A case study of a 76-year-old man with end-stage chronic obstructive pulmonary disease (COPD) with refractory breathlessness and the challenges in managing the dyspnoea he had been experiencing are described. A multi-modal approach is the mainstay of management, encompassing pharmacological agents, home oxygen therapy, and non-pharmacological approaches, namely, breathing techniques and smoking cessation. As this patient was at an advanced stage of disease, integration of palliative care with disease care was needed. Administering oxygen therapy for a patient who is still smoking and has household members who are current smokers need firm adherence to rules. The AIC HOME Programme is also briefly described.

Objective To investigate the effect of video-assisted thoracoscopic surgery( VATS) in thoracic disease,and the feasibility to carry out VATS for basic hospital. Methods The data of VATS treatment were collected to compare the differences between study group and control group,and evaluate the the feasibility to carry out VATS for basic hospital. Results The operation time was (100. 75±22. 72) min, blood loss was (54. 27±26. 21) mL,postoperative drainage was (920. 67±171. 99) mL. The postoperative complications were fewer,post-operative hospital stay was shorter,incision time was shorter(P=0. 000) and pain scores was lower(P=0. 000) in study group than that in control group. Basic hospital has the capacity to conduct this technical. Conclusion VATS is feasible to carry out in basic hospital.

Objective To observe the expression level of macrophage stimulating protein (MSP) in acute on-chronic liver.failure (ACLF) patients,and to explore the clinical significance and correlation with different immune regulatory factors.Methods The double antigen sandwich enzyme-linked immunosorbent assay method was used to detect MSP in the peripheral blood of 45 patients who were diagnosed with ACLF and 32 cases of chronic hepatitis B (CHB).The MSP levels were compared among ACLF patients with different outcomes,and the MSP level of healthy person was used as control.Meanwhile,liver function and hepatitis B virus (HBV) load were detected,and the expressions of peripheral blood CD4+ interferon (IFN)γ+ (helper T cell 1 Th1),CD4+ interleukin (IL)-4+ (helper T cell 2,Th2),CD4+IL-17+ (helper T cell 17,Th17) and CD4+ CD25+ Foxp3+ (regular T cell,Treg) were measured by flow cytometry.The comparison of means between two samples was done by t test,and oneway ANOVA and linear correlation analysis were also used.Results The serum MSP levels in ACLF patients,CHB group and healthy control were (1.65±0.46) ng/mL,(1.43±0.32) ng/mL and (1.23±0.21) ng/mL,respectively.The serum MSP level in ACLF patients was significantly higher than both CHB patients (t=2.163,P=0.035) and healthy control (t=4.032,P=0.01).The MSP level in ACLF survival group was statistically higher compared with ACLF death group ([2.29 ± 0.42] ng/mL vs [1.42±0.17] ng/mL,t=1.973,P=0.042).Th2,Th17 cells in ACLF group,CHB group and healthy control group were (1.51±0.27) ％ and (1.94±1.02)％,(0.42±0.08)％ and (0.55±0.36)％,(0.23±0.19) ％ and (0.26±0.19) ％,respectively,which were all significantly different (F=7.759 and 37.229,respectively;both P＜0.01).The MSP level was positively associated with the number of Th2 (r=0.386,P=0.032) and Th17 (r=0.644,P=0.000),and the ratio of Th17/Treg (r =0.605,P=0.000);while it was negatively associated with the number of Th1 (r=-0.212),Treg (r=-0.262) and the ratio of Th1/Th2 (r=-0.394) (all P＞0.05).Conclusion MSP is involved in the progress of ACLF,and it may be associated with clinical outcomes and cellular immune imbalance of ACLF patients.

Jagged-1 protein is one of the ligands belonging to Notch signaling pathway. Notch signaling pathway is one of the major signaling pathways mediated by contact between cells and plays an important role to regulate the process of proliferation and differentiation of hematopoietic cells in the hematopoietic microenvironment. To study the biological effect after the combination of receptor and ligand in Notch signaling pathway and the mechanism of Notch signaling pathway in bone marrow stromal cells mediated-drug resistance, a NIH-3T3 cell line over-expressing Jagged-1 protein was constructed for further research purposes. A full coding region of Jagged-1 gene was cloned and inserted into eukaryotic expression plasmid to construct pEGFP-IRES2-Jagged-1 eukaryotic expression vector, then transfected into NIH-3T3 cell line, a mammalian cells. As a result Western blot analysis confirmed that the transfectant NIH-3T3 cells highly expressed Jagged-1 protein and flow cytometry analysis confirmed that the NIH-3T3-pEGFP-IRES2-Jagged-1 cell line over-expressed Jagged-1 protein was monoclonal after screened by selective medium and limiting dilution analysis. It is concluded that the pEGFP-IRES2-Jagged-1 eukaryotic expression vector and a stable transfectant monoclonal NIH-3T3 cell line are successfully established. The construction of the stable transfectant monoclonal NIH-3T3 cell line which overexpressed Jagged-1 protein, provides the conditions to further study the mechanism of the bone marrow stromal cell-mediated drug resistance and to discover the new drug targets.
Animals ; Calcium-Binding Proteins ; genetics ; Genetic Vectors ; Humans ; Intercellular Signaling Peptides and Proteins ; genetics ; Jagged-1 Protein ; Ligands ; Membrane Proteins ; genetics ; Mice ; NIH 3T3 Cells ; Plasmids ; Receptors, Notch ; metabolism ; Serrate-Jagged Proteins ; Signal Transduction ; Transfection

INTRODUCTIONThis study aims to assess the safety and feasibility of brachial arterial puncture for coronary procedures when radial access is not possible. Radial arterial approach is the usual option for coronary procedures in our hospital. Whenever radial access is not possible, the brachial approach is preferred instead of the femoral approach. As many clinicians considered percutaneous brachial coronary angiography as an obsolete and hazardous procedure, we carried out this study to compare the outcomes of the brachial approach to the femoral approach in our centre.

MATERIALS AND METHODSWe retrospectively evaluated all cases of brachial artery puncture and femoral artery puncture in our centre from 1 January 2007 to 31 March 2009 through a prospectively collected database and looked for all complications which occurred in both groups.

RESULTSThe femoral group had a slightly higher incidence of major complications--3 out of 121 cases (2.5%) in the femoral group and 1 out of 180 cases (0.6%) in the brachial group, even though this was not statistically significant (P = 0.15). There was also no difference between these 2 groups for minor complications: 8 patients (4.4%) in the brachial group and 6 patients (5%) in the femoral group developed haematoma that did not require any blood transfusion or surgery. There was no incidence of brachial artery thrombosis and no puncture-related neurological deficit documented in the brachial group.

CONCLUSIONBrachial artery puncture and catheterisation may be a viable, safe and efficient alternative to the transfemoral approach in a centre that is experienced with the arm approach, when radial access is not possible.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Brachial Artery ; Cardiac Catheterization ; adverse effects ; methods ; Coronary Angiography ; methods ; Feasibility Studies ; Female ; Femoral Artery ; Humans ; Male ; Middle Aged ; Retrospective Studies

Background Extranodal natural killer/T-cell (NK/T cell) lymphoma,nasal-type,is a rare lymphoma.Skin is the second most common site of involvement after the nasal cavity/nasalpharynx.The aim of this study was to investigate the clinicopathologic features,immunophenotype,T cell receptor (TCR) gene rearrangement,the association with Epstein-Barr virus (EBV) infection and p53 gene mutations of the lymphoma.Methods The clinicopathologic analysis,immunohistochemistry,in situ hybridization for EBER1/2,TCR gene rearrangement by polymerase chain reaction (PCR),mutations of p53 gene analyzed by PCR and sequence analysis were employed in this study.Results In the 19 cases,the tumor primarily involved the dermis and subcutaneous layer.Immunohistochemical staining showed that most of the cases expressed CD45RO,CD56,CD3ε,TIA-1 and GrB.Three cases were positive for CD3 and two cases were positive for CD30.Monoclonal TCRY gene rearrangement was found in 7 of 18 cases.The positive rate of EBER1/2 was 100％.No p53 gene mutation was detected on the exon 4-9 in the 18 cases.Fifteen cases showed Pro (proline)/Arg (arginine) single nucleotide polymorphisms (SNPs) on the exon 4 at codon 72.The expression of p53 protein was 72％ (13/18) immunohistochemically.Conclusions Cutaneous NK/T-cell lymphoma is a rare but highly aggressive lymphoma with poor prognosis.No p53 gene mutation was detected on the exon 4-9,and Pro/Arg SNPs on p53 codon 72 were detected in the cutaneous NK/T-cell lymphoma.The overexpression of p53 protein may not be the result of p53 gene mutation.

OBJECTIVE Choosing the optimizing assistance materials and the best proportional to make the solid dispersion of Ginkgolides,which so that can tremendously improve the dissolution rate of Ginkgolides.METHODS We determine the dissolution rate of the solid dispersion respectively,which are made by Eudragit EPO and PVP K30 in different drug-material ratio.In addition,quantitative phase determination of them are measured by DSC,X-RD and SEM.RESULTS The dissolu-tion rate of the solid dispersion with the Ginkgolides-EPO ratio in 1∶2,1∶4,1∶6,1∶8 were 65%,68%,70% and 71%respectively in five minutes.In the corresponding proportion,The dissolution rate of the solid dispersion made by PVP K30 were 40%,50%,66%,70% respectively.In the same time,the dissolution rate of the drug substance were 10%.Phase i-dentification results showed that Ginkgolides can evenly dispers in amorphous state in the solid dispersion.CONCLUSION The solid dispersion with the Ginkgolides-EPO ratio of 1∶2 is the best choice to preparation,which has the tremendous drug-loading and dissolution efficiency,thereby having a excellent prospect of application.

BACKGROUNDExtranodal natural killer/T-cell (NK/T cell) lymphoma, nasal-type, is a rare lymphoma. Skin is the second most common site of involvement after the nasal cavity/nasalpharynx. The aim of this study was to investigate the clinicopathologic features, immunophenotype, T cell receptor (TCR) gene rearrangement, the association with Epstein-Barr virus (EBV) infection and p53 gene mutations of the lymphoma.

METHODSThe clinicopathologic analysis, immunohistochemistry, in situ hybridization for EBER1/2, TCR gene rearrangement by polymerase chain reaction (PCR), mutations of p53 gene analyzed by PCR and sequence analysis were employed in this study.

RESULTSIn the 19 cases, the tumor primarily involved the dermis and subcutaneous layer. Immunohistochemical staining showed that most of the cases expressed CD45RO, CD56, CD3ε, TIA-1 and GrB. Three cases were positive for CD3 and two cases were positive for CD30. Monoclonal TCRγ gene rearrangement was found in 7 of 18 cases. The positive rate of EBER1/2 was 100%. No p53 gene mutation was detected on the exon 4 - 9 in the 18 cases. Fifteen cases showed Pro (proline)/Arg (arginine) single nucleotide polymorphisms (SNPs) on the exon 4 at codon 72. The expression of p53 protein was 72% (13/18) immunohistochemically.

CONCLUSIONSCutaneous NK/T-cell lymphoma is a rare but highly aggressive lymphoma with poor prognosis. No p53 gene mutation was detected on the exon 4 - 9, and Pro/Arg SNPs on p53 codon 72 were detected in the cutaneous NK/T-cell lymphoma. The overexpression of p53 protein may not be the result of p53 gene mutation.

Adolescent ; Adult ; Aged ; Child ; Epstein-Barr Virus Infections ; diagnosis ; genetics ; metabolism ; Female ; Humans ; Immunohistochemistry ; Immunophenotyping ; In Situ Hybridization ; Lymphoma, T-Cell ; diagnosis ; genetics ; metabolism ; Male ; Middle Aged ; Mutation ; Receptors, Antigen, T-Cell ; genetics ; metabolism ; Skin Neoplasms ; diagnosis ; genetics ; metabolism ; Tumor Suppressor Protein p53 ; genetics ; Young Adult

OBJECTIVETo explore the diagnostic implication of immunophenotyping and gene rearrangement in subcutaneous panniculitis-like T-cell lymphoma (SPTL).

METHODSAccording to the selection criteria of 2005 WHO-EORTC classification for cutaneous lymphomas, 20 SPTL patients were enrolled in this study. A 10-antibody panel was used for immunophenotyping and in addition, polymerase chain reaction for TCR gamma and IgH gene rearrangement and in situ hybridization for EBER1/2 were also employed.

RESULTSThere were 9 males and 11 female with a mean age of 29.5 years. Immunophenotypic study showed that all the patients expressed one to three T-cell associated antigens (CD2, CD3 or CD45RO), 18 patients were positive for beta F1, 18 for CD8, 20 for TIA-1 and 16 for granzyme B. None of the patients expressed CD4, CD20 and CD56. TCR gamma gene rearrangement was found in 16 of 20 cases (80.0%) and none for IgH gene rearrangement. The positive rate of EBER1/2 was 25.0% (5/20).

CONCLUSIONSSince the majority of SPTL patients show clonal TCR gene rearrangements, correlations among clinical presentation, histological features, immunophenotype and gene rearrangement data are considered important in confirming a diagnosis of SPTL.

Adolescent ; Adult ; Antigens, CD20 ; immunology ; CD56 Antigen ; analysis ; immunology ; Child ; Female ; Gene Rearrangement ; genetics ; Humans ; Immunophenotyping ; methods ; In Situ Hybridization ; Lymphoma, T-Cell ; classification ; diagnosis ; genetics ; immunology ; Lymphoma, T-Cell, Cutaneous ; classification ; diagnosis ; genetics ; immunology ; Male ; Middle Aged ; Panniculitis ; RNA, Viral ; immunology ; isolation & purification ; Skin Neoplasms ; immunology ; Subcutaneous Tissue ; Young Adult

ation were complicated, with the characteristics as the obvious decreasing number of patients, with no food-borne isolates in 2007.