Objective To observe the effects of nebulized nitric oxide donors on pulmonary and systemic hemodynamics during pulmonary hypertension induced by hypoxia (FiO_2=0.1,for 1 hour)in newborn piglets. Methods Twenty-four anesthetized and mechanically ventilated piglets were randomly divided into four groups:(1)group S (n=6),control group;(2)group C (n=6),receiving saline after hypoxia;(3)group NTG,receiving nebulized nitroglycerin after hypoxia;(4)group SNP,receiving nebulized sodium nitroprusside after hypoxia. Mean arterial pressure (MAP)and mean pulmonary arterial pressure (MPAP)were monitored continuously. Arterial blood gas analysis was determined at baseline,1 hour after hypoxia,termination of nebulization and 0.5 h after nebulization. After nebulization,blood methemoglobin (MetHb)and plasma NO level were measured.Results Acute hypoxia resulted in a significant increase in MPAP. At 1 hour after hypoxia,MPAP in group C,group NTG and group SNP were significantly higher than that in group S(P0.05).After nebulization,there were no significant differences in plasma NO level and blood MetHb level between groups. No rebound pulmonary hypertension was observed after withdrawal of nebulization. Conclusion Both NTG and SNP nebulization could be used as selective pulmonary vasodilators for acute hypoxic pulmonary hypertension.

AIM: To evaluate the efficacy and complications of intravitreal injection of triamcinolone acetonide ( TA ) for the treatment of macular edema caused by pre-retinal membrane of the macular.
METHODS: Totally 23 patients ( 24 eyes ) with macular edema caused by pre-retinal membrane of the macular were treated withintravitreal injection of 4mg TA. Best-corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) , slit - lamp examination, fundus fluorescein angiography ( FFA ) and optical coherence tomography (OCT) were performed before and after treatment. The SPSS 12. 0 software was used for statistical analysis.
RESULTS: After 10, 30, 90d of treatment of TA, as compared with before treatment, visual acuity improved significantly ( P<0. 05 ), and central macular thickness (CMT) was significantly thinner (P<0. 01). The average central macular thickness decreased from 522 ± 126μm before treatment to 264±115μm, 245±128μm, 286±131μm at 10, 30, 90d after treatment. Macular edema reduced. IOP increased in 7 eyes ( 29%) , one cataract case, no other complications associated with vitreous injection.
CONCLUSION: Intravitreal injection of TA in the treatment of macular edema caused by pre - retinal membrane of the macular is simple, safe and easy to operate. It can quickly reduce macular edema, and improve the visual acuity in the short term. Part of patients may recur after injection in the first half of the year.

Objective To report the experience and results in comparing laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN) in the treatment of clinical T_2 stage renal cell carcinomas. Methods Between Feb. 2004 and Jul. 2007, 30 patients (12 females and 18 males with average age of 58.0±8.5 years, range 42-68 years) received LRN and 36 patients (16 females and 20 males with average age of 60.0±9. 0 years, range 52-70 years) received ORN. The average tumor sizes in the LRN and ORN groups were (8. 5±2.2)cm (range 7-12 cm) and (8. 8±2.1)cm (range 7-14 cm) respectively. Renal cell carcinoma was histopatologically confirmed in all the patients of these 2 groups after surgery. Results The operative time in the ORN group (130±27 min) was significantly shorter than that in the LRN group (176±23 min), P<0. 01. The estimated blood loss in the LRN group (200±80 ml) was also significantly less than that in the ORN group (380±185 ml) , P<0. 01. Patients in LRN group experienced significantly earlier bowel function recovery (P<0. 01) and shorter duration of drainage (P<0. 01) than those in the ORN group after operation. No severe perioperative complications occurred in all patients. The follow-up range was 6-27 months (average 15±2 months). During the follow-up, 2 patients in the LRN group developed lung metastasis. In the ORN group, 2 patients developed liver metastasis and 1 developed lung metastasis. Conclusion LRN has the advantages of minimal invasiveness and rapid postoperative recovery comparable to those of ORN, and it might be an alternative treatment option for the clinical T_2 stage renal cell carcinomas.

Objective To explore the clinical significance of second transurethral resection (TUR) in patients with T1 urothelial cell carcinoma of the bladder.Methods The 142 cases with urothelial carcinoma were recruited.All patients underwent transurethral resection of bladder tumor (TURBT) and were diagnosed as stage T1 urothelial carcinoma of the bladder.The 68 of 142 cases underwent second TUR after the initial surgery.Tumor recurrence rate,progression rate and recurrence-free survival were compared.Results There were no statistical differences in age,gender,follow-up time,number of tumors,size of tumors or grade of tumors between patients with and without second TUR.Of the 68 cases that underwent second TUR,25 cases (36.8%) had residual tumor and 6 of them (8.8%) had muscle-invasive bladder cancer.After an average observation for 26.8 months,patients who underwent second TUR showed lower recurrence rate,higher recurrence-free rate and longer recurrence-free survival than patients without second TUR [37.1% vs.58.1%,x2=5.962,P=0.015;41% vs.35.1%,x2=8.502,P=0.004;21 months vs.12 months,U= 1584,P= 0.002].While the progression rate showed no statistical difference between them (14.5% vs.25.7%,x2 =2.570,P=0.109).Conclusions Second TUR provides an effective way to completely excise tumor.Second TUR is beneficial to the decrease of recurrence rate and improvement of recurrence-free survival.However,its effect on tumor progression needs further discussion.

Objective This study was to explore the expression and significance of HMA2 in bladder cancer , analyze its correlations to clinicopathologic and recurrence of bladder cancer. Methods The expression of HMGA2 protein in 148 specimens of bladder cancer and 30 specimens of normal bladder tissues was detected by immunohistochemtry, its correlations to clinicopathologic features was analyzed. Results There was no expression of HMGA2 protein in normal bladder tissues,while the expression level of HMGA2 protein was getting higher with the increase of tumor pathology grade and stage. The positive rate of HMGA2 protein was 21.3% in G1 bladder cancer, 60. 3% in G2 bladder cancer, 82.1% in G3 bladder cancer, its difference is significant (P＜0. 001). It was significantly lower in non-muscle invasive bladder cancer than in muscle invasive bladder cancer (43.3% vs 72. 7%, P=0. 003). The patients were followed up for 2～95 months, patients of recurrence was 64,HMGA2 protein expression was significantly higher in patients with recurrence than with non-recurrence (54.7% vs 25.0%, P=0. 007). Conclusions The expression of HMGA2 protein was highly in bladder cancer, the positive rate of HMGA2 protein expression was related with classification,TMN stage and recurrence, but not with sex, age, tumor number (P＞0. 05). The detection of the expression of HMGA2 protein is in favor of diagnosis and prognostic evaluation of bladder cancer.

Objective To understand the clinical distribution characteristics and antimicrobial resistance of pathogens causing healthcare-associated infection(HAI) in a comprehensive hospital.Methods Clinical data of patients with HAI in this hospital between May 2012 and May 2015 were collected,the distribution and antimicrobial resistance of pathogens isolated from patients were analyzed.Results A total of 6 563 cases of HAI occurred among 183 850 patients,incidence of HAI was 3.57％,445 patients were isolated at least two kinds of pathogens,375 (84.27％) patients were isolated two kinds of pathogens,132 of whom were infected with both gram negative bacilli.4 478 specimens were sent for pathogenic detection,2 503 (55.90％) of which were isolated pathogens;a total of 2 755 pathogens were isolated,including 1 713(62.18％) strains of gram-negative bacilli,732(26.57％) gram positive cocci,304(11.03％) yeast-like fungi,and 6(0.22％) anaerobic bacteria.524(19.02％)strains were mainly from patients in department of neurology.The main specimen was sputum (n =1 340,48.64％).The isolation rates of carbapenem-resistant Escherichia coli (CREC),Klebsiella pneumoniae (CRKP),Acinetobacter baumnannii (CRAB),and Pseudomonas aeruginosa (CRPA) were 0.39％ (2/510),1.66％ (3/181),59.14％ (207/ 350),and 5.29 ％ (11/208) respectively;isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) was 21.55％(25/116).Conclusion Multidrug-resistant organisms causing HAl are various,it is necessary to understand distribution characteristics and prevalence of pathogens,monitor multidrug-resistant organisms,and implement contact isolation measures,so as to prevent the outbreak of HAI.

OBJECTIVETo evaluate the prognostic effects of neoadjuvant chemotherapy (NAC) in patients with local advanced gastric cancer.

METHODSWe retrospectively analyzed prognosis in 191 patients with advanced gastric cancer, of whom 71 were treated with NAC and 120 received surgery only between February 2007 and July 2013. Postoperative complication rate was recorded. Survival by clinicopathological features, pathological T and N stages, and histopathological tumor regression was retrospectively compared between the two groups.

RESULTSAccording to Response Evaluation Criteria in Solid Tumors, none of the 71 patients in the NAC followed by surgery group showed complete response, 36 showed partial response, 25 had stable disease, and 10 had progressive disease. The chemotherapy response rate was 50.7%; the disease control rate was 85.9%. Grade 3/4 adverse events were seen in less than 20% patients, with acceptable toxicities. No difference was found in the overall postoperative complication rates between the two groups (7 versus 22 cases, P=0.18). Median survival time was significantly different, at 54 months in the NAC combined with surgery group and 25 months in the surgery-only group (P=0.025).

CONCLUSIONIn patients with operable gastric adenocarcinomas, NAC can significantly improve overall survival without increasing surgical complications.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; mortality ; pathology

Objective To understand the correlation of enterovirus 71 (EV71), P-selectin glycoprotein ligand-1 (PSG L-1), and scavenger receptor B2 (SCARB2) and to explore the possible pathway and mechanismof EV71 infection by observing the expression of EV71, PSG L-1 and SCARB2 in tissues of infants with brain stemencephalitis. Methods T he organs and tissues of infants with EV71-VP1 positivi-ty in their brain stems were chosen. Expression and distribution of EV71-VP1, PSG L-1, and SCARB2 were detected and compared by immunohistochemistry. Results Strong staining of EV71-VP1 was ob-served in the neuron, glial cells, the inflammatory cells of perivascular cuffing, parietal cells of the gas-tric fundus gland while alveolar macrophages, intestinal gland epitheliumcells, mucosa lymphoid nodule and lymphocyte of palatine tonsil showed moderate staining and weak staining were displayed in mesen-teric lymph nodes and lymphocyte of spleen. PSG L-1 expression was detected in parietal cells of the gastric fundus gland, tonsillar crypt squamous epithelium, alveolar macrophages and leukocytes in each tissue. SCARB2 expression was observed in all the above tissues except the intestines and spleen. Con-clusion T he distribution of EV71 correlates with SCARB2 expression. SCARB2 plays an important role in virus infection and replication. Stomach may be an important site for EV71 replication.

OBJECTIVEMany studies have demonstrated that low levels of insulin-like growth factor-I (IGF-I) may be associated with the hypoxic-ischemic brain damage (HIBD) and that IGF-I has a neuroprotective effect. The role of IGF-II, a structurally and functionally homologous polypeptide with IGF-I, is unclear in HIBD. This study was designed to observe the changes of serum and cerebrospinal fluid (CSF) IGF-II levels in neonates with hypoxic-ischemic encephalopathy (HIE) and to investigate its effects on HIE.

METHODSSerum and CSF IGF-II levels in 41 neonates with HIE were measured by radioimmunoassay in the acute phase (postnatal age 12-24 hrs) and the convalescence phase (postnatal age 10-12 days). The 41 HIE neonates included 10 cases of mild, 12 moderate, and 19 severe HIE. Serum samples of 10 normal neonates were used as controls.

RESULTSIn the acute phase, serum IGF-II levels in the Mild HIE group (203.28 +/- 40.09 ng/mL) and the Moderate HIE group (192.33 +/- 39.66 ng/mL) were not significantly reduced, but were obviously reduced in the Severe HIE group (116.72 +/- 39.50 ng/mL) compared with normal controls (229.38 +/- 43.39 ng/mL) (P<0.01). During the convalescence phase, serum IGF-II levels in the Mild HIE group (285.53 +/- 49.44 ng/mL) and in the Moderate HIE group (278.69 +/- 51.34 ng/mL) increased significantly (P < 0.01); CSF IGF-II levels increased in the Mild HIE group from 27.23 +/- 7.82 ng/mL (acute phase) to 81.58 +/- 9.77 ng/mL (convalescence phase) (P < 0.01) and also increased in the Moderate HIE group from 23.43 +/- 7.79 ng/mL (acute phase) to 78.48 +/- 10.44 ng/mL (convalescence phase) (P < 0.01). The patients from the severe HIE group whose neurological symptoms or signs were improved in the convalescence showed higher serum and CSF IGF-II levels than in the acute phase (254.08 +/- 48.50 ng/mL vs 122.21 +/- 46.26 ng/mL; 69.42 +/- 10.20 ng/mL vs 15.05 +/- 7.03 ng/mL; P < 0.01). A positive correlation was found between the serum and CSF IGF-II levels in the HIE group (r=0.69, P < 0.01).

CONCLUSIONSIGF-II levels in serum and CSF are associated with the pathogenesis and the prognosis of neonatal HIE.

Female ; Humans ; Hypoxia-Ischemia, Brain ; metabolism ; Infant, Newborn ; Insulin-Like Growth Factor II ; analysis ; cerebrospinal fluid ; Male

OBJECTIVETo determine the frequency distribution and antibiotic resistance of pathogens isolated from the cerebrospinal fluid samples of children with bacterial meningitis (BM) and to provide a basis for the timely and effective treatment of childhood BM.

METHODSRetrospective analysis was performed on pathogens isolated from 5097 cerebrospinal fluid samples collected from children in Kunming Children's Hospital between January 2008 and June 2012, as well as drug sensitivity test results. Kirby-Bauer antibiotic testing was used to analyze the sensitivity of these pathogens to commonly used antibiotics.

RESULTSA total of 116 pathogen strains were detected from the 5097 cerebrospinal fluid samples, including 77 (66.4%) Gram-positive strains, 30 (25.9%) Gram-negative strains, and 9 (7.8%) fungal strains, with a positive rate of 2.28%. The six most frequently isolated pathogens were Staphylococcus epidermidis (32 strains, 27.6%), Streptococcus pneumoniae (15 strains, 12.9%), Escherichia coli (15 strains, 12.9%), Staphylococcus haemolyticus (9 strains, 7.8%), Cryptococcus neoformans (8 strains, 6.9%) and Staphylococcus aureus (6 strains, 5.2%). Coagulase-negative staphylococci was the predominant pathogen in neonates and young infants with BM, and its sensitivity rates to penicillin, erythromycin and clindamycin were lower than 40%. Streptococcus pneumoniae had a penicillin sensitivity rate of 13.4%, while sensitivity rates to erythromycin and clindamycin reached 60.0%. No Staphylococcus and Streptococcus pneumoniae pathogens resistant to vancomycin were found. Gram-negative bacilli had relatively high sensitivity rates to imipenem, meropenem, cefoperazone/sulbactam and cefepime.

CONCLUSIONSGram-positive cocci are the predominant pathogens for childhood BM over the past five years. The detected pathogens develop high resistance to commonly used antibiotics. To prevent misdiagnosis, careful attention should be paid to BM caused by Cryptococcus neoformans.

Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; isolation & purification ; Gram-Positive Cocci ; drug effects ; isolation & purification ; Humans ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial ; cerebrospinal fluid ; drug therapy ; microbiology ; Retrospective Studies