Technetium-99m-sestamibi SPECT for the diagnosis and follow-up of nasopharyngeal carcinoma

This study was to investigate a better way to detect and differentiate primary, residual, recurrent nasopharyngeal carcinoma (NPC) lesions post-radiotherapy in patients with NPC by means of routine computed tomography (CT) in combination with ⁹⁹Tc^m-sestamibi single photon emission computed tomography (⁹⁹Tc^m-MIBI SPECT). Forty-eight patients with histologically confirmed primary NPC underwent ⁹⁹Tc^m-MIBI SPECT at the 3rd month before and after radiotherapy, and at the 6th month after radiotherapy. All patients had contemporaneous CT examinations. Histopathologic results and/or clinical follow-up data (over 18 months) were used as the golden standard for evaluating residual/recurrent lesions. The radioactive count ratio of nasopharynx to scalp was obtained as the MIBI uptake index (MUI). Receiver operating characteristic analysis was employed to define the cut-off value of MUI for malignancy. With MUI 2.15 as the cut-off point, the accuracy for detecting primary NPC was 94.12%. The mean MUI in the local-regional of the nasopharynx in such negative cases was 1.21±€0.12 at the 3rd month, while the mean MUI was higher in the other 15 patients with histologically confirmed recurrent/residual lesions (MUI=1.40€±€0.16, t=4.71, P<0.001). The optimal cut-off point of 1.33 of MUI was defined with 89.58% accuracy for differentiating residual/recurrent lesions from the benign process post radiotherapy, while CT evaluations showed an accuracy of 81.25%. A combination of CT and ⁹⁹Tc^m-MIBI SPECT for 37 NPC patients with congruent results showed an accuracy of 97.30% for differentiating residual/recurrent NPC from benign lesions. ⁹⁹Tc^m-MIBI SPECT plays a role in evaluating residual/recurrent lesions post-radiotherapy. The combination of CT and ⁹⁹Tc^m-MIBI SPECT can give more accurate diagnosis in the follow-up of NPC.     

Comparative analysis of membranous and other nephropathy subtypes and establishment of a diagnostic model

This study aimed to compare clinical features between membranous nephropathy (MN) and nonmembranous nephropathy (non-MN), to explore the clinically differential diagnosis of these two types, and to establish a diagnostic model of MN. After renal biopsy was obtained, 798 patients were divided into two groups based on their examination results: primary MN group (n = 248) and non-MN group (n = 550). Their data were statistically analyzed. Logistic regression analysis indicated that anti-PLA2R antibodies, IgG, and Cr were independently correlated with MN, and these three parameters were then used to establish the MN diagnostic model. A receiver operating characteristic (ROC) curve confirmed that our diagnostic model could distinguish between patients with and without MN, and their corresponding sensitivity, specificity, and AUC were 79.9%, 89.4%, and 0.917, respectively. The cutoff value for this combination in MN diagnosis was 0.34. The established diagnostic model that combined multiple factors shows a potential for broad clinical applications in differentiating primary MN from other kidney diseases and provides reliable evidence supporting the feasibility of noninvasive diagnosis of kidney diseases.     

Diagnosis and treatment for advanced hilar cholangiocarcinoma: experience of 24 cases

The aim of this paper is to evaluate the efficacy of the surgical treatment for advanced hilar cholangiocarcinoma (CCA) in order to improve the resection rate and curative effect. A retrospective analysis was performed on the data of 24 patients who had undergone surgical treatment for advanced hilar CCA. According to the Bismuth classification, there were four cases of type IIIa, six cases of type IIIb, and 14 cases of type IV. Based on the treatment approaches, these patients were divided into three groups: $` Radical resection group: There were five cases (one type IIIa, three type IIIb, and one type IV). The tumor visible to the naked eyes was resected thoroughly and the cut margin was free of tumor by microscopic examination. Then, Roux-en-Y hepatico-jejunal anastomosis was performed to restore the bile flow. $a Palliative resection group: There were 11 cases. The bile flow was restored by Roux-en-Y hepatico-jejunal anastomosis directly in five cases (two type IIIa, three type IIIb) and by internal drainage through a hepatico-jejunal bridge in the other six cases (one type IIIa, five type IV). $b Simple internal biliary drainage group: There were eight cases of type IV, including three cases with the internal drainage through hepatico-jejunal bridge by laparotomy, three cases with endoscopic retrograde biliary drainage (ERBD), two cases with percutaneous transhepatic biliary drainage (PTBD). The rate of radical resection was 20.8% and the overall resection rate was 66.7%. All of the 24 patients were followed-up. The cumulative surviving rates were significantly different among these three groups (Log-rank ?² = 17.56, P = 0.0002). For advanced hilar CCA, the best choice of treatment is radical resection. If radical resection is impractical, palliative resection combined with partial hepatectomy can significantly prolong the survival time. Internal drainage through a hepatico-jejunal bridge can enhance the surgical resection rate and decrease the occurrence rate of postoperative biliary leakage.     

Detection of maternal serum thromboxane B2 in different durations of pregnancy and prediction of preeclampsia

This study was aimed to detect maternal serum levels of thromboxane B2 (TXB2) in different durations of pregnancy and explore the predictive value of TXB2 for preeclampsia. By employing a prospective and double-blind study method, 180 pregnant women with previously normal blood pressures during their progestation were included in the study. Peripheral venous blood samples were obtained during 10⁺⁰–14⁺⁶ (period I), 20⁺⁰–24⁺⁶ (period II) and 30⁺⁰–34⁺⁶ (period III) weeks of gestation. Maternal serum levels of TXB2 were measured by enzyme-linked immunoassay. The pathogenetic condition and pregnancy outcomes of these cases were observed. (1) Among the 180 previously normotensive women, ten developed preeclampsia (case group; four severe and six mild preeclampsia). One hundred and seventy remained normal till the end of pregnancy (control group). (2) With development of pregnancy, the levels of maternal serum TXB2 in the 180 cases gradually ascended as seen through the Wilcoxon Signed Ranks Test. There was a statistical significance in maternal TXB2 levels between two different gestational stages (P<0.01). (3) The levels of maternal serum TXB2 were slightly higher in the case group than in the control group during period I of gestation, but the difference was not statistically significant (P>0.05); the levels of TXB2 were significantly higher in the case group than in the control group during periods II and III of gestation (both P<0.05). (3) The best cutoff points of maternal TXB2 were 3750 and 4400ng/mL during periods II and III of gestation by receiver operator characteristic (ROC) curve; and the sensitivity, specificity, positive predictive value, negative predictive value and odds radio of TXB2 in predicting preeclampsia were 80%, 69.5%, 13.3%, 98.33%, 9.11 and 90%, 68.82%, 13.84%, 99.13, 19.86, respectively. Higher levels of maternal serum TXB2 were detected a long time before clinical symptoms appeared. The maternal serum TXB2 after 20 weeks of gestation had predictive value, and the index after 30 weeks was superior to that prior to 30 weeks .     

A rare case of B-lymphoproliferative disorder with villous lymphocytes harboring t(8;14)(q24;q32) translocation

Splenic lymphoma with villous lymphocytes (SLVL) or splenic marginal zone lymphoma with circulating villous lymphocytes is rare, and prolymphocytic transformation of SLVL is rarer. At present, only one case of SLVL with t(8;14)(q24;q32) translocation has been reported. In this study, we report a case of B-lymphoproliferative disorder with villous lymphocytes harboring t(8;14)(q24;q32) chromosome translocation that we inclined to SLVL with a prolymphocytic transformation. A 73-year-old female showed marked hepatosplenomegaly and high lymphocytosis (lymphocytes>200×10⁹/L). The abnormal lymphocytes had short coarse villi and round nuclei with prominent nucleoli. The immunophenotypes showed CD19⁺, CD20⁺, HLA-DR⁺, CD22⁺, CD5⁺, Kappa⁺, CD25^dim, CD71^dim, Lambda⁻, CD7⁻, CD10⁻, CD23⁻, CD34⁻, CD33⁻, CD13⁻, CD14⁻, CD117⁻, CD64⁻, CD103⁻, and CD11c⁻. The karyotype showed complex abnormality: 46XX,+3,−10, t(8;14)(q24;q32)[11]/46XX[⁹]. The cytoplasmic projection, immunological characteristics, and trisomy 3 chromosome abnormality supported the diagnosis of SLVL. However, the presence of prominent nucleoli and high lymphocytosis suggested prolymphocytic transformation, probably as a result of t(8,14) chromosome translocation. In this report, we described an unusual case of B-lymphoproliferative disorder with villous lymphocytes harboring t(8;14)(q24;q32) translocation, which could provide help in the diagnosis and differential diagnosis of B-lymphocytic proliferative diseases.     

Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia

Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%–60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1–7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of<150 × 10⁹/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32–38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.     

Emergency adult living donor right lobe liver transplantation for fulminant hepatic failure

Fulminant hepatitis is fatal in most cases and timely liver transplantation is the only effective treatment. This study evaluates the survival outcomes of patients who underwent living-donor liver transplantation (LDLT) using right lobe liver grafts for fulminant liver failure due to hepatitis B infection. Nine cases of adult right lobe LDLT were performed in our department from September 2002 to August 2005 and the clinical and following-up data were reviewed. According to the pre-transplant Child-Pugh-Turcotte classification, the nine patients were classified as grade C. The model for end-stage liver disease (MELD) score of these patients ranged from 16 to 42. The principal complications before transplantation included abnormal renal function, hepatic coma of different degrees and alimentary tract hemorrhage. The main complications after transplantation included pulmonary infection in two cases, acute renal failure in three cases and transplantation-related encephalopathy in one case. No primary failure of vascular or biliary complications occurred. The one-year survival rate was 55.6%. There were no serious complications or deaths in donors. In general, it is extremely difficult to treat fulminant hepatitis by conservative regimen, particularly, in cases with rapid progression. Emergency adult living-donor liver transplantation is an effective treatment for fulminant hepatitis patients and is relatively safe for donors.     

Preparation,identification, and clinical application of anti-HBs monoclonal antibody that binds both wild-type and immune escape mutant HBsAgs

Using a standard cellular fusion technique and indirect enzyme-linked immunosorbent assay (ELISA), a hybridoma cell line strain secreting anti-HBs monoclonal antibody (mAb) (defined G6 mAb) was obtained. The cells grew and secreted mAb stably. Antibody titers in the culture supernatant and ascites were 2.048×10⁶ and 4.096×10⁶, respectively. By applying the anti-HBs G6 mAb and horseradish peroxidase (HRP)-labeled goat anti-HBs antibody, we developed a sandwich ELISA (defined G6m ELISA) for detecting both wild-type and immune escape mutant HBsAgs (IEM HBsAg). The assay was performed to detect 17 species of genome recombinant expression HBsAg, including two wild-type species and 15 IEM HBsAg species, which varied in the “a” determinant, in a group of patients infected with hepatitis B virus (HBV). The patients previously had a lower ELISA detection signal [(absorbance of patients/absorbance of normal people (P/N): 1.0―4.5)]. The results demonstrated that the sensitivity of this assay to wild-type HBsAg was no less than 0.125g/L; 12 of 15 IEM HBsAg species (P/N≥2.5) were positive for G6 mAb. Of the positive IEM HBsAg species, two had a low absorbance value at 450nm (A₄₅₀), one had an intermediate A₄₅₀ value and nine had a high A₄₅₀ value, which was 7.55%(mean), 59.4% and 92.1%―109.4% of the wild-type A₄₅₀ value, respectively. The two species with low A₄₅₀ value and the three negative species mutated at the bases 120―124 in the first loop of the HBV “a” determinant. Using the G6 ELISA and two commercial ELISA kits (A and B), 177 patients were tested. The G6 ELISA had a significantly higher detection rate than either commercial ELISAs (19.21% vs 14.89% and 6.21%, respectively; P<0.01, P<0.05, respectively).     

Characterization of Bacillus amyloliquefacien contaminating 75% alcohol disinfectant

The clinical characterization of Bacillus amyloliquefacien contaminating 75% alcohol disinfectants were studied. The bacteria were cultured and observed by using bacterial examination under the hospital infection monitor. According to the regulations, the resistance of bacterial to physical and chemical factors was tested. Drug sensitivity tests for 20 commonly used medicines were carried out using a K-B method. The bacterial plasmids were analyzed using the Birnboim method. The bacteria were found after being cultured in the clinically-used 75% alcohol disinfectant fluid. Their total number was more than 800 cfu/mL and they were identified as Bacillus amyloliquefacien. The bacteria were also found to be resistant to boiling for 5 min. It grew well in 95% alcohol disinfectant and was insensitive to 84 disinfectant fluids containing chlorine (1000 mg/L) and such disinfectants as ozone. They were able to be sterilized better through routine ultraviolet exposure for 30 min or gas pressure. The bacteria contained a 2.5 kb plasmid and were sensitive to 13 drugs and insensitive to 7 drugs of the 20 drugs tested. It was suggested that alcohol disinfectant fluid was easily contaminated by Bacillus amyloliquefacien, and the bacteria was resistant to disinfectant fluids such as alcohol and 84 disinfectants     

The value of ultrasound elastography in differential diagnosis of superficial lymph nodes

The study evaluated the value of ultrasound elastography in differentiating the benign and malignant superficial lymph nodes. A total of 112 subjects, including 82 patients with enlarged lymph nodes and 30 healthy volunteers, were recruited. All the subjects were examined by B-mode ultrasonography, power Doppler ultrasonography and elastography. Most of the patients were histopathologically confirmed by needle aspiration cytology and some patients were diagnosed by clinical data combined with follow-up findings. The sensitivity, specificity and accuracy of B-mode ultrasonography were 59.8%, 76.5% and 67.1%, those of the blood flow classification by power Doppler ultrasonography 77.0%, 82.3% and 79.4% and those of elastographic classification 74.7%, 97.1% and 84.5%, respectively. The elasticity of the lymph nodes was quantitatively measured and defined as stiffness value. When the stiffness value of 2.395 was taken as the cutoff point, the sensitivity and specificity of elastography were 78.41% and 98.51%, and the Youden index reached the highest, with the value being 0.7692. The stiffness values of two indeterminate benign lymph nodes, the elastrographic findings of which were rated as patterns 2 and 3, were below the cutoff point. The elastographic findings of 10 malignant lymph nodes were also classified as pattern 2 or 3. Only one of them had the stiffness values below the cutoff point. It was concluded that ultrasound elastography is a novel, noninvasive and convenient tool for the differentiation of the nature of the superficial lymph nodes in clinical practice.     

Prokaryotic expression and purification of fusion protein HSP70-EGFP and its application in the study of dendritic cells internalization antigen

To study the endocytic activity of dendritic cells (DCs) by obtaining fusion protein HSP70-EGFP as exogenous antigen and loading it with DCs derived from human peripheral blood. Fusion protein HSP70-EGFP was prokaryotically expressed, isolated and purified. DCs were isolated and cultured from human peripheral blood. The DCs were divided into 3 groups in the endocytic experiment. There were 10⁶ DCs in each group. Group 1 and 2 were respectively incubated for 30 min. with HSP70-EGFP and EGFP. Group 3 was incubated with HSP70 for 30 min, and then incubated for 30 min. with HSP70-EGFP. Subsequently, 3 groups were placed in an incubator at 37°C for 0.5, 1, 2 and 24 h. Flow cytometry (FCM) was adopted to detect the amount of DCs with EGFP inside. IL-12 Eli-spot was adopted to detect the amount of DCs which secreted IL-12. There were 5 types in the experiment: LPS, inactive LPS, HSP70-EGFP, EGFP and no antigen. Fusion protein HSP70-EGFP was successfully obtained and its molecular weight was 97 000. It accounted for 35.32% of the total protein. Under irradiation of an ultraviolet lamp, the protein solution sent out viridescent fluorescence. The result detected by FCM indicated that after incubation for 0.5 h at 37°C, the positive rate in group 1 was 63%, while the other 2 groups were negative. After incubation for 1, 2 and 24 h at 37°C, the positive rates in the 3 groups were above 80%. The IL-12 Eli-spot examination shows that with HSP70-EGFP being loaded, the amount of DCs secreting IL-12 was 134.09 ± 31.78/10⁵ cells, a little lower than that of DCs with LPS loaded (with the average point of 156.36 ± 15.73). There was no significant difference between the 2 groups (P < 0.01). By contrast, both of them were significantly higher than inactive LPS-(33.78 ± 1.40)/10⁵ cells and EGFP-loaded (23.13 ± 4.57)/10⁵ cells DC groups in the amount of DCs secreting IL-12 (P < 0.01). The results suggest that receptor-mediated phagocytosis plays a main role in the preliminary stage of DCs internalizing HSP70-EGFP. With increasing incubation time, pinocytosis begins to dominate. HSP70-EGFP may promote DCs to secret cell factor IL-12.     

Meta-analysis of the diagnostic efficiency of frequency-doubling technology for primary glaucoma

The overall diagnostic capabilities and utility of frequency-doubling technology (FDT) in patients with primary glaucoma, which was diagnosed by standard automated perimetry (SAP) and/or optic disc appearance as the gold standard, were assessed. A comprehensive electric retrieval in MEDLINE, EMBASE, Cochrane Library, BIOSIS, Previews, HMIC, IPA, OVID, CNKI, CBMdisc, VIP information, CMCC, CCPD, SSreader, 21dmedia and manual retrieval in related textbooks, journals, congress articles and their references at home and abroad were performed to identify relevant articles in English or Chinese. The corresponding references were retrieved by means of electric retrieval and manual retrieval from different databases or materials. Criteria for inclusion or exclusion were established according to validity criteria for diagnostic studies published by the Cochrane Methods Group on Screening and Diagnostic Tests. The quality of the included articles was then assessed and characteristics were extracted. Statistical analysis was performed with Meta Test version 0.6 software to test the heterogeneity of the included articles. The appropriate effects model was selected to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed. Twenty-one studies out of 206 retrieved articles were included, with a total of 3172 patients. The reported sensitivity of FDT ranged from 0.51 to 1.00, and specificity from 0.58 to 1.00. The pooled weighted sensitivity and specificity of FDT with 95% confidence intervals (95% CI) after correction for standard error were 0.86 (0.80 0.90) and 0.87 (0.81 0.91), respectively. The AUC of SROC was 93.01%. Sensitivity analysis demonstrated no disproportionate influences of individual studies. The included articles are of good quality and FDT can be a highly efficient diagnostic test for primary glaucoma based on Meta-analysis.     

Differential diagnosis of cervical nerve compression syndrome of the external intervertebral foramen

The aim of the present research is to study the mechanism of cervical nerve compression syndrome of the external intervertebral foramen and its differential diagnosis with cervical spondylosis. Diagnostic treatment with muscle relaxant, vasodilator, neurotrophic medicine and celecoxib (COX)-2 inhibitor were performed in 20 patients with cervical nerve compression syndrome of the external intervertebral foramen and 20 patients with cervical spondylosis confirmed by operation. Diagnostic local block therapy was performed additionally in cases showing little effect after diagnostic treatment. All the patients were followed up postoperatively for more than one year. Fifteen cases with cervical nerve compression syndrome of the external intervertebral foramen were healed by the diagnostic treatment. The other five cases had a short-term remission and there was no recurrence after diagnostic local block therapy. Diagnostic treatment led to short-term alleviation of the symptom in 20 cases with cervical spondylosis confirmed by operation, the results of which was far from satisfactory and operation was undertaken finally in all the 20 cases. The etiology of cervical nerve compression syndrome of the external intervertebral foramen lies in the compression of the cervical plexus, brachial plexus and cervical dorsal rami by the tendinous decussating fibers of the scalenus anticus, medius, minimus and the posterior muscles of the neck. Diagnostic treatment was propitious to differentiate cervical nerve compression syndrome of the external intervertebral foramen from cervical spondylosis.     

NES1/KLK10 and hNIS gene therapy enhanced iodine-131 internal radiation in PC3 proliferation inhibition

NES1 gene is thought to be a tumor-suppressor gene. Our previous study found that overexpression of NES1 gene in PC3 cell line could slow down the tumor proliferation rate, associated with a mild decrease in BCL-2 expression. The BCL-2 decrease could increase the sensitivity of radiotherapy to tumors. Thus, we supposed to have an “enhanced firepower” effect by combining overexpressed NES1 gene therapy and ¹³¹I radiation therapy uptake by overexpressed hNIS protein. We found a weak endogenous expression of hNIS protein in PC3 cells and demonstrated that the low expression of hNIS protein in PC3 cells might be the reason for the low iodine uptake. By overexpressing hNIS in PC3, the radioactive iodine uptake ability was significantly increased. Results of in vitro and in vivo tumor proliferation experiments and ¹⁸F-fluorothymidine (¹⁸F-FLT) micro-positron emission tomography/computed tomography (micro-PET/CT) imaging showed that the combined NES1 gene therapy and ¹³¹I radiation therapy mediated by overexpressed hNIS protein had the best tumor proliferative inhibition effect. Immunohistochemistry showed an obvious decrease of Ki-67 expression and the lowest BCL-2 expression. These data suggest that via inhibition of BCL-2 expression, overexpressed NES1 might enhance the effect of radiation therapy of ¹³¹I uptake in hNIS overexpressed PC3 cells.     

Endoscopic resection of a huge Brunner's gland adenoma

Brunner’s gland adenoma is a rare tumour of the duodenum, which is usually benign. A 71-year-old woman presenting with epigastric pain, upper gastrointestinal haemorrhage and melaena was reported in this paper. Upper gastro-intestinal (GI) endoscopy revealed a large pedunculated tumour on the superior part of the duodenal bulb. Endoscopic polypectomy was successfully performed by clipping and nylon thread without any complications. Histological examination revealed a Brunner’s gland adenoma.     

Spontaneous firing properties of rat medial vestibular nucleus neurons in brain slices by infrared visual patch clamp technique

Domestic application of infrared patch clamp techniques on brain slices is limited. The key of the technique is to prepare high-quality brain slices. The present paper describes the preparation procedure of brainstem slices and the spontaneous firing properties of rat medial vestibular nucleus (MVN) neurons. By infrared differential interference contrast technique, neurons of rat MVN were visualized directly at the depth of 50–100 ?m underneath the surface of slices. Firing activities of MVN neurons were recorded by the whole-cell patch clamp technique in artificial cerebrospinal fluid (ACSF) and low Ca²⁺ - high Mg²⁺ fluid. The firing mode was more irregular and depressive in low Ca²⁺ - high Mg²⁺ fluid than in ACSF. According to the averaged waveform of action potentials, cells were classified as the neurons with monophasic after-hyperpolarization potential (AHP), and the neurons with biphasic AHP. The resting membrane potential (RMP), input resistance (Rin) and membrane capacitance (Cm) of neurons were recorded and compared between groups. With infrared videomicroscopy, patch clamp recordings could be made under direct observation in freshly prepared brainstem slices. The discharge activities of MVN neurons were spontaneous and the firing mode was modulated by extracellular calcium concentration. The basic membrane properties of two types of neurons were not significantly different, while the differences in waveform might play a role in the segregation between tonic and kinetic cells.     

Diagnosis and therapy of lacrimal system diseases by micro lacrimal endoscope

The lacrimal endoscope is applied to the diagnosis and therapy of the disorders of the lacrimal system in combination with laser or micro drills under orthophoria. The changes of mucous membranes, the characteristics of pathological changes and the predilection sites of lacrimal system diseases were initially approached. One hundred and forty six pairs of eyes of 128 patients with lacrimal system disease were observed by the lacrimal endoscope in the Ophthalmology Department of Tongji Hospital from June 2006 to March 2007. The dynamic changes in mucous membranes, lesion sites, secreted substances and formation of membrane could be observed under orthophoria. Combined with laser or micro drill, the endoscope was applied to the therapy of lacrimal system disorders and the difference before and after the treatment was observed. Results are as follows: (1) The examination and therapy using the lacrimal endoscope were completed under topical anesthesia in 122 patients, and 6 patients of neonatorum dacryocystitis were examined and treated under general anaesthesia. All patients reported painless. (2) Sharp images of the lacrimal system were obtained by the endoscope. Normal lacrimal mucosal membrane was smooth and light pink, expanded and unobstructed during irrigation. In chronic dacryocystitis patients, the inhomogeneous colour of mucosal membranes was red and white, with different degrees of fibrotic membranes at the superior, middle and inferior parts of the nasolacrimal canals and secreted substances at sac could be observed. The lacrimal ducts could not be expanded and obstructed during irrigation. The patients with lacrimal system obstruction had different extents of membrane formation, and stenosis or complete obstruction of the lacrimal duct could be observed, and the corresponding mucosal membrane was not smooth which could not be expanded and obstructed during irrigation. (3) After the treatment by the endoscope combined with laser or micro drill, the major proliferation of the membrane disappeared and the lacrimal duct was unobstructed during irrigation. The cure rate and effective rate were 80.1% and 93.1%, respectively. The lacrimal endoscope is a new method in the diagnosis of lacrimal system diseases. Through a combination with laser or micro drill to carry out the therapy under orthophoria, it will bring a great change to the diagnosis and therapy of lacrimal system diseases.     

Simultaneous detection and characterization of toxigenic Clostridium difficile directly from clinical stool specimens

We employed a multiplex polymerase chain reaction (PCR) coupled with capillary electrophoresis (mPCR-CE) targeting six Clostridium difficile genes, including tpi, tcdA, tcdB, cdtA, cdtB, and a deletion in tcdC for simultaneous detection and characterization of toxigenic C. difficile directly from fecal specimens. The mPCR-CE had a limit of detection of 10 colony-forming units per reaction with no cross-reactions with other related bacterial genes. Clinical validation was performed on 354 consecutively collected stool specimens from patients with suspected C. difficile infection and 45 isolates. The results were compared with a reference standard combined with BD MAX Cdiff, real-time cell analysis assay (RTCA), and mPCR-CE. The toxigenic C. difficile species were detected in 36 isolates and 45 stool specimens by the mPCR-CE, which provided a positive rate of 20.3% (81/399). The mPCR-CE had a specificity of 97.2% and a sensitivity of 96.0%, which was higher than RTCA (x² = 5.67, P = 0.017) but lower than BD MAX Cdiff (P = 0.245). Among the 45 strains, 44 (97.8%) were determined as non-ribotype 027 by the mPCR-CE, which was fully agreed with PCR ribotyping. Even though ribotypes 017 (n = 8, 17.8%), 001 (n = 6, 13.3%), and 012 (n = 7, 15.6%) were predominant in this region, ribotype 027 was an important genotype monitored routinely. The mPCR-CE provided an alternative diagnosis tool for the simultaneous detection of toxigenic C. difficile in stool and potentially differentiated between RT027 and non-RT027.     

Direct acting antiviral-induced dynamic reduction of serum α fetoprotein in hepatitis C patients without hepatocellular carcinoma

Direct acting antiviral (DAA) treatments may reduce the elevated α fetoprotein (AFP), but data on how these treatments affect elevated AFP in patients with chronic hepatitis C (CHC) remain insufficient. In the present study, the frequency of baseline AFP elevations and their related factors, AFP dynamics during and after DAA treatment, and factors associated with AFP reduction was assessed. This retrospective study included 141 patients with CHC without hepatocellular carcinoma who received DAA and achieved sustained virological response. The details are as follows: mean post-treatment follow-up was 99 weeks (12–213); mean age, 57.8 years old; 52%, males; 79%, genotype (GT) 1; and 47%, cirrhosis. Pre-treatment AFP elevation (>5.5 ng/mL) was seen in 48.2% patients. On multivariate analysis, baseline AFP>5.5 was associated with the presence of cirrhosis (P=0.001), co-existing non-alcoholic steatohepatitis (NASH) (P = 0.035), and GT 1 (P = 0.029). AFP normalization was seen in 28.2% patients at treatment week 2, in 52% at the end of treatment, and in 73.4% at the end of follow-up. Post-treatment week 24 AFP normalization was associated with the absence of cirrhosis (P = 0.003), Child--Pugh score<6 (P = 0.015), and baseline AFP<10 (P = 0.015). AFP elevation is common in patients with CHC and independently associated with NASH, cirrhosis, and GT 1. DAA treatment resulted in AFP normalization as early as treatment week 2. Post-treatment week 24 AFP normalization is independently associated with the absence of cirrhosis, Child--Pugh score<6, and baseline AFP<10.