Concurrent chemoradiotherapy is the optimal regimen for patients with inoperable locally advanced non-small cell lung cancer (LA-NSCLC).The application of new technologies such as positron emission tomography (PET)/CT and four dimensional CT (4D-CT) enhances the accuracy of radiotherapy and decreases adverse reaction.Induction chemotherapy and consolidation chemotherapy do not show benefit to survival.The targeted therapy and immunotherapy have the potential of improving the outcomes of inoperable LA-NSCLC.

Lignocellulosic biomass is a promising new source of renewable biofuel that can help reduce reliance on fossil fuels.Researches have been done over the last decades.And considerable progress has been made.The abilities and pathways of natural microorganisms to produce ethanol from cellulose are different.So the researches of reconstructing and recombinating the useful genes from different strains are of great significance to improve the yield of ethanol production and reduce the cost.The characteristics and mechanisms of natural ethanologenic strains and the research progress of constructing recombinant strains was introduced and also analyzed the perspectives and challenges.

Autoimmune Lymphoproliferative Syndrome ; classification ; diagnosis ; immunology ; physiopathology ; therapy ; Child, Preschool ; Diagnosis, Differential ; Disease Progression ; Humans ; Infant ; Treatment Outcome

Objective To compare the manipulation of two different methods of percutaneous dilatational tracheostomy (PDT),the guidewire dilating forceps (Portex method) and the modified onestep dilation technique (Ciaglia Blue Rhino method,CBR method).Methods From March 2013 to February 2014,48 patients eligible to meet the criteria of tracheostomy in ICU were collected and were divided into two groups at random.The length of time consumed for operation,amount of blood lost during operation and the operation complications were compared between two groups.The participant surgeons were asked which method they preferred,Portex or CBR.Results Of them,the mean age was 76.7 ± 11.6 years old,and 25 patients (52.1％) were male.The reasons for tracheotomy were the length of time needed for mechanical ventilation support expected to be longer than 2 weeks (n =30),severe disturbance of consciousness (n =17),and upper airway obstruction (n =1).The patients enrolled in the study were randomly divided into Portex and CBR groups.There were no significant differences in age,gender,APACHE Ⅱ score,the reason of tracheotomy,the length of time for mechanical ventilation support before tracheotomy,and the preoperative coagulation function between two groups.CBR method can easily be done with less operation time required than Portex [(5.9 ±4.3) min vs.(9.9 ± 1.5) min,P ＜0.01],and had obviously fewer operation complications and less amount of blood lost than Portex method (P ＜ 0.05).The male surgeons with a slew of surgical practice were in preference to Portex,whereas female doctors with less work experience and without surgical practice preferred CBR.Conclusions The CBR method can easier be done and was better than the Portex method in minimizing operative trauma and reducing the complications,especially it can easily be accepted by female doctors with less work experience and without surgical practice and it is worth using widely in clinic.

To explore the value and attentive problems of the innovative practical teaching reform of dermatology staff room,the author constructed a new practical teaching system by carrying out advanced teaching methods,gradually establishing the on-line test system and setting up the evaluation and feedback system. The result showed that the innovative practical teaching reform of dermatology staff room had strong applicability and operability.

Objective China is experiencing increasing disease burden and economic burden of acute myocardial infarction(AMI),while the healthcare resources are limited and unevenly distributed.Hospitalization duration is an important measure of health resource utilization index.This study aims to describe the time trend of Length of stay(LOS) for AMI inpatient care in eastern urban areas of China,and to identify potential hospital-level factors associated with the LOS,which is an important indicator of resource utilization.Methods The study randomly selected a representative sample of patients admitted for AMI in 2001,2006 and 2011,from urban hospitals in eastern China.After central data abstraction from medical records,patients' characteristics,treatments and outcomes were compared between 3 hospital groups that were divided according to their median of LOS.Results Five thousand and forty-seven AMI cases were included in the analyses.The average LOS were (15.3±10.2),(13.5±8.7) and (12.2±7.8) d in 2001,2006 and 2011 respectively,with a decreasing trend(F=10.93,P<0.001).After adjusted for patients' characteristics,there were no significant different in LOS between years.Patients' characteristics were similar between high-,middle-and low-LOS hospitals,however,in high-LOS hospitals,use rates of aspirin,clopidogrel and statins were even lower(P≤0.001).LOS were longer 1.9 d in the hospitals with relatively small AMI inpatient treatment volumes(30-80 annually,t=2.97,P<0.01).Conclusions The average LOS for AMI in eastern urban areas of China is much longer than in western countries.Conclusion between hospitals have highlighted the gaps in care quality and efficiency.Standardized clinical pathways and hierarchical medical system are essential strategies in the new healthcare reform.

Objective: To assess trends of β-blocker use within 24h of admission in ideal candidates with acute myocardial infarction (AMI) in eastern urban China from 2001 to 2011. Method: A 2-stage random sampling design was performed. In the first stage, a simple random-sampling was used to identify participating hospitals. In the second stage, a systematic sampling was conducted in 2001, 2006 and 2011 to select cases from the participating hospitals. Data was obtained by central medical record abstraction. 10-year trend and predictors of early β-blocker application were assessed with weighted calculation for each year to represent the overall situation of eastern urban China. Results: 35 hospitals were sampled and 32 of them were finally participated. With necessary exclusion, 1399 ideal candidates were included in this analysis. The early weighted β-blocker application rates in 2001, 2006 and 2011 were 64.7%, 69.7%, and 60.9% respectively, P=0.0447 for trend. Patients with chest pain at admission (OR=2.22, 95% CI 1.19-4.13), higher systolic blood pressure (OR=1.40, 95% CI 1.11-1.77) or faster heart rate (OR=2.01, 95% CI 1.58-2.55) were more likely to use β-blocker; in contrast, compared with NSTEMI patients, STEMI patients seemed less likely to receive such treatment (OR=0.55, 95% CI 0.37-0.81). Conclusion: The early β-blocker therapy in eastern urban China is suboptimal for ideal AMI patients who could benefit from it. The application pattern has not been changed from 2001 to 2011 which might be related to physicians' misunderstanding of relevant evidence or guidelines. Our study may help to create an important target to improve the quality of AMI care.

Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections (BSIs) in a tertiary hospital.Methods Positive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.BSIS events were identified and the epidemiology data were collected.Results A total of 149 patients and 154 BSIs events were confirmed by pathogenic and clinical evidence.The inpatients' BSIs rate was 0.8％ in our hospital in 2012.According to the disease entities of the first BSIs onset,15 patients (10.1％) were from surgical departments,83 patients (55.7％) from the medical departments,and 51 patients (34.2％) from ICU.Thirty-three patients (22.1％) were diagnosed as septic shock.Sixty-eight patients died during hospital stay.The in-hospital mortality rate was 45.6％.Among the 154 BSIs events,125 (81.2％) were nosocomial and 29 (18.8％) were community-acquired.A total of 188 strains were isolated from all BSIs,including 106 strains of (56.4％) gram-negative bacilli,67 (35.6％) strains of gram-positive bacteria,and 15 (8.0％) strains of fungi.One hundred and fifty-nine strains of bacteria (84.6％) were isolated from 125 events of hospital-acquired BSIs.Twenty-six strains of bacteria were from catheter related bloodstream infections (CRBSIs).In gram-negative BSIs,there were more enterobacteriaceae in community-acquired BSIs.More non-fermentative bacteria were found in hospitalacquired BSIs than in community-acquired ones.The distribution of gram-negative bacilli was quite different between surgical departments,non-surgical departments and ICU (P =0.049).Conclusions Pathogens of BSIs are quite different according to disease entities and where the patients are from.Local epidemiology of BSIs and distribution of related pathogens are helpful to physicians searching the optimal empirical antibiotics and improving the outcome.

Objective To randomly compare the therapeutic effect and safety between Levetiracetam (LEV) and Phenobarbital (PB) in the treatment of neonatal seizures.Methods A total of 61 infants with acute convulsion were randomly divided into 2 groups:LEV group (n =30) and PB group (n =31) during January 2013 to December 2014 in Urumqi Children's Hospital.All neonates received routine management including etiology treatment and adverse drug reaction monitoring.In the LEV group,subjects received oral formulation of LEV with initial loading dose 30 mg/kg,followed by 15 mg/kg twice a day.If the seizures were not controlled completely,PB treatment was added until seizures were completed controlled.If seizures were controlled quickly,the dose of PB was gradually reduced and LEV was used as monotherapy.The subjects in PB group received intramuscular or intravenous injection of PB with 10 mg/kg as the first dose,then 5 mg/(kg · d) oral PB was administered,if seizures were not controlled,LEV treatment was added,then dose of PB was gradually reduced until seizures were controlled completely,and then patients were switched to LEV monotherapy gradually.The drug adverse reactions were observed.Results (1) After LEV or PB monotherapy,66.7％ (20/30 cases) and 54.8％ (17/31 cases) of the subjects obtained sustainable seizure free respectively.Although,there was a higher control ratio in LEV group,but no significant difference was observed between the 2 groups (P ＞0.05).(2) LEV group (16/30 cases,53.33％) had higher rapid seizure control ratio with seizure controlled within 24 h after first dosage administration than that of PB group (8/31 cases,25.80％),and there was significant difference (x2 =4.841,P =0.028).Further more,if adding the cases who had to change to use another comparative one (LEV or PB) due to their seizures failure control with the first one treated,LEV group (21/44 cases,47.72％) still had higher rapid seizure control ratio in total patients than that of PB group(10/41 cases,24.39％),and there was significant difference (x2 =4.988,P =0.026).(3) Eight cases who changed to LEV after PB as the first treatment drug failed obtained sustainable seizure free.(4) One case in PB group with transient urinary retention was observed but the symptom disappeared 36 h after PB withdrawal,and no significant drug adverse reaction was observed in LEV group.Conclusion LEV is more rapid and safe for seizure control of neonates than PB.

A novel method based on the separation and enrichment effect of magnetic beads and the fully complementary hybridization of two DNA strands was developed for highly sensitive detection of bacterial DNA using a surface-enhanced Raman spectroscopy (SERS) with 5,5’-dithio-bis(2-nitrobenzoic acid) (DTNB)-modified gold nanoparticles as reporter probes. Capture probe was immobilized onto the surface of streptavidin-enwrapped magnetic beads ( SA-MB ) through high affinity between biotin and avidin, by which the target bacterial DNA sequences that connected with the reported probe decorated AuNPs with DTNB and SH-DNA ( AuNPs@DTNB@DNA) were captured and loaded onto the magnetic beads by the hybridization reaction with the capture probe. Compared with previous methods, this design shortened the distance between particles by the ways that the magnetic beads tempted to nanoparticles aggregation, and produced the plasma resonance coupling effect, which increased the SERS signal significantly. The results showed that, under the optimized conditions and in the concentration range from 5 pmol/L to 5 nmol/L, the method performed a good linear relationship between Raman intensity and DNA concentration. The limit of detection ( LOD) of bacterial DNA was estimated to be 5 pmol/L. The method is simple and low cost, and can be used in the sensitive and selective detection of bacterial DNA.