Objective To explore the epidemiology,etiology and prevention strategy of early respiratory infections (≤1 month) in lung transplantation recipients with donation after cardiac death donors.Method The clinical data of donors and recipients,particularly on early respiratory infections,were retrospectively analyzed in 17 lung transplantations.Result From Jan.2015 to Apr.2015,12 episodes of early respiratory infections (≤ 1 month) in 17 lung transplantation recipients occurred (12/17,70.6％).The organisms most frequently involved were bacteria:Pseudomonas aeruginosa (4/26,15.4％),Klebsiella pneumoniae (4/26,15.4％),Staphylococcus aureus (3/26,11.5％),and Acinetobacter baumannii (3/26,11.5％).Of 26 bacterial strains,3 were Methecillin resistant Staphlococcus aureus,3 were carbapenem resistant Acinetobacter baumanni,2 were carbapenem resistant Pseudomonas cepacia,2 were extended spectrum b-lactamase-producing Klebsiella pneumoniae,and one was carbapenem and quinolone resistant Pseudomonas aeruginosa.Conclusion The morbidity of early infections is high in lung transplantation recipients.In our experience,bacterial respiratory infections are most common in the early post-transplant period (≤ 1 month).Incidence of Aspergillus spp.and Cytomegalovirus pneumonia is lower than before lung transplantation,probably due to the spread of universal prophylaxis.

Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted.Biopsy or surgical pathological findings served as the golden standard.The main outcome measure was the diagnostic accuracy of alarm features.Results Among 921 gastrointestinal outpatients,39 patients (4.2％) with malignancy were detected,including 13 (33.3％) with esophageal cancer,24 (61.5％) with gastric cancer and 2(5.1％) with duodenal ampulla cancer.36 patients (92.3％) were found with advanced cancer.In 137patients who had alarm features,21 (15.3％) were found to have malignancy and all were advanced.The sensitivity,specificity,positive predictive value and negative predictive value of alarm features were 53.8％(21/39),86.8％ (766/882),15.3％ (21/137) and 97.7％ (766/784),respectively.Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy.Noninvasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.

Objective To explore the efficacy and safety of conversion from calcineurin inhibitor (CNI) to sirolimus (SRL) as major immunosuppressive therapy in lung transplant recipients.Method Retrospective analyses were conducted for the clinical data of all the patients undergoing lung transplantation in Wuxi People's Hospital between January 2011 and December 2014.Sixteen were given conversion treatment with Sirolimus in the postoperative irnmunosuppressive therapy.We analyzed the opportunity and reasons in the conversion treatment,and the safety,effectiveness and complications of the conversion treatment.Result The follow-up period was 8 to 25 months,and the median time of conversion was 6 months after operation (2-18 months).The indications of conversion concluded:malignant tumor (n =8),renal dysfunction (n =5),lymphangioleiomyomatosis (n =1) and intractable diarrhea caused by CNIs (n =2).Four cases suffered from interstitial pneumonitis associated with Sirolimus and one case suffered from spontaneous pneumothorax,and they all conversed back to CNIs.In those patients,cancer recurrence occurred in 4 cases (of them,there were 3 deaths),and 3 patients developed chronic rejection.Those recipients receiving the conversion treatment due to renal dysfunction showed recovery of renal function to some extent.Conclusion It's effective and safe to converse the immunosuppressive therapy based on Sirolimus.Sirolimus should be reduced or withdrawn when interstitial pneumonitis associated with Sirolimus occurred.

Objective To evaluate the clinical value of the three-category classification of severe acute pancreatitis (SAP).Methods Clinical data of 337 traditional SAP patients,who were admitted to Peking Union Medical College Hospital (PUMCH)from January 2001 to December 2012,were retrospectively studied.These patients were classified into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) according to the latest 2013 Atlanta Classification.SAP patients were further categorized as critical acute pancreatitis (CAP) and non-CAP.Disease severity,therapy and prognosis among three groups were compared.Results Among the total 337 traditional SAP patients,253 were classified as MSAP and 84 as SAP.In the group of SAP,40 patients were categorized as CAP and 44 as non-CAP.Compared with non-CAP patients,CAP patients had significantly higher mortality rate which was 70％ (28/40).Other results were all significantly higher in CAP group rather than non-CAP group,including ICU admission rate 77.5％(31/40),length of ICU stay (15.5 ± 20.6) days,Ranson,APACHE Ⅱ,BISAP,MCTSI,modified Marshall scores 4.6 ± 1.4,16.8 ± 5.8,3.0 ± 1.0,8.6 ± 1.7,and 7.4 ± 2.9,respectively (P ＜ 0.01 in each endpoint).These parameters of SAP group were also significantly higher than those of MSAP group (P ＜0.01).Conclusions Using the new three-category classification to distinguish traditional severe acute pancreatitis,namely MSAP,SAP,and CAP,can better reflect the severity of disease,predict outcome and guide clinical management.

0.05). But there were significant differences between them and the stronger positive rate cases. There were significant differences between the positive and stronger positive rate of MTS 1 protein comparing normal gastric mucosa to small intestinal type(84.6%,61.5%), colonic type(85.7%, 50.0%) of IM and gastric carcinoma (83.0%,60.4%)( P

OBJECTIVETo explore the effect of endotoxin concentration in dwellings on the prevalence of atopic asthma in children.

METHODSStandardized questionnaires of asthma were distributed to the parents of 2986 school children aged between 8 and 12 years and endotoxin content in children's mattress was measured by a kinetic limulus assay. A radioallergosorbent technique--fluorescence enzyme immunoassay (RAST-FEIA) was used to measure the level of specific IgE in serum.

RESULTSComplete data was available for 904 children with males more than females. There were both negative associations seen between endotoxin levels and both atopic asthma (OR = 0.48, 95% CI: 0.32-0.72, P < 0.05) and atopic sensitization (OR = 0.65, 95% CI: 0.49-0.94, P < 0.05) but not with non-atopic asthma and wheeze. Comparing with normal people, patients with atopic sensitization, atopic wheeze and atopic asthma had a higher levels of endotoxin (M-W U: 15 138.0, P < 0.01, M-W U: 4858.0, P < 0.01, M-W U: 4041.0, P < 0.01).

CONCLUSIONExposure to endotoxin in early lives of children might have a protective effect on atopic asthma and sensitization.

Asthma ; epidemiology ; prevention & control ; Child ; China ; epidemiology ; Data Collection ; Endotoxins ; blood ; Environmental Exposure ; Humans ; Hypersensitivity, Immediate ; epidemiology ; Immunoglobulin E ; blood ; Respiratory Sounds

Objective To study the teaching effect of prevention in clinical epidemiology teaching.Methods 187 clinical medical students of Grade 2010 from China Medical University were selected as the research objectives.2 teaching hours of prevention content was increased in the clinical epidemiology teaching,and the anonymous questionnaire survey was used to assess the teaching effectiveness.A total of 187 questionnaires were issued and 187 valid questionnaires were collected.All the data were analyzed by SPSS 16.0.Results 82.9％ (155 people) of the students believed that the addition of preventive content was necessary,40.1％ (75 people) of the students believed that there was a significant increase in the content of the prevention.For the understanding of the content,only 11.2％ (21 people) of the students said they had a complete understanding of the class,but after teaching 51.3％ (96 people) of the students expressed a clear understanding of the content.82.4％ (154 people) of the students thought that the teaching contents of prevention was tightly combined with the clinical,and 74.9％ (140 people) of the students thought that 2 hours setting was appropriate.Students' demands for prevent content also included:1) how to strengthen prevention in daily life;2) tumor disease prevention,including current international popular tumor vaccine;3) of emergent public health event instance;4) occupational disease prevention measures,etc.Conclusion Increasing the contents of prevention in the clinical epidemiology teaching has made students of clinical medicine change their clinical concept and realize the key role of prevention in clinical treatment.At the same time,this study understands students' needs for the content of prevention,and provides a basis for the setting and op-timization of clinical epidemiology course in the future.

Objective To analyze the clinical and OTC gene mutation characteristics of 1 case with ornithine transcarbamylase deficiency (OTCD) and to deepen the understanding of OTCD.Methods One case of 14-month female OTCD patient was analyzed.Clinical data of the child patient was collected and venous blood 2 mL from the patient and her parents was extracted respectively.Polymerase chain reaction was used to amplify the fragment where various exon of OTC and its neighboring intron were distributed, followed by direct sequencing to detect mutation.Results It was showed that late-onset OTCD child patient had contracted the disease for 3 months,with intermittent drowsiness, vomiting and psychomotor development regression.Cerebellar ataxia was the main symptom of the child patient when she was taken to Tianjin Children's Hospital.According to brain MRI, the lesion was severe.Blood chemistry showed mild hepatic lesion and increased blood ammonia.According to urine gas chromatography mass spectrometry analysis,there was a rise in uracil and orotic acid.OTC genetic testing showed the child patient and her mother were in the 8th exon,c.852C ＞ G (p.Y284X).Missense mutation occurred in this locus.The mother had normal phenotype.Conclusions Clinically OTCD has the symptoms of hyperammonemia and the resulting in varying degrees of damage to the nervous system and the liver.Without clinical specificity, this disease is easy to be misdiagnosed.Methods like blood ammonia and urine metabolic disease screening, blood amino acid analysis and genetic testing help confirm the disease earlier.As for treatment, early intervention and chronic control of blood ammonia level to guard against hyperammonemia will lead to better curative effect.

Objective To explore the relationship between expression of P-glycoprotein (P-gp), a product of multidrug resistance (MDR) gnne, in the peripheral blood of children with intractable or newly diagnosed epilepsy for drug resistance. To establish a marker of drug resistance. To evaluate the therapeutic effect of flunarizine in the treatment of intractable epileptic patient with or without overexpression of P-gp. Methods The expression of P-gp in peripheral blood were investigated in 86 epileptic children (41 in intractable epilepsy group, 45 in newly diagnosed epilepsy group) and 44 healthy children (controlled group) by flow cytometry. Intractable epileptic patients with or without overexpression of P-gp were given flunarizine 2.5 - 5 mg, po, qn, for 3 months and followed up. Results Overexpression of P-gp were found in 23 (56.1%) patients of intractable epilepsy group, in 10 (22.2%) patients of newly diagnosed epilepsy group and three (6.8%) children of the controlled. In intractable epilepsy group, 17 out of 23 cases (73.9%) patient with overexpression of P-gp became tolerant to antiepileptic drugs, while 3 out of 18 cases (16.7%) patient without expression of P-gp became tolerant to antiepileptic drugs, and there was significant difference between them (P < 0.01) . In the newly diagnosed epilepsy group, seven out of 10 cases (70%) with overexpression of P-gp became intractable epileptic patient and three out of 35 eases (18.6%) without expression of P-gp became intractable epileptic patient, there was significant difference between them (P < 0.01). Twenty patients of intractable epilepsy group were given flunarizine for three months, 11 of 17 patients with P-gp overexpression and 1 of 3.patients without P-gp expression were effective. When reexamined, P-gp expression in 6 out of 11 patients became negative. Conclusions It is suggested that overexpression of P-gp in the peripheral blood of intractable epileptic patients might be a significant marker of drug resistance. Newly diagnosed epileptic patients with overexpression of P-gp may develop intractable epilepsy. P-gp was a predictable marker of intractable epilepsy. Flunarizine could be a choice in treatment of intractable epilepsy with overexpression of P-gp. The antiepileptic mechanism of flunarizine may involve in reversing of P-gp.

Objective To prepare human vascular endothelial growth factor receptor 2 (VEGFR2)-targeted liquid perfluorocarbons-filled nanocapsules ultrasound contrast agent,and to investigate its ability of targeting human umbilical endothelial vein cells(HUEVC) and the peculiarity of the enhancing ultrasound imaging in vitro.Methods Rotary evaporation/emulsion technique was used to prepare biotinylated liquid perfluorocarbons-filled nanocapsules (LNCs).VEGFR2-tageted LNCs (V2-LNCs) was further made through conjugating the ligand (biotinylated anti-VEGFR2 antibody) to the surface of LNCs by biotin-avidin system and its appearance,distribution,size and zeta-potential properties were assessed.Immunofluorescent staining assay was used to identify the combination of ligand with the nanocapsules.The ability of V2-LNCs targeting with HUEVC in vitro was evaluated under the fluorescence microscope.Quantitative and statistical analysis were performed to evaluate the ultrasound contrast enhancement of the nanocapsules in vitro.Results The V2-LNCs are uniform and stabilized with size about (98.45 ± 0.07)nm.The ligation of antiVEGFR2 antibody and nanocapsules was positive in immunofluorescent straining assay.In vitro,targeting ability research showed the V2-LNCs could actively adhere to HUEVC,while the control was negative.At the same time,using anti-VEGFR2 antibody to pre-incubation with HUVEC could effectively block the interaction between V2-LNCs and HUEVC.The ultrasound images proved both V2-LNCs and LNCs can significantly enhanced ultrasound imaging contrast agent effect at a concentration of 5 mg/ml in vitro.Conclusions A stable VEGFR2-targeted liquid perfluorocarbons-filled nanocapsules was prepared successfully with biotin-avidin method and effectively bound to HUVEC specially in vitro.Also the liquid perfluorocarbons-filled nanocapsules can strongly enhance the ultrasound contrast in vitro,which might be taken as a kind of vascular ultrasound contrast agent and to get the basic experimental data for the later research.