The clinical treatment of locally advanced thymic epithelial tumors still faces many challenges, a multidisciplinary treatment model based on surgery is the main treatment method. In recent years, the surgical treatment of locally advanced thymic epithelial tumors has progressed rapidly, especially in the field of minimally invasive treatment. But controversies still exist and there are concepts needed to be clarified and principles to abide by. This article focuses on current status and recent progress in diagnosis and treatments of locally advanced thymic epithelial tumors.

Objective To investigate the distribution of pathogens and positive alarming time of blood culture,and provide basis for laboratory diagnosis and clinical treatment. Methods Blood specimens from clinical departments in a hospital in May-November 2015 were collected,positive alarming time of blood culture was recorded,species of pathogens were identified. Results A total of 157 pathogenic strains were isolated from blood culture specimens, gram-positive cocci,gram-negative bacilli,and fungi accounted for 31 .85% ,57.32% ,and 10.83% respectively. The median positive alarming time were as follows:Enterobacteriaceae 0.50 day,non-fermenting bacteria 0.63 day, Enterococcusspp. 0.60 day,Streptococcusspp. 0.80 day,Staphylococcusspp. 1.01 days,and fungi 1.44 days, respectively. Conclusion Positive alarming time of blood culture specimens from early to late are as follows:Enter-obacteriaceae,Enterococcus,non-fermentative bacteria,Streptococcus spp.,Staphylococcus spp.,and fungus. Positive alarming time of pathogens causing bloodstream infection are all within 4 days,and most of them are within 1 day.

5#. The hybridoma cell lines grew well after continuous culture for more than three months or after being stored in liquid nitrogen for six months, and the titers of secreting McAbs were stable.Conclusion:The McAbs against respiratory syncytial virus are obtained. It lay a foundation for early diagnosis and further study of RSV.

Objective To evaluate the efficacy of combined anterior and posterior approaches in treatment of severely unstable lower lumbar burst fractures.Methods A retrospective case series study was made on clinical data of 14 patients with lower lumbar burst fractures collected from August 2009 to August 2014.There were 12 males and 2 females,with a mean age of 39 years.Seven fractures occurred at L3,five at L4,and two at L5.Nine patients were associated with injury to the posterior ligament complex (PLC).According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in two patients,grade C in four,grade D in five and grade E in three.All patients underwent posterior pedicle screw fixation combined with anterior spinal canal decompression and titanium mesh or iliac bone grafting.Lumbar lordosis angle,vertebral height,spinal canal decompression,ASIA grade and complications were evaluated after operation.Results Two patients experienced cerebrospinal fluid leakage postoperatively,which were healed after 2 weeks' local pressure treatment.Three patients experienced recurrent lumbar pain postoperatively,which were relieved after the removal of internal fixation 18 months after operation.All patients were followed up for 12-36 months (mean,18 months).Compared to the detection before operation,final follow-up showed improved lumbar lordosis [(30.2 ± 7.3) ° vs.(41.3 ± 6.5) °],decreased loss of the anterior vertebral height [(62.3 ± 21.5) ％ vs.(11.8 ± 7.8) ％] and reduced canal compromise [(65.7 ± 30.5) ％ vs.(21.9 ± 12.7)％] (all P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade C in one patient,grade D in three and grade E in ten (P ＜ 0.05).Follow-up showed no apparent graft loosening,pseudarthrosis,implant breakage and severe kyphosis.Conclusion Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fractures can effectively reconstruct the height and stability of the vertebral body,restore the spinal canal volume,and attain satisfactory clinical outcome.

Objective Identification of anatomic structures are essential for totally thoracoscopic anatomic pulmonary segmentectomies, however sometimes the procedure are difficulty.This study was to assess whether three-dimensional computed tomography angiography(3D-CTA) could contribute to the preoperative arrangement of thoracoscopic complex segmentectomy.Methods Between September 2012 and August 2014, 29 patients were performed thoracoscopic complex segmentectomies under the guidance of preoperative 3D-CTA.The segmentectomies pattern were based on the nodules' diameter, location,and pathology.The targeted vessels and bronchus were marked in preoperative simulated segmentectomies.Results Of the 29 cases, 9 right upper lobe segmentectomies, 13 left upper segmentectomies, and 7 bibasilar segmentectomies were achieved, among which 6 subsegmentectomies were also inclued.The mean lesion diameter, operative time and intraoperative blood loss were(1.35 ± 0.80) cm, (190.53 ± 50.83) min, and (26.90 ± 32.24) ml respectively.Under the guidance of preoperative 3D-CTA , 8(27.5％) nodules were detected accurately, moreover 2(6.9％) aberrant arteries and 1 (3.4％) aberrant bronchus were observed.According to the marked vessels and bronchus preoperatively, 27 (93.1％) arteries, 25 (86.2％)veins,and 29(100％) bronchus were identified and dissected in the operation.Three cases converted to unplanned segmentectomies.No serious complications or death occurred.Conclusion 3D-CTA is an effective tool to enhance security and efficiency in thoracoscopic complex anatomical segmentectomy.

Objective To investigate the expression changes of nuclear factor-kappa B(NF-kB) and intercellular adhesion molecule-1(ICAM-1)in rats with severe acute pancreatitis(SAP)and the effect of pretreatment of pioglitazone,a specific peroxisome proliferator-activated receptor?(PPAR?),)ligand, on the development of SAP.Methods Fifty-four SD rats were divided into sham operation group(C), SAP group(A)and pioglitazone pretreatment group(Ⅰ).The SAP was induced by retrograde infusion of 5% sodium taurocholate(0.1 ml/100 g)into the biliopancreatic duct.The rats inⅠgroup were intraperi- toneally injected with pioglitazone(2 mg/100 g)two hours before operation.The rats were sacrificed at 3,6 and 12 hrs,the blood,ascites and pancreatic tissues were collected(6 rats once for each group). The expressions of NF-kB and ICAM-1 in pancreatic tissues were measured by immunochemistry,mean- while the serum amylase,the amount of ascitic,pancreatic wet/dry ratio were measured.The pathologi- cal changes of pancreatic tissues were observed by immunochemistry staining with hematoxylin and eosin and the score of the tissues were evaluated.Results Pretreatment with pioglitazone could significantly attenuated the severity of SAP,including reduction of amylase and ascites,and the mass and pathological scores of the pancreatic tissue were decreased after 6 hrs of medication.The expression of ICAM-1 and NF-kB activity were inhibited.Conclusions Above findings demonstrate that pioglitazone can attenuate the severity of SAP by inhibition of ICAM-1 expression and NF-kB activation.The beneficial effects of pioglitazone might be due to its anti-inflammatory activities.The pioglitazone can be used as a new drug in treatment of SAP.

Objective To select more rapid,sensitive and specific method in detection of respiratory syncytial virus(RSV)directly from clinical specimens.Methods RSV was detected by virus isolation in tissue culture,direct smears and detection by indirect immunofluorecence assay(IFA),rapid culture assay,sandwich enzyme linked immunosorbent assay(ELISA)as well as labbed streptavidin biotin method(LSAB)from 45 specimens(nasopharyngeal aspirates,NPAs) collected from infants and young children with acute lower respiratory tract infection.Results Of 45 NPAs,12 cases(26.7%) were positive by virus isolation,14 cases(31.1%) were positive for RSV by direct detection of RSV antigen by IFA,20 cases(44.4%) were positive with rapid culture assay,4 cases(8.9%)were positive by sandwich ELISA,4 cases(8.9%)were positive by LSAB.Conclusion Rapid culture assay and direct detection of RSV in NPAs direct smears by IFA are rapid,sensitive method in the diagnosis of RSV infections.

Objective To assess the clinical value of dual-energy CT (DECT) Volume software in quantitative analysis of urate crystals.Methods The DECT data of 60 gout patients based on the American College of Rheumatology diagnostic criteria were analyzed retrospectively.The volumes of urate crystals were quantitatively analyzed by using Volume software with two senior radiologists.The results were statistically analyzed.Results Seventy-two joints of 60 gout patients were scanned by DECT.40 of 43 joints had urate crystals in foot and ankle with the average volume of (0.621±0.742) cm3;18 of 19 joints had urate crystals in knee with the average volume of (0.842±1.086) cm3;10 of 10 joints had urate crystals in hand and wrist with the average volume of (0.796±0.583) cm3.There was no statistical difference for volume measurement between two doctors (P>0.05).The volumes of urate crystals in 4 patients with regular medication were reduced.Conclusion Volume software of DECT can quantitatively analyze urate crystals with a good repeatability, which has high application value in clinical diagnosis and treatment monitoring of gout.

Objective:Comparing the different effects between using electrotome and ultrasonic scalpel in segmentectomy for separating intersegmental plane.Methods:The ex vivo porcine lungs were chosen for experiments, the a segment of the cranial lobe of the right lung(RS1a) was removed by using electrotome(coagulation mode) or ultrasonic scalpel, the values of minimum air leak pressure among them were compared, and also the hematoxylin and eosin staining for evaluating the injury degree of incision edge.Results:The mean values of minimum air leak pressures for the intersegmental plane after segmentectomy were(17.3±1.0)cmH 2O by electrotome, (16.4±2.9) cmH 2O by ultrasonic scalpel, the differences did not reach significance between electrotome and ultrasonic scalpel( P=0.17). When focused on heat injury degree of incision edge, electrotome caused a heavier damage than ultrasonic scalpel[(819.70±158.00)μm vs.(354.35±98.81)μm, respectively, P<0.01]. Conclusion:Electrotome and ultrasonic scalpel presented different merits and defects, and we should opt energy devices rationally for separating inter-segmental plane.

Objective To investigate the effects of blockade of OX40/OX40L costimulation pathway on mice islet allograft tolerance in CD40/CD154 costimulation pathway blockade mice.Methods C57BL/6 mice were induced into diabetes mellitus as recipients,and were transplanted with DBA/2 mice islets.The recipients were divided into four groups,(1) treated with IgG as controls,(2) anti-OX40L mAb,(3) anti-CD154,(4) combined treatment of anti-OX40L mAb and anti CD154mAb.The mean survival time (MST) of islet allograft was observed.The expression of OX40 in activated T cells of CD154 deficient mice was detected.Effector T cells were obtained from the spleen of CD154 deficient mice cultured with or without anti-OX40L mAb for 3 days.The proliferation of T cells was assayed.Results The MST in the control group,anti-OX40L mAb group,anti-CD154 mAb group and anti OX40L mAb + anti-CD154 mAb group was 19,22,48,and ＞150 days respectively (P ＜0.05).The OX40 expression was readily induced in the 66％ activated T effector cells.CD154 deficient T effector cells proliferation was inhibited by the addition of anti-OX40L mAb in the culture in a dose-dependent fashion.Conclusion The blockade of OX40/OX40L costimulation pathway can promote islet allograft tolerance in CD40/CD154 costimulation pathway blockade mice by inhibiting the proliferation of T cells.