Objective To explore the effect and its clinical significance of different dose of glucocorticoids on inflammation mediators in patients with acute exacerbation of chronic obstructive pulmonary diseases.Methods 45 patients admitted to our hospitals from March 2007 to March 2011 were randomly divided into 3 groups:methylprednisolone 40 mg group (methylprednisolone 40mg,iv,qd),methylprednisolone 80 mg group (methylprednisolone 80mg,iv,bid),and control group (without any glucocorticoids).The changes of dyspnea scores,arterial blood gas analysis,clinical symptom scores and serum IL-6,IL-8 and tumor necrosis factor (TNF) levels were detected in patients of each group before and at the 7th day after treatment.The related adverse drug reactions were recorded.Results The improvements in clinical symptom scores,Borg scores,PaCO2,PaO2 after treatment were higher in methylprednisolone 40 mg group and methylprednisolone 80 mg group than in control group (F=3.6747.162 and 42.88,respectively,P＜0.01 or 0.001),and the above improvements was better in methylprednisolone 80 mg group than in methylprednisolone 40 mg group (all P＜0.05).The decreases in levels of serum IL-8,TNF-α,IL-6,C-RP after the treatment were more significant in methylprednisolone 40 mg group and methylprednisolone 80 mg group than in control group (F=12.65,16.17,30.99,respectively,all P＜0.001),and the decrements were more significant in methylprednisolone 80 mg group than in methylprednisolone 40 mg group(all P＜0.05).NO serious adverse drug reactions happened during the course of treatment in the three groups.Conelusions Short-term and moderate dose of glucocorticoid treatment is effective and safe in treating the patients with acute exacerbation of chronic obstructive pulmonary diseases.Methylprednisolone 80 mg injection daily can more obviously improve AECOPD symptoms,and reduce the levels of inflammatory factors better.

Objective To evaluate the clinical performance of CLINITEK Atlas urine dry chemistry analyzer and its supplementary strips,which could be used for other hospitals as reference.Methods Five hundred and one samples of random fresh urine were collected and analyzed by CLINITEK Atlas urine dry chemistry analyzer.10 parameters were reported for each sample,including SG,pH,BLD,LEU,PRO,GLU,KET,UBG,BIL and NIT.According to the medicals standard of the People's Republic of China,General Technical Requirements for Urine Analyzer(YY/T 0475-2004),General Technical Requirements for Chemical Reagent Strips for Urinalysis(YY/T 0478-2004)and physical,Chemical and Microscopic Examination of Urine(WS/T 229-2002),the precision,accuracy,carryover,stability,sensitivity and consistency of each parameter were evaluated.The agreement was assessed between the results for BLD and LEU obtained from CLINITEK Atlas analyzer and phase contrast microscope,and calculated the sensitivity and specificity of CLINITEK Atlas analyzer for BLD and LEU using phase contrast microscope as the gold standard.SG and pH test was performed among 200 specimens by CLINITEK Atlas analyzer,and then compared with the results obtained from MASTER-SUR-NM specific gravity refractometer and pH precision test strips respectively.In addition to SG and pH,the other eight parameters were compared with the results obtained from CLINITEK 500 urine analyzer,and Kappa value and consistency were calculated.Results The accuracy,precision,sensitivity,carryover and stability of 10 parameters could meet all the requirement of standards.SG and pH had good correlation with urine specific gravity refractometer (r =0.9838,P ＜0.001)and pH meter (r =0.8884,P ＜0.001),respectively.Compared with phase contrast microscope,BLD and LEU had coincidence rates of 90.4％ and 90.8％,respectively; Sensitivities were 90.7％ (301/332) and 83.3％ (200/240) ; Specificities were 89.9％ (152/169) and 97.1％ (255/261).Compared with CLINITEK 500,all the parameters,except for SG and pH,had good coincidence rates of ＞ 87.6％.Conclusion The performance of CLINITEK Atlas urine dry chemistry analyzer can meet the clinical requirements of all standards.

Objective To investigate the safety and efficiency of China-made stent in patients with acute myocardial infarction(AMI).Methods Thirty-six patients with AMI were enrolled in our study,with mean age(57?9.7)years old.China-made stent were implanted successfully.Eighteen patients had acute anterior myocardial infarction,14 had acute inferior myocardial infarction,2 had acute lateral myocardial infarction,2 had acute posterior accompanied with right ventricular myocardial infarction.There were 12 patients with diabetes,20 patients with hypertension,18 patients with smoking.Results Thirty-seven China-made stents were implanted in the 36 patients.There were no complications during the procedure.All have acquired TIMI 3 flow.There were no thrombosis in the stent in 20 patients at the 7-day following up.Conclusion It is safe and efficient with the China-made stent implanted in patients with acute myocardial infarction.

Objective To investigate pathological characteristics and differential diagnosis of desmoplastic melanocytic nevus.Methods Four cases of desmoplastic melanocytic nevus were analyzed based on the clinical manifestations and histological,immunohistochemical and fluorescence in situ hybridization (FISH) features.Results Of the 4 cases,2 were male and 2 were female.Their age ranged from 19 to 30 years with the average age being 26.5 years.The skin lesions were located on the extremities in 3 cases,on the vulva in 1 case.Histologically,the lesions were bilaterally symmetrical intradermal nevus.Nevus cells appeared epithelioid and/or fusiform,some were clustered or scattered in the proliferative fibrous tissue.None of lymphocyte aggregation,necrosis or ulceration was observed.Immunohistochemical examination showed positive staining for S100 and Melan A in 3 cases,positive staining for P16 in 2 cases,Ki-67-1abeling index less than 5％ in all the 4 cases,and negative staining for factor XⅢ (FXⅢ) and CD34 in 2 cases.FISH assay showed no copy-number variations in gene loci 6p25 (RREB1),6q23 (MYB),6p11.1-q11.1 (Cep6) and 11q13 (CCND1) in desmoplastic nelanocytic nevus.Conclusion Desmoplastic melanocytic nevus is a kind of histologically unique,benign melanocytic nevus,and immunohistochemical staining for Ki-67,S-100,Melan A and FXmand FISH assay on melanoma can be helpful for the differential diagnosis between cutaneous fibrous histiocytoma and melanoma.

ObjectiveTo elucidate the association between aquaporins (AQPs) expression in kidney tissue and edema of nephrotic syndrome(NS) patients.MethodsNS patients were divided into edema group (14 cases) and non-edema group (8 cases).Ten patients without NS were used as control group.Expressions of AQP1,AQP2,and AQP4 in renal tissues of 3 groups were detectedbyimmunohistochemistrywithstandardtechniquesandsemi-quantitativeanalysis.Association between AQPs expression and edema was examined.ResultsThe positive index of AQP1 expression in proximal tubules in edema group was 0.0373±0.0110,which was significantly lower as compared to non-edema group (0.0510±0.0120) and control group 0.0574±0.0100),while the difference between non-edema and control groups was not significant.The positive index of AQP1 expression in glomerulus was 0.0106±0.0037 in edema group,which was significantly higher than that in non-edema group(0.0021±0.0013) and control group(0.0020±0.0012),while no significant difference was found between the last two groups.AQP2 mainly localized in the collecting duct system.The positive indexes of AQP2 expression were 0.0498±0.0081,0.0370± 0.0072 and 0.0255±0.0103 in edema group,non-edema group and control group,respectively.The differences were significant among 3 groups.AQP4 expression was not found in the renal cortex and collecting duct system.ConclusionsAQPs expression is different in renal tissues of NS patients.AQP2 may play an important role in the edema of NS patients,and AQP1 may involve in the occurrence of edema.

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population.Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai,respectively.Based on the over-60-year old people health examination program,6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated.The prevalence of CKD in urban and rural areas was compared,and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis.Results (1) The survey objectives with an average age of (69.57+7.04) years,including 4345 cases of the city residents and 1806 cases of rural residents,were enrolled.The age structures of urban and rural showed differences,population over 80 years old account for 13.1％ of the rural total,significantly higher than 7.4％ in the urban population (P ＜ 0.001).(2) The prevalence rates of diabetes,hyperuricemia,hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents,which were 26.4％ vs 13.7％,9.9％ vs 2.3％,53.7％ vs 37.4％,51.4％ vs 15.6％ (all P＜ 0.01).The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas,which were 32.9％ vs 44.2％,84.6％ vs 62.8％ (all P ＜ 0.01).Compared with those in rural areas,the treatment rates of hypertension and high blood lipids in urban residents were increased (all P ＜ 0.01).(3) The prevalence of CKD was 23.4％.Female CKD prevalence was higher than male,respectively 26.3％ and 18.5％ (P ＜ 0.01).In urban CKD prevalence was 22.2％,lower than 25.2％ in rural.The prevalence rate of hematuria in urban areas was lower than in rural areas,but the prevalence rate of decline in renal function was higher (all P ＜ 0.05).With the increase of age,the prevalence rate of CKD was increased (P ＜ 0.01).(4) Age (OR=1.072),smoking history (OR=1.543),previous history of kidney disease (OR=1.351),diabetes (OR=1.373),hyperuricemia (OR=2.498),obesity (OR=1.364),history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population,while the higher education (OR=0.676,OR=0.604) and drinking (OR=0.585) had negative correlation (all P ＜ 0.05).Age (OR=1.032),female (OR=1.860) had positive correlation with CKD in rural elderly population (all P ＜ 0.05).Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district.The prevalence of CKD is higher in urban areas than in rural.Age is a common factor for CKD in urban and rural.Previous smoking,history of kidney disease,diabetes,hyperuricemia,obesity,history of interventional therapy,education and drinking have correlation with urban CKD patients.Female has correlation with rural CKD population.

Objective: To investigate the relationship between serum HGF levels and clinical severity of essential hypertension (EH). Methods: The serum HGF concentrations of 44 patients with EH were measur ed by ELISA. Results: The serum HGF levels in patients with EH w ere higher than that in control. Furthermore, the serum HGF levels of EH patient s with coronary atherosclerosis (CAS) were significantly higher than those of EH patients without CAS ［(920.8±250.0） pg/ml vs （747.9±132.1） pg/ml, P <0.01］ or control ［（643.8±98.2） pg/ml, P<0.01)］.The changes of HGF l evel were correlated with the clinical courses (r=0.63, P<0.01) and stag es (r=0.69, P<0.01) of hypertension. Conclusion: HGF may be considered as a new index for the severity of hypertension and an useful bio chemical parameter for estimating the development of atherosclerosis.

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

Objective To study the influence of different microembolism on left ventricular systolic synchronism in pigs by detecting the real-time dypyridamole stress contrast echocardiography (RT-MCE).Methods Eighteen miniature pigs were randomly divided into three groups and underwent microembolization injection procedure through the middle of anterior descending coronary artery with different numbers of microsphere injection,as:group A(dosage 50 thousands,3 pigs),group B (dosage 120 thousands,8 pigs) and group C (dosage 150 thousands,7 pigs).The peak values and the time-to-peak circumferential strain(Circ.Strain),radial velocity (Radial Vel.) and radial strain (Radial Strain) were obtained both at mitral valve level and papillary muscle level at left ventricle short axis views using two-dimensional speckle tracking imaging(STI)analyzed by Philips Q-Lab 8.1 workshop,respectively.Results No significant difference in the presence of contraction synchrony was observed using RT-MCE.The time-to-peak Circ.Strain of microembolism related segments were prolonged at 1 week after microembolism detecting with dypyridamole stress RT-MCE (P＜0.05,both intro-group and inter-group).While time-to-peak radial strain were extended since 6 hours after the intervention to 1 week after the procedure.Conclusions Dypyridamole stress RT-MCE can be used to measure the myocardial perfusion accurately.The elongation of time-to-peak circ.strain and radial strain were developed with time in microembolism related segments.

Objective To assess the effect of ultrasound contrast agent SonoVue on the dimensions and systolic function of left and right ventricle in pigs. Methods Sixteen pigs were randomly assigned to two groups. Intravenous injection of 1 ml of SonoVue were given in study group, and repeated 20 min later. The control group was given the same doses of saline. Before and after the administration of contrast agent, the end-diastolic dimension (LVEDD, RVEDD). end-systolic dimension ( LVESD, RVESD) and fractional shortening(LVFS,RVFS) of left and right ventricle were measured. The time to reach the extreme value of these parameters and the time to return to the baseline were recorded. Results There was no significant difference regarding the parameters at baseline between the two groups. After injection of SonoVue,RVEDD significantly increased from (25. 88 ± 1. 38) mm at baseline to its maximum of (33. 26 ± 0. 99)mm( P < 0. 05). Accordingly,RVFS significantly increased from (26. 90 ± 1. 92) % to (33. 92 ± 2. 53) % ( P <0. 05). Meanwhile,LVEDD remarkably decreased from (38.10 ± 1. 39)mm at baseline to its minimum of (26.25 ± 0. 65)mm( P <0. 05) and LVFS remarkably decreased from (36. 24 ± 1. 93) % to (29.13 ± 3.00) % ( P < 0. 05). There was no change in the control group after administration of the saline. When SonoVue was given repeatedly, the maximum RVEDD and RVFS was (29. 98 ± 1. 23) mm and (31. 09 + 1.90) % , respectively, which had less increase compared to the first time. Minimum LVEDD and LVFS was (31. 91 ± 1, 64)mm and (32. 17 ± 2. 31)%,respectively,with less decrease compared with which at first injection. It took (10. 15±0. 59) min for the right and left ventricle to reach the extreme value and (9.00± 0. 56) min to return to the baseline at the first injection. The time used for the right and left ventricle to reach its peak change and back to baseline after second injection of SonoVue were shorter [(8.73± 0.55) min and (6.89± 0.43) min, respectively,both P <0.05]. Conclusions Administration of SonoVue was associated with acute, transient dilation of right ventricle and compression of left ventricle. The influence of SonoVue on the right and left ventricle became less at it second injection.