Brucella meningoencephalitis in children with status epilepticus A case report and literature review / 中国热带医学

@#Abstract: Objective　To investigate the clinical characteristics and incidence of Brucella encephalitis and meningitis in children. Methods We report the clinical data of a child with Brucella melitensis meningitis in children, and summarize the incidence, diagnosis methods and treatment of Brucella encephalitis or meningitis in children, taking into account the relevant domestic and foreign literature from January 2014 to December 2020. Results　A 4-year-old girl was admitted to the hospital with status epilepticus on March 15, 2021 because of interrupted right limb numbness for 16 hours and convulsions for 2 hours. She had 2 non-febrile convulsions three months before admission and was diagnosed with epilepsy. This incident was acute, accompanied by low fever, with epilepsy as the main manifestation. Cerebrospinal fluid test suggested central nervous system infection, but the nature of infection could not be determined by routine and biochemistry of cerebrospinal fluid.The cerebrospinal fluid next generation sequencing confirmed that the pathogen of the infection was B. melitensis, which was further verified by the peripheral blood antibody test. After effective antibiotics combined with a full course of treatment, the patient recovered after six months of treatment. A total of 60 articles were retrieved in the database, including 29 in Chinese. During this period, a total of 7 cases of brucellosis in children with nervous system involvement were reported, one of which was a case report, and the other 6 cases were mentioned in the comprehensive analysis of children with brucellosis. Conclusions　Brucella encephalitis or meningitis in children has a low incidence and various clinical features, which are easy to be misdiagnosed or missed.

Establishment of a culture system for human nasal mucosa organoids with controllable differentiation / 南方医科大学学报

OBJECTIVE@#To establish a culture system for human nasal mucosal organoids with controllable differentiation to reproduce the structure and function of the source tissue through staged expansion-differentiation culture.@*METHODS@#Fresh samples of surgically resected middle turbinate and nasal polyp tissues were collected, from which the nasal mucosa epithelial cells were isolated by enzymatic digestion and filtration for continuous culture at the air-liquid interface for expansion (EO group) or staged culture for expansion and differentiation (DO group). Immunohistochemical staining was used to characterize the structure, cellular composition and ciliary function of nasal mucosal organoids in the two groups. The secretion function of the differentiated nasal mucosal organoids in DO group was evaluated using PAS staining.@*RESULTS@#Both of the two organoid culture systems yielded vacuolar or solid spherical 3D organoids, and their diameters increased progressively with time. On day 16 of culture, more vacuolar organoids occurred in DO group, while more solid spherical organoids were seen in EO group, and the proportion of vacuoles was significantly greater in DO group than in EO group [(54.67±13.26)% vs (21.67±8.57)%, P < 0.05]. Short tandem repeat (STR) test of the nasal mucosal organoids and the source tissue showed a 100% match between them. On day 21 of culture, scanning and transmission electron microscopy of the nasal mucosal organoids identified ultrastructure of cilia in DO group and short villi structure in most of the organoids in EO group. Immunohistochemical staining showed positivity for P63 (basal cells), β-tubulin (ciliated columnar cells), and MUC5AC (goblet cells) in the organoids. Compared with those in EO group, the organoids in DO group showed significantly greater percentages of ciliated cells [(7.95±1.81)% vs (27.04±5.91)%, P < 0.05] and goblet cells [(14.46±0.93)% vs (39.85±5.43)%, P < 0.05) with a similar percentage of basal cells [(56.91±14.12)% vs (53.42±15.77)%, P > 0.05]. The differentiated nasal mucosal organoids in DO group were positively stained for glycogen.@*CONCLUSION@#The staged expansion-differentiation culture method allows more stable and prolonged growth of the cultured cells in vitro to produce organoids with controllable differentiation closely resembling the morphological structure and functions (ciliary function and secretory function) of the source tissue.

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea

Objective@#Written exposure therapy (WET) is exposure therapy for post-traumatic stress disorder (PTSD). Compared to evidencebased treatments for PTSD, WET requires only five sessions, has a shorter session time, and no between-session assignments. The current study examined the efficacy of WET among Korean patients with PTSD due to various traumatic events on PTSD symptoms, depressive symptoms, and global functioning levels. @*Methods@#The study recruited 41 patients with a current primary diagnosis of PTSD in psychiatric outpatient clinics. Assessments were conducted at baseline, and at 6, 12, and 24 weeks following the first treatment session. @*Results@#In total, 25 patients started WET. Findings showed a significant reduction in the rate of PTSD diagnosis and symptom severity scores. Fourteen of 23 (60.9%) patients at 6 weeks, 15 of 22 (68.2%) patients at 12 weeks, and 14 of 18 (77.8%) patients at 24 weeks no longer met the diagnosis of PTSD. Depressive symptoms and global function scores also improved after WET. The dropout rate was 8% (n=2). @*Conclusion@#This study suggests the feasibility of implementing WET among various types of patients with PTSD in Korea and other Asian countries.

Phenolic glycosides from the stems of Homalium stenophyllum / 中国天然药物

The phytochemical investigation of the stems of Homalium stenophyllum afforded seven new phenolic glycosides (1-5 and 8-9) and two known compounds (6 and 7). Their structures were elucidated by comprehensive analyses of NMR spectroscopic, mass spectrometric data and chemical hydrolysis. Additionally, their anti-inflammatory activities against the NO production in LPS-induced macrophages were evaluated.

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea

Objective@#Written exposure therapy (WET) is exposure therapy for post-traumatic stress disorder (PTSD). Compared to evidencebased treatments for PTSD, WET requires only five sessions, has a shorter session time, and no between-session assignments. The current study examined the efficacy of WET among Korean patients with PTSD due to various traumatic events on PTSD symptoms, depressive symptoms, and global functioning levels. @*Methods@#The study recruited 41 patients with a current primary diagnosis of PTSD in psychiatric outpatient clinics. Assessments were conducted at baseline, and at 6, 12, and 24 weeks following the first treatment session. @*Results@#In total, 25 patients started WET. Findings showed a significant reduction in the rate of PTSD diagnosis and symptom severity scores. Fourteen of 23 (60.9%) patients at 6 weeks, 15 of 22 (68.2%) patients at 12 weeks, and 14 of 18 (77.8%) patients at 24 weeks no longer met the diagnosis of PTSD. Depressive symptoms and global function scores also improved after WET. The dropout rate was 8% (n=2). @*Conclusion@#This study suggests the feasibility of implementing WET among various types of patients with PTSD in Korea and other Asian countries.

Posttraumatic Stress Disorder and Cognitive Fucntioning:A Literature Review / 신경정신의학

Cognitive deficits due to posttraumatic stress disorder (PTSD) affect patients’ social and occupational functioning and lead to social costs. Thus, it is important to understand the nature and extent of PTSD-related neurocognitive deficits to clarify the mechanisms underlying cognitive changes, identify factors that interfere with treatment, and help interpret clinical profiles. This study reviewed recent studies on the relationships between PTSD and neurocognitive domains. The magnitude of the influence of PTSD differs across cognitive function domains. Also, the extent of the effect on any given domain may also differ according to the type of trauma experienced by the subject. In addition to its negative effects on cognitive functioning, PTSD was associated with increased response to threats or trauma-related stimuli, which compromised task performance. Although each PTSD symptom may have a different effect on each cognitive function, it was difficult to generalize the results. This study is significant in that our conclusions, which emerged through a review of studies regarding the relationship between PTSD and cognitive functioning, provide a theoretical basis for further research.

Posttraumatic Stress Disorder and Cognitive Fucntioning:A Literature Review / 신경정신의학

Cognitive deficits due to posttraumatic stress disorder (PTSD) affect patients’ social and occupational functioning and lead to social costs. Thus, it is important to understand the nature and extent of PTSD-related neurocognitive deficits to clarify the mechanisms underlying cognitive changes, identify factors that interfere with treatment, and help interpret clinical profiles. This study reviewed recent studies on the relationships between PTSD and neurocognitive domains. The magnitude of the influence of PTSD differs across cognitive function domains. Also, the extent of the effect on any given domain may also differ according to the type of trauma experienced by the subject. In addition to its negative effects on cognitive functioning, PTSD was associated with increased response to threats or trauma-related stimuli, which compromised task performance. Although each PTSD symptom may have a different effect on each cognitive function, it was difficult to generalize the results. This study is significant in that our conclusions, which emerged through a review of studies regarding the relationship between PTSD and cognitive functioning, provide a theoretical basis for further research.

The efficacy and safety of salvage surgery for local recurrent nasopharyngeal carcinoma: a systematic review and Meta-analysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To assess the current evidence regarding the efficacy, safety, and potential advantages of endoscopic compared with open salvage surgery for patients with local recurrent nasopharyngeal carcinoma.@*Methods@#A systematic search of Pubmed/Medline, Embase, and Cochrane databases ranged between 2000 and 2017 was conducted. Included studies reported specific residual or local recurrent nasopharyngeal cancer survival data. Proportional Meta-analysis was performed on both outcomes with a random-effects model and the 95% confidential intervals were calculated by Stata 12.0 software.@*Results@#A total of 24 case series studies were included in the Meta-analysis.The pooled 2-year overall survival rates of endoscopic and open group were 84% (95%CI:72%-93%), 68%(95%CI:59%-77%),respectively.The pooled 2-year disease-free survival rates of endoscopic and open group were 68%(95%CI:53%-81%), 65%(95%CI:54%-75%),respectively. The pooled 5-year overall survival rates of endoscopic and open group were 72%(95%CI:37%-97%), 48% (95%CI:40%-56%),respectively.The pooled 5-year disease-free survival rates of endoscopic and open group were 65%(95%CI:29%-93%), 50%(95%CI:43%-57%),respectively.The combined outcome of endoscopic was higher than open procedure. In addition, less severe complications, lower local recurrence rates(27%vs32%).The 2-year overall survival rates of endoscopic was higher than open procedure in the staging of rT1, rT2, and rT3 (93%vs87%; 77%vs63%; 67%vs53%) , but was equal to open in the staging for rT4 (35%vs35%) .Meta-regression showed that the heterogeneity was correlated with advanced tumor ratio.@*Conclusions@#The present Meta-analysis reveals that endoscopic approach offers a safe and efficient alternative to open approach with better short-term outcome and fewer postoperative complications in selecting patients strictly.

Sesquiterpenes from Artabotrys hongkongensis / 中国中药杂志

The chemical consituents from Artabotrys hongkongensis were separated and purified by column chromatographies with silica gel, Sephadex LH-20, ODS and RP-HPLC. The structures of the isolated compounds were identified on the basis of physicochemical properties and spectroscopic analysis, as well as comparisons with the data reported in the literature. As a result, 16 sesquiterpenes were isolated and elucidated as blumenol A (1), 4, 5-dihydroblumenol A (2), (6R, 9S)-3-oxo-a-ionol (3), 3-hydroxy-β-ionone (4), dehydrovomifoliol (5), (3R, 6R, 7E) -3-hydroxy-4, 7-megastigmadien-9-one (6), sarmentol F (7), 10-oxo-isodauc-3-en-15-oic acid (8), fukinone (9), petasitolone (10), β-eudesmol (11), trans-3β-(1-hydroxy-1-methylethyl)- 8aβ-methyl-5-methylenedecalin-2-one (12), 10-hydroxyaristolan-9-one (13), aristol-8-en-1-one (14), aristolan-9-en-1-one (15), and aristolan-1, 9-diene (16). This is the first study on the chemical consituents of A. hongkongensis, and all compounds were isolated from the genus Artabotrys for the first time.

Profiling of Proteins Regulated by Venlafaxine during Neural Differentiation of Human Cells

OBJECTIVE: Antidepressants are known to positively influence several factors in patients with depressive disorders, resulting in increased neurogenesis and subsequent relief of depressive disorders. To study the effects of venlafaxine during neural differentiation at the cellular level, we looked at its effect on protein expression and regulation mechanisms during neural differentiation. METHODS: After exposing NCCIT cell-derived EBs to venlafaxine during differentiation (1 day and 7 days), changes in protein expression were analyzed by 2-DE and MALDI-TOF MS analysis. Gene levels of proteins regulated by venlafaxine were analyzed by real-time RT-PCR. RESULTS: Treatment with venlafaxine decreased expression of prolyl 4-hydroxylase (P4HB), ubiquitin-conjugating enzyme E2K (HIP2) and plastin 3 (T-plastin), and up-regulated expression of growth factor beta-3 (TGF-beta3), dihydropyrimidinase-like 3 (DPYSL3), and pyruvate kinase (PKM) after differentiation for 1 and 7 days. In cells exposed to venlafaxine, the mRNA expression patterns of HIP2 and PKM, which function as negative and positive regulators of differentiation and neuronal survival, respectively, were consistent with the observed changes in protein expression. CONCLUSION: Our findings may contribute to improve understanding of molecular mechanism of venlafaxine.

F-01A, an antibiotic, inhibits lung cancer cells proliferation / 中国天然药物

AIM@#In an effort to identify novel, small molecules which can affect the proliferation of lung cancer cells, F-01A, a polyether antibiotic isolated from the fermentation broth of Streptomyces was tested.@*METHOD@#F-01A was tested for its antitumor properties on the lung cancer cell line SPC-A-1, at six doses (0.1, 0.5, 1, 2.5, and 5 μmol·L(-1)), using various cellular assays. Cell viability was measured by the MTT assay, Hochest 33258 was used to study nuclear morphology; DNA ladder and the loss of mitochondrial membrane potential were also evaluated.@*RESULTS@#F-01A induces apoptosis against SPC-A-1 cells in a dose-dependent manner. The IC50 is 0.65 μmol·L(-1), and the inhibition at 5 μmol·L(-1) is 87.89%. Further, JC-1 staining indicates F-01A could induce the loss of mitochondrial membrane potential, and the DNA fragment is evident.@*CONCLUSION@#Mechanistic analysis showed that F-01A induced apoptosis of cancer cells probably in the mitochondrial pathway. The antitumor actions of F-01A involve activation of the apoptotic pathway against SPC-A-1 cells, and it may be valuable for further drug development.

Efficacy observation on chronic tension-type headache treated with acupuncture at galea tendon-muscle node / 中国针灸

<p><b>OBJECTIVE</b>To explore the better therapy for chronic tension-type headache (CTTH).</p><p><b>METHODS</b>Two hundred and eighty-eight cases were randomized into a sticking needling group (150 cases) and an acupuncture group (138 cases). In the sticking needling group, the manual sticking needling technique was adopted to stimulate the galea tendon-muscle node. In the acupuncture group, the conventional acupuncture therapy was applied to Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Taiyang (EX-HN 5), Touwei (ST 18), Hegu (LI 4), etc. The treatment was given once a day, and 30 days made one session. After two sessions of treatment and after three months follow-up, CTTH score (including the score of headache attack frequency and the score of headache severity) was observed and compared before and after treatment separately. The efficacy was evaluated in two groups.</p><p><b>RESULTS</b>CTTH score was all reduced after treatment in the two groups (both P<0.01), the score in the sticking needling group was lower than that in the acupuncture group (2.38 +/- 1.22 vs 4.16 +/- 2.54, P < 0.01). The effective rate was 97.3% (146/150) in the sticking needling group, which was better than 88.4% (122/138) in the acupuncture group (P < 0.05).</p><p><b>CONCLUSION</b>The manual sticking needling technique at galea tendon-muscle node achieves the superior results of reducing the pain attack frequency and severity of CTTH as compared with the acupuncture therapy of the routine acupoint selection.</p>

Comparison for Risk Estimate of Aspiration between the Revised Dysphagia Assessment Tool and Videofluoroscopy in Post-Stroke Patients

PURPOSE: The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool. METHODS: A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis. RESULTS: In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy. CONCLUSION: The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.

Thyroid Carcinoma in Patients Less Than 20 Years of Age at Diagnosis: Clinicopathologic Characteristics / 대한내분비외과학회지

PURPOSE: This study determined the clinicopathologic characteristics in young patients with thyroid carcinoma. METHODS: We retrospectively reviewed the records of 39 patients who were <20 years of age when diagnosed between January 1985 and December 2008. RESULTS: The mean age was 17.28 years (range, 4~20 years). There were 33 females and 6 males, with a mean follow-up period of 110 months (range, 1~263 months). The initial surgery consisted of total thyroidectomy in 29 patients (74%), and lobectomy and isthmectomy in 10 patients (25%). The mean size of the tumors was 2.56 cm (range 0.4~7 cm), and 31 (79%) of 39 patients had perithyroidal tissue invasion. Papillary and follicular carcinoma was reported in 31 (79%) and 6 patients (15%), respectively. Three patients had a recurrence and no patients had progression of metastasis at the time of diagnosis. CONCLUSION: Further collaborative studies are needed to refine the surgical approach, particularly the extent of lymph-node dissection, radioactive iodine dosing, and clinical approach.

Effect of needling the mimetic muscle on recovery of mimetic function in the patient of spontaneous facial paralysis / 中国针灸

<p><b>OBJECTIVE</b>To observe therapeutic effects of different acupuncture methods for recovery of mimetic function in the patient of spontaneous facial paralysis.</p><p><b>METHODS</b>One hundred and thirty-four cases of facial paralysis were randomly divided into a mimetic muscle acupuncture group (mimetic muscle group, n = 79) and a routine acupoint group (n = 55). The mimetic muscle group were treated by encircling needling frontal belly of epicranial muscle, orbicular muscle of eye, orbicular muscle of mouth and buccinator muscle, and the routine acupoint group with acupuncture at Dicang (ST 4), Jiache (ST 6), Yangbai (GB 14), Sibai (ST 2), Cuanzhu (BL 2), etc. on the affected side. Their therapeutic effects were compared after they were treated for 2 courses.</p><p><b>RESULTS</b>The effective rate and the good rate were 94.9% and 92.4% in the mimetic muscle group and 70.9% and 52.7% in the routine acupoint group, respectively, with a significant difference between the two groups (P < 0.05).</p><p><b>CONCLUSION</b>The therapeutic effect of needling the mimetic muscle on spontaneous facial paralysis is superior to that of the routine acupuncture therapy.</p>

Studies on the alkaloids from stem of Artabotrys hainanensis / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the alkaloids from the stem of Artabotrys hainanensis.</p><p><b>METHOD</b>Compounds in plant extracts were separated by silica gel and sephadex LH-20 column chromatography. Chemical structures were elucidated by chemical and spectral analyses including UV, 1H-NMR, 13C-NMR, ESIMS and ESI-MS-MS.</p><p><b>RESULT</b>Eight alkaloids were isolated and identified as spinosine (1), 3-hydroxynornuciferine (2), juzirine (3), artabotrine (4), liridine (5), assimilobine (6), isococlaurine (7), N-demethylarmepavine (8).</p><p><b>CONCLUSION</b>All alkaloids were isolated from this plant for the first time and compounds 1, 3, 7 and 8 were isolated from genus Artabotrys for the first time.</p>

Effect after Change of Evaluation Method in Surgical Clerkship Program / 한국의학교육

PURPOSE: Since 2002, Department of Surgery, Yonsei University Wonju College of Medicine attempted to revise the evaluation method of surgical clerkship program. The purpose of this study was to analyze the effect after change of evaluation method. METHODS: Major changes in current revisions were summarized as follows; (1) multiple evaluator, (2) student's attitude evaluated by rating scale method, (3) attendance and procedure evaluation were measured in numbers according to the fixed criteria, (4) addition of clinic-based items such as problem-solving items in the final written examination. We compared the measurement of revised evaluation at 2002 with those at 1999. And the correlation or simple linear regression analysis between score of clerkship and student academic grade score were taken. RESULTS: The clerkship score of students at 2002 showed more powerful discrimination between high performance group and poor group than that of 1999's. Even though the subject score of clerkship was significantly correlated with grade score regardless of evaluation method of clerkship, the subject score of clerkship at 2002 was more closely correlated with a grade score than 1999's. The score of knowledge-based items from final written examination is not correlated with clerkship score, but on the other hands, there was significant correlation between score of clinic-based items and clerkship score. CONCLUSION: In conclusion, variable measurements under the exact guideline and principle are more reliable method in evaluation of surgical clerkship.

Proper Treatment for Megacolon after Various Anoplasties for Anorectal Malformation

PURPOSE: The megacolon after repairing an anorectal malformation is not a rare complication, and there is much controversiy on the causes, the treatment of choice and the results after a longterm follow-up. We present 5 cases of a megacolon after the repair of an anorectal malformation, which were controlled with either a surgical resection or conservative treatment. METHODS: Five patients with a megacolon after the repair of an anorectal malformation were studied. A retrospective chart review was done and fecal continence was evaluated with an individual interview. RESULTS: All five patients initially underwent conservative treatment with laxatives and/or enemas. One Patient responded well to conservative treatment and the diameter of the bowel reduced to normal size. Another patient responded to conservative treatment after correcting the location of the anus. Three patients needed a surgical resection and one of those needed a further procedure to correct the anal location. After the surgical resection of the megacolon and/or correction of the anus (one out of the three patients), they soon reported an almost normal bowel habit. CONCLUSION: The first step in treating a megacolon after repairing an anorectal malformation was conservative treatment. However patients without an adequate response to conservative treatment are best managed with a surgical resection. The cause of the megacolon is now under investigation and the lack of adequate management after repair is one of the subjects.

Morphometric Evaluation of PGP9.5 and NCAM Expressing Nerve Fibers in Colonic Muscle of Patients with Hirschsprung's Disease

A quantitative assessment of the density of the protein gene product 9.5 (PGP9.5), the neural cell adhesion molecule (NCAM), and the low-affinity nerve growth factor receptor (NGFR) expressing nerve fibers in the circular muscle layer in the colon was carried out by morphometric analyses from 13 patients with Hirschsprung's disease (HD). The difference in the nerve fiber density between the ganglionic and aganglionic segments was compared by calculating the ratio of the sum of the areas occupied by positively stained nerve fibers per unit area of the muscle after immunohistochemical staining on paraffin embedded tissue sections using computer software. There was an obvious difference in the density of the PGP9.5 stained nerve fibers between the ganglionic (0.0380 +/- 0.0171) and aganglionic segments (0.0143 +/- 0.01661). The NCAM-positive nerve fibers were fewer in number than those of both the PGP9.5-positive fibers and NCAM-positive fibers, which were also markedly lower in number in the aganglionic segment (0.0066 +/- 0.0076) than in the ganglionic segment (0.0230 +/- 0.0195). Immunostaining for low-affinity NGFR revealed much fainter staining in the ganglionic and aganglionic segment without a statistically significant difference in their density. Considering the fact that PGP9.5 is a very sensitive marker for nerve fibers, the results of this study reaffirm the innervation failure of the proper muscle in HD. The decreased NCAM expression level in the aganglionic segment appears to be caused not by the selective down-regulation of NCAM expression among the nerve fibers but by a markedly reduced number of nerve fibers.

The Results of Surgical Treatment for Suppurative Cervical Lymphadenitis in Children

PURPOSE: The results of surgical treatment for acute suppurative cervical lymphadenitis in children were evaluated with literature reviews. METHODS: Children under 15-year old who required operative management for acute suppurative cervical lymphadenitis between January 1996 and December 2000 were evaluated with retrospective manner. The clinical characteristics, pathologic results and microbiologic studies were reviewed. RESULTS: 37 patients were treated with surgical methods. 36 patients recovered fully after surgical intervention without any recurrence and one patient expired of sepsis. CONCLUSION: The classical treatment, incision and drainage, is one of the treatment of choice for the recovery from suppurative cervical lymphadenitis in children.