Clinical and epidemiological investigation of a child with asymptomatic COVID-19 infection following reoccurrence.

Objective: To investigate the case of a child infected with coronavirus disease 2019 (COVID-19) who had subsequent viral reactivation. Methods: We retrospectively analyzed the clinical manifestations, epidemiological data, laboratory and imaging examinations, treatment, and follow-up of the child. And then, we searched related literature using PubMed. Results: The 9-year-old boy was exposed to COVID-19 in Malawi and tested positive for NAT in Haikou, China. He was asymptomatic and admitted to our hospital. After six negative NATs, he was discharged from the hospital and quarantined in a hotel. His infection was reactivated again after 22 days (interval between first and last positive NATs). The cycle threshold (Ct) values of positive tests were 25 and 31, and the gene sequencing viral loads were very low. The viral strain Kenya/P2601/2020, a variant of the hCoV-19/Wuhan/IVDC-HB-01/2019 genome (GISAID accession IL: EPI_ISL_402119), was found when polymerase chain reaction enrichment was used to sequence the virus. However, people around him tested negative for COVID-19. Conclusion: First, we confirmed the reactivation of COVID-19 in a child. The risk of recurrent infection with SARS-CoV-2 was low, and the policy of strictly isolating patients carrying long-term viral ribonucleic acid should be reconsidered. The interval positivity was most likely due to incorrect sampling and/or testing methods. SGS and aB testing are recommended for children with viral reactivation. Second, SARS-CoV-2 viral reactivation cannot be ruled out. The possible mechanisms, such as prolonged infection and viral latent reactivation, need further investigation.

Overexpression of phosphatidylethanolamine-binding protein 4 (PEBP4) associates with recurrence of meningiomas.

BACKGROUND AND PURPOSE: Abnormal expression of phosphatidylethanolamine-binding protein 4 (PEBP4) has been identified in various types of malignant tumors. In the present study, we investigated the expression of PEBP4 in meningioma cases and examined whether PEBP4 expression was correlated with outcomes among these patients. MATERIALS AND METHODS: The expression levels of PEBP4 and Ki-67 in human meningioma tissues from 65 patients were evaluated by immunohistochemical staining. The correlation between PEBP4 immunoreactivity in meningioma samples and patients' clinical outcomes was examined using the Kruskal-Wallis correlation test. The prognostic value of PEBP4 expression in meningiomas patients also was investigated. RESULTS: Immunohistochemical analysis revealed up-regulated PEBP4 expression in both atypical and anaplastic meningiomas compared with classical meningiomas (13.38 ± 4.19% vs. 3.64 ± 2.04%, P < 0.001). PEBP4 immunoreactivity in meningioma samples was closely correlated with that for Ki-67 (Spearman r = 0.7922, P < 0.0001). PEBP4 expression was also associated with tumor differentiation grade and clinical recurrence (P < 0.05). Multivariate regression analysis showed with high PEBP4 expression was associated with a longer recurrence-free survival (hazard ratio=0.252, 95% confidence interval: 0.067-0.940, P = 0.040). CONCLUSION: PEBP4 may play an important role in the progression of meningioma, as high PEBP4 expression was associated with a higher pathological grade of meningioma. Moreover, PEBP4 expression may be a meaningful prognostic biomarker in meningioma.

Perigastric Hyaline-Vascular Variant Castleman's Disease.

Castleman disease (CD) is a rare chronic lymphoproliferative disease with unknown etiology and pathogenesis disease. When the lesion is located in the mediastinum, the diagnosis of CD is easy. However, if the lesion presents as a perigastric mass mimicking other subserosal gastric mesenchymal tumors, the diagnosis can be challenging. As few sonographic manifestations of hyaline-vascular variant CD, especially contrast-enhanced ultrasound (CEUS) imaging, as well as computed tomography (CT) and histopathological imaging, have been reported in literature, this case may provide a vivid example of a comprehensive CEUS and CT usage in the diagnosis and surgery with regard to CD. This report presents a case of a 50-year-old female diagnosed with hyaline-vascular variant CD in a random physical examination, the ultrasound examination first revealed a 24.3 mm × 15.4 mm hypoechogenic lesion abutting the stomach, esophagus, and liver, which was under the suspicion of gastrointestinal stromal tumor. Following a series of medical examinations, including CEUS, CT, postoperative histopathological examination, and immunohistochemical analysis, the patient was diagnosed with hyaline-vascular variant unicentric CD. After the mass was completely excised through laparoscopic surgery, the woman recovered very well without recurrence during a follow-up period of 15 months. Thus, mastering ultrasound and CT-imaging characteristics of CD and applying ultrasound and CT examination together would do help to preoperative diagnosis.

[Carbon Monoxide and Pain Regulation: A Review].

Carbon monoxide (CO) is an endogenous gasotransmitter produced by the degradation of heme in the presence of heme oxygenase (HO) in mammals. It has been demonstrated that CO participates in a variety of physiological activities and pathological processes, and is closely related to cell protection and homeostasis maintenance in organ tissues. It has been shown by a growing number of studies that CO may play a regulatory and interventional role in the process of the occurrence and development of pain through a variety of mechanisms of action. However, its mechanism of action is still not fully understood and the uncontrollable factors concerning CO administration also placed considerable limitation to its application. This paper reviews the potential targets and pathways of CO in pain regulation and discusses the challenges and opportunities in the clinical application of CO in order to provide suggestions for further exploration and development of CO analgesics.

Epidemiological investigation of a COVID-19 family cluster outbreak transmitted by a 3-month-old infant.

OBJECTIVE: To investigate the clinical characteristics, epidemiological characteristics, and transmissibility of coronavirus disease 2019 (COVID-19) in a family cluster outbreak transmitted by a 3-month-old confirmed positive infant. METHODS: Field-based epidemiological methods were used to investigate cases and their close contacts. Real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) was used to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for all collected specimens. Serum SARS-CoV-2 IgM and IgG antibodies were detected by Chemiluminescence and Gold immnnochromatography (GICA). RESULTS: The outbreak was a family cluster with an attack rate of 80% (4/5). The first case in this family was a 3-month-old infant. The transmission chain was confirmed from infant to adults (her father, mother and grandmother). Fecal tests for SARS-CoV-2 RNA remained positive for 37 days after the infant was discharged. The infant's grandmother was confirmed to be positive 2 days after the infant was discharged from hospital. Patients A (3-month-old female), B (patient A's father), C (patient A's grandmother), and D (patient A's mother) had positive serum IgG and negative IgM, but patients A's grandfather serum IgG and IgM were negative. CONCLUSION: SARS-CoV-2 has strong transmissibility within family settings and presence of viral RNA in stool raises concern for possible fecal-oral transmission. Hospital follow-up and close contact tracing are necessary for those diagnosed with COVID-19.

Spatial Clustering of Severe Hand-Foot-Mouth Disease Cases on Hainan Island, China.

The incidence of severe hand-foot-mouth disease (HFMD) in Southeast and East Asia has increased in recent years. This study explored spatial clusters of the incidence and proportion of severe HFMD cases on Hainan Island, where the prevalence and mortality of HFMD were the highest in China during 2011. A spatial autocorrelation statistic (Anselin's Local Moran I) was calculated for the Empirical Bayesian (EB)-smoothed dataset of severe HFMD cases. Significant spatial clusters were detected for both the incidence and proportion of severe HFMD cases. Population density was higher in spatial clusters with a high proportion of severe HFMD cases among total HFMD cases. We speculate that a higher proportion of severe HFMD cases were diagnosed in densely populated townships. This should be considered when analyzing the HFMD database of Hainan Island.

Risk Factors for Severe Hand-Foot-Mouth Disease in Children in Hainan, China, 2011-2012.

The incidence of severe/fatal cases of hand-foot-mouth disease (HFMD) has increased in South Asia. In China, Hainan Province had the highest incidence of mortality associated with HFMD in 2011. This study investigated the risk factors for severe HFMD in Hainan. The HFMD survey database for Hainan Province for 2011 and 2012 was analyzed, and the biological and behavioral characteristics of severe (n = 980) and nonsevere (n = 1679) HFMD were compared. The association between each explanatory variable and the severity of HFMD was investigated using a logistic regression model after adjusting for confounders. Human enterovirus 71 infection, a peak body temperature >39°C, living outside urban areas, visiting a village clinic, low birth weight, never breastfed, cared for by grandparents, and caregiver with <6 years of education were associated with severe HFMD. Individual characteristics that are generally shared by children in households of low socioeconomic status tended to increase the risk of severe HFMD.

[Superiority of modified method in urine drainage for hypospadias repair: a 20 years' experience with 864 cases].

OBJECTIVE: To explore an ideal urine drainage method and new urethral secretions of hypospadias repair. METHODS: The authors retrospectively analyzed 864 cases of hypospadias undergoing hypospadias repair and different post-operative urine drainages. The patients were divided into 5 groups based on the methods of urine drainage. RESULTS: The rates of such complications as cystospasm, infection of incisional wound and urinary fistula were as follows: modified method group: 2.86%, 3.33%, 1.90%; 3-tube method group: 10.77%, 11.54%, 8.46%; He's method group: 20.89%, 15.04%, 9.75%; traditional method group: 36.25%, 41.25%, 37.50%; 1-tube method group: 56.47%, 58.82%, 48.23%. The modified method was significantly better than all the other four methods (P < 0.05). CONCLUSION: As an ideal drainage method of urine and new urethral secretions of hypospadias repair, the modified method boosts the success ratio of hypospadias repair.