Child ; Cryptococcosis ; complications ; immunology ; Cryptococcus neoformans ; immunology ; pathogenicity ; Diagnosis, Differential ; Humans ; T-Lymphocytopenia, Idiopathic CD4-Positive ; complications ; diagnosis

We have conducted a tireless practice and exploration in order to establish a solid,long-term and appropriate social practice basement for medical students,which is the platform for them carrying on social practice activities.Practice has proved that early preparation for basement construction is the basis,support from local government is the key,leaders' attention 、abundant fund and multi-sectional coordination are the guarantee,and that diverse forms as well as effective social practice activities is the fundamental way to promote basement construction.

Objective To retrospectively review clinical results of combined coronary artery bypass grafting (CABG) and other heart surgical procedures.Methods Combined CABG and other heart surgical procedures have been done in 134 consecutive cases (male 114, female 20), aged from 48 to 76 years with a mean of 61.7. Coronary angiograph showed that all patients have coronary stenosis with left main involved in 20 cases, and 41 cases have diffused coronary artery disease. 56 patients have post myocardial infarction left ventrical aneurysms, and 42 patients have valve dysfunction which need surgical correction. Left ventricular ejection fraction (EF) were equal to or lower than 45% in 63 patients and in 13 patients EF is less than 30%. All the patients received combined CABG under the support of cardiopulmonary bypass (CPB) and other heart surgical procedures (Transmyocardial laser revascularization in 36, valve procedures in 42, and left ventricle aneurysm resection or plasty in 56 patients simultaneously). Results The mean number of grafts was 2.46 per patient. Intra-aortic balloon pump was required in 6 cases for 11 to 54 hours Postoperative. 3 patients died postoperatively with mortality rate 2.2% (two from low cardiac output syndrome, and one from multiple organs failure). 131 patients recovered and discharged.Conclusion Combined CABG and other heart surgical procedures in more demanding than CABG along but can be done with acceptable morbidity and mortality if good surgical plan can be designed and all the heart abnormalities can be corrected simultaneously.

Aged ; Female ; Foreign Bodies ; pathology ; Humans ; Laryngeal Diseases ; Larynx ; pathology ; Vestibule, Labyrinth

Objective To explore the therapeutic effects of human glial cell line-derived neurotrophic factor (GDNF)-engineered rat neural stem cell (NSC) transplantation in rat model of Parkinson's disease ( PD) . Methods SD rats received a single injection of 24 μg of 6-hydroxydopamine (6-OHDA) at two sites in right striatum. Then 10 days after surgery, the successful animal models of PD were divided into 3 groups: PD model group ( 2 μl transplantation media was injected in right striatum), NSC group (transplanted were 2×10~5 NSCs infected by bare lentivirus) and GDNF group (transplanted were 2×10~5 GDNF-engineered NSCs). The rotation scores were assessed 5 weeks, 7 weeks and 9 weeks after transplantation. The dopaminergic neurons in substantia nigra ( SN ) were analyzed quantitatively using immunohistochemistry for tyrosine hydroxylase (TH), and the dopamine and its metabolites, dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) were analyzed 9 weeks after transplantation by high performance liquid chromatography ( HPLC) . Results GDNF-engineered NSC transplantation could effectively improve the behavioral performance in rats. At the 5th week after cell transplantation, the rotation turns within 90 min were (993. 9±159. 1) turns, (956. 7±136. 3) turns and (433. 6±100. 9) turns in PD model group, NSC group and GDNF group respectively (F=95. 694, P = 0. 000). At the 7th week, the rotation turns within 90 min were (964. 2 ± 152.0) turns, (909. 2 ± 136. 3) turns and (399. 4±84. 4) turns in PD model group, NSC group and GDNF group respectively (F = 106. 134, P=0. 000). At the 9th week, the rotation turns within 90 min were (909. 5±152. 2) turns, (865. 5± 129. 1) turns and (312. 2±63. 7) turns in PD model group, NSC group and GDNF group respectively (F= 151. 100, P = 0.000). GDNF-engineered NSC transplantation could significantly increase the levels of dopamine and its metabolites in injured striatum. The concentrations of dopamine in injured striatum was higher in GDNF group than that in PD model group and NSC group C(7. 5±0. 8) ng/mg vs. (3.3±0.3) ng/mg and (3. 7±1. 3) ng/mg, F=59. 543, P = 0. 0003. The level of DOPAC was higher in GDNF group than that in PD model group and NSC group C(0. 9±0. 1) ng/mg vs. (0. 5± 0. 1) ng/mg and (0. 6±0. 2) ng/mg, F= 17. 293, P=0. 000]. The concentration of HVA in injured striatum was higher in GDNF group than that in PD model group and NSC group [(0. 9±0. 1) ng/mg vs. (0.5±0. 1) ng/mg and (0. 6±0. 2) ng/mg, F=35.175, P = 0.000]. Conclusions engineered NSC transplantation improves the function of dopamine system in SN and striatum, and GDNF gene therapy has potential clinical value.

Objective To investigate the effect of Xuebijing injection on release of high mobility group box 1 (HMGB1) in endotoxin-induced cells. Methods HMGB1 concentration and mRNA expression were analyzed by enzyme-linked immunosorbent assay (ELISA) and RT-PCR, respectively. The effects of Xuebijing injection with 2, 10 and 50 mg/ml on HMGB 1 concentration in the culture medium of 200 ng/ml lipopolysaccharide-induced macrophage-like RAW 264.7 cells and BRL-3A hepatocytes, and HMGB1 mRNA expression in lipopolysaccharide-induced macrophages were observed. Results 50 mg/ml Xuebijing injection significantly decreased HMGB1 concentration in the culture medium of lipopolysaccharide-induced macrophages and hepatocytes(P< 0.01), and inhibited HMGB1 mRNA expression in macrophages. Conclusion Xuebijing injection inhibits endotoxin-induced release of HMGB1.

Objective:This study was aimed to investigate the safety and feasibility of applying duodenal feeding tube in thoracoscopy-and laparcoscopy-guided esophagectomy for esophageal carcinoma. Methods:Clinical data of 73 esophageal carcinoma patients who underwent esophagectomy and received a duodenal feeding tube by thoracoscopy and laparoscopy from March 2011 to September 2012 were analyzed retrospectively. Modes of operation included the separation of the esophagus by thoracoscopy, separation of the stomach by laparoscopy, reconstruction of the digestive tract, and so on. Results:A duodenal feeding tube was carefully placed at the site of esopha-gectomy of the patient. Operation time lasted from 180 min to 410 min, with an average of 273 min. The duodenal feeding tube was placed at 27 min into the operation. Intra-operative blood loss ranged from 50 mL to 450 mL, with an average of 120 mL. No post-operative death was encountered among the cases. After surgery, anastomotic fistula and gastrointestinal discomfort occurred in 2 and 5 of the 73 cases, respectively. Conclusion:Placement of a duodenal feeding tube at the site of esophagectomy through thoracoscopy and laparoscopy is completely safe and feasible.

Objective To determine the efficacy of stent based rapamycin (Rapa) and methotrexate (MTX) alone or in combination of them to reduce in stent neointimal hyperplasia Rapamycin is a potent immunosuppressive agent that inhibits smooth muscle cell (SMC) proliferation by blocking cell cycle progression Methods Stents were coated with PLGA (poly/lactic co glycolic acid) polymer containing 68-96 ?g Rapa or 250-300 ?g MTX or 58-81 ?g Rapa and 120-170 ?g MTX respectively Twenty five stents (metal, n =8; MTX, n =5; Rapa, n =7; Rapa and MTX, n =5) were implanted in the coronary arteries of 25 pigs Results After 28 days, the mean neointimal thickness was (2 18?1 03) mm 2 in the bare metal stent group; (0 94?0 88) mm 2 in the Rapa group; (0 47?0 24) mm 2 in the combination Rapa and MTX group, (3 93?1 48) mm 2 in the MTX group Compared with metal group the mean neointimal thickness was significantly decresed in Rapa groups and combined group The in stent restenosis was 25% (2/8) in metal group and 80% (4/5) in MTX group after 28 days, and there was no restenosis in the other two groups Conclusion Stent based delivery of Rapa via PLGA polymer can feasibly and effectively reduce in stent neointimal hyperplasia by inhibiting cellular proliferation However there are no effects to reduce in stent neointimal hyperplasia by MTX eluting stents in this study

Objective To review the strategies for multiple coronary artery bypass in patients with calcified ascending aorta.Methods From June 2002 to December 2007,36 patients with multiple coronary artery disease and calcified ascending aorta underwent OPCAB without aortic side-bite clamping.The patients(28 males and 8 females) aged from 60 to 83 years with a mean of(69.1?6.7) years.Fifteen of the patients had a history of stroke.Coronary angiogram revealed that 3 patients had double vessels disease and the others had triple vessels disease,involving the left main stem in 14 cases.The left ventricular ejection fraction ranged from 0.32-0.69.Calcified ascending aortic plaque can be explored in 30 of the patients during operation while intra-operative transesophageal echocardiography indicated calcified aorta only in 28.No-touch technique was used in 22 patients either with LIMA as the only inflow and the saphenous vein grafts was anastomosed to the LIMA in 15 patients,or with bilateral internal mammary arteries as the only inflows in 7 patients.Proximal anastomotic device was employed in 14 patients to finish the proximal anastomosis of greater saphenous vein grafts without aortic side-biting clamping.Intra-operative graft flow meter was used to check the flow of grafts before chest closure. Results Totally 116 cases of distal anastomosis were performed in the 36 patients(2-5 in each,mean 3.2?0.9).The patients woke up from anesthesia in 2 to 22 hours.Intraoperative measuring of graft flow revealed satisfying blood flow in all the grafts.In the 15 patients with LIMA as the only inflow,the total graft flow in the main stem of LIMA was basically the sum of each connected grafts.Only one patient died after surgery,showing a mortality rate of 2.7%.Eight patients(26.7%) had transient atrial fibrillation after the operation,2 showed pulmonary infection,4 had chest fluid,1 showed infection of the incision at the lower limb.All the complications were cured.30 patients achieved a 6-to 60-month follow-up with a mean of(33.8?11.2) months.During the period,11 patients(37 grafts) were examined by angiography,which showed that all the grafts of LIMA to LAD and vein grafts were patent,except in two vein grafts,which were occluded in the diagnol branches. Conclusions In patients with remarkable ascending aortic calcification,OPCAB combined with aorta no-touch technique or proximal anastomosis device can effectively decrease the incidence of postoperative stroke.

Objective:To investigate the clinicopathological characteristics of lung cancer patients with axillary lymph node metastasis (ALNM). Methods:The clinical data of 91 lung cancer patients with ALNM who were treated in Zhejiang Cancer Hospital from January 1st, 2007 to December 31st, 2013 were retrospectively analyzed. The relevance of the sites of the tumor site, local lymph node, and ax-illary lymph node was checked by contingency table. Survival rates were calculated by the Kaplan-Meier method and compared by a log-rank test. Cox proportional hazards model was applied to analyze the prognostic factors. Results:The proportion of lung cancer pa-tients with ALNM was 0.63%, and the patients were often presented with adenocarcinoma, peripheral tumor type, pleura invasion with pleural effusion, or chest wall invasion. A relationship between tumor sites, local lymph node sites, and axillary lymph node sites was observed. The median survival time of lung cancer patients with ALNM was 19.02 months, and the two-year survival rate is 62.64%. Patients identified with ALNM at the initial diagnosis reported poor prognosis (P=0.002). Cox regression analysis showed that the relative risk of death in patients with ALNM at initial diagnosis was elevated 2.18 times (95%CI:1.330?3.572, P=0.003). Conclu-sion:ALNM in lung cancer is rare, and it may involve through direct chest wall invasion and spread from supraclavicular and mediasti-nal lymph node metastasis or systemic origin. Patients detected with ALNM at the initial diagnosis indicated poor prognosis.