This paper reports diagnostic results of 200 cases of hemoptysis. The causes of hemoptysis mainly include: bronchial and pulmonary infections (28%), tracheal,bronchial and pulmonary tumor (22.5%),tuberculosis (9.5%), pulmonary abscess (4%), other pulmonary diseases (2.5%), dosprders pitside the lungs (6.5%), and diseases of unidentified reason (5.5%). The diagnostic procedure of hemoptysis is also discussed. It is especially emphasized that the Pulmonary biopsy via bronchia and technique of systematic segmental lavage are of crucial importance for the diagnosis of hemoptysis.

Objective Based on the liver biopsy samples in the past 10 years, this study aimed to investigate the incidence of fatty liver, the relationship among fatty liver and other underlying liver diseases, the clinical and pathological characteristics and the risk factors of fatty liver. Methods In the total 658 cases of liver biopsy from 1988 to 1997, there were 71 cases of fatty liver, among them 68 cases were nonalcoholic fatty liver. Matched by sex and age, 155 cases of non fatty liver cases were taken as control. All cases had had the tests of liver function, blood lipid profile, blood glucose and hepatitis virus markers. Liver biopsy samples were investigated by pathologists. Results The incidence of fatty liver among all the liver biopsy cases was 10.8%. The patients' ALT, AST, TB and CB levels in fatty liver group were significantly lower than in non fatty liver group ( P

Objective To study the effects of broad-spectrum antibiotics, including the third generation Cephalosporin and Carbapenems, on intestinal enterococci in septic rats. Methods Ninety-one SD rats were randomly divided into normal control group, scald group, scald group with 3 days of ceftriaxone treatment, scald group with 9 days of ceftriaxone treatment, scald group with 3 days of imipenem treatment, scald group with 9 days of imipenem treatment, and sepsis group, sepsis group with 3 days of ceftriaxone treatment, sepsis group with 9 days of ceftriaxone treatment, and sepsis group with 3 days of imipenem treatment, sepsis group with 9 days of imipenem treatment. All the animal were subjected to 30% TBSA Ⅲ degree scald injury on their back, followed by endotoxin challenge with a dose of 20mg/kg 24 hours after the burn injury. The animals were treated with intraperitoneal injection of ceftriaxone (60mg/kg, q12h) or imipenem (60mg/kg, q12h) 24h after the second hit with endotoxin. At the end of the treatment, intestinal enterococci in colon were cultured. The number and variety of the bacteria were also determined. Results The number of enterococci in the gut of the septic rats was significantly increased after the second hit with endotoxin, exceeding that of the rats in normal control group and scald group(P

Objective To study the effects of broad-spectrum antibiotics, including the third generation Cephalosporin and Carbapenems, on intestinal commensal bacilli in rats with sepsis. Methods Ninety-one SD rats were randomly divided into normal control group, scald group, scald group with 3 days of ceftriaxone treatment, scald group with 9 days of ceftriaxone treatment, scald group with 3 days of imipenem treatment, scald group with 9 days of imipenem treatment, and sepsis group, sepsis group with 3 days of ceftriaxone treatment, sepsis group with 9 days of ceftriaxone treatment, and sepsis group with 3 days of imipenem treatment, sepsis group with 9 days of imipenem treatment. All the animal were subjected to 30% Ⅲdegree scald injury on their back, followed by endotoxin challenge with a dose of 20mg/kg 24 hours after the burn injury. The animals were treated with intraperitoneal injection of ceftriaxone (60mg/kg, q12h) or imipenem (60mg/kg, q12h) 24h after the second hit with endotoxin. At the end of the treatment, bacilli in the colon were cultured. The number and variety of the bacteria were also determined. Results The antibiotics obviously reduced the number of colibacilli(P

To evaluate availability of permissive hypercapnia (PHC) in patients with severe acute respiratory distress syndrome (ARDS). Method: To observe the influence of different tidal volumes (V_T) on pulmonary mechanics and hymodynamies in 10 patients with severe ARDS. Result : PHC was induced by decreasing VT from 10-12 ml/kg(routine V_T) to 6-8 ml/kg (small V_T). Arterial oxygen pressure and saturation remained unchanged, but pulmonary venous mixture increased(P

0.05).The clinical outcomes were evaluated according to improvement HSS knee joint function scoring,and the score showed an average of 87.5 points (range,71-97).[Conclusion]The dual-incision technique resulted in accurate fracture reduction with low tissue complication rate,and the medial and lateral plating treatment achieved improved stabilization which enabled mobilization of the knee joint to start immediately after surgery.Medial and lateral plating treatment with dual incisions is a safe and effective technique for Schatzker type Ⅴ tibial plateau fractures.

Objective To report long term results of 30 patients with primary intracranial germinoma and evaluate the treatment policy. Methods After the tumor of these 30 patients was completely or partially removed they were routinely given radiation therapy with the conventional extenal irradiation. Of these 30 patients, 28 received prophylactic whole brain irradiation followed by the cone down technique to the local site to an effective dose except 2 patients who were treated locally without prophylactic irradiation.Nineteen patients received prophylactic spinal cord irradiation.Results The overall 5 ,10 , 15 ,19 year survival rates were 93.1%, 87.6% ,87.6% and 68.2%,respectively.The two patients who did not receive prophylactic whole brain irradiation (1 patient) or too low a dose of that (1 patient) developed metastasis in the brain and spinal cord were given a second course of radiotherapy. One survived for 17 years and the other is living now over 10 years. The overall response rate (CR + PR) was 95%.Conclusions While surgery is indicated to reduce the tumor volume, shunt the hydrocrania and obtain a pathologic diagnosis, radiotherapy is invaluable to cure germinoma. Prophylactic whole brain irradiation of 26～30 Gy is necessary and the curative local dose should be 50～55 Gy. Prophylactic spinal cord irradiation is not indicated routinely except some appropriate patients. For patients younger than 14 years, shielding of the pituitary is necessary while the prophylactic whole brain is being irradiated. The tumor dose at the sella turcica region should be limited to 56 Gy, and the spinal cord need not be irradiated prophylactically.

BACKGROUND: It is often seen in clinical practice that children, aged3-15 years, suffer from knee pain of unknown cause at night, which occurs frequently. Most of them can be called "pain of growth".OBJECTIVE: To analyze the related factors of knee pain in adolescents and observe the interventional effect of alpha-D3 (α-D3).DESIGN: Case control analysis, self-control analysis SETTING: Department of Orthopaedics, Jinshan Hospital Affiliated to Shanghai Fudan University PARTICIPANTS: We admitted 22 children outpatients, aged 3 to 15years, who suffered from recurrent attack of knee pain of unknown reasons and received treatment in Jinshan Hospital Affiliated to Shanghai Fudan University from June 1998 to August 2002, servingas group A. Another 20children outpatients of fracture recovered for half a year were recruited simultaneously, serving as Group B (control group).METHODS: Group A adopted the therapy of α- D3 of 0.25 μg taken orally once everyday for successive 7 days then stopped to observe the symptoms for the next three weeks. Four weeks was one therapeutic course.If the pains were still alive or reoccurred, another therapy period was needed until they vanished. The contents of bone gla protein (BGP), blood calcium (Ca2+), blood phosphorus (P3+), blood magnesium (Mg2+), alkaline phosphatase (ALP) and bone mineral density (BMD) of patients were detected between Group A and Group B. GBP index and change of pain in knee at night was observed with α-D3 before therapy and 1,3 and 6months after therapy. After one therapy period, the levels of blood Ca2+, P3+,Mg2+, ALP, BGP, CT, urine and X-ray of knees were detected again, so was BMD after 6 months.MAIN OUTCOME MEASURES: ① Blood Ca2+, P3+, Mg2+, ALP contents of children patients were detected before and after therapy . ② In the Group A, content of BGP was detected before and 1,3 and 6 months after therapy, and BMD before and 6 months after therapy; The above indexes were detected 6 months and one year after bone fracture healing in the control group. ③ Therapeutic effect of α-D3.RESULTS: All the 42 patients entered the stage of result analysis. ① The levels of blood Ca2+, P3+, Mg2+, ALP of patients who suffered pain in knee were all normal before and after therapy . ②BGP content of patients in the control group was significantly lower 1 year after bone fracture healing than 6 months after bone fracture healing [(7.06±0.74), (7.44±1.16)μg/L,P ＜ 0.01]; BGP content of patients in Group A was 15.98 μg/L before therapy , which was significantly higher than that in the control group .BGP content was (12.12±2.2), (10.6±81.31), (7.60±0.95)μg/L , respectively in 1,3 and 6 months after therapy. There was significant difference of BGP content between before and after therapy (P ＜ 0.05). ③ There was no significant difference of BMD of patients between two groups (P ＞ 0.05).④ Symptoms of pain in knee at night improved or disappeared after α-D3therapy, and the therapeutic time was 9 to 83 days.CONCLUSION: Although the knee pain of adolescents and children at night can not reach the diagnostic criterion of rachitis, it is still correlated with the deficiency of bone mineralization, in clinical practice, the BGP determination should be used as a means of monitoring the pain of unknown cause. There is significant effect using vitamin D3 in treatment of knee pain of children at night.

ObjectiveTo study the effects of small-dose glucocorticoid (GC) on glucocorticoid receptor (GR) and cellular immune function in critical patients.MethodsForty ICU critical patients admitted in Shanghai Changzheng Hospital from March 2007 to March 2009 were enrolled in the study and were divided into GC group and non-GC group according to the use or absence of GC.Blood samples were collected at days 1,7 and 10 after GC treatment to detect GR binding affinity of mononuclear leukocytes (MNLs) and polymorphonuclear leukocytes (PMLs) in the peripheral blood and the CD4/CD8 ratio in the T lymphocytes.The method of GC use was that the hydrocortisone was given intravenously at a dose of 100 mg every eight hours.ResultsGR binding capacity of MNLs at day 1 and 7 showed no statistical difference between the GC and non-GC groups.GR binding capacity of MNLs in the GC group was lower at day 1 and was much lower at day 7 (P ＜ 0.05 ).However,in the non-GC group,it was lower at day 1,but showed significant improvement at day 7 ( P ＜ 0.05 ).The change of GR binding capacity of PMLs was similar to that of MNLs.There was no significant difference of CD4/CD8 ratio between the GC and non-GC group at day 1.The ratio of CD4/CD8 in the non-GC group was significantly higher than that in the GC group at day 10 (P ＜0.05).CD4/CD8 ratio in the GC group showed a slight reduction at day 10,with no significant difference from that at day 1.While,the non-GC group showed a significant increase of CD4/CD8 ratio at day 10 as compared with that at day 1 (P ＜ 0.05 ).ConclusionLow-dose GC plays some role in the negative feedback regulation of GR binding capacity of peripheral blood leukocytes and in the inhibition of cellular immune function.

Objective To investigate the correlation between the frequency of myeloid-derived suppressor cells (MDSC) and the frequency of regulatory T cells (Treg) in the peripheral blood in patients with chronic hepatitis B (CHB) and its clinical significance.Methods A total of 45 CHB patients including 23 mild-to-moderate CHB patients,22 severe CHB patients,and 15 healthy controls were enrolled.The frequencies of MDSC and Treg in the peripheral blood were studied using flow cytometry and its correlation with clinical data was analyzed by Sepearman correlation analysis.Results The median frequency of MDSC in CHB patients was 0.414％,which was significantly higher than that in healthy controls 0.226％ (Z=-2.356,P=0.018 9).The frequency of MDSC in CHB patients was negatively correlated with the level of alanine transaminase (ALT) and aspartate transaminase (AST) (r=-0.480,-0.478; both P＜0.01),but had no relations with hepatitis B virus (HBV) viral load (r=-0.049,P=0.75).An increase frequency of MDSC was observed in CHB patients with an ALT of 5 × upper limits of normal (ULN) or less or AST of 3 × ULN or less.The frequency of MDSC in CHB patients was positively correlated with that of Treg (r =0.345,P =0.02).Conclusions The activation and proliferation of MDSC may facilitate and maintain HBV persistent infection.The change of the frequency of MDSC is in line with that of Treg,indicating that immunosuppressive functions of MDSC may be related with the development of Treg in CHB.