Objective To investigate the diagnosis and treatment of mutinous cystadenoma of the pancreas.Method The clinical data of 12 cases with pancreatic mutinous cystadenoma was confirmed by pathology from May 2000 to May 2009 was retrospectively analysed.Results The accuracy rates of ultrasound,CT and MRCP were 50.0%(5/10),66.7%(6/9)and 83.3%(5/6)respectively.Pancreaticoduodenectomy,duodenum-preserving pancreatic head resection,distal pancreatic resection,distal pancreaticresection and splenectomy,segment pancreatic resection were performed according to the site of tumors.Completed resectable rate was 91.7%(11/12),palliative resection in 1 case,postoperative pancreatic leakage in 3 cases.2 cases cured;1 case died of intra-abdominal infection caused by pancake fistula 1 month later;1 case died of tumor recurrence and metastasis 25 months later.Conclusions Pancreatic cystic neoplasms is lack of specific clinical manifestations.Combined with application of imaging methods,can improve the diagnosis rate.Operation is the most effective therapy.The feasible procedures for mucinous cystadenoma of the pancmas should be choiced according to the site of tumors.

Objective To investigate the phenotype and the immunoregulatory function of CD8αα+TCRαβ+regulatory T cells in peripheral blood samples from mice.Methods The distribution profile and the phenotype of CD8αα+TCRαβ+regulatory T cells in C57BL/6 mice were detected by flow cytometry.The cytokines released by CD8αα+TCRαβ+regulatory T cells upon the stimulation with anti-CD3 antibody were analyzed by cytometric bead array.The in vitro immunosuppressive activity of CD8αα+TCRαβ+regulatory T cells on activated CD4+T cells was analyzed by using flow cytometry and carboxyfluorescein succinimidyl ester ( CFSE ) .An adoptive cell transfer assay was set up to evaluate the immunoprotective effects of CD8αα+TCRαβ+ regulatory T cells in a mouse model of experimental autoimmune encephalomyelitis ( EAE) .Results CD8αα+TCRαβ+regulatory T cells were detected in liver, spleen and peripheral blood samples collected from na?ve C57BL/6 mice.Compared with CD8αβ+TCRαβ+regulatory T cells, CD8αα+TCRαβ+regulatory T cells showed a memory-activated phenotype of CD25+CD122high CD44high CD62Llow CD69high NK1.1+DX5+.CD8αα+TCRαβ+regulatory T cells could produce IL-2 after 24 hours stimulation with anti-CD3 antibody, followed by producing IFN-γ, TNF-α, IL-4, IL-17A and traces of IL-6 and IL-10. In vitro, CD8αα+TCRαβ+regulatory T cells specifically suppressed the proliferation of activated CD4+T cells ( P<0.01 ).Moreover, they could delay the onset of EAE in mice and reduce clinical score (P<0.01).Conclusion CD8αα+TCRαβ+regulatory T cells were a unique population with immunoregula-tory function, which could be used as a potential therapeutic target in the treatment of autoimmune disease.

Objective To investigate the clinical features and molecular characteristics of bacteremia caused by K. pneumoniae and study on the differences between classical and hypervirulent K. pneumonia( hvKP) . Methods The clinical features of 70 cases of K. pneumoniae bacteremia collected from Beijing Chaoyang Hospital from 2008 to 2012 were retrospectively analyzed. The patients were identified according to the records from the Clinical Microbiology Department. Patients′ data were obtained from medical records. The molecular characteristics of the K. pneumoniae strains were also studied using PCR, multilocus sequence typing and pulsed field gel electrophoresis( PFGE) methods. Data were analyzed using the statistical package SPSS for windows version 17. 0. For categorical data, different groups were compared using the Chi-square test to analyze the quantitative variables. P≤0. 05 was considered to be statistically significant. All susceptibility data were analyzed using Whonet, version 5. 6. Results The hvKP was identified from 31. 4% of the patients with K. pneumoniae bacteremia, which displayed 4 serotypes ( K1, K2, K20, and K57). About 40. 9% (9/22) hypervirulent strains were isolated from patients without underlying diseases, while 95. 8% (46/48) of the classic K. pneumoniae infections were found in patients with the presence of one or more underlying diseases. More hvKP positive patients (95. 5%, 21/22) had community-acquired infections compared with classical K. pneumonia (cKP) infected patients (35. 4%, 17/48). There was a significant difference between these two groups (χ2 =21. 912,P <0. 001). Two ESBLs-producing hvKP strains were found. The 22 hvKP isolates had 14 different PFGE patterns, among which 6 isolates ( patients with primary liver abscess) shared similar PFGE patterns. Conclusions The
emerging hvKP was prevalent in patients with severe community-acquired infections in healthy individuals. Two ESBLs-producing hvKP strains were identified. Drug resistance had a rising trend, which called for more attention in clinical settings.

Objective:To explore the correlation among childhood trauma, obsessive-compulsive symptoms, and implicit and explicit memory in patients with obsessive-compulsive disorder(OCD).Methods:Fifty-two OCD patients were enrolled, and the childhood trauma was investigated by using the childhood trauma questionnaire short-form(CTQ-SF). The degree of obsessive-compulsive symptoms was assessed by using the Yale-Brown obsessive symptoms scale (Y-BOCS). In addition, the abilities of implicit memory and explicit memory were tested by vocabulary perception speed tasks and vocabulary recognition tasks.According to the scores of CTQ-SF, the patients were divided into abuse group( n=26) and neglect group( n=26). SPSS 22.0 software was used for t-test and Pearson correlation analysis. Results:Results of obsessive-compulsive symptoms, implicit memory, and explicit memory showed no differences between the abuse group and the neglect group( t=-1.959-1.839, P>0.05). The scores of obsessions symptoms(12.52±4.61) were positively correlated with the total scores of CTQ-SF (40.10±10.20)( r=0.331, P<0.05). On the subscale, the scores of obsessions were positively correlated with the scores of physical abuse(7.89±3.02), sexual abuse(6.47±2.28)( r=0.373, P<0.01, r=0.356, P<0.05). There was a negative correlation between the scores of physical abuse and the accuracy of explicit memory(68.75±13.33)( r=-0.281, P<0.05). The scores of physical neglect(8.98±2.67) was positively correlated with implicit memory response time(4 285.94±2 067.42)( r=0.314, P<0.05). Conclusion:Obsessions in patients with OCD are related to traumatic childhood experiences, especially physical abuse and sexual abuse.Physical trauma may influence the level of implicit and explicit memory in patients with OCD.

Objective: To investigate the hospital employee satisfaction and trustworthiness in the background of the trusteeship mode and to find out the problems after trusteeship.Methods: Minnesota satisfaction questionnaire (MSQ) and the self-made questionnaire were used to conduct the survey.Results: The overall employee satisfaction (3.80±0.86) and trustworthiness (3.95±0.77)were higher.The highest level of trustworthiness concerned the cultural connotation (84.8%) followed by the management concept (82.8%) for overall satisfaction.The lowest level of employee satisfaction concerned income and workload (53.7%), followed by the working conditions and environment (55.3%).The administrative staff satisfaction was higher compared to that of medical staff (p=0.001), which showed significant statistical differences.Conclusions: The hospital has made some achievements after the trusteeship system reform, however, it still needs improvement and further strengthening in many aspects.The hospital must always keep abreast of the demands of workforce and improve the staff satisfaction so as to promote its continuous and sustainable development.

Background and purpose:Whether axillary sentinel lymph node biopsy (ASLNB) could replace axillary lymph node dissection (ALND) in patients who converted after neoadjuvant chemotherapy (NAC) from cN+ to ycN0 is still contentious, and the previous study only evaluated the pathological status of ALN without internal mammary lymph node (IMLN) condition. This study is to evaluate roles of ASLNB and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC.Methods:From Jan. 2012 to Dec. 2014, 60 breast cancer cT1-4N0-3M0patients who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept surgery after NAC from our department were enrolled into the retrospective study. Patients with cN0 before NAC and ycN0 after NAC underwent ASLNB (group A). Patients with cN+ received NAC and ycN0 after NAC (group B) were treated with ASLNB and ALND. Only patients whose clinical nodal status remained positive (ycN+) after NAC underwent ALND without ASLNB (group C). All the patients received radiotracer injection and patients in group A and group B received blue dye injection additionally. Meanwhile, IM-SLNB would be performed for all patients with IM-SLN visualization.Results:The number of patients enrolled in group A, group B and group C was 6, 45 and 9 cases respectively. The accuracy rate of ASLNB in group A was 100% (6/6). Only one patient was axillary sentinel lymph node (ASLN) positive performed ALND. With combination of blue dye and radiolabeled colloid, the accuracy rate of ASLNB in group B was 100% (48/48) and the false negative rate (FNR) was 17.9% (5/28). The FNR in patients with 1, 2 and>2 SLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/7). All of the ALNs were positive in group C. The visualization rate of IM-SLN was 63.3% (38/60). The detection rate of IM-SLNB was 97.4% (37/38) and the metastasis rate was 8.1% (3/37). The incidence of complications was 5.3% (2/38).Conclusion:ASLNB can be performed either before or after preoperative chemotherapy for patients with cN0 disease. Among women with cN+ converted to ycN0 who had 3 or more SLNs examined, the FNR could return to be less than 10%. Those patients whose nodes are still ycN+ should perform ALND. IM-SLNB should be performed routinely in all breast cancer patients after NAC, for it might help to make clear of the nodal staging and the pathological status of IM-SLN and provide the accurate indication of radiation to the internal mammary area in case of under-stage and under-/over-treatment, expecting to develop the deifnition of pathological complete response (pCR).

Background and purpose:Sentinel lymph node biopsy is regarded as the standard of care in pa-tients without clinical axillary lymph node metastases in early-stage breast cancer. Accurate detection of sentinel lymph node is an important step for staging, prognosis, and treatment. In this study, a new sentinel lymph node tracer was produced by the rituximab to combine with the lfuorescence tracer (indocyanine green, ICG), and to identify the most appropriate combination ratio of the two agents. Its biological property and safety limitation were evaluated.Methods:Rituximab was combined directly with ICG. The new tracer was analyzed for labeled rate by instant thin-layer chroma-tography-silica gel, molecular integrity by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and molecular immune activity by ELLAS. The safety limitation was tested according to the Chinese Pharmacopeia. The localization ability of sentinel lymph node was tested in mice.Results:The new tracer was intact and kept the immune activity of rituximab. The ICG labeled rate of rituximab was 100%. The new tracer was bacteria and pyogen free, and was safe to body with location injection. The most appropriate combination ratio of rituximab and ICG was 4∶1 and 6∶1 with the best sentinel lymph node imaging. The location of sentinel lymph node identiifed by the new tracer was accorded with the radiotracer.Conclusion:The preparation method of the new sentinel lymph node tracer is simple and no radioactive injury. The new tracer has no bacteria, no pyogen and no acute toxicity, and can be used in sentinel lymph node visual-ization.

Objective To compare the errors of double-center and single-center setup, and to study the role of both on reducing the rotational setup errors for the patients with esophageal carcinoma depend on rigid registration errors between online kV-cone-beam computed tomography (kV-CBCT) images and plans for CT images. Methods 20 patients with middle esophageal carcinoma received image scanning before treatment every week by using double-center setup and CBCT, and single-center setup images of 20 patients were taken from the X volume image (XVI) system. Then the images of both setup types, registration errors of CT image and rotational setup errors were compared respectively. Every patient received kV-CBCT scanning analysis before treatment every week, and 6 times in total. 240 group of kV-CBCT images from all of the patients were off-line matched with plans for CT images to calculate the errors of X-axis, Y-axis, Z-axis. Then the data of linear errors and rotational setup errors from patients were collected, aiming at putting the error data into the patients treatment program and analyzing the significances. Results The standard registration of double-center setup was as follows: T (X) (0.28 ±0.19) cm, T (Y) (0.27 ±0.19) cm, T (Z) (0.33 ±0.12) cm, R (X) (0.40 ±0.19)° , R (Y) (0.30 ±0.18)° , R (Z) (0.30 ±0.19)° . The standard registration of single-center setup was as follows:T(X) (0.32±0.20) cm, T(Y) (0.29±0.25)cm, T(Z) (0.31±0.16) cm, R(X) (2.2±0.68)°, R(Y) (0.5±0.32)°, R(Z) (2.10±0.60)°. There were statistical differences between linear errors in T(X) and rotational setup errors in R(X), R(Y) or R(Z) (P< 0.05). Conclusion Double-center position can reduce the rotational setup errors, especially in X-axis, Y-axis errors, and may provide more help for the radiation oncology departments without on-board CBCT.

Objective To investigate the change of antimicrobial resistance among gram-positive cocci from 1999 to 2006 in Beijing Chaoyang Hospital. Methods Antimicrobial susceptibility test was car-ried out by MIC method, data were analyzed by WHONET 5.3 software. Results A total of 6192 clinical isolates were collected. The top four pathogens were Staphylococcus coagulase-negative, Staphylococcus au-reus, Enterococcus faecalis and Enterococcus faecium. The prevalence of methicillin-resistant S. aureas and coagulase-negative were identified in 88.4% and 86.9%, respectively. The resistance rates of S. aureus to penicillin G and ampicillin were more than 90.0% during 1999-2006. Neither strains of S. aureus nor strains of coagulase-negative Staphylococcus were found resistant to vancomycin. Vancomyein-resistant Enterococci (VRE) strains were firstly isolated in 2003, thirteen vancomycin-resistant E.faecalis isolates were identified as VanB genotype by PCR and sequencing. The VanA gene was confirmed by PCR and sequencing in seven-teen vancomycin-resistant E.faecium, vancomycin-resistance E.faecium rate increased sharply. The most ac-tive antibiotics against E. faecalis were vancomycin, ampicillin, penicillin with the susceptible rates of 98.7%, 95.7% and 85.6%, however, the susceptibility rate of E. faecalis to penicillin decreased from 94.3%-84.6%. The resistance rates of E.faecalis to clindamycin was 99.0%. The resistance rates of E. faecium to erythromycin and clindamycin were more than 95.0%. The resistance rates of E.faecium to ampi-cillin, penicillin, ciprofloxacin were more than 90.0%. The most active antibiotics against E. faecium was vancomycin. The susceptibility rate of E.faecium to tetracycline increased from 27.8% to 82.6%. Conclu-sion Vancomycin remains highly active against gram-positive cocci. A total of 30 Enterococci isolates were found resistant to vancomycin.