Hepatic echinococcosis:Clinical and therapeutic aspects

Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoc- cus multilocularis （E. multi/ocular/s） and Echinococcus granulosus （E. granulosus） infection, respectively. Cys- tic echinococcosis （CE） has a worldwide distribution, while hepatic alveolar echinococcosis （AE） is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the per/cyst; old cysts typically present internal septa- tions and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration （PAIR）] and more effective drugs （such as benzoimidazoles） have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease

The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography （ERCP） in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.

Approaches to Census Mapping:Chinese Solution in 2010 Rounded Census

China still use sketch maps as control devices that guarantees consistency and accuracy of population counting in previous census.Although the rapid advancement of geospatial technologies provides many possible solutions of digital census mapping,existing researches do not answer which solution is suitable to China.Subject to many constraints originated from characteristics of China,a practical solution of census mapping based on remote sensing imagery and auxiliary geographic information was proposed and proved to be feasible through evaluation analysis and a three-stage pilot study.Imagery with 2.5 meters and higher resolution,innovative workflow of census areas delineation,easy-to-use census mapping software packages and training organization all together provide the all-around supports for the 2010 rounded census (the 6th census) mapping activities.A digital census geographic framework detailed at the level of enumeration area was established in the 2010 rounded census which fills in the gaps in the field of modern geospatial census in China.The spatially referenced digital census database,especially the detailed census units,is of great value in successive census,sampling survey and many other census-related fields.Future work including quality evaluation of census areas,census mapping solution in the Tibet Autonomous Region are also discussed.

Induction of IgA and sustained deficiency of cell proliferative response in chronic hepatitis C

AIM： In the present study, antibody and peripheral blood mononuclear cells （PBMC） proliferative responses against hepatitis C virus （HCV） antigens were evaluated in HCV chronically infected patients. METHODS： Paired serum and PBMC samples were taken six months apart from 34 individuals, either treated or not, and tested by enzyme-linked immunosorbent assay （ELISA） and carboxyfluorescein succinimidyl ester staining. RSULTS： Over 70% of the patients showed specific IgG and IgM against capsid, E1 and NS3, while HVR-1 was recognized by half of the patients. An increase in the levels of the anti-capsid IgM （P = 0.027） and IgG （P = 0.0006） was observed in six-month samples, compared to baseline. Similarly, a significantly higher percent of patients had detectable IgA reactivity to capsid （P = 0.017） and NS3 （P = 0.005） after six months, compared to baseline. Particularly, IgA against structural antigens positively correlated with hepatic damage （P = 0.036）. IgG subclasses evaluation against capsid and NS3 revealed a positive recognition mediated by IgG1 in more than 80% of the individuals. On the contrary, less than 30% of the patients showed a positive proliferative response either of CD4＋ or CD8＋ T cells, being the capsid poorly recognized. CONCLUSION： These results confirm that while the cellular immune response is narrow and weak, a broad and vigorous humoral response occurs in HCV chronic infection. The observed correlation between IgA and hepatic damage may have diagnostic significance, although it warrants further confirmation.

Unusual site of recurrent musculoskeletal hydatid cyst: Case report and brief review of the literature

A case of a large multiplex recurrent hydatid cyst involving the left gluteal muscle and the left iliopsoas, accompanied with degeneration of the musculature of the left upper leg is presented along with a review of the relevant literature. Very few such cases have been reported worldwide. The presented case is also distinguished by the involvement of muscles of distant anatomic areas.

DIAGNOSIS AND TREATMENT OF MEDIASTINAL ENTEROGENOUS CYSTS IN CHILDREN

Objective To investigate the diagnosis and therapy of mediastinal enterogenous cysts in children. Methods Clinical data of 17 cases with mediastinal enterogenous cysts within 19 years in our hospital were retrospectively analyzed. Results One case was intramural esophageal cyst and 16 cases were enteric cysts, two among which were complicated with abdominal enteric duplications. Most cases presented with symptoms of respiratory distress. Twelve cases were complicated with vertebral anomalies. Ultrasound helpful in confirming the cystic nature of these lesions. posterior mediastinum. of 12 cases and magnetic resonance imaging of 4 cases were Eight cases had technetium-99m pertechnetate scintigraphy of posterior mediastinum.Conclusions Most patients present with symptoms of respiratory distress, complicated with vertebral anomalies. Ultrasonography and magnetic resonance imaging may be helpful in confirming the cystic nature of these lesions. Technetium-99m pertechnetate scintigraphy is the most effective method for differentiation of the disease from other mediastinal cysts.

Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation:An ex-vivo pilot experimental study in animal models

AIM： To evaluate radiofrequency thermal ablation （RTA） for treatment of cystic echinococcosis in animal models （explanted organs）. METHODS： Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80℃, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic. RESULTS： The subjects of the study were 17 cysts （nine hepatic and eight pulmonary）, who were treated with RTA. Pathology showed 100% success rate in both hepatic （919） and lung cysts （8/8）; immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts. CONCLUSION： RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in v/vo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.

Controlling malignant pericardial effusion by intrapericardial administration of recombinant mutant human tumor necrosis factor in patients with carcinoma

Objective: To evaluate the therapeutic efficacy of injecting recombinant mutant human tumor necrosis factor (rmhTNF) into pericardial cavity of carcinoma patients with malignant pericardial effusion. Methods: In 20 cases of malignant pericardial effusion, the intrapericardial catheter was inserted into pericardial cavity, and then rmhTNF of 1.5 × 107 U was infused. The infusion was repeated every 5-7 days with the total 4-6 times. If the effusion disappeared, rmhTNF was then used 2 more times and then the intrapericardial catheter was pulled out. Results: Of 20 patients, 14 were complete response (CR), 4 were partial response (PR) and 2 no change (NC). The disappearance of effusion in 6 cases lasted for more than 6 months. Conclusion: Injecting rmhTNF into pericardial cavity may be a better way to control malignant pericardial effusion and has mild side effects.

CARDIAC ECHINOCOCCOSIS

CARDIAC echinococcosis is clinically rare. We have received a case with multiple echinococcosis recently, which involved heart, mediastinum, andliver.

Giant hepatic hydatid cyst: A case report

Large type 1 cysts are prone to perforation. Furthermore, insufficient drainage with subsequent abscess is a frequent problem of large cysts. We report here a case of a 19-year old man who was admitted to the hospital with pain in the right upper quadrant and epigastric region. An asymmetrical right upper quadrant enlargement was detected on physical examination. UItrasonography and computerized tomography revealed a type 1 giant hydatid cyst in the right hepatic lobe, measuring 16 cm in diameter. During operation, partial cystectomy and drainage were done. The large dead space was obliterated by the ＇sandwich＇ method. Omentum and gelatin sponges were used to fill the cavity. The postoperative period was uneventful and the patient was discharged on the 5^th postoperative day.

USING CRYOPRESERVED HOMOGRAFT PERICARDIAL PATCH IN STAGED COMPLETE REPAIR FOR TETRALOGY OF FALLOT

Objective To compare the difference of effect while using homograt pericardium patch and Gore-rex patch in staged complete repair for Tetralogy of Fallot （TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF underwent the staged complete repair. Gore-rex patches were used to enlarge the RVOT of 13 patients, and cryopreserved homograft pericardium patches were used to enlarge the RVOT of 15 patients. The patients were followed up with 2-dimensional echocardiography and chest x-ray. Results One operative death in Gore-rex patch group, the mortality was 7. 7% ; 1 early postoperative death in cryopreserved homograft pericardium patch group, the mortality was 6. 7%. Between 2 groups, hemostasia time in operation room with significant difference （ P 〈 0. 01 ）, pericardial cavity drainage volume with difference （ P 〈 0. 05 ）. Gore-rex patch group was followed up 2 to 4.5 years, homograft pericardium patch group was followed up 0. 8 to 2.1 years. Echocardiography showed that there was significant difference of the residual obstruction at RVOT level （ P 〈 0. 01 ）. No calcification shadow was discovered on the chest x-ray of both groups. Conclusion Homograft pericardium is tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch maybe helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in cardiac surgery.

Comparative study of catheter-mediated gene transfer into heart

OBJECTIVE: To investigate the feasibility and features of 3 catheter-mediated approaches of gene transfer into heart, including direct myocardial injection (DMI), coronary artery perfusion (CAP), and intrapericardial cavity injection (ICI). METHODS: Fifteen dogs were used, and 0.3 ml (1 x 10(9) pfu) of an adenovirus (Adex1SR LacZ) was injected into the heart by 3 methods. The dogs were killed 5 days following injection, and gene expressions in heart and liver were evaluated by histochemical analysis. RESULTS: The results showed that (1) the CAP method was relatively less damaging and induced sparse LacZ expression in the myocardium, and the gene expression was also found in both vessels within the myocardium and liver; (2) gene transfer by DMI resulted in intense LacZ expression around the injection accompanied by a local inflammatory response; (3) LacZ expression elicited by ICI was detected in either the inner surface of the parietal pericardium or epicardial surface of the heart, and also in the myocardium underlying the visceral pericardium. CONCLUSION: Three catheter-mediated methods of gene transfer into the heart may be used and a reasonable approach should be chosen according to purpose.

素质·悟性·风格——为人之师的教学经

人人民教师，作为培养人才的人，自己必须首先是一个人才。我国先秦时期的著名教育家荀子说过：“师说有四，而博习不与焉。尊严而惮，可以为师；耆艾而信，可以为师；诵说而不凌不犯，可以为师；知微而论，可以为师。”就是说当教师的必须具有崇高的信仰威信，深厚的知识...

“打鸡血”+游戏+煽情 企业培训的标配?

全面数字化的进程,正重塑着互联网生态。面临加速折叠的残酷现实,唯有问道高手有效学习,才是提升竞争力的制胜武器.如今,'游戏+娱乐+口号'成了某些企业培训的标配。要不,再放上'励志+游戏+煽情'的调料,能行吗?君不见,当下市场鱼龙混杂,许多培训公司或培训大师们都是几副药包治百病,翻来覆去就那么几个课程,就那么几个案例,就那么几个游戏,不管面对什么样的企业,什么素质的人员,什么样的环境,都开同样的方子,他们往往是:读过几本营销书、听过几次培训课、嘴巴上的'吹嘘功夫'还了得,能讲几个故事,侃几个段子。

书坛“牛皮癣”

眼下治病、办证等广告犹如天女散花,无孔不入,就连小小的信箱、门牌也未能幸免于难,被贴得伤痕累累。只要肯掏腰包,就算你小学没毕业,也能搞个本科过过瘾。真不知什么时候,走在大街上,背上被贴一"性病包治"之类的广告,是一道什么样的风景?因为没有从根源上去查处.

Comparative study of catheter-mediated gene transfer into heart

To investigate the feasibility and features of 3 catheter mediated approaches o f gene transfer into heart, including direct myocardial injection (DMI), coron ary artery perfusion (CAP), and intrapericardial cavity injection (ICI) Methods Fifteen dogs were used, and 0 3?ml (1×10 9 pfu) of an adenovirus (Adex1SR La cZ) was injected into the heart by 3 methods The dogs were killed 5 days foll owing injection, and gene expressions in heart and liver were evaluated by histochemical analysis Results The results showed that ① the CAP method was relatively less damaging and indu ced sparse LacZ expression in the myocardium, and the gene expression was also f ound in both vessels within the myocardium and liver; ② gene transfer by DMI res ulted in intense LacZ expression around the injection accompanied by a local inf lammatory response; ③ LacZ expression elicited by ICI was detected in either t he inner surface of the parietal pericardium or epicardial surface of the heart, and also in the myocardium underlying the visceral pericardium Conclusion Three catheter mediated methods of gene transfer into the heart may be used a nd a reasonable approach should be chosen according to purpose

Experimental study on a novel compound extracted from Traditional Chinese Medicine for treatment of alveolar echinococcosis

To evaluate the efficacy of a novel compound derived from Traditional Chinese Medicine (TCM) for treatment of alveolar echinococcosis in the Kuming mouse Methods The compound was extracted from TCM by serial procedures including amalgamation of TCM drugs, boiling in a beaker, cold condensation using a reflux instrument, evaporation by mild heating and finally, formation of a deep brown powder An animal model of alveolar echinococcosis was established concurrently A bit of alveococcus tissue derived from alveolar echinococcosis in the mouse was transplanted into the peritoneal cavity of the musculus of a Kuming mouse The duration of infection after inoculation was classified as either 1 week or 10 weeks; the animals were again divided into treated groups and control groups Estimation of the alveococcus inhibitory rate and electron microscopic observation served as the main methods for assessment of efficacy The infected mice in the treated groups were intra gastrically administered once per day with the TCM extractive powder at doses of 20 mg·kg 1 for three months continuously All the animals were sacrificed and examined half a month after the end of TCM treatment Results Total wet weight of alveococcus collected from the 9 mice in the treated group after one week of infection was 37 8 g ( ±s , 4 196±2 090 g), which was markedly lower than the amount collected from 10 mice of the control group (121 3 g, ±s , 12 1±4 3 g) Therefore, the inhibitory rate of the alveococcus was 65 7% ( P 【0 01 ) Similarly, the total wet weight of alveococcus from 7 mice of the treated group after 10 weeks of infection was 4 3 g ( ±s , 0 62±1 21 g), which was much lower than the amount collected from 6 mice of the control group (17 85 g, ±s , 2 93±3 28 g) The inhibitory rate of alveococcus was 80 6% ( P 【0 01) Furthermore, the ultrastructural appearances of alveococcus showed obvious differences between the two groups Conclusion TCM extractive powder for treatment of murine alveococcosis is considered to be a hopeful anti echinococcus compound it is a topic for further study

Cell membrane-coated nanoparticles for tumor-targeted drug delivery

Nanoparticles can be enriched at tumor site and improve the therapeutic efficacy of many chemother- apy drugs with the well-known enhanced permeability and retention （EPR） effect. While conventional preparations of materials for nanoscale drug delivery system mainly focused on chemical synthesis, recently the combination of synthetic carrier and natural biomimetic carrier has gained more and more attention. As a new generation of biomimetic nanoparticles, cell membrane-coated nanoparticles combine the complex biological functions of natural membranes and the physicochemical properties of synthetic nanomaterials for a more effective drug delivery. Herein, we briefly review the recent advances on cell membrane-coated nanoparticles for tumor-targeted drug delivery via the prolonging systemic circulation lifetime and the active targeting effect. Since the preferential accumulation of cell membrane-coated nanopar- ticles in tumor site, they are able to improve the therapeutic efficacy of conventional chemotherapy drugs in antitumor treatment as well as to reduce the systemic toxicity. We also introduce a systematic targeted strategy for the promising application of this platform on brain tumors.

Persistence of VRC01-resistant HIV-1 during antiretroviral therapy

VRC01, a broadly neutralizing monoclonal antibody （bnmAb）, can neutralize a diverse array of HIV-1 isolates by mimicking CD4 binding to the envelope glycoprotein gpl20. We have previously demonstrated the presence of VRC01-resistant strains in an HIV-1 infected patient during antiretroviral therapy. Here, we report follow-up studies of two subsequent samples from the same patient. With genetic and phenotypic analysis of over 70 full-length molecular clones of the HIV-1 envelope, we show that VRC01-resistant HIV-1 continued to exist and change in its proportion of the infecting virus during treatment with a highly active antiretroviral therapy. Consistent with our previous observation, the resistant phenotype was associated with a single asparagine residue at position 460 （N460）, a potential N-linked glycosylation site in the V5 region. The persistence and continuing evolution of VRC01-resistant HIV-1 in vivo presents a great challenge to our future preventative and therapeutic interventions based on VRC01.