OBJECTIVE To investigate the pathogens of HAP and their drug resistance in our hospital,the impact of duration of hospitalization on etiology,and the risk factors for the resistant pathogens.METHODS The respiratory tract secretion was collected from HAP patients to culture and analyze the susceptibility of antimicrobials,compare the etiology of early-onset and late-onset HAP including prior antibiotics exposure and severity of HAP to drug resistant bacteria.RESULTS During the period of study,there were 1.04% of patients suffering from HAP.Early-onset HAP was commonly caused by G+ cocci while the main agents of late-onset HAP were G-bacilli.Most of the HAP pathogens were resistant to the antimicrobials commonly used in clinic with the prior antimicrobials exposure and the severe HAP increased the resistant bacteria rate(P

Objective To evaluate the clinical characteristics and surgical risks for elderly patients with gastric cancer. Methods The clinical data from 607 patients, who received surgical therapy for gastric cancer between January 2006 and December 2009, were retrospectively analyzed.Among them, 267 patients were over 65 years of age, and the other 340 patients (≤65 years of age)were served as control. Complete surgical resection was done by doctors in same group. The preoperative complications such as cardiopulmonary disease and post-operative complications as well as pathologic patterns were compared between two groups. Results Coexisted diseases were found more in elderly patients than in controls (68.91% vs 31.63 %, P＜0.01). Whereas there was no significant difference between two groups with respect to post-operative complication [28. 19% (75/267)vs 25.59 % (87/340)]. However, the incidence of cardiopulmonary complications, especially pulmonary infection, was higher in elderly patients than in controls (17.23% vs 5.29% ,P＜0.01). The digestive tract complications were related to the pattern of radical operation. Post-operative complication occurred less in patients treated with D1 radical operation than those with D2 and D3 radical operation.Conclusions The incidence of post-operative complication in elderly patients with gastric cancer was closely related to the surgical method. The elderly patients may has less complications if they were operated with D1 radical method which can reduce risk of complication and improve the quality of life.

Objective To explore the relationship between K-ras gene and cholangiocarcinoma by detecting the K-ras gene mutation of bile duct tissues.Method We studied all the patients who presented to our hospital from June 2010 to June 2012 with stenosis of the bile duct.There were 17 cases of cholangiocarcinoma and 17 cases of benign stenosis.From the DNA extracted from the paraffin tissues,we used the HRM assay for K-ras gene mutation.Result We found that the HRM method and the DNA typing had exactly the same result for the DNA content which confirmed the effectiveness of the HRM assay.Of note,the K-ras mutation rate was found to be significantly higher in the cholangiocarcinoma cases (11/17) when compared with the benign cases (3/17).Conclusion The mutation of the K-ras gene was closely related to cholangiocarcinoma.Our results suggest a new way to diagnosis cholangiocarcinoma.

Objective To compare the purification process of two types of ceramic hydroxyapatite(CHT I and CHT II)to remove the aggregates from two monoclonal antibodies(mAb 1 and mAb 2).Methods All the chromatography runs were performed on AKTA AVANT 150 with Tricon 10/50 column.The dynamic binding capacity( DBC) of two types of CHT was studied firstly, and then purification research was carried out selecting the suitable DBC.The column was equilibrated with 5 mmol/L sodium dihydrogen phosphate pH 6.5, and then was eluted with gradient buffers which were 10 mmol/L sodium dihydrogen phosphate pH 6.5 and 2 mol/L sodium chloride pH 6.5.Aggregate content in loading and elution pool was evaluated by size exclusion chromatography.Scale-up process was carried on 20 cm height chromatography column XK16/40.Results DBC of CHT I for mAb 1 was 40 mg/mL and mAb 2 was 45 mg/mL.After purity, monomer content of mAb 1 reached 98.6% and yield was 92.5% and monomer content of mAb 2 reached 98.8%and yield was 91.5%.DBC of CHT II for mAb1 was 16 mg/mL and mAb 2 was 20 mg/mL.After purity, monomer content of mAb 1 reached 99.8% and yield was 91.8% and monomer content of mAb 2 reached 99.9% and yield was 92.2%.Conclusion Two types of CHT both can remove aggregates effectively from monoclonal antibodies when aggregate content reaches more than 10%, and results conform to the regulations.CHT I has higher dynamic binding capacity than CHT II, and CHT II is superior to CHT I in removing aggregate efficiency.The purification process is simple and can be easily scaled up in pilot and manufacture.Therefore, it meets the requirement pilot and scale production.

Objective:To compare the bone dimensional changes following tooth extraction alone with extraction plus ridge preservation ( using deproteinized boving bone mineral Bio-Oss? and bioresorbable collagen mambrane Bio-Gide?) in periodontal compromised extraction sockets .Methods: Eighteen molars of sixteen subjects requiring tooth extraction because of periodontal destruction were enrolled in this study .The subjects were assigned to the control group ( extraction alone , EXT) or to the test group ( ridge-preservation procedure with Bio-Oss? and Bio-Gide?, RP) .Parallel periapical X-rays and cone-beam computed tomography ( CBCT ) scans were taken immediately after tooth extraction alone or plus ridge-preservation ( baseline ) and 6 months later .The changes of horizontal ridge width and vertical ridge height were assessed .Results:At the central buccal aspect , the ridge height increased 2 .9 mm in RP group, and reduced 1.0 mm in EXT group.At the distal buccal aspect , the ridge height increased 1.45 mm in RP group, and reduced 1.45 mm in EXT group.The differences between the groups reached statistical significance (P<0.05).The mean ridge width increased at the 1 mm below the crest (the horizontal ridge width was measured with grafting material at three levels at 1 mm below the most coronal aspect of the crest,HW1), which amounted to 3.40 to 5.80 mm in RP group, and 1.45 to 2.90 mm in EXT group.The mean ridge increased at the 4 mm below the crest ( the horizontal ridge width was measured with grafting material at three levels at 4 mm below the most coronal aspect of the crest ,HW4 ) , which amounted to 0.40 to 3.50 mm in RP group, and reduced 0.10 to increased 0.15 mm in EXT group.The test group and the control group were not significantly different (P>0.05).Conclusion:The ridge-preservation approach using Bio-Oss? in combination with Bio-Gide? can significantly increase vertical ridge height and horizontal ridge width after tooth extraction compared with extraction alone in periodontal compromised molars .

Objective:To evaluate bone formation in human extraction sockets with absorbed surrounding walls augmented with Bio-Oss(R) and Bio-Gide(R) after a 6-month healing period by histologic and histomorphometric analyses.Methods:Six fresh molar tooth extraction sockets in 6 patients who required periodontally compromised moral tooth extraction were included in this study.The six fresh extraction sockets were grafted with Bio-Oss(R) particle covered with Bio-Gide(R).The 2.8 mm × 6.0 mm cylindric bone specimens were taken from the graft sites with aid of stent 6 months after the surgery.Histologic and histomorphometric analyses were performed.Results:The histological results showed Bio-0ss(R) particles were easily distinguished from the newly formed bone,small amounts of new bone were formed among the Bio-Oss(R) particles,large amounts of connective tissue were found.Intimate contact between the newly formed bone and the small part of Bio-Oss(R) particles was present.All the biopsy cylinders measurement demonstrated a high inter-individual variability in the percentage of the bone,connective tissues and BioOss(R) particles.The new bone occupied 11.54％ (0-28.40％) of the total area;the connective tissues were 53.42％ (34.08％-74.59％) and the Bio-Oss(R) particles were 35.04％ (13.92％-50.87％).The percentage of the particles,which were in contact with bone tissues,amounted to 20.13％ (0-48.50％).Conclusion:Sites grafted with Bio-Oss(R) particles covered with Bio-Gide(R) were comprised of connective tissues and small amounts of newly formed bone surrounding the graft particles.

Objective To investigate the value of timely duodenal papilla fenestration for reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical data of 181 patients with difficult biliary cannulatian during ERCP at the Xinhua Hospital of Shanghai Jiaotong University from July 2006 to December 2009 were retrospectively analyzed.Of the 181 patients,98 patients who received traditional incubation were in the control group,and the other 83 patients who received early duodenal papilla fenestration were in the test group.The success rate of selective incubation and incidence of pancreatitis were compared between the 2 groups.All data were analyzed using the t test,chi-square test or Wilcoxon rank sum test.Results The success rate of incubation,incidences of hyperamylasemia and pancreatitis were 85.7％ ( 84/98 ),7.1％ (7/98) and 10.2％ ( 10/98 ) in the control group,and 94.0％ ( 78/83 ),18.1％ ( 15/83 ) and 2.4％ (2/83) in the test group,respectively,and there were significant differences between the 2 groups (x2 =10.12,5.03,4.41,P＜0.05).The numbers of patients with mild,moderate and severe pancreatitis were 3,5 and 2 in the control group,and 1,1,0 in the test group,respectively,and there was a significant difference between the 2 groups ( Z =- 2.11,P ＜ 0.05 ).Conclusion Timely duodenal papilla fenestration is safe and effective in reducing the incidence of pancreatitis for patients with difficult biliary cannulation during ERCP.

Objective To evaluate diagnostic value of plasma D-dimer (D-D),fibrinogen (Fg) and Ddimer/fibrinogen (D/F) ratio in acute lower extremity deep vein thrombosis (DVT) after artificial joint replacement.Methods From August 2009 to December 2011,273 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) underwent venography of lower extremity deep vein at 35 days postoperatively.According to results of angiography,all patients were divided into DVT group including 66 patients (15 males and 51 females,median age 66 years) and non-DVT group including 207 patients (70 males and 137 females,median age 63 years).Plasma levels of D-D and Fg were measured by immunoturbidimetry and solidification methods respectively preoperatively and at 3-5 days postoperatively.The differences of plasma levels of D-D and Fg and D/F ratio between the two groups were analyzed with statistical method.Furthermore,diagnostic value of postoperative plasma D-D and D/F ratio in acute DVT was assessed using a receiver operating characteristic (ROC) curve.Results There was no statistical significance in preoperative plasma levels of D-D and Fg,and postoperative plasma levels of Fg between two groups.However,the postoperative plasma levels of D-D and D/F ratio were higher in the DVT group than those in the nonDVT group,and there was significant difference between two groups.In addition,the ROC curve analysis showed that the area under curve of postoperative plasma D-D and D/F ratio was 0.688 and 0.684,respectively,but this difference did not reach statistical significance.Conclusion Plasma Fg may be meaningless for the diagnosis of acute DVT after artificial joint replacement.Although plasma D-D and D/F ratio may be useful for diagnosing acute DVT,the diagnostic accuracy is low.

AIM: To construct recombinant adenovirus containing transcription factor T-bet (T-box expressed in T cells),and induce type-1 T-helper differentiation of lymphocytes. METHODS: T-bet gene was cloned from total RNA of lymphocyte stimulated with IFN-? with RT-PCR methods,then subcloned into transfer vector pAdtrack-CMV in BgIII/SaII sites. The new transfer vector pAdtrack-CMV. T-bet was digested with Pme I,subsequently cotransformed into BJ5183 cells with adenoviral backbone plasmid pAdEasy-1. The resultant plasmid pAd. T-bet was linearized by Pac I and transfected into 293 cells with liposome LIPOFECTAMINE 2000 for producing Ad.T-bet. The recombined adenovirus Ad.T-bet was identified through RT-PCR and Western blotting methods. Lymphocytes purified from patients suffering from liver cancer was infected with liposome and Ad.T-bet with multiplicity of infection (m.o.i) 5000,and the concentration of IFN-? in culture media was evaluated with ELISA methods. RESULTS: T-bet gene was successfully cloned from lymphocytes and incorporated into recombinant adenovirus Ad.T-bet. Lymphocytes infected with Ad. T-bet constantly and strongly secreted Th1 cytokine IFN-?. CONCLUSION: Recombinant adenovirus Ad.T-bet effectively induces type-1 T-helper differentiation,which is a promising method for restoration of patients' immune reaction against cancer.

Objective To investigate the levels of activated Stat3 (p‐Stat3) and the expression levels of SOCS3 as well as their clinical significance and its impact on the pathogenesis ,progression ,and prognosis in patients with gastric cancer .Methods The levels of p‐Stat3 and SOCS3 were tested in 53 cases of gastric cancer tissues (test group) and 27 cases of adjacent non cancerous tis‐sues (control group) by immunohistochemistry (IHC) .The clinical pathological and follow up data were analyzed .Results The levels of activated p Stat3 were significantly higher in gastric cancer tissues than in non cancerous tissues .The levels of SOCS3 were lower in cancer tissues than in non cancerous control tissues (P<0 .05) .p‐Stat3 showed significantly different levels among TNM stages and tumor differentiation ,and the expression levels of SOCS3 were negatively associated with cancer invasion ,lymph node metastasis and TNM stages in cancer patients (P<0 .05) .Furthermore ,a negative correlation was observed between the levels of activated p‐Stat3 and SOCS3 in gastric cancer tissues (r= -0 .492 ,P<0 .05) .Kaplan Meier survival analyses indicated that the p‐tat3 levels were negatively correlated with total survival of gastric cancer patients ,the higher the levels of p‐Stat3 was ,the lower the total survival rate would be (χ2 = -5 .05 ,P<0 .05) .On the contrary ,the levels of SOCS3 showed a positive correlation with total survival (χ2 =10 .852 ,P<0 .05) .Conclusion Increased a p‐Stat3 and decreased expression of negative Stat3 regulator SOCS3 may play important roles in the development and progression of gastric cancer ,both of which would potentially serve as prognostic mark‐ers for gastric cancer .