In March,2009,novel influenza pandemic A(H1N1)virus emerged in Mexico and rapidly disseminated worldwide.Secondary pulmonary infection is a predominant contributor to the death of novel influenza A(H1N1),The most common causative pathogens of secondary pulmonary infection in novel influenza A(H1N1)include Streptococcus pneumoniae,Haemophilus influenzae and Staphylococcus aureus.The recognization of the pathogenesis of secondary pulmonary infection in novel influenza A(H1N1)is critically significant to the strategy in diagnosis and treatment of novel influenza A(H1N1).Therefore,we elaborate the current situation of secondary pulmonary infection in novel influenza A(H1N1)and provide insight into the clinical diagnosis and treatment of novel influenza A(H1N1).

Objective To evaluate the antitumor effect of SEB-scFv fusion Drotein on gastric cancer. Methods Typical changes of morphologic features and super-microstructure were observed when SEB-scFv fusion protein was used in SGC7901 cens;and the effects of SEB-scFv and its concentration on the cell growth were examined by methyltetrazolium(MTT)assay;DNA ladder and flow cytometry were employed respectively to detect the inhibition phenomenon or apoptosis.We produced a subcutaneous gastric tumor model in baby SD rats by implanting SGC7901 cells.The SEB and SEB-scFv were injeeted to the vena caudalis in the trial groups,and normal saline to the control group.The weight of the tumor and the survival were recorded after treatment. Results Cell inhibitory rate was increased along with increased concentration of SEB-scFv fusion protein.Electron microscopy revealed that the cell presented typical changes of apoptosis.FCM indicated that the apoptotic rate of SGC7901 cell lines significantly increased with increasing dose of SEB-scFv fusion protein,and agarose gel electrophoresis appeared marked DNA ladder.The average weight of tumor in the SEB-scFv group was lower than that in control groups(P＜0.05).The tumor inhibition rate was 61.3%,and the mean survival period of rats in SEB-scFv group was longer than that of other group(P＜0.05)with a survival prolongation rate of 54.6%. Conclusion The resuhs indicate that SEB-scFv fusion protein has an obvious antitumor effect on gastric cancer.

Objective To evaluate the efficacy of eucalyptol-limonene-pinene enteric capsule on stable chronic obstructive pulmonary disease (COPD) in the elderly.Methods A total of 120 patients with stable COPD were randomized into ELP group (n=63) with conventional treatment combined ELP and control group (n=57) with conventional treatment without ELP.Primary outcome was the number of exacerbations per year, and secondly outcomes were lung function parameters and St.George's Respiratory Questionnaire (SGRQ).Results After 1 year of treatment, numbers of exacerbations per patient per year were lower in ELP group than in control group (0.70 times/y vs.1.21 times/y, Z=-3.887, P=0.000).The proportion of exacerbation-free patients were 25.4％(16/63) in ELP group and 5.3％ (3/57) in control group (x2 =9.103, P=0.003).The differences in the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/ FVC ratio (FEV1％) between 5 different time points measurements were statistically significant in both groups (ELP group: F=15.429, 36.389, 33.278, respectively, all P=0.000;control group: F=54.238, 94.213 and 83.774, respectively, all P=0.000).Difference in FEV1/FVC ratio between 5 different time point was statistically significant in control group(F=2.766, P=0.043), but not in ELP group(F=0.861, P=0.451).After treatment, SGRQ score was decreased in both group, and difference in symptom score was statistically significant between the two groups (t=2.109, P =0.037).The adverse reactions were found in 3 cases in ELP group, and in 2 cases in control group with no statistically significant difference between the two groups [3 (4.8％) vs.2 (3.5％), x2 =0.013, P=0.732].Conclusions Long-term oral administration of eucalyptol-limonene-pinene enteric capsule can significantly decrease exacerbation frequency, improve quality of life, delay the deterioration in lung function, and have good safety in elderly patients with stable COPD.

Objective To evaluate laparoscopic radical resection of metachronous colorectal carcinoma.Methods A total of 13 patients with metachronous colorectal carcinoma undergoing laparoscopic resection in Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2013 to December 2015 were analyzed retrospectively.Results The mean time of surgery was (156 ± 9) min.Tumors were located in the right hemicolon in 3 cases,in the transverse colon in one,in the left hemicolon in 2,in the sigmoid colon in four and in the rectum in 4.The mean blood loss was (66 ± 21) ml.There was no conversion to open surgery.Two patients were done with protective ileostomy.Postoperative gastrointestinal function recovery time was (2.5 ± 0.7) days.One postoperative intra-abdominal bleeding was successfully controlled laparoscopically.Posteperative length of hospital stay was (26.2 ± 2.9) days.The median follow-up was 12 months (5-30 months) with no cancer recurrence.Conclusions Laparoscopic radical resection of metachronous colorectal carcinoma has good curative effect,and high success rate in spite of previous history of laparotomy.

OBJECTIVETo evaluate the soft profile and hard tissue changes after maxillary protraction with skeletal anchorage implant in treatment of Class III malocclusion during growth period.

METHODS18 patients with skeletal Class III malocclusion were treated with maxillary protraction for about 9 months, (3.5 +/- 0.1) N, with skeletal anchorage implant and face mask. Cephalometric records were analyzed to assess the changes of maxillo-facial structure of the hard and soft tissue before and after treatment.

RESULTSAll patients' Class III profiles were corrected. Maxillary growth increased, chin clockwise rotated, facial convexity angle increased, lower lip protrusion decreased. Facial vertical height ratio, nasolabial angle, upper lip protrusion and mentolabial sulcus changed unconspicuously. Upper incisors kept in sites, lower incisor upright, maxilla moved forwards. SNA, ANB significantly increased. SNB decreased and the mandible clockwise rotated.

CONCLUSIONThe maxilla is effectively protracted without significant rotation by using skeletal anchorage implant. The undesired effects of conventional protraction therapies, such as labial tilt of upper anterior teeth and extrusion of the maxillary molars, are reduced or eliminated with skeletal anchorage implant. These effects can conspicuously correct profiles of the patients with skeletal Class III malocclusion, make the profile more harmonious and aesthetic.

Cephalometry ; Chin ; Extraoral Traction Appliances ; Face ; Humans ; Incisor ; Lip ; Malocclusion, Angle Class III ; Mandible ; Maxilla ; Molar

OBJECTIVETo investigate the clinical characteristics, diagnosis and treatment as well as prognostic factors of the giant gastrointestinal stromal tumor (GIST).

METHODSClinical data of 235 patients with high risk GIST treated in the Union Hospital, Tongi Medical College, Huazhong University of Science and Technology between January 2005 and July 2015 were retrospectively analyzed. Patients were divided into giant GIST group (diameter equal to or larger than 10 cm, 119 cases) and high risk group (diameter less than 10 cm, 116 cases) according to tumor size. Clinical characteristics and prognosis of two groups were compared and the clinical features of giant GIST were summarized. Multivariate analysis was performed to evaluate the prognostic factors of giant GIST with Cox regression model.

RESULTSOf the 119 patients with giant GIST, which accounted for 50.6%(119/235) of all the high risk patients, there were 63 male and 56 female patients with a median age of 53(20-82) years. Primary giant GIST of 43(36.1%) located in the stomach, of 39(32.8%) in the small intestine, 5(4.2%) in the colon and rectum, and of 32 (26.9%) outside the gastrointestinal tract (mesentery, retroperitoneum, abdominal cavity, etc) and pelvic. Compared to high risk group, age of onset was younger [ratio of ≤50 years, 44.5%(53/119) vs. 31.9%(37/116), P = 0.046] and incidence of outside the gastrointestinal tract was significantly higher [26.9%(32/119) vs. 9.5%(11/116), P=0.000] in giant GIST group. All the giant GIST patients underwent surgical resection, including 115 cases(96.6%) of R0 resection, 3 cases(2.5%) of R1 resection and 1 case(0.9%) of R2 resection, besides, 32 cases(26.9%) underwent expanded resection (namely, underwent lymphadenectomy or combined organ resection simultaneously). Thirty-nine giant GIST cases(32.8%)accepted imatinib 400 mg/d for targeted therapy after operations, which was not significantly different with high risk group (46 cases, 39.6%, P=0.232). Relapse and metastasis occurred in 8 cases in giant GIST group. The 1-, 3-, 5-year overall survival rates of giant GIST group were 94.5%, 89.3%, 79.4% respectively and of high risk group were 99.1%, 92.9%, 85.1% respectively, and no significant difference was found (P=0.788). The 1-, 3-, 5-year recurrence-free survival rates of giant GIST group were 93.6%, 85.1%, 72.8% respectively and of high risk group were 99.1%, 91.7%, 84.2% respectively, and no significant difference was found as well (P=0.932). Multivariate analysis revealed that gender (P=0.047, RR=0.383, 95%CI:0.149-0.987), mitotic count (P=0.001, RR=0.216, 95%CI:0.087-0.538) and targeted therapy(P=0.019, RR=5.719, 95%CI:1.324-24.695) were prognostic risk factors of overall survival (OS), moreover, tumor size (P=0.024, RR=0.368, 95%CI:0.155-0.875) and mitotic count(P=0.007, RR=0.357, 95%CI:0.169-0.755) were prognostic risk factors of RFS.

CONCLUSIONSGiant GIST is not unusual in GIST and more likely occurs outside gastrointestinal tract. Complete surgical excision combined with targeted therapy can improve the prognosis significantly. The prognosis of giant GIST and common high risk GIST is similar. Mitotic count is the most important prognostic factor.

Abdominal Cavity ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; therapeutic use ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; drug therapy ; pathology ; Humans ; Imatinib Mesylate ; therapeutic use ; Intestine, Small ; Lymph Node Excision ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Young Adult

OBJECTIVETo assess the effect of laparoscopic colectomy on the exfoliated cancer cells in peritoneal cavity, recurrence and metastasis of patients with colonic carcinoma.

METHODSOne hundred and fifty-nine patients with colonic cancer proven by colonoscopy and pathology were divided into two groups based on patient's preference: laparoscopic group (n=74) and open group (n=85). The positive rate of exfoliated cancer cells in peritoneal cavity was compared by cytological detection before and after cancer resection. Recurrence, metastasis rate and 3-year survival were compared between the two groups.

RESULTSThe positive rates of exfoliated cancer cells in peritoneal cavity were 12.2% (9/74) in the laparoscopic group and 15.3% (13/85) in the open group before cancer resection without significant difference (P=0.718); 20.3% (15/74) and 30.6% (26/85) after cancer resection without significant difference (P=0.138). The follow-up ranged from 4 to 45 months. The 3-year local recurrence rates were 13.6% (8/59) and 8.8% (6/68) (P=0.455), the 3-year distal metastasis rates were 11.9% (7/59) and 17.6% (12/68) (P=0.416) and the 3-year survival rates were 79.7% and 80.0% (P=0.998), and the differences were not statistically significant.

CONCLUSIONThe laparoscopic operation does not increase the recurrence and metastasis rate and results in similar survival in patients with colonic cancer as compared to open procedure.

Adult ; Colonic Neoplasms ; diagnosis ; surgery ; Female ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; etiology ; Peritoneal Cavity ; pathology ; Prognosis ; Survival Rate

Laparoscopic sigmoidectomy for cancer is considered as a simple surgical approach, which is suitable for primary laparoscopic surgery. However, the success of laparoscopic sigmoidectomy is closely related to the anatomical characteristics of the sigmoid colon. The length, adhesion and morphology of the sigmoid colon vary greatly. The differences of the length, width, adhesion and morphology of the mesentery are large. The distribution of vessels is diversified. The high ligation or the low ligation is still controversial. The location of the sigmoid colon cancer is also not constant. These problems have great influence on the operation. Before operation, the tumor must be accurately located and the anatomical characteristics of the sigmoid colon must be fully evaluated. The operation can be carried out smoothly and the complications during and after the operation can be reduced.
Colectomy ; Colon, Sigmoid ; anatomy & histology ; Humans ; Laparoscopy ; methods ; Sigmoid Neoplasms ; surgery ; Treatment Outcome

Objective: To analyze the consistency of gastroscopic biopsy in the diagnosis of high grade intraepithelial neoplasia(HGIN) and postoperative pathological diagnosis, and explore the risk factors associated with missed diagnosis of HGIN. Methods: From January 2012 to December 2018, the clinical data of 63 patients who were diagnosed with HGIN by gastroscopic biopsy prior to operation and underwent complete resection in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. There were 55 males and 8 females, with a median age of 60 (35 to 76) years old. The gender, age, endoscopic lesion shape, longest diameter, CT image and inflammatory markers were analyzed, to investigate the correlation between them and pathological upgrading after operation. Receiver operating characteristic (ROC) curve was drawn to analyze the cut off value of measurement data, and the comparison of count data was performed by chi-square test or Fisher exact probability method. Univariate analysis was used to screen potential risk factors, and multivariate logistic regression analysis was futher utilized to analyze the independent risk factors of postoperative pathological upgrading. Results: A total of 63 patients were enrolled, including 47 cases underwent surgical resection and 16 cases underwent endoscopic submucosal dissection(ESD). Among them, 19 patients(30.2%) were pathologically diagnosed with HGIN, while 44 patients(69.8%) were pathologically diagnosed with invasive cancer after resection. Preoperative contrast-enhanced CT showed that 11 patients(17.5%) with perigastric fat spiculation around the lesion, all of which were confirmed as invasive carcinoma after operation. Univariate analysis showed that the longest diameter of the lesion ≥2 cm (P=0.002), ulcer lesions under gastroscopy (P=0.013), platelet to lymphocyte ratio (PLR) ≥103 (P=0.030), lymph node enlargement (P=0.046) and spiculation of the perigastric fat (P=0.025) were significant differences between the groups. Logistic regression analysis showed that the longest diameter of the lesion ≥2 cm (P=0.033) and ulcer lesions under gastroscopy (P=0.007) were independent risk factors for predicting postoperative pathological upgrading. Conclusions Gastroscopy biopsy in the diagnosis of high-grade intraepithelial neoplasia of the stomach has poor consistency with pathological diagnosis after operation. Clinicians should take active surgical intervention, especially for cases with the longest diameter of the lesions ≥2 cm, ulcer or perigastric fat spiculation on CT.