Objective Lungs from non-heart-beating donors for transplantation require protection against warm ischemic damage.This study investigated the preservative effect of Ventilation with cooled carbon monoxide during warm ischemia in non-heart-beating donor rat lungs.Method 18 rats were divided into a CO group (n =6),which received ventilation with low-dose carbon monoxide at normal temperature during a 4-hour warm ischemic period; a Control group (n =6),which received no ventilation at normal temperature; a cooling CO group (n =6),which received ventilation with cooled carbon monoxide.PaO2,Myeloperoxidase (MPO) activity,Bronchoalveolar lavage (BAL) neutrophil count and the wet-to-dry (W/D) lung weight ratio were recorded in every group.Quantitative real-time RT-PCR was used to analysis the expression of IL-1β and caspase 3 mRNA in graft lung tissures.Result Endobronchial temperatures and lung surface temperatures in the Cooling CO group were lower than those in the corresponding Control group and CO group (P＜ 0.01).Lower wet/dry lung weight ratio,MPO activity,BAL neutrophil count,expression of IL-1β and caspase 3 mRNA in graft lung tissures were seen in the Cooling group compared with the Control group and CO group (P＜0.05).Conclusion Ventilation with cooled carbon monoxise can decrease lung temperature and improve the protecting effect on non-heart-beating donor rat lungs againt worm ischemic injury by inhibiting the expression of proimflammatory factor IL-1β and apoptosis-associated gene caspase 3.

Objective The aim of this randomized,double-blind,placebo-controlled trial was to evaluate the efficacy of the Saccharomyces boulardii (S.boulardii) power in preventing antibiotic-associated diarrhea (AAD) in hospitalized children with pneumonia.Methods Two hundred and forty-five hospitalized children with pneumonia were randomly divided into two groups,group 1 treated with antibiotics and S.boulardii power (n =104),and group 2 with antibiotics and placebo,along with S.boulardii power and zinc when suffered from diarrhea (n =141).All children received montmorillonite powder and fluid replacement therapy for diarrhea.The stool frequency and consistency were observed.Diarrhea incidence,diarrhea and pneumonia duration of treatment,and therapeutic effect were recorded.Results AAD is more prevalent in group 2 than in group 1 (P ＜0.05).A 55.7％ relative risk reduction in AAD was seen in group 1 compared with group 2 (RR =0.443,95％CI 0.233 ～ 0.845,P =0.012).Patients with preventive treatment of S.boulardii power in broup 1 had lower AAD incidence compared with those in group 2 (P ＜ 0.05).Both the diarrhea and pneumonia duration of treatment in group 1 were shorter than that in group 2(P =0.001 for diarrhea duration,P =0.030 for pneumonia duration,respectively).No drug related adverse reactions were found during the observation period.Conclusion Preventive use of S.boulardii power may effectively reduce the risk of AAD,improve therapeutic effect,and shorten hospital stays for hospitalized children with pneumonia.

Objective To explore the significant risk factors in patients with Tile C pelvic frac-tures.Methods We conducted a retrospective review of all patients with Tile C pelvic fractures in Nanjing First Hospital from January 2010 to December 2014.The data gathered on each patient in-cluded:age,sex,mechanism of injury,visiting time after injury,shock index,Injury severity scale (ISS),Revised trauma score (RTS),Glasgowcoma scale (GCS),lowest PaO2/FiO2 ,6 h lactate clearance rate,concomitant injures and interventious of Tile C pelvic fractures.The data were tested using Student’t-test,χ2 test and logistic regression method.Results The study include 139 consecutive patients.The total mortality was 29.5%.Among them,36 (25.9%)patients died within 48 hours after admission.Multivariate regression analysis showed that shock index (OR=2.591,95%CI 1.041-4.216), ISS (OR = 47.96,95%,CI 15.89-147.23 ),RTS (OR = 6.917,95% CI 1.147-13.862 ),GCS (OR =4.172,95%CI 2.962-6.268),lowest PaO2/FiO2 (OR= 117.016,95% CI 51.011-176.032),6 h lactate clearance rate (OR=2.785,95%CI 1.191-4.892),concurrent head (OR=6.302,95%CI 2.270-13.175)or chest (OR=12.233,95%CI 5.193-33.985)injures were associated with high morality of Tile C pelvic frac-ture (P <0.01).The performing digital subtraction angiography with intravascular embolization can cut the mortality (OR=0.887,95%CI 0.875-0.899).Conclusion In our study,high trauma score,serious shock, coma,PaO2/FiO2 decreased and 6 h lactate clearance rate decreased,combined with the head and chest inju-ry are the important reasons of mortality in patients with Tile C pelvic fracture.It’s vital to control shock actively,use trauma scale and emphasize multidisciplinary cooperation to reduce mortality in patients with Tile C pelvic fractures.

Objective To investigate the metabolite changes in the preschool children with autism spectrum disorder (ASD) using MR spectroscopy (MRS) and explore the associations between image findings and clinical variables, which may provide a noninvasive brain biochemical method for the early diagnosis and prevention of autism. Methods Twenty one cases of preschool ASD children (3-6 years old) and age-and sex-matched 20 preschool healthy controls underwent single voxel short (SVS) short TE (TE=30 ms) MRS. The absolute metabolite concentrations in the anterior cingulate cortex (ACC) , anterior middle anterior cingulate cortex (aMCC) and posterior cingulate (PCC) were quantitatively analyzed using LCModel software. Two independent sample t tests were used for analysis. The relationships between metabolite concentrations and diagnostic and statistical manual of mental disorders (DSM-IV) , childhood autism rating scale (CARS) and autism behavior checklist (ABC) were analyzed by Pearson correlation analysis. Results Compared to control subjects, ASD patients had significantly lower N-acetylaspartate (NAA) values (4.35 ± 0.80, 6.34±0.82, 8.04±0.97 mmol/L respectively) in ACC, aMCC and PCC (t=2.640, P=0.012;t=2.182, P=0.035;t=3.343, P=0.002) , had significantly lower choline (Cho) 1.32±0.22 mmol/L (t=2.905, P=0.006) and glutamine and glutamate complex (Glx) 10.02 ± 0.88 mmol/L (t=2.090, P=0.043) in PCC. Cho, total creatine (tCr) , myo-Inositol (MI) and Glx levels did not differ between groups in other aforementioned regions (P>0.05). Negative correlations between the NAA ualues in the PCC and CARS (r=-0.504, P=0.020) were detected, and no significant correlation among DSM-IV, CARS, ABC and other metabolite values (P>0.05). Condnsions The biochemical changes in the preschool children with ASD in cingulate reflect the neuronal loss, structural or functional damage and cell membrane enzyme metabolic dysfunctions, may reveal the pathological basis of ASD. These results may provide noninvasive and quantitative methods for the diagnosis and prognosis evaluation of ASD child.

BACKGROUNDTo investigate immunoexpression of P14ARF protein in non-small cell lung cancer (NSCLC) and to evaluate the prognostic significance.

METHODSThirty-nine tumor specimens were immunohistochemically examined with FL-132 antibody against P14ARF protein.

RESULTSP14 nuclei immunoexpression was found in 25 tumor specimens (64.1%). The patients in stage I and II had a much higher P14 expression rate than the patients in stage III and IV [78.0%(18/23) vs 43.8%(7/16) P =0.043]. The P14 expression rate in patients with and without metastasis was 78.3%(18/23) and 43.8%(7/16) respectively (P=0.043). The mean survival time of patients without P14-immunopositive staining was significantly shorter than that of patients with P14-immunopositive staining (17 months vs 45 months, P=0.023 5).

CONCLUSIONSPatients with the expression of P14ARF protein have a better prognosis. Detection of P14ARF protein in lung cancer tissues may be helpful to predict the prognosis of NSCLC.

BACKGROUNDTo evaluate the biological significance of the lymphnode micrometastasis in non-small-cell lung cancer (NSCLC).

METHODSNinety regional lymph nodes indicated to be tumor free by conventional histopathologic methods were taken from 39 patients who underwent pulmonary resection for NSCLC. CK immunohistochemical staining was used to detect the micrometastatic tumor cells in lymph nodes. Expressions of p53, p21(ras) and Ki67 in primary pulmonary lesions were also detected by immunochemical methods.

RESULTSMicrometastasis were found in 26 lymph nodes (28.89%) of 22 patients (56.4%). The proportion of patients with micrometastasis whose primary lesions had the expressions of p53, p21(ras) and Ki67 was higher than those without micrometastasis whose primary lesions had no expressions of p53, p21(ras) and Ki67. The proportion of patients with micrometastasis whose tumor size was more than and less than 3 cm was 55.6% and 58.3% respectively (P=1.000).

CONCLUSIONSExpressions of p53, p21(ras) and Ki67 in primary pulmonary lesions has certain relations with micrometastasis in lymph nodes.

ObjectiveBronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management.Aim of this paper is to examine complications and long-term survival of our personal series and those reported in literature.MethodsBetween 1985 and 2010,48 patients underwent carinal resection:a right tracheal sleeve pneumoneetomy was performed in 47 patients and a left tracheal sleeve pneumonectomy in 1 patient.The anastomosis was performed with aid of high-frequency jet ventilation or introfield tube ventilation.ResultsOverall morbidity and mortality rate was 25％ and 6.3％ respectively,and there was no death in operation.5-yearsurvival rate of patients with squamous and adenocarcinoma was 27.3％ and 12.5％,respectively,P =0.04.The overall 5-year survival rate was 24.3％.Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival:52％,13％ and 0,respectively).Multivariate analysis showed that nodal status was the only independent prognostic factor( P =0.006 ).ConclusionWith careful selection of patients and meticulous surgical technique,Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity,proriding good long-term results.

Objective To evaluate the effects of ambroxol on prevention of bronchopulmonary complications after thoracotomy in patients with chronic obstructive pulmonary disease(COPD).MethodsTotal 161 elderly patients aged ≥70 years with COPD undergoing thoracotomy were randomly allocated to two groups:ambroxol group (300 mg/d,6 d) and placebo group as control.Pulmonary complications were evaluated by clinical symptoms,radiographic changes,and blood gas analysis. Results The incidence rates of atelectasis were 8.6％ in ambroxol group and 28.8％ in placebo group,respectively.The PaO2 values after surgery in ambroxol group decreased more than in placebo group (P＜0.05) compared with the preoperative values.Side effects were not found in all patients.Conclusions Ambroxol should be considered as an alternative pharmacologic approach for the prevention of post-thoracotomy pulmonary complications in the elderly patients with COPD.

Objective To evaluate the complications and prognostic factors of lung transplantation performed in a single center.Methods A rettospective analysis of demographic and outcome data of lung transplantation was performed.Survival analyses were performed using Kaplan-Meier estimation.Results Between January 2003 and April 2011,42 lung transplant procedures were performed.Overall survival rate at 1,3,and 5 years were 89％,59％ and 38％,respectively.1,3,and 5 years survival in patients with COPD was 83％,66％ and 45％,respectively,which were better than other primary end stage lung diseases ( 78％,17％ and 17％,respectively,P =0.013).Postoperative complications included pulmonary bacterium infection in 8 patients (20％),fungal infection in 12 (30％),and airway complications in4 (9.5％).35％ of patients had at least 1 episode of acute rejections within the first year,and 22.5％ of patients had BOS.2 patients underwent single lung retransplantation.Conclusion In this single center study,patients with COPD may have a good long-term survival.The most common postoperative complications were pulmonary infection and airway complication.

Objective:To investigate the variation characteristics and influencing factors of HIV/AIDS subtypes in Wuxi city of Jiangsu Province from 2014 to 2016.Methods:HIV/AIDS population in Wuxi city in 2014 was selected as the research object, and the HIV molecular epidemiology and follow-up study were carried out. Collect epidemiological information, extract DNA from blood samples, amplify pol gene fragment by nest-PCR and sequence, use ChromasPro 1.6 software and MEGA 7.0 software to construct the HIV-1 sequence database, and use FastTree2.1.10 software to construct the phylogenetic tree to confirm the subtype; in 2016, the same population was followed up, and the HIV subtype variation was analyzed, and the influencing factors of subtype variation were explored by multivariate logistic regression. Results:A total of 612 HIV/AIDS cases in 2014 and 2016 were collected. The age of the subjects was mainly 30 years old or above (85.46%, 523/612), and the proportion of people over 50 years old was higher (228/612, 37.25%). The main route of transmission was homosexuality, accounting for 49.67%. A total of 1224 samples were detected and CRF01 _ AE、CRF07_ BC、B、CRF08_ BC、CRF67_ 01B、CRF55_ 01B、CRF68_ 01B, 7 subtypes of HIV-1 and 5 unique recombinant types (URFs) was detected. CRF01_ AE and CRF07_ BC was still the main genotype in Wuxi, Jiangsu Province, accounting for 66.75%. There were 29 cases (3.56%) of URFs recombinant strains. During 2014-2016, the variation rate of subtypes was 14.63%, and the most common variation was CRF01_ AE changes to CRF07_ BC(13.95%). Marital status (OR=0.363, 95% CI: 0.137-0.964) and baseline CD4 level (OR=0.414, 95% CI: 0.192-0.891) were associated with subtype variation.Conclusions:The HIV-1 subtypes of HIV/AIDS patients in Wuxi city are diverse and complex, the proportion of recombinant subtypes is rising, the URFs that are difficult to determine the genotype increase significantly, and the variation rate of HIV-1 subtypes among HIV/AIDS infected people is high. It is necessary to strengthen the monitoring of HIV-1 subtypes.