基于邪之所凑 其气必虚论治复发性病毒性角膜炎

“邪之所凑,其气必虚”出自《黄帝内经》,后世医家及著作对其内涵反复阐明并通过临床实践逐渐丰富,广泛运用于临床各科疾病,对中医眼科治疗有重要指导意义。病毒性角膜炎为眼表多发病、疑难病,反复发作是其特征,此病侵犯眼实质,严重影响视力。主要病因为正气虚弱、正不胜邪,多为本虚标实。此文从“邪之所凑,其气必虚”理论出发,分析复发性病毒性角膜炎的病因病机,探讨其在复发性病毒性角膜炎治疗中的指导意义。

复发性病毒性角膜炎外周血T细胞的变化

目的:研究复发性病毒性角膜炎患者外周血T淋巴细胞亚群、T细胞激活状态及Th1/Th2模式,进一步探讨其免疫发病机制。方法:运用流式细胞仪检测30例复发性病毒性角膜炎患者血浆TH1(IFN-r,TNF-a,IL-2),TH2(IL-10,IL-5,IL-4)细胞因子水平以及外周血淋巴细胞CD3+,CD4+,CD8+T细胞和CD3+HLA-DR+,CD4+HLA-DR+,CD8+HLA-DR+T细胞百分率,并与健康对照组比较。结果:复发性病毒性角膜炎患者血浆IFN-r,IL-2水平有明显上升(P<0.05);IL-4水平下降(P<0.05)。CD4+细胞下降(P<0.05);CD4+HLA-DR+T及CD8+HLA-DR+T细胞上升(P<0.05)。结论:复发性病毒性角膜炎患者T细胞过度活化和Th1/Th2平衡的偏离;Th1激活增强,Th2激活减弱与病毒性角膜炎的复发、迁延有关。

复发性病毒性脑炎的临床特点(附2例报告)

目的探讨复发性病毒性脑炎的临床特点。方法回顾性分析2例复发性病毒性脑炎患者的临床资料。结果 2例患者中1例男性(71岁),1例女性(35岁),临床表现为反复发作的癫痫伴智能或意识障碍、失语等;影像学检查示病灶多发于脑皮质,均伴颞叶受累;脑电图以广泛慢波为主。给予足量抗病毒药物及糖皮质激素治疗后,症状明显好转,随访2～4个月未见复发。结论复发性病毒性脑炎患者的临床表现以颞叶症状为主,其发病机制可能为病毒的再激活所致,早期足量抗病毒治疗效果较好。

小儿36例复发及慢性过敏性紫癜临床分析

目的分析小儿复发及慢性过敏性紫癜的临床特点及预后。方法回顾性分析皮疹复发及慢性组、肾炎复发及慢性组及普通对照组过敏性紫癜患儿的临床特点,并比较3组患儿紫癜性肾炎的临床分型及预后。结果3组患儿持续性皮疹、严重腹痛、肾炎的症状与体征发生率比较差异均有统计学意义(P<0.05);3组患儿紫癜性肾炎临床类型的构成及预后分级比较,差异均无统计学意义(P>0.05)。结论对于年龄超过9岁、严重腹痛、持续性皮疹、肾炎者,转为复发及慢性过敏性紫癜的可能性较大,应积极寻找诱因,多方面综合治疗,以防止病情进一步加重。

小儿复发及慢性过敏性紫癜的临床特点分析

目的：探讨小儿慢性过敏性紫癜的临床特点。方法选取2010年1月～2013年1月收治的153例小儿过敏性紫癜患者进行分析研究，随机分为3组，分别是皮疹复发及慢性过敏性紫癜组（A组）28例、肾炎复发及慢性过敏性紫癜组（B组）22例以及对照组103例。分析三组患者的临床表现和患儿紫癜性肾炎临床分型。结果患儿出现不同程度的关节疼痛、腹痛、消化道出血、肾炎以及持续性皮疹，且3组患儿的严重腹痛、持续性皮疹和肾炎的发生率差异有统计学意义（P＜0.05）。3组患儿紫癜性肾炎的临床分型差异无统计学意义。结论患儿临床出现不同程度的关节疼痛、腹痛、消化道出血、肾炎、持续性皮疹等症状，要进行必要的抗敏、输液、去病因、止痛以及对症处理，并进一步探讨更加有效的治疗措施，防止病情进一步扩大。

Patterns of Relapse and Management Options in Unknown Primary Cervical Metastatic Carcinoma

Objective: To analyze the patterns of relapse and management options in unknown primary cervical metastatic carcinoma (UPCMC) as well as to discuss its treatment strategies. Methods: Clinical data of 111 cases of eligible UPCMC were retrospectively studied. Neck control, primary relapse and long-term survival were compared among different groups. Results: Primary carcinomas ultimately appeared in 12 cases (10.8%, 12/111). Neck control rate was 36.9%. Overall 5-year survival rate was 41.4%. Neck control, N stage and primary control were prognostic factors for UPCMC. Neck control was affected by N stage and whether or not comprehensive radiotherapy was administered. Conclusion: UPCMC should primarily be treated by radiotherapy except for cases with N1 or N2 insensitive to radiation. Bilateral necks radiotherapy is the optimal choice in terms of neck radiotherapy. Selective total pharyngeal irradiation is recommended for potential primary treatment.

Combined carriership of TLR9 -1237C and CD14 -260T alleles enhances the risk of developing chronic relapsing pouchitis

AIM： To investigate the single nucleotide polymorphisms （SNPs） in genes involved in bacterial recognition and the susceptibility to pouchitis or pouchitis severity. METHODS： Analyses of CD14 -260C〉T, CARD15/ NOD2 3020insC, Toll-like receptor （TLR）4 ＋896A〉G, TLR9 -1237T〉C, TLR9＋2848G〉A, and IRAKM ＋ 22148G〉A SNPs were performed in 157 ileal-pouch anal anastomosis （IPAA） patients （79 patients who did not develop pouchitis, 43 infrequent pouchitis patients, 35 chronic relapsing pouchitis patients） and 224 Italian Caucasian healthy controls. RESULTS： No significant differences were found in SNP frequencies between controls and IPAA patients. However, a significant difference in carriership frequency of the TLRg-1237C allele was found between the infrequent pouchitis and chronic relapsing pouchitis groups [P = 0.028, odd＇s ratio （OR） = 3.2, 95%CI = 1.2-8.6]. This allele uniquely represented a 4-locus TLR9 haplotype comprising both studied TLR9 SNPs in Caucasians. Carrier trait analysis revealed an enhanced combined carriership of the alleles TLR9 -1237C and CD14 -260T in the chronic relapsing pouchitis and infrequent pouchitis group （P = 0.018, OR = 4.1, 95%CI = 1.4 -12.3）. There is no evidence that the SNPs predispose to the need for IPAA surgery. The significant increase of the combined carriershoip of the CD14-260T and TLR9-1237C alleles in the chronic relapsing pouchitis group suggests that these markers identift a subgroup of IPAA patients with a rish of developing chronic or refractory pouchitis.

Replication of hepatitis B virus in primary duck hepatocytes transfected with linear viral DNA

AIM: To explore the expression and replication of hepatitis B virus (HBV) DNA in primary duck hepatocytes (PDHs).METHODS: Complete HBV genome was transfected into PDHs by electroporation (transfected group, 1.19×1012copies of linear HBV DNA/1×107 PDHs). After 1-5 d of transfection, HBsAg and HBeAg in the supernatant and lysate of PDHs were measured with the IMX System.Meanwhile, replicative intermediates of HBV DNA were analyzed by Southern blotting and Dot blotting. PDHs electroporated were used as control group.RESULTS: HBsAg in the hepatocyte lysates of transfected group was 15.24 (1 d), 14.55 (3 d) and 5.13 (5 d; P/N values, positive≥2.1) respectively. HBeAg was negative (＜2.1). Both HBsAg and HBeAg were negative in the supernatant of transfected group. Dot blotting revealed that HBV DNA was strongly positive in the transfected group and negative in the control group. Southern blot analysis of intracellular total DNA indicated that there were relaxed circular (rc DNA), covalently closed circular (ccc DNA), and single-stranded (ss DNA) HBV DNA replicative intermediates in the transfected group, there was no integrated HBV DNA in the cellular genome. These parameters were negative in control group.CONCLUSION: Expression and replication of HBV genes can occur in hepatocytes from non-mammalian species.HBV replication has no critical species-specificity, and yet hepatic-specific regulating factors in hepatocytes may be essential for viral replication.

study to determine guidelines for pediatric colonoscopy

To investigated characteristics, diagnosis, bowel-cleansing preparation, sedation, and colonoscope length and diameter in Japanese pediatric patients receiving total colonoscopy. METHODSThe present study evaluated consecutive patients aged ≤ 15 years who had undergone their first colonoscopy in Kurume University between January 2007 and February 2015. Data were retrospectively analyzed. We identified 110 pediatric patients who had undergone colonoscopy that had reached the cecum, allowing the observation of the total colon. RESULTSHematochezia, abdominal pain, and diarrhea were the most common symptoms. For bowel-cleansing preparation, pediatric patients aged ≤ 12 years were treated with magnesium citrate, and patients aged 13-15 years were treated with polyethylene glycol 4000. For sedation, thiamylal with pentazocine, which has an analgesic effect, was used in patients aged ≤ 6 years, and midazolam with pentazocine was used in patients aged ≥ 7 years. Regarding the choice of endoscope, short and thin endoscopes were selected for younger patients, particularly patients aged ≤ 3 years. Positive diagnoses were made in 78 patients (70.9%). Inflammatory bowel disease (n = 49, 44.5%), including ulcerative colitis (n = 37, 33.6%) and Crohn’s disease (n = 12, 10.9%), was the most common diagnosis. CONCLUSIONColonoscopy offers a high diagnostic capability for pediatric patients with gastrointestinal symptoms. The selection of appropriate management the performance of colonoscopy is important in pediatric patients.

Primary hepatic carcinoid:A case report and literature review

Carcinoids are tumors derived from neuroendocrine cells and often produce functional peptide hormones.Approximately 54.5% arise in the gastrointestinal tract and frequently metastasize to the liver.Primary hepatic carcinoid tumors(PHCT) are extremely rare;only 95 cases have been reported.A 65-year-old man came to our attention due to occasional ultrasound findings in absence of clinical manifestations.His previous medical history,since 2003,included an echotomography of the dishomogeneous parenchymal area but no focal lesions.A computed tomography scan performed in 2005 showed an enhanced pseudonodular-like lesion of about 2 cm.Cholangio-magnetic resonance imaging identified the lesion as a possible cholangiocarcinoma.No positive findings were obtained with positron emission tomography.Histology suggested a secondary localization in the liver caused by a low-grade malignant neuroendocrine tumor.Immunohistochemistry was positive for anti chromogranin antibodies,Ki67 antibodies and synaptophysin.Octreoscan scintigraphy indicated intense activity in the lesion.Endoscopic investigations were performed to exclude the presence of extrahepatic neoplasms.Diagnosis of PHCT was established.The patient underwent left hepatectomy,followed by hormone therapy with sandostatine LAR.Two months after surgery he had a lymph nodal relapse along the celiac trunk and caudate lobe,which was histologically confirmed.The postoperative clinical course was uneventful,with a negative follow-up for hematochemical,clinical and radiological investigations at 18 mo post-surgery.Diagnosis of PHCT is based principally on the histopathological confi rmation of a carcinoid tumor and the exclusion of a non-hepatic primary tumor.Surgical resection is the recommended primary treatment for PHCT.Recurrence rate and survival rate in patients treated with resection were 18% and 74%,respectively.

Recurrent Seizures Manifestations in a Case of Congenital Hypoparathyroidism:a Case Report

HYPOPARATHYROIDISM is characterized by hypocalcemia, hyperphosphatemia and low or inappropriately normal levels of parathyroid hormone （PTH）. PTH is a key calcium regulatinghormone essential for calcium homeostasis, vitamin D-dependent calcium absorption, renal calcium reabsorption and renal phosphate clearance. Hypoparathyroidism may be due to congenital or acquired disorders. Causes include autoimmune diseases, genetic abnormalities, destruction or infiltrative disorders of the parathyroid glands.

Depression Among Sexually Transmitted Disease Patients

Objective: To investigate the depression status of patients withsexually transmitted diseases (STDs). Methods: The depression status of fifty-one hospitalized STDpatients was evaluated in a randomized control study usingZung's Quantitativc Table. 18 healthy control patients withsimilar demographic backgrounds were randomly chosen ascontrols. Patients with scores above or equal to 40 wereconsidered to be suffering from depression. Results: The prevalence rate of depression in the patient groupwas obviously higher than that of in the control (X^2=16.456,P<0.01). Prevalence of depression was found to be significantlyrelated to occupation (P<0.05). Though the prevalence was notfound to differ significantly between those with a treatmentcourse less than 2 months and those with one longer or equal to2 months (X^2=0.041, P>0.05), the mean depression scores of theformer group were significantly higher than those of the latter(P<0.01). No significant differences were found between newversus relapsing disease, married versus non-married, maleversus female, or differing educational backgrounds. Conclusion: STD patients showed significant prevalence ofdepression.

Long Dan Xie Gan Formula Granule Promotes Pro-Inflammatory Cytokine Expression in Female Guinea Pigs with Recurrent Genital Herpes

Objective To explore the effects of Long Dan Xie Gan formula granule(LDXGFG)on regulation of pro-inflammatory cytokines in female guinea pigs with recurrent genital herpes(herpes simplex virus 2,HSV-2).Methods Levels of pro-inflammatory cytokines in blood of HSV-2-infected guinea pigs,including IL-6,IL-8,IL-10,IL-12,IFN-α,IFN-β,IFN-γ,and TNF-α,were detected by ELISA;corresponding gene expression levels in tissues were detected by real-time PCR.Results IL-6,IL-10,IL-12,IFN-α,IFN-γand TNF-αdecreased significantly in both blood and diseased tissues after infection with recurrent genital herpes.Upon feeding LDXGFG to HSV-2-infected guinea pigs,IL-6,IL-10,IL-12,IFN-α,IFN-γand TNF-αdemonstrated significant increases,similar to the effects of acyclovir(ACV).LDXGFG promoted the expression of pro-inflammatory cytokines in blood and tissue,with a stronger effect than ACV.Moreover,LDXGFG demonstrated broader effects than ACV.Conclusion The present results suggest that LDXGFG can serve as an alternative,inexpensive,and long-term treatment for HSV-2 infection.

Nodular liver lesions involving multiple myeloma: A case report and literature review

We report a case of a 62-year old woman admitted to our hospital for multiple nodular metastatic liver lesions found by ultrasonography in a regular medical examination. Routine laboratory tests were normal. PET-CT showed multiple bone lesions and nodular liver lesions. Liver biopsy revealed nodular infiltration of multiple myeloma with positive staining of kappa light chain. Further investigation of bone marrow aspiration, immunofixation and immunoelectrophoresis of serum protein, urine test for Bence-Jones protein, 132-microglobulin in serum and urine confirmed the diagnosis. The patient also coinfected with hepatitis C virus （HCV）. With six cycles of chemotherapy with VAD schedule, she achieved complete remission. In this report, a literature review of liver lesions involving multiple myeloma is also provided.

Etiology and Prevention of Recurrent Condyloma Accuminata

The possible causes of condyloma acuminatarecurrence arc summarized: such as patients with cellularimmune denciencies, physical therapy triggering subclinicalinfective foci, sowing of the virus particles, and insufficienttherapy. Corresponding preventive measures are addressed,including: immunomodulators improving cellular immunity,ensuring the range and depth of physical therapy, and trcatingsexual partners simultaneously.

Predictive biomarker and clinicopathological characteristics analysis for recurrence of early gastric cancer

Objective: The aim of this study was to identify the correlation between the clinicopathological characteristics and recurrence in early gastric cancer (EGC), what's more, we attempt to look for a predictive biomarker to predict and treat for re-currence of EGC. Methods: This study retrospectively analyzed 178 early gastric cancer patients who had the complete post-operative and follow-up medical records in the First Affiliated Hospital of Yangtze University (China) between January 1995 to December 2005. All of them were followed-up to December 2009 regularly. Computer tomography (CT), endoscopy, and single photon emission computed tomography (SPET-CT) were used to diagnose for recurrence of EGC. Immunohistochem-istry (IHC) and fluorescence in situ hybridization (FISH) were used for the detection of cerbB2. Chi-square test was applied to this study for statistics analysis. Results: Fourteen patients had recurrence. Eighteen patients were cerbB2-positive, including twelve recurrence patients and six norecurrence patients. Sex, tumor depth, and lymph node metastasis were related to the recurrence of EGC. Also, cerbB2-positive patients had the higher recurrence rate compared to the cerbB2-negative patients. Conclusion: Recurrence of EGC after curative resection can be predicted by using some clinicopathological characteristics. CerbB2 can be used as a predictive biomarker for recurrence of EGC.

QUALITATIVE STUDY FOR A MULTI-DRUG RESISTANT TB MODEL WITH EXOGENOUS REINFECTION AND RELAPSE

One tuberculosis transmission model is formulated by incorporating exogenous reinfec- tion, relapse, and two treatment stages of infectious TB cases. The global stability of the unique disease-free equilibrium is obtained by applying the comparison principle if the effective reproduction number for the full model is less than unity. The existence and stability of the boundary equilibria are given by introducing the invasion reproduction numbers. Furthermore, the existence and local stability of the endemic equilibrium are addressed under some conditions.

Adoptive transfer of T cells transduced with a chimeric antigen receptor to treat relapsed or refractory acute leukemia: efficacy and feasibility of immunotherapy approaches

Treatment outcomes of acute leukemia(AL) have not improved over the past several decades and relapse rates remain high despite the availability of aggressive therapies. Conventional relapsed leukemia treatment includes second allogeneic hematopoietic stem cell transplantation(allo-HSCT) and donor lymphocyte infusion(DLI), which in most cases mediate, at best, a modest graft-versus-leukemia effect, although their clinical efficacy is still limited. Although allo-HSCT following myeloablative conditioning is a curative treatment option for younger patients with acute myeloid leukemia(AML) in a first complete remission(CR), allo-HSCT as a clinical treatment is usually limited because of treatment-related toxicity. The overall DLI remission rate is only 15%–42% and 2-year overall survival(OS) is approximately 15%–20%, with a high(40%–60%) incidence of DLI-related graft-versus-host disease(GVHD). Therefore, development of new, targeted treatment strategies for relapsed and refractory AL patients is ongoing. Adoptive transfer of T cells with genetically engineered chimeric antigen receptors(CARs) is an encouraging approach for treating hematological malignancies. These T cells are capable of selectively recognizing tumor-associated antigens and may overcome many limitations of conventional therapies, inducing remission in patients with chemotherapy-refractory or relapsed AL. In this review, we aimed to highlight the current understanding of this promising treatment modality, discussing its adverse effects and efficacy.