Objective To investigate the diagnosis and treatment of abdominal compartment syn-drome (ACS)aftergiantabdominal incisional hernia surgery.Methods The diagnosis and treatment of eight cases of ACS after giantabdominal incisional hernia surgery in our hospital from June 201 0 to June 201 4 were retrospectively analyzed.Results Seven cases of ACS were cured,with a cure rate of 87.5%. One case with chronic pulmonary heart diseasedied ofsevere lung infection caused by ARDS,with a mor-tality of 1 2.5%.The cured patients discharged and werefollowedup for threeto six months,without any signs of recurrence and organ dysfunction.Conclusion Abdominal compartment syndrome is a serious complication aftergiantabdominal incisional hernia surgery,with treatment difficult and high mortality.The keysinreducingmortalityare early diagnosis and comprehensive treatment.

Objective To investigate the changes of the serum vascular adhesion protein-1(VAP-1)and high sensitivity C reac-tive protein(hs-CRP) in diabetic nephropathy(DN) and the effects in the development of diabetic nephropathy .Methods 40 cases of DN were enrolled as the DN group ,39 cases of type 2 diabetic mellitus were enrolled as the T2DM group ,and 46 cases of healthy persons were enrolled as the control group .The levels of the serum VAP-1 and hs-CRP were tested by ELISA ,the blood glucose (Glu) was tested by autochemistry analyzer and the concentrations of glycosylated hemoglobin A-1(GHbA-1) was tested by high performance liquid chromatography(HPLC) .All the resoults were compared with that of the control group .Results the differences of the levels of VAP-1 ,hs-CRP ,Glu ,GHbA-1 in different groups were ststisticlly significant (P<0 .05) ,the levels of VAP-1 and hs-CRP were higher in DN group than that of T2DM group and the control group ,and the level of hs CRP was higher in T2DM group than that of control group .The positive correlation was found in T2DM group between VAP-1 with hs-CRP and Glu(r=0 .568 ,0 .755 ,P<0 .05 ,0 .01) ,hs-CRP with Glu and GHbA-1(r= 0 .886 ,0 .475 ,P< 0 .01 ,0 .05) ,and Glu with GHbA-1(r=0 .471 ,P<0 .05) .In DN group ,the level of VAP-1 has positive correlation with the levels of hs-CRP ,GHbA-1 ,Glu(r= 0 .521 , 0 .830 ,0 .454 ,P<0 .05 ,0 .01 ,0 .05) ,the levels of hs-CRP has positive correlation with that of Glu (r=0 .690 ,P<0 .001) .Conclu-sion the changes of the levels of Glu and GHbA-1 in patients with T2DM could affect the increase of VAP-1 and hs CRP ,high content of VAP-1 could cause microangiopathy and renal function damage .Antagonist therapy of VAP-1 is important for the pre-vention of the DM complication .

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique.Methods Normal pelvic CT scans of 52 adults (27 males and 25 females;aged from 18 to 74 years,averaging 47.2 years) were obtained to create pelvic 3D models.After the acetabulum was thickened by 5 mm,the width (d) of the safe zone for placement of the medial iliosciatic plate was measured.After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured,the ratio (r) of d/w was calculated.The recombined innominatum model was cut through the center of the acetabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch.The cross-section was marked as M.In males,4 points at distances of 1.0 cm,1.5 cm,2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked.At the 4 points,the angulations (∠ a,∠b,∠ c and ∠ d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M.In females,3 points at distances of 1.0 cm,1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a,∠b,and ∠c were measured.The differences in the above parameters were compared between males and females.Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56 ±2.44 mm in males and 24.36 ±2.47 mm in females;the ratio (r) was 0.61 ± 0.07 in males and 0.54 ± 0.05 in females.The safe angulations for screw placement in males,∠ a,∠b,∠cand ∠d,were 88.04°±3.18°,77.81°±3.85°,68.01°±4.11°and56.81°±4.81° while those in females,∠a,∠b and ∠c,were 91.29°±4.52°,76.23°±3.82° and 62.79°±3.51°,respectively.There were statistically significant differences between males and females in values of d,r,∠ a and ∠ c (P ＜ 0.05).Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate,the differences between males and females should be taken into account.Besides,specific safe angles should be chosen according to the position of the plate.

OBJECTIVE: To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. METHODS: A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment. RESULTS: Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology. CONCLUSION The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.
Dissent and Disputes ; Expert Testimony ; Forensic Medicine ; Gynecology/statistics & numerical data* ; Hospital Departments/statistics & numerical data* ; Humans ; Incidence ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Retrospective Studies ; Time Factors

Objective To discuss the technique and value of preoperative reformatting with three-dimensional computed tomography technique for C_2 pedicle screw track.Methods GE Light Speed 16 Pro spinal CT scans of 15 adult dry vertebrae were loaded into an imaging station (software ADW4.2).Two methods of C_2 pedicle screw techniques were analyzed through virtual screw trajectory by VR (volume rendering) and MPR (multiple planar reformatting) techniques,in method A,screw entry point was the intersection between the media-vertical and the cranial line of C_2 inferior facet joint,in method B,the screw track was from the cranial and medial quadrant of the dorsal part of C_2 inferior facet joint.Results The screw track could be observed dynamically from any plane.Two vertebrae were ob- served with smaller height in isthmus and the medial edge of the transverse foramen since no space was a- vailable for the screw.The screw trajectories data were compared between method A and method B,which showed that the angles towards the cephalad (in sagittal plane) and midline (in transverse plane) were bigger in method A than in method B (P＜0.05,0.01),but the safe screw diameter was smaller in method A than in method B (P＜0.05),and there was no difference of the screw length between the two methods(P＜0.05 ).Conclusion In this research,the individual C_2 pedicle screw entry points, screw diameter and security screw angle can be simulated,and the screw track can be observed dynami- cally to make sure if it transits the bone structure completely.Preoperative three-dimensional computed tomography reformatting for pedicle screw track is of great value in clinical and basic researches.

Objective To analyze the differences of size and charge heterogeneities between origi-nal humanized anti-TNF-αantibody and four similar biotherapeutic products ( SBP ) .Methods The size exclusion chromatography ( SEC-HPLC ) and weak cation exchange chromatography ( WCX-HPLC ) were used to analyze the size and charge heterogeneities , respectively.Carboxypeptidase B (CpB) treatment was employed to analyze the source of charge heterogeneity of the antibody products .Results Four SBPs showed the same pattern with the originator in SEC-HPLC, and no significant difference with the percentage of mono-mer was observed .The percentages of the aggregates of SBP-3 and SBP-4 were a little higher than those of the originator .The charge distribution of SBPs was significantly different from the originator ′s, especially in the basic region .The results from the samples treated with CpB indicated that the difference of charge distri -bution in the basic region might be caused by the C-terminal lysine variants .Conclusion Four SBPs showed similar size heterogeneity with the originator , but significant differences with charge heterogeneity were observed among them .The study suggested that more attention should be paid to the charge heterogene -ity analysis of the biosimilar products .

The biological activity of ADCC by anti-CD20 monoclonal antibody was determined by BioGlo™ Luciferase Assay System using Jurkat/NFAT-luc+FcγRIIIa cell line as effector cell and WIL2-S cell line as target cell. The developed method was verified for specificity, precision and accuracy. Anti-CD20 monoclonal antibody showed a dose-response mode by the developed method, and the determination result complied with the following four-parameter equation: y = (A-D)/[1 + (X/C)(B)] + D. The optimized parameters of the method were determined including the antibodies diluted concentration (18,000 ng·mL(-1)), dilution rate (1:5), the ratio of effector cell and target cell (6:1), and induction time (6 h). The values of eight independent tests have passed a statistical test for curve regression analysis, linear or parallelism, which showed the method possessed good specificity. Four different dilute groups of recovery rates sample were determined for 3 times, and the result showed mean relative potencies of (44.39±3.93)%, (72.74±2.78)%, (128.28±7.01)% and (168.19±2.70)% respectively, with a variation coefficient of less than 10%, and the recoveries of (88.78±7.85)%, (96.99±3.70)%, (102.63±5.61)% and (112.12±1.80)% respectively. A novel reporter gene method for determination of biological activity of ADCC by anti-CD20 monoclonal antibody was successfully developed, which showed strong specificity, good reproducibility and high accuracy, and might be used routinely.

The process of diagnosis,epidemiological survey and treatment of two cases of African imported quartan malaria is reported in this paper.

Objective To summarize the clinical characteristics of primary pigmented nodular adrenocortical disease (PPNAD).Methods Eight patients with PPNAD from 2001 to 2009 in PUMC Hospital were reviewed,their clinical data were collected.Results PPNAD often occurred in adolescents.62.5% of patients with PPNAD were complicated with Carney complex(CNC).In addition to general features of Cushing's syndrome,amenorrhea and growth retardation in stature were very frequent in clinical manifestations of PPNAD.Plasma ACTH was undetectable,circadian rhythm of plasma cortisol was disappeared,glucocorticoid excretion was increased paradoxically during the dexamethasone suppression test in 50% patients with PPNAD.Adrenal imaging from 75% patients revealed normal-sized adrenal glands or suspectable micronodular changes.Adrenal pathologic analysis revealed numerous brown cortical nodules containing lipofuscin pigmentation.Unilateral adrenalectomy may relieve symptoms of Cushing's syndrome,but plasma ACTH and circadian rhythm of plasma cortisol were difficult to recovere.Hypercorticoidism might re-occure after unilateral adrenalectomy.Conclusion PPNAD should be bewared in ACTH independent Cushing's syndrome patients without apparent adrenal mass,and CNC should be screened and followed up.

Here we discuss whether N terminal sequencing is appropriate as one of the conventional control methods for monoclonal antibody products. We determined the N terminal sequences of two monoclonal antibody products targeting two antigens separately with both Edman degradation and mass peptide spectrometry. We also identified the characteristic peptide fragments with mass spectrometry. Furthermore, we analyzed their heterogeneity with ion exchange chromatography, capillary zone electrophoresis and Imaged Capillary Isoelectric Focusing. Edman degradation method showed that the N terminal 15 amino acids of heavy and light chains of the two monoclonal antibodies were identical. Peptide mass spectrometry demonstrated that T1 peptide fragments of heavy and light chains of the two antibodies were also the same. But in contrast, peptide mapping and the three analytical methods for heterogeneity analysis could effectively identify and differentiate the two antibodies. The N terminal sequences of two monoclonal antibodies are identical because the number of framework sequences of humanized or human monoclonal antibodies is relatively limited, so whether N terminal sequencing analysis could be regulated as one of the practical control methods should be carefully discussed. Our work also proves that the above analytical methods could combinatorially applied to the identification of monoclonal antibody products, and are more objective compared to N terminal sequencing.
Amino Acid Sequence ; Antibodies, Monoclonal ; isolation & purification ; Chromatography, Ion Exchange ; Humans ; Isoelectric Focusing ; Mass Spectrometry ; Peptide Mapping ; Peptides ; Sequence Analysis, Protein ; methods