prognosis is related with the severity of early paralysis and neuron damage. MR imaging is helpful to understand the pathological mechanism of AFP.

Child, Preschool ; Enterovirus A, Human ; pathogenicity ; Female ; Follow-Up Studies ; Hand, Foot and Mouth Disease ; diagnosis ; pathology ; virology ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Paralysis ; diagnosis ; pathology ; virology ; Prognosis