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 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 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.

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 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).

Objective To observe the effects of instant hyperbaric oxygen (HBO) therapy on brain edema and aquaporin-4 (AQP4) expression after cerebral ischemia in rats. Methods 18 healthy adult male Sprague-Dawley rats were randomly divided into sham group (n=6),control group (n=6) and HBO group (n=6). Middle cerebral artery occlusion model was established with modified Longa method in the control group and HBO group. HBO was administered after cerebral ischemia immediately in HBO group for 60 min. They were observed with the neurological function score, brain tissue water content and AQP4 experssion 6 h after operation. Results Compared with the control group, the neurological score in HBO group improved significantly (P<0.05), while the brain tissue water content and brain AQP4 expression decreased (P<0.05). Conclusion HBO may improve the neurological function and brain edema after cerebral ischemia, which may relate with inhibiting the expression of AQP4.

Objective:To analyze clinical characteristics of drug-induced hypersensitivity syndrome (DIHS) , and to compare the European, Japanese and Chinese diagnostic criteria.Methods:A total of 45 patients confirmedly diagnosed with DIHS according to the DIHS criteria originally proposed by Bocquet, were collected from the First Affiliated Hospital (Southwest Hospital) of Army Medical University between January 2009 and January 2019. Clinical data on the 45 patients were retrospectively analyzed, clinical characteristics were summarized and re-evaluated according to the European, Japanese and Chinese diagnostic criteria separately, and differences were analyzed in terms of the latency period, time to rash regression, eosinophil count, liver function indices, etc. One-way analysis of variance was used to compare means among multiple groups, and t test to compare means between two groups. Results:Of the 45 patients, 38 presented with eruptive drug eruptions, and 44 were accompanied by liver damage, 40 by elevated counts of peripheral white blood cells, 38 by eosinophilia, 21 by lymphadenectasis, and 4 by mucosal damage. Common culprit drugs included allopurinol (10 cases) , anti-tuberculosis drugs (7 cases) , cephalosporins (7 cases) , and Chinese medicine (4 cases) . Forty patients were treated with glucocorticoids, and 17 with glucocorticoids and intravenous gamma globulin. After treatment, 44 patients received improvement and 1 died. According to the European diagnostic criteria, there were 29 patients with suspected DIHS and 16 with confirmed DIHS; according to the Japanese diagnostic criteria, 37 patients could be confirmedly diagnosed with DIHS, but 8 could not be confirmedly diagnosed; according to the Chinese diagnostic criteria, 17 patients could be confirmedly diagnosed, but 28 could not be confirmedly diagnosed. According to the Japanese diagnostic criteria, the latency period was significantly longer in the patients with a confirmed diagnosis (36.91 ± 21.73 d) than in those without (20.00 ± 20.82 d, P = 0.04) . Conclusions:Common culprit drugs for DIHS include allopurinol, anti-tuberculosis drugs and cephalosporins. Most patients with DIHS are accompanied by liver damage, and the European diagnostic criteria are preferentially recommended for DIHS.

Objective To explore the indication,surgical procedure and the postoperative treatment of breast conserving modified radical mastectomy for early stage breast cancer .Methods The clinical data of 21 patients with early stage breast cancer underwent breast conserving modified radical mastectomy were analyzed retrospectively. Results All patient recovered uneventfully. All the external configuration of the breast were fine. There were no recurrence and no complications in this series. Conclusions The breast conserving modified radical mastectomy is recommended for the early stage breast cancer. The external configuration of breast is fine postoperatively, and patients have higher survival quality.But follow up is necessary in order to find and treat the recurrence of breast cancer.

The purpose of this study was to evaluate the features of mediastinal lymph nodes in lung cancer patients during endoscopic ultrasonography(EUS), and to establish the clinical method for the preoperative staging of lung cancer using EUS. The EUS patterns of 103 lymph nodes in 21 patients with lung cancer were evaluated. Confirmation of benign and malignant lymph nodes was obtained by surgical resection and pathology. The following features were compared between benign and malignant lymph nodes: short axis , long axis, distinct margins and the shape of nodes. The results showed that all of the lymph nodes were hypoechoic. Both the short axis greater than 1.0cm and distinct margins or round shape independently predicted malignant invasion ( P

Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding(LAGB) on weight loss and obesity related metabolic diseases in obesity patients.Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept.General Surgery of PUMC hospital in a multidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed.The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated.Results Mean body weight of the subjects was 129.1kg and mean body mass index(BMI)44.9 kg/m2.All patients underwent LAGB successfully without perioperative mortality.Early postoperative complications included 1 case (3.6％) of pulmonary infection and long-term complications included 2 cases (7.1％)of port infection.Mean body weight and BMI decreased gradually after LAGB.The mean percentage of excess weight loss(％ EWL)at postoperative 24 months was 41.3％.％ EWL of the group with regular follow-up and good compliance was significantly better than the other group.Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up.Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients.Better services can be provided for obesity patients in a multidisciplinary modality,It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.