Objective:To study the factors of nickel titanium instrument(NTI)seperation in posterior tooth root canal therapy.Meth-ods:NTIs were used in 1 498 patients with 1 562 involved posterio teeth and 3 518 root canals for RCT from Jun.2009 to May.2012. The relation of instrument seperation(IS)with gender,age,tooth position,working years of the dentists,bending degree of the in-volved tooth canal and the NTI form was analyzed statistically.Results:68 out off 1 198 applied NTIs(5.68%)were seperated in cal-nal preparation.Single factor analysis showed that IS incidence was not statistically different between male and femal(χ2 =0.013,P >0.05),it was statistically different among the patient ages(χ2 =-354.258,P <0.05),between molar and premolar(χ2 =-201.344,P <0.05),among working years of the dentists(χ2 =13.763,P <0.05),bending degree of involved teeth(χ2 =22.414,P <0.05),times of NTI uses(χ2 =16.807,P <0.05),taper of NTIs(χ2 =18.283,P <0.05)and diameter of NTIs(χ2 =21.312,P <0.05).Logistic analysis showed that age,tooth position,working years of dentists,bending degree of involved tooth canal,frequency of NTIs applica-tion and NTI form were independent risk factors for NTI seperation.Conclusion:Dentists should take appropriate technique and stand-ard operation sequence to reduce the incidence of nickel titanium instrument seperation.

Objective To investigate appropriate diagnosis and treatment of solitary fibrous tumor of the pleura (SFTP).Methods Clinical and pathological data of ten patients treated in our hospital from 2002 to 2007 were reviewed. Results Our series consisted of three men and seven women. In two patients correct diagnosis was made before operation through ultrasonography-gnided core needle biopsy. All the patients were treated surgically including three resected by video-assisted thoracic surgery (VATS). Histopathologically, five tumors were malignant and the other five were benign. Immunohistochemical staining showed malignant SFTP (3/5) were less frequently positive for CD34 than benign group (5/5). Nestin was only detected in malignancies (2/5), which were negative for CD34. Except for one, all patients were followed-up for 6 to 35 months (mean 17.3 months). One patient experienced a recurrence and one died of brain metastasis. Conclusion Ultrasonography-guided core needle biopsy combined with immunohistochemical analysis is a safe and rapid method to provide a confirmatory diagnosis before surgery. For smaller, pedunculated tumors, VATS may be a bettor approach. Besides, we speculated CD34-negative and nestin-posifive might be a malignant marker for SFTP.

In order to obtain enough fusion protein for developing preclinical studies of IFNbeta-HAS, we screened Pichia pastoris transformants expressing high-level protein by immunology method. The yield of IFNbeta-HSA was about 500 mg/L by fed-batch fermentation. The purity of IFNbeta-HSA reached 96% through the steps of ultrafiltration, Blue Sepharose FF, Ni2+-IMAC and DEAE Sepharose FF. Analysis of Western blotting showed that IFNbeta-HSA had the antigenicity of IFNbeta and HSA. The specific activity was about 1.96 x 10(7) IU/mg by standard survival activity test on WISH cells challenged with VSV virus. This study provided a method to produce IFNbeta-HSA.
Fermentation ; Humans ; Interferon-beta ; biosynthesis ; genetics ; Pichia ; genetics ; metabolism ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; isolation & purification ; Serum Albumin ; biosynthesis ; genetics

Objective To investigate the role of endothelial bioreacter device in sepsis porcine model.Method Sepsis porcine model was induced gy established endotoxin (LPS,0.25 mg·kg~(-1)) in healthy hybrid swines. The animals were randomly divided(random number) into endothelial bioreactor device group(EBR group) and sham circulation group( Sham group)( n = 6, respectively). After the infusion of endotoxin, extracorporeal circulation was started with the blood flow of 30 mL/min. The blood went through the endothelial bioreactor, then went back to the body via internal jugular vein in the EBR group. The bioreactor with the same size and without endothelial cells(ECs) was used in the sham group. Hemodynamic variables, blood biochemistry, inflammatory markers, Endothelin-1(ET-11) and yon Willebrand Factor(vWF) were examined just before and every hour after the injection. When the survival time of the animals was recorded,the animals were sacrificed to calculate the lung injury score. The time-dependent hemodynamics and cytokine data were compared between groups by repeated measurement ANOVA .Student's t -test was used to analyze the survival time. Results The mean artetial blood pressure (MAP) remarkably decreased in both groups after LPS injection, while the decreasing rate in EBR group was significantly lower than that in control group after 2 hours( P < 0.05). The ET- 1 level in EBR group increased after a slight decrease at the beginning, while that in the sham group went on increasing(P<0.01). The vWF levels increased first, then returned to the baseline in the sixth hour in both groups, while the change in EBR group was significantly less than that in the sham group(P<0.05). The Lung Injury Score in EBR-treated group was significantly lower than that in the sham group(6.1 ± 0.9 vs. 8.2 ± 1. 0, P < 0.05). These physiologic and biochemical alterations were associated with a significant advantage to the survivals in the EBR group when compared with the control sham group(6.7 ± 1.32 vs. 5.2 ± 0.61 h, P < 0.01 ). Conclusions Timely intervention in endotoxin shock with EC therapy by using tissue-engineered bioreactor may improve cardiovascular performance and alter the natural course of this disease process, probably via modulating ioflammation and coagulation cascades.

Objective To evaluate the clinical application of Vater ampulla-duodenal conjunction resection in the treatment of periampullary carcinoma. Methods From January 2005 to July 2006, 15 patients underwent this modus operandi, including carcinoma of duodenal papilla (6 cases), Vater ampulla (5 cases) and lower part of common bile duct (4 cases). The descending part of duodenum, Vater ampulla, head of pancreas and common bile duct were excised en bloc followed by reconstruction of GI conduit. Result One patient died of stress ulcer 2 months postoperatively, the 14 patients recovered uneventfully without any major complications, and 3-16 months follow-up found no tumor recurrence. Conclusion Vater ampulla-duodenal conjunction resection as a new surgical procedure provides enough tumor margin clearance while causing less trauma than standard pancreatoduodenectomy in selected cases of periampullary carcinoma.

Objective To summarize the clinical characteristics and prognosis of subcutaneous panniculitis-like T-cell lymphoma(SPTCL). Methods This study retrospectively analyzed the clinical data of 5 SPTCL patients diagnosed in the First Affiliated Hospital with Nanjing Medical University, and presented with a corresponding literature review. Results Four patients initiated symptoms with rash. Three patients had hepatomegaly and/or splenomegaly, and one was accompanied with hemophagocytic lymphohistiocytosis (HLH). Tumor cells diffusely infiltrated into subcutaneous tissues with hemotoxylin and eosin staining, and rimmed around single adipocyte. The neoplastic cells consistently expressed proteins of CD3, CD43 and CD45RO, and characteristically had the phenotype of CD4- CD8+CD56- T cells which expressed cytotoxic proteins. Two of five patients received DHAP courses as initial treatment, and three patients took the DA-EPOCH recipe. Two patients received autologous stem cell transplantation as second-line treatment. Median overall survival(OS)time was not reached(range 4-107 months), and five-year survival rate was 75 %. While the OS time of patient with HLH was only 10 months. Conclusion Patients with SPTCL own a relatively good prognosis,but those accompanied with HLH have poor outcome.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Fluorodeoxyglucose F18 ; Humans ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; drug therapy ; pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed

肌肉硬度； 竖脊肌； 信度； 康复训练

BACKGROUNDThe anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly. This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.

METHODSFrom April 1984 to July 2012, in Beijing Anzhen Hospital, 23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A. We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation, diagnosis, and treatments of these two kinds of congenital coronary abnormalities.

RESULTSThe 23 patients (13 males and 10 females, aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months, 16 cases) and adult type (age of onset older than 12 months, 7 cases). Four patients were diagnosed with CLMCA-A (three males and one female, aged ranging from 3 months to 2 years). The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection, heart failure, dyspnea, feeding intolerance, diaphoresis, and failure to thrive. And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis, dilated cardiomyopathy, and acute myocardial infarction. As for the adult-type ALCAPA, cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease, myocarditis, or patent ductus arteriosus. In ECG examination: Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I, avL, and V4-V6, especially in lead avL. However, ECG of adult-type ALCAPA lacked distinct features. In chest radiography: pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A, while pulmonary artery segment dilation was more common in adult type. In echocardiography, the common features of infantile-type ALCAPA and CLMCA-A included left ventricular enlargement, left ventricular systolic function normal or mildly reduced in CLMCA-A or significantly reduced in ALCAPA, and moderate to large mitral valve. It was performed in 9 of 23 cases of ALCAPA and showed the origin of the dilated right coronary artery (RCA) from the right sinus of the aortic root and absence of LCA origin in angiography. After opacification of RCA, reverse flow in the LCA and pulmonary artery was visualized through coronary artery collateral circulation. Angio was performed in three of the four cases of CLMCA-A and showed left main coronary artery was a blind end, with diameter of only 1.1-2.0 mm. Treatment and prognosis: 21 patients with ALCAPA had cardiac surgery and 6 of them died postoperatively. Fifteen postoperative patients survived without overt symptoms within the follow-up period of 6-166 months (median 17 months). As for treatment of CLMCA-A, four patients took digoxin and diuretics without undergoing cardiac surgery. Their clinical symptoms improved during the close follow-ups.

CONCLUSIONSALCAPA and CLMCA-A are two rare coronary artery abnormalities that affect cardiac function in infants and children. In younger patients with cardiomegaly and heart dysfunction these two congenital coronary diseases should be noticed.

Adult ; Aged ; Bland White Garland Syndrome ; diagnosis ; pathology ; surgery ; Cardiac Surgical Procedures ; Child ; Child, Preschool ; Coronary Vessel Anomalies ; pathology ; surgery ; Coronary Vessels ; pathology ; surgery ; Echocardiography ; Electrocardiography ; Female ; Humans ; Infant ; Male ; Middle Aged ; Pulmonary Artery ; pathology ; surgery ; Young Adult

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.