Sepsis is featured with acute onset, rapid progress and high mortality.Because its clinical manifestations is very similar to noninfectious systemic inflammatory response syndrome, it is difficult to diffferentiate the two diseases, which results in delayed use or abuse of anti-infective drugs.Procalcitonin is widely recognized as a sepsis biomarker, but it has its limits.Procalcitonin must be interpreted cautiously, in conjunction with the clinical picture.Dynamic monitoring of procalcitonin can give clinicians more help.

Objective To understand the awareness rate of pulmonary tuberculosis(TB) prevention and control among residents in Beijing, so as to provide basis for giving publicity on knowledge of pulmonary tuberculosis prevention and control.Methods Residents in Beijing were randomly selected for questionnaire survey, the main content of questionnaire included The 2006 national survey on knowledge, attitudes and practice about tuberculosis prevention and control, the core knowledge of pulmonary TB prevention and control, as well as the related symptoms of suspected tuberculosis were also included.Results A total of 520 questionnaires were collected, 503 of which were qualified, the effective rate was 96.73%.Among respondents, the total awareness rate of five core knowledge about pulmonary TB prevention and control was 40.87%, 78.93% of the respondents knew that pulmonary TB was a chronic respiratory infectious disease which could seriously damage people's health,48.51% knew that the majority of patients with pulmonary TB could be cured as long as they persisted in correct treatment, only 19.68% knew that examination and treatment of pulmonary TB in the county (district) level TB control institutions could enjoyed national free policy.Nearly 53.48% of respondents knew 4 or more suspected pulmonary TB symptoms, only 7.36% of respondents could recognize all eight symptoms of pulmonary TB.Conclusion Residents in Beijing have low awareness of pulmonary TB prevention and control knowledge.If patients in the early stage of pulmonary TB can not identify symptoms, it is not only delay treatment and increase the spread of tuberculosis, but also induce the transmission of multidrug-resistant Mycobacterium tuberculosis, so produce more challenges to pulmonary TB prevention and control.

From October 1985 to April 1989, free flaps using post tibial vessel of the healthy leg as a bridgework were applied to 7 cases of extensive traumatic wounds, including damage of main vessels, exposure of bone and large soft tissue defect, of the lower limbs. Success was obtained in all cases. The operative method, indication, selection of the skin donor area and the key factor of operative success were introduced and discussed in the article.

ObjectiveTo explore the effect of carotid artery sympathetic net exfoliation combined with hyperbaric oxygen therapy on athetosic type cerebral palsy (CP).Methods46 CP children (athetosic type) were divided into the treatment group (n=25) and control group (n=21). All cases of two groups were treated with carotid artery sympathetic net exfoliation as well as children of the treatment group were added with drug and hyperbaric oxygen therapy. Therapeutic effect of two groups was compared.ResultsOne week after operation, the effect rate was 66.67% in control group and 64% in treatment group with no significant difference between two groups. 3 months after operation, the effect rate of the treatment group increased to 96.00%, but that of the control group was not changed, there was a significant difference between two groups (P<0.05).ConclusionCarotid artery sympathetic nerve net exfoliation can improve the symptoms of athetosic type CP children, if combined with hyperbaric oxygen therapy, the curative effect will be further improved.

Objective: To discuss the effect of intensive insulin therapy on D-lactic acid and diamine oxidase level in patients with sepsis.Methods: 48 patients was divided into control group and conventional group randomly.Content of D-lactic acid and diamine oxidase in serum was detected with absorption spectrometry before and after therapy.Result: D-lactic acid and diamine oxidase in patients decreased significantly in control group compared to that of conventional group.Conclusion: Insulin can depress interstinal permeability and ameliorate sepsis symptom resulted from bacterial translocation from intestine.

Objective To investigate the prognosis of patients with primary liver cancer in different pathological types after hepatectomy,and to analyze the effects of clinicopathological factors on the survival.Methods The clinical data of 567 patients with primary liver cancer who received hepatectomy at the Affiliated Hospital of Qingdao University from January 1997 to December 2008 were retrospectively analyzed.All patients were divided into hepatocellular carcinoma (HCC) group,cholangiocarcinoma (CC) group and combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) group.The survival and risk factors of the patients were analyzed.All data were analyzed by using the chi-square test,t test,analysis of variance.The survival curve was drawn by the Kaplan-Meier method and the survival of the 3 groups was compared by the Log-rank test.The risk factors were analyzed by the one-way analysis of variance and COX regression model.Results The results of pathological examination confirmed that 92.9％ (527/567) patients were with HCC,4.6％ (26/576) with CC and 2.5％ (14/567)with cHCC-CC.The median cumulative survival time of patients with HCC was 48 months,which was significantly longer than 19 months of patients with CC and 14 months of patients with cHCC-CC (Log-rank value =4.354,8.847,P ＜ 0.05).The median tumor-free survival time of patients with HCC was 26 months,which was significantly longer than 9 months of patients with CC and 9 months of patients with cHCC-CC (Log-rank value =6.479,7.708,P ＜ 0.05).The tumor recurrence rate within 1 year of patients with HCC was 28.8％ (152/527),which was significantly lower than 57.7％ (15/26) of patients with CC or 9/14 of patients with cHCC-CC (F =17.046,P ＜ 0.05).No vascular thrombosis was detected in patients with CC,but the regional lymph node metastasis rate was 19.2％ (5/26),which was significantly higher than 2.8％ (15/527) of patients with HCC (x2 =19.082,P ＜ 0.05).Level of alpha-fetoprotein,TNM staging,tumor diameter,multiple foci,liver capsule invasion,satellite foci and lymph node metastasis were risk factors for the survivals of patients with primary liver cancer after hepateetomy (x2 =8.648,118.786,59.548,7.639,13.200,43.842,15.540,P ＜ 0.05).Vascular tumor thrombosis and Child-Pugh classification were the risk factors for the survivals of patients with HCC or cHCC-CC (x2 =70.446,6.230,P ＜ 0.05).TNM staging,tumor diameter,satellite foci and vascular tumor thrombusis were the independent risk factors for the survivals of patients with primary liver cancer (RR =1.420,1.050,1.513,1.899,P ＜ 0.05) ; TNM staging,tumor diameter and vascular tumor thrombosis were the independent risk factors for the survivals of patients with HCC (RR =1.432,1.888,1.052,P ＜ 0.05).TNM staging and tumor diameter were the independent risk factors for the survivals patients with CC (RR =1.473,1.503,P ＜ 0.05).Conclusion Although CC and cHCC-CC take small proportion in the primary liver cancer,the tumor recurrence rate is higher and the survival rate is lower when compared with patients with HCC.

Objective To investigate the effect of curcumin on apoptosis in hippocampal neurons and the expression of c-Jun N-terminal kinase 3 (JNK3) and postsynaptic density protein 95 (PSD95) in hippocampus during cerebral ischemia-reperfusion (I/R) in rats with spontaneous hypertension (SH) .Methods One hundred and thirty-five male rats (homologous with WKY) with SH and 90 male normotensive WKY rats, weighing 275-325 g,were used in this study. The WKY rats were randomized into 2 groups ( n = 45 each) : sham operation group (WS group) and cerebral I/R group (W-I/R group) . The rats with SH were randomly divided into 3 groups ( n = 45each) : sham operation group (S-S group), cerebral I/R group (S-I/R group) and curcumin group (S-C group) .Global cerebral ischemia was produced by 4 vessel-occlusion method. The bilateral common carotid arteries were only exposed but not ligated in W-S and S-S groups. Intraperitoneal corn oil 10 ml/kg was injected at 30 min of reperfusion in W-I/R and S-I/R groups. Intraperitoneal curcumin 100 mg/kg was injected at 30 min of reperfusion in S-C group. Three animals in each group were sacrificed at 2 h, 6 h, 1 d, 3 d and 7 d of reperfusion and their brains were harvested for determination of apoptosis in hippocampal neurons and the expression of JNK3 and PSD95in hippocampus. Results The number of apoptotic neurons was significantly increased in S-S group compared with W-S group ( P < 0.05) . The number of apoptotic neurons was significantly increased and the expression of JNK3was up-regulated in S-I/R group compared with S-S group ( P < 0.05) . The number of apoptotic neurons was significantly decreased and the expression of JNK3 was down-regulated in S-C group compared with S-I/R group (P <0.05) . There was no significant difference in the expression of PSD95 among all the groups ( P > 0.05) . Conclusion Curcumin can inhibit apoptosis in hippocampal neurons and the mechanism is related to down-regulation of the expression of JNK3 in hippocampus. The mechanism by which curcumin down-regulates the expression of JNK3in hippocampus may not be related to PSD95 pathway.

Objective To investigate the feasibility of rat sodium/iodide symporter (rNIS) as a reporter gene monitoring rat bone marrow mesenchymal cells (rBMSC) transplanted to rat myocardium in vivo.Methods Recombinated adenovirus vector was constructed by rNIS/enhanced green fluorescence protein (EGFP) (Ad-rNIS/EGFP).rBMSC transfected by Ad-rNIS/EGFP were studied using fluorescence microscope.Fifteen rats were transplanted with rBMSC and randomly divided into three groups:rNIS group (with rNIS transfection), blocked group (with rNIS transfection) by oral intake of perchloric sodium before planar imaging(GE Millennium MPR SPECT), and control group (without rNIS transfection).All rats underwent 99Tcm-pertechnetate planar imaging.The biological distribution of 99Tcm-pertechnetate was studied.The expressions of rNIS gene and protein in myocardium were measured by real time polymerase chain reaction (PCR) and western blot, respectively.The expressions of CD29, CD44, CD90, CD11b, CD34 and CD45 were measured by immunohistochemistry.Results rBMSC transfected by Ad-rNIS/EGFP showed EGFP expression under fluorescence microscope.The transplanted rat myocardium could be visualized on 99Tcm-pertechnetate planar imaging in rNIS group.The relative uptake ratio( Rheart/Rhmb, RUR) was 6.7 ±0.4.RUR in control group (3.0 ±0.2) was lower than that in rNIS group (t =2.78, P=0.03).The percentage injection dose per gram of tissue (% ID/g) of the transplanted myocardium was 60.2 ± 20.8 in rNIS group,which was higher than that (2.5 ± 0.4) % ID/g of control group ( t = 7.13, P＜0.001 ).rNIS gene and protein were highly expressed in transplanted myocardium in rNIS group but less expressed in control group.The expressions of CD29, CD44 and CD90 were positive, CD45 and CD45 negative CD11b mildly positive in the myocardium transplanted with infective rBMSC.Conclusion rNIS can efficiently monitor rBMSC transplanted to rat myocardium.

Objective To study the prognosis of patients with huge hepatocellular carcinoma (HCC) after R0 resection.Methods 517 patients with primary HCC who underwent R0 resection from January 1997 to December 2008 at the Affiliated Hospital of Medical College Qingdao University were analyzed retrospectively.Results The 5-and 10-years overall survivals (OS) in patients with huge HCC (≥10 cm; n=69) and in patients with HCC ＜10 cm (n=448) were 24％,18％ and 49％,30％,respectively.The median OS was 23.0 and 58.0 month (P＜0.001,log rank test) ; and the median disease-free survivals (DFS) were 15.3 and 34.8 month (P＜0.001),respectively.The recurrence rate within the first year and the extrahepatic recurrence after resection in patients with huge HCC was significantly higher than in patients with HCC ＜10 cm (44.9％ vs.24.3％,P=0.022;32.7％ vs.16.0％,P=0.004).Independent poor prognostic factors of OS and DFS for patients with huge HCC after R0 resection were portal hypertension and vascular invasion.Preoperative transcatheter arterial chemoembolization (TACE) was an independent prognostic factor for better DFS.Conclusions Surgical resection for huge HCC is safe and feasible.For huge HCC after resection,portal hypertension and vascular invasion were poor prognostic factors.Preoperative TACE improved DFS after resection.

Objective To analyze the factors that influence the survival condition during the first year after hepatectomy in patients with hepatocellular carcinoma (HCC). Methods Five hundred twentyeight HCC cases undergoing hepatectomy were included from January 1997 to December 2008.The factors and survival outcomes in these patients were analyzed. Results There were 302 patients dying during a medium follow-up of 35 months and 1-year cumulative survival was 85％.The causes of death during first year were tumor recurrence (78.1％,75/96) and liver dyscompensation ( 19.8％,19/96).By Cox regression analysis,tumor size ≥5 cm (P =0.047 ),vascular invasion ( P =0.018),histologic moderately and poorly differentiation ( P =0.001 ) and pathologically positive margin ( P =0.004 ) were significantly associated with tumor recurrence,and portal hypertension was an independent factor for patients dying from liver dysfunction ( P =0.001 ).Positive tumor margin was the most important factor associated with postoperative death within one year (59.3％,60/96). Conclusions During the first year after HCC resection,tumor recurrence and liver dysfunction are main factors influencing HCC patients' survival,nonR0 resection is the main factor causing tumor recurrence,and portal hypertension is an independent factor for patients dying of liver dyscompensation.