Protracted bacterial bronchitis (PBB) is one of the most common causes of chronic wet cough in children.Pediatricians have paid more attention to the PBB.Three most commonly identified bacteria are non-typeable Haemophilus influenzae,Streptococcus pneumoniae and Moraxella Mora bacteria.The occurrence of PBB is associated with bacterial biofilm formation in the airway,tracheobronchomalacia,systemic immune function disorder,and environmental pollution.The clinical presentations of PBB are wet cough and wheezing.Pulmonary signs are moist rale and(or) wheezeing.International guidelines recommend the treatment of Amoxicillin and C1 avulanate,the courses are at least two weeks.Domestic scholars have also used traditional Chinese medicine or western medicine therapy for the treatment of PBB.

A 56-year-old female patient of Han nationality presented with generalized erythema and vesicles for 6 days,as well as high fever for 2 days.Twenty days prior to hospitalization,the patient received surgical treatment combined with oral methazolamide and glucocorticoids for glaucoma.The patient had a history of allergy to sulfanilamides.On admission,the patient presented with generalized erythema,vesicles and occasional erosions with bilateral eyelid and oral involvement.Nikolsky's sign was positive.Wheezing sound was heard over the right lung.Genetic testing showed that HLA-B5901 allele was positive.The patient was diagnosed with methazolamide-induced toxic epidermal necrolysis (TEN) complicated by pneumonia,and managed with immunoglobulin (25 g/day,5 days),glucocorticoids (the largest dose equivalent to methylprednisolone 160 mg/day),fresh plasma,antibiotics,as well as other supporting and symptomatic treatments.The condition was controlled after 2 weeks,and the patient was cured and discharged from hospital after 25 days.The fact that the patient carried HLA-B5901 allele suggests that HLA-B5901 is strongly correlated with methazolamide-induced TEN or Stevens-Johnson syndrome in Chinese descendants or Han population,besides in Japanese and Korean descendants.

Objective To explore the expression, as well as the proportion of subsets of the natural killer (NK) T cells in peripheral blood of patients with esophageal carcinoma before and after surgery, and provide ideas and experimental basis for immune treatment through tests. Methods Using CD3, CD56, CD4 and CD8 antibody to study the NKT cells and its subsets. Peripheral NKT cell subsets in 59 patients with esophageal carcinoma were analysed by flow cytometer. Results With the ratio of CD+3 CD+56 CD+8/CD+3 CD+56 CD+4 gradually increased, the proportion of phase Ⅲ- Ⅳ patients with esophageal carcinoma is gradually decreased between the groups. One-way ANOVA analysis showed that there were differences between the groups (P ＜0.05). The ratio of CD+3 CD+56 CD+8/CD+3 CD+56 CD+4 was in Non-linear related to CD+3 CD+56 CD+4NKT cells; CD+3 CD+56 CD+8; NKT cells were positively correlated with CD-3 CD+56 NK cells and negatively correlated with CD+3 T cells.Conclusion The ratio of CD+3 CD+56 CD+8/CD+3 CD+56 CD+4 may relate to tumor burden, and is helpful to determine the extent of disease in patients with esophageal carcinoma and prognosis.

Objective To study the significance of discrimination of scarce cardiac masses by echocardiography. Methods Twenty-nine patients with cardiac masses selected randomly were examined by transthoracic echocardiography and transesophageal echocardiography to observe their shape, internal echo, margins, membrane and blood flow. Results Twenty-three patients in twenty-nine cases were confirmed by surgery and pathology including eight benign masses and fifteen malignant masses, but the other six patients with metastasis carcinoma had no pathologic results. Eighteen patients got correct diagnosis, nine patients weren′t diagnosed in character and two patients were made a wrong diagnosis. Conclusions Echocardiography is the only noninvasive method which can provide reliable evidences for clinic before surgery to discriminate scarce cardiac masses.

Objective To discuss the management and selection of donor and recipient veins in the transfer of vascularied autogeneous submandibular gland (SMG).Methods The SMGs of 48 patients with severe keratoconjunctivitis were transfered to the temporal region by microsurgery from June,2002 to June,2013.The secreted saliva was used as the substitute of tear.Donor and accepting-site vessels,vessels crisis and managements,survival of grafts were retrospectively analysed.Results Transplantation succeeded in 45 patients and failed in 3.For donor veins,39 were facial veins,12 were venae comitantes of facial artery,1 was vein near the duct.For revipient veins,41 were superficial temporary veins,6 were deep temporary veins and 5 were veins in the upper neck.For revipient artery,except superficial temporary artery,deep temporary artery was also a good selection.After surgery,2/5 venous crisis cases were rescued by reanastomosising veins.TC99m examination suggested that the 49 TSMGs were survived,and the ducts were unobstructed.Follow up lasted for 6 months to 10 years,the symptoms of photophobia and anemophobia were alleviated,the symptoms of corneal xerosis disappeared.Good clinical efficacy was obtained after transplantion.Conclusion During SMGs transplantion,facial veins,venae comitantes of facial artery or vein near the duct can be used for donor vein.For recipient veins,except the superficial temporary veins as major,deep temporary veins or veins in the upper neck is also a secection.Correct selection and microsurgical management of donor and revipient veins are keys to successful SMGs transplantion.

Objective NKT cells are very important as a kind of non-specific immune cells. Much attention in antitumor significance has been received in the study of its effect on malignant diseases. The aim of this study was to detect the expression of NKT cells and its CD+8 NKT subsets in peripheral blood of esophageal patients and normal person, and to analyze the changes in the expression of NKG2D and NKG2A receptorsand its clinical pathological factors. Methods By flow cytometric analysis, 53 patients with esophageal carcinoma and 39 normal controls were analysed for peripheral blood of NKT cells and CD+8 NKT subsets, and the expression of NKT cells NKG2A and expression of NKG2D receptor. The clinical pathological factors were collected for the comparative analysis. Results Compared with the normal control group, the expression of NKT cells in peripheral blood of esophageal patients increased [(4.32±0.73) %, (5.97±1.29) %] (t =3.562, P <0.01), and the expression level of its surface receptor NKG2D reduced [(17.56±5.92) %, (15.12±1.56) %] (t =3.892, P <0.05), but the express levels of NKG2A [(4.02±1.41) %, (5.99±4.59) %] in creased (r = 4.015, P <0.05), those expression change with the development of the esophageal cancer. Conclusion The increased expression of NKT cells and CD+8 NKT subsets in the peripheral blood of patients with esophageal carcinoma refletcs that the immune feedback of patients' antineoplastic effect is strengthened. The decresed expression of the active receptor NKG2D and the increased expression of the inhibitory receptor NKG2A on NKT cells might be one of mechanisms leading to the reduction of NKT cell activity and immune escape of patients with esophageal carcinoma. The changes of surface receptors of NKT cells may be associated with the development of the esophageal cancer.

Objective To evaluate the effects of sinomenine on the expression of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) during renal ischemia-reperfusion (I/ R) in rats.Methods Fifty-four male Wistar rats, weighing 180-220 g, were randomly divided into 3 groups (n=18 each) using a random number table: sham operation group (group S) , group I/R and sinomenine group (group SIN).Renal I/R was induced by clamping the left renal pedicle for 45 min followed by reperfusion in I/R and SIN groups.In group S, the bilateral renal pedicels were only exposed.Sinomenine 60 mg/kg was intraperitoneally injected at 30 min before reperfusion in group SIN, while the equal volume of normal saline was given in group S and group I/R.At 6, 12 and 24 h (T1-3) of reperfusion, 6 rats from each group were chosen, and blood samples were drawn from the hearts for determination of the serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations.The animals were then sacrificed, and the left kidney was removed and embedded into a paraffin block for determination of the expression of HIF-1α and VEGF in the renal tissues (by immuno-histochemistry).Results Compared with group S, the serum Cr and BUN concentrations were significantly increased at T1-3 , and the expression of HIF-1α was significantly up-regulated at T2,3 in group I/R and group SIN, and the expression of VEGF was significantly upregulated at T2,3in group I/R, and at T1-3 in group SIN.Compared with group I/R, the serum Cr concentration at T1-3 and serum BUN concentration at T2,3 were significantly decreased and the expression of HIF-1α at T2,3and VEGF at T1-3was significantly up-regulated in group SIN.Conclusion The mechanism by which sinomenine attenuates renal I/R injury is related to up-regulation of the expression of HIF-1α and VEGF in the renal tissues of rats.

Objective To investigate the effect of sinomenine on the levels of nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-two healthy male Wistar rats, aged 6-9 weeks, weighing 180-220 g, were randomly assigned into 4 groups (n =18 each) using a random number table: control group (group C), sinomenine group (group SIN), group I/R, and sinomenine+I/R group (group SIN+I/R).The animals were anesthetized with 10％ chloral hydrate 350 mg/kg.The left renal pedicles were clamped with atraumatic microclips for 45 min followed by reperfusion, and the right kidney was removed immediately after onset of reperfusion to establish the model of renal I/R injury.Sinomenine 60 mg/kg was injected intraperitoneally at 30 min before reperfusion in group SIN +I/R, and at the corresponding time point in group SIN.At 6, 8 and 12 h of reperfusion, the blood samples were drawn by cardiac puncture for measurement of serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations.The left renal specimens were obtained for examination of pathological changes (with light microscopes) and for determination of the rate of NF-κB-positive cells and iNOS expression in renal tissues (by immunohistochemistry).Results Compared with group C, the concentrations of serum Cr and BUN, and rate of NF-κB-positive cells were significantly increased, and the expression of iNOS was up-regulated in I/R and SIN+I/R groups, and no significant change was found in the parameters mentioned above in group SIN.Compared with group I/R, the concentrations of serum Cr and BUN, and rate of NF-κB-positive cells were significantly decreased, and the expression of iNOS was down-regulated in group SIN+I/R.The microscopic examination showed that the pathological changes of kidney were significantly attenuated in group SIN+I/R compared with group I/R.Conclusion The mechanism by which sinomenine attenuates renal I/R injury is related to inhibited activity of NF-κB and down-regulated expression of iNOS in rats.

Objective To evaluate the effect of sinomenine on apoptosis in renal tubular epithelial cells of rats subjected to renal ischemia-reperfusion (I/R), and the relationship with C-Jun N-terminal kinase (JNK) signaling pathway.Methods Fifty-four male Wistar rats, aged 6-8 weeks, weighing 180-220 g, were randomly divided into 3 groups (n =18 each) using a random number table: sham operation group (group S), I/R group and sinomenine group (group SIN).Renal ischemia was induced by occlusion of the left renal pedicle for 45 min followed by reperfusion, and the right kidney was removed immediately after onset of reperfusion in anesthetized rats in I/R and SIN groups.In group SIN, sinomenine 60 mg/kg was injected intraperitoneally at 30 min before reperfusion, while the equal volume of normal saline was given instead of sinomenine at the same time point in S and I/R groups.Six animals in each group were selected at 0.5, 6 and 24 h of reperfusion, blood samples were collected by cardiac puncture for determination of serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations.Immediately after blood sampling, the left kidney was removed for examination of pathological changes in renal tissues (with light microscopes) and for determination of phosphorylated JNK (p-JNK) and caspase-3 expression (by immune-histochemistry) and apoptosis in renal tubular epithelial cells (by TUNEL).The apoptotic rate was calculated.Results Compared with group S, the serum Cr and BUN concentrations were significantly increased, the expression of p-JNK and caspase-3 was up-regulated, and the apoptotic rate was increased in I/R and SIN groups.Compared with group I/R, the serum Cr and BUN concentrations were significantly decreased, the expression of p-JNK and caspase-3 was down-regulated, and the apoptotic rate was decreased in group SIN.The microscopic examination showed that the pathological changes of kidney were significantly attenuated in group SIN compared with group I/R.Conclusion The mechanism by which sinomenine attenuates renal I/R injury is related to inhibited activation of p-JNK signaling pathway and reduced apoptosis in renal tubular epithelial cells of rats.

Objective To evaluate the effect of lappaconitine on renal ischemia-reperfusion (I/R) injury in mice.Methods Thirty-six male Wistar rats,weighing 180-220 g,were randomly divided into 3 groups (n=12 each) using a random number table:sham operation group (group S),group I/R and lappaconitine group (group LA).Renal I/R was induced by occlusion of the left renal pedicle for 45 min with atraumatic microclips followed by reperfusion,and the right kidney was removed after atraumatic microclips were released.At 30 min before reperfusion,lappaconitine 4 mg/kg was injected intraperitoneally in group LA,and normal saline 2 ml was given in S and I/R groups.In group S,the left renal pedicle was only isolated.At 5 and 24 h of reperfusion,blood samples were taken from the inferior vena cava for determination of serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations,and kidney specimens were obtained for histopathologic examination (with light microscope) and for determination of the expression of cyclooxygenase-2 (COX-2) and matrix metalloproteinase-2 (MMP-2) in renal tissues (by immunohistochemistry).Results Compared with group S,the serum Cr and BUN concentrations were significantly increased,and the expression of COX-2 and MMP-2 in renal tissues was up-regulated at 5 and 24 h of reperfusion in I/R and LA groups.Compared with group I/R,the serum Cr and BUN concentrations were significantly decreased,the expression of COX-2 and MMP-2 in renal tissues was down-regulated at 5 and 24 h of reperfusion and histopathologic changes were reduced in group LA.Conclusion Lappaconitine can attenuate renal I/R injury through inhibiting the expression of COX-2 and MMP-2 in rats.