The biological characteristic of carcinomas is determined both by the stromal microenvironment and the oncogene or anti-oncogene.The tumor stroma is also known as the reactive stroma which is composed of base member,immunocell,capillary,fibroblasts and ECM.Fibroblasts are the majority of tumor stromal cells.The relationship between fibroblasts and the initiation,progression of carcinoma has being in the spot light.In this review,we summarized the advance in the study of carcinoma-associated fibroblasts.

OBJECTIVE:To compare the differences in the contents of water-soluble total protein,total phenolic acid and total polysaccharides among the water decoctions of crude Cibotium barometz and processed products and to illuminate the effect of pro-cessing on 3 kinds of components of C. barometz. METHODS:UV-visible spectrophotometry was adopted to determine the con-tents of water-soluble total protein,total phenolic acid and total polysaccharides in the water decoction of crude C. barometz and 4 processed products,namely sand-scorch C. barometz,yellow wine C. barometz,salt C. barometz and steamed C. barometz,at wavelengths of 590,760 and 489 nm respectively. RESULTS:The contents of water-soluble total protein in 5 samples were 4.03%,3.32%,3.13%,3.33% and 3.49%,those of total phenolic acid therein were 0.25%,1.34%,1.38%,2.34% and 1.41%,and those of total polysaccharides therein were 28.56%,36.06%,45.21%,49.60% and 49.01%,respectively. CONCLU-SIONS:All above processing methods have an effect to some degree on the contents of the 3 kinds of components of C. barometz, where the contents of water-soluble total protein are lower after processing,while those of total phenolic acid and total polysaccha-rides are higher thereafter.

Objective To investigate the effects of Pseudomonas aeruginosa vaccine (PA) on proliferation and invasiveness of the hepatocellular carcinoma cell line MHCC97L with metastatic potential. Methods Proliferation, growth curve, plate efficiency, flow cytometry, transwell invasion assay, cell motility assay, scarification test, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP2) protein activity were evaluated after cells were treated with PA at various concentrations. Results PA can inhibit the proliferation and plate efficiency of MHCC97L cell markedly in a dose-dependent manner. The IC50 of cells treated with PA for 48 h and 72 h was 3.1 ×108/ml and 1.9 × 108/ml, respectively. The doubling time increased and plate efficiency decreased gradually when cells treated with 0.5 × 108/ml, 1 × 108/ml and 2 × 108/ml PA (P＜0.01). PA could induce cell cycle arrest at the G1 phase in a dose-dependent manner by flow cytometric analysis. The average amount of invading cell per field in cell invasion assay and motility assay were 4. 8 ± 1.3 and 8. 8±2.2 when cells treated with 1× 108/ml PA, which was significantly lower than that of control group (8. 6±2. 1 and 15. 6±1.2 ) (P＜0.01) Scarification test showed that the metastatic ability of cells treated with 1 × 108/ml PA significantly lower than that in the control group. Comparison between cells treated with 1 × 108/ml PA and control group, no remarkable difference was found regarding expression of VEGF and MMP2 in supernatant of cell culture. Conclusion PA can inhibit proliferation and plate efficiency of HCC cell line MHCC97L, which is in part mediated by the cell cycle arrest at the G1 phase. PA could inhibit invasiveness of HCC cell line MHCC97L, which is unrelated to the VEGF and MMP2 protein activity.

Objective To evaluate the prognostic value of blood lactate (Lac) level in sepsis patients with or without diabetes.Methods 106 patients admitted to intensive care unit (ICU) of Zhongshan Hospital Affiliated to Fudan University from April 2015 to November 2016 were enrolled. The patients with age > 18 years and the length of hospital stay > 24 hours were included. Records including blood Lac, serum creatinine (SCr), white blood cell count (WBC), platelet count (PLT), sequential organ failure assessment (SOFA) on the first day of admission; minimum oxygen index (PaO2/FiO2) in 3 days after admission; mechanical ventilation, whether there was a history of diabetes, usage of biguanides, etiology control treatment, usage of continuous renal replacement therapy (CRRT) were collected. According to the level of blood Lac patients were divided into high Lac group (Lac > 2 mmol/L) and low Lac group (Lac ≤ 2 mmol/L);based on their diabetic history, sepsis patients were divided into the diabetes group and non-diabetes group. The survival curve of each group was analyzed by Kaplan-Meier regression analysis, and the factors influencing the prognosis were analyzed by multivariate Cox regression analysis.Results There were 76 males and 30 females sepsis patients, with an average age of (68.1±14.7) years old. In the 51 patients of low Lac group, there were 7 patients who suffered from diabetes. While in the 55 patients of high Lac group, there were 12 patients who suffered from diabetes. Compared with low Lac group, high Lac group had a higher age, higher SOFA score, and a lower proportion of patients who had the treatment of etiology control (allP < 0.05). There was no significant difference of blood Lac in sepsis patients with diabetes and those without diabetes (mmol/L: 3.03±2.73 vs. 2.81±2.40,P > 0.05). Kaplan-Meier survival curve analysis showed that the 90-day survival rate in the high Lac group was significantly lower than that in the low Lac group (56.36% vs. 90.20%,χ2 = 0.697,P = 0.008). The high Lac group without diabetes had lower survival rate, and the 90-day survival rate was significantly lower than that of the low Lac group without diabetes (58.14% vs. 90.90%,χ2 = 7.152,P = 0.007); there was no significant difference in 90-day survival rate between the high Lac group and the low Lac group with diabetes (50.00% vs. 85.71%,χ2 = 0.012,P = 0.914). Multivariate Cox regression analysis showed that blood Lac was an independent risk factor for the prognosis of sepsis patients [odds ratio (OR) = 3.863, 95% confidence interval (95%CI) = 1.237-12.060,P = 0.020]. After stratification according to their diabetic history, the blood Lac was an independent risk factor for the prognosis of sepsis patients without diabetes (OR = 4.816, 95%CI = 1.407-15.824, P = 0.010), but the blood Lac had no effect on the prognosis of sepsis patients with diabetes (OR = 0.000, 95%CI =0.000-1.103,P = 0.270).Conclusions The predictive value of blood Lac on sepsis patients with or without diabetes was different. The blood Lac was related with the prognosis of sepsis patients without diabetes, while further study should be conducted for the prognostic value of blood Lac in sepsis patients with diabetes, and it's possible to increase the cut-off-point of Lac level in these patients.

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Objective:To investigate the influence of admission to intensive care unit (ICU ) on the postoperative complications in patients with esophageal carcinoma .Methods :A total of 391 patients with esophageal carcinoma confirmed by surgery in Department of Thoracic Surgery ,Zhongshan Hospital ,Fudan University ,from Jan 2009 to Dec 2009 ,were chosen .All the patients had clinical data and postoperative follow‐up data in detail . Patients were divided into postoperative ICU group (treatment group) and postoperative general ward group(control group) .The control group was further classified into control group A(without unplanned ICU admission) and control group B(with unplanned ICU admission) based on whether unplanned admission to ICU was conducted .The occurrence rates of postoperative complications were compared among the three groups . Logistic regression was performed in multivariate analysis of postoperative complications .Results:On Day 1 after surgery ,the APACHE Ⅱ score was higher in treatment group than in control group I(P<0 .05) .However ,there was no increase on rate of postoperative complications in treatment group .The APACHE Ⅱ score ,as well as the occurrence rate of postoperative complications ,was lower in control group A than those in control group B (P<0 .01) .The APACHE Ⅱ score in treatment group was higher than that in control group B (P< 0 .05) .However ,the occurrence rate of postoperative complications in treatment group was lower than that in control group B (P<0 .01) .On Day 1 after surgery ,the higher the postoperative acute physiology and chronic health evaluation(APACHE)Ⅱ score was ,the higher the occurrence rate of postoperative complications was(HR= 0 .631 ,95% CI:0 .405~ 0 .983 ,P< 0 .05) .Postoperative planned ICU admission could diminish postoperative complications ,and it was the independent factor(HR= 1 .588 ,95% CI:1 .147‐2 .199 ,P< 0 .01).Conclusions :If prompt admission to ICU for comprehensive treatment was conducted after esophageal cancer operation , the occurrence rate of complications could be reduced in esophageal cancer patients .

Objective:To investigate the risk factors related to intensive care unit (ICU) readmission .Methods :A total of 2491 patients who had been transferred into Department of Critical Care Medicine of Zhongshan Hospital ,Fudan University from Nov 2008 to Dec 2011 were included .Clinical data of all the patients during their first admission to ICU were collected .All the patients were classified into non‐readmission group(Group A) and readmission group(Group B) on the basis of whether there was readmission to ICU .All the patients’ treatments were conducted under supervision of attending intensivist and in accordance with routine treatment of Department of Critical Care Medicine and related clinical guidelines .Logistic regression was performed in multivariate analyses of ICU readmission .Results:If the first admission to ICU was due to emergency ,then the chance of ICU readmission was raised(HR=4 .929 ,95% CI:1 .936‐12 .549 ,P<0 .01) .If patient underwent tracheotomy during the first ICU stay ,then the chance of ICU readmission increased (HR= 3 .395 ,95% CI:1 .622‐7 .107 , P< 0 .01) . Conclusions :Both the admission to ICU under emergency and the tracheotomy during the first ICU admission are independent risk factors for ICU readmission .

Objective:To construct the delirium prevention nursing program in ICU children and explore its clinical effect.Methods:The literature analysis and expert meeting method were used to construct the delirium prevention nursing program in ICU children. Using the convenient sampling method, a total of 315 ICU children who were admitted to Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February to July 2020 were selected as the control group and 309 ICU children admitted from August 2020 to January 2021 were selected as the experimental group. The control group adopted routine nursing, while the experimental group adopted delirium prevention nursing program in ICU children on the basis of routine nursing. The differences in the incidence of delirium, mechanical ventilation time, ICU stay and ICU costs were compared between the two groups.Results:After the intervention, the incidence of delirium in the experimental group was 15.9% (49/309) and the ICU stay was 4.0 (2.5, 7.0) days, which were lower than 29.2% (92/315) and 5.0 (3.0, 10.0) d in the control group, and the differences were statistically significant (χ 2=15.892, Z=-2.341; P<0.05) . Conclusions:The establishment and application of delirium prevention nursing program for ICU children can effectively reduce the incidence of delirium in ICU children and length of stay in ICU.

Wuhan is the city with the most serious outbreak of corona virus disease 2019 (COVID-19) in China. The outbreak of community has exhausted the current medical resources. With integrating local and support medical resources from other province, Wuhan City has rapidly rebuilt a new emergency medical system of classified treatment, and effectively responded to the overload medical demand after the outbreak in the community.