Objective To investigate the clinical significance of soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-1β(IL-1β) in pregnant women with chorioamnionitis. Methods The levels of sICAM-1, IL-1β,CRP and WBC were detected by enzyme linked immunosorbent assay in maternal serum of 56 pregnant women with PPROM and 38 pregnant women with PROM. Every embryolemma was histopathologically confirmed after deliver-y. Results Chorioamnionitis in PPROM was more than that in PROM of full term(P<0.05). The serum levels of sI-CAM-1, IL-1β, CRP and WBC in chorioamnionitis in pregnant women were higher than those in non-chorioamnionitis (P <0.05). The serum levels of sICAM-1 was more sensitive and specific than those of CRP and WBC. The serum levels of IL-1β was more sensitive than those of CRP and WBC, but their specificity was similar. Conclusion The levels of sICAM-1 and IL-1β in maternal serum are good clinical biological markers for predicting chorioamnionitis in pregnant women.

OBJECTIVE To analyze the risk factors and the drug-resistance of nosocomial acquired lung infection by Chryseobacterium meningosepticum.METHODS A retrospective investigation of the clinical correlative data and the drug sensitivity results of 60 cases with nosocomial acquired lung infection by C.meningosepticum from Jan 2004 to Jan 2006 was conducted in local hospital.RESULTS The patients were mainly distributed at ICU,respiration and neurosurgery wards.They had severe underlying diseases(100.0%),tracheal intubation(56.7%),central venous catheter(25.0%) and urine catheter(16.7%) treatments and applications of more than three antibiotics(68.3%).The drug-resistance of C.meningosepticum was serious.The antibiotic drugs which had higher susceptibility ratio were cefoperazone/sulbactam,fluoroquinolones,et al.CONCLUSIONS The main risk factors of nosocomial acquired lung infection by C.meningosepticum are severe underlying diseases,various invasive treatments,long-term hospitalization and inappropriate use of broad spectrum antibiotics.Clinical isolates are multi-drug resistant to many kinds of antibiotics.

Objective To evaluate the effect of dexmedetomidine on brain injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes, aged 18-64 yr, with body surface area of 1.6-2.0 m2, with left ventricular ejection fraction＞30％, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ), scheduled for elective cardiac surgery with CPB, were equally and randomly divided into control group (group C) and dexmedetomidine group (group D) using a random number table.Before induction of anesthesia, dexmedetomidine was given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery in group D, and the equal volume of normal saline was given in group C.After induction and before skin incision (T0) , at 30 min after beginning of CBP (T1) , at 30 min after the end of CBP (T2) , at the end of surgery (T3) , and at 24 and 72 h after surgery (T4.5) , blood samples from jugular bulb were drawn for determination of serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-10, S-100β protein and neuron-specific enolase (NSE).Results Compared with group C, the serum concentrations of TNF-α and S100β at T1-3 and IL-6 and NSE at T1.4 were significantly decreased, and the serum concentrations of IL-10 at T1-4 were increased in group D (P＜0.05).Conclusion Dexmedetomidine given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery can reduce the brain injury in the patients undergoing cardiac surgery with CPB, and the mechanism is related to inhibited inflammatory responses.

OBJECTIVE To investigate the profile of pathogen of infection in kidney disease patients. METHODS Pathogen of infection in kidney disease patients in our hospital from Jan 2004 to Feb 2006 was retrospectively investigated. RESULTS A total of 240 pathogen strains were isolated from 223 cases.Of the 240 isolated strains the rate of strains of Gram-negative bacilli was 55.4%,that of the Gram-positive cocci was 26.3%,the rate of fungi was 10.0% and that of the Gram-positive bacilli was 8.3%.The positive rate of Escherichia coli was the highest followed by Haemophilus influenzae.54.2% Of isolates were from urine,21.3% from sputum.The isolated pathogens resisted at different degrees to antibiotics which were used frequently in clinic.The rate of polyinfection was not high. CONCLUSIONS Pathogen of infection in kidney disease patients is mainly Enterobacteriaceae.The isolates mainly are E.coli which is multi-resistant.It mainly causes the urinary infections.

Objective To investigate the effects of autologous blood withdrawal-reinfusion on the perioperative coagulation function in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB ) . Methods Eighty-four ASA physical status Ⅱ-Ⅳ patients ,without impairment of coagulation function ,scheduled for cardiac surgery with CPB ,were equally and randomly divided into 2 groups using a random number table :autologous blood withdrawal-reinfusion group (group ABWR , n= 44 ) and control group (group C , n= 40 ) . Decreased coagulation function was diagnosed based on the following two criteria :laboratory standard of decreased coagulation function and clinical signs .After anesthesia and before the beginning of operation (T1 ) ,at 5 min after heparin was reversed with protamine (T2 ) ,at the end of operation (T3 ) and at 24 h after the end of operation (T4 ) ,venous blood samples were obtained to measure the blood routine and parameters of coagulation function . Blood routine included the red blood cell (RBC ) , hemoglobin (Hb ) , hematocrit (Hct ) , platelet count , and plasma fibrinogen concentration (Fib) .The parameters of coagulation function included thrombelastography (TEG) variables and prothrombin time (PT ) ,activated partial thromboplastin time (APTT ) ,international normalized ratio (INR ) , and activated clotting time (ACT ) . The volume of intraoperative blood loss , amount of mediastinal drainage at 6 and 24 h after operation , consumption of tranexamic acid and heparin during operation , and consumption of fibrinogen after operation ,and requirement for transfusion of allogeneic RBCs ,fresh frozen plasma (FFP) and platelet during operation and within 24 h after operation were recorded .The development of decreased coagulation function during operation and within 24 h after operation .Results Compared with group C , perioperative consumption of allogeneic RBCs were decreased ,reaction time (R) measured by celite-activated TEG was increased at T3 (P<0.05) ,and no significant change was found in the blood routine index ,incidence of decreased coagulation function ,volume of intraoperative blood loss ,amount of mediastinal drainage ,consumption of tranexamic acid and heparin , and postoperative consumption of fibrinogen in group ABWR ( P> 0.05 ) . Conclusion Autologous blood withdrawal-reinfusion provides similar effects on coagulation function with allogeneic blood transfusion ,and does not increase the development of decreased coagulation function in patients undergoing cardiac surgery with CPB .

Objective To monitor the clinical epidemiology and etiology of acute diarrhea in children in the outpatient setting in Shanghai .Methods An active surveillance study in Children′s Hospital of Fudan University between August 2013 and July 2014 was conducted .Outpatient children with acute diarrhea were enrolled in this study and stool samples were collected .Pathogens including norovirus ,diarrheagenic Escherichia coli (DEC) , nontyphoidal Salmonella spp .(NTS),Campylobacter,Shigella,pathogenic vibrio and Yersinia enterocolitica were identified and typed .The χ2 test was used for statistical analysis .Results Of the 881 stool samples from enrolled children , the pathogens included into the target detection were identified in 246 (27 .92% ) cases . Norovirus ,DEC ,NTS ,Campylobacter and Shigella were detected in 98 (11 .12% ) cases ,74 (8 .40% ) cases , 61 (6 .92% ) cases ,34 (3 .86% ) cases and 2 (0 .23% ) cases ,respectively .Neither pathogenic vibrio nor Yersinia enterocolitica was identified .Children younger than 36 months old (3 .27% ,26/794) had a lower risk (χ2=7 .41 ,P=0 .006) of Campylobacter infection compared with older children (9 .20% ,8/87) .Vomiting (37 .76% ) and watery diarrhea (21 .34% ) were more commonly seen in children with norovirus infection;fever and mucous stool were commonly seen in diarrheal children with NTS infection (40 .98% and 21 .31% ,respectively) and Campylobacter infection (29 .41% and 26 .47% ,respectively) .Conclusion Enteric pathogens play a major role in childhood acute diarrhea in Shanghai .Continuous monitoring of enteric pathogens will be helpful for reasonable treatment and prevention of acute diarrhea in children .

OBJECTIVETo evaluate the value of cone-beam CT (CBCT) in the diagnosis and orientation of supernumerary teeth in the anterior maxilla.

METHODS195 supernumerary teeth in the anterior maxilla of 146 patients were included, which were examined by CBCT. The number, shape, size, 3-dimensional position, growth direction of the supernumeraries and their relationship with the neighboring teeth were analyzed.

RESULTSThe 146 patients aged from 5 to 39, and males were affected more than females in a ratio of 2.95:1. 102 (69.9%) patients had single supernumerary teeth. Of the 195 supernumerary teeth, 126 (64.6%) were near the middle line, 131 (67.2%) were conical, 51 (26.2%) were curved root, 98 (50.3%) were inverted and had a length of (11.97 +/- 2.40) mm. The supernumerary teeth often caused complications.

CONCLUSIONThe position of the supernumerary teeth is varied in the maxilla, and often causes permanent dentition complications. CBCT imaging yields accurate 3-dimensional pictures of supernumerary teeth, local dental and bony structures, which is helpful for diagnosis and orientation of supernumerary teeth.

Adolescent ; Adult ; Child ; Child, Preschool ; Cone-Beam Computed Tomography ; Female ; Humans ; Male ; Maxilla ; Tooth Root ; Tooth, Supernumerary ; Young Adult

OBJECTIVETo investigate the gene expression of 4-1BB in peripheral blood mononuclear cells (PBMCs) and the possible significance of the 4-1BB pathway after clinical orthotopic liver transplantation (OLT).

METHODS4-1BB mRNA levels in PBMCs from 22 OLT patients were analyzed by RT-PCR. 4-1BB protein expressed on the surface of CD(4)(+) and CD(8)(+) T cells were detected by flow cytometry, and visualized with direct immunofluorescence and confocal fluorescence microscopy. Patients with primary liver cancer (PLC) and healthy volunteers served as controls. Six cases of recently performed liver transplantation were also observed in this study.

RESULTS4-1BB mRNA was detected in PBMCs from both liver transplant patients with long-term graft acceptance (22 cases) and from transplant patients on day 1 to day 3 post-transplantation (6 cases), but was not found in PBMCs from transplant patients on day 7 to day 30 post-transplantation (6 cases). 4-1BB mRNA was also not found in samples from 8 of the healthy controls and 7 of the PLC patients, though very low expression was detected in the other 4 healthy volunteers and 6 PLC patients. Simultaneously, 4-1BB protein was expressed at nearly undetectable levels on CD(4)(+) and CD(8)(+) T cells from healthy controls, PLC patients, as well as OLT patients within the first month post-transplantation (6 cases). However, 4-1BB expression was found on the surface of CD(4)(+) and CD(8)(+) T cells from liver transplant patients with long-term graft acceptance. Direct immunofluorescent staining and confocal fluorescence microscopy clearly revealed evidence of 4-1BB protein on cell membranes of CD(4)(+) and CD(8)(+) T cells from liver transplant patients with long-term graft acceptance. Simultaneously, a significantly higher percentage of CD(3)(+) CD(25)(+) T cells were found in liver transplant patients with long-term graft acceptance group as compared with the healthy control group (P < 0.05). The expression of 4-1BB protein on T cells did not correlate with the survival time of OLT patients postoperation.

CONCLUSIONSThis study demonstrates that although patients remain in stable condition after liver transplantation under the treatment of immunosuppressants, activated T cells are present to some extent and 4-1BB protein may be involved in this process. Effector T-cells can exert permanent immunoresponses against grafts under these circumstances. Therefore, we conclude that a new immune response balance is established under the combination of both treatment with immunosuppressants and natural immune responses against alloantigens. Manipulation of the 4-1BB/4-1BBL pathway may provide a therapeutic technique for prolonging graft survival.

Adult ; Antigens, CD ; Female ; Gene Expression ; Humans ; Leukocytes, Mononuclear ; chemistry ; Liver Transplantation ; Male ; Middle Aged ; Receptors, Nerve Growth Factor ; genetics ; physiology ; Receptors, Tumor Necrosis Factor ; genetics ; physiology ; Tumor Necrosis Factor Receptor Superfamily, Member 9

Objective we assessed our institutional outcomes of hybrid treatment for aortic arch disease with supra-aortic debranching and endovascular stent graft repair.Methods From March 2016 to November 2016,6 patients underwent Hybrid total aortic arch repair:1 had aortic arch pseudoaneurysm;1 had type Ⅲ aortic dissection;4 had aortic arch aneurysm because of hypotension,of whom 1 with aneurysm prerupture and 1 with Aortic intramural hematoma.Supra-aortic vessels were involved and high-risk for traditional operations in all patients.Bifurcated artificial vessels were used,main vessel was end-to-side anastomosed with ascending aorta.Branching vessel were end-to-end anastomosed with right innominate artery and left subclavian artery,end-to-side anastomosed with left common carotid artery.Then,stent graft was implanted into ascending aorta and aortic arch.All patients were followed postoperatively,with regularly contrast computed tomography angiogram (CTA) and echocardiography(discharge,three months,six months,and yearly).Results Hybrid procedure with supra-aortic debranching and endovascular stent graft repair were completed in all patients,technical success rate was 100％.There were no perioperative obvious morbidity and mortality,follow-up period were 2-9 months.1 patients had stroke during follow-up period,condition improved after treatment.Supra-aortic vessels were patency and there were no endoleak in all patients.There were no recurrent aortic disease during follow-up period.Conclusion Hybrid aortic arch replacement can be performed with good postoperative and early results in high-risk patients for traditional open repair.

Objective To evaluate the effect of dexmedetomidine (DEX) on inflammatory responses in patients performed cardiac surgery with cardiopulmonary bypass (CPB) at perioperative period,and explore the influencing factors of postoperative cognitive dysfunction (POCD) in these patients.Methods Eighty patients scheduled for cardiac surgery with CPB at hospital from July 2013 to June 2014 were randomized into control group and DEX group (n=40).Before induction of anesthesia,DEX was administered to the patients from DEX group with a loading dose of 1 μg/kg followed by maintenance dose of 0.5 μg/ (kg·h),while the same dose of normal saline was administered to patients from control group.Before incision (T0),30 min after beginning of CBP (T1),30 min after end of CBP (T2),end of surgery (T3),24 h after end of surgery (T4) and 72 h after end of surgery (T5),venous blood samples from jugular bulb catheters were drawn,and serum concentrations of tumor necrosis factor α (TNF-αt),interleukin (IL)-6 and IL-10 were determined.One d before operation,3nd,7th,90th and 180th day after operation,the cognitive functions of patients were tested with mini-mental state examination (MMSE),digit span subtest (DSpan),digit symbol subtest (DSy) and trail making test (TMT).The DSpan contained digit span forward subtest (DSpan-F) and digit span reverse subtest (DSpan-R).Results The serum concentrations of TNF-α,IL-6 and IL-10 in two groups at T1,T2 and T3 were significantly higher than those at T0 (P＜0.05);the serum concentrations of TNF-α and IL-6 in DEX group were significantly lower than those in control group (P＜0.05),while that of IL-10 in DEX group was significantly higher than that in control group (P＜0.05).In the control group,all results excepted for TMT on the 3nd d after operation,MMSE and DSpan-R results on the 7th d after operation,and DSpan-R results on the 90th d after operation were significantly lower than those results one d before operation (P＜0.05);in the DEX group,MMSE and DSpan-R results on the 3nd d after operation were significantly lower than those results one d before operation (P＜0.05);MMSE and DSpan-R results on the 3nd and 7th d after operation,and DSpan-R results on the 90th d after operation in the DEX group were significantly higher than those in the control group (P＜0.05);TMT on the 3nd after operation in the DEX group was significantly lower than that in the control group (P＜0.05).The incidence rate of POCD in the DEX group on the 3nd and 7th d after operation (23.5％ and 14.7％) was significantly lower than that in the control group (46.9％ and 37.5％,P＜0.05).Conclusion DEX with a loading dose of 1 iμg/kg followed by maintenance dose of 0.5 μg/ (kg· h) can reduce the early incidence of POCD in cardiac surgery with cardiopulmonary bypass,but can not reduce the late incidence.