Objective To analyze the clinical features of overlap syndromes(OS),I.e.,chronic obstructive pulmonary disease(COPD)complicated with obstructive sleep apnea hypoventilation syndrome (OSAHS).MethodsFrequency of episodes of acute exacerbation,severity,quality of life,exercise endurance,complications and three-year survival rate were investigated in eight patients with OS and 10 patients with pure COPD.Results Both quality of life and exercise endurance in OS group were lower than those in COPD group(P＜0.05).Annual frequency of acute exacerbation episodes and severity were more and three-year survival rate was lower in OS group than those in COPD group(P＜0.05).Complications of hypertension,diabetes,erythrocythemia,respiratory failure and heart failure were all more frequent in OS group than those in COPD group.Among all the above clinical features,increased frequency of acute exacerbation episodes was the most significant.Conclusions OS is clinically more severe than pure COPD,so more attention should be paid to it.Survival for patients with OS can not extended by nocturnal oxygen therapy alone,which may be beneficial when combined with biphasic positive airway pressure(BiPAP)or continuous positive airway pressure(CPAP)ventilation.

OBJECTIVE To analyze the multi-drug resistant genes(genes encoding extended-spectrum ?-lactamases,outer membrane protein gene oprD2,aminoglycoside-modifying enzyme genes,sulfonamides and disinfectant-resistance gene and plasmid-mediated quinolone resistance gene) of Pseudomonas aeruginosa clinical strains.METHODS The drug-resistance to 15 antibiotics was detected by the disc agar diffusion(DAD) and microdilution broth method in 32 P.aeruginosa strains isolated from Jun to Dec 2006.Twenty-eight related drug-resistant genes and outer membrane protein gene oprD2 were examined by PCR method.RESULTS The resistance rate of 32 P.aeruginosa strains to amikacin,ceftazidime,ciprofloxacin,cefepime,cefoperazone/sulbactam,imipenem,meropenem,levofloxacin,piperacillin/tazobactam,aztreonam and piperacillin were 9.4%,25%,59.4%,68.7%,68.8%,78.1%,81.1%,81.3%,84.4% and 94.4%,respectively,and that to others antibiotics were 100%.The detective rate of aminoglycoside-modifying enzyme genes(aac(6′)-Ⅱ,aac(3)-Ⅱ,aac(6′)-Ⅰ,aph(3′)-Ⅵ,ant(3″)-Ⅰ and aac(3)-Ⅰ) were 68.8%,62.5%,21.9%,9.4%,9.4% and 6.3%,and the genes encoding extended-spectrum ?-lactamases(blaFOX,blaIMP,blaVIM and blaDHA) were 37.5% 15.6% 6.3% and 9.3%,respectively.Twenty-two(68.8%) of them were detected in oprD2 and 9(28.1%),but positive in qacE?-sul1 gene.CONCLUSIONS The detective rate of aminoglycoside-modifying enzyme genes,extended-spectrum ?-lactamases genes and the loss rate of outer membrane protein gene oprD2 are high in these 32 multi-drug resistant P.aeruginosa clinical strains.

Objective:To detect the expression of IL-17A、IL-10 and IFN-? in patients wth different forms of inflammatory bowel disease(IBD) during clinical remission phase and investigate their role in the onset and treatment of IBD.Methods:Tissue samples were obtained from patients with ulcerative colitis(UC,n=46),Crohn's disease(CD,n=12),and normal colorectal tissues(n=20).IL-17A expression was evaluated by a standard immunohistochemical procedure.Serum IL-17A、 IL-10 and IFN-? levels were determined by ELISA.Results:IL-17A expression was not detected in samples from normal colonic mucosa but was present in the mucosa of IBD.The level of IL-17A significantly increased in IBD patients while it was not detected in the sera of normal individuals.The level of IL-10 in patients with Crohn's disease was significantly higher than that in patients with ulcerative colitis and control group(P

ObjectiveToinvestigatetheeffectofhigh-andlow-riskhumanpapillomavirus(HPVs)ontheexpressionofp16proteininthelesionsofcondylomaacuminata(CA),Bowenoidpapulosis(BP)andBowen'sdisease(BD).MethodsHPV6/11,HPV16/18DNAinthelesionswereexaminedwithFQ-PCRmethodin30casesofCAandinnormalskinormucosaof12cases.HPV16DNAweredetectedwithinsituhybridizationmethodin30casesofBPand15casesofBD.P16,Ki-67proteinswereexaminedwithimmunohistochemicalSPmethodinthesamespecimens.ResultsBothp16proteinandKi-67expressionwereincreasedinHPV-infectedlesions(P

OBJECTIVE To explore the drug-resistance,the existing forms,genotype,and transfer ways of extended spectrum ?-lactamases(ESBLs) and plasmid AmpC enzyme in Klebsiella pneumoniae.METHODS The drug sensitivity of K.pneumoniae to 17 antibiotics was done by slip-diffusion and microdilution methods.The genotype of two enzymes was assessed by PCR and sequencing.The transfer ways of K.pneumoniae drug-resistant gene were identified by transconjugants-test.RESULTS The ESBLs were mainly produced in 55 cefoxitin resistant K.pneumonia strains.The major genotypes of ESBLs and plasmid AmpC nzyme were CTX-M,MIR and DHA.These genes could be transferred from clinical isolates to recipient bacteria.CONCLUSIONS ESBLs as well as AmpC enzymes are the most important resistance mechanism in K.pneumoniae.The resistance could be transferred through the bacterial conjugation.

Objective:To investigate the role of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) in regulating proliferation of airway smooth muscle cells in ovalbumin(OVA)-induced asthma rats. Methods：Male Wistar rats (n=16) were randomized into OVA-induced asthma group and control group(8 rats each). The histomorphological changes of bronchia and lung tissues were observed by H-E staining. The expressions of proliferating cell nuclear antigen(PCNA) and PTEN were assayed by immunohistochemistry. Reverse transcription-polymerase chain reaction(RT-PCR) was carried out to determine the changes in the expression of PTEN mRNA. Results: The typical pathological features of asthma were revealed in the OVA-exposed rats including numerous inflammatory cells infiltrated around the bronchia and in the lung tissues, the thickened airway smooth muscle and the narrowed airway. The levels of PCNA were distinctly increased in OVA-induced asthma group than that of control（P < 0.05），while the levels of PTEN and PTEN mRNA were significantly decreased in lung tissues of OVA-exposed rats（P < 0.05）. Conclusion：The gene inactivation of PTEN may play a pivotal role in proliferation of airway smooth muscle cells in asthma rats, and the most probable mechanism is associated with the functions of PI3K signaling pathway.

Objective To evaluate the significance of platelet activation and the expression of inter-leukin (IL)-1β in patients with RA. Methods The activation of platelets and the expression of IL-1β in pla-telets in 50 RA patients(22 high-active, 28 mediate/low active ) and 30 normal controls were determined us-ing flow cytometry. Meanwhile, inflammatory indicators such as erythrocyte sedimentation(ESR), C-reactive protein (CRP) and DAS28 were also recorded. T test and correlation analysis were performed. Results The platelet activation in RA group(19.2±4.8) was higher than the control group(9.0±2.9)(t=10.5, P=0.001). The expression of IL-1β in platelets in RA group(41±11) was higher than control group(21±8)(t=9.01, P =0.000) .The platelet activation in high-active RA group(22 ±4) was higher than mediate/low active RA group(17 ±4)(t =3.96,P =0.001). The expression of IL-1β in platelets in high-active RA group(45 ±10) was higher than mediate/low active RA group (38 ±10)(t =2.329,P =0.024). The expression of IL-1β in platelets in RA group was positively correlated with the level of ESR、CRP and DAS28 (r value and P value were 0.576, 0.578, 0.618 and 0.000, 0.000, 0.000 respectively). Conclusion The platelets of patients with RA are activated and may suggest that IL-1β, which may associate with disease activity. Our research suggest that platelet may play a role in the inflammatory process of RA by secreting IL-1β.

Objective To evaluate the effects of delayed cord clamping (DCC) on preterm infants with gestational age ＜32 weeks.Methods Literatures from January 1,1990 to April 30,2013 in Cochrane library,PubMed,EMBASE,China Academic Journal Network Publishing Database,Wanfang Medical Database and VIP Database were searched.Randomized controlled trials (RCT) of DCC in preterm infants with gestational age ＜32 weeks were screened and evaluated.DCC was defined as cord clamping in 30-90 s after delivery,and early cord clamping (ECC) (＜30 s) was as the control.Rev Man 5.1.0 was used for statistical analysis.Mean difference (MD) and 95％CI were used for continuous data while OR and 95％CI were for categorical data.Results Nine studies (11 articles) involving 373 infants were included.Compared with ECC,DCC improved hematocrit (MD=4.19,95％CI:2.97-5.40,Z=6.74,P＜0.000 01),blood volume (MD=11.70,95％CI:6.02-17.38,Z=4.04,P＜0.0001) and mean arterial pressure of preterm infants with gestational age ＜32 weeks (MD=3.11,95 ％CI:1.30-4.92,Z=3.37,P=0.0008),decreased the usage of volume expansion for hypotension (OR=0.32,95％CI:0.11-0.98,Z=2.05,P=0.04) and the incidence of necrotizing enterocolitis (OR=0.48,95％CI:0.25-0.92,Z=2.22,P=0.03).Meanwhile,DCC had no influence on the peak bilirubin concentration,the incidence of sepsis,patent ductus arteriosus,retinopathy and intracranial hemorrhage,also no influence on neonatal mortality on dcscharge,mental developmental index and psychomotor developmental index at seven-month old.Conclusions DCC might be a safe procedure to improve prognosis of preterm infants less than 32 weeks' gestational age.However,due to small sample size and lack of data on follow up,it is necessary to launch clinical trials with higher quality and larger scale to further evaluate the effect and safety of DCC.

Objective To detect Chlamydia trachomatis phage Vp1 gene in clinical swab specimens and anti-Vp1 antibodies in serum specimens.MethodsCervical and urethral swab as well as serum specimens were collected from attendees to the sexually transmitted disease(STD) clinic in the Tianjin Institute of STD,during March 2008 to March 2011.PCR was conducted to detect chlamydial phage Vp1 gene in swab samples,enzyme linked immunosorbent assay(ELISA) and Western blot to detect anti-Vp1 antibody in sera.The swab specimens positive for Vp1 gene were subjected to cell culture followed by the detection of Vp1 protein with an immunofluorescence-based method.ResultsTotally,36 out of 1542 swab specimens turned out to be positive for Vp1 gene,and 23 out of 453 serum specimens for anti-Vp1 antibody.No positive results were obtained in the Vp1 gene-positive swab specimens by cell culture and immunofluorescence-based assay.ConclusionThe Vp1 gene of Chlamydial trachomatis phage and anti-Vp1 antibody are successfully detected from clinical swab and serum specimens respectively.

Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction.Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nanjing Medical University.Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients.The outcomes assessed included diet scores,time to diet,length of hospital stay,treatments fees and complications.Results Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome with significant higher GOOSS score compared with that before treatment (P ＜0.05),but score improves faster in stenting group.Clinical success for endoscopic stenting and surgical gastrojejunostomy was 96.6％ and 92.9％ respectively,and technical success was 100％ for both of them.Endoscopic stenting group was found to have lower early complication rate(3.4％ VS 23.8％,P ＜0.05),higher late complication rate(24.1％ VS 6.9％,P ＜0.05),less time to diet,hospital stay and treatment fees(all P value ＜ 0.05)than surgical gastrojejunostomy group.The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group.There were no significant differences in complication between two groups (27.6％ VS 11.9％,P ＞ 0.05).Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome effectively and safely,but endoscopic stenting improves GOOSS scores more rapid with less time to diet,less early complication rate and easy-dealing late complications,also it needs less hospital stay and fees.It's a better choice for patients with less survival expectation.