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Background Alveolar echinococcosis (AE) is a zoonotic parasitic disease caused by Echinococcus multilocularis larval tapeworm infections in humans that severely impairs the health of affected patients in the northern hemisphere. Methods The expression levels of 20 cytokines associated with AE infection were measured by enzyme-linked immunosorbent assay, and the correlations between these cytokines were analysed in the R programming language. Results Serum cytokine levels differed among individuals in both the AE patient and healthy control groups. The results of the correlations among the cytokines showed obvious differences between the two groups. In the AE patients group, Th1 and Th2 cytokines formed a more complicated network than that in the healthy control group. Conclusions The altered correlations between Th1 and Th2 cytokines may be closely associated with AE infection, which may provide a new explanation for the essential differences between AE patients and healthy individuals.

To investigate the effect of triptolide on the excursion of Tc and Th cells in peripheral blood of systemic lupus erythematosus (SLE) BALB/c-un nude mice induced by pristane.Eighteen female BALB/c-un nude mice were randomly divided into blank, SLE and triptolide group, each with 6 mice by random table method. Group SLE and group triptolide were established by single intraperitoneal injection of pristane, and blank group was used as blank control group. SLE model was established by single intraperitoneal injection. Triptolide group was fed with triptolide at the dose of 5 mg/(kg·d), and the blank group and SLE group were fed normally. Blood samples were collected from the caudal vein before treatment and 1, 3 and 6 months after treatment respectively. Fluorescence labeled flow cytometry was used to delect Tc and Th lymphocyte subsets at different stages of treatment.After treatment for 3 and 6 moths, the percentages of Tcl, Thl cells and CD8The mechanism of triptolide in the treatment of SLE may be related with the excursion of Tc and Th cells to Tcl and Tc2 to maintain the relative homeostasis of Tc and Th cells at different stage, thus affecting the immune response and the inflammatory reaction.雷公藤甲素对系统性红斑狼疮BALB/c-un裸小鼠外周血Tc与Th细胞漂移的影响.观察雷公藤甲素对Pristane（姥鲛烷）诱发的系统性红斑狼疮（systemic lupus erythematosus，SLE）BALB/c-un裸小鼠外周血Tc与Th细胞漂移的影响。.用随机表法将雌BALB/c-un裸小鼠18只机编号后随机均分为空白、SLE和雷公藤甲素3组，每组动物数6只。SLE组和雷公藤甲素组用Pristane单次腹腔注射的方法建立SLE模型，空白组作空白对照。雷公藤甲素组按 5 mg/（kg•d）灌服雷公藤甲，空白组和SLE组正常饲喂。分别于治疗前、治疗后1、3和6个月从尾静脉采血，采用荧光标记的流式细胞术检查治疗不同阶段Tc与Th淋巴细胞亚群。.在治疗3和6个月时与SLE组同期比较，雷公藤甲素组Tcl、Thl细胞和CD8雷公藤甲素治疗SLE的机制可能与其调节Tc与Th细胞向Tcl和Tc2漂移，维持治疗不同阶段Tc与Th细胞相对稳态而影响免疫应答及炎症反应过程有关。.

Echinococcosis is a serious zoonotic parasitic disease that is highly endemic in Qinghai Province. The present study aimed to investigate the prevalence of echinococcosis among schoolchildren in Golog Tibetan Autonomous Prefecture to improve early diagnosis and treatment of patients and to provide information for echinococcosis prevention and control. A total of 11,260 schoolchildren from five counties (Maqin, Gander, Dari, Jiuzhi, and Banma) in Golog Tibetan Autonomous Prefecture, Qinghai Province, were screened for echinococcosis. Screening involved ultrasound imaging combined with serologic examination as an auxiliary diagnostic test. The prevalence of echinococcosis in the schoolchildren was 2.1% (235/11,260), with a rate of 0.8% for cystic echinococcosis (CE; 89/11,260) and 1.3% for alveolar echinococcosis (AE; 146/11,260). Additionally, one child had a mixed infection. The prevalence ranged between 1.1% and 4.1% among the five investigated counties, and was highest in Dari County (4.1%). The prevalence of echinococcosis was higher in girls than in boys and gradually increased with age. In addition, children with CE mainly had type 1 (CE1) and type 3 (CE3) lesions, and children with AE mainly had small-diameter calcified lesions, suggesting that they were in the early asymptomatic stage of echinococcosis. In conclusion, children of Golog Tibetan Autonomous Prefecture appear to exhibit the highest recorded prevalence of CE and AE globally. Ultrasound is useful for screening populations in regions where both CE and AE are endemic.

To investigate the prevalence of echinococcosis in Yushu Prefecture of Qinghai Province in 2012.Two to three towns were selected in each of Chengduo, Nangqian, Qu malai, Yushu, Zaduo and Zhiduo Counties from June to August in 2012. Ultrasound examination was conducted for residents aged over 1 year, and ELISA was performed to detect serum antibody against Echinococcus. Visceral dissection was performed to detect hydatid infection in rodents and livestock. ELISA was used to detect Echinococcus antigen in collected dog feces.A total of 7 025 residents received ultrasound examination, of whom 319 showed hydatid cysts with a morbidity rate of 4.54%. ELISA showed a serum antibody positive rate of 16.38% （457/2 790）. The mobidity of hydatid disease was highest in Chengduo County （7.41%, 181/2 444）, and the rate of serum antibody was highest in Yushu County （23.18%, 127/548）. The morbidity and serum antibody in males were 3.91% （118/3 018） and 13.93% （172/1 235） respectively, and those in females were 5.02% （201/4 007） and 18.33% （285/1 555）. In terms of age distribution, the morbidity was relatively higher in residents of 60- （8.39%, 38/453） and 40- years （6.61%, 67/1 014）; and the rate of serum antibody was highest in residents over 70 years （33.93%, 19/56）. In terms of occupation, the morbidity was relatively higher in herdsmen （5.28%, 252/4 777）, Herdsmen-peasants （6.52%, 24/368）, and religious workers（3.37%, 11/326）, while the rate of serum antibody was relatively higher in children（24%, 6/25）, religious workers （18.79%, 31/165） and herdsmen（18.34%, 328/1 788）. In terms of education level, the morbidity and the rate of serum antibody were both highest in the uneducated（5.04%, 41/4 779; 18.34%, 359/1 958, respectively）. In terms of residential pattern, the morbidity and the rate of serum antibody were both highest in those who were settled in winter and nomadic in summer （8.25%, 227/2 753; 19.48%, 158/811, respectively）. There were significant differences in the morbidity and the rate of serum antibody in aspects of residential region, sex, age, occupation, education level and residential pattern (P0.05 or P0.01). In 872 rodents detected, the Echinococcus hydatid rate was 0.46% （4/872）, while in 809 cattle and sheep detected, the Echinococcus hydatid rate was 10.14% （82/809）. The fecal antigen positive rate in 838 samples of dog feces was 10.74%（90/838）.It shows a high morbidity of hydatid diesease and serum antibody positive rate in residents, a high Echinococcus hydatid rate in cattle and sheep, and a high fecal antigen positive rate in dogs in Yushu Prefecture.

There are several sites for measuring body temperature. Correct reading of core temperature is imperative for patients undergoing major operations under anesthesia. In certain situations, the sites of measurement may be close to the surgical area, and thus the measurement is easily prejudiced by the influence environment. We hypothesized that the body temperature, if monitored in the esophagus, would be lower than obtained from the tympanic membrane during thoracotomy for lung pathology under general anesthesia.The study involved 32 patients, of American Society of Anesthesiologists (ASA) physical status I or II, who were to undergo elective thoracotomy for lung disorders. General anesthesia was induced with fentanyl, propofol, and rocuronium and maintained with sevoflurane in oxygen. The tympanic membrane probe was placed prior to when general anesthesia was administered, and the esophageal probe was inserted after administration of general anesthesia. Both the individualized temperatures were recorded at 5-minute intervals, and were compared at each change of surgical situation.The tympanic membrane temperature was higher than esophageal temperature after initiation of one-lung ventilation (OLV) with statistical significance. The magnitude of decrease in temperature between two individualized temperatures, as compared from start of OLV, was greater in tympanic membrane temperature, especially at 30 minutes after OLV (p 0.02, difference = -0.09 ± 0.22) and at the time point of the lowest temperature (p = 0.002, difference = -0.14 ± 0.24). There was no clinical difference of situation found (difference 0.5°C) in the measuring sequences.The accuracy of esophageal temperature seemed not to be affected during thoracotomy for lung lesion, in comparison with that of tympanic temperature. From clinical viewpoints, the monitoring of esophageal temperature could be more reliable in such surgical situation.

To understand the status of echinococcosis in Maqing County of Qinghai Province in order to facilitate echinococcosis control in this region.Ultrasonic scanning and indirect hemagglutination assay were used to detect echinococcosis infection in residents1 year old, according to the People's Republic of China Health Industry Standard--Diagnostic Criteria for Hydatid Disease (WS257-2006). Meanwhile, ELISA was used o detect the Echinococcus antigen in dog's feces collected in Youyun, Dangluo and Xiadawu townships.Ultrasonic scanning showed that the prevalence of hydatid disease in the residents was 7.4% (116/1 561), cystic hydatid disease 5.3% (82/1 561), alveolar hydatid disease 2.2% (34/1 561). The serum positive rate in human population was 23.8%(307/1 288). Of the 82 cases of cystic hydatid disease, 23 cases (28.1%) had the hydatid cyst with a diameter of10 cm. The prevalence in males and females in the county was 5.3% (40/753) and 9.4% (76/808), respectively (P0.05). Among populations with different occupations, the highest prevalence of hydatid disease fell into houseworkers (11/61, 18.0%), monks (5/41, 12.2%) and herdsmen (84/758, 11.1%). Among the age groups, the groups of60 years (24/132, 18.2%) and 30-40 years (31/302, 10.3%) had higher prevalence of hydatid disease. The three townships with the higher prevalence were Youyun (29/247, 11.7%), Changmahe (6/63, 9.5%) and Dangluo (54/645, 8.4%). Of the 199 samples of dog's feces, 54 were positive for Echinococcus antigens (27.1%), with a positive rate of 40.4% (23/57) in Youyun towship, being significantly higher than in the other two (P0.05).Maqin county is a co-endemic area of cystic echinococcosis and alveolar echinococcosis. The prevalence is higher in females and those over 60 years-old.

Objective: The minimally invasive procedure is the trend in nowadays neurosurgical techniques. We designed a new targeting method using three-dimensional (3D) reconstructed CT images combining neuroendoscope for hypertensive putaminal hemorrhage (HPH). Methods: Eleven consecutive unconscious patients with a significant volume of HPH were treated with neuroendoscope via a selected frontal or temporal trephination. All the CT images were operated and reconstructed by an independent neuroradiologist for measuring the selected frontal or temporal entry point, depth of penetrating path, and surgical trajectory on the basis of the plane formed by bilateral orbitomeatal lines. The nasion and the external auditory meatus were the reference points for the selected frontal and temporal trephinations respectively. All the surgical trajectories were designed as perpendicular to the underground for minimizing the possibility of human errors after aseptic surgical draping. The intra-operatively sonography was routinely used after trephination for confirmation of the planned surgical path and early detection of possible enlarged hematoma. Results: Ten of the 11 patients regained consciousness postoperatively without complications. All the patients had an accurate trajectory of penetrating path and the average hematoma evacuation rate was 82% (83% for frontal approach and 81% for temporal approach). Conclusion: Use of the 3D reconstructed CT imaging technique combining neuroendoscope may add as a minimally invasive, economic, and timesaving way for targeting HPH. It also serves as a reliable and useful alternative for hospitals without stereotactic or navigating modalities. However, further prospective studies were needed to clarify its efficacy and safety compared to conventional surgeries.

Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. Regardless of emergent supportive medical treatment, it is associated with a very high mortality rate. Here, we present the case of a 33-year-old pregnant woman with amniotic fluid embolism, who sustained cardiac arrest and was rescued with early application of extracorporeal membrane oxygenation. The management of amniotic fluid embolism is to initially focus on rapid cardiopulmonary stabilization. Hemodynamic decompensation may be transient and recoverable within a few hours. Early application of extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical therapy before severe organ damage supervenes.

An epidemiological investigation on echinococcosis was made in Jiuzhi County of Qinghai Province, western China. Ultrasonography and an indirect hemagglutination test revealed a morbidity of 8.0% (124/1,549) and a seroprevalence of 25.8% (287/1,113), respectively, in the Tibetan population. The morbidity in herdsmen (16.6%) and Buddhist priests (15%) was significantly higher than that in other occupation groups (3.2%), and it was higher in females (9.8%) than in males (6.2%). The ultrasound images showed a coexistence of cystic echinococcosis (CE) and alveolar echinococcosis (AE), occupying 69 and 31% of the cases, respectively. An Echinococcus Western blot assay was performed as a serological backup test for differentiating CE and AE. The assay revealed that serum samples from most cases with a positive AE image showed a specific antibody against antigen bands at 16/18 kDa. Autopsy proved that 9 out of 12 stray dogs were infected with Echinococcus granulosus (n = 8) and E. multilocularis (n = 1). Inspection at the abattoirs demonstrated a hydatid rate of 78.5% in yaks and 82.6% in sheep. The data indicate that Jiuzhi County is an important endemic area for both CE and AE, in both human and animal populations.

Selenium deficiency is an important environmental risk factor of Kaschin-Beck disease (KBD), and appropriate selenium supplement can reduce the prevalence of KBD. Guide and Xinghai counties, active endemic areas of KBD in Qinghai Plateau, are characteristic with low level of selenium. The aim of this article was to explore the relationship between selenium content and prevalence of children KBD in some active endemic areas from Guide and Xinghai counties. The historical data of KBD were collected, including the detectable rates of KBD and selenium contents of the hair of children, and then the relationship between the prevalence of KBD and selenium contents of hair was analyzed. In KBD endemic areas of Guide County, the detectable rates of X-ray and metaphysic lesion were declined from 25.00 and 16.96% in 2000 to 13.75 and 13.75% in 2010, respectively. Similarly, in KBD endemic areas of Xinghai County, the detectable rates of X-ray and metaphysic lesion were declined from 46.51 and 40.31% in 2000 to 10.64 and 8.51% in 2010, respectively. The selenium contents of hair in Xinghai county were increased from 130.01 ± 48.08 μg/kg in 2003 to 211.8 ± 86.64 μg/kg in 2010(t = 2.98, P < 0.05); the selenium content of hair in Guide County were increased from 142.30 ± 62.02 μg/kg in 2003 to 182.09 ± 78.46 μg/kg in 2010 (t = 3.12, P < 0.05). There was a negative correlation between the prevalence of KBD and selenium contents of hair (r = -0.785). There was a close relationship between selenium content and prevalence of KBD. Selenium could reduce the prevalence of KBD, so it is very necessary to supplement selenium appropriately for KBD prevention.

Many etiologies may cause sciatica, and intra-abdominal masses usually affect the lumbosacral plexus by local invasion or distal metastases. Lumbosacral plexopathy caused by compression of intra-abdominal tumors instead of invasion is rarely seen. A 67-year-old woman had a 3-month history of progressive neurogenic claudication, lumbago and left L5 radiculopathy with foot drop. Nocturia and progressive abdominal distension with voiding dysfunction were also noted. Imaging studies showed a huge pelvic mass with severe compression of the left lumbosacral trunk. There was no direct invasion of the lumbosacral plexus by the pelvic mass noted in the preoperative imaging studies or intraoperative findings. Bilateral ovarian borderline mucinous cystic tumor with pseudomyxoma peritonei (PMP) was diagnosed, and the sciatica was improved dramatically after subsequent abdominal debulking surgery. Although rare, neural compression caused by PMP and intra-abdominal masses needs to be considered in the differential diagnosis of sciatica.

Coronary artery fistulae (CAF) are an infrequent coronary abnormality. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE) in the treatment of CAF. A 61 year-old woman presented with chest pain and symptoms consistent with unstable angina. Subsequent coronary angiography revealed the presence of 2 CAF, one extending from the left anterior descending artery to the pulmonary artery (PA) and the other extending from the proximal right coronary artery to the PA. Surgical ligation of the CAF without coronary bypass was arranged. Intraoperative TEE was successfully employed to localize the CAF, monitor fistula blood flow and heart wall motion, and confirm successful ligation. The patient recovered without complications. This case highlights the utility of intraoperative TEE during ligation of CAF.

To make an epidemiological investigation on echinococcosis in Darlag County, Guoluo Tibetan Autonomous Prefecture of Qinghai Province.Local participants were screened for echinococcosis using B ultrasound from August to September in 2007. IHA was carried out to detect antibody in human sera. Indirect ELISA using recombinant-AgB and Em18 antigen was conducted to further diagnose the human alveolar echinococcosis (AE) and cystic echinococcosis (CE) . The prevalence of echinococcosis in wild rodents, yaks, sheep and dogs was examined either by dissection or through slaughterhouses. Adult worms and hydatid cysts were detected by PCR-RFLP to discriminate 3 Echinococcus species and genotype of Eg. Dog feces were tested by double antibody sandwich ELISA method to confirm the coproantigen positive rate.1723 people were examined by ultrasound and 236 were clinically diagnosed as hydatid diseases with an overall morbidity of 13.7%, of which 5.5% were CE and 8.2% were AE. Prevalence in males and females was 11.6% and 15.6% respectively with a statistically significant difference (chi2=7.0, P0.05) . Prevalence in herdsmen and monks/nuns was as high as 23.0% and 13.2%, respectively. Adult worms were found in 5 out of 9 stray dogs by necropsy. 27 of 239 pikas (Ochotona curzoniae) were infected by E. shiquicus (11.3%). CE prevalence in sheep and yaks was 26.4% and 5/16 respectively. The Eg genotype was G1 (sheep strain).Three species of Echinococcus, e.g. E. granulosus, E. multilocularis and E. shiquicus are all prevalent in Darlag County. The prevalence of both AE and CE in human population is high in the area. Domestic dogs are the primary definitive host for both E. granulosus and E. multilocularis.

Background Epidural patient-controlled analgesia (EPCA) and intravenous patient-controlled analgesia (IVPCA) have been used widely in parturients after cesarean section. Although many studies have demonstrated the safety and effectiveness of both EPCA and IVPCA, their effects on bowel activity of patients who have undergone cesarean section delivery have not yet been investigated. The purpose of this study was to compare the effect of EPCA and IVPCA on bowel activity after cesarean section. Methods We collected data from 726 parturients who consented to receive either EPCA or IVPCA for postoperative analgesia following cesarean section delivery. All patients used postoperative PCA for at least 2 days. The analgesic solution for EPCA was 0.05% bupivacaine plus fentanyl (3 μg/mL), and that for IVPCA was 0.1% morphine. The patients were assessed by visual analog pain scale (VAS) scores at rest and in a dynamic state, time to first flatus passage after the surgery, and overall satisfaction after completion of the PCA course. Student's t test was used to determine intergroup differences. Results There were statistically significant differences between the EPCA and IVPCA groups in the time to first flatus passage, overall satisfaction and VAS scores at rest and in a dynamic state. Patients in the EPCA group had a shorter time to first flatus passage, higher overall satisfaction and lower VAS scores. In addition, regional anesthesia offered an apparently shorter time to first flatus passage in comparison with general anesthesia. Conclusion PCA is safe and effective in alleviating postoperative pain following cesarean section. EPCA offers a faster return of bowel activity, lower VAS scores, and better patient satisfaction than IVPCA.

Postoperative limitation of cervical movement and adjacent disc degeneration are major causes of postoperative neck pain after anterior cervical discectomy and interbody fusion (ACDF). We present a retrospective study of dynamic radiographic change following ACDF with cages. We performed ACDF in 50 patients with cervical degenerative diseases, divided into three groups based on the level of interbody fusion (Group A: one-level; Group B: two-level; Group C: three-level). Preoperative and postoperative flexion-extension X-rays were acquired and cervical range of motion (ROM), lordosis, fusion rate, cage subsidence rate, postoperative neck pain as evaluated by visual analogue scale (VAS) and upper adjacent level segmental movement were evaluated. The average following time was 14.6 months. The mean change in lordotic curve was -2.31 +/- 9.53 degrees for Group A, 5.60 +/- 6.96 degrees for Group B, and 3.23 +/- 7.50 degrees for Group C (p value = 0.03). The mean change in flexion angle was -5.46 +/- 8.69 degrees for Group A, -10.2 +/- 7.38 degrees for Group B, and -13.86 +/- 10.33 degrees for Group C (p value = 0.039). The mean change in total cervical ROM was -3.85 +/- 18.74 degrees for Group A, -12.73 +/- 10.31 degrees for Group B, and -16.95 +/- 10.57 degrees for Group C (p value = 0.02). Follow-up cervical MRI for patients with persistent neck pain showed no evidence of adjacent level degeneration. There were no significant differences between the three groups with respect to postoperative change in cervical extension angle, upper adjacent level segmental movement, neck pain VAS, fusion rate or cage subsidence rate. The further decrease in total cervical ROM and flexion movement after multi-level ACDF was observed. However, a more long-term follow-up was needed to assess the actual aetiologies of upper adjacent level degeneration.