Objective To compare the efficacy of four different methods to locate tracheal tube in the tracheal:modified transillumination method,21/23 cm rule,marked the intubation at a distance,and fiberoptic bronchoscope.Methods A prospective randomized controlled trial was conducted.120 endotracheally intubated adult patients with American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅱ and admitted to Central Hospital of Fengxian in Shanghai from January to March 2015 were enrolled.The patients were randomly divided into four groups (n =30) and located by 21/23 cm rule,marked the intubation at a distance,fiberoptic bronchoscope and modified transillumination method (using homemade locator guided by a red laser fiber to position the depth of tube) respectively.An endotracheal tube was inserted and measured the distance of the tube tip to the carina (TTC),vocal cords to tracheal tube cuff (VC-TC) in three different neck positions,i.e.neck in flexion,neutral,and extension position.The number of improper position in four groups was recorded.Results There were no significant differences in gender,age,and body mass index among the four groups.Six of the 30 patients using marked tracheal tuba method failed to find vocal cords with laryngoscope,while the other three methods all completed successfully.① From neck flexion to extension,TTC was gradually increased,while VC-TC was gradually decreased.In neck flexion and extension positions,TTC distance in the 21/23 cm rule group was significantly shorter than that in the fiberoptic bronchoscope group (cm:1.44 ± 1.14 vs.2.11 ±0.54,3.01 ±1.18 vs.3.80±0.71,both P ＜ 0.05),and the distance was also shorter than that in modified transillumination method group (cm:1.44 ± 1.14 vs.1.93 ± 0.81,3.01--1.18 vs.3.45 ± 0.91,both P ＞ 0.05).VC-TC distance in the 21/23 cm rule group was significantly longer than that in the modified transillumination,the marked intubation,and the fiberoptic bronchoscope groups in neck neutral and extension positions,respectively (cm:3.07 ± 1.08 vs.2.28±0.76,2.29±0.90,2.49±0.86;2.64±0.94 vs.1.82±0.72,1.81-0.94,2.02±0.91,all P ＜ 0.05).TTC and VC-TC distances in three neck positions in the modified transiflumination group were shorter than those in the fiberoptic bronchoscope group without statistical significance.② If TTC was too short,an accidental bronchus intubation could happen,while if VC-TC was too short,an accidental damage of the vocal cord inducing by the cuff press could happen.In the 21/23 cm rule group,there were 7 cases that the tube wrongly inserted to bronchus in neck flexion,and 1 case in neutral and extension positions respectively.In the marked intubation group,there were 4 cases that the tube wrongly inserted into bronchus in neck flexion,and 1 case in neck neutral position,and there were 4 cases that the vocal cords were pressed by the cuffs in extension position.In the modified transillumintion and the fiberoptic bronchoscope groups,there was only 1 case that the tube wrongly inserted to bronchus in neck flexion respectively.Conclusions When neck position changed during trachea intubation,it was easier that the tube wrongly inserted to bronchus for 21/23 cm rule method to locate the position.Bronchus intubations and cuff press vocal cords could happen using the marked tube method,which was less be found using modified transillumination or fiberoptic bronchoscope methods.Finally,the modified transillumination methods can be used to locate with satisfactory effect.

Objective To investigate the stability of immunophenotyping in the course of relapse or at treatment failure of patients with acute lymphoblastic leukemia(ALL) and that of immunophenotyping of positive minimal residual disease(MRD).Methods From Aug.2000 to Dec.2007,33 children with ALL who relapsed or treated failure were enrolled. These children were detected MRD by flow cytometry. The immunophenotyping of children who relapsed or treated failure were compared with that of initial therapy;the immunophenotyping of MRD relapsed was compared with that of initial therapy.Results 1.In 23 out of 27 cases (85.18%) with B-ALL,changed at least 1 antigen between diagnosis and relapse.Six children with CD45 down-modulation and 2 children with CD45 up-modulation.Two children with CD19 down-modulation and 1 child with CD19 up-modulation.Six children with CD34 down-modulation and 4 children with CD34 up-modulation. Five children with CD10 down-modulation and 7 children with CD10 up-modulation.2.Six children with T-ALL had the same expression in CD45 between relapse and treatment failure. 3.These were 15 children had the least 1 case MRD,25 cases MRD were detected,these was 1 case up-modulation in CD45,1 case down-modulation in CD19,2 cases up-modulation and 8 cases down-modulation in CD34,3 cases up-modulation and 6 cases down-modulation in CD10.Conclusions Immunophenotyping of children with ALL may change at relapse and treatment failure. The frequency of change in B-ALL is higher than that of in T-ALL,but the change can not impact the detection of MRD.

Background Retinal development continues during the early postnatal period in mammals.Correct arrangement of layers and precise location of various cells in the retina are vital for forming normal visual function during critical period plasticity.Spectral-domain optical coherence tomography(SD-OCT)provides highquality in vivo retinal imaging and the possibility to measure retinal thickness longitudinally. Objective The present study was to investigate the changes of retinal thickness during critical period plasticity in rats. Methods In vivo consecutive scanning of retinal image was performed in 10 SPF Sprague-Dawley rats at postnatal day 14(P14),P18,P21,P24 and P42 with SD-OCT,and retinal histopathological examination was used to detect retinal morphologic changes at the same postnatal ages in 20 matched rats.The whole retinal thickness,the thickness from inner limiting membrane(ILM)to inner plexiform layer(IPL),the thickness of inner nuclear layer(INL)and the thickness from outer nuclear layer(ONL)to retinal pigment epithelium(RPE)were measured using Cirrus HD-OCT system and HMIAS-2000 Imaging System in retinal sections.The measurement parameters by Cirrus HD-OCT and those by hematoxylin-eosin staining were compared.The use of animals followed the Statement of National Institute of Health (USA). Results In vivo high-resolution images of rat retinas with SD-OCT compared well with histology,which enabled quantitative comparison of the SD-OCT and histological data during critical period plasticity in rats.From P14 to P42,the retinal thickness gradually decreased with the increase of rat ages(F=15.425,P=0.000),and so were the thickness from ILM to IPL,the thickness of INL and the thickness from ONL to RPE(F=3.973,P=0.007;F=17.529,P=0.000;F=7.038,P=0.000).The retinal thickness,thickness of INL.thickness from ONL to RPE measured by Cirrus HD-OCT were significantly correlated with those measured by retinal sections among P14,P18,P21,P24 and P42 rats(r=0.794,P=0.000;r=0.784,P=0.000;r=0.681,P=0.000). Conclusion SD-OCT is a demonstratably valuable technology to study the structure of retinas in rats.The retinal thickness is shown to reduce in thickness throughout the development of the retina during critical period plasticity due to the decrease in thickness of INL and the distance from the ONL to RPE,as illustrated by OCT scanning.

ObjectiveTo evaluate the effect of auscultation, partial pressure of carbon dioxide in end-expiration (PETCO2), transillumination technique to judge whether the endotracheal tube is misplaced into the esophagus. Methods A blinded randomized controlled trial was conducted. Sixty patients with American Society of Anesthesiology (ASA) gradeⅠ-Ⅱundergoing endotracheal intubation in Fengxian Central Hospital admitted from September 2014 to February 2015 were enrolled. Two endotracheal tubes with the same size were respectively inserted into the trachea and esophagus for the same depth after general anesthesia by the same person. Two blinded anesthetists with different experience checked the tube position using three methods including auscultation, PETCO2, and transillumination technique, respectively. The order of the tubes tested (trachea or esophagus) and the method used were randomized according to randomise numbers table. The experienced anesthetists conducted the test first, followed by an inexperienced anesthetist conducting the same methods. The numbers of right and wrong determinations with different methods by different anesthetists were recorded.Results Sixty patients underwent the procedures for 180 times, with intratracheal intubation for 90 times, and esophageal intubation for 90 times. It was shown that the results were not different in two groups [96.7% (174/180) vs. 92.2% (166/180),χ2 = 3.500,P = 0.057]. By using auscultation, the correct rate of experienced anesthetist was higher than that of inexperienced (95.0% vs. 78.3%,χ2 = 5.786,P = 0.013). Using PETCO2, both anesthetists were correct in all cases, and the accuracy was 100%. Using transillumination, the experienced anesthetist was mistaken in 3 cases (accuracy was 95.0%), while the inexperienced mistook in 1 case (accuracy was 98.3%), and no significant difference was found between two groups (χ2 = 0.500,P = 0.250). The correct rate of using transilluminaion was significantly higher than that of using auscultation (χ2 = 7.563,P = 0.004). The sensitivity and specificity of the auscultation was 70.0% and 80.0%, that of transillumination technique was 96.7% and 93.3%,and PETCO2 was 100%, respectively, for two groups.ConclusionsPETCO2 is the most reliable method for determining tube position, and it is superior to auscultation and transilluminaion. Transillumintaion technique is superior to auscultation, irrespective of anesthetists' experience, while the accuracy of auscultation showed an obvious relationship with the anesthetists' experience.

Objective To evaluate the in vitro activity of seven imidazole antifungals against clinical isolates of common Candida species.Methods According to the Clinical and Laboratory Standards Institute (CLSI) microdilution method M27-A3,the in vitro activity of luliconazole,ketoconazole,miconazole,econazole,clotrimazole,sertaconazole and bifonazole was determined among 183 clinical isolates belonging to 5 species of Candida.Results The minimal inhibitory concentration range was 0.03-8 (geometric mean:0.067) mg/L for ketoconazole,0.03-16 (geometric mean:0.071 ) mg/L for miconazole,0.03-8 (geometric mean:0.207) mg/L for econazole,0.03-8 (geometric mean:0.061 ) mg/L for clotrimazole,0.03-16 (geometric mean:0.187) mg/L for sertaconazole and 0.03 -＞16 (geometric mean:1.050) mg/L for bifonazole. Luliconazole exhibited a superior activity against the 5 species of Candida in vitro,with the MIC range being 0.03-8 mg/L,geometric mean MIC 0.087 mg/L,MIC50 0.06 mg/L and MIC90 0.5 mg/L,respectively.However,some Candida isolates were identified to be relatively insensitive to these tested antifungals,including luliconazole.Conclusion All the tested imidazole antifungals,except for bifonazole,show an excellent activity against Candida species in vitro,but there exist a few Candida strains with relative insensitivity.

OBJECTIVETo investigate the effects and safety of leflunomide combined with hormone therapy for refractory IgA nephropathy.

METHODSThirteen patients with refractory IgA nephropathy were treated with leflunomide and hormone therapy, and the clinical data were collected and evaluated before and in weeks 2, 4, 8, 12, 16, 20 and 24 during the treatment.

RESULTSLeflunomide therapy significantly improved proteinuria (Plt;0.001) and increased serum albumin in these patients (Plt;0.001) but caused no significant changes in serum creatinine (Pgt;0.05). Only mild tolerable adverse effects were observed.

CONCLUSIONLeflunomide combined with hormone therapy can be one of the safety and effective choices for treatment of refractory IgA nephropathy.

Adult ; Drug Resistance ; Drug Therapy, Combination ; Female ; Glomerulonephritis, IGA ; drug therapy ; Hormones ; therapeutic use ; Humans ; Immunosuppressive Agents ; therapeutic use ; Isoxazoles ; therapeutic use ; Male ; Middle Aged ; Proteinuria ; prevention & control ; Time Factors ; Treatment Outcome ; Young Adult

ObjectiveTo dynamically observe the paradoxical effect (inhibitory at low concentratin but promotive at high concentration) of caspofungin and micafungin across Candida species in vitro.MethodsA broth microdilution testing was performed following the Clinical and Laboratory Standards Institute(CLSI) M27-A2 document to observe the paradoxical effect of caspofungin and micafungin across 85 Candida strains.The growth of Candida was observed on a daily basis for 7 days.ResultsAt 48 hours,the prevalence of paradoxical growth in C.albicans,C.glabrata,C.parapsilosis,C.tropicalis,C.dubliniensis and other species of Candida was 90％,20％,41.7％,37.5％,33.3％ and 28.6％ respectively after caspofungin treatment,and 5％,0,0,25％,33.3％and 0 respectively after micafungin treatment.The concentration range of caspofungin required for the paradoxical growth of C.albicans,C.glabrata,C.parapsilosis,C.tropicalis,C.dubliniensis and other species of Candida was 4-16,8-32,8-32,2-8,2-8,8-32 μg/ml respectively,and that of micafungin for the paradoxical growth of C.albicans,C.tropicalis and C.dubliniensis was 4-16,4-32 and 1-8 μg/ml,respectively.After 48 hours,the prevalence of paradoxical growth still increased in C.parapsilosis,C.glabrata,and other species of Candida following caspofungin treatment,and in C.albicans and C.glabrata following micafungin treatment.ConclusionsThe occurrence,and time of occurrence,of paradoxical effect of echinocandins is Candida speciesand drug-specific.The prevalence of paradoxical effect is higher for caspofungin than for micafungin,which seems unrelated to their MICs against Candida species.

The study was aimed to analyse and enumerate the dendritic cells (DC) subsets in peripheral blood and bone marrow (BM) of healthy individuals in China by using 2 panel 4-color flow cytometry (FCM). The percentage and absolute number of Lin-HLA-DR+CD11chiBDCA1+ myeloid DC (mDC) and Lin-HLA-DR+CD123hiBDCA2+ plasmacytoid DC (pDC) were detected in 35 normal BM (NBM) and 29 normal peripheral blood (NPB), the results were compared with the Lin-HLA-DR+CD11chimDC and Lin-HLA-DR+CD123hi pDC obtained by 3-color FCM. The results indicated that both absolute count of DC subset and relative count of pDC in BM were decreased along with increase of age, the absolute count of DC subset in male BM was higher than that in femoral BM (p<0.05). The DC subsets in NBM and NPB were different whatever by 3 or 4-color cytometric analysis, there were more mDCs than pDCs in PB and the ratio of mDC to pDC was 2.70 and 2.31 respectively. In contrast, pDCs predominated in BM, the ratio of mDC to pDC in BM was 0.90 and 0.71 respectively. The quantity of DC subsets significantly correlated to both frequency (mDC r=0.86; pDC r=0.96, p<0.05) and absolute number (mDC r=0.95; pDC r=0.98, p<0.05) between 3 and 4-color cytometric analysis. The quantity of DC subsets in PB and BM were significantly different, counted by 3 and 4-color cytometric analysis except pDC in PB (p<0.001). The quantity of DC subsets were much higher by 3-color than that by 4-color analysis. Since some Lin-HLA-DR+CD11chimDC and Lin-HLA-DR+CD123hi pDC were BDCA1- and BDCA-2dim/- respectively, that more were in BM than in PB. It is concluded that the DC absolute enumeration is correlated with sample type, gender, age and total nucleated cells (p<0.05). 4-color antibody combination may help to identify the real DC subsets in BM. DC subsets in NBM and NPB are different, that more mDC are in PB whereas more pDC in BM.
Adult ; Aged ; Bone Marrow Cells ; classification ; cytology ; Cell Count ; Dendritic Cells ; classification ; cytology ; Female ; Flow Cytometry ; Humans ; Male ; Middle Aged ; Young Adult

Objective To analyze the clinical value of minimal residual disease(MRD) of acute myeloblastic leukemia(AML) with AML 1-ETO by using the real-time quantitative reverse transcriptase polymerase chain reaction(RQ-RT-PCR).Methods From Jan.2001 to Jan.2007,the MRD of 32 AML1-ETO-positive AML patients were analyzed by using PQ-RT-PCR.The detection of the AML1-ETO was taken after the induced chemotherapy every 1.5-2.0 months during the consolidation therapy.The survival of different stages in children with AML was analyzed by SPSS 10.0 software and calculated by using Kaplan-Meier analysis.Results Thirty-two patients received the induced chemotherapy and 29 patients with complete remission morphologically,3 patients had no complete remission morphologically and then gave up.Patients with molecular remission were associated with a high probability of survival(P=0.001 8).Patients with high transcript levels at diagnosis had no difference in event free survival with patients with low transcript levels.The quality of molecular response after induction,6 months in the chemotherapy as well as consolidation period,has significant impact on the event free survival(P=0.023,0.000 1,0.004 9).Conclusion The current study demonstrate that quantitative evaluation of AML1-ETO transcript levels is important and may be helpful for therapeutic decisions in future.

OBJECTIVEFlow cytometry may be used to detect minimal residual disease (MRD) in acute lymphoblastic leukemia because leukemic cells often display aberrant phenotypes when compared to normal cells. The present study was designed to establish a flow cytometric method for detecting MRD in children with B-ALL and evaluate its clinical prognostic value. The investigators also aimed to study the value of the detection of MRD by flow cytometry in childhood B-ALL without effective antibody combinations.

METHODSThirty-six cases of childhood B-ALL with effective antibody combinations were performed MRD analysis after induction therapy. The authors detected MRD in 6 cases without effective antibody combinations by the four-color antibody combinations consisting of CD(45)/CD(19)/CD(10)/CD(34) and CD(45)/CD(19)/CD(20)/CD(22) and detected the aberrance of the minor subsets of CD(19)(+) cells.

RESULTS(1) Forty-two cases of childhood B-ALL were screened for antibody combinations of interest and were identified in 86% (36/42) of the cases. The sensitivity of this method was 0.01%. (2) Patients with MRD levels > or = 0.01% at 9 and 12 months of therapy had significantly low disease-free survival compared with patients with MRD levels < 0.01%. (3) Six out of seven patients with recurrence in the BM had MRD levels > or = 0.1% prior to recurrence. Patients with MRD levels > or = 0.1% during chemotherapy had significantly low disease-free survival as compared with patients with MRD values < 0.1%. (4) Two out of seven patients with recurrence had positive results of the qualitative PCR prior to recurrence. (5) Five patients with recurrence had no shift of antigen expression at relapse except that a patient missed CD(13). (6) Detectable MRD was not found in six patients without effective antibody combinations.

CONCLUSION(1) Flow cytometry is a sensitive and specific method for detecting MRD of childhood ALL, and could predict the coming relapse. (2) Patients with MRD levels > 10(-3) had poor prognosis. (3) The levels of MRD at month 9 and 12 had prognostic value. (4) The value of antibody combinations consisting of CD(45)/CD(19)/CD(10)/CD(34) and CD(45)/CD(19)/CD(20)/CD(22) should be further investigated in patients without effective antibody combinations.

Adolescent ; B-Lymphocyte Subsets ; immunology ; Child ; Child, Preschool ; China ; Disease-Free Survival ; Female ; Flow Cytometry ; methods ; Humans ; Immunophenotyping ; methods ; Male ; Neoplasm, Residual ; diagnosis ; immunology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; immunology ; therapy ; Sensitivity and Specificity ; Treatment Outcome