Objective To investigate the genetic variants in the protein C (PC) and endothelial protein C receptor (EPCR) genes associated with the risk and outcome of acute respiratory distress syndrome (ARDS) patients in Chinese Han race.Methods Five tagSNPs (single nucleotide polymorphism,SNP) in the PC and EPCR genes were genotyped in patients with ARDS (n =275) and non-ARDS (n =337) in order to find the association between them in this case-control study.The SNPs were genotyped by SNPstream Beckman platform.Then,the correlation between the associated SNPs and plasma levels of activated protein C (APC) in patients with ARDS was investigated.The APC levels were measured using enzyme linked immunosorbent assay (ELISA) method.Results Association analysis rcvealed that two PC SNPs in perfect linkage disequilibrium,rs1799809 and rs1158867,were significantly associated with susceptibility to ARDS.T allele frequency of rs1799809 in ARDS patients was significantly higher than that in non-ARDS patients (OR =1.569,95％ CI:1.192-2.066).And the genotype frequencies of rs1799809 were also significantly different between these two groups (P =0.007).The association remained significant after adjustment for multiple comparisons.Haplotype consisting of three SNPs in the PC gene was also associated with susceptibility to ARDS.The frequency of haplotype CCC in the ARDS samples was significantly lower than that in the non-ARDS group (P ＜ 0.01).Moreover,ARDS patients canrying rs1799809 TT genotype showed lower serum levels of APC than patients with TC and CC genotypes (Padj =0.02).However,genotype and allele analyses of EPCR did not show any significant difference between ARDS and non-ARDS patients.Conclusions These findings indicated that common genetic variation in the PC gene was significantly associated with susceptibility to ARDS in Chinese Han race.The PC genetic variation influenced plasma concentration of APC in patients with ARDS.

OBJECTIVE To investigate the in vitro antimicrobial susceptibility of Streptococcus pneumoniae and guide the rational use of drug clinically. METHODS We performed statistical analysis of the susceptibility of 62 strains of S.pneumoniae isolated in our hospital from May 2007 to Aug 2008. RESULTS S.pneumonia e could be isolated from various specimens,most of them were isolated from sputum(84.0%).S.pneumoniae could be detected from many hospital wards,but more strains isolated from pediatric(67.8%) and respiratory(11.4%) departments.A total of 67.7% of S.pneumoniae isolates were penicillin non-susceptible,the resistance prevalence to tetracycline was 87.1%,to erythromycin 79.0% and to trimethoprim/sulfamethoxazole 49%,while they were highly susceptible to ofloxacin(90.3%),vancomycin(91.9%),levofloxacin(95.2%),moxifloxacin(96.8%) and rifampicin(98.4%),and more strains showed multi-resistance from penicillin non-susceptible isolates. CONCLUSIONS The resistance to penicillin of S.pneumoniae is serious in our hospital.The tetracycline and erythromycin are not the best ckoice in treating S.pneumoniae infection,and the new fluroquinolones show strong activity against S.pneumoniae.

Objective To investigate the rituximab plus bendamustine (R-Benda) therapeutic effect for relapsed extragastric mucosa-associated lymphoid tissue (MALT) lymphoma.Methods Ten patients (three females and seven males) with relapsed extragastric MALT lymphoma undergoing therapy with R-Benda were defined.Bendamustine was given at a dose of 90 mg/m2 on days 2 and 3 in nine patients and at 70 mg/m2 in one patient, while all received 375 mg/m2 rituximab on day 1.Results Nine patients received six courses of therapy,while one patient discontinued therapy after five courses for personal reasons, while one elderly patient had progressive disease after three courses.Tolerance of therapy was excellent, and all except one patient responded.Eight patients achieved the complete remission, one achieved the partial remission, and one patient progressed.Toxicities were mild and mainly hematological.After a median follow-up of 24 months (range, 5-43 months), 9 patients were alive.Conclusion R-Benda regime has high activity and good tolerance for patients with relapsed extragastric MALT lymphoma.

OBJECTIVETo discuss the therapeutic effect of free anterolateral thigh flap for the treatment of burn scar carcinoma.

METHODSFrom Jun. 2005 to Feb. 2013, 10 cases with burn scar carcinoma at craniofacial area and extremities underwent radical excision and transposition of free anterolateral thigh flaps for the leaving wounds.

RESULTSThe flaps in 10 cases survived completely and primarily without any complications. The operation time was 7 hours in average. The patients were followed up for 5 months to 2 years (1 year, in average) without no recurrence and no functional morbidity in donor sites. The cosmetic results were satisfactory in all the cases, even with hair growth in 6 cases.

CONCLUSIONThe free anterolateral thigh flap is suitable for the treatment of burn scar carcinoma.

Adult ; Aged ; Burns ; complications ; Cicatrix ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Surgical Flaps

Objective To investigate the changes of circulaling progenitor cells and endothelial progenitor cells(EPCs)in non-septic and septic shock patients using flow cytometry.Method A total of 27 sepsis patients hospitalized in emergency department of Zhongshan hospital during August 2007 to February 2008 were enrolled in this study.The patients were dividedinto septic shock group(n=12)and non-septic shock group(n=15).Ten healthy individuals and ten non-sepsis ICU patients were collected as controls.Peripheral blood mononuclear cells(PBMCs) were isolated by Ficoll density gradient centrifugation,and EPCs labelled with antibodies against CDl33,CD34 and VEGFR-2 were identified and isolated by three-color fluorescence flow cytometry.Differences within the groups were analyzed using One way ANOVA.Results The percentages ofprogenitor cells and EPCs in the PBMC fraction in healthy controls were(0.25%4-0.14%),(0.09%-I-0.02%),respectively,and those in ICU controls were(O.38%.4-0.29%),(0.12%.4-0.02%).The percentages of progenitor cells and EPCs were significantly higher in栅sel如c shock patients(0.57%±0.12%),(0.22%.4-0.10%)than in heathy and non-sepsis ICU controls(P<0.05).However.the percentages of progenitor cells and EPC8 in septic shock pa.tienta(O.20%±0.12%,0.04%-t-O.01%)was obviousely lower than those in healthy,ICU controls and ilionseptic shock patients(P<0.05).Sptic shock survivors had significantly higher numbers of cEPCs than nonsur.vivors(P<0.05).Conclusions The level of progenitor cells and EPC8 in peipheral blood of sepsis patients might be the valuable markers to as.se88 the severity and outcome ofthese ptienS.

OBJECTIVE To assess the clinical characters,diagnosis and treatment of invasive pulmonary(aspergillosis) in hemopathy patients.METHODS The hospitalized patients with hemopathy from Jul 2004 to Jun 2005 was retrospectivly analyzed.RESULTS Among 155 hemopathy cases,3 cases developed invasive pulmonary(aspergillosis),from them 2 died and 1 cured.CONCLUSIONS Overimmnosuppression is one of the main risk factors for invasive pulmonary aspergillosis.Amphotericin B is still the best choice for the treatment of aspergillosis and its gradual,low concentration administration can ease the side effects.

Objective:To investigate the inducing effects of sunitinib malate on expression of NKG2D ligands in nasopharyngeal carcinoma cell ABCG2high CNE2/DDP.Methods:ABCG2highCNE2/DDP cells and Allo-NK cells were isolated by magnetic activated cell sorting(MACS).Flow cytometry was used to evaluate the purity of isolated cells and the expression of NKG2D-ligands on target cells before and after incubation with sunitinib malate.Then the cytotoxic sensitivity of treated and un-treated ABCG2high CNE2/DDP cells to Allo-NK cells were measured by LDH releasing assay.Results:The positive rate of ABCG2 in ABCG2highCNE2/DDP cells was(91.40?2.32)%.More than 90% of isolated Allo-NK cells were proven to be CD3-CD16+CD56+ cells.The expression of MICA,MICB,ULBP1,ULBP2 and ULBP3 on ABCG2high CNE2/DDP cells incubated with sunitinib malate increased from(2.92?0.33)%,(4.27?0.33)%,(5.80?0.62)%,(11.10?3.15)%,and(7.75?1.14)% to(89.12?4.56)%,(66.10?2.22)%,(67.56?4.19)%,(69.37?8.83)%,and(63.28?3.31)%,respectively.At the E ∶T ratios of 10 ∶1 and 20 ∶1,the cytotoxic sensitivities of ABCG2high CNE2/DDP cells to Allo-NK cells increased from(15.32?13.86)% and(27.26?6.81)% to(41.12?4.12)% and(57.25?2.37)%,respectively,after treatment with sunitinib malate,with significantly difference found in the cytotoxic sensitivities of target cells in each group before and after sunitinib malate treatment(F=15.58,P=0.000).Conclusion:Sunitinib malate can up-regulate expression of NKG2D-ligands(MICA/B,ULBP1-3)in ABCG2high nasopharyngeal carcinoma cells,which results in higher cytotoxic sensitivity to Allo-NK cells.

Objective To investigate the possible association of TLR4 polymorphisms with susceptibility and prognosis of SCAP.Method A total of 360 CAP patients hospitalized in emergency department of Zhongshan hospital from May 2005 to April 2008 were enrolled in this case-control study.Patients were excluded if they had metastatic tumors,autoimmune diseases,AIDS or received immunosuppressive drugs.This study was approved by the ethical committee of Zhongshan hospital,Fudan University.Patients were divided into SCAP group(n = 180)and NSCAP group(n = 180)according to the illness severity,and were divided into survival group(n = 300)and death group(n = 60)according to the 30-day mortality.Hapmap database of Han Chinese population was used to select the Tag SNPs.Primer 3 software was used to design the PCR and sequencing primers.Genomic DNA was extracted from peripheral blood mononuclear cells.Genotyping was performed by sequencing the PCR products.We used X2 analysis to evaluate the significance of differences in genotype and allele frequencies between different groups.Results The distributions of three TagSNPs(rs2149356,rs11536879,rs1927907)were consistent with Hardy-Weinberg equilibrium.The allele and genotype frequencies of three TagSNPs in the SCAP group did not differ from the NSCAP group.Also,no significant difference was found between survivor group and non-survivor group.The haplotype frequencies of CA,TA and TG were not significantly different between SCAP group and NSCAP group.And no significant difference of haplotype frequency was existed between survivor group and nonsurvivor group.Conclusions This study suggested that TLR4 gene polymorphisms were not significantly associated with the susceptibility and prognosis of SCAP.

Objective To assess the clinical outcome of varicose veins with incompetent great saphenous vein(GSV) treated with ultrasound guided foam sclerotherapy. Methods Forty limbs with moderate to severe symptomatic varicose veins with incompetent GSV in 38 patients were injected with foam sclerosing agent (Fibro-Vein) under ultrasound guidance. There were 36 patients with unilateral varicose veins and 2 with bilateral varicose veins. No of them suffered from deep vein incompetence or perforating vein incompetence. Second injection was performed one month after the initial injection in 7 limbs. Thirty-eight of 40 limbs were followed up with clinical examination and duplex ultrasound scan 30-47 months (mean 40 months) after the treatment. Results Among 38 limbs with follow-up mild debilitation was found in two limbs(5. 3%). There were no other symptoms or complications. Duplex ultrasound demonstrated four type of results: type I, sclerosed GSV trunk with no detectable venous flow in 32 of 38 limbs (84. 2%) ;type II,patent GSV trunk in 3 limbs (7. 9%) ,two of them had mild reflux in the GSV trunk;type III,sclerosed GSV trunk and mild reflux in the GSV tributaries, 1/38(2. 6%) ; type IV,sclerosed proximal GSV trunk,patent distal GSV communicated with a superficial vein and mild reflux in the veins, 2/38 (5. 3% ). Conclusions Clinical examination and duplex ultrasound scan demonstrated excellent results of varicose veins with incompetent GSV treated with ultrasound guided foam sclerotherapy 40 months after the treatment. Sclerotherapy is less invasive treatment option for varicose veins with incompetent GSV with satisfactory clinical and cosmetic outcome.

Objective To investigate the regularity of intrapulnonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma.To provide a basis for more accurate determination of N stage and indication for pulmonary segmental resection.Methods A prospective study was performed from March 2014 to December 2015.103 cases of cT1 N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection in the thoracic surgery department of China-Japan Friendship Hospital.Intrapulmonary lobar and segmental lymph nodes were dissected and sorted carefully then sent to the pathological department with the corresponding lung specimen and other lymph nodes.Statistical analysis was carried out considering size of the lesion,imaging features,serum CEA levels,pathological subtypes and so on.Results In total 103 cases,pN0 was confirmed in 82 cases,pN1 in 15 cases,pN1 + N2 in 5 cases,and skipping-pN2 in 1 case.14 cases(93.3％) in pN1 group were detected with station 12-14 lymph node metastasis,while only 5 cases (33.3％) were detected with station 12-14 LSNs metastasis.4 cases(66.7％) in pN2 group were detected with station 12-14 lymph node metastasis,while only 1 case(16.7％) with station 13 and station 7 lymph node metastasis.If LSNs were not detected,the false negative rate of N staging could be as high as 6.1％ (5/82),The rate of missed diagnosis of lymph node metastasis might be 30％ (6/20) to N1 stations alone.41.2％ (7/17)cases with metastasis to the adjacent LSNs had been proved with metastasis to the isolated LSNs.The metastasis rate of the isolated LSNs was significantly lower(P =0.049) in pure GGNs compared with those part-solid/solid nodules.Invasive adenocarcinoma had higher metastasis rate of isolated LSNs,compared with preinvasive lesions or minimally invasive adenocarcinomas,with no statistical difference between groups (P =0.055).No significant difference in isolated LSNs metastasis rate was found between groups with different serum CEA levels(P =0.251) or tumor size(P =0.197).Conclusion Dissection of intrapulmonary lobar and segmental lymph nodes might facilitate a more accurate N stage,reduce the false negative rate of lymph node metastasis,and provide basis for more accurate assessment of prognosis and postoperative adjuvant treatment.The sampling area of lymph nodes during segmental resection should include the adjacent LSNs of the target segment.The isolated LSNs metastasis rate of cT1N0M0 stage lung adenocarcinoma with pureGGN as imaging feature is relative low,which might be suitable for segmentectomy when meeting other criteria.