OBJECTIVE:To evaluate efficacy and safety of caspofungin for non-effect/intolerant to fluconazole in patients with invasive fungal infetion(IFI) in intensive care unit(ICU).METHODS:A retrospective analysis was conducted in 14 IFI patients in ICU who was without effect/intolerant to gluconazole.They were treated with caspofungin in a dose of 70 mg in the first day,and then in a dose 50 mg?d-1 for 3～28 d.RESUITS:Of total 14 cases,2 cases had been diagnosed including 1 case of candidemia albicans and 1 case of pulmonary candidosis glabrata;5 probable cases including 2 cases of pulmonary aspergillus species,2 cases of pulmonary candidosis albicans and 1 cases of pulmonary candidosis parapsilosis;In 7 suspected cases pathogen fungus were not found out.One patient died of respiratory failure at third day of treatment.Clinical efficacy of death case cannot be evaluated.Of total evaluable 13 cases,2 were cured(2/13,15.4%),4 markedly effective cases(4/13,30.8%),2 improved cases(2/13,15.4%) and 5 ineffective cases(5/13,38.5%),the overall effective rate was 46.2%.Caspofungin can be tolerated by all patients during therapy without drug related adverse reaction.CONCLUSION:Caspofungin is certain of efficacy and safety for non-effect/intolerant to fluconazole in IFI patients in ICU,and is the first choice for IFI patients in ICU.

Objective To establish a culture system in vitro of fetal and adult human retinal neural cells provide a model for the basic research of retinal neural cells and the medicinal exploitation. Methods Fetal human retinas(10~13 weeks after conception) and adult human retinas(20~40 years old) were dissected, dissociated, and put into culture plate which was coated with polylysine or rat tail gel. Specific growth factor EGF?FGF? BDNF or NT-4 were added to the culture medium. BrdU incorporation, Tunnel assessment and immuno-histochemistry and immuno-fluorescent staining were applied to determine cells proliferation, apoptosis and identify the component of cultured cells. Results Fetal human retinal cells and adult human retinal cells survived for up to 100 and 180 days in vitro. The addition of EGF?FGF? BDNF or NT-4 promoted the survival of both fetal and adult retinal neurons and stimultated proliferation of fetal retinal cells. The neurons or the rate of ganglion cells was observed with higher percentage in the group with growth factor adding than the group without. Conclusion Fetal and adult human retinal cells can be maintained in vitro and the fetal cells also can be expanded, which are helpful to generate retinal neurons for basic research and drug exploitation. The exogenous growth factors added to the culture medium can promote survival, proliferation and differentiation of retinal cells in culture.

Objective To investigate the experience of diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and nonreflux megaureter (NRM).Methods The retrospective study of UPJO with NRM was based on 10 years information retrieved from January 2005 to December 2015.The data of 13 patients (8 males and 5 females) were available and recorded.Mean age at surgery was 3.7 years old (range 1.8 to 14 years).The diagnosis and mangement were summarized.Coexisting ureterovesical junction obstruction (UVJO) and vesicoureteral reflux,iatrogenic stricture and vesicoureteral reflux were excluded.Intravenous pyelography,voiding cystourethrography,ultrasound and CT reconstruction were performed before operation.Only six patients had an accurate diagnosis as UPJO with UVJO before surgery.Pyeloplasty was the initial surgical management choice for 10 patients,and ureteroneocystostomy in 3 patients.Results UVJO were diagnosed with pyelography techniques in 3 patients after pyeloplasty,while 4 were diagnosed as nonreflux and nonobstruction megaureter.Of the 10 patients who underwent initial pyeloplasty,additional ureteroneocystostomy was required in 3 and the prognosis was good.Additional pyeloplasty was required in 2 of the 3 patients who initially underwent ureteroneoeystostomy.Mean follow-up time from last operation was 23.3 months (6-53 months),the overall prognosis was good.Conclusions It is often difficult to correctly diagnose coexisting UPJO and NRM.In patients with UPJO,it is highly recommended nephrostomy radiography after pyeloplasty to evaluate the distal ureterovesical junction.Initial pyeloplasty is always recommended as first-line therapy.Additional ureteroneocystostomy was required when hydroureteropelvic was aggravated.

A new phenethanol, (2'R)-4-(2', 3'-dihydroxy-3'-methyl-butanoxy)-phenethanol (1), along with other eleven known benzene derivatives (2-12) were isolated from the roots, stems and leaves of Clausena excavata (Rutaceae). Compounds 3 and 4 are new natural products, and compounds 5-8, 10-12 were isolated from C. excavata for the first time. Their structures were elucidated on the basis of MS, 1D and 2D NMR spectroscopic analyses including HSQC, COSY and HMBC experiments. 1 was tested for its cytotoxicities against A549, HeLa and BGC-823 cancer cell lines, and antimicrobial activities against Candida albicans and Staphylococcus aureus. The results showed that 1 did not exhibit cytotoxic and antimicrobial activities.

Objective To discuss the clinical and pathological features of malignant rhabdoid tumor of the ureter (MRTU).Methods One case of MRTU was reported, a six-year-old girl was admitted to our hospital on May 29, 2014, and presented left loin pain 2 weeks, ultrasound showed gradually progressing hydronephrosis and hydroureter.During a physical examination, she felt tenderness in the left kidney area and no mass was palpable in abdomen.The ultrasound showed left sided gross hydroureteronephrosis and a round hyperechogenic mass in the inferior pole of the left ureter (In front of the left iliac vessel), with no obvious borders.Contrast-enhanced CT suggested a gross dilatation of the left kidney and ureter with a solidappearing lesion in the lower ureter;neither additional abdominal abnormalities nor enlarged lymph nodes were seen in both examinations.The surgery began with incision of left lower abdomen.The partial ureter of neoplasm was excised along with invaded psoas and posterior peritoneum by gross inspection, then ureteroureterostomy was performed.The severed ureter was completely blocked with the ill-defined neoplasm and was 3.3 cm in length and 2.1 cm in width.Results The ureteral neoplasm was excised,along with the invaded psoas and posterior peritoneum,after that ureteroureterostomy was performed.HE showed the diffuse large round nuclei, vesicular chromatin, prominent nucleoli cells, and moderate amounts of eccentrically placed eosinophilic cytoplasm.Immunohistochemical studies were positive for cytokeratin, epithelial membrance antigen and vimentin, negative for INI1, METU hereby was confirmed.She underwent a chemotherapy regimen consisting of ICE, alternating with VDC.Four courses chemotherapy (3 months) later,CT scan suggested hematogenous metastasis of lung.The family refused further treatment and the patient died of systemic metastasis eight months after surgery.Conclusion MRTU was a rare and highly aggressive tumor with a poor prognosis.

BACKGROUND: In recent years, the incidence of inflammatory bowel disease is yearly increasing, and there are no effective treatment plans. Mesenchymal stem cells have achieved good outcomes in the treatment of immune-related diseases such as systemic lupus erythematosus, myocardial infarction and graft-versus-host disease. Numerous studies have shown that mesenchymal stem cells have their unique advantages in thetreatment of inflammatory bowel disease. Therefore, increasing concern has been placed on the treatment of inflammatory bowel disease by mesenchymal stem cells. OBJECTIVE: To summarize the existing research on the treatment of inflammatory bowel disease by mesenchymal stem cells, and to discuss its application and safety. METHODS: “Mesenchymal stem cells, inflammatory bowel disease, pathogenesis, treatment” were used as keywords to search CNKI, WanFang and PubMed databases for relevant literatures in the past 20 years both in Chinese and English. Finally, 62 papers were selected for review. RESULTS AND CONCLUSION: Mesenchymal stem cells have the abilities of self-renewal, tissue migration and pluripotency, as well as strong immunomodulatory effects. They not only show satisfying therapeutic effects in systemic lupus erythematosus, myocardial infarction, graft-versus-host disease and other immune-related diseases, but also have promising prospects in inflammatory bowel disease. However, little is reported in clinical studies, and there are still many problems, such as safety, encountered in the treatment of inflammatory bowel disease with mesenchymal stem cells.

Objective To evaluate volume doubling time (VDT) and net mass doubling time of tumor (nMDT) of pulmonary pure ground glass nodules (PGGN) of different pathological types and to investigate whether VDT and nMDT can help to differentiate invasive pulmonary adenocarcinomas from minimally invasive adenocarcinomas and preinvasive lesions.Methods Fifty-one pathologically confirmed pGGNs in 46 patients were retrospectively evaluated,in whom at least two HRCT scans were obtained preoperatively (median scan times,3 times;range,2-6 times) with 1-month or longer follow-up interval (median follow-up interval,251 days;range,30-1 552 days).According to the rechecked results of the postoperative pathological section,51 pGGNs were divided into two groups:group A,invasive adenocarcinoma (IAC),30 pGGNs (58.8％);group B,21 pGGNs (41.2％),including 8 minimally invasive adenocarcinoma (MIA),7 adenocarcinomas in situ (AIS) and 6 atypical adenomatous hyperplasia (AAH).The volume,cumulative percentage of volume growth and VDTs of pGGNs were automatically acquired by Lung VCAR (advantage windows 4.6,GE HealthCare).Subsequently,the mass,cumulative percentage of mass growth and nMDTs of pGGNs were calculated.The count data and measurement data between two groups were compared using Fisher exact probability and Mann-Whitney U test,respectively.A pairwise comparision were performed by using Wilcoxon signed-rank test.Subsequently,the receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of VDT and nMDT for the differential diagnosis of IAC and MIA/AIS/AAH,and calculated the area under the curve (AUC).Results The median VDT and nMDT of 51 pGGNs were 1 854.11 days (range,165.22—+∞ days) and 1 138.45 days (range,95.92—+ ∞ days),respectively.The median nMDT was shorter than the median VDT,and the difference was significant (Z=-2.444,P=-0.O15).The median VDTs of IAC and MIA/AIS/AAH were 847.07 days (165.22—+∞ days) and 4 460.09 days (691.14—+∞ days),respectively.The median nMDTs of IAC,MIA/AIS/AAH were 769.93 days (95.92—+∞ days) and 3814.77 days (611.56—+∞ days),respectively.The median VDT and nMDT of IAC were significantly shorter than those of MIA/AIS/AAH (Z=-3.443,-3.860,P＜ 0.01,respectively).Differentiating IAC from MIA/AIS/AAH,the optimal cutoff value of VDT was 2095.86 days (sensitivity,71.4％;specificity,80.0％),the optimal cutoff value of nMDT was 1 169.77 days (sensitivity,81.0％;specificity,76.7％).Conclusions In pulmonary pGGNs,IAC showed significantly shorter VDT and nMDT than MIA/AIS/AAH.When VDT is shorter than 2 095.86 days or nMDT is shorter than 1 169.77 days,IAC is suggested.

Objective To summarize the experience about the diagnosis and treatment of bladder benign neoplasm in children.Methods A retrospective study was conducted for a total of 15 patients with bladder benign neoplasm from October 2006 to May 2016.There were 10 males and 5 females with a mean age of 8.7 years (ranging 1.1-13.8 years).The clinical manifestations of 15 patients included hematuria in 9 patients,frequent micturition with urgent and painful in 3 patients,dysuria in 1 patient,abdominal pain in 2 patients and headache during voiding in 1 patient.Ultrasound showed solid masses in the bladder with iso-echoic or nonhomogeneously hypoechoic.CT scanning showed regular or irregular mass with some enhancement in the bladder.All cases received tumor complete resection by opening operation and bladders were preserved.Among the 15 cases,neoplasms located in the anterior,posterior and lateral wall of bladder in 9 cases,ureteral orifice in 4 cases and trigone of bladder in 2 cases.The size of tumors ranged from 1.2 to 6.0 cm (mean 3.1 cm).The tumors were unifocal and seemed like papillary or cauliflower.The literatures of benign neoplasm of bladder were reviewed,which focused on the clinic characters,pathological classification and therapeutic method.Results Pathologic type included papilloma in 5 patients,inverted papilloma in 1 patient,inflammatory myofibroblastic tumor in 7 patients,hemangioma in 1 patient,pheochromocytoma in 1 patient.Fifteen patients were followed up for 6 to 36 months,mean 26.7 months.All patients recovered well without relapse or metastasis Conclusions Bladder benign neoplasm in children is rare with many kinds of pathological classification.The major clinical manifestation is gross hematuria while dysuria is unusual.Tumors are fewer in trigone of bladder.The best treatment is to resect the tumor completely with bladder preservation if possible.

Objective To investigate the effect of COX￣2 inhibitor celecoxib on radiosensitity of irradiation￣resistant cell line CNE￣2R of nasopharyngeal carcinoma and the potential mechanism. Methods Via exposing to a series of X￣ray (2, 4, 6, 8 Gy, 3 times for each dose), radio￣resistant cell subline CNE￣2R was established from human nasopharyngeal carcinoma cell CNE￣2.Radiosensitivity was detected by clone formation assay.CNE￣2R and CNE￣2 cell lines were exposed to 25, 50, 75 μmol.L-1 celecoxib, respectively.Western blotting was used to detect the protein expression of COX￣2.Clone formation assay was performed to measure the survival fraction of CNE￣2 and CNE￣2R after radiotherapy alone or radiotherapy combined with 30 μmol.L-1 celecoxib treatment.Flow cytometry was used to measure influence of radiotherapy alone or radiotherapy combined with 30 μmol.L￣1celecoxib treatment on cell apoptosis.Number of residual γ￣H2AX foci was observed by immunofluorescence assay. Results The colony forming assay demonstrated that the values of SF2, D0 , Dq , and N of CNE￣2R cell subline [(0.81±0.05), (2.15±0.07) Gy, (2.94±0.08) Gy, (3.91±0.07), respectively] was significant higher than those of CNE￣2 cell line [(0.61±0.08), (1.47±0.06) Gy, (1. 68 ± 0. 10) Gy, (3. 13 ± 0. 05), respectively]. The expression of COX￣2 protein was significantly downregulated with increasing celecoxib concentration.Surviving fraction was decreased in both CNE￣2 and CNE￣2R cell lines after irradiation.After radiotherapy combined with celecoxib, apoptosis rates of CNE￣2 and CNE￣2R cell lines [(13.10±0.63)%, (5.30±0.75)%] were higher than those of the corresponding control groups [(4.90±0.71)%, (1.82±0.82)%].Celecoxib increased radiosensitivity in nasopharyngeal carcinoma CNE￣2R and CNE￣2 cell lines.The number of residual γ￣H2AX foci after irradiation was increased by celecoxib pretreatment.The difference was statistically significant (P<0.05). Conclusion Celecoxib can enhance radiosensitivity of radio￣resistant cell subline CNE￣2R of human nasopharyngeal carcinoma in vitro.

To cultivate high-quality medical talents,Shanghai Jiao Tong University School of Medicine established a multidisciplinary and comprehensive basic medical practical integration curriculum Medical Functional Experiment.Over several years' exploration and renovation,insisting on student-centered,this course has established a modular experiment teaching system with emphasis on foundation,combina-tion with clinical and focusing on innovation.Integration curriculum adopts four-stage teaching pattern which is suitable for medical students,and implements diversified teaching method and evaluation system.And meanwhile,the paper explores the ideas and approaches to further deepen the construction of teaching staff,expand experimental teaching techniques,strengthen the construction of curriculum materials,and strengthen the cultivation of teachers' innovative ability.