Typical Zollinger-Ellison syndrome-atypical location of gastrinoma and absence of hypergastrinemia: A case report and review of literature.

BACKGROUND: Zollinger-Ellison syndrome (ZES) results from hypersecretion of gastrin from pancreatic or duodenal neuroendocrine tumors, commonly referred to as gastrinomas. The high levels of gastrin lead to a typical presentation involving watery diarrhea and multiple ulcers in the duodenum. Here, we have presented the rare case of a patient with ZES and absence of hypergastrinemia as well as an atypical location of gastrinoma. CASE SUMMARY: A 72-year-old woman presented with the typical clinical manifestations of ZES, including upper abdominal pain, significant watery diarrhea, and acidic liquid vomitus. Surprisingly, however, she did not have an increased level of serum gastrin. In addition, there was no evidence of gastrinoma or any other ulcerogenic tumor. Esophagogastroduodenoscopy was conducted to examine the upper digestive tract. Revised diagnoses were considered, and an individualized treatment plan was developed. The patient responded to antacid medication while experiencing intermittent, recurring bouts of ZES. 18F-AlF-NOTA-octreotide positron emission tomography (18F-OC PET)/computed tomography (CT) helped locate the tumor. Postoperative pathology and immunohistochemistry results suggested that the tumor was a gastrinoma located at an unconventional site. CONCLUSION: This present case study demonstrates the possibility of ZES-like manifestation in patients with absence of hypergastrinemia. 18F-OC PET/CT is a relatively new imaging technique that can be applied for diagnosing even tiny gastrinomas that are atypical in terms of location.

HPV Prevalence and Genotype Distribution Among Women From Hengyang District of Hunan Province, China.

Most cervical cancers were closely associated with human papillomavirus (HPV) infections. Therefore, understanding the ecological diversity of HPV prevalence and genotype distribution among various populations in different geographical regions was essential for optimizing HPV vaccination and maximizing the vaccination effects. A total of 12,053 patient data from the three-level hospitals in Hengyang city were retrospectively analyzed. In this study, the HPV prevalence was 10.16% overall, and the multiple-type infection rate was 1.83%. The HR-HPV infection rate was 8.52%. The top six HPV genotypes were as follows in descending order: HPV16, HPV58, HPV52, HPV39, HPV51, and HPV53. The HPV prevalence in the group above 60 years old was the most, and their HR-HPV infection rate corresponded to the most too. The infection rates of HPV and HR-HPV among outpatients were both lower than those among the hospitalized-patients, respectively. Among the hospitalized-patients, the infection rates of HPV and HR-HPV among the 50-60 years group were the most in both. The HR-HPV ratio-in-positive among HPV-positive patients with the histopathologic examination was higher than that among those patients without. Among 52 HPV-positive patients with cervical squamous carcinoma, the ratio-in-positive of HPV16 was 61.54%. This study demonstrated that the HPV prevalence varied with age among women from Hengyang district of Hunan province in China and showed that HPV16, HPV58, HPV52, HPV39, HPV51, and HPV53 genotypes were more popularly distributed in this region, which could provide the experimental basis for Chinese public health measures on cervical cancer prevention.

Acute Interstitial Nephritis Following Multiple Asian Giant Hornet Stings.

BACKGROUND: The Asian giant hornet is the largest wasp species in the world. Its stings can cause acute interstitial nephritis and acute renal failure. From July to October, 2013, Asian giant hornet attacks have killed 42 people and injured 1675 people with their powerful venomous stings in Hanzhong, Ankang, and Shangluo, three cities in the southern part of Shaanxi Province, China. CASE REPORT: We report here a case of a 42-year-old man with acute interstitial nephritis following multiple Asian giant hornet stings. On admission, the patient had difficulty breathing, headache, and numbness in both limbs (arm and leg). He was treated in the Emergency Department and Department of Nephrology with plasma exchange and dialysis within 24 hours after being stung. A kidney biopsy revealed acute interstitial nephritis with interstitial infiltrations of eosinophils and lymphocytes. After intensive treatment, his liver function recovered within 10 days. Along with oral methylprednisolone, his renal function recovered 1 month later. CONCLUSIONS: This case shows that acute interstitial nephritis happens several days after being stung. Since the number of deaths in southern Shaanxi province is much higher than other places, our report draws the attention of fellow clinicians to the acute interstitial nephritis following multiple Asian giant hornet stings.

Steroidal saponins from dragon's blood of Dracaena cambodiana.

Six new steroidal saponins, cambodianosides A-F (1-6), together with seven known ones, were isolated from the dragon's blood of Dracaena cambodiana. The structures of 1-6 were elucidated on the basis of detailed spectroscopic analysis, including 1D and 2D NMR techniques and chemical methods. The cytotoxicities of all the isolated compounds were evaluated in vitro against three human cancer cell lines, and compounds 7, 8, and 11 showed significant inhibitory activities.

Orthotopic detaenial sigmoid neobladder after radical cystectomy: technical considerations, complications and functional outcomes.

PURPOSE: In recent years the orthotopic neobladder has gained increasing popularity in patients who undergo radical cystectomy. However, there are only a few reports of orthotopic neobladders reconstructed from the sigmoid without detubularization. We investigated the complications and functional outcomes of the orthotopic sigmoid neobladder reconstructed using our detaenial technique. MATERIALS AND METHODS: We performed a retrospective study of the detaenial sigmoid neobladder in 210 consecutive patients who underwent radical cystectomy at our institution from January 2003 to March 2010. ANOVA was used to investigate urodynamic finding differentials with time. Univariable and multivariable analyses were done to determine factors influencing continence. RESULTS: Median followup was 48 months. Early complications (90 days or less) were observed in 65 patients (31%). Late complications (greater than 90 days) were observed in 45 patients (21.5%). Five-year daytime and nighttime complete continence rates were 74.6% and 57.1%, respectively. Younger age was the only independent factor associated with complete continence during the day (OR 2.342, 95% CI 1.803-3.041, p <0.001) and night (OR 1.193, 95% CI 1.087-1.310, p <0.001). Mean maximal capacity and post-void residual urine were 328.8 and 22.2 ml, respectively. The mean maximal flow rate was 18.5 ml per second. The mean end filling pressure, pressure at maximal capacity and maximal intravesical pressure were 35.8, 55 and 60.6 cm H2O, respectively. These parameters remained stable with time (each p >0.05). CONCLUSIONS: This study confirms that detaenial sigmoid neobladder is a safe, feasible alternative for urinary diversion.

Genome and molecular characterization of a CSFV strain isolated from a CSF outbreak in South China.

In the present study, the full-length nucleotide sequences of the CSFV-GZ-2009 strain of classical swine fever virus (CSFV) isolated from a hog pen in Guangdong province in China was determined. Results demonstrated that the genome of CSFV-GZ-2009 is 12,298 nucleotides (nt) in length, is composed of a 373-nt 5'-untranslated region (UTR), has an 11,697-nt open reading frame encoding a polyprotein of 3,898 amino acids, and has a 228-nt 3'-UTR. Genome comparison of the CSFV-GZ-2009 isolate (GenBank accession No. HQ380231) with other CSFV strains was also analyzed. Gene regions from CSFV-GZ-2009 and other known strains were shown to share 92.7-96.7% identity at the nucleotide level and 94.7-99.2% identity at the amino acid level. Phylogenetic analysis of the full-length genome and the following regions E(rns), E2 and NS5B revealed that the CSFV-GZ-2009 isolate was classified within subgroup 1.1 of group I and closely related to the highly virulent strain JL1 (06), cF114, Shimen and SWH with pairwise distances of 0.0037, 0.0043, 0.0058 and 0.0107, respectively. Analysis of recombination with the SimPlot program demonstrated that strain CSFV-GZ-2009 was not a naturally homologous recombinant. Furthermore, the change of clinical signs of pigs after infection of CSFV-GZ-2009 isolates showed typical symptoms such as diarrhea, persistent fever, and mononuclear lymphocytopenia after CSFV infection. Based on phylogenetic analysis and an animal infection test, we could conclude that the CSFV-GZ-2009 isolate belonged to subgroup 1.1 of group I and was of high virulence.

Classical swine fever virus failed to activate nuclear factor-kappa b signaling pathway both in vitro and in vivo.

BACKGROUND: Classical swine fever virus (CSFV) is the cause of CSF which is a severe disease of pigs, leading to heavy economic losses in many regions of the world. Nuclear factor-kappa B (NF-κB) is a critical regulator of innate and adaptive immunity, and commonly activated upon viral infection. In our previous study, we found that CSFV could suppress the maturation and modulate the functions of monocyte-derived dendritic cells (Mo-DCs) without activating NF-κB pathway. To further prove the effects of CSFV on the NF-κB signaling pathway, we investigated the activity of NF-κB after CSFV infection in vivo and in vitro. METHODS: Attenuated Thiverval strain and virulent wild-type GXW-07 strain were used as challenge viruses in this study. Porcine kidney 15 (PK-15) cells were cultured in vitro and peripheral blood mononuclear cells (PBMCs) were isolated from the blood of CSFV-infected pigs. DNA binding of NF-κB was measured by electrophoretic mobility shift assays (EMSA), NF-κB p65 translocation was detected using immunofluorescent staining, and p65/RelA and IκBα expression was measured by Western Blotting. RESULTS: Infection of cells with CSFV in vitro and in vivo showed that compared with tumor necrosis factor alpha (TNF-α) stimulated cells, there was no distinct DNA binding band of NF-κB, and no significant translocation of p65/RelA from the cytoplasm to the nucleus was observed, which might have been due to the apparent lack of IkBa degradation. CONCLUSIONS: CSFV infection had no effect on the NF-κB signaling pathway, indicating that CSFV could evade host activation of NF-κB during infection.

Adenovirus-vectored shRNAs targeted to the highly conserved regions of VP1 and 2B in tandem inhibits replication of foot-and-mouth disease virus both in vitro and in vivo.

Foot-and-mouth disease is a highly contagious and economically important disease of cloven-hoofed animals. RNA interference (RNAi) can be used as a rapid and specific antiviral approach. It was shown that treatment with recombinant adenovirus (Ad(VP1-2B)) carrying shRNAs targeted to the VP1 and 2B genes of FMDV expressed in tandem had marked antiviral effects against FMDV both in IBRS-2 cells and guinea pigs. Treatment with Ad(VP1-2B) both before and after FMDV infection was most effective in IBRS-2 cells, as the FMDV RNA transcripts could not be detected within 48 h post-challenge (hpc), and the viral RNA copy number at 72 hpc was only 0.02% of that in the positive control group. Delivery of Ad(VP1-2B) reduced significantly the susceptibility of guinea pigs to FMDV infection. All guinea pigs were protected within 3 days post challenge (dpc) when they were injected twice with the same dose of Ad(VP1-2B), and a third treatment with the same dose of Ad(VP1-2B) at 3 dpc was necessary to confer longer lasting protection (up to 6 dpc). In conclusion, application of such a adenovirus vector to inhibit more than one viral gene may be an advantageous method for prevention and therapy of FMDV infection.

Cytotoxic and antibacterial flavonoids from dragon's blood of Dracaena cambodiana.

Chemical studies on the constituents from the dragon's blood of Dracaena cambodiana led to the discovery of three new flavonoid derivatives (1- 3) and six known compounds (4- 9). The structures of the three new compounds were elucidated by NMR and MS spectroscopic analyses. All compounds were evaluated for their growth inhibitory activity against human cell lines K-562, SMMC-7721, and SGC-7901, as well as antibacterial activities against Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). As a result, compounds 1, 2, 5, 7, and 9 showed cytotoxicity against K-562, SMMC-7721, and SGC-7901 cell lines. All these compounds were observed to exhibit antibacterial activities against S. aureus, and compounds 1- 4, 6, 8, and 9 were observed to exhibit antibacterial activity against MRSA.

The renal histopathological spectrum of patients with nephrotic syndrome: an analysis of 1523 patients in a single Chinese centre.

BACKGROUND: Nephrotic syndrome is caused by a variety of glomerulopathy. The current study investigated the renal histopathological spectrum of patients with nephrotic syndrome who received a renal biopsy in our department within the last 15 years. METHODS: One thousand five hundred and twenty-three consecutive patients (≥14 years old at renal biopsy) with nephrotic syndrome were recruited. Patients were divided into four groups according to age at the time of renal biopsy. The renal histopathological spectrum was also compared between nephrotic-range proteinuria patients with and without hypoalbuminaemia. RESULTS: Among the 1523 patients, the most common cause of nephrotic syndrome was idiopathic membranous nephropathy (IMN) (20.7%), followed by minimal change disease (MCD) (20.4%). Among the patients aged 14-24, 25-44, 45-59 and ≥60 years, the most common cause of nephrotic syndrome was MCD (33.0%), lupus nephritis (LN) (23.0%), IMN (37.9%) and IMN (42.3%), respectively. Among the female patients aged 14-24 and 25-44 years, LN was the leading cause of nephrotic syndrome (35.8 and 36.2%, respectively). The proportion of patients with renal amyloidosis increased in parallel with patient age. The comparison between nephrotic patients with and without hypoalbuminaemia suggests that patients with MCD, LN or renal amyloidosis were more likely to develop hypoalbuminaemia. CONCLUSIONS: The renal histopathological spectrum of nephrotic syndrome differs between ages. MCD, LN and IMN were the main cause of nephrotic syndrome among younger patients, and IMN was the main cause of nephrotic syndrome among older patients. The proportion of patients with renal amyloidosis increased in parallel with patient age.

Using human hair follicle-derived keratinocytes and melanocytes for constructing pigmented tissue-engineered skin.

BACKGROUND: Traditional tissue-engineered skin does not produce a satisfactory long-term result because it lacks natural skin pigmentation and leads to discolored cosmetically unpleasing skin that only functions to cover the body of patients. Additionally, the cell sources for tissue-engineered skin are generally derived from normal skin, which is often limited in patients with skin defects. METHODS: In this study, hair follicle melanocytes and keratinocytes were isolated from human scalp. The melanocytes were co-cultured with keratinocytes until the second passage and then purified. Purified melanocytes and keratinocytes were seeded onto the chitosan-gelatin membrane for 1 week to construct pigmented tissue-engineered skin. The pigmented skin equivalent was used to resurface the skin defect in nude mice. Four weeks after grafting, skin biopsies were harvested to take hematoxylin and eosin staining and immunohistochemistry staining of Melan-A and HLA-ABC. RESULTS: Large quantities of purified melanocytes can be obtained with co-culture method. The hematoxylin and eosin staining of repaired skin biopsy demonstrated that the tissue-engineered skin can repair skin defects successfully. Engineered skin contained pigmentation and stained positive for Melan-A and HLA-ABC, which confirmed the presence of melanocytes and its sources were of human origin. CONCLUSION: This study demonstrated the possibility of constructing pigmented tissue-engineered skin with human hair follicle-derived keratinocytes and melanocytes, which brings a promising method to make up for the deficiency of traditional tissue-engineered skin and provides an alternative treatment for depigmentation diseases.

[Transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients less than 50 years old].

OBJECTIVE: To evaluate the therapeutic effect of transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia in patients below 50 years of age. METHODS: Twelve patients with benign prostatic hyperplasia patients (mean age 48.2 years, range 46-49 years) underwent transurethral enucleation of the prostate. The middle lobe and two lateral lobes were enucleated with the preprosthetic sphincter and anterior fibromuscular stroma preserved during the operation. The patients were followed up to evaluate the lower urinary tract symptoms and sexual activity after the surgery. RESULTS: The 12 patients were followed up for 3 to 6 months. The symptoms of lower urinary tract obstruction were improved obviously after the surgery, and the International Prostate Symptom Score (IPSS) decreased from 24±5.1 to 8.8±1.4 and peak urine flow rate (Qmax) increased from 8.1±4.2 ml/s to 20.1±4.2 ml/s at 3 months postoperatively. All the 12 cases had residual urine (12-44 ml) preoperatively, but after the surgery, only 4 still had residual urine of less than 30 ml. All the patients had normal erection function postoperatively, and 10 had normal ejaculation; the other 2 patients recovered normal ejaculation 3 and 5 months after the operation, respectively. CONCLUSIONS: Transurethral enucleation can alleviate the low urinary tract obstruction symptom and improve the sexual function by avoiding preprosthetic sphincter injury in relatively young patients with benign prostatic hyperplasia.

Correlation of pepsin-measured laryngopharyngeal reflux disease with symptoms and signs.

OBJECTIVE: Pepsin detection in throat sputum has been posited as a reliable biological marker of laryngopharyngeal reflux disease (LPRD). This study was designed to further correlate pepsin concentration with symptoms and signs of LPRD. STUDY DESIGN: Cross-sectional study. SETTING: Nanfang Hospital of Southern Medical University. SUBJECTS AND METHODS: Fifty-six laryngitis patients were divided into a reflux laryngitis group and a chronic laryngitis group based on the reflux symptom index (RSI), reflux finding score (RFS), and proton pump inhibitor treatment for two weeks. Oral and hypopharyngeal secretions from the study patients and from 15 healthy subjects were collected. Thirty-six obstructive sleep apnea (OSA) patients were divided into a mild-moderate group and a severe group by the apnea-hypopnea index (AHI). Bedtime and first-morning oral secretions were collected. Enzyme-linked immunosorbent assay was used to measure the pepsin concentration. RESULTS: In laryngitis patients, the total score of RSI and RFS (P < 0.05), and the symptoms, including clearing throat often, coughing, and sensing a lump in the throat (P < 0.006), were more severe in the pepsin-positive group. No significant differences were found between the oral and hypopharyngeal secretions. In OSA, pepsin levels in the first-morning oral secretions were correlated with AHI, mean SaO(2), and mini SaO(2) (P < 0.01). However, RSIs were not significantly correlated with these indicators. CONCLUSION: Higher levels of pepsin in sputum were associated with higher RSI and RFS in cases of laryngitis. There was no relationship between pepsin levels and RSI in cases of OSA. There were no differences of pepsin concentration in sputum collection methods or in collection timing.

[Effect of terbutaline on sodium transport in alveolar type I and type II cells].

OBJECTIVE: To explore the effect of terbutaline on sodium transport in rat alveolar type I (ATI) and type II (ATII) cells of rats. METHODS: The whole cell currents were recorded from ATII cells isolated from rat lungs perfused with or without amiloride (inhibitor of epithelial sodium channel) and ZnCl(2) (inhibitor of cyclic nucleotide-gated cation channel) in the whole cell recording mode using the patch-clamp technique. The effect of terbutaline on the currents was examined. RESULTS: The main currents recorded from ATII cells were amiloride-sensitive and Zn(2+)-sensitive. The amiloride-sensitive and Zn(2+)-sensitive current shared a similar proportion (P>0.05). Both currents could be significantly increased by terbutaline (P<0.05), and the proportion of amiloride-sensitive current was 1.7 times that of Zn(2+)-sensitive current (P<0.05). CONCLUSION: There are functional epithelial sodium channels (ENaC) and cyclic nucleotide-gated cation channels (CNG) on freshly isolated ATII cells, both serving as the main channels for sodium transport. Terbutaline increases the absorption of alveolar fluid primarily by increasing sodium transport of ENaC and CNG on ATI and AT II cells.

[Repair of the large skin and vessel defect of upper arm with free anterolateral thigh flap].

OBJECTIVE: To explore an effective method for repairing the large skin and vessel defect of upper arm. METHODS: The large skin defect was repaired by the free anterolateral thigh flap. The vessel defect was reconstructed with the end branch of descending branch from lateral femoral circumflex artery, or the large muscular branch through bridge-like vascular anastomosis. RESULTS: Since 2003, 5 cases were treated. All the flaps survived completely with a soft tissue texture. They were followed up for 8-24 months. The cosmetic and functional results were both satisfactory with less morbidity in the donor sites. The blood supply of the flap and the end of extremities was not affected by weather. CONCLUSIONS: Anterolateral thigh flap is very suitable for large skin and vessel defect of upper arm.

[Laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction for bladder tumor in a 3-year-old boy].

OBJECTIVE: To present a case of laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction for bladder tumor in a child. METHODS: A 3-year-old boy with bladder rhabdomyosarcoma underwent laparoscopic radical cystectomy and detenial sigmoid colon orthotopic neobladder reconstruction. The bilateral pelvic lymphadenectomy and cystectomy were performed laparoscopically, and removal of the mobilized specimens and urinary diversion operation were managed through enlarged abdomen incision. The urinary diversion procedure included construction of the detenial sigmoid pouch, bilateral stented antiflux implantation of the ureters in the pouch and orthotopic anastomosis of the neobladder with the urethra. RESULTS: The total operative time was 6 h, and the laparoscopic procedure lasted for about 3.5 h. The intraoperative blood loss was 50 ml, and 200 ml concentrated red blood cell transfusion was used for the safety of the patient. Six dissected lymph nodes in each pelvic side and the surgical margins of the ureter and urethra were all free of tumor invasion. Bowel peristalsis recovered 3 days after the operation, and the pelvic drainage and the neobladder drainage tubes were removed on day 7 and 14, respectively. The urethral catheter and ureteral stents were removed 25 days after the operation. The daytime urine control and micturition recovered 1 week after the operation. The neobladder capacity was about 110 ml, with residual urine volume of 10 ml and peak flow rate of 12 ml/s after 5 months. No perioperative complications occurred such as water-electrolyte and metabolic acid-base balance disorders, urinary leakage, reflux or bowel obstruction. CONCLUSION: Laparoscopic radical cystectomy is minimally invasive, reduces intraoperative blood loss and allows rapid postoperative recovery, and can be a promising approach to management of bladder rhabdomyosarcoma in children.