Objective To investigate the clinical manifestations, auxiliary examination, diagnosis and therapy of Aspergillus tracheobronchitis (ATB).Methods Clinical data of 4 ATB patients treated in Qingdao Municipal Hospital from June 2012 to September 2015 were analyzed retrospectively. The related literature was also reviewed.Results The main clinical manifestations were cough, sputum production, short of breath, fever and hemoptysis. All the four patients had predisposing factors. The ifndings of CT scan mainly included bronchial wall thickening, obstruction of bronchial lumen or no significant abnormality. Bronchoscopy showed mucosal erosion, necrosis, tracheal stenosis and obstruction of airway by pseudo-membrane. The diagnosis was confirmed by histopathology in all the four cases. They were treated with anti-Aspergillus therapy. The two patients with airway stenosis were treated with interventional therapy via bronchoscope. As for the outcome, one patient was improved after therapy. Another was cured. The remaining two patients died.Conclusions The clinical manifestations and chest imaging of ATB are nonspecific. Bronchoscopy is an important tool for diagnosis of ATB. Early diagnosis and proper anti-Aspergillus treatment are critical for improving prognosis.

Objective: To assay minimal biofilm eradication concentration (MBEC) of various extraction compounds from Galla Chinensis to 5 oral bacterial biofilms, and then to set up traditional Chinese medicine empirical study methods of pharmacodynamic susceptibility. Methods:5 cariogenic bacteria strains were selected (Streptococcus mutans ATCC25175, Streptococcus sanguis ATCC10556, Lactobacillus rhamnosus AC413, Actinomyces naeslundii WVU627, Actinomyces viscosus ATCC19246) in present study. Various extraction compounds of Galla Chinensis were GCE (aqueous extract), GCE-B(300 ml/L alcohol extract), GCE-C(500 ml/L acetone extract),GCE-D(1 000 ml/L acetone extract), gallic acid and methyl gallate. ①Observed oral bacterial biofilm formation in MBECTM-Device at different-time-stages. ②MBECTM -HTP-Assay:The minimal inhibitory concentration (MIC) and minimal biofilm eradication concentration (MBEC) of various extraction compounds of Galla Chinensis on 5 oral bacteria strains were determined. Results:5 oral bacterial biofilm were readily formed on the lid of MBECTM-Device under selected condition (observed by SEM). 5 oral cariogenic bacteria growing as planktonic populations were sensitive to 6 extraction compounds of Galla Chinensis. When compared to 6 extraction compounds of Galla Chinensis, 5 oral cariogenic bacterial biofilm were 2-16 times less susceptible than growing planktonic bacteria. GCE and GCE-B are the most effective medicine against 5 oral cariogenic bacterial biofilm. GCE-C and GCE-D were effective in killing oral-bacterial biofilm at relatively high concentration, but gallic acid and methyl gallate were less effective.Conclusion:GCE and GCE-B are the most effective medicine against 5 oral cariogenic bacterial biofilm of 6 extraction compounds from Galla Chinensis. MBEC can provide a relatively accurate medicine concentration for clinical test.

Objective To investigate the clinical characteristics and risk factors of non-premature STEMI patients underwentprimaryPCI with multivessel disease.Methods Data of clinic and coronary angiographic features were retrospectively compared between group of 371 younger STEMI patients (male age ＜ 55 years,female ＜ 65 years) and group of 662 older STEMI patients.All patients were admitted to hospital from January 2005 to January 2015 and treated with primary PCI.The patients' gender,smoking history,family history of coronary heart disease (CHD),hypertension,type 2 diabetes mellitus,previous myocardial infarction and revascularization,stroke history,serum uric acid,lipids etc.were documented.The comparison of coronary artery disease characteristics and the incidence of adverse events during hospitalization were also carried out between two groups.Results (1) Prevalence of males (88.4％ vs.76.9％),smokers (74.9％ vs.51.5％),family history of CHD (21.0％ vs.9.7％) and levels of diastolic blood pressure,total cholesterol,low density lipoprotein cholesterol (LDL-c),triglycefides,and low cholesterol were significantly higher in the non-prematuregroup than in the premature group (all P ＜ 0.01),while high density lipoprotein cholesterol (HDL-c) was lower in non-prematuregroup (P ＜ 0.01).(2) The incidence of in-hospital events in both groups were low.There was less ventricular tachycardia in the non-premature group (1.5％ vs.0.3％) (P＜0.05).(3) There were no statistically significant differences in the number of infarct vessels,site ofinfarctbetween two groups.(4) Logistic regression analysis showed that smoking (OR =2.22,95％ CI:1.588-3.108) (P ＜ 0.05),family history of CHD (OR=2.12,95％CI:1.431-3.140) (P＜0.05),triglyceride concentration (OR=1.971,95％CI:1.475-2.635) (P＜0.05),LDL-c (OR=1.193,95％CI:1.008-1.413) (P=0.04) were independent risk factors fornon-premature STEMI withmultivessel disease.Conclusion Smoking,family history of CHD,triglyceride concentration,LDL are main risk factors of younger age STEMI patients with multiple vessel disease;Compared with younger age patients,older age patients during hospitalization are more likely to occur ventricular tachycardia.Regardless of age difference,the characteristics of coronary artery lesions show no significant difference.

ObjectiveTo investigate the efficacy and advantages through the combination of transurethral resectoscope outer sheath and ueteroscopy for treatment of bladder stones.MethodsThe Wolf F24 transurethral resectoscope was first placed in bladder to observe the lesions in 68 patients with bladder stones.With the moving out of the body and inner sheath,F8 ureteroscopy sheath was sent into the bladder through outer sheath,then,holmium laser lithotripsy was performed.ResultsSixty-eight patients got successful operations without postoperative stones residual,significant postoperative bleeding,urethral tear,bladder injury and infection complications. The gravel rate reached 100％ 20 - 60 minutes ( 36.7 ± 5 ) min.ConclusionThe combination of transurethral resectoscope outer sheath and ueteroscopy is effective and safe for treatment of bladder stones.

Objective To investigate the effects of recombinant human granulocyte colonystimulating factor(G-CSF) on murine thymic emigration and subsets reconstitution after a sublethal dose of irradiaton.Methods Female BALB/c mice were irradiated with a 6.0 Gy of γ-ray total-body irradiation and then randomly divided into GCSF group and control group.For mice in the GCSF group,recombinant human G-CSF 100 μg · kg-1 · d-1 was injected subcutaneously once daily for 14 continuous days and mice in the control group were given the same volume of phosphate buffered solution (PBS).At 7,14,21 and 28 days later,mice were killed and thymus mononuclear cell suspension were analyzed by flow cytometry for the percentage of the four stages of thymic CD4 -CD8 - double negative cells (DN1-4) and the CD4 + CD8 + double positive ( CD4 + CD8 + DP),CD4 + CD8 - single positive ( CD4 + SP),CD4 -CD8 + single positive cells (CD8 + SP).Real-time PCR was used for detection and quantitation of murine T cell receptor rearrangement excision circles(sjTRECs) of the thymic cells of 30 and 60 d after irradiation.Results The percentage of thymic DN1 cells in GCSF group was significantly higher than that of the control group 7 d after irradiation (t =9.59,P ＜ 0.05 ).21 d later,the proportion of thymic DN3 and DN4 cells were higher than those of the control group ( t =16.37,7.6,P ＜ 0.05 ).The percentage of thymic CD4 + CD8 + DP cells decreased 7 d after irradiation,increased at 14 d,decreased again at 21 days,and then got a permanent recover.The percentage of thymic CD4 + CD8 + DP cells in the GCSF group recovered to normal and was significantly higher than that of the control group 28 days after irradiation (t =12.22,P＜ 0.05).The percentage of thymic CD8 + SP cells of the GCSF group was significantly higher than that of the control group 21 d after irradiation ( t =3.77,P ＜ 0.05 ),while G-CSF had no obvious influence on the percentage of the thymic CD4 + SP cells.The sjTRECs copies in the GCSF group was significantly higher than that of the control group 30 d after irradiation ( t =5.95,P ＜ 0.01 ),which disappeared 60 d later.Conclusions G-CSF could promote the proliferation and differentiation of thymic DN and DP cells,enhance the recent thymic emigrants and accelerate central immunologic reconstitution after acute irradiation.

Objective To evaluate the diagnostic value of the multislice spiral computed tomography angiography (MSCTA) in the diagnosis of moyamoya disease and explore its future application. Method The image data of 10 patients with moyamoya disease undertaken MSCTA and digital subtraction angiography (DSA) were reviewed analysis. Results MSCTA could clearly show stenosis, multiple occlusion or abnormalities of the cerebral vessels. Volume-rendering helped to show the relationship between the abnormal vessels and the surrounding tissues. Combined maximum intensity projection (MIP) and multiplsnar reconstruction (MPB) images could clearly show abnormally increased vessels (moyamoya disease vessels). The rate of occlusion and stenosis showed by MSCTA were 66.2%(53/80)and 67.5%(54/80)by DSA. There was no significant difference between the two methods (P>0.05). The images of MSCTA were basically same as those of DSA. Conclusions MSCTA is sensitive in diagnosing moyamoya disease, which is an important basis for early diagnosis. Early diagnosis and treatment is effective in improving prognosis of moyamoya disease.

Objective To evaluate the effect of continuous infusion of dexmedetomidine on the oxidative stress in patients undergoing percutaneous coronary intervention (PCI).Methods Fifty patients, with acute myocardial infarction who required for emergency PCI, 39 males, 11 females, aged 47-79 years, weighting 45-83 kg, ASA physical status Ⅲ or Ⅳ, were selected and randomly divided into two groups (n=25 each) using a random number table: the control group (group C) and the dexmedetomidine group (group D).In group D, a loading dose of dexmedetomidine 0.5 μg/kg was infused intravenously for 10 min before surgery, and then dexmedetomidine was infused at a rate of 0.2-1.0 μg·kg-1·h-1 during the operation until the end of operation.Patients in group C received the same dose saline in the same way.RASS score was maintained at-2-2 scores in the two groups.Blood samples were collected before the anesthesia induction (T0), at the end of the operation (T1), 6 h after the operation (T2) and 24 h after the operation (T3) to determine the observed changes of PMN, SOD and MDA.The intraoperative adverse reactions including hypotension, bradycardia and hypoxemia were recorded.Results Compared with T0, the number of PMN and the serum concentration of MDA at T1-T3 significantly increased, while effective serum SOD at T1-T3 significantly decreased (P＜0.01 or P＜0.05).The serum concentration of MDA and the number of PMN at T1-T3 in group D were significantly lower than those in group C, while the effective serum SOD was significantly higher than that in group C (P＜0.05).There was no significant difference of intraoperative adverse reactions including hypotension, bradycardia and hypoxemia between the two groups.Conclusion Continuous infusion of dexmedetomidine can decrease oxidative stress thus to alleviate myocardial reperfusion injury.

This article analyzes the factors of influencing practice quality from such aspects as hospital management,medical reform,clinical teachers and students and points out that only by enhancing the management of practice hospital as well as the system of examining and assessment,raising the teacher guidance and teaching consciousness and guiding the students to properly handle with the relations between employment,entrance exam for postgraduate and practice can we guarantee the clinical practice quality.

Objective To research the special manifestations of magnetic resonance cholangiopancreatography(MRCP) in carcinoma of pancreatic head.Methods MRCP in 22 cases with pancreatic head carcinoma confirmed by operation and pathology (including SE sequences with T1WI and fat saturation,FSE with T2WI and fat saturation and MRCP in coronal sectior) were performed before operations.Additional CE MRA on abdominal vessels including abdominal ateries, portal veins and superior mesenteric arteries and their veins in 16 cases also examined before operations. Results Carcinomas of the pancreatic head were diagnosed correctly by MRCP in 21 cases, and 1 case was misdiagnosed as chronic pancreatitis. MRCP all demonstrated abrupt interruption at pancreatic head segments of dilated left common bile duct and main pancreatic duct at the pancreatic head ones, their left segments were dilate with higher signal and both didn't cross each other, because they were destroyed by carcinomas of pancreatic head. Destruction and no cross each other of pancreatic head segments of choledochus and main pancreas duct,it was called "no cross sign". CE MRA demonstrated destruction of abdominal ateries in 3 cases, portal vein in 3 cases and superior mesenteric vein in 4 cases and not being resected.Conclusion "No cross sign"on MRCP examination is of important value in diagnosis of carcinoma of the pancreatic head.

Objective To investigate the clinical characteristics and prognosis in the patients with type 2 diabetes mellitus and invasive pulmonary aspergillosis(IPA) for better management of the disease .Methods Clinical data of 9 cases of type 2 diabetes associated with IPA treated in Qingdao Municipal Hospital from January 2008 to December 2013 were analyzed retrospectively . Results The diagnosis of IPA was proven in 5 and probable in 4 of the 9 patients .The main clinical manifestations were fever , cough and expectoration .The findings of CT scan mainly showed pulmonary nodules along the bronchovascular bundle and cavity signs .Bronchoscopy showed congestion ,edema ,and erosion of bronchial mucosa covered with yellow‐white or brown pus ,partially or completely blocking the lumen .Antifungal treatment was effective for 4 patients .The other five patients died . Conclusions Type 2 diabetes mellitus is a risk factor for developing invasive pulmonary aspergillosis .Early diagnosis and proper treatment are critical for improved prognosis .