Respiratory tract infection remains a hot clinical topic.Disappointingly, routine microbiology tests do not meet the needs of target antimicrobial therapy.Widespread practice of antibiotic empiricism has lead to dramatic use of broad-spectrum antibiotics and antimicrobial resistance.The application of new clinical microbiology tests to identify the offending pathogen may allow administration of narrow spectrum antibiotic therapy.To do so,the full clinical microbiology armamentarium with newer point-of-care tests and polymerase chain reaction tests must be exploited.The return of the sputum gram stain and introduction of newer molecular tests would provide information for judicious selection of antimicrobials.

ObjectiveTo evaluate the safety and efficacy of pull through technique in the treatment of middle or low rectal cancer.MethodsRetrospective study was made on 101 patients of rectal cancer undergoing pull through resection in terms of the safety and efficacy. The technique was in brief to make coloanal anastomosis through an everted rectal stump, and pull back the proximal colon into the pelvic cavity. ResultsAll postoperative patients were followed up from 5 to 10 years. Normal or good fecal continence was achieved in 87% (88/101) of the patients, fair in 7 9%(8/101), and poor in 4 9%(5/101). Anastomotic fistula developed in 5 patients (4 9%), and local recurrence rate was 15%. The 5, and 10 year survival rates were 64% and 58%, respectively. ConclusionsColoanal anastomosis provides effective treatment for middle and low rectal cancer with a satisfactory long term survival rate and quality of life.

Objective To detect the neurofibromin expression and observe the biological features of the osteoblasts of patients with type 1 neurofibromatosis and scoliosis. Methods 10 cases of congenital scoliosis and 8 cases of NF1 scoliosis were chosen. The two groups were with the similar age(with the average of 11.7 years and 12.5 years) and Cobb angle(with the average of 85? and 94?). Cancellous bone was harvested from the ilia and the bone explants culture system was used. Proliferation of the osteoblasts, and also the specific differentiation index including alkaline phosphatase, type Ⅰ collagen and osteocalcin was assayed in sewnd generation osteoblasts. Neurofibromin expression in the two kinds of osteoblasts was detected with immunoprecipitation followed by Western blot. Results Compared to the osteoblasts of patients with congenital scoliosis, lower level of neurofibromin was expressed in osteoblasts of patients with NF1 scoliosis, (the OD value was 1.05?0.06 and 2.59?1.40 respectively, P=0.002). The level of alkaline phosphatase, type Ⅰ collagen and osteocalcin were significant lower in osteoblasts of patients with NF1 scoliosis than those of CS patients (44.69 IU/mg vs 51.38 IU/mg, P=0.019; 226.34 ng/mg vs 249.93 ng/mg, P=0.014; 7.41 ng/mg vs 8.87 ng/mg, P=0.049). But the proliferation rate of the NF1 osteoblasts was significant higher than that of the CS osteoblasts (3.34 and 2.70 respectively, P=0.049). Conclusion With the decrease of neurofibromin expression, the NF1 osteoblasts show some defects in their function, these function defects may contribute to varieties of skeletal abnormalities as dystrophic change and decreased bone density.

0.05),the overall response rate was 56.0% .Symptoms(18/25) related to cancer improved and side-reactions were tolerable. Conclusions:Treatment of relapse and metastatic colorectal cancer with combined chemotherapy based on oxaliplatin,irinotecan and 5-Fu by arterial intervention and iv drip is safe and effective,with only slight side-effects. This treatment can improve the symptoms and life quality of patients.

Objective To discuss the mechanism of injury,treatment decisions,complications and surgical results of the floating hip injuries (FHI).Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001to June 2011.There were 25 males and 8 females,with an average age of 34.6 years (range,4-73 years).The mechanism of injury was motor vehicle collision for 20 patients,fall down from a height for 11,crushed injury for 1,and sports-related injury for 1.According to Liebergall classification for the floating hip injuries,there were 7 cases for type Ⅰ (21.2％),9 for type Ⅱ (27.2％)and 17 for type Ⅲ (51.6％).All patients had associated injuries,the average injury severity score (ISS) was 28.9.Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures.Surgical stabilization methods included ORIF or intramedullary nailing (29 cases),external fixation (1 case),total hip arthroplasty (2 cases).Acetabular fractures were treated with open reduction and internal fixation (ORIF) in 16 cases.Thirteen patients suffered pelvic fractures underwent surgical stabilization for at least one component of ring disruption.Results Twenty-eight cases (84.8％) were followed up for 2.3 to 10.1 years (average,3.5 years).Thirteen patients were followed up in the 16 patients who suffered type Ⅰ or Ⅱ fractures.According to Majeed functional evaluation,the results were excellent in 8 cases,good in 3 and fair in 2,with the excellent and good rate being 84.6％.Fifteen patients with type Ⅲ were followed up,according to D'Aubigné and Postel evaluation criterion.The joint functions were excellent in 7 cases,good in 4,fair in 3,and poor in 1,with the excellent and good rate being 73.3％.According to Ma Yuanzhang functional evaluation,the knee functions of the all patients were excellent in 23 cases,good in 3,and fair in 2,with the excellent and good rate being 92.9％.Complications seen in these patients included post-traumatic osteoarthritis of the hip developed in one hips,2 patients developed heterotopic ossification (HO),one case of avascular necrosis of the femoral head,and two femoral nonunions.The most severe complication was traumatic sciatic nerve palsy,which was found in 5 patients.Conclusion Ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip) are severe injuries usually caused by high-energy trauma.The femur fracture will most commonly be addressed first,and surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.

Objective Evaluation of left ventricular ( LV) function has great clinical significance in patients with early chro-nic kidney disease (CKD).The study was to evaluate whether two-dimensional speckle tracking imaging (2D-STI) technique can offer additional information of cardiac dysfunction in early CKD patients . Methods Conventional echocardiography and 2D-STI echocar-diography were performed in CKD group of 20 patients at stage Ⅱ-Ⅲ and control group of 20 healthy volunteers .LV structure and function were evaluated by conventional echocardiography .Multidirectional strain , strain rate and LV twist parameters were analyzed by 2D-STI technique. Results There was no statistical difference in conventional echocardiographic parameters such as left atrial diam -eter, end-diastolic LV diameter and ejection fraction between CKD group and control group .By applying 2D-STI technique, CKD group had significantly decreased value of global longitudinal strain (-19.8 ±2.4)%and strain rate(-1.1 ±0.3)S-1 in comparison to control group(-22.6 ±2.1)%、( -1.8 ±0.2)S-1, along with significant increase in the values of maximum LV rotation (11.6 ± 4.4)°and LV twist(19.6 ±3.8)°in comparison to control group(8.2 ±3.7)°、(13.5 ±3.6)°(P<0.05).There was no differences in both global circumferential and radial deformation parameters as well as maximum rotation value of LV assist device between two groups(P>0.05). Conclusion 2D-STI can detect subclinical LV dysfunction sensitively in early CKD patients .

Objective This study is to investigate the expressions of MACC1 and c-Met genes in prostate cancer tis?sues and to explore the relationship between these gene expressions with the development, invasion and metastasis of pros?tate cancer. Methods The expressions of MACC1 and c-Met genes were examined in 30 cases of benign prostatic hyperpla?sia and 67 cases of prostate cancer using citron acid-microwave-SP immunohistochemical method and analysed with their clinical pathological features. Results Expressions of MACC1 and c-Met in prostate tissues show statistical difference ac?cording to Gleason score, PSA level, pathological stages and whether bone metastasis occurs after radical surgery ( P<0.05 or P < 0.01), but their expressions in prostate tissue show no significant difference among different sex, age and whether smoking or not. Expression of MACC1 in prostate tissue of stageⅢandⅣcancer is significantly higher than that in benign prostatic hyperplasia (BPH) tissues (P<0.05) while the expression of c-Met only shows statistical difference in prostate tis?sue of stage Ⅳcancer compared with that in BPH (P < 0.05). There is a positive correlation between the expression of MACC1 with expression of c-Met in prostate cancer tissues (P<0.01). Kaplan-Meier curves revealed that the survival rates was lower and survival time of bone-free metastasis were shorter in patients with high MACC1 and c-Met expressions in prostate tissue than those with low expressions of MACC1 and c-Met in prostate tissue. Conclusion Expression of MACC1 and c-Met is closely related to the development, invasion and metastasis of prostate cancer, so MACC 1 and c-Met may be used as promising diagnostic and prognostic markers for prostate tumor, and as new therapeutic targets for prostate cancer.

Objective To assess the coronary flow reserve in the patients with systemic lupus erythematosus(SLE)by transthroracic echocardiography(TTE).Methods Coronary sinus blood flow of 24 SLE patients and 18 matched healthy controls were assessed by TTE.The coronary flow reserve was calculated as the ratio of hyperemic to baseline blood flow.Hyperemia was induced by intravenous administration of dipyridamole.Results Adequate recordings of blood flow in the coronary sinus under both conditions were obtained by TTE in all study subjects.Patients with SLE were found to have significantly decreased coronary flow reserve comparing with normal SUbiects(1.55±0.21 versus 2.51±0.33.P＜0.01).Conclusions Coronary flow reserve can be measured by TTE in SLE patients,Coronary flow reserve is impaired suggesting that SLE patients may have subclinical coronary artery disease.

Objective To summary the color Doppler imaging feature of localized Castleman disease.Methods From January 1997 to November 2011,32 localized Castleman diseases which were proved by pathology were analyzed.Results Round-like,hypoechoic,hypervascular lesions were showed in 23 hyalinevascular type lesions,2 of them with calcium,3 of them with structure liked lymph node hilum.Round-like,hypoechoic,hypervascular lesions or normal lymph node were showed in 5 plasma- type lesions and 4 mixed type lesions.Conclusions When round like,hypoechoic,hypervascular lesion is found by ultrasonography,Castleman should be considered.Calcium or lymph nod hilum-like structure is special finding in diagnosis of Castleman disease by ultrasonography.

AIM To study the anti-inflammatory effects and mechanisms of pristimerin. METHODS Several inflammatory models were established, such as ear edema induced by croton oil, hind paw swelling by carrageenan, elevation of capillary permeability by acetic acid in mice and a-cute peritonitis induced by carrageenan in rats. Protein content was measured by Coomassie brilliant blue method, nitric oxide (NO) content by Griess reaction assay, N-acetyl-?-D-glucosamini-dase (NAG) activity by colorimetry, superoxide dismutase (SOD) activity by hydroxylamine method, catalase (CAT) activity by ultraviolet spectro-photometry, and malondialdehyde (MDA) content by fluorescence method in peritoneal exudate in rats. RESULTS Pristimerin ip 0. 156 - 0. 625 mg ? kg-1 or im 1-4 mg - kg-1 inhibited ear edema, hind paw swelling, and elevation of capillary permeability in mice. In the rat peritonitis induced by carrageenan, pristimerin im 1 - 2 mg ?kg-1 reduced neutrophil counts, lessened protein and NO content, inhibited the production of MDA and decreased NAG activity, while augmented the SOD and CAT activity in exudate. CONCLUSION Pristimerin has a significant anti-inflammatory effect which may be related to the inhibition of NO production, scavenging oxygen free radicals, anti-lipoperoxidation and stabilizing lysosome membrane.