The expansion of high-containment bio-defense laboratory in USA is introduced in such aspects as the increase of laboratory magnitude,amplification of laboratory area and the funding growth of the United States National Institutes of Health(NIH).In addition,a series of problems caused by the expansion are analyzed in the perspective of the biosafety training,information exchange of laboratory and public participation.

Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma.Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma.Based on the fluid resuscitation strategies,63 patients were treated with aggressive fluid resuscitation (AFR),and 61 with limited fluid resuscitation (LFR).A restrictive rehydration principle was performed with intensive hemodynamic monitoring:mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2O for 48 hours in LFR group; mean arterial pressure was kept in basic level and central venous pressure between 8-12 cmH2O in AFR group.No significant differences were shown in the rest of treatments.Parameters were compared between groups such as blood pressure,shock index,coagulation function,imaging data,GCS,and GOS at 6 months postinjury.Results Between-group differences were insignificant with regard to mean arterial pressure (MAP),shock indices,ISS,trauma severity indices (TSI),and GCS (P ＞0.05).Blood pressure fluctuation in LFR group was (18.5 ±9.9) mmHg vs (29.4 ± 11.1) mmHg in AFR group (P ＜ 0.01).Eight patients developed intracranial hemorrhage progression in LFR group,with 3 being treated with craniotomy.In comparison,19 patients developed intracranial hemmorrhage progression in AFR group,with 10 being treated with craniotomy (P ＜ 0.01).Improvement in coagulation disorders was better in LFR group than in AFR group.On days 7 after admission,GCS in LFR groups was (9.1 ± 3.6) points vs (7.2 ± 2.3) points in AFR group (P ＜0.05).At 6-month follow-up,results were 34 good and 27 poor in LFR group,better than 23 good and 40 poor in AFR group.Conclusion For moderate to severe craniocerebral injury combined with multiple trauma,LFR is effective to treat coagulation disorders and hemorrhagic shock,reduce the probability of delayed intracranial hemorrhage,and further improve the outcome.

Tic disorders (TD) is a kind of neuropsychiatric disorders developing during childhood and cha-racterized by tics.In August 2020, the TD Consortium Neurology Group of Chinese Pediatric Society, Chinese Medical Association has developed an English version of Expert Consensus on Diagnosis and Treatment of Tic disorders in children to help improve the diagnosis, treatment and long-term management of TD, as well as international communication.Now the consensus is interpreted as follows, including its pathophysiology, clinical characteristics, diagnosis, comorbidity, treatment and prognosis.

Objective To investigate the association between the presence of cerebral microbleeds and chronic kidney disease in patients with ischemic stroke.Methods Patients with ischemic stroke within 1-6 months were consecutively recruited.Cranial MRI was taken within two weeks after recruitment.Cerebral microbleeds were assessed using Microbleed Anatomical Rating Scale on gradient echo MRI.Demographics including sex,age and risk factors were obtained.Chronic kidney disease was defined and classified according to National Kidney Fundation-Kidney Disease Outcome Quality Initiative Guideline.Glomerular filtration rate (GFR) was estimated by using the abbreviated Modification of Diet in Renal Disease equation.Results Of the 636 patients included,mean age was (59.8 ± 10.1) years,435 (68.4％) were male.Sixty-six had decreased estimated GFR (eGFR; ＜ 60 ml · min-1 · 1.73 m-2).Two hundred and one (31.6％) patients had cerebral microbleeds,which were most commonly located in deep or infratentorial location (133/201,66.2％).The presence of cerebral microbleeds was much higher in patients with decreased eGFR than the others (48.5％ (32/66) vs 29.6％ (169/570),x2 =9.709,P =0.002).Age,history of hypertension and decreased eGFR were associated with the presence of cerebral microbleeds in univariate analysis.In multivariate analysis,decreased eGFR was independently associated with the presence of cerebral microbleeds in deep or infratentorial location (OR =1.457,95％ CI 1.044-2.034,P =0.027),but not associated with the presence of cerebral microbleeds in pure lobe.Conclusion Impaired kidney function is associated with the presence of cerebral microbleeds in deep or infratentorial regions in patients with ischemic stroke.

Objective To explore the outcomes of the oncology, the fertility and pregnancy on patients with early-stage cervical cancer after undergoing fertility-sparing treatments, and to investigate its value on clinical treatment. Methods A total of 29 patients with cervical cancer (stage Ⅰa2-Ⅰb1) who had undergone the fertility-sparing treatments in Renji Hospital, School of Medicine, Shanghai Jiaotong University from February 2010 to September 2015 were analyzed retrospectively. Surgical procedures included transvaginal cervical cold knife conization (CKC)+laparoscopic pelvic lymphadenectomy (PLD) or total laparoscopic uterine cervix extensive resection (RT; contains PLD); 48 patients with early cervical cancer under going laparoscopic uterine extensive resection (RH; contains PLD) by the same group of physicians in the same period were chosen as the control group. The perioperative related indicators, postoperative specimen examination, pregnancies after surgery and postoperative tumor follow-up results were retrospectively analyzed and compared between the two groups. Results (1) Among these 29 patients in the study group, 26 cases were underwent the fertility-sparing surgery quick frozen pathological examinations were positive in 3 cases, which underwent total laparoscopic RT eventually. (2) The perioperative related indicators: compared with the study group and the control group, the operation time [(182 ± 21), (147 ± 24) minutes, respectively] has significant difference (t=6.563, P<0.01). There were no significant difference (P>0.05) in intra-operative blood loss [(102±26), (99±34) ml], postoperative aerofluxus time [(1.3±0.4), (1.1±0.9) days], the average length of hospital stay [(11.2 ± 2.1), (10.6 ± 3.5) days], rate of urine retention [10%(3/29), 10%(5/48)] and rate of postoperative infection [3%(1/29), 2%(1/48)]. (3)Postoperative specimen examination:compared with the study group and the control group, there were no significant difference (P>0.05) innumber of removed lymphatic nodes (23.4 ± 4.1, 22.8 ± 3.9), length of cardinal ligament [(2.9 ± 0.5), (3.0 ± 0.6) cm], lengthof uterosacral ligament [(2.6±0.7), (2.8±0.4) cm], length of removed vaginal [(3.4±0.3), (3.5±0.3) cm]. (4) Pregnancies after surgery and postoperative tumor follow-up results:in the study group, only 14 patients had fertility requirement after treatments. Pregnancies occurred in 5 women (5/14), which included1 case of full-term labor, 1 case of preterm labor, and 3 cases of spontaneous abortion. The Average follow-up time in postoperative patients of the study group and control group was 29.4, and 30.2 months respectively. In follow-up period, compare with study group and the control group, there was no significant difference (χ2=0.004, P>0.05) in the recurrence rate [4%(1/26), 4%(2/48)]. Conclusion Fertility-sparing surgery of early-stage cervical cancer is safe but the outcome of the fertility and pregnancy is still need toimprove.

Objective To investigate the incidence and risk factors of cerebral microbleeds(CMB) in ischemic stroke patients.Methods Patients with cerebral infarction for 1～6 months were recruited.Clinical data were recorded.MRI was reviewed blindly to determine the number of CMB and lacunar infarcts and the white matter lesions(WML).The independent risk factors of CMB were analyzed with the Logistic multivariable regression.Results 636 subjects were included.CMB were found in 250 cases(39.3%).The incidence of CMB in patients of ≤50,50～65 and >65 years old were 27.2%,38.1% and 47.6% respectively(P<0.05).CMB was more frequent in patients with more lacunar infarcts(P<0.05).The incidence of CMB in patients with negative,mild,moderate and severe WML were 21.9%,33.8%,46.9%and 63.1% respectively(P<0.05).Logistic regression analysis showed that history of hypertension(OR=1.523,95% CI 1.019～2.276),severity of WML(OR=1.535,95% CI 1.258～1.874) and lacunar infarcts(OR=1.517,95% CI 1.087～2.118) were the independent risk factors for presence of CMB.Conclusion CMB was frequent in ischemic stroke.The frequency of CMB increased with aging,grade of lacunar infarcts and WML.History of hypertension,severity of WML and lacunar infarcts were the independent risk factors for CMB presence.

Objective To assess the feasibility of a novel 99Tcm labelled polypeptide analogue for interleukin-11 receptor ( IL11R) imaging in a bone metastases model for prostate cancer. Methods A novel circular polypeptide analogue of IL11 ( c( CGRRAGGSC ) ) was indirectly labeled with 99Tcm and the product was named as 99Tcm-DTPA-IL11 RR. The labeling efficiency, radiochemical purity and stability of the product were measured with paper chromatography and high performance liquid chromatography (HPLC). The biodistribution of 99Tcm-DTPA-IL11RR was investigated in 28 ICR normal mice. The organ radioactivity was measured as percentage activity of injection dose per gram of tissue ( %ID/g). The models of bone metastases from prostate cancer were established at the tibias of BALB/c nude mice bearing human prostate cancer PC-3 cells. The tumor bearing ( n= 5 ) and standard closed fracture nude mice models underwent both 99Tcm-DTPA-IL11RR and 99Tcm-methylene diphosphonate (MDP) scintigraphy study. The images were acquired at 0.5, 1,2, 4, 6, 8, 24 h after intravenous injection of the tracers. The competitive inhibition imaging was perfomed in three tumor bearing mice. One-way variance analysis was used. Results The labeling efficiency was 90.7%. The radiochemical purity of 99Tcm-DTPA-IL11RR in normal saline solution was (99.57 ±0.09)%, (99.29 ±0.18)%, (98.95 ±0.78)%, (98.67 ±0.11)%, (96.53 ±0.91)%, (95.20±0.70)%, (88.38 ±0.22)% and (36.17±1.29)% at room temperature after0, 1,2, 3, 4, 6, 8 and 24 h, respectively. The tracer radiochemical purity in the blood of ICR mice remained over 90% at 37 C for 6 h. The labeling compounds were excreted mainly through kidney. The peak uptake of bone ( ( 1.910 ±0.109) %ID/g) and liver ( (0.366 ±0.030) %ID/g) was at 4 h after injection. In the tumor bearing mice, the uptake of spine marrow and large joints of extremities was mild. The highest uptake at tumor region was at 4 h and persistent at 6-8 h after injection. The tumor to non-tumor ratios (T/NT) were 1.17 ±0.17, 2.20 ±0.29, 3.20 ±0.15, 3.67 ±0.23, 13.61±0.85, 9.45 ±0.37 and 3.33 ±0.30 at 0.5,1, 2, 4, 6, 8 and 24 h, respectively (F=621.54, P＜0.05). In the standard closed fracture models,high uptake of 99Tcm-MDP was shown at the fracture site, with no increased 99Tcm-DTPA-IL11RR uptake noted. The tumor uptake was significantly depressed after a pre-injection of the unlabeled polypeptide analogue. Conclusions The synthesis of 99Tcm-DTPA-IL11RR is stable and the labeling efficiency is high. It may be a potential molecular probe in metastatic bone imaging for prostate cancer.

The microstructure of cationic cyclopeptide (TD-34) treated Caco-2 cell membrane was observed, and we discussed the relationship between membrane structure and insulin transmembrane permeability. Atomic force microscope (AFM) was used to observe living cell membrane in air condition and tapping mode. Results showed that the surface of Caco-2 cell membrane treated with TD-34 lost its smoothness and nearly doubled its roughness. Apparent permeability coefficients (P(app)) of insulin in Caco-2 cell monolayers increased 2.5 times. In conclusion, AFM can be used to observe microstructure of cationic cyclopeptide treated cell membrane and cationic cyclopeptide enhanced insulin delivery across Caco-2 cell membrane by increasing membrane fluidity.

Objective To study normal flora components of conjunctiva, explore the relationship between normal flora and ocu- lar bacterial infections.Methods The data of 1 198 bacterial cultures of conjunctiva in non-infectious cataract patients were re- viewed and compared with the results of 985 specimens of conjunctivitis, keratitis and endophthalmitis from January 2000 to December 2004.Results Positive culture of conjunctiva in non-infectious cataract patients was 628 in 1 198 specimens (52.4%).These bacteria including gram-positive cocci and gram-neganve bacilli constituted the normal flora of conjunctiva. Staphylococcus epidermidis was the predominant bacteria (51.1%, 341/667) and its prevalence increased during this 5-year period.S.epidermidis and S.aureus were also the most frequently isolated pathogens in specimens of conjunctivitis, keratitis and endophthalmitis.The correlation was statistically significant between the positive rate in normal eye and conjunctivitis or keratitis in terms of these two species, but not statistically significant between normal eye and endophthalmitis.The resistance rate of normal flora of conjunctiva to ampicillin, amikacin, tobramycin, ciprofloxacin, and ofloxacin increased year by year. The resistance rate to gentamicin and the combination of two drugs decreased.The changing resistant pattern was similar in pa- tients with eye infection.Conclusions There is a close relationship between the normal flora S.aureus and S.epidermidis of conjunctiva and the bacterial infection of ocular surface, but no significant correlation between normal flora and the pathogen of endophthalmitis.

Objective To provide an effective theoretical basis for future selection and recruitment of military flying cadets.Methods Two hundred military qualified flying cadets by comprehensive assessment samples and 200 military flying cadets by medical fitness samples were interviewed with questionnaires and subjected to a physical examination.The comprehensive assessment samples were classified by symptoms and attributive specialties for statistical analysis.A database was established, cleaned and analyzed by EpiData 3.02, SPSS 16.0 with double checking.Results There was no differ-ence between the comprehensive assessment team and the medical fitness team in age, areas, academic scores and psycho-logical performance.The ten top symptoms according to the comprehensive assessment were abnormal chest circumference, abnormal body mass,iris cyst,abnormal hypersplenotrophy,gallbladder polyps,flat foot,skin disease, intrahepatic calcifica-tion focus, joint disease and reproductive system disease.The attributed specialties included surgery, ultrasonics, ophthal-mology,ENT,radiology, ECG and internal medicine departments.The surgery and ultrasonics department contributed the most from the comprehensive assessment and accounted for 55.52%and 16.37%, respectively.Conclusion The compre-hensive assessment for military flying cadets has an important effect on military aviator selection.Continuous observation should be carried out among the military flying cadets by comprehensive assessment in their aviation training.