A 69-year-old man with fever,pulmonary nodules,joint pain and superficial lymphadenopathy was admitted to our hospital.The patient had a history of ten year hypertension.She smoked a pack of cigarettes daily for forty years and quitted for fifteen years.Family history of coronary heart disease,diabetes,cancer or other diseases was negative.Chest CT showed a nodule in the left lung lower lobe.Percutaneous lung biopsy revealed a large number of atypical B cell proliferation and infiltration which involved the vessel wall.The atypical B-cell phenotype and genotype was EBERs (+),CD20 (+),CD30 (+),CD15 (-).The patient was diagnosed as pulmonary lymphomatoid granulomatosis (LYG),an angiodestructive and angioinvasive lymphoproliferative disorder which is an Epstein-Barr virus associated B cell disorder with reactive T lymphocytes.The patient received six courses of chemotherapy.In this rare case,misdiagnosis of LYG often occurred due to the complex clinical presentation and non-specific imaging.Percutaneous or open lung biopsy is the main choice in the diagnosis of LYG.

ObjectiveTo explore the significance and the scheme of OSCE ( Objective structural clinical examination ) applied in clinical resident training and examination. MethodsOSCE were adopted to train and evaluate residents clinical skills. 180 residents were trained through OSCE for two weeks.Then a test on clinical skills of the residents by OSCE was conducted after training. 172 questionnaires of evaluation on the training effect were collected and analyzed. ResultsWith regard to the training and examination of clinical skill, 96.51％ residents considered that it was helpful for clinical work, 98.26％ considered that it would make their operation more standandized. ConclusionThe training through OSCE is an important way to improve and evaluate clinical skills of residents and may be widely applied.

Blood Platelets ; Humans ; MicroRNAs

Surgical resection is still the mainstay for treatment of intrahepatic cholangiocarcinoma (ICC).Gemcitabine and cisplatin is a systemic therapy practice standard for patients with non-resectable ICC.Neoadjuvant therapy with liver transplantation may be a new therapeutic option for patients with ICC.In addition, radiotherapy, hepatic intra-arterial therapy, ablation therapy and molecular targeted therapy are important components of comprehensive therapy for ICC.

Objective To study the immunomodulatory property of Compound Shougong powder(SGS) on S180 tumor-bearing mice.Methods The S180 model of tumor-bearing mice by Kunming mice were prepared.Then,the tumor-bearing mice were randomized into the model group,positive control group,and SGS groups (29.25g/kg,19.50g/kg,9.75g/kg).Besides the normal group,the other groups were used intragastric administration of into tumor-bearing mice by one time,14 consecutive days.The carbon clearance,quantitative hemolysis and DNFB induced delayed-type hypersensitivity were applied to assay effects of SGS on nonspecific immunity,humoral immunity and cellular immunity.Results Compared with the model control group,in the SGS groups,the tumor-bearing mice with spleen and thymus index of organ improved (all P ＜ 0.05),and the clearance index and values of phagocytic index were elevated(all P ＜0.05),and the productions of IgM and IgG in serum and hemolysin in splenocytes were enhanced(all P ＜0.05),and the percentages of T cells expressing CD4+,CD8+ and the ratio of two subset of T lymphocyte increased,and the IL-2 production of spleen lymphocytes was also improved (all P ＜ 0.05).Conclusion SGS showed significant immunomodulatory property on tumor-bearing mice through specific and nonspecific immunity.

Objective To investigate clinical effect and safety of ostium secundum atrial septal defect(ASD) treatment via one -stop hybrid and classical surgical procedures.Methods 45 patients were diagnosed ostium secun-dum simple ASD by ultrasound cardiogram and clinical manifestation,they were divided into one -stop hybrid proce-dure group (n =20)and classical surgical procedure (n =25).Age,gender,weight,post operation hospital day,on -pump time,blood transfusion amount,drainage flow,incision length and incidence of complication between the two groups were compared.Results Age and weight had no difference between the two groups(t =0.40 and 1.64,P >0.05),but the proportion of female cases in one -stop hybrid procedure group was higher than post operation(χ2 =9.45,P <0.05).Hospital day was shorter(t =11.11,P <0.05),drainage amount was fewer(t =81.68,P <0.05), incision length(t =22.51,P <0.05)was shorter.Incidence of complication had no statistically significant difference between the two groups(χ2 =0.35,P >0.05).And one -stop hybrid procedure group was off -pump without blood transfusion.Conclusion One -stop hybrid procedure was simple,could make a quick recovery post operation and was an ideal method for ostium secundum ASD treatment.

Objective To investigate the activation of nuclear factor-B (NF-B)and hypoxia-inducible factor-1 (HIF-1)in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Subjects were classified into mild-to-moderate OSHAS group (n = 16), severe OSAHS group (n = 14) and the matched control group (n=30). Gene and protein expressions of NF-B and HIF-1 were measured by RT-PCR, Western blot in peripheral blood mononuclear cells (PBMC). Results NF-κB p65 mRNA and NF-κB p65 protein,HIF-1α mRNA and HIF-1α protein in PBMC were significantly higher in severe OSAHS group than those in mild–to-moderate group and control group (P<0.01). But there were no significant difference in NF-κB p65 mRNA and NF-κB p65 protein between mild-to-moderate group and control group (P=0.068, P=0.254 respectively). Only gene (P<0.05) not the protein (P=0.777) of HIF-1αwas higher in mild-to-moderate as compared with control group. Both NF-κB p65 mRNA and HIF-1αmRNA were positively correlated with AHI (r=0.493, P=0.006, r=0.508, P=0.004), while negatively correlated with nighttime lowest blood oxygen saturation (LSaO2)(r=-0.488, P=0.006, r=-0.46, P=0.011). There was a positive correlation between NF-κB p65 protein level and AHI (r=0.669, P<0.001). HIF-1αprotein level was positively correlated with AHI, ODI (r=0.628, P=0.001;r=0.480, P=0.018). There were positive correlations between NF-κBp65mRNA and HIF-1αmRNA (r=0.543, P=0.002), NF-κBp65 and HIF-1αprotein respectively (r=0.716, P<0.001). Conclusions As the gene and protein of NF-κB and HIF-1 were up-regulated in patients with OSAHS, and also positively correlated with the severity of sickness. We conclude that both NF-κB and HIF-1 were involed in the pathogenesis of OSAHS.

Objective To assess the clinical threatment results of pilon fractures managed with arthroscopyassisted minimally invasive percutaneous plate osteosynthesis (MIPPO).Methods 33 patients with pilon fractures were classified into 3 groups according to the Ruedi-Allgower classification:type Ⅰ in 26 cases,type Ⅱ in 5 cases,type Ⅲ in 2 cases,including 29 males and 4 females,aged 22 to 51 years,mean 31.5 years of age.All patients were treated with arthroscopy-assisted MIPPO with the postoperative follow-up time of 12 to 84 months.Results The clinical surgery efficacy according to Mazur's criterion was evaluated as excellent in 22 cases,good in 8 cases,fair in 3 cases.The excellent and good rate was 90.9％.Conclusion Arthroscopy-assisted MIPPO surgical treatment is an effective method for Pilon fractures with the advantages of good healing,minimal trauma and less complications,it is worthy of clinical application.

Objective To investigate the protective effect of hepatocyte growth factor (HGF) on cultured Sprague-Dawley rat cortical neurons injured through hypoxia/reoxygenation.Methods Primary cultured cerebral cortical neurons were isolated from newborn rots.Neurons were pre-incubated with different concentrations (15,30 and 60 μg/L) of HGF.The cell viability was detected by MTT.Apoptosis was measured by Hoechst 33258 staining and flow cytometer.Lactate dehydrogenase (LDH) and caspase-3 activity were determined by colorimetry.Results Compared with normal group,hypoxia/reoxygenation treatment significantly decreased cell viability,increased LDH activity and the percentage of apoptotic cells.Pretreatment of HGF for 12 h could remarkably reverse the decrease of cell viability and the increase of apoptosis rate in neurons induced by hypoxia/reoxygenation treatment.HGF pre-treatment also attenuated the activity of LDH and caspase-3 in a dose-dependent manner.The effects of HGF could be inhibited by a special PI3K/Akt pathway inhibitor,LY294002.Condusion HGF could attenuate rat cortical neuron injury induced by hypoxia/reoxygenation.The neuroprotective effect of HGF may be related to activating PI3K/Akt pathway,and further suppressing the expression of caspase-3.