Respiratory tract infection remains a hot clinical topic.Disappointingly, routine microbiology tests do not meet the needs of target antimicrobial therapy.Widespread practice of antibiotic empiricism has lead to dramatic use of broad-spectrum antibiotics and antimicrobial resistance.The application of new clinical microbiology tests to identify the offending pathogen may allow administration of narrow spectrum antibiotic therapy.To do so,the full clinical microbiology armamentarium with newer point-of-care tests and polymerase chain reaction tests must be exploited.The return of the sputum gram stain and introduction of newer molecular tests would provide information for judicious selection of antimicrobials.

ObjectiveTo evaluate the safety and efficacy of pull through technique in the treatment of middle or low rectal cancer.MethodsRetrospective study was made on 101 patients of rectal cancer undergoing pull through resection in terms of the safety and efficacy. The technique was in brief to make coloanal anastomosis through an everted rectal stump, and pull back the proximal colon into the pelvic cavity. ResultsAll postoperative patients were followed up from 5 to 10 years. Normal or good fecal continence was achieved in 87% (88/101) of the patients, fair in 7 9%(8/101), and poor in 4 9%(5/101). Anastomotic fistula developed in 5 patients (4 9%), and local recurrence rate was 15%. The 5, and 10 year survival rates were 64% and 58%, respectively. ConclusionsColoanal anastomosis provides effective treatment for middle and low rectal cancer with a satisfactory long term survival rate and quality of life.

0.05),the overall response rate was 56.0% .Symptoms(18/25) related to cancer improved and side-reactions were tolerable. Conclusions:Treatment of relapse and metastatic colorectal cancer with combined chemotherapy based on oxaliplatin,irinotecan and 5-Fu by arterial intervention and iv drip is safe and effective,with only slight side-effects. This treatment can improve the symptoms and life quality of patients.

Objective To detect the neurofibromin expression and observe the biological features of the osteoblasts of patients with type 1 neurofibromatosis and scoliosis. Methods 10 cases of congenital scoliosis and 8 cases of NF1 scoliosis were chosen. The two groups were with the similar age(with the average of 11.7 years and 12.5 years) and Cobb angle(with the average of 85? and 94?). Cancellous bone was harvested from the ilia and the bone explants culture system was used. Proliferation of the osteoblasts, and also the specific differentiation index including alkaline phosphatase, type Ⅰ collagen and osteocalcin was assayed in sewnd generation osteoblasts. Neurofibromin expression in the two kinds of osteoblasts was detected with immunoprecipitation followed by Western blot. Results Compared to the osteoblasts of patients with congenital scoliosis, lower level of neurofibromin was expressed in osteoblasts of patients with NF1 scoliosis, (the OD value was 1.05?0.06 and 2.59?1.40 respectively, P=0.002). The level of alkaline phosphatase, type Ⅰ collagen and osteocalcin were significant lower in osteoblasts of patients with NF1 scoliosis than those of CS patients (44.69 IU/mg vs 51.38 IU/mg, P=0.019; 226.34 ng/mg vs 249.93 ng/mg, P=0.014; 7.41 ng/mg vs 8.87 ng/mg, P=0.049). But the proliferation rate of the NF1 osteoblasts was significant higher than that of the CS osteoblasts (3.34 and 2.70 respectively, P=0.049). Conclusion With the decrease of neurofibromin expression, the NF1 osteoblasts show some defects in their function, these function defects may contribute to varieties of skeletal abnormalities as dystrophic change and decreased bone density.

Objective To discuss the mechanism of injury,treatment decisions,complications and surgical results of the floating hip injuries (FHI).Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001to June 2011.There were 25 males and 8 females,with an average age of 34.6 years (range,4-73 years).The mechanism of injury was motor vehicle collision for 20 patients,fall down from a height for 11,crushed injury for 1,and sports-related injury for 1.According to Liebergall classification for the floating hip injuries,there were 7 cases for type Ⅰ (21.2％),9 for type Ⅱ (27.2％)and 17 for type Ⅲ (51.6％).All patients had associated injuries,the average injury severity score (ISS) was 28.9.Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures.Surgical stabilization methods included ORIF or intramedullary nailing (29 cases),external fixation (1 case),total hip arthroplasty (2 cases).Acetabular fractures were treated with open reduction and internal fixation (ORIF) in 16 cases.Thirteen patients suffered pelvic fractures underwent surgical stabilization for at least one component of ring disruption.Results Twenty-eight cases (84.8％) were followed up for 2.3 to 10.1 years (average,3.5 years).Thirteen patients were followed up in the 16 patients who suffered type Ⅰ or Ⅱ fractures.According to Majeed functional evaluation,the results were excellent in 8 cases,good in 3 and fair in 2,with the excellent and good rate being 84.6％.Fifteen patients with type Ⅲ were followed up,according to D'Aubigné and Postel evaluation criterion.The joint functions were excellent in 7 cases,good in 4,fair in 3,and poor in 1,with the excellent and good rate being 73.3％.According to Ma Yuanzhang functional evaluation,the knee functions of the all patients were excellent in 23 cases,good in 3,and fair in 2,with the excellent and good rate being 92.9％.Complications seen in these patients included post-traumatic osteoarthritis of the hip developed in one hips,2 patients developed heterotopic ossification (HO),one case of avascular necrosis of the femoral head,and two femoral nonunions.The most severe complication was traumatic sciatic nerve palsy,which was found in 5 patients.Conclusion Ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip) are severe injuries usually caused by high-energy trauma.The femur fracture will most commonly be addressed first,and surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.

Objective To summary the color Doppler imaging feature of localized Castleman disease.Methods From January 1997 to November 2011,32 localized Castleman diseases which were proved by pathology were analyzed.Results Round-like,hypoechoic,hypervascular lesions were showed in 23 hyalinevascular type lesions,2 of them with calcium,3 of them with structure liked lymph node hilum.Round-like,hypoechoic,hypervascular lesions or normal lymph node were showed in 5 plasma- type lesions and 4 mixed type lesions.Conclusions When round like,hypoechoic,hypervascular lesion is found by ultrasonography,Castleman should be considered.Calcium or lymph nod hilum-like structure is special finding in diagnosis of Castleman disease by ultrasonography.

Background Researches have demonstrated that ocular hypertension induces the ischemia-reperfusion of retina and further leads to the degeneration of retinal ganglion cells,but its mechanism is beyond understanding.Objective The present study aims to observe the effects of static pressure on the morphology,proliferation activity and viability of cultured retinal microvascular endothelial cells (RMECs) and evaluate the expression of ET-1 and NO in these cells under variant static pressure.Methods RMECs were isolated from 30 healthy Wistar rats and cultured using explant culture method by Ⅷ factor antibody and PECAM-1 antibody.The static pressure of 1.33kPa,2.67kPa,5.33kPa and 10.67kPa was used in culture bottle respectively.The RMECs without static pressure were used as normal control group.The morphology of RMECs under the different static pressure was observed by inverted phase contrast microscopy,and the number of RMECs was counted using the counting plate.Cellular viability was studied by trypan blue staining.The changes of ET-1 and NO_2~-/NO_3~-,two metabolic products of NO,in the medium were detected by radioimmunoassay and Griess's nitrate reductase method.The expression of ET-1,eNOS and iNOS mRNA in RMECs was analyzed by semi-quantitative RT-PCR 24 hours after treatment of variant static pressure.Results Cultured RMECs sticked well at 24 hours and reached to confluence at 48 hours and showed the red fluorescence for Ⅷ factor antibody and PECAM-1 antibody.Enlargement of nuclei,extenders of cell bodies and suspension of RMECs in medium were observed.The number of RMECs was gradually increased.The cell viability was reduced with the raise of static pressure among these four groups(F=12.205,P＜0.01;F=11.180,P＜0.01).The static pressure increased the content of ET-1 released by RMECs in 2.67kPa,5.33kPa and 10.67kPa of static pressure groups,and concentrations of NO_2~-/NO_3~- in the medium showed a significant increase in 5.33kPa and 10.67kPa of static pressure groups compared with normal and 1.33kPa of static pressure groups(P＜0.01).The expressions of ET-1 mRNA,eNOS mRNA and iNOS mRNA were considerably enhanced in 5.33kPa and 10.67kPa of static pressure groups compared with normal control group(P＜0.01).Conclusion Raised static pressure causes the alteration of RMGCs structure and morphology.Static pressure could upregulate the expressions of ET-1,eNOS and iNOS mRNA in RMECs and increase the release of ET-1 and NO.This pathway might be one of pathologic mechanisms of retinal injury induced by high intraocular pressure.

ObjectiveTo study the differentiation of adipose tissue-derived mesenchymal stem cells (ADMSCs) into cardiomyocytes in vitro. MethodsADMSCs were isolated and purified by the method of digesting and adhering to the culture plastis. The third generation of cells were determined with immunocytochemistry method and induced by 5-aza. On the 7th, 14th, 21st, 28th day after being induced, the surface antigen of myoblast cell and cardiac myocyte were determined, the expression of gene of GATA4 and Nkx2.5 were tested, and the content of atrial natriuretic polypeptide (ANP) assayed. ResultsImmunocytochemical staining showed CD44, CD13, CD105 positive, CD45, CD34, HLA-DR, factor Ⅷ negative. After being induced by 5-aza, the direction of cell arraying was gradually similar. The cells were stained positively for Desmin, α-Sarcomeric Actin, myosin heavy chain and Troponin T. The cells express GATA4 and Nkx2.5 and secrete ANP. ConclusionThere was mesenchymal stem cells in human adipose tissue. 5-aza may induce ADMSCs to differentiate into cardiomyocytes in vitro.

Objective To assess the coronary flow reserve in the patients with systemic lupus erythematosus(SLE)by transthroracic echocardiography(TTE).Methods Coronary sinus blood flow of 24 SLE patients and 18 matched healthy controls were assessed by TTE.The coronary flow reserve was calculated as the ratio of hyperemic to baseline blood flow.Hyperemia was induced by intravenous administration of dipyridamole.Results Adequate recordings of blood flow in the coronary sinus under both conditions were obtained by TTE in all study subjects.Patients with SLE were found to have significantly decreased coronary flow reserve comparing with normal SUbiects(1.55±0.21 versus 2.51±0.33.P＜0.01).Conclusions Coronary flow reserve can be measured by TTE in SLE patients,Coronary flow reserve is impaired suggesting that SLE patients may have subclinical coronary artery disease.

OBJECTIVE:To study the effects of Xiaoruzeng capsule on the gastric acid and pepsin in rats. METHODS:Rats were randomized into a blank group (distilled water),a positive control group (3.6 mg/kg omeprazole ) and the groups of low, middle and high doses of Xiaoruzeng capsule [2.25,4.5,9.1 g(crude drug)/kg]. These groups were respectively marked as groups A,B,C,D and E,with 10 rats in each group. All the rats were given corresponding drugs,ig,for consecutive 10 d. Their suc-cus gastricus was collected 3 h after the last administration,and determined for pH value with precision pH test strip and for free acidity and total acidity by acid-base neutralization titration method. The content and activity of pepsin were determined and calculat-ed with the test kit and microplate reader. The pathological change of the stomach was observed under the electron microscope. RE-SULTS:Compared with group A,groups B,C and D had higher pH value of succus gastricus;groups C,D and E had lower free acidity;groups B,C and D had lower total acidity,group E had higher total acidity;groups B,D and E had lower activity of pep-sin;and group C had higher content of pepsin. Compared with group B,group D had lower pH value of succus gastricus;group C had lower total acidity;group E had higher acidity;and groups C,D and E had higher activity of pepsin. There was statistical sig-nificance(P<0.01 or P<0.05). Gastric mucosal erosive haemorrhage was noted in three rats in group E,and other groups demon-strated no obvious pathological change. CONCLUSIONS:Low dose of Xiaoruzeng capsule can slightly inhibit the gastric acid in rats,but will not effect the activity of pepsin.