Objective To investigate the adjuvant effect of intravenous immunoglobulin on patients with sepsis-associated thrombocytopenia. Methods A total of 229 patients with sepsis with platelet count less than 3 × 109/L, were included in this prospective, randomized, controlled study. The patients were divided into the intervening group and the control group. Conventional treatments were applied in the two both groups , while in the intervening group, intravenous immunoglobulin with a dose of 0.4 g/(kg·d) for 5 consecutive days was administered. The end-points were the platelet counts on day 1,day 3,day 5,and day 7 post-intravenous immunoglobulin, patients’ in-ICU time and the 28-day in-hospital mortality. Results Compared with the control group, the platelet count recovered dramatically after 5-day intravenous immunoglobulin in the intervening group. Moreover , the 28-day in-hospital mortality and in-ICU time were also dramatically improved in the intervening group. Conclusion Intravenous immunoglobulin can enhance the recovery of platelet counts , shorten the in-ICU time and reduce the hospital mortality in patients with sepsis- associated thrombocytopenia (PLT count < 30 × 109/L).

Objective To investigate the effect of continuous venous-venous hemofiltration (CVVH) and continuous venous-venous hemodialysis (CVVHD) on patients with lactic acidosis.Methods A total of 137 cases with lactic acidosis were included in this prospective randomized control study.lhe patients were collected from the University of Hong Kong-shenzhen Hospitall and the First Affiliated Hospital of Shantou University Medical College from April 2009 to April 2013.Inclusion criteria were patients with lactic acidosis.Exclusion criteria were patients with end-stage malignancy or terminal stage of illnesses.The patients were randomly divided into two groups:CVVH group and CVVHD group,and patients of both group were intervened with conventional treatments as well.For each group,the lactic acid and blood gas analysis were tested before CRRT,and at 4 hours,8 hours,12 hours,24 hours,and 48 hours of CRRT.The patients' mortality and length of ICU stay time were analysed and recorded.Statistical analysis was performed using SPSS 15.0software.Results When the length of time for treatment was the same,the efficacy between CVVH group and CVVHD group showed no difference in blood lactic acid level [4 h:(11.65 ± 3.39) mmol/L vs.(11.12±2.65) mmol/L; 8 h:(8.78±2.35) mmol/L vs.(8.59±2.09) mmol/L; 12 h:(6.91 ±1.67)mmol/Lvs.(6.74±1.76) mmol/L;24h:(1.66±0.39) mmol/Lvs.(1.51±0.30) mmol/L; 48 h:(0.95 ±0.24) mmol/L vs.(0.66 ±0.20) mmol/L,P ＞ 0.05) and pH value [4 h:(6.93 ±0.14) vs.(7.05±0.09);8h:(7.04±0.10)vs.(7.12±0.05); 12h:(7.13±0.07)vs.(7.20±0.04);24h:(7.30±0.03) vs.(7.38±0.04); 48h:(7.41 ±0.03) vs.(7.46±0.02),P＞ 0.05].There are also no difference in the hospital mortality (11.4％ vs.10.4％,P=0.854) and length ofICU stay time [(9.5 ±2.4) d vs.(8.8 ± 2.9) d,P =0.329].Conclusions Both CVVH and CVVHD can effectively correct hyperlactemia,enhance acid-base balance,contributing no differences in length of ICU stay time and patients' hospital mortality.

Objective To explore the current status of humanistic care among medical students in clinical practice in obstetrics and gynecology department and its related influencing factors and to propose the corresponding countermeasures.Methods Scale of humanistic care quality was used in the survey for clinical practice students in obstetrics and gynecology department.ResultsThe total score rate of human care quality of medical students before clinical teaching were (84.12 ± 9.24)with a scoring rate of 72％.Significant differences were observed in the medical students with different medical professional(P ＜0.05).The total score of humanistic care quality of medical students after clinical teaching were (96.41 ± 1 1.53 ),significant higher than that of before training ( P ＜ 0.05 ).ConclusionHumanistic care quality in medical students needs to be strengthen.Clinical training in obstetrics and gynecology department combined with humanities education has important practical significance to improve the quality of medical students.

Objective To define individualized internal target volume (ITV) for hepatocellular car-cinoma using four-dimensional (4D) CT, and to compare the differences in target volume definition and dose distribution among 3D, 4D and respiratory-gated plans. Methods 4DCT scanning was obtained for 12 pa-tients with hepatoceUular. Gross tumor volume (GTV), clnical target volume (CTV) and normal tissues were contoured on all 10 respiratory phases of 4DCT images. The 3D, 4D and gated treatment plans were prepared for each patient using three different planning target volumes (PTVs): 1) PTV3D was derived from a single CTV plus conventional margins;2) PTV4D was derived from ITV4D, which encompassed all 10 CTVs plus setup margins (SMs);3) PTV_(Gating) was derived from ITV_(Gating), which encompassed 3 CTVs within ga-ting-window at end-expiration plus SMs. The PTV volume and dose distribution were compared among differ-ent plans. Results The PTV3D was the largest in all 12 patients, but still missed partial target volume in 5 patients when comparing with PTV4D. Both the 4D plans and the gated plans spared more normal tissues than the 3D plans, especially the hver. Without increasing normal tissue dose, the 4D plans allowed for increas-ing the calculated dose from (50.8±2.0) Gy (3D plans) to (54.7±3.3) Gy, and the gated plans could further increase the dose to (58.0±3.9) Gy. Conclusions The 4DCT-based plans can ensure optimal tar-get coverage with less irradiation of normal tissues and allow dose escalation when compared with 3D plans.Respiratory gated radiotherapy can further reduce the target volumes to spare more surrounding tissues, espe-cially for patients with large extent of respiratory mobility.

Objective To explore the effect and safety of the operationive treatment of calculus incarceration in neck of gallbladder.Methods We analyzed retrospectively the clinical data of 26 cases with calculus in carceration In neck of Gallbladder.Results All 26 cases patients were found to have serious cholecystitis and unclear anatomic site in Calot's trangle.Six patients'operative way had to transform from laparoscopiccholecystectomy to cholecystectomy.Endogenous membrane of gallbladder were excised retrogradely in the operation.In operative process,there were no injury in extrahepatic bile duct,intestinal canal and vascular.The all patients were recovery and discharge after operation.Conclusion It is one kind of good choice to open the gallbladder,aspirate the bile and extract the stones.And then performing endogenous membrane retrograde cholecystectomy.For treatment of the Calot's trangle areas,blunt dissection may used.It is dangerous that using sharp dissection and electrosurgical knife.

A new species of genus shewarella Shewanellade decolorations S12, was isolated from activated sludge of a textile-printing waste-water treatment plant. In the anaerobic condition, S12 could conserve energy for growth by using Fe3 + as the terminal electron acceptor. At the optimal condition of pH8, temperature 30℃, ferric citrate 800mg/L, sodium lactate 2g/ L, yeast extract 0. 5g/ L , the cell growth increased with the raise of the amount of the Fe3+ reduction in 8k The effect of different carbon soucres, nitrogen sources, pH values and growth temperatures on the anaerobic Fe3 + reduction of Shewanella decolorations S12 was investigated. LB was favorable for Fe3 + reduction. Glucose and sodium lactate also were favorable for Fe3+ reduction. The cell growth and Fe3 + reduction increased with the raise of the amount of the yeast extract from 0 to 4g/L The amounts of the sodium lactate of 6g/ L and ferric citrate of 800mg/L were suitable for strain S12 growth and Fe3+ reduction. In the optimum initial pH value range of 6 -8 for Fe3+ reduction, strain S12 growth increased with the raise of the pH val- ue. Strain S12 could growth and reduce Fe3+ at the temperature range of 20 -40℃. The best temperature for strain S12 growth and Fe3 + reduction was 301.

OBJECTIVETo evaluate the detective efficacy of Chromogenic Coliform and Escherichia Coli Agar (CCEA).

METHODSA new chromogenic medium CCEA prepared by Huankai laboratory was used to compare with a classical medium of violet red bile agar (VRBA), and other two Chromogenic media Agar I and Agar II by detecting separately 11 reference strains, thirteen sterile samples with Coliform or E.coli and other four samples, and the accordant rates of detection were observed.

RESULTSCCEA had the good selectivity. To seven kinds of quality strains in the resultant analysis, CCEA with VRBA and Agar I had not shown salience difference (P > 0.05), and CCEA with Agar II had significant difference (P < 0.05). CCEA showed more advantages than the Agar II. To thirteen sterile samples with Coliform or E.coli in resultant analysis, CCEA with Agar I and Agar II had shown no significant difference (P > 0.05), while CCEA with VRBA had significant difference (P < 0.05). CCEA might be more advantageous than the VRBA. In analysis of the four actual samples of Coliform, CCEA with VRBA, Agar I and Agar II showed no significant difference (P > 0.05). The accordant rates were 90%, 71.88%, 86.25% and 81.25% respectively, showing CCEA > Agar I > Agar II > VRBA. To two actual samples of E.coli in the resultant analysis, the CCEA with Agar I and Agar II had not shown significant difference (P > 0.05). The accordant rates were 100% respectively.

CONCLUSIONSThe CCEA might be more advantageous than the VRBA, having the same efficacy as with Agar I and Agar II.

Bacteriological Techniques ; Culture Media ; Enterobacteriaceae ; isolation & purification ; Escherichia coli ; isolation & purification

OBJECTIVETo study the correlation of polymorphisms of CYP1A1 MSPI and glutathiones S-transferase (GST-M1) independently and in combination with the risk of lung cancer.

METHODSA case control study which included 91 cases of lung cancer and 138 controls collected from the First Affiliated Hospital of Sun Yat-sen University of Medical Sciences, Guangzhou Tumor Hospital and The Red Cross Hospital of Guangzhou or conmunity area. All subjects were investigated with a uniform questionnaire. Blood samples were collected from all cases and controls for detecting CYP1A1 MSPI and GST-M1 polymorphisms which were analyzed by PCR and RFLP.

RESULTSIt showed that there was no significant difference in frequencies of this genotypes of CYP1A1 MSPI between the two groups. The frequency of GST-M1 null (0/0) genotype was higher in the case group than in the control group, with an OR of 1.38 (95% CI 0.81 - 2.38), but there was no statistical significance. However, combination of several genotypes was strongly associated with lung cancer. There was a synergistic interaction between the m2m2 genotype of CYP1A1 MSPI and GST-M1 (0/0) genotype, with an OR of 2.47 (95% CI 1.03 - 5.90).

CONCLUSIONThe combination of two genetic polymorphisms significantly increases the risk of lung cancer.

Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cytochrome P-450 CYP1A1 ; genetics ; Female ; Genotype ; Glutathione Transferase ; genetics ; Humans ; Lung Neoplasms ; etiology ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic ; Risk ; Smoking ; adverse effects

【Objective】To investigate whether bone marrow mesenchymal stem cells（BMSC）over-expressing FoxM1genecanattenuatelipopolysaccharide（LPS）-inducedapoptosisofalveolarepithelialcells，andexploreitspossi⁃ blemechanism.【Methods】SDratBMSCwereisolatedandculturedbywholebonemarrowadherencemethod.FoxM1 genewasoverexpressedinBMSCbylentiviraltransfection.TheexpressionofthetargetgeneFoxM1wasverifiedbyWestern blot.ApoptosisofA549cellswasmeasuredbyTUNELandflowcytometry.Andthemulti-factorlevelofsupernatantin BMSC-A549co-culturesystemwasdetectedbyMilliplexmethod.【Results】TUNELandflowcytometryconfirmedthat theapoptosisrateofA549inducedbyLPSdecreasedafterco-culturewithBMSCoverexpressingFoxM1，andthediffer⁃ encewasstatisticallysignificant（P <0.05）.MilliplexassayshowedthatthelevelsofIL-13，IL-21，IL-23，MIP-1a， MIP-1bandinBMSCoverexpressing FoxM1 geneandA549co-culturesystemweresignificantlyincreased，whilethe MIP-3alevelissignificantlyreduced.【Conclusion】BMSCoverexpressingFoxM1genecanattenuateLPS-inducedapop⁃ tosisofalveolarepithelialcells.BMSCmayplayananti-apoptoticrolebychangingthelevelsofinflammation-related cytokinesreleasedbyA549cells.

OBJECTIVESTo evaluate the value of the metastatic to examined lymph nodes (rN) ratio in gastric cancer patients who underwent radical resection.

METHODSIn this retrospective study, data were collected from the medical records of 710 patients who underwent radical gastrectomy (R0) for gastric cancer from 1980 to 2006 in the Department of Surgical Oncology at the First Affiliated Hospital of China Medical University. The patients were divided into 2 groups according to the number of examined lymph nodes: Group 1 consisted of 327 patients with <15 examined lymph nodes and Group 2 consisted of 383 patients with ≥15 lymph nodes. rN categories staging and pN categories were divided separately according to the metastatic lymph node ratio and the examined lymph nodes. The prognostic factors were analyzed by univariate (Log-rank) and multivariate (Cox model) analysis methods.

RESULTSThe median survival time was 74 months (95% CI:55.6-92.4 months) in Group 1 and 96 months (95% CI:77.8-119.2 months) in Group 2, and the difference was not statistically significant (P>0.05). On multivariate analysis, the N ratio remained as an independent prognostic factor in both Group 1 (P<0.01, RR=1.225, 95% CI:1.102-1.362) and Group 2 (P<0.01, RR=1.421, 95% CI:1.269-1.592). However, pN stage was an independent prognostic factor only in Group 1. When the rN ratio classification was applied, there were no significant differences between each categories (P>0.05). However, the overall survival of patients with pN1 disease in Group 1 was significantly shorter than that in Group 2 according to the pN stage classification (P<0.01).

CONCLUSIONSThe metastatic lymph node ratio is an independent prognostic factor of the prognosis of gastric cancer. The staging system based on metastatic lymph node ratio (rN) is more reliable than the system based on the number of metastatic lymph nodes in the prediction of the prognosis of gastric cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; surgery