[Analysis of clinical characteristics of persistent HBeAg positivity in patients with chronic hepatitis B treated with nucleos(t)ide analogues]

Objective: To explore the clinical characteristics of persistent HBeAg positivity in patients with chronic hepatitis B treated with nucleos(t)ide analogues. Methods: A retrospective analysis was performed according to different data types. An independent sample t-test, Mann-Whitney U test, chi-square test, or Fisher's exact probability method were used. Chronic hepatitis B patients followed up for four years were collected from the follow-up case database of the Department of Infectious Diseases of Zhongshan Third Hospital from January 2009 to December 2018 and were divided into two groups, A and B, with 87 and 145 cases respectively, according to the duration of HBeAg-negativity≤ 3 and persistent positivity >3 years. Statistical analysis was conducted on the age, gender, family history, baseline, follow-up visit duration, liver function, and other data among the two patient groups. Results: There were no statistically significant differences in gender, age, family history of liver cirrhosis, family history of liver cancer, liver cirrhosis condition before treatment, fatty liver disease combined condition before treatment, baseline HBsAg, anti-HBc, alanine aminotransferase, albumin, or total bilirubin between the two groups of patients (P > 0.05). HBV DNA and HBeAg were significantly higher in group B than those in group A at baseline, with P≤0.001. Aspartate aminotransferase and γ-glutamyl transferase were significantly higher in group A than those in group B at baseline. The proportion of family history of hepatitis B was significantly higher in group B (69.0%) than that in group A (50.6%) among the two groups of patients, and the difference was statistically significant (P = 0.005). The proportion of mothers with hepatitis B was significantly higher in group B (25.5%) than in group A (11.5%), P = 0.010. During the treatment process, the HBV DNA quantification was significantly higher in group B than that in group A at 0.5 and 1 years (P≤0.002). The proportion of HBV DNA <100IU/ml was also significantly different at six months and one year (χ(2)=30.327, P < 0.001 and χ(2)=11.779, P = 0.001). The HBsAg level was higher in group B than that of group A in the second and fourth years, P < 0.05. During the entire treatment process, the HBeAg level was significantly higher in group B than that in group A (P < 0.001). A total of seven cases developed liver cirrhosis or cancer during follow-up, including three cases in group A and four cases in group B (P > 0.05). Conclusion: HBeAg-positive patients with chronic hepatitis B have persistent HBeAg positivity when treated with long-term nucleos(t)ide analogues. Accordingly, a greater proportion of this kind of patient family and mothers have a remarkable history of hepatitis B and a reduced HBV DNA relapse rate in the early stages (within a year or less).

[Risk factors analysis and prediction model establishment of malignant tumor in patients with polymyositis/dermatomyositis]

Objective: To analyze the risk factors of polymyositis/dermatomyositis (PM/DM) complicated with malignant tumor and to construct clinical prediction model. Methods: A total of 427 PM/DM patients, who were admitted to Rheumatism Immunity Branch, the Second Affiliated Hospital, Air Force Medical University from January 1, 2015 to January 1, 2021, were enrolled in the study, including 129 males and 298 females. The mean age was (51.4±12.2) years. The patients were divided into control group (without malignant tumor, n=379) and case group (with malignant tumor, n=48) according to whether they were complicated with malignant tumors. In the two groups, 70% of the patients' clinical data were randomly selected as the training set data, and the remaining 30% were used as the validation set data. The clinical parameters were retrospectively collected, and risk factors of PM/DM complicated with malignant tumor were analyzed by binary logistic regression. R software was used to construct a clinical prediction model for malignant tumors in PM/DM patients using training set data. Validation set data were used to assess the feasibility of the model. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive ability, accuracy and clinical applicability of the nomogram model. Results: The age of the control group was (50.4±11.8) years, and males accounted for 26.9%(102/379); the age of the case group was (59.1±12.7) years, and the proportion of males was 56.3% (27/48). The proportion of male, age, the positive rate of anti-transcription mediator 1-γ (TIF1-γ) antibody, glucocorticoid therapy resistance, and levels of creatine kinase (CK), carbohydrate antigen 125(CA125) and carbohydrate antigen 199 (CA199) were all higher in the case group than those in control group, while incidence of interstitial lung disease (ILD), arthralgia, Raynaud's phenomenon, serum albumin (ALB) level and lymphocyte (LYM) count were all lower than those in control group (all P<0.05). Binary logistic regression analysis showed that male (OR=2.931, 95%CI: 1.356-6.335), glucocorticoid therapy resistance (OR=5.261, 95%CI: 2.212-12.513), older age (OR=1.056, 95%CI: 1.022-1.091), elevated CA125 (OR=8.327, 95%CI: 2.448-28.319) and positive anti-TIF1-γ antibody (OR=7.529, 95%CI: 2.436-23.270) were risk factors of malignancy in PM/DM patients (all P<0.05); and complicated with ILD (OR=0.261, 95%CI: 0.099-0.689), complicated with arthralgia (OR=0.238,95%CI:0.073-0.779), elevated LYM count (OR=0.267, 95%CI: 0.103-0.691) were protective factors of malignancy in PM/DM patients (all P<0.05). The AUC of ROC curve predicting malignancy in PM/DM patients with the training concentrated prediction model was 0.887 (95%CI: 0.852-0.922), with a sensitivity of 77.9% and a specificity of 86.3%; it was 0.925 (95%CI: 0.890-0.960), 86.5% and 88.0% in the validated centralized prediction model, respectively. The correction curves of the training set and the validation set indicated that the predictive model had good calibration ability. Both the DCA curves of the training set and the validation set showed that the proposed predictive model had good clinical applicability. Conclusions: Older age, male, glucocorticoid therapy resistance, not complicated with ILD and arthralgia, elevated CA125, positive anti-TIF1-γ antibody, decreased LYM count are risk factors for malignancy in PM/DM patients, and the established nomogram model shows good predictive ability.

[New pathological classification and clinical implications of pituitary neuroendocrine tumors of the 2022 WHO version]

In 2022, the World Health Organization proposed a new classification for pituitary adenomas. The major nomenclature change from the previous edition was the transition from"adenoma"to"pituitary neuroendocrine tumor"(PitNETs). The new classification provided the detailed histological subtypes of PitNETs for routine use of antibodies such as pituitary transcription factors (PIT1, TPIT, SF1, GATA3, and ERα) and hormones. The major PIT1, TPIT, and SF1 lineage-defined PitNETs types and subtypes featured distinct morphologic, molecular, and clinical differences. Unlike the 2017 WHO classification, the 2022 WHO version updated some concepts as follows: (1) Mammosomatotroph, acidophil stem cell tumors and mixed somatotroph/lactotroph tumor represented distinct PIT1-lineage PitNETs; (2) The diagnostic category of PIT1-positive plurihormonal tumor was replaced by the immature PIT1-lineage tumor and the mature plurihormonal PIT1-lineage tumor; (3) The term"metastatic PitNET"was advocated to replace the previous terminology"pituitary carcinoma". The new classification emphasizes the importance of pathological classification of PitNETs. Obviously, accurate pathological interpretation is the key to judge the clinical treatment pathway and prognosis of patients.

Dynamic Interaction Between Mucosal Immunity and Microbiota Drives Nose and Pharynx Homeostasis of Common Carp (Cyprinus carpio) After SVCV Infection

The crosstalk between the immune system and microbiota drives an amazingly complex mutualistic symbiosis. In mammals, the upper respiratory tract acts as a gateway for pathogen invasion, and the dynamic interaction between microbiota and mucosal immunity on its surface can effectively prevent disease development. However, the relationship between virus-mediated mucosal immune responses and microbes in lower vertebrates remains uncharacterized. In this study, we successfully constructed an infection model by intraperitoneally injecting common carp (Cyprinus carpio) with spring viremia of carp virus (SVCV). In addition to the detection of the SVCV in the nose and pharynx of common carp, we also identified obvious histopathological changes following viral infection. Moreover, numerous immune-related genes were significantly upregulated in the nose and pharynx at the peak of SVCV infection, after which the expression levels decreased to levels similar to those of the control group. Transcriptome sequencing results revealed that pathways associated with bacterial infection in the Toll-like receptor pathway and the Nod-like receptor pathway were activated in addition to the virus-related Rig-I-like receptor pathway after SVCV infection, suggesting that viral infection may be followed by opportunistic bacterial infection in these mucosal tissues. Using 16S rRNA gene sequencing, we further identified an upward trend in pathogenic bacteria on the mucosal surface of the nose and pharynx 4 days after SVCV infection, after which these tissues eventually reached new homeostasis. Taken together, our results suggest that the dynamic interaction between mucosal immunity and microbiota promotes the host to a new ecological state.

[Recommendations for diagnosis and treatment of primary biliary cholangitis in China (2021)]

Primary biliary cholangitis is a chronic autoimmune cholestatic disease with a progressive course. This disease is not rare in China, but standardized diagnosis and treatment for primary biliary cholangitis are insufficient. Based on the evidence and guidelines from China and other countries, Rheumatology Branch of Chinese Medical Association developed the recommendations of diagnosis and treatment for primary biliary cholangitis in China. The aim is to help clinicians recognize clinical characters, therapeutic selection and prognosis judgement of primary biliary cholangitis, which will contribute to make diagnosis in time, to select treatment properly and to manage follow-up scientifically.

[Otological and hearing characteristics in children with Turner syndrome]

Objective: To explore the otological and hearing characteristics in children with Turner syndrome (TS), to determine risk factors of hearing loss, and to discuss algorithms for future surveillance. Methods: The clinical data of otolaryngology in children with TS from January 2018 to April 2020 were reviewed retrospectively. A total of 46 female children with TS, aged from 5 to 18 years were enrolled. Karyotypes included 17 cases (37.0%) of monosomy, 16 cases (34.7%) of mosaicism, and 13 cases (28.3%) of abnormal X chromosome structures. The otoscopic characteristics, audiological performance, and otologic diagnoses were evaluated. Multivariate logistic regression and Mann-Whitney U test were used for statistical analysis. Results: The most common otologic comorbidity was otitis media with effusion (OME), including 20 cases (43.5%) with 33 ears (35.9%). 14 cases (30.4%) were diagnosed with hearing loss. The regression analysis revealed that the age (OR=1.345, 95%CI: 1.072-1.760) and comorbidity of OME (OR=9.460, 95%CI: 2.065-60.350) were risk factors associated with hearing loss. In TS with OME, when compared with the mean air conduction threshold, the hearing loss of the group with pars flaccida retractions was significantly higher ((24.3±13.8) dB HL vs. (14.4±4.2) dB HL, U=59.500, P=0.008) than that of the group with none retractions. Conclusion: OME and hearing loss are common in children with TS. As age increases or suffers from OME, the risk of hearing loss increases.

Interactions Between Commensal Microbiota and Mucosal Immunity in Teleost Fish During Viral Infection With SVCV

The mucosa of vertebrates is a particularly complex but dynamic environment in which the host constantly interacts with trillions of commensal microorganisms and pathogens. Although the internal and external mucosal microbiomes with immune defense of mammals have been well investigated, the relationship between mucosal microbes and their host’s immune responses has not been systematically understood in the early vertebrates. In this study, we compared the composition and distribution of mucosal microbiota in common carp (Cyprinus carpio), and found that there were significant differences of microbiota between in the internal (gut) and external mucosal (buccal mucosa, gills and skin) tissues. Next, we successfully constructed an infection model with spring viremia of carp virus (SVCV). Specifically, following viral infection, the immune and antiviral related genes showed different up-regulation in all selected mucosal tissues while significant morphological changes were only found in external tissues including buccal mucosa, gills and skin. Using 16S rRNA gene sequence, we revealed that the abundance of Proteobacteria in mucosal tissues including buccal mucosa, gills and gut showed increased trend after viral infection, whereas the abundance of Fusobacteria significantly decreased in gut. In addition, the loss of dominant commensal microorganisms and increased colonization of opportunistic bacteria were discovered in the mucosal surfaces indicating that a secondary bacterial infection might occur in these mucosal tissues after viral infection. Overall, our results firstly point out the distribution of internal and external mucosal microbiota and analyze the changes of mucosal microbiota in common carp after SVCV infection, which may indicated that the potential role of mucosal microbiota in the antiviral process in early vertebrates.

Prevailing Role of Mucosal Igs and B Cells in Teleost Skin Immune Responses to Bacterial Infection

The skin of vertebrates is the outermost organ of the body and serves as the first line of defense against external aggressions. In contrast to mammalian skin, that of teleost fish lacks keratinization and has evolved to operate as a mucosal surface containing a skin-associated lymphoid tissue (SALT). Thus far, IgT representing the prevalent Ig in SALT have only been reported upon infection with a parasite. However, very little is known about the types of B cells and Igs responding to bacterial infection in the teleost skin mucosa, as well as the inductive or effector role of the SALT in such responses. To address these questions, in this study, we analyzed the immune response of trout skin upon infection with one of the most widespread fish skin bacterial pathogens, Flavobacterium columnare This pathogen induced strong skin innate immune and inflammatory responses at the initial phases of infection. More critically, we found that the skin mucus of fish having survived the infection contained significant IgT- but not IgM- or IgD-specific titers against the bacteria. Moreover, we demonstrate the local proliferation and production of IgT⁺ B cells and specific IgT titers, respectively, within the SALT upon bacterial infection. Thus, our findings represent the first demonstration that IgT is the main Ig isotype induced by the skin mucosa upon bacterial infection and that, because of the large surface of the skin, its SALT probably represents a prominent IgT-inductive site in fish.

Mediation of Mucosal Immunoglobulins in Buccal Cavity of Teleost in Antibacterial Immunity

The buccal mucosa (BM) of vertebrates is a critical mucosal barrier constantly exposed to rich and diverse pathogens from air, water, and food. While mammals are known to contain a mucosal associated lymphoid tissue (MALT) in the buccal cavity which induces B-cells and immunoglobulins (Igs) responses against bacterial pathogens, however, very little is known about the evolutionary roles of buccal MALT in immune defense. Here we developed a bath infection model that rainbow trout experimentally exposed to Flavobacterium columnare (F. columnare), which is well known as a mucosal pathogen. Using this model, we provided the first evidence for the process of bacterial invasion in the fish BM. Moreover, strong pathogen-specific IgT responses and accumulation of IgT⁺ B-cells were induced in the buccal mucus and BM of infected trout with F. columnare. In contrast, specific IgM responses were for the most part detected in the fish serum. More specifically, we showed that the local proliferation of IgT⁺ B-cells and production of pathogen-specific IgT within the BM upon bacterial infection. Overall, our findings represent the first demonstration that IgT is the main Ig isotype specialized for buccal immune responses against bacterial infection in a non-tetrapod species.

[Safety and efficacy of DCV-based DAAs therapy for chronic HCV infection in China]

Objective: To evaluate the efficacy and safety of DCV-based DAAs therapy for chronic HCV infected Chinese patients. Methods: An open-label, non-randomized, prospective study was designed. Fifty-two patients with chronic HCV infection were enrolled. Among them, there was one patient after liver transplantation, 2 patients after kidney transplantation, 3 patients with hepatocellular carcinoma, and 4 patients with HBV infection. Thirteen cases with chronic hepatitis C (one compensated cirrhosis) who were negative for resistance-related variants [NS5A RAS (-)] of gene 1b and NS5A were treated with daclatasvir (DCV) + asunaprevir (ASV) for 24 weeks. Twenty-five cases of CHC (six compensated cirrhosis) with GT 1b, 2a, 3a, 3b, 6a were treated with DCV + SOF ± RBV for 24 weeks. 8 cases with decompensated cirrhosis of gene 1b and NS5A RAS(-) were given DCV + SOF + RBV regimen for 12 weeks. Six cases with decompensated cirrhosis, of gene 2a, 1b, 2a, 3a, 3b, were given DCV + SOF + RBV regimen for 24 weeks. HCV RNA, blood routine test, liver and kidney function, and upper abdominal ultrasound/MRI were measured at baseline, 4 weeks of treatment, end of treatment, and 12 weeks of follow-up. The incidence of adverse events and laboratory abnormalities during treatment were recorded. A t-test was used to compare the measurement data between two groups, and analysis of variance was used to compare the measurement data between multiple groups. Results: Sixteen patients (100%) achieved SVR12 after treatment, with 0% recurrence rate. Rapid virological response (RVR) of the four treatment regimens were 76.92%, 54.17%, 87.50%, and 83.33%, respectively, and 32 patients achieved 100% virological response after the completion of treatment. The incidence of adverse events of chronic hepatitis C with cirrhosis and decompensated cirrhosis was 62.5% and 64.29%, respectively. The most common adverse event was fatigue in CHC (25.00%), and elevated indirect bilirubin in decompensated cirrhosis (42.86%). No serious adverse drug events, deaths or adverse reactions occurred. Conclusion: DCV-based DAAs regimen is promising option for the treatment of HCV genotypes, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and HCV infection after liver/kidney transplantation in china. Above all, it has high SVR12 with good tolerability and safety profile.

[Improvement and effect analysis of a new neuroendoscopic trans-nasal-sphenoidal pituitary tumor resection approach]

Objective: To modify the individual neuroendoscopic surgical approach of pituitary tumors with specific imaging features, and to analyze the clinical outcomes. Methods: The clinical data of 116 patients with pituitary tumors who underwent surgical treatment at the pituitary tumor diagnosis and treatment center of Ruijin Hospital from April 2014 to December 2017 were collected, then the resection effects and complication rates of pituitary tumors from three different kinds of transsphenoidal approaches (e.g. classical single nostril approach, bilateral approach, "one-and-a-half" approach) were compared. Results: Pituitary tumor resection with "one-and-a-half" trans-nasal-sphenoidal approach achieved the same surgical effects with the bilateral approach, which was difficult to resect with the single-nostril classical approach. And it had significant advantages in the average length of postoperative hospitalization ( "one-and-a-half" : 6.9 days, bilateral: 12.5 days, P<0.01), the average postoperation VAS of olfactory retention ( "one-and-a-half" : 8.6, bilateral: 7.0, P<0.01) and preventing posterior nasal septum perforation (the occurrence rate of "one-and-a-half" : 0%, bilateral: 27%). Conclusion: The "one and a half" approach increases the ability to control and completely resect the lesion beyond the medial edge of the internal carotid artery on the same side of the nostril involving endoscope. It is a good supplement and improvement to the bilateral approach.

[Association between platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with disease activity in Takayasu arteritis patients]

Objective: To explore the relation between platelet-to-lymphocyte ratio (PLR) or neutrophil-to-lymphocyte ratio (NLR) with disease activity in Takayasu arteritis (TA) patients. Methods: Present retrospective study involved 289 patients with TA, who were hospitalized in our department between January 2010 and October 2017, and 280 age and gender matched healthy controls,who underwent thealth examination in our health examination center during the same period (control group). TA patients were further divided into active and inactive groups (180 and 109 cases respectively) according to Kerr scores. The clinical data were compared between groups. Pearson correlation analysis was used to evaluate the relationship between PLR or NLR and disease activity (Kerr score or C-reactive protein or erythrocyte sedimentation rate). Receiver operating characteristic (ROC) curve was employed to judge the cut-off value of disease activity for TA patients. Results: PLR and NLR were significantly higher in TA group than in control group(137.33 (97.38, 193.37) vs. 120.55 (96.86, 144.60) and 2.38 (1.76, 3.57) vs. 1.66 (1.35, 2.08) , respectively, all P<0.001). PLR and NLR were significantly higher in active TA group than in inactive TA group (163.43 (123.64, 224.15) vs. 110.53 (84.22, 147.24) and 2.59 (1.96, 3.94) vs. 1.95 (1.53, 2.86) respectively, all P<0.001). PLR and NLR of active group were significantly decreased after 6 months treatment (164.05 (123.29, 226.29) vs. 104.67 (77.22, 138.43) and 2.58 (1.96, 3.91) vs. 2.15 (1.67, 2.60) respectively, all P<0.001). PLR was positively correlated with Kerr score (r=0.439, P<0.001), C-reactive protein (r=0.328, P<0.001) and erythrocyte sedimentation rate (r=0.410, P<0.001). NLR also exhibited a positive relationship with Kerr score (r=0.235, P<0.001), C-reactive protein (r=0.169, P=0.005) and erythrocyte sedimentation rate (r=0.123, P=0.037). A PLR level of 176.709 was shown to be the best predictive cut-off value for TA disease activity (sensitivity 44.6%, specificity 93.0%, and area under the curve=0.766).A NLR level of 2.128 was shown to be the best predictive cut-off value for TA disease activity (sensitivity 70.9%, specificity 47.7%, and area under the curve=0.691). Conclusion: PLR and NLR are useful markers for predicting disease activity of TA patients.

[Laryngeal clefts: a review of current literature]

Laryngeal clefts as exceptionally rare congenital anomalies have been reported more and more recently. The clinical symptoms and presentations base on degree of clefts and variety of comorbidities. Mild types of clefts may have minimal clinical impact, whereas severe types may be life-threatening and even lead to death before diagnosis. With more attention of these anomalies and advances in endoscopy, the diagnosis, evaluation and surgery of laryngeal clefts have acquired great improvement, especially International Pediatric Otolaryngology Group(IPOG)have reported consensus guidelines on the diagnosis and management of type Ⅰ laryngeal clefts in 2017. This review of laryngeal clefts may be beneficial to decrease missed diagnosis or misdiagnosis and to achieve individual-based treatment.

[Pediatric laryngeal clefts: an experience in the diagnosis and management of 13 cases]

Objective: To investigate the diagnosis and management of laryngeal cleft. Method: The clinical data of 13 cases of laryngeal cleft treated between 2007 and 2015 was analyzed retrospectively. Results: The children with laryngeal cleft were classified according to the classification of Benjamin-Inglis, as type Ⅰ(11 cases), typeⅡ(1 case) and type Ⅲ(1 case). All patients were confirmed by microlaryngobronchoscopy under general anaesthetic. Eleven typeⅠ and 1 type Ⅱ clefts were managed conservatively, with which all type Ⅰ patients were successfully managed, while the type Ⅱ patient was resolved by surgical endoscopy. The type Ⅲ patient was treated by open repair but the results was poor. Conclusions: Patients who suffered with choking on feeding or recurrent aspiration pneumonia, especially coexisted with other congenital malformation, needed detailed evaluation for laryngeal cleft, although which was a rare congenital abnormality. Electronic laryngoscope could be the first step to screen the cleft, while microlaryngobronchoscopy is the gold standard for diagnosis of laryngeal cleft. The majority of children with lower type clefts can be managed conservatively. Surgical endoscopy has high success rate when strictly following the indication. Type Ⅲ and Ⅳ clefts have high mortality for usually combining with severe complications and abnormalities.

Enhanced toxicity to the cyanobacterium Microcystis aeruginosa by low-dosage repeated exposure to the allelochemical N-phenyl-1-naphthylamine

It has been puzzling whether and how a plant could exert a strong allelopathic inhibition to the target organisms by releasing low concentrations of allelochemicals. Plant allelochemicals have been proposed to be released continuously, however, direct evidence from specific allelochemicals is urgently required. In the present study, the toxicity of allelochemical N-phenyl-1-naphthylamine (NPN) towards the cyanobacterium Microcystis aeruginosa by two different exposure patterns was compared. One was low-dosage repeated exposure (LRE), in which 50  μg L^-1 NPN was repeatedly dosed to simulate the continual release of allelochemicals, and the other one was high-dosage single exposure (HSE) as per the routine toxicity assay. The results showed a significant growth inhibition to M. aeruginosa in the LRE group, where the inhibition rate reached above 90% from day 6 to day 9. The cell-membrane damage ratio increased from 64.05% on day 5 up to 96.60% on day 9. PSII photosynthesis activity expressed as Fv/Fm, Φ_PSII, NPQ and ETRmax was also thoroughly inhibited in this group. Whereas the growth and PSII photosynthesis activity of M. aeruginosa in the HSE group were inhibited initially, but recovered gradually from day 4 or 5, which was accompanied by a continuous reduction of NPN content in culture solutions. Although NPN content in the LRE group was relatively lower, it remained at a more stable level throughout the experiment. These results indicate that continual release of low-dosage allelochemicals by aquatic plants plays crucial roles in their potent inhibition against cyanobacteria. Low-dosage continual exposure pattern needs to be investigated further.

[Causes and management of pediatric spontaneous tonsillar haemorrhage]

Objective: To analyze the causes and management plan of pediatric spontaneous tonsillar haemorrhage(STH). Methods: According to the criteria of STH difined by Griffies, patients with STH from December 2013 to January 2016 were included in this retrospective study. Results: A total of 11 patients were reviewed. The etiological diagnosis included 3 pediatric Epstein-Barr virus associated infectious mononucleosis(EBV-IM), 3 suspected pediatric EBV-IM to 3 acute suppurative tonsillitis, 1 acute viral tonsillitis and 1 hemophilia A. The management strategies included antiviral, antibacteria, transfusion, surgical examination followed with bipolar coagulation hemostasis under general anesthesia. No patient treated with tosillectomy. Conclusions: STH is now a rare condition, the causes of which in child are more or less different from adult.This emergency can be treated in time if a detailed management plan for pediatric STH is formulated.

[Quality of life of patients with nonfunctioning pituitary adenoma: a meta-analysis]

OBJECTIVE

To evaluate the quality of life (QoL) of patients with nonfunctioning pituitary adenoma (NFPA) after systematic treatment.

METHODS

We searched all published articles involving in the QoL of patients with NFPA on line, and analyzed the results by the Revman5.3 software.

RESULTS

Five studies met the criteria of meta-analysis.The results of meta-analysis wereas follows: Physical function MD=0.76, 95%CI (-4.13, 5.64 ), P=0.76; Physical prole MD=-2.05, 95%CI (-7.41, 3.31), P=0.45; Body pain MD=3.50, 95%CI (1.11, 5.90), P=0.004; General health MD=-7.19, 95%CI (-12.77, -1.61), P=0.01; Vatility MD=-3.48, 95%CI (-7.39, 0.43), P=0.08; Social function MD=-4.64, 95%CI (-6.99, -2.38), P<0.000 1; Mental health MD=-0.05, 95%CI (-2.30, 2.20), P=0.96; Role emotion MD=-5.08, 95%CI (-8.20, -1.91), P=0.002.

CONCLUSIONS

This meta-analysisindicated thatthe QoL of patients with NFPA was damaged on the dimensions of general health, social function and role emotion.The dimension of physical painin patients with NFPA was better than that in general population, and there was no difference between other health dimensions.

Studies on the energy release of rice mitochondria under different conditions by means of microcalorimetry

The thermodynamic and kinetic behaviors of energy release of mitochondria isolated from rice (Oryza sative L.) were studied by using a LKB 2277 Bioactivity Monitor under different conditions. The thermogenesis curves of energy release of the rice mitochondria (which had been kept at 0-3 degrees C for 15 h and 40 day before the determination) were determined respectively at 25 and 30 degrees C, and the difference in shape of the thermogenesis curves and thermodynamic and kinetic characteristics were compared. The thermodynamic and kinetic parameters of energy release of the mitochondria in the thermogenesis increasing stage have been calculated, and the experimental thermokinetic equations of the thermogenesis have been established. The results indicated that the lower the temperature, the slower the energy release of the rice mitochondria. Both the thermogenesis and the energy release rate of the rice mitochondria increased after the mitochondria was kept at lower temperature for 40 days. One can use the methods to characterize the ability of the rice mitochondria to release energy under different conditions.

Metric representation of DNA sequences

A metric representation of DNA sequences is borrowed from symbolic dynamics. In view of this method, the pattern seen in the chaos game representation of DNA sequences is explained as the suppression of certain nucleotide strings in the DNA sequences. Frequencies of short nucleotide strings and suppression of the shortest ones in the DNA sequences can be determined by using the metric representation.

[Enzymehistochemical and immunohistological changes of skeletal muscle motor end-plates and muscle fibers and their relation to the time of death]

In order to investigate the relationship between the retrograde changes of the skeletal muscle and the time of death in various postmortem intervals (PMI), a systemic study of the enzymehistochemical activity of AChE, SDH, LDH, Ca(2+)-ATPase and the immunohistochemical reaction of SYN in motor end-plates and muscle fibers was conducted in rats under different temperatures and at various PMI. The results were analyzed and compared by an image processing system. It was found that these changes were related to the PMI, especially AChE changes. The AChE could be used as a sign-enzyme of skeletal muscle to date death.

Study on the role of mast cells in the development of liver fibrosis during diethylnitrosamine (DEN) -induced hepatocarcinogenesis in rats

The mast cells (MC) and their roles in the development of liver fibrosis during experimental hepatocarcinogenesis in rats have been studied immunohistochemically and electron microscopically. Pronounced MC hyperplasia occurred after beginning of the treatment of DEN. The vast majority of mast cells in fibrotic livers was present in thickened fibrous septa. Intracellular or pericytial collagen type IV and laminin staining were found in mast cells, collagen types I, III and fibronectin were negative. Mast cells mainly distributed in proximity to basement membrane and the electron microscopical observation revealed a close topographic relationship between mast cells and fibroblasts. The fibroblasts phagocytized the granules released by mast cells and thus were activated, showing enhanced formation of collagenous fibrils. The mast cells may be derived from blood circulation or replicated in situ. Those findings indicated that mast cells take part in the process of fibrosis at least by two ways: (1) It directly synthesizes the basement membrane components; (2) It stimulates the fibroblasts or other types of cells which have the potential functions in fibrogenesis by releasing granule mediators or cytokines acting upon the fibrosis process.

[The expression of PCNA and EGF gamma in tumor cells of experimental hepatocellular carcinoma of liver and squamous cell carcinoma of stomach in rats]

The expression of PCNA and EGF gamma in chemically induced hepatocellular carcinoma and squamous cell carcinoma cells from rats were observed with immunohistochemical techniques. The results showed that the carcinoma cells of both tumors revealed a positive immunoreaction to both factors. According to the amount of MC surrounding the tumor cell nests, the specimens could be divided into two groups: the group with abundant MC infiltration and the group with little or no MC infiltration. The PCNA positive cells in carcinoma cell nests of both groups were calculated respectively. It revealed that the amount of PCNA positive cells in the group with little or no MC was significantly more than that in the other group. The ratio between the 2 groups in liver carcinoma was approximately 3:1 and in stomach cancer it was 2:1. An overexpression of EGF gamma was observed in tumor tissues of both groups, but the amount of EGF gamma positive cells in the group with little or no MC was much higher than that of the group with abundant MC.

[Study on the relationship between most cells and tumor growth speed during hepatocarcinogenesis in the rats]

The nucleolar organizer regions (NORs) of normal rat hepatocytes and hepatocytes in the precancerous hyperplastic nodules as well as the cells of hepatocellular carcinoma induced by Nitrosomorpholine in rats were observed with aid of AgNOR-staining and electron microscopy. The observation revealed that the number of Ag-granules in the NORs of carcinoma cells was significantly more than that in the hyperplastic and normal hepatocytes. The ultrastructural observation of the nucleoli of interphase nuclei showed just the same result as the AgNOR-staining. The alcian blue-PAS-ABC combined staining revealed a very marked infiltration of mast cells (MC) within the carcinoma tissue and in its surroundings in 4 animals, while other 5 animals showed only a slight or no MC infiltration in the surroundings of carcinoma tissue. The observation of the phenotype of MC revealed that only one of the animals with carcinoma showed a relatively marked infiltration of both mucosa mast cells (MMC) and connective tissue mast cells (CTMC), while all other rats showed mainly an infiltration of CTMC. The Ag-granules in the NORs of carcinoma cells of the carcinomas with more MC infiltration were less than that of carcinomas with only slight or without MC infiltration. The difference was statistically significant. The significance of above mentioned results was discussed and a relationship between MC and prognosis of liver carcinoma was suggested.

[Role of mast cells in the development of liver fibrosis during experimental hepatocarcinogenesis in rats]

The role of mast cells (MC) in the development of liver fibrosis during experimental hepatocarcinogenesis in rats has been studied light microscopically, histochemically and electron microscopically. An increase in the number of MC in the proliferated connective tissue was found. The histochemical examination showed that the increased MC almost exclusively were connective tissue mast cells (CTMC), whilst mucosa mast cells (MMC) were only rarely seen. The electron microscopical observation revealed a close topographical relationship between MC and fibroblasts sending out pseudopodia, which encircled granula released from MC and phagocytized them. The fibroblasts with phagocytized MC granules were markedly activated showing enhanced formation of collagenous fibrils. Finally, the role of MC in the development of liver fibrosis is discussed.

A consecutive ultrastructural study of action of homoharringtonine on fibroblasts in vitro

The authors studied the effect of homoharringtonine (Hh), a semisynthetic Chinese herb, on the ultrastructure of in vitro cultured human conjunctival fibroblasts (HFb) and its mechanism of action. Preliminary results showed that the main characteristics of HFb damage caused by Hh were invagination of the nuclear membrane, aggregation and margination of chromatin, and massive vacuolization of the cytoplasm. In addition, Hh can inhibit the secretion of collagen fibers and the synthesis of microfilaments. Therefore, Hh might be an effective agent in the prevention and treatment of proliferative eye disorders.

[Morphometric studies on the growth of bile canaliculi during liver regeneration in rats]

Morphometric analysis of the liver during regeneration after partial hepatectomy showed that the mean area and number of bile canaliculi increased, while the volume density of microvilli related to the lumina of the canaliculi decreased. These changes were observed 12 hours after the operation, which gradually returned to normal on the third day after operation. It indicated that the decrease of volume density of microvilli was the result of enlargement of bile canaliculi, which was different from the decrease of microvilli due to passive widening of the canaliculi such as in cholestasis from loss of microvilli. All these phenomena suggest that enlargement of the area of bile canaliculi during liver regeneration may be due to the increase of membranous protein synthesis. Moreover, the increase of the number of bile canaliculi suggests that the proliferation of hepatocytes is associated with formation of new branches of bile canaliculi.

A highly efficient method for staining ultrathin sections

A simple and efficient staining method to handle simultaneously thirty (or even more) electron microscope grids with ultrathin sections is described. The device applied is easily constructed from inexpensive and readily available materials but can bring easily high quality staining results, and the amount of stain and washing water required is very small.

[The effect and mechanism of estrogen on hepatocyte regeneration in rats]

Liver regeneration model following partial hepatectomy was used to study the effect and mechanism of estrogen on hepatocyte regeneration of rats. Each animal in the experimental groups received a single injection of diethylstilbestrol (DES) subcutaneously. Results showed that estrogen had a remarkable promoting effect on hepatocyte regeneration. Both 3H-TdR labelling and mitosis indices of hepatocytes in the experimental groups increased markedly. In DES-treated rats, synthesis of estrogen receptor of hepatocyte increased gradually and the translocation of ER from cytoplasm to nucleus was also enhanced at the same time, indicating that the mechanism of DES on hepatocyte regeneration consisted promoting of the interaction of ER and nucleus. There was no statistically significant difference (P greater than 0.05) found in the number of Kupffer cells between all the experimental and their corresponding control groups. But in ultrastructure, Kupffer cells of animals in the experimental groups presented increase of cell size with abundant cytoplasm; longer and more pseudopodia as well as phagolysosomes, suggesting that DES could activate Kupffer cell and promote its function. The relationship between Kupffer cells and liver regeneration is discussed.

Immunohistochemical localization of vascular endothelial cell factor VIII/von Willebrand factor antigen in human normal and disordered gastric tissues

Vascular endothelial cell factor VIII/von Willebrand factor antigen (FVIII/vWF Ag) of normal and disordered gastric tissues was studied with staphylococcus protein A-gold (PAG) labelling followed by photochemical silver reaction. FVIII/vWF Ag was localized clearly in the tissue fixed with various common fixatives and embedded in paraffin without enzyme treatment. The most satisfactory staining and the least nonspecific background were observed in the tissues fixed with Zamboni's and Bouin's solutions. The staining reaction could be enhanced, if the sections were pretreated with trypsin and subtilisin. Under the electron microscope, the gold particles were found over the Weibel-Palade bodies of vascular endothelial cells in the tissues fixed either in Zamboni's solution or in Zamboni's solution-osmium tetroxide, and embedded either with Lowicryl K4M or with Epon 812. It has been proved to be a better technique in investigation of FVIII/vWF Ag in vascular endothelial cells.

Light and electron microscopic detection of lectin binding sites in normal and disordered human gastric tissues

Lectins are now widely used as histochemical markers and probes for carbohydrate structures in glycoproteins. In the present study, a method is described for the light and electron microscopic detection of Ulex europaeus agglutinin I binding sites in the normal and neoplastic tissues. The results showed that the gastric mucus-producing cells and some vascular endothelial cells could be strongly stained with labelled lectin in normal mucous membrane. The positive staining reactivity was reduced greatly in neoplastic tissue either in paraffin sections or in thin sections. This suggested that the secretions of gastric carcinoma are different from those of normal gastric mucosa and represent differentiation of neoplastic cells to some degree.