ObjectiveTo study the sirolimus (SRL)-associated interstitial pneumonitis,which is a severe side effect of sirolimus therapy. Methods In 7 renal grafts treated with SRL, interstitial pneumonitis (8 times) was diagnosed. One patient suffered a relapse after sirolimus treatment was given again. Two patients received de novo sirolimus treatment, and rest 5 patients were switched from a calcineurin inhibitor-containing regimen to a SRL-based protocol for various indications: chronic allograft nephropathy (n = 4) and cancer (n = 1 ). The patients presented with fever, dyspnea on exertion and the chest X-ray or computed topographic (CT) scan on admission showed bilateral mostly peripheral interstitial infiltrates. ResultsSRL was discontinued in 4 patients and the dose was reduced in the remaining 3 patients. Symptoms were improved within 3-14 days in all patients, the radiographic findings improved within 2-4 weeks, and the lesions were absorbed completely in 2-6 months.ConclusionThe frequency of interstitial pneumonitis appears to be increased in renal transplant patients receiving SRL. Discontinuation or reduced dose of SRL appears to be the safest treatment option for the patients with interstitial pneumonitis.

Objective To assess the predictive value of neutrophil gelatinase associated protein lipocalin (uNGAL) in urine for detection of acute kidney injury(AKI) in patients with severe traumatic brain injury. Methods Patients with severe traumatic brain injury from the ICU were collected from Jan. 2011 to May. 2013 in our hospital. 43 cases that met the RIFLE criteria for diagnosis of AKI in the ICU within 7 days were selected as AKI group. Another 43 cases that were matched for age ,gender ,illness severity , surgery method with AKI cases ,selected as non‐AKI group. The levels of uNGAL and Scr were measured when the patients admit‐ted in the ICU with 15 min ,at 24 h ,48 h ,72 h. the sensitivity and specificity of uNGAL and Scr for diagnosis for AKI were evalua‐ted by ROC curve. Results The incidence of severe traumatic brain injury AKI was 42. 16% (43/102). The uNGAL levels in the AKI group were higher when the patient stayed in the ICU longer and no obvious in the non AKI group. When admitted to the ICU 24 h ,the level of uNGAL(720. 32 ± 684. 25)ng/mL in AKI group was significantly higher than that (421. 92 ± 351. 20)ng/mL in non AKI group. The difference was statistically significant (P< 0. 05). The levels of Scr between two groups were not statistically significant. The area under ROC curve of uNGAL and Scr were 0. 879 (95% CI :0. 807 - 0. 949) and 0. 612 (95% CI :0. 493 -0. 731). When the cutoff value of uNGAL was 180 ng/mL ,the sensitivity and specificity were 0. 890 and 0. 823 respectively. The sensitivity was superior to Scr. Conclusion uNGALis superior to Scr for early diagnosis of AKI in patients with severe traumatic brain injury and it could be used as a biomarker for early diagnosis of AKI.

Objective To explore the role of hypoxia inducible factor 1α(HIF-1α)-mediated signaling pathway in angiotensin Ⅱ(Ang Ⅱ)induced renal interstitial fibrosis. Methods Renal tubular epithelial cells were cultured and treated with different concentrations (10-9-10-6 mol/L)of Ang Ⅱ for 24 h and 48 h.Real-time quantitative PCR and Western blotting were preformed to detect the mRNA and protein expressions of HIF-1α,prolyl hydroxylase 2 (PHD2)and tissue inhibitor of metalloproteinase 1 (TIMP-1)in renal tubular epithelial cells. Results HIF-1αmRNA level was increased with Ang Ⅱ treatment in a concentration dependent manner.When cells were treated with Ang Ⅱ concentration at 10-7mol/L for 24 h,the mRNA level was markedly increased by 166%.Furthermore,by real-time quantitative PCR and Western blotting,compared with the control group,Ang Ⅱincreased the mRNA and protein levels of HIF-1α and TIMP-1 (P<0.05,respectively),while the mRNA and protein levels of PHD2 were decreased markedly (P<0.05,respectively)in renal tubular epithelial cells.Conclusion Ang Ⅱ reduces HIF-1αdegradation in renal tubular epithelial cells probably by reducing the expression of PHD2,which increases the expressions of HIF-1α and TIMP-1 involved in renal interstitial fibrosis.

Objective To investigate the expressions of CXCR4 in Barrett esophagus (BE), esophageal adenocarcinoma (EADC) and esophageal squamous cell carcinoma (ESCC), and its relationship with pathology, clinical staging and lymph node metastasis. Methods The expressions of CXCR4 in 56 cases of normal esophageal mucosa, 80 BE (including 22 BE with multifocal dysplasia), 25 EADC and 48 ESCC were examined with immunohistochemical method. Results CXCR4 was expressed in most samples of BE (80. 8% ), EADC (68. 0% ) and ESCC (78.4%) without significant difference ( P ＞ 0. 05 ), which was significantly higher than that in normal esophageal mucosa (39. 3%, P ＜0. 01 ). The level of CXCR4 expression in BE, EADC or ESCC were not related with gender, age, or location of the foci ( P ＞ 0. 05). There was no significant difference in CXCR4 expression between BE without dysplasia or BE with multifocal dysplasia ( P ＞ 0. 05 ). CXCR4 expression level in well-differentiated EADC was significantly higher than that of mild or poorly differentiated (P ＜ 0. 05 ). CXCR4 expression level was higher in EADC with lymph node metastasis than those without ( P ＜ 0. 05 ). CXCR4 level in ESCC with TNM staging grades Ⅲ -Ⅳ was higher than that of grades Ⅰ - Ⅱ, and this variable was also higher in cases with lymph node metastasis than those without (P ＜ 0. 05), so was the case of well and poorly differentiated ESCC (P ＜ 0. 01 ). Conclusion Increased expression level of CXCR4 may be a common feature of EADC and ESCC, which is irrelevant to pathological types. CXCR4 level rises at the stage of BE, which is associated with the degree of tumor differentiation, lymph node metastasis and TNM staging. CXCR4 expression is of guiding significance in the diagnosis of BE, EADC and ESCC, and is the potential drug target.

Objective To discuss on the relationship among innovation,scientific nature and ethics in medical articles,in order to improve the academic quality of manuscripts.Methods Take Chinese Journal of Radiological Medicine and Protection as an example,innovation was emphasized in the field of radiation diagnosis and treatment,while the cases lack of innovation were pointed.However,the lessons from many papers showed that those papers only with innovation would be rejected because of defect in scientific nature and ethics.Results Innovation is the soul of the paper,and the scientific and ethical nature is the foundation and premise of innovation.Conclusions While the innovation is emphasized,the scientific nature and ethics of the thesis should be not ignored.These three aspects are integral.

In order to observe the nutrition state in the severe multiple trauma patients undergoing adjuvant recombinant human growth hormone (rhGH) nutritional support therapy, 45 patients with severe multiple traumas (ISS>25) were randomly divided into 3 groups. All the 3 groups had been supplied with nitrogen and caloricity according to the need of patients for 16 days. The rhGH therapy started 48 h after surgery and lasted for 14 days in two rhGH-treated groups in which rhGH was 0.2 and 0.4 U/(kg . d) respectively, and the resting group served as control one. The levels of nitrogen balance, prealbumin and safety variables (blood sugar, Na+, TT3 and TT4) were observed and compared among the three groups. The levels of nitrogen balance on the postoperative day (POD) 3 and 5 in the rhGH-treated groups were -1.28+/-3.19, 5.45+/-2.00 and -0.18+/-2.55, 6.11+/-1.60, respectively, which were significantly higher than those in the control group (-5.17+/-1.68 and -1.08+/-3.31, P<0.01). The values of prealbumin on the POD 3 and 5 in the rhGH-treated groups were 180.19+/-27.15, 194.44+/-50.82 and 194.94+/-29.65, 194.11+/-16.17, respectively, which were significantly higher than those in the control group (117.42+/-19.10 and 135.63+/-28.31, P<0.01). There was no significant difference between the rhGH 0.2 U/(kg . d) group and rhGH 0.4 U/(kg . d) group in both of the levels of nitrogen balance and prealbumin. It is concluded that the nutritional support therapy with adjuvant rhGH which starts 48 h after surgery improves the nutrition state of the patients with severe multiple trauma. It is safe for severe multiple trauma patients who accept rhGH at the dose of 0.2 and 0.4 U/(kg . d).

Objective: To treat low-grade limb malignant tumors with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf. Methods:From January 2005 to January 2011, 10 patients [age (27.0±6.5) years] suffering from low-grade limb malignant tumors were treated with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf:7 were histopathologically diagnosed as parosteal osteosarcoma, and 3 as peripheral chondrosarcoma. According to the Enneking staging system, 8 were in Stage IA and 2 were in IB. Results:All the patients were followed-up for (50±23) months. All the patients had bony union at the last follow-up. The length of tumor bone resection was (9.5±2.7) cm, operation time was (150±45) min, intraoperative blood loss was (1000±350) mL, and drainage volume was (450±200) mL. hTe only fracture in the host bone during the operation was treated by internal ifxation. Local recurrence occurred in 1 patient was treated by a wide operative margin and reconstruction with a prosthesis. There was no distal metastasis. A ccording to the Enneking system, 9 patients had excellent results and 1 had good results. Conclusion:Hemicortical excision for low-grade limb malignant tumors is safe and effective.

Objective:To evaluate the efficacy of femoral primary malignant bone tumors treated by limb salvage, with wide en bloc excision and reconstruction of the defect with recycled pasteurized autogratf.
Methods: From January 2008 to January 2011, 11 patients (7 males, 4 females), aged (11.0±2.5) years suffering from femoral primary malignant bone tumors were treated with en bloc excision and reconstruction of the defect with recycled pasteurized autograft. Ten patients were histopathologically diagnosed with high-grade osteosarcoma, and 1 with Ewing’s sarcoma.According to the Enneking staging system, all patients were in Stage IIb.
Results:All patients were followed-up for 24-65(42±20) months and all showed bony union at the last follow-up. hTe length of tumor bone resection was (17.5±3.2) cm, the operation time was (180±35) min, the intraoperative blood loss was (1200±250) mL, and drainage volume was (650±125) mL. Local skin necrosis occurred in 1 patient (9.1%), which was resolved by debridement. Nonunion occurred in 3 patients (27.3%), who were treated by secondary iliac crest cancellous bone gratfing.Pulmonary metastasis occurred in 1 patient (9.1%) who died 35 months post-operatively. According to the function assessment by the Enneking system, 5 patients had excellent results, 4 had good results, 1 fair and 1 poor results, with a satisfaction rate of 81.2%.
Conclusion:A pasteurized autograft can be an easily accessible and economical alternative for children’s malignant bone tumor of femurs.

Objective To evaluate the value of using fluorescence in situ hybridization (FISH)technique for the detection of chromosome aberration of urine exfoliated cells for the diagnosis of bladder tumor.MethodsFISH technique were used to detect the abnormalities of chromosome 3,7,17 and 9p16 site from 20 normal people, and to establish the threshold.The morning's first urinations were available from 75 patients with bladder cancer and 25 patients without urothelial tumor, then were detected using FISH technique and urine cytology respectively.The sample was considered positive if two or more probes results higher than the criteria,or one probe has two or more abnormal results.Results The sensitivity of single using were 73.3％ (55/75),76.0％ (57/75),62.7％ (47/75) and 62.7％ (47/75) for the 4 probes (3,7, 17 and 9p16)respectively.The sensitivity of combined detection was 85.3％ (64/75) and specificity was 96.0％ (24/25) The sensitivity and specificity of urine cytology examination was 9.3％ (7/75) and 100％ (25/25) .The sensitivity of FISH examination was significantly higher than that of urine cytology examination (85.3％ vs 9.3％ ,x2 = 57.00, P ＜ 0.001) .Sensitivity of FISH examination was not correlated with cancer pathologic grading(low vs high : 84.2％ vs 86.5％, x2 = 0.08, P ＞ 0.05)and clinical stage (ta-tl : 82.9％, t2-t4 :87.5％, x2 = 0.32 ,P ＞ 0.05) .ConclusionFISH technique is a non-invasive and effective method for the early diagnosis of bladder tumor and is more sensitive than urine cytology.Furthermore, FISH technique can be used to predict the tumor's biological behavivor and prognosis.

Objective To investigate the role of the expression of latent transforming growth factor beta binding protein-1 (LTBP-1) and transforming growth factor beta receptor type Ⅱ(TGF-beta R Ⅱ) in the pathogenesis of condyloma acuminatum (CA). Methods Samples were resected from the lesions of 30 patients with CA and prepuces of 17 normal human controls. The mRNA and protein expressions of LTBP-1 and TGF-betaR Ⅱ were assessed by quantitative real-time PCR and a streptavidin-biotin-peroxidase staining technique, respectively. Results As shown by Real time PCR, the mRNA expression levels of LTBP-1 and TGF-betaR Ⅱ were significantly higher in CA tissues than those in the controls, with the average value of 2 (-Delta Delta α) being 2.46 and 3.43, respectively. A lower intensity of stainning was observed for LTBP-1 and TGF-betaR Ⅱ in CA tissues compared with the normal controls (182.51±9.89 vs 167.78±12.56, 187.35± 11.23 vs 170.15±13.21, t = 5.62, 3.70 respectively, both P <0.01). Conclusion The decrease in the expres-sion of both LTBP-1 and TGF-betaR Ⅱ may lead to the abnormality in the activation of TGF-beta and signal transduction pathways.