Objective To discuss the cause, managment and prevention of the postoperative complications of orbital implantation by clinical case analysis, and to provide reference for the future clinical work. Methods 175 cases of orbital implantation from Aug. 2011 to Aug. 2013 were retrospectively analyzed in our department. The postoperative complications occurrence, related symptomatic treatment, and the reasons of complications were analyzed. Results Complications occurred in 175 cases of 9 cases(5. 14%),including 4 cases of the con-junctival cyst (2.29%),3 cases of orbital implants exposure(1.71%),1 case of orbital chronic infection(0.57%)and 1 case of subcon-junctival tissue atrophy(0. 57%). All of them had obtained good curative through cyst excision or orbital implanting again after the active treatment. There were no complication occurred again. Conclusion The postoperative complications should be positively analyzed, and early positive precaution could reduce most of the complications.

A multiplex real-time PCR was developed to detect ctxA of Vibrio cholerae, gyrB and tdh of Vibrio parahaemolyticus simultaneously. The multiplex real-time PCR were evalidated by detection for the three genes in 47 toxigenic V. cholerae O1 and O139 strains (ctxA+; O1=3, O139=44), 25 non-toxigenic V. cholerae strains (ctxA-; O1=12, O139=6, non-O1 and non-O139=7), 116 V. parahaemolyticus strains with or without tdh (73 or 43) and 9 other bacteria strains. The specificity and sensitivity of the multiplex real-time PCR in detection for the ctxA and the tdh genes in the strains tested were both 100.0%, compared to the results by routine PCRs. In the detection for V. parahaemolyticus specific gyrB using the multiplex real-time PCR, all of 116 V. parahaemolyticus strains were positive, and 9 other strains and 72 V. cholerae strains were all negative. The multiplex real-time PCR is a sensitive, specific and quick assay not only for detecting virulence genes of V. cholerae and V. parahaemolyticus but also for identifying V. parahaemolyticus at species level. In addition, two real-time PCRs for detection of V. parahaemolyticus virulence genes trh1 and trh2 were also developed.

Female ; Fungemia ; etiology ; therapy ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Retrospective Studies

Objective To describe a new kind of Y-shaped metallic stent delivery system and evaluate its feasibility and preliminary effect for managing multiple airway stenoses involving the lower trachea and the tracheal carina.Methods The Y-shaped metallic stent delivery system consisted of three- tier structure.The inner-tier was composed of four parallel guiding tubes,which was used for two guidewires and two threads passing through,the middle-tier was delivery catheter,which contained the four guiding tubes,and the outer-tier was introducer sheath.Under the fluoroscopic guidance,15 patients with multiple stenoses involving the lower trachea and the tracheal carina were treated with the new covered self-expandable Y-shaped metallic stents.Results Stent placement in the tracheo-bronchial tree was technically successful in all patients with obliteration of the dyspnea immediately after stent placement,and SaO_2 was increased form preoperative 75%—89% to postoperative 96%—99%.During follow-up a period of 3—58 weeks (M 22 weeks),all stenosis were resolved without stent-related complications,and the general physical of all 15 patents was improved with no occurrence of obviously dyspnea and bleeding.Karnofsky performance status(KPS)was improved from preoperative 26%—45% to postoperative 72%—95%.Five patients died of the following causes unrelated to stent insertion:multiple organ failure(n=3),cachexia(n=1)and pulmonary infection caused by gastrobronchial fistula(n=1),and the remaining 10 patients were alive with no evidence.of dyspnea at the time of this report.Conclusion Deployment of the covered Y-shaped metallic stent with the use of Y metallic stent delivery system in the management of airway stenoses involving the lower trachea and the tracheal earina was a simple and safe procedure and with a good short-term clinical efficacy.

BACKGROUND: Sepsis is a common complication of infections, burns, traumas, surgeries, poisonings, and post-cardiopulmonary resuscitation. The present study aimed to investigate prognostic value of CD4+CD25+ regulatory T cells (Treg) in peripheral blood of patients with sepsis. METHODS: Periphery blood from 28 patients diagnosed with sepsis was collected on day 1 and 7 after hospitalization in the ICU of Shanghai Changzheng Hospital between December 2013 to April 2014. The blood was used for analyses of Treg ratio using flow cytometry and for analyses of blood routine test, C-reactive protein (CRP), bilirubin, procalcitonin (PCT), and coagulation. APACHE II and sequential organ failure assessment (SOFA) scores were also investigated. The results were compared between two outcome groups of survival or death to evaluate prognostic value for sepsis. RESULTS: The patients had an average age of 60.36±15.03 years, APACHE II score 16.68±7.00, and SOFA score 7.18±3.78. Among the 28 patients, 12 had severe trauma (42.9％), 10 had septic shock (35.7％), and 9 (32.2％) died. The median ratio of Tregs was 2.10％ (0.80％, 3.10％) in the survival group vs. 1.80％ (1.15％, 3.65％) in the death group (Z=–0.148, P=0.883) on day 1; however it was significantly changed to 0.90％ (0.30％, 2.80％) vs. 5.70％ (2.60％, 8.30％) (Z=–2.905, P=0.004). CONCLUSION: With better prospects for clinical application, dynamic monitoring of Tregs ratio in peripheral blood has potential value in predicting prognosis of sepsis.

Objective:To produce rhBMP-4 with bioactivity in E.coli. Methods: The full-length human BMP-4 gene was mutated by PCR without changes in amino acid sequence, then the synthesized gene was cloned into plasmid pET-3c, transducted into BL21(DE)plysS, and induced by adding IPTG to a final concentration of 1.0 mmol/L. The protein product was purified using ion-exchange chromatography method and then renaturated, bioactivity was checked by C2C12 differentiation in vitro and mouse ectopic bone formation in vivo. Results: A 438 bp gene fragment encoding mature peptide of hBMP-4 was cloned , the protein product was mostly in the form of inclusion body, after renaturation, the engineering protein shows better bioactivity. Conclusion:The mutant strategy can enhance the expression of bioactive rhBMP-4 in E.coli expression system.

OBJECTIVETo develop a multiplex real-time PCR for the detection of Salmonella invasion protein A gene (invA), enterotoxigenic Escherichia coli (ETEC) heat-labile I enterotoxin gene (elt), and Shigella or enteroinvasive E. coli (EIEC) invasive plasmid antigen H gene (ipaH).

METHODSUnder the optimized reaction conditions of the multiplex real-time PCR, invA, elt, and ipaH were determined in 10-fold series of dilution of DNA extracted from Salmonella enterica serovar Typhimurium, ETEC 44815 strain and Shigella F301 strain. The three genes were examined in 90 fecal samples from diarrhea patients using the multiplex real-time PCR. When PCR-positive samples were found, the target strains were isolated and identified.

RESULTSThe detectable concentration for this multiplex real-time PCR was 10 CFU/microl for Shigella F301 strain, 10(2) CFU/microl for S. enterica serovar Typhimurium and ETEC 44815 strain, respectively. Out of 90 fecal samples from diarrhea patients, thirteen were found positive for elt gene (14.4%), and five were found positive for ipaH gene (5.6%). Three E. coli strains positive for elt gene and four E. coli strains positive for ipaH gene were isolated successfully from the PCR-positive samples mentioned above. The detection of invA, elt and ipaH genes was completed in 10 h, which included an enrichment period of 6 h.

CONCLUSIONThe multiplex real-time PCR assay can detect invA, elt, ipaH simultaneously in a single reaction, moreover, it can detect for virulence genes in strains of Salmonella, ETEC, and Shigella or EIEC and screen these pathogens in fecal specimens from patients with diarrhea with a high specificity.

DNA, Bacterial ; analysis ; Diarrhea ; microbiology ; Escherichia coli ; genetics ; Feces ; microbiology ; Humans ; Polymerase Chain Reaction ; methods ; Salmonella ; genetics ; Shigella ; genetics

OBJECTIVETo explore the influencing factors for the severity of bronchopulmonary dysplasia (BPD) in preterm infants.

METHODSThe clinical data of 110 preterm infants who were diagnosed with BPD and had a hospital stay of over 28 days between January 2011 and December 2013 were analyzed. These BPD infants were divided into 3 groups according to the clinical criteria: mild group (n=52), moderate group (n=44), and severe group (n=14). The relationship between the severity of BPD and the gestational age, birth weight, asphyxia, oxygen therapy, pregnancy complications, intrauterine pneumonia and mechanical ventilation was analyzed.

RESULTSThe severity of BPD was correlated with the following factors: gestational age, birth weight, prenatal infection, duration of oxygen inhalation with a concentration of >40%, use of mechanical ventilation, parameters and duration of mechanical ventilation, duration of continuous positive airway pressure, adoption of intubation surfactant extubation (INSURE) approach, Ureaplasma urealyticum infection, intrauterine pneumonia and patent ductus arteriosus. Logistic regression analysis indicated that the mechanical ventilator parameter peak inspiratory pressure (OR=1.260, 95%CI: 1.096-1.448) and duration of mechanical ventilation (OR=1.010, 95%CI: 1.005-1.016) were independent risk factors for the severity of BPD, while the INSURE approach was a protective factor (OR=0.208, 95%CI: 0.060-0.923).

CONCLUSIONSThe severity of BPD is associated with various factors in preterm infants. The important measures for preventing BPD include avoiding the birth of preterm infants with a very low birth weight, shortening the duration of mechanical ventilation, preventing and reducing pulmonary infections, and applying the INSURE approach.

Birth Weight ; Bronchopulmonary Dysplasia ; etiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Logistic Models ; Male ; Pregnancy ; Respiration, Artificial ; adverse effects ; Severity of Illness Index

Adolescent ; Body Height ; Chromosomes, Human, X ; Female ; Growth Hormone ; deficiency ; Humans ; Karyotyping ; Monosomy ; Mosaicism ; Turner Syndrome ; genetics ; metabolism ; pathology

BACKGROUNDAlthough severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation (NPPV), increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure, especially hypercapnic acute respiratory failure (HARF). To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy, a prospective case-control study was conducted at a university respiratory intensive care unit (RICU) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) during the past 3 years.

METHODSForty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups, which were carefully matched for age, sex, COPD course, tobacco use and previous hospitalization history, according to the severity of encephalopathy, 22 patients with Glasgow coma scale (GCS) < 10 served as group A and 21 with GCS = 10 as group B.

RESULTSCompared with group B, group A had a higher level of baseline arterial partial CO2 pressure ((102 +/- 27) mmHg vs (74 +/- 17) mmHg, P < 0.01), lower levels of GCS (7.5 +/- 1.9 vs 12.2 +/- 1.8, P < 0.01), arterial pH value (7.18 +/- 0.06 vs 7.28 +/- 0.07, P < 0.01) and partial O(2) pressure/fraction of inspired O(2) ratio (168 +/- 39 vs 189 +/- 33, P < 0.05). The NPPV success rate and hospital mortality were 73% (16/22) and 14% (3/22) respectively in group A, which were comparable to those in group B (68% (15/21) and 14% (3/21) respectively, all P > 0.05), but group A needed an average of 7 cm H2O higher of maximal pressure support during NPPV, and 4, 4 and 7 days longer of NPPV time, RICU stay and hospital stay respectively than group B (P < 0.05 or P < 0.01). NPPV therapy failed in 12 patients (6 in each group) because of excessive airway secretions (7 patients), hemodynamic instability (2), worsening of dyspnea and deterioration of gas exchange (2), and gastric content aspiration (1).

CONCLUSIONSSelected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD; a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.

Aged ; Brain Diseases ; therapy ; Carbon Dioxide ; blood ; Case-Control Studies ; Female ; Glasgow Coma Scale ; Humans ; Hypercapnia ; therapy ; Male ; Middle Aged ; Oxygen ; blood ; Positive-Pressure Respiration ; adverse effects ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; complications