Objective To explore the value on application of combined C-reactive protein(CRP), serum albumin(PA)with blood routine inspection in diagnosis of bacterial infectious diseases in children.Methods 98 cases of patients confirmed infectious diseases in our hospital were selected as the study objects, and 68 cases with bacterial infectious diseases were as the bacterial infection group, while 30 cases with non-bacterial infection were as the non-bacterial infection group.Another 50 cases of healthy children were as the control group.All the children and children in the control group were given CRP, PA and blood routine detection, The diagnostic coincidence rates were evakuated according to the examination Results .ResultsCRP and WBC levels in the bacterial infection group were significantly higher than those in the non-bacterial infection group and the control group (P<0.05), PA level in the bacterial infection group were significantly higher than that in the non-bacterial infection group and the control group (P<0.05), The children's urine and cerebrospinal fluid or sputum bacterial culture results as the gold standard, 68 cases were true positive, and 30 were negative.CRP diagnosis showed 40 cases were positive, 58 cases negative, 13 cases false positive, and 41 cases false negative, the detection sensitivity was 39.71%, specificity was 56.67%, and coincidence rate was 44.90%.PA diagnosis showed 43 cases were positive, 55 cases negative, 12 cases false positive, and 37 cases false negative, the detection sensitivity was 45.59%, specificity was 60.00%, and coincidence rate was 50.00%.WBC diagnosis showed 47 cases were positive, 51 cases negative, 14 cases false positive, and 35 cases false negative, the detection sensitivity was 48.53%, specificity was 53.33%, and coincidence rate was 52.04%.CRP, PA, WBC combined diagnosis showed 62 cases were positive, 36 cases negative, 3 cases false positive, and 9 cases false negative, the detection sensitivity was 86.76%, specificity was 90.00%, and coincidence rate was 87.76%.The sensitivity, specificity and coincidence rate of CRP, PA and WBC combined diagnosis were significantly higher than those of CRP, PA and WBC diagnosis results.There were no significant differences in sensitivity, specificity and coincidence rate among single diagnosis of CRP, PA and WBC.Conclusion Implementation of combined CRP, PA with WBC in diagnosis of bacterial infection in children can effectively improve diagnostic coincidence rate.and provide theoretical basis for clinical treatment.

Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in the elderly patients undergoing minimally invasive direct coronary artery bypass (MIDCAB).Methods Thirty six patients of both sexes,aged 65-78 yr,with the left ventricular ejection fraction ≥ 45％,with body mass index ＜ 30 kg/m2,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅰ-Ⅲ),scheduled for elective MIDCAB in the left thorax,were randomly divided into 2 groups (n =18 each):double-lumen endotracheal tube group (group D) and bronchial blocker group (group B).Anesthesia was induced with midazolam 0.05 mg/kg,etomidate 0.3 mg/kg,fentanyl 10μg/kg and cisatracurium 0.15-0.20 mg/kg.The patients were intubated with a left-sided double-lumen endotracheal tube 5 min later in group D.The patients were intubated with a single-lumen endotracheal tube 5 min later,and then Coopdech bronchial blocker was inserted into the primary bronchus in group B.The patients were mechanically ventilated.Before induction of anesthesia,at 2 min before intubation,immediately before and after intubation,and at 1 and 2 min after intubation,mean arterial pressure (MAP),heart rate (HR),and mean pulmonary arterial pressure (mPAP) were recorded and rate-pressure product (RPP) was calculated.The requirement for vasoactive drugs was recorded during induction of anesthesia.Lung collapse developed after the pleura was opened was also recorded.Surgical exposure was scored at the end of operation.Results Compared with group D,MAP,HR RPP and mPAP were significantly decreased after intubation,the requirement for nicardipine and esmolol was decreased,and no significant change was found in the requirement for atropine and metaraminol,rate of lung collapse and score of surgical exposure in group B.Conclusion Compared with doublelumen tube,bronchial blocker can provide sufficient exposure of the surgical filed,and intubation-induced fluctuation of hemodynamics is small in the elderly patients undergoing MIDCAB.

Objective To study the correlation between dopamine and glutamate receptor NMDA NR_1 and NMDA NR_(2A),and to share the understanding of the mechanism of dopamine in the synaptic complex of inner hair cells.Methods Forty guinea pigs were divided randomly into four groups and the whole intacochlear perfusions were performed.The perfused cochleas were taken out as preparations 2 hours after perfusing,the contralateral cochleas were also taken out as the normal control group in the group perfused with artifical perilymph solutions.All the preparations were divided into 5 groups:①normal control cochleas;②perfused with artificial perilymph solutions;③perfused with artifical perilymph solutions containing 10 mmol/L dopamine；④perfused with artificial perilymph so lutions containing 30 mmol/L dopamine；⑤perfused with artifical perilymph solutions containing 50 mmol/L dopa mine.The semi-quantitive RT-PCR was used to observe the difference in the amount of glutamate receptor NMDA NR_1、NMDA NR_(2A).Results Dopamine inhibited the compound action potential(CAP),the increase of CAP threshold was observed and correlated with the contentration of dopamine in the perfusion solution.Regarding the amount of glutamate receptor NMDA NR_1 mRNA,there was no significant difference between group ① and group ② (P＞0.05).But a significant difference was observed the other 3 groups when compared to group ①(P＜0.05).No significant difference was detected among the 5 groups in the amount of glutamate receptor NMDA NR_(2A) (P＞0.05).Conclusion Dopamine may inhibit the cochlear auditory afferent nerve.The significant correlation between dopamine and glutamate receptor NMDA NR_1 was observed,the amount of glutamate receptor NMDA NR_1 decreased along with the increasing of the contentration of dopamine in the perfusion solution.And there was no significant correlation between dopamine and glutamate receptor NMDA NR_(2A).

Researches find that microRNAs(miRNAs) participate in cell proliferation,differentiation and apoptosis.Dysregulation of miRNA exist in almost all kinds of tumors,including esophageal cancer.MiRNAs bind to mRNA of oncogene or tumor suppressor gene by perfectly or partly base-pair complementarity,and then,promote mRNA degradation or inhibit translation of target mRNA.Recently studies have comfirmed that miRNA functions as a significant regulator in esophageal cancer and it is involved in tumorigenesis,development and prognosis.MiR-21 binds to programmed cell death 4(PDCD4) mRNA and inhibits the translation of PDCD4,then promotes tumorigenesis of esophageal cancer.MiR-106-25 polycistron is activated by genomic amplification,and then suppresses the expressions of P21 and Rim,and subsequently promotes the occurrence and progress of esophageal cancer.

Objective To investigate the surgical treatment of gastrointestinal stromal tumor (GIST) based on the clinical characteristics of GIST in different locations.Methods The clinical data of 486 GIST patients who received surgical treatment at the Peking Union Hospital from January 2003 to December 2012 were retrospectively analyzed.There were 461 patients with primary GIST and 25 with secondary GIST.The clinical characteristics and surgical treatment methods were analyzed.All data were analyzed using the chi-square test.Results Of the 461 patients with esophageal stromal tumors,6 received partial esophagectomy.Of the 234 patients with gastric stromal tumors,183 received partial gastrectomy,23 received proximal gastrectomy + cardiectomy,23 received distal gastrectomy,2 received total gastrectomy and 3 received exploratory laparotomy.Of the 51 patients with duodenal stromal tumors,34 received partial duodenectomy,9 received pancreatico-duodenectomy,5 received pylorus-preserving pancreaticoduodenectomy,3 received palliative surgery.Of the 116 patients with small intestinal stromal tumors,110 received partial small intestinal resection and 6 received palliative surgery.Of the 29 patients with rectal stromal tumors,13 received posterial transsphincteric surgery of the rectum,12 received transanal local resection of rectal tumors and 4 received abdominoperineal resection; laparotomy was performed on 25 patients with GIST in other positions.Of the 25 patients with secondary GIST,10 patients with liver metastasis of GIST received hepatic segmentectomy,1 received hepatobiopsy; 6 received abdominopelvic tumor resection; 5 received portial resection of the small intestine or colon; 1 received sigmoid colostomy; 1 received splenectomy and 1 received intracranial tumor resection.Of the 461 patients with primary GIST,patients who received combined devisceration accounted for 12.58％ (58/461),and the ratio of combined cholecystectomy was the highest,which was 34.5％ (20/58).Combined devisceration was considered for patients with duodenal stromal tumors,gastric stromal tumors and small intestinal tumors.Laparoscopic surgery accounted for 20.39％ (94/461) of all the surgery,and the ratio of laparoscopic surgery which carried out in recent 5 years was 28.52％ (77/270),which was significantly higher than 8.90％ (17/191) of the earlier 5 years (x2=36.67,P ＜ 0.05).Conclusion Different surgical treatment methods including minimally invasive surgery could be adopted according to different clinical characteristics of GIST in different locations,and radical resection of GIST is the main objective.

Objective To investigate the expression and distribution of basic fibroblast growth factor (bFGF)and platelet-derived growth factor (PDGF)in the different phases of femoral neck fracture.Methods Immunohistochemical assays were used to determine the expression and distribution of bFGF and PDGF protein in 36 human specimen of femoral neck fracture.A was measured and analyzed by CMIAS color imaging analysis system for signals of bFGF protein were found high in the mesenchymal cells,monocyte and vascular endothelial cells at 1st week after fracture in 9 subjects,with A of (0.4076 ±0.0902).The weakly positive signals of PDGF protein were found in the mesenchymal cells,while strongly positive in the vascular endothelial cells with A of (0.2261 ±0.0636).At 2rd week,in 9 cases the expression of bFGF and PDGF was strongly expressed in fibroblasts,endothelial cells,cartilage cell and cartilage matrix,osteoblast,with A of[(0.6404±0.0920)and (0.7457±0.0756)]and significandy higher than that at 1st week (P＜0.05,P＜0.01).There was no significant difference between the 3rd and 3nd week with A of[(0.7168±0.1346)and (0.8033±0.0491),P＞0.05 ].The expression of bFGF and PDGF protein was reduced obviously at 4th week but was positive in young and cartilage tissue,with A of [(0.5374correlation between bFGF and PDGF protein in different phases (r1week=0.792,r2week=0.834,r3week=0.880,entiation of cartilage cell and osteoblast,and induce proliferation of vascular endothelial cells and new blood vessel.③ Both bFGF and PDGF are bone growth factors, cooperating in regulating proliferation and differentiation of cartilage cell and osteoblast for fracture healing.

Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Method The clinical data of 32 patients with Mirizzi syndrome with non-circumferential defect of bile duct were repaired using the patient's own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap.Results All the patients were operated success fully.There was no operative mortality.The defects in the bile duct were repaired using gallbladder pedicle flap in 25 patients,umbilical venous flap in 5 patients and omental flap in 2 patients.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 days.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9 to 12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed -up for 1 to 5 years.All patients had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using the patients' own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome was effective.This surgical treatment is a good choice.

Objective To investigate the effect of dexmedetomidine versus sevoflurane to perioperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods A total of 135 patients (90 males,45 females,aged 45-82 years,ASA grade Ⅱ or Ⅲ) with coronary heart disease,undergoing endoscopic thoracic and abdominal surgery,were divided into control group (group C),dexmedetomidine group (group D) and sevoflurane group (group S) by random number table.Anesthesia induction and maintenance were adopted by etomidate 0.2 mg/kg,propofol 0.5 mg/kg,atracuronium sulfonate 0.2-0.3 mg/kg and fentanyl 5.0-6.0 μg/kg.Dexmedetomidine was given the continuous injection from 10 min before the start of the operation to the end in group D.Equal volume of saline was given in group C.Sevoflurane was inhaled from the induction of anesthesia 30 min before the end of surgery.ST segment changes of electrocardiogram were recorded for diagnosis of myocardial ischemia during the operation and postoperative 72 hours.Results The incidence of myocardial ischemia in group C,group D and group S were 26.7% (12 cases),6.7% (3 cases),8.9% (4 cases) during the operation and 13.3% (6 cases),8.9% (4 cases) and 8.9% (4 cases) postoperative 72 hours.Conclusion Dexmedetomidine and sevoflurane can improve the balance of blood oxygen supply and demand to reduce cardiovascular complications of non-cardiac surgery in patients with coronary heart disease.

Objective To study the protective effects of Tianma xingnao capsule on brain blood circulation in mice and rats.Methods The arteria carotis externa was ligated,and arteria carotis interna was kept.The left carotid artery was exposed and placed over an ultrasonic flow probe.The brain flow volume was recorded with an Ultrasonic Volume.The pursiness time of mice was observed to evaluate the effect of Tianma xingnao capsule on cerebral ischemia and anoxia.The permeability of normal blood-cerebral barrier was investigated in mice.Results Tianma xingnao capsule significantly increased brain blood flow and prolonged mouse pursiness time.Tianma xingnao capsule at a dose of 4 g/kg significantly elevated the content of Evans in mouse brain.Conclusions Tianma xingnao capsule can increase the brain blood flow in rats and improve brain blood circulation in mice.It is obviously advantageous to protect against cerebral ischemia and hypoxia.

Objective To explore the risk factors affecting prognosis of invasive fungal infection .Methods The clinical data of 208 hospitalized patients diagnosed with invasive fungal infection in Sun Yat-sen memorial hospital from 2007 to 2011 were reviewed . The factors affecting prognosis were determined by univariate and logistic regression analysis .Results The fatality rate of adult inpa-tient with invasive fungal infection was 21%.The univariate analysis showed that difference of seven indicators was significant between the survive group and death group:advanced age (over 60 years old), hospitalization time,fasting plasma glucose level, hypoalbumin-emia, using more than two kinds of broad spectrum antibiotic for more than two weeks , kinds of invasive operations , and multiple organ dysfunction syndrome ( MODS) .Binary logistic regression showed that the difference of five indicators was significant between the two groups:advanced age (over 60 years old), hypoalbuminemia, using more than two kinds of broad spectrum antibiotic for more than two weeks, kinds of invasive operations , and multiple organ dysfunction syndrome .Conclusions The indicators such as advanced age (over 60 years old), hypoalbuminemia, the use of more than two kinds of broad spectrum antibiotic for more than two weeks , kinds of invasive operations , and multiple organ dysfunction syndrome might be independent risk factors of death in patients with invasive fungal infection.Early medical intervention should be made in clinical work , in order to reduce fatality rate of patients with invasive fungal in-fection.