Objective To investigate the clinical value of INSURE technology in very low and extremely low birth weight infants requiring respiratory support.Methods From June 2010 to August 2012,83 cases of very low and extremely low birth weight infants who had difficulty in breathing and required respiratory support were admitted into First Hospital of Tsinghua University and divided into two groups:INSURE group (n=41) and mechanical ventilation (MV) group (n=42).Infants in INSURE group accepted intubate-pulmonary surfactant-extubate to continuous positive airway pressure and those in MV group accepted intubation with or without pulmonary surfactant treatment,and mechanical ventilation without extubation.Arterial blood gases at 1 h and 12 h after treatment were compared between the two groups by t test.The incidence of respiratory distress syndrome,ventilator associated pneumonia,air leaking,chronic lung disease,intracranial hemorrhage,retinopathy,leukoencephalomalacia disease were compared with Chi-square test.Hospitalization costs,duration of ventilation,oxygen inhalation and hospital stay were compared by rank-sum test.Results (1) PO2 in INSURE group after one hour of treatment were (78.7 ±11.5) mm Hg(1 mm Hg=0.133 kPa),which were higher than those before treatment [(50.1 ±10.8) mm Hg,t=9.737,P＜0.05]; while PCO2 was lower[(48.3±8.9) mm Hg vs (54.9±11.5) mm Hg,t=-3.428,P＜0.05].PO2 in MV group after one hour of treatment were (80.2±10.0) mm Hg,which were higher than those before treatment [(51.3±9.8) mm Hg,t=10.093,P＜0.05]; while PCO2 was lower[(45.6±9.5) mm Hg vs (57.1±12.8) mm Hg,t=-4.526,P＜0.05].(2) There were no difference in PO2 and PCO2 between the two groups after one hour of treatment (P＞0.05).After 12 hours of treatment,no differences were found in PO2[(89.4±11.5) mm Hgvs (90.2±10.8) mm Hg,t=0.093] and PCO2[(44.2±5.9) mm Hg vs (39.1± 7.3) mm Hg,t=0.126] between INSURE group and MV group (P＞0.05 respectively).(3) The incidence of ventilator associated pneumonia,air leaking,intracranial hemorrhage and chronic lung disease in INSURE group were 7.3％ (3/41),4.9％ (2/41),4.9％ (2/41) and 4.9％ (2/41),which were lower than those in MV group [34.1％ (14/42),x2=27.470; 16.7％ (7/42),x2=8.651;19.0％ (8/42),x2 =8.814; 11.9％ (5/42),x2 =4.275](P＜0.05 respectively).Duration of ventilation,oxygen inhalation,neonatal intensive care unit stay in INSURE group were 5 d (3-7 d),8 d (5-11 d) and 16 d (11-25 d),which were all shorter than those of MV group [8 d (4-12 d),Z=-1.947; 12 d (8-22 d),Z=-2.013; 21 d (12-35 d),Z=-1.782](P＜0.05 respectively).Conclusions INSURE technology could be used in very low and extremely low birth weight infants because of less invasiveness,fewer complications,safety and low-cost.

Objective To explore the influence of salinomycin in the growth, apoptosis and invasion of human bladder cancer 5637 cells,and to clarify its possible mechanism.Methods The human bladder cancer 5637 cells cultured invitro at logarithmic growth phase were divided into control group and different doses of salinomycin(15, 30 and 60μmol·L-1 )groups.The inhibitory rate of the growth of 5637 cells in various groups was measured by MTT assay. Flow cytometry was used to detect the apoptotic rates of 5637 cells in various groups. The invasiveness of 5637 cells was tested by Matrigel Invasion Assay.The expression levels ofβ-catenin protein in 5637 cells in various groups were determined by Western blotting method. Results Compared with control group,the inhibitory rates of growth of human bladder cancer 5637 cells in different doses of salinomycin groups were increased significantly(P<0.05);the apoptotic rates were increased(P<0.05).the number of cells passed the Matrigel was decreased(P<0.05),and the expression level ofβ-catenin protein was decreased (P<0.05).Compared with low dose of salinomycin group,the inhibitory rate of growth of 5637 cells in high dose of salinomycin group was increased(P<0.05);the apoptotic rate was increased(P<0.05),the number of cells passed the Matrigel was decreased (P < 0.05 ), and the expression levels of β-catenin protein was decreased (P<0.05). Conclusion Salinomycin can inhibit the growth of 5637 cells significantly,increase the apoptosis,and decrease the cell invasion;the inhibitory effect may act by inhibiting the Wnt/β-catenin pathway.

Objective:To investigate the onset of hepatic artery-portal vein shunts (HAPVS) in primary liver cancer (PLC) pa-tients through digital subtraction angiography (DSA) and to devise a suitable strategy for treating both lesions and shunt tracts. In the process, the therapeutic effect on such patients can be enhanced. Methods:A total of 769 PLC patients who accepted transarterial che-moembolization (TACE) were analyzed retrospectively. We examined the image characteristics of 112 cases with HAPVS based on shunt type. For patients with middle or severe fistula, we initially attempted to overpass the fistula. Then, we either embolized the tumor lesions or merely provided chemotherapy to the patients. For patients with mild peripheral fistula, we embolized the tumor and fistula si-multaneously. Then, the accompanying arterial-vein shunt and portal vein tumor thrombus (PVTT) were handled at the same time. Re-sults: DSA findings showed that portal veins were observed in the early stage of angiography. A total of 52 of the 112 cases with HAPVS involved mild shunts, 34 exhibited moderate shunts, and 26 reported severe shunts. Among these cases, 31 involved central-and central peripheral-type artery-portal vein fistula, whereas 81 involved peripheral-type artery-portal vein fistula. Seven cases were examined in combination with hepatic artery-liver vein shunts, and 50 cases were investigated in conjunction with PVTT. Tumor embo-lization was successful in 101 cases (90.1%). Moreover, catheters successfully overpassed shunt tracts and embolized the tumors in 48 cases (42.9%). Shunt tracts were successfully closed in 74 cases (66.1%), and no serious complication was observed. Conclusion:Pe-ripheral-type artery-portal vein fistula and mild-to-moderate shunts were easier to close than central-type artery-portal vein fistula and severe shunts were. Tumor embolization and shunt closure were successful in most patients. Therefore, TACE is a safe and reliable method for treating HAPVS in PLC.

OBJECTIVE:To evaluation of the efficacy and safety of azithromycin in the treatment of acute infections METHODS:A randomized controlled multicenter clinical study was used to compare the clinical efficacy of azithromycin(200mg q d for 3～5 days) with erythromycin(500mg b i d for 5 days) RESULTS:The cure rate,effective rate,and bacterial clearance rate were 76 7%,95 0%,and 94 3% respectively for azithromycin group and were 48 3%,76 7%,and 77 4% respectively for erythromycin group with a side-effect incidence of 10 0% for azithromycin group and 39 3% for erythromycin group CONCLUSION:Azithromycin is superior to erythromycin in clinical efficacy,safety and side-effect incidence

Objective:To analyze the influence of clinicopathological features on the prognosis of anorectal malignant melanoma (AMM), and to establish a more accurate prognosis prediction model.Methods:From January 1, 2006 to December 31, 2018, at Fudan University Shanghai Cancer Center, the data of 89 patients diagnosed with AMM and underwent operation were retrospectively analyzed. The Cox proportional hazard regression model was used to analyze factors affecting the prognosis. Backward elimination was used to select variables, Nomogram prognosis prediction model was established and verified internally, and the consistency index was calculated.Results:Among 89 AMM patients, 65 (73.0%) were female, 78(87.6%) were <70 years old, and the most common tumor location was the rectum (48.3%, n=43), followed by the anal canal (31.5%, n=28) and the anorectal canal (20.2%, n=18). Thirty-eight (42.7%) patients directly received abdominal-perineal resection (APR), 37 patients (41.6%) received interferon-based immunotherapy, and 11 patients (12.4%) received both systemic chemotherapy and immunotherapy. The 3-year disease-specific survival (DSS) rate was 41.6%(37/89), and the 5-year DSS rate was 31.5%(28/89). The results of multivariate Cox analysis showed that age ≥70 years old and T2 stage were risk factors of the prognosis of AMM patients (hazard ratio ( HR)=11.29, 4.83; 95% confidence interval ( CI) 2.89 to 44.13, 1.66 to 14.11; both P<0.01), while neurovascular invasion, immunotherapy treatment, systemic chemotherapy combined with immunotherapy, APR after extensive local resection, directly APR and APR combined with inguinal lymphadenectomy were protective factors of the prognosis ( HR=0.09, 0.23, 0.10, 0.13, 0.26, 0.02; 95% CI 0.02 to 0.34, 0.10 to 0.57, 0.02 to 0.49, 0.03 to 0.52, 0.08 to 0.90, 0.00 to 0.27; all P<0.05). The Nomogram model was further established with age, gender, tumor location, T stage, distant metastasis, medication chemotherapy and surgical treatment. The results of the Nomogram model internal verification indicated that the accuracy of the model in predicting 1-year, 3-year and 5-year DSS was good, and the consistency index was 0.749, which was significantly higher than the consistency index of traditional TNM stage (0.607). Conclusions:Most AMM patients are <70 years old, and the majority of them are female. The common location of AMM is rectum, and many patients receive immunotherapy. Age ≥70 years old and T2 stage are risk factors affecting the prognosis of AMM patients. Neurovascalar invasion, immunotherapy based comprehensive treatment, APR after extensive local resection, directly APR and APR combined with inguinal lymphadenectomy are protective factors of the prognosis. Nomogram prognosis prediction model established based on the clinicopathological features and treatment of AMM patients has higher accuracy and clinical reference value than the traditional TNM stage system.

Objective To evaluate the outcome of the surgical-treated ankle fractures. Methods We reviewed the outcomes of 92 cases of ankle fracture which had complete follow-up data from January 2000 to April 2008. The outcomes were assessed by AOFAS (American Orthopaedic Foot & Ankle Society) scoring scale, VAS scale, satisfaction degree of patients and range of ankle motion. The differences in AOFAS scoring and ankle motive range between involved and contralateral extremity, AO fracture types, involved positions (solemaleolar, bimaleolar, trimaleolar), follow-up timing were statistically analyzed. Results Follow-ups averaged 55 months. All cases had fracture healed. The average AOFAS score was 93.6 points. The excellent to good rate was 100%. VAS score was 0.17 points on average. Satisfaction score was 9.62 points on average. Statistical analysis showed that the motive range of ankle joint between involved and con-tralateral extremity had a significant difference, but there were no significant differences in AOFAS scores and range of ankle dorsiflexion-plantarflexion between AO fracture types, involved positions and different follow-up durations, Conclusion Surgical treatment for ankle fractures can have a good clinical result.

Objective To discuss the curative effect of different operative methods for the treatment of urethrocutaneous fistula (UCF) after urethroplasty.Methods Clinical data of 54 cases of UCF from January 2003 to July 2011 were collected.Simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were performed according to the size,location,number and whether there was urethral stricture of UCF.The treatment effect was recored and analyzed.Results The success rate of UCF repair was 85％ (46/54).There were 4 patients cured after second surgery.The success rates of repair of UCF with simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were 95％,76％,82％,and 83％,respectively.Postoperative recurrence was observed in 5 patients in 6 months after the surgery and 4 of them received the re-operation.Conclusion According to the principle and the individual circumstance,taking personalized operative methods may improve the success rate of the repair of all kinds of UCF.

Objective To summarize and evaluate our surgical approach of tetralogy of Fallot with complete atrioventricular septal defect.Methods 11 patients underwent surgical correction at our institute between June 2007 and April 2012.All of the 11 patients received biventricular or partial biventricular repair through a combined right atrial and right ventricular outflow tract approach.Two-patch technique was used in all 11 children.To minimize the incision in the right ventricular outflow tract(ROVT),8 patients underwent a transatrial approach to close ventricular septal defect.A transannular patch was needed in 7 patients,and a monocuspid valve was inserted in 1 of these patients.Results One hospital death occurred during intensive care stay due to severe low cardiac output syndrome and one late death took place six months after operation because of pneumonia and heart failure.The mean follow-up time was (21.20 ± 19.08) months (range,3-60 months).The KaplanMeier curve for the survival rate was 79.5％ at 5 years.Several postoperative complications occurred during the first 3 months,including 1 mild RVOT obstruction and 1 pulmonary artery stenosis,2 tiny residual atrial septal defects and 1 slight residual ventricular septal defect.Moderate pulmonary valve regurgitation was present in all patients,whether transannular patch was used or not.All survivors remained in good condition in NYHA class Ⅰ or Ⅱ.Conclusion Outcomes of complete correction of tetralogy of Fallot with complete atrioventricular septal defect are favorable during follow-up time.It is feasible to close a ventricular septal defect with a 2-patch technique through a transatrial approach alone.Accurate suturing is the key to the success of the surgery.

Objective To evaluate the implementing effects of the first round malaria control project supported by the Global Fund on malaria control in Sichuan Province so as to provide the evidence for intensifying the control strategy of malaria. Meth?ods Based on the requirements of the malaria project of Globe Fund the comprehensive malaria control measures including case identification health education and training for doctors were carried out. Results In 2007 the malaria incidence was 0.12/10 000 while it was 1.66/10 000 in 2002 with a reduction rate of 92.77%. The number of malaria endemic towns reduced from 13 to 2. The awareness rate of knowledge about malaria of the local residents rose from 26.86%to 79.83% χ2=403.00 P<0.01 with an increase rate of 197.21%. The awareness rate of knowledge about malaria of the students rose from 36.87%to 99.22% χ2=359.62 P<0.01 with an increase rate of 169.11%. Conclusions With the support of Globe Fund the trans?mission of malaria has been effectively controlled. The capacity of malaria control and the malaria control knowledge of the inhab?itants have been enhanced. The implementation of the project has significant effects on malaria control in Sichuan Province.

Objective To study the expression of tumor stem cell marker aldehyde dehydrogenase 1 (ALDH1)in invasive bladder cancer tissue and to clarify its relationship with the biological behavior of bladder cancer. Methods The ALDH1 expression in 109 cases of primary invasive carcinomas specimens (case group)and 20 cases of normal bladder tissue surrounding cancer (control group)was detected by immunohistochemistry. At the same time,the ALDH1 expression in 6 cases of metastatic pelvic lymph node tissue and 20 cases of non-metastatic pelvic lymph node tissue was detected. The relationship between the ALDH1 expression and the chinicopathological charateristics of invasive bladder cancer and its influence in the survival rate and disease-free survival were analyzed. Results The positive rates of ALDH1 expression in bladder cancer tissue and normal bladder tissue were 33.94%(37/109)and 5.00% (1/20),respectively,there was significant different between them (P<0.01);they were 19.05% (8/42)and 43.28% (29/67)in the cases with non muscle invasive and nmuscle invasive bladder cancer, respectively,there was significant difference (P<0.01);they were 13.04% (3/23)and 39.53% (34/86)in the cases of bladder cancer with low grade and high grade,respectively,there was significant difference (P<0.05);they were 50.00% (3/6)and 12.90% (4/31)in the tissue of bladder cancer with metastatic lymph nodes and non metastatic ones,respectively,there was significant difference (P<0.05);they were 50.00% (3/6)and 0.00%(0/20)in the metastatic lymph nodes and non metastatic ones,respectively,there was significant difference (P<0.01).The overall survival rate in the patients with positive ALDH1 expression was 64.9% while it was 84.7% in negative ones,there was significant difference (P<0.05);the disease-free Survival was 51.4% and 75% in the patients with positive and negative ALDH1 groups,respectively,there was significant difference (P<0.05). Conclusion The high expression of tumor stem cell marker ALDH1 is associated with staging, grading and prognosis of invasive bladder cancer.ALDH1 may play a role in the tumorigenesis,progression and metastasis of bladder cancer.