Objective To research the risk of osteopo'rotic vertebral fractures with PKP after the PMMA injected location and dose of occurrence of vertebral refracture.Methods 78 cases of vertebral osteoporotic thoracolumbar vertebral compression fracture patients with PKP treatmentin were selected.According to position of postoperative PMMA in the vertebral body,they were divided into the side of the group of 35 patients and a median group of 43 patients.Compared two groups of patients before and after surgery,VAS,ODI score,the SI and Cobb angle and analyzed the PMMA leakage occur with the relationship of the amount of bone cement injected.Results There were significant differences in visual analogue pain scale(VAS),Oswestry disability index(ODI),sagittal index(SI) and Cobb angle of each group preoperatively versuspostoperatively (all P ＜ 0.05).No statistical difference was noted in the VAS,ODI,SI and Cobb angle between two groups preoperatively versus postoperatively(all P ＞ 0.05).PMMA injection volume between the the leakage group and the non-leakage patients had statistically significant difference (P ＜ 0.05).Conclusion PKP could obtain better clinical therapeutic effect in osteoporotic vertebral fractures treatment.Different PMMA positions had no significant influence on the therapeutic results.PMMA injected dose is a risk factor for bone cement leakage,which will increase the risk of vertebral fractures again.

Objective To investigate the role of p38 MAPK on gastric ischemia/reperfusion (I/R)-induced injury in mice. Methods C57BL/6 mice were randomly divided into three groups; sham+vehicle group, I/R+vehicle group (as control), and I/R+ CNI-1493 group. The gastric I-R injury mice were prepared by occluding the celiac artery for 30 min followed by reperfusion for 1 h. Sham-operated animals underwent the same surgical procedure without clamping. Physiological saline (0.9% NaCl, 10 ml/kg) or CNI-1493(a p38 MAPK inhibitor, 10 ml/kg, 2 mg/ml) was intraperitoneally administered 1 h before ischemia. A picture of the whole stomach was obtained after fixation with formalin, and the bleeding area in the whole stomach was obtained by a digital imaging analyzer (Image J 1. 4. NIH). The levels of phospho- and total-mitogen-activated protein kinases (MAPKs including p38, JNK, and ERK), phospho-nuclear factor-κB (NF-KB) and cleaved Caspase-3 in the injured stomach tissue were determined by Western blotting analysis. Results Compared with sham+vehicle group, I/R group had markedly larger gastric bleeding area (P < 0.05), activated p38, JNK, and ERK (P <0.05), and markedly increased NF-κB p65 and cleaved Caspase-3 expression (P <0.05). Pretreatment with CNI-1493 significantly inhibited the above changes in 1/R group (P < 0. 05). Conclusion Activation of MAPK/NF-KB pathway play a very important role in I/R-induced gastric injury. Pretreatment with p38 MAPK inhibitor, CNI-1493, can inhibit MAPK/NF-κB pathway, decrease expression of apoptosis protein expression, and reduce gastric mucosal bleeding.

ObjectiveTo improve the long term outcomes of the surgery for Stafford type A aorticdissection, we performed ascending aorta and total aortic arch replacement combined with transaorticstented graft implantation into the descending aorta for acute type A aortic dissection.MethodsFrom May 2005 to February 2011,36 consecutive patients with acute Stanford type A aorticdissection underwent this procedure.Right axillary artery cannulation was routinely used forcardiopulmonary bypass and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10 cm long selfexpandable graft.34 patients were followed up for 2 ～36 months.ResultsCardiopulmonary bypass time was (160 ± 31)min, average cross clamp time was (101 ±26)min, and average selective cerebral perfusion and lower body arrest time was (31 ± 16)min.The in-hospital mortality was 5.5％ (2/36).One patient died of multi-organ failure postoperatively and another died of cerebral infarction 9 day after surgery.No one suffered from spinal cord injury perioperatively.There was no late death during follow up.ConclusionsAscendingaorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to better long term outcomes of type A aortic dissection.

The study was aimed to detect the expressions of costimulatory molecules on CD3(+)CD4(+) T cells so as to accumulate informations for investigation of mechanism of myelodysplastic syndrome. 11 healthy blood donors as control and 38 patients with MDS de novo were studied. 38 MDS patients were divided into RA/RARS group and RAEB/RAEB-t group according to FAB classification. The expressions of CD28, CD154, CTLA-4, PD-1, CD25 on CD3(+)CD4(+) T cells in peripheral blood were detected by FCM. The results indicated that as compared with normal controls, the expression of CD28 in MDS patients decreased, and CD154 increased. The percentages of CTLA-4, PD-1 and CD25 in MDS were obviously higher than that in normal controls; the differences of CTLA-4, PD-1 and the ratio of CTLA-4/CD28 between RAEB/RAEB-t and RA/RARS were more significant with progressing of MDS. In conclusion, the expressions of costimulatory molecule in MDS patients were abnormal, which may be involved in the pathogenesis of MDS.
Adult ; Antigens, CD ; metabolism ; Apoptosis Regulatory Proteins ; metabolism ; CD28 Antigens ; metabolism ; CD40 Ligand ; metabolism ; CTLA-4 Antigen ; Case-Control Studies ; Female ; Humans ; Interleukin-2 Receptor alpha Subunit ; metabolism ; Lymphocyte Count ; Male ; Middle Aged ; Myelodysplastic Syndromes ; immunology ; metabolism ; Programmed Cell Death 1 Receptor ; T-Lymphocytes ; immunology ; metabolism ; Young Adult

OBJECTIVETo investigate the incidence, pathogens, and clinical features of infection in consecutive cases from 2010 to 2012 in Peking Union Medical College Hospital.

METHODThe incidence, pathogen, treatment, and outcomes of patients with hematological diseases who had positive findings of bacterium in their samples from 2010 to 2012 were retrospectively analyzed.

RESULTSThere were 449 positive samples (5.8%) from 4 890 patients during this period, among which 388 were proved to be with pathogenic bacteria. Samples separated from patients with community-aquired infections accounted for 8.4% of all positive samples. Most community-aquired infections were caused by Gram-negative bacteria (75%), although no multidrug-resistant bacteria was observed. Samples separated from patients with nosocomial infections accounted for 91.6% of all positive samples. Respiratory tract (49.4%) and peripheral blood (32.6%) were the most common samples with positive results. Skin soft tissues (10.4%), and urine (3.7%) were less common samples. Most of the pathogenic bacteria of the nosocomial infections were Gram-negative (66.9%). The most common Gram-negative bacteria included Escherichia coli (13.8%), Pseudomonas aeruginosa (12.1%), and Klebsiella pneumonia (12.1%), while Staphylococcus aureus (10.4%), Enterococcus faecium (7.0%), and Staphylococcus epidermidis (5.1%) were the most common Gram-positive bacteria. Gram-negative bacteria consisted of most of sputum samples and peripheral blood samples. Samples from the surface of skin wound and anal swab were composed largely by Gram-positive bacteria (63.8%). The detection rates of extended-spectrum beta-lactamase-producing Klebsiella pneumonia/Klebsiella oxytoca, Escherichia coli, and Proteus mirabilis were 24.0%, 87.9% and 38.4%, respectively. The resistance to Acinetobacter baumannii was serious. Multidrug-resistant, extensive drug resistant and pan drug resistant A. baumannii acountted for 74% of all A. Baumannii infections. Stenotrophomonas maltophilia showed low resistance to sulfamethoxazole/trimethoprim, levofloxacin and minocycline. Also, 22 methicillin-resistant Staphylococcus aureus and 9 methicillin-resistant Staphylococcus Epidermidis were detected, which were only sensitive to vancomycin, teicoplanin, and linezolid. All patients were treated in the haematology wards and most of them were under agranulocytosis or immunosuppression. Finally, 22 patients reached clinical recovery through anti-infective therapy, whereas 49 patients died. Among those deaths, 42 patients attributed to severe infections and infection-associated complications. Fourteen of all the deaths might be infected with drug-resistance bacteria. There were 61 samples proved to be bacteria colonization. Nonfermenters such as Acinetobacter baumannii and Stenotrophomonas maltophilia made up for a large amount of bacteria colonization.

CONCLUSIONSThe pathogens of nosocomial infections in the hematology ward are mainly Gram-negative bacteria. The incidences and pathogens vary from different infection sites. Nosocomial infection still has a higher mortality rate. Once nonfermenters are detected positive, the pathogenic or colonial bacteria should be distinguished.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteria ; isolation & purification ; Bone Marrow Transplantation ; Cross Infection ; microbiology ; Female ; Hematologic Diseases ; complications ; microbiology ; Hematology ; Hospital Departments ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult