Objective To investigate the effect of budesonide inhalation combined with azithromycin in treatment of children with mycoplasma pneumonia and the corresponding clinical nursing pathway.Methods From February 2010 to 2011,100 cases of children patients with mycoplasma pneumonia (all with budesonide inhalation combined with azithromycin) were randomly divided into the experimental group and the control group with 50 patients in each group.The experimental group adopted clinical nursing pathway,while the control group underwent routine care.After one or three-month follow-up,forced vital capacity (FVC),forced vital capacity 1s (FEV1),peak expiratory flow values (PEF) and other pulmonary functional indexes and clinical efficacy were compared between two groups.Results The clinical effective rate of the experimental group was 94％,higher than the control group.FVC,FEV1,PEF changes in the experimental group were better than the control group.Conclusions Budesonide inhalation combined with azithromycin in treatment of mycoplasma pneumonia in children has good effect,coupled with the clinical nursing pathway can effectively improve lung function,reduce the incidence of adverse reactions during treatment,significantly improve the prognosis,should be used widely in clinic.

After exploring the incubated diseases in TCM theory and its developed courses,we put forward its core point.In the same time,after analyzing the EB virus infection disease,including its causes,the syndrome characters and the immunocompetence,thus we put forward the theory,such as "the EB virus infection is incubated diseases in TCM and its therapeutic principle is concept of viewing the situation as a whole".

Plastic bronchitis is a rare condition characterized by bronchial casts, that may result in respiratory failure, suffocation and even death.Therefore, early diagnosis and treatment are of great significance.This article summarizes the imaging characteristics of plastic bronchitis, in order to further improve the understanding of the disease among pediatricians, radiologists, and emergency physicians.

Objective To evaluate the efficacy of ureteroscopic pneumatic lithotripsy for ureteric calculi.Methods From January 2003 to June 2007,221 patients with ureteric calculi underwent ureteroscopic pneumatic lithotripsy in our hospital.Under continuous epidural anesthesia combined with spinal anesthesia,the surgery was performed in lateral lithotomy position.Double-J catheter was used for drainage after the operation.Results The mean operation time was 55 minutes(ranged from 15 to 118 minutes).Among the patients,the calculi were found in the upper ureter in 16 cases,middle segment in 52 cases,and lower ureter in 153 cases.A total of 228 stones in the 211 patients were all fragmented with a success rate of 100%.The discharging rate was 95.5%(211/221).ESWL was used in 7 cases with unsatisfied outcomes and 3 patients who had ipsilateral renal calculi.A 3-to 6-month follow-up was achieved in 189 of the patients,who had no recurrence during the period.Conclusions Ureteroscopic pneumatic lithotripsy is a minimal invasive and effective treatment for ureteric calculi.Postoperative ESWL is an alternative which can increase the rate of stone clearance.

Objective To evaluate the morphological features and distribution of Cajal-like cells in the human upper urinary tract after the laparoscopic nephrectomy.MethodsFrom January 2008 to August 2008,specimens of the kidney were obtained from 23 patients after laparoscopic nephrectomy in our hospital.Each specimen included the renal calyces,renal pelvic,and proximal ureter.HE staining and CD117 immunohistochemical staining were performed.The Cajal cells harvested from normal colon were used as positive control.The cells were observed under light microscope and the distribution of the Cajal-like cells in the upper urinary tract were analyzed.ResultsThe morphology of Cajal-like cells in the human upper urinary tract were similar to those collected from the colon,both showed fusiform shape and were positive for CD117.The Cajal-like cells within the colon were located surrounding the myenteric nerve plexus between the smooth muscles,whereas the Cajal-like cells distributed in the human upper urinary tract were diffused within the lamina propria and muscles.The density of Cajal-like cells at the renal calyces,renal pelvic,and proximal ureter was 15.4?5.4/cm2,22.6?6.6/cm2,and 19.9?5.8/cm2,respectively.The density at the renal calyces was significantly lower than those in the renal pelvic and proximal ureter(P=0.000,P=0.014),whereas,no significant difference was found in density between the renal pelvic and proximal ureter(P=0.129).ConclusionsCajal-like cells exist in the human upper urinary tract with different distribution characteristics from those in the gastrointestinal tract.In the upper urinary tract,the density of the cells is various,which may be related to the functions of the different parts of the tract.

443) ?mol/L) due to upper urinary calculous obstruction,urgently treated by pneumatic lithotripsy(EMS,Switzerland) under ureteroscopy,from August 2002 to April 2006 in this hospital.After stone fragmentation and removal,an indwelling double-J stent was placed into the ureter at the same time.Results The continuity of the ureter was restored after one session of lithotripsy in all the 9 cases(14 sides).The ureteral calculi were thoroughly removed on one session in 7 cases(12 sides).Few residual stones were found in the renal pelvis in 2 cases(2 sides),in one of which the stones were spontaneously expelled after oral medication,and in another,after extracorporeal shock wave lithotripsy(ESWL).No severe complications happened,such as ureteral avulsion,rupture,or perforation.Concentrations of serum creatine were decreased to normal levels within 3~7 days after operation in all the 9 cases.The gross blood urine disappeared in 1~4 days postoperatively.The patients were discharged from the hospital after 3~7 days (mean,5 days) after operation.The double-J catheter was removed at 1~2 months postoperatively.Follow-up examinations in 7 cases for 2~30 months(mean,14 months) found normal levels of serum creatine and no recurrent urinary stones under B-ultrasonography or X-ray radiography.Conclusions Ureteroscopic pneumatic lithotripsy in the treatment of acute renal failure due to upper urinary calculous obstruction is an effective treatment with short operation time,safety,and minimal trauma.By using this procedure,both sides of ureteral stones can be removed on one session.

Objective To evaluate clinical effects of single-dose intra-arterial infusion chemotherapy for the treatment of refractory bladder cancer after transurethral resection of bladder tumor (TURBt). Methods A retrospective analysis was made on clinical data of 12 cases of refractory bladder cancer treated by single-dose intra-arterial infusion chemotherapy after TURBt from November 1999 to June 2005. The bladder tumor was resected as thoroughly as possible. Postoperatively, a bilateral internal iliac arteriography was made by using the Seldinger technique. The tumor vessels and normal blood supply were identified through the intubation of the right femoral artery. Half dose of chemotherapeutics (epirubicin 25 mg) was infused into both internal iliac artery, then tumor vessels of bladder was selected and infused with peripheral embolization agent (a mix of fragmented gelatin sponge and cisplatin 200 mg). The embolization agent was used repeatedly until all tumor vessels were embolized. Intravesical instillation with epirubicin was carried out postoperatively, and cystoscopy was performed every 3 months after operation. Results After intra-arterial infusion chemotherapy, there were 12 cases of nausea and anepithymia, 3 cases of vomiting, and 2 cases of fever, all of which were symptomatically relieved with expectant treatment. Mild hip pain occurred in 6 cases and subsided in 3~5 days. Decreased erythrocyte and leucocyte were restored to normal levels in 2 weeks. Liver and renal functions did not present marked changes. Follow-up was conducted for 4~55 months (mean, 34 months). There were 1 case of recurrence at 32 postoperative month and 11 cases of progression free survival. Conclusions This technique lowers the recurrent rate of refractory bladder cancer and the incidence of side effects, being a new alternative for patients who are not willing to receive total cystectomy.

Objective To evaluate the curative effectiveness of ureteroscopic pneumatic lithotripsy in the treatment of ureteral lithiasis.Methods Ureteroscopic pneumatic lithotripsy was performed in 158 cases of ureteral calculi(163 sides)by using the Wolf F8/9.8 rigid ureteroscope and the EMS pneumatic ballistic lithotriptor from August 2002 to April 2006.The operation was carried out under intravertebral anesthesia.Under the irrigation with normal saline,the ureteroscope was advanced into the ureter.Then the ureteral stones were fragmented by pneumatic lithotripsy and removed.Afterwards,a further exploration of the ureter above the lesion was conducted and a double-J drainage tube was placed.Results The operation time was 15-90 min(mean,40 min).The total successful fragmentation rate was 96.9%(158/163),involving a success rate of 86.6%(13/15)for upper stones,96.9%(46/49)for middle stones,and 100%(99/99)for lower stones.The stone migration into the renal pelvis was encountered in 2 cases of upper ureteral calculi(treated by extracorporeal shock wave lithotripsy following a double-J tube placement)and in 3 cases after stone fragmentation(treated by stone expulsion with drugs or extracorporeal shock wave lithotripsy following a double-J tube placement).Ureteral perforation happened during the procedure in 3 cases(1.8%),requiring a double-J tube placement.No serious complications occurred,such as ureteral mucous avulsion or rupture and injuries of neighboring organs or vessels.No conversion to open surgery was required.Follow-up checkups for 1-38 months in 125 cases with B-ultrasonography or KUB film found no recurrence.Conclusions Ureteroscopic pneumatic lithotripsy is a safe,effective,and feasible technique for ureteral lithiasis.

Objective To evaluate the techniques of controlling renal pedicle and dealing with incisional wound of kidney during retroperitoneoscopic nephron-sparing surgery for kidney tumors.Methods 9 patients with kidney tumors underwent retroperitoneoscopic nephron-sparing surgery from December 2003 to January 2007.Renal artery was blocked incompletely with silicone tube and the tumor was resected using an ultrasound scalpel 0.5-1.0 cm distant from the tumors.Incisional wound of kidney was sutured with absorbable stitch combined with biological fibrin glue and hemostatic gauze.Results All the procedures were successful without any converting to open surgery.The operative time was 2-3.5 h(mean,2.6 h).The blood loss was 50-400 ml(mean,150 ml).No complications such as perioperative haemorrhage and urinary leakage occurred.Pathological examination confirmed renal clear cell carcinoma in 8 patients and angiolipoleimyoma in 1 patient.Incisional margins were all of negative tumor cell.9 patients were followed up for 4 to 36 months(mean,13 months),and showed normal renal function and no local recurrence and organ metastasis.Conclusions With the command of techniques of controlling renal pedicle and dealing with surface of wound of kidney,retroperitoneoscopic nephron-sparing surgery is safe and effective.

[ ABSTRACT] AIM:To explore the effects of romidepsin ( FK228) , a novel histone deacetylase inhibitor, on the effector and regulatory T cells in vitro.METHODS:As the reactive cells, lymphocytes, CD4 +T cells and CD8 +T cells were labelled with CFSE, and stimulated with anti-CD3 and anti-CD28 mAbs in the presence and absence of different levels of romidepsin (experimental group and positive control group), or PBS (placebo group).After 72 h, the proliferation of the cells was detected in different groups.The lymphocytes were stimulated with anti-CD3 and anti-CD28 mAbs in the pres-ence and absence of different levels of romidepsin ( experimental group and positive control group ) , or PBS ( placebo group) .After 72 h, the percentage of CD4+Foxp3 +T cells and the levels of related cytokines were detected in different groups.RESULTS:The proliferation of CFSE-labelled lymphocytes, CD4 +T cells and CD8+T cells triggered by anti-CD3 and anti-CD28 mAbs all were inhibited when cultured with romidepsin at concentrations of 1 μmol/L, 3 μmol/L and 5 μmol/L in a dose-dependent manner (P<0.05).Compared with placebo group, in the presence of anti-CD3 and anti-CD28 mAbs, 1 μmol/L romidepsin did not increase the percentage of CD4 +Foxp3 +T cells ( P>0.05 ) .When cultured with romidepsin at concentrations of 3 μmol/L and 5 μmol/L, the percentage of CD4 + Foxp3 +T cells was enhanced markedly ( P<0.05) .The levels of IL-10 and TNF-αin the supernatant were markedly increased in positive control group
and 3 experimental groups ( P<0.05 ) , and the levels of cytokines in different experimental groups were gradually de-creased with the elevation of FK228 concentration (P<0.05).The level of TGF-βwas slightly increased in positive con-trol group with no significant difference compared with placebo group (P>0.05).With the increase in the concentration of FK228 in different experimental groups, the TGF-βlevel was increased in a dose-dependent manner and there were signifi-cant differences in the 3 experimental groups.Meanwhile, significant differences existed between experimental groups and placebo group and between experimental groups and positive control group (P<0.05).CONCLUSION:Romidepsin in-hibits the proliferation of CD4 +and CD8 +effector T cells and increases the percentage of CD4 +Foxp3 +regulatory T cells. It may be related to the increased level of TGF-β, but independent of IL-10.