Objective:To search for a prophetic marker reflecting the progress of acute respiratory distress syndrome (ARDS).Methods:The serum was obtained from normal controls and patients at difierent stages of ARDS:systemic inflammatory response syndrome (SIRS),acute lung injury(ALI),ARDS and just before dying.Clara cell secretory protein (CC16) in serum was detected using enzyme-linked immunoadsordent assay (ELISA).Results:In the early stage of inflammatory reaction,that is,stage of SIRS,the CC16 levels in serum were higher than normal controls ( P 0.01).Conclusion:The determination of CC16 in serum is a sensitive marker reflecting the integrity of alveolar epithelium and vascular endothelial cell.The alteration of CC16 is presented in the early period of acute inflammatory reaction.The alteration of CC16 is earlier than that of blood gas analysis.CC16 may serve as a helpful marker to foresee and evaluate prognosis of ARDS in early stage.

Objective:To explore the clinical value of detection of sulfated glycosaminoglycan(GAG) segment and IgG antibody to tuberculosis(TB-IgG) to diagnose tuberculous pleuritis and malignant pleural effusion.Methods:Using the lung tumor antigen(LTA) diagnostic kit and tuberculosis antibody colloidal gold diagnostic kit to detecte the GAG and TB-IgG of serum and pleural fluid separately of 357 patients suffering from hydrothorax.We proceeded a retrospective study and then had statistical evidence.Results:The positive rate and specificity of GAG of pleural effusion of lung cancer patients were 80.3%(106/132),88.4%,and that of serum were 54.5%(72/132),90.2%.The positive rate and specificity of TB-IgG of pleural effusion of tuberculous pleuritis were 66.2%(102/154),86.2%,and that of serum were 33.8%(52/154),83.7%.The specificity of GAG,combined with TB-IgG by measuring the pleural fluid of tuberculous pleuritis and malignant pleural effusion would increase to 97.0% and 98.2% separately.Conclusion:Detection of GAG and TB-IgG of pleural fluid is helpul for diagnosis of tuberculous pleuritis and malignant pleural effusion.GAG combined with TB-IgG can act as differential diagnosis marker of tuberculous pleuritis and malignant pleural effusion for its higher specificity.

Objective:To investigate the production of IL-10 and IL-12 by alveolar marcrophage and peripheral blood mononuclear cell from lung cancer patients,to evaluate the cellular immune state,and to provide justification for IL-12 therapy in the fields of Lung cancer.Methods:AM and PBMC were obtained from 57 patients with Lung cancer,33 patients with benign pulmonary disease,and 12 normal control.IL-10 and IL-12 in the culture supernatants were measured quantitatively by ELISA.Results:(1) Higher levels of IL-10 were found in Lung cancer group than that in NC and BPD group.IL-12 showed significantly lower levels than that in NC and BPD group.(2) The levels of IL-10 had negative correlation with that of IL-12 in Lung cancer group.(3) The levels of IL-10 in Lung cancer group of stage Ⅲ,Ⅳ were significantly higher than that of stage Ⅰ～Ⅱ.The levels of IL-12 in Lung cancer group of stage Ⅳ were significantly lower than that of stage Ⅰ～Ⅱ.(4) Higher levels of IL-10 were found in SCLC group than that in NSCLC group.The levels of IL-12 from PBMC and AM in SCLC group were lower than that in adenocarcinoma,adenocarcinoma and squamous carcinoma groups separately.Conclusion:(1) results suggest the defect of cell-mediated immunity function presents both in local and general immune response in Lung cancer patients.(2)The basal levels of IL-10 and IL-12 are related to the stage and extent of malignancy.

Objective:To explore the expression of pressure-sensitive transient receptor potential channel (TRPC1)in bronchial epithelium cells of the patients with chronic obstructive pulmonary disease (COPD),and to explain the molecular mechanism about the participation of TRPC1 in airway remodeling.Methods:Sixty-four patients who needed fiberoptic bronchoscope for diagnosis were selected. All the patients were used as non-operation group and divided into COPD group (40 cases of mild to moderate grade)and control group (24 cases without chronic airway inflammatory disease)according to Respiratory Disease Guideline. The level of the forced expiatory volume/forced vital capacity (FEV1/FVC)in the first second and forced expiatory volume in the first second of the expected value (FEV1%pred)were detected by lung function test.The expression levels of TRPC1, matrix metalloproteinase (MMP-9)and transforming growth factor-β1 (TGF-β1 )in bronchoalveolar liquid (BALF) were measured by ELISA. The relevance among expression level of TRPC1 and levels of FEV1/FVC, FEV1%pred,MMP-9,TGF-β1 was analyzed.Seventeen lung samples from the patients underwent pulmonary lobectomy were selected.All the patients were used as operation group and divided into COPD group (8 cases of mild to moderate grade ) and control group (9 cases without chronic airway inflammatory disease ). Then indictator relevance to airway remodeling,such as thickness-diameter ratio (TDR%),percentage of wall thickness (WA%) were measured.The immunohistochemistry experiment was used to detect the distribution characteristics of TRPC1 protein in human bronchial epithelial cells. The Imagepro-plus 6.0 software was used to analyze the expression difference of TRPC1 protein between COPD and control groups. Western blotting method was used to detect the expression level of TRPC1 . The correlation between the expression level of TRPC1 and TDR%, WA% was analyzed.Results:The lung function detection results showed that in non-operation group,the levels of FEV1%pred and FEV1/FVC in COPD group were decreased compared with control group (P<0.05).The expression levels of TRPC1,MMP-9 and TGF-β1 in COPD group were increased compared with control group (P<0.05). The expression level of TRPC1 was negatively correlated with FEV1%pred (r= -0.34,P=0.002)and FEV1/FVC (r= -0.38,P=0.004).The expression level of TRPC1 was positively correlated with MMP-9 (r=0.36, P=0.004)and TGF-β1 (r=0.61,P=0.002).The immunohistochemistry results in operation group displayed that the TRPC1 protein was mainly distributed in the epithelial columnar cell nucleus and the cell membrane near lumen within the bronchial epithelium.The ratio of integrated optical density (IOD)to area within the bronchial epithelium in COPD group was significantly higher than that in control group (P<0.05).The expression level of TRPC1 protein detected by Western blotting method in COPD group was higher than that in control group (P<0.05).The expression level of TRPC1 was positively correlated with TDR% (r=0.59,P=0.002)and WA%(r=0.60,P=0.002).Conclusion:The TRPC1 channel in human bronchial epithelial cells of COPD patients is actived and up-regulated.The expression level of TRPC1 channel is positively correlated with impared extent of lung function and the expression levels of cytokines relevant to airway remodeling. All above imply that pressure-sensitive TRPC1 channel could promote the development of airway remodeling.

Objective To explore the relationship between different airway pressure and expression of related cytokines to airway remodeling.Methods Fourty-two chronic obstructive pulmonary disease cases (COPD group) and thirty-three control cases were collected.The above cases underwent mechanical ventilation in the period of general anesthesia.According to different levels of peak inspiratory pressure(PIP), above two groups, randomly and respectively, were divided into high PIP (HPIP, 24 cmH2O) group, moderate PIP (MPIP, 22 cmH2O) group, low PIP (LPIP, 20 cmH2O) group.All positive end expiratory pressure (PEEP) was set to 5 cmH2O.Then the collection of BALF was performed before and 3 hours after applying ventilator.The related factors to airway remodeling, such as fibroblast growth factor 2 (FGF-2), transforming growth factor β1 (TGF-β1) and matrix metalloproteinase-9 (MMP-9), were measured by enzyme-linked immunosorbent assay (ELISA) and Western blot.Results 1)Beforemechanical ventilation, the levels of FGF-2, TGF-β1 and MMP-9 in COPD group were higher than control group (P<0.01).2)3 hours after mechanical ventilation, we saw significant upregulated expression of FGF-2, TGF-β1, MMP-9 in HPIP subgroup in control group (P<0.05) and the 3 factors levels of COPD group were all increased (P<0.05).Moreover, HPIP subgroup was significantly higher than MPIP and LPIP subgroup in COPD group (P<0.05).3)The expression of FGF-2, TGF-β1, MMP-9 in BALF had a positive correlation with the airway pressure levels in COPD group(P<0.01).Conclusions Under mechanical ventilation, sustained high airway pressure may enhance the expression of FGF-2, TGF-β1 and MMP-9 which may result in airway remodeling by mechanosensitive cation channel in bronchial epithelial cells, especially in COPD patients.

With the development of internationalization of medical education,teaching specialty in English has been a new task for many general medical colleges and universities.Many problems need to be analyzed and solved.In the process of teaching international students diagnostics,teaching mode has been actively explored.The management of teaching,the foundation of teaching team,the selection of teaching materials and reformation of teaching mode are the key points that affect the teaching quality directly.

Objective To provide a good anatomical foundation for transposition of the branch of median nerve superficial flexor muscle repairing the movement branch of ulnar nerve to recover the function of intrinsic muscle, by anatomic study of the muscle branch of the superficial flexor muscle of the median nerve and the movement branch of ulnar nerve. Methods Twenty adult upper limb specimens immersed fixed by formalin were elected and expose the midian nerve and ulnar nerve. Then every anatomical index was measured. Simulate to manipulate that the branch of superficial flexor muscle repair the motor b ranch of ulnar nerve. Calculate the number of myelinated nerve fibers of the branch of superficial flexor muscle. Results The distance between the position into muscle and styloid process of radius and styloid process of ulna: (21.4±1.8)mm, the distance that can be separated: (27.1±1.2)mm, the transverse diameter: (1.2±0.2)mm, anteroposterior diameter: (0.7 ± 0.1 )mm. No injury separated distance between the sensory branch and motor branch of ulnar nerve: (7.1 ± 0.7)cm. The 4th muscular branches of median nerve flexor digitorum superficialis was 1378.9± 107.9. Conclusion The 4th muscular branches of median nerve flexor digitorum superficialis can be used to repair the motor branch of the ulnar nerve to recover the function of intrinsic muscle of hand.

Objective : To understand the current situation and influencing factors of occupational burnout among vaccination personnels in Haining. Methods : The vaccination staffs of all vaccination clinics in Haining were investigated by the general questionnaire and Maslach Burnout Inventory. Logistic regression model was used to analyze the influencing factors for job burnout of vaccination personnels. Results : A total of 160 questionnaires were distributed and 158 valid questionnaires were collected. The effective rate of questionnaires was 98.75%. A total of 91 vaccination staffs suffered from occupational burnout,accounting for 57.59%. Among them,the median（inter-quartile range）of the scores of emotional exhaustion,depersonalization and personal achievement were 13.00（14.00）,4.00（6.00）and 26.50（17.00）,respectively,which were all lower than the normalized scores（22.19,7.12 and 36.53,P<0.05）. The results of logistic regression analysis showed that having confidence in vaccination was a protective factor for emotional failure（OR=0.175,95%CI：0.058-0.523）and low sense of achievement（OR=0.272,95%CI：0.079-0.937）in vaccination personnels;having experience in adverse event following immunization（AEFI）was a risk factor for depersonalization（OR=3.125,95%CI：1.472-6.633）and occupational burnout（OR= 2.391,95%CI：1.189-4.807）in vaccination personnels. Conclusion A certain proportion of vaccination staffs in Haining suffered from occupational burnout. The experience of AEFI was a risk factor for their occupational burnout.

Objective To research the clinical value between gene polymorphism of human platelet alloantigens (HPA) 1-6, 9, 15 and platelet transfusion refractoriness ( PTR) .Methods Totally 40 patients with platelet transfusion refractoriness( PTR) were randomly selected, and patients and donors’ peripheral blood specimens were collected and tested these samples with platelet GP specific antibodies, and judged the results of platelet transfusion, and with the help of the combination of PCR and direct sequencing for classification of HPA 1-6,9,15 antigens and observe the percent platelet recovery ( PPR ) after the same type of platelet transfusion, and explore the relationship between HPA gene polymorphism and PTR. Results There was no HPA-b gene was found neither on patients and donors’ HPA 1,4,9, showed the distribution of aa homozygous form; HPA 5,6 were mainly aa homozygous form, little bb homozygous form was discorvered.And HPA 2,3,15 were distributed of polymorphism, the frequency of HPA 2,3,5,6,15 were found with polymorphism.Conclusion For these patients who were happened with PRT many times, in addition to taking HLA into account, HPA gene polymorphism are also need to be considered.Most people only need to test patients and donors’ HPA2,3,15 gene to decrease the occurrence of PTR significantly when making HPA matching.

13 C isotopic abundance of intracellular free amino acid with a characteristic of fast- turnover can quickly reflect changes in intracellular metabolic state. But the concentration of intracellular free amino acid is low, the existed 13 C isotope detection method based on GC-MS can not satisfy the requirement with full scan mode. In this study, the selected ion monitoring method was used to detect accuracy higher likelihood of analysis of 13 C isotopic abundance of free intracellular amino acid. First, in the full scan mode we analyzed of the fracture law of different amino acids, found the feature corresponding to each amino acid fragments, and established 16 kinds of free intracellular amino acids characteristic fragment library. Then using this characteristic fragment library, only specific m/z signal was detected in sample analysis, which realized the selected ion monitoring and improved the quality of signal. The results of amino acid standards showed that the signal-to-noise ratio, measurement precision and accuracy were improved by 17, 2. 0 and 3. 8 times compared with the full scan mode. In the analysis of coenzyme Q10 producing strains of samples, this method was successfully used to detect isotopic abundance of 8 kinds of free intracellular amino acids. This method plays an important role in the detection of 13 C isotopic abundance of the intracellular free amino acid in cell metabolism research.