The skin biopsy specimens from fifteen patients with Langerhans cell histiocytosis were studied. Thirteen out of fifteen cases were positive to S100 protein antibody and peanut agglutinin, but negative to Mac387 and lysozyme antibodies, and three cases were positive for CD1 antibody by immunohistochemistry. Birbeck granules were demonstrated in one of the three cases by electron microscopy. Ten cases were analysed by flow cytometry, six cases (60%) were aneuploid, DNA index was 1.38?0.32, proliferative index was 38.69%. These results showed that these pathognomonic histiocytes were of Langerhans cell origin and their potential malignancy could not be ruled out.

Objective To investigate genetic relationships among five serotypes of two variants of Cryptococcus neoformans. Methods PCR mediated DGGE (denaturing gradient gel electrophoresis) and sequence analysis of 28S rDNA of C. neoformans were performed in ten reference strains, C. neoformans capsular-deficient strain CAP10, and nineteen clinical isolates from non-HIV patients. Results The results of DGGE and analysis of nucleotide sequences of 28S rDNA showed identical patterns and nucleotide sequences in the serotype A and D of C. neoformans var. neoformans, which were distinct from the serotye B and C of C. neoformans var. gattii. The patterns and sequences of serotype AD coincided with those of C. neoformans var. gattii. The patterns and nucleotide sequences of C. neoformans capsular-deficient strain CAP10 (serotype D) and serotype A and D were identical. Of the nineteen clinical isolates, seventeen had patterns of serotype A and D, and the others had patterns of serotype B and C. Conclusions PCR mediated DGGE integrated with sequence analysis of 28S rDNA is a valuable tool for the classification of C. neoformans. The clinical isolate of C. neoformans var. neoformans is predominant in Chinese non-HIV patients. Serotype AD is genetically close to C. neoformans var. gattii rather than C. neoformans var. neoformans. The data seem not to be in favor of previous study that serotype A, C. neoformans var. grubii, is a new variant of C. neoformans.

Objective To evaluate inspiratory and expiratory high resolution CT (HRCT) lung findings in normal adults and set up inspiratory and expiratory HRCT criterion for further clinical diagnosis and differentiating diagnosis. Methods Sixty-four healthy adults underwent inspiratory and expiratory lung HRCT scanning. The lung density and slice area in upper, middle and lower fields were measured in inspiratory and expiratory phases respectively. Results The lung density in inspiratory phase was (-795?58)HU, the lung density in expiratory phase was (-706?59)HU, the inspiratory expiratory value difference was (90?43)HU, and the expiratory inspiratory area ratio was 0.72? 0.14. Conclusion HRCT will be a new method for lung function testing in future.

Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.

Objective To investigate the effects of 3 different blood purification methods with single treatment or continuous treatment for 2 months on the physiological and biochemical indexes of patients with maintenance of hemodialysis (MHD). Methods The clinical data of 90 patients who underwent MHD in Department of the Blood Purification of Wuhan General Hospital of PLA from March 2016 to April 2017 were retrospectively analyzed, and they were divided into three groups: hemodialysis (HD) group, hemodiafiltration (HDF) group and HD + hemoperfusion (HP) group, 30 cases in each group. All the patients were treated routinely with erythropoietin and iron, and original oral antihypertensive drugs were continuously taken. The patients in HD group underwent 3 times of HD each week, 4 hours each time; the patients in HDF group applied once HDF and twice of HD each week, once 4 hours, and post dilution method was adopted with the replacement volume 50 - 70 mL/min; the patients in HD+HP group performed once HD+HP and twice HD each week, 4 hours each time. The levels of blood creatinine (SCr), urea nitrogen (BUN), plasma leptin (LP), serum parathyroid hormone (PTH), serum hypersensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), etc. were collected before single dialysis, 4 hours and 2 months after continuous treatment, and the differences in above indexes were compared among the three groups. Results With the prolongation of dialysis time, renal function related indexes (SCr, BUN), macromolecular toxin related indexes (LP, PTH) and micro inflammation related indexes (hs-CRP, IL-6) in the three groups were significantly lower than those before dialysis, the degrees of decrease of the indexes after continuous treatment for 2 months were more obvious than those after single treatment for 4 hours, but there were no statistical significant differences in inter-group comparisons of SCr and BUN among the three groups (both P ＞ 0.05). After 2 months of continuous treatment, the degrees of decrease of LP, PTH and hs-CRP and IL-6 levels in group HD+HP were more significant than those in either HD group or HDF group [LP (ng/L): 7.56±2.67 vs. 9.55±3.67, 8.82±2.47, PTH (ng/L): 356.88±189.46 vs. 520.55±330.16, 487.43±234.26, hs-CRP (mg/L):10.30±3.21 vs. 21.43±4.46, 12.31±3.92, IL-6 (ng/L): 18.56±4.62 vs. 34.21±6.77, 19.84±6.41, all P ＜ 0.05]. Conclusion HD+HP can effectively improve the physiological and biochemical indexes of MHD patients, and is an ideal way to treat MHD patients.

Objective To obtain a better understaning of the clinical features of Castleman tumor associated paraneoplastic pemphigus. Methods The clinical features and therapy of 10 cases of this disease, diagnosed in the Department of Dermatology of Peking University First Hospital were analyzed. Results Castleman tumor was shown to be the most common neoplasm associated with paraneoplastic pemphigus in China. The clinical presentations, histopathologic characteristics, CT scan findings, and immunologic features were all unique. The early diagnosis and removal of the Castleman tumor are crucial for the treatment of this tumor-associated autoimmune disease. Conclusions Because Castleman tumor is directly related to the induction of autoimmunity, early diagnosis and prompt removal of the tumor are essential to the management of this disease.

Objective To explore the clinical effect of continuous venous-venous hemofiltration (CVVH) combined with hemoperfusion (HP) in treatment of patients with hypertriglyceridemia pancreatitis (HTGP). Methods The clinical data of 33 patients with moderate and severe HTGP who were treated by CVVH combined with HP were retrospectively analyzed from March 2012 to March 2017 in Wuhan general hospital of the people's liberation army. The differences of vital signs and the serum levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), amylase (AMS), interleukin-6 (IL-6), blood calcium (Ca2+) and white blood cell count (WBC), haemoglobin (Hb), platelet count (PLT) before and 24 hours,72 hours and 1 week after therapy were compared, the changes of recovery time to target serum TG level, frequency of blood purification therapy, time for disease situation becoming stable, days staying in hospital and mortality were observed. Results The levels of LDL were not high in patients with HTGP, the levels of TG and TC were decreased significantly after using CVVH plus HP, and after treatment for 24 hours statistical differences appeared compared with those before treatment [TG (mmol/L):7.14±1.04 vs. 11.90±2.03, TC (mmol/L): 7.47±1.04 vs. 10.20±1.26], the decline persisting to 1 week after treatment;the drop rates of TG and TC were the largest after the first combined treatment, and the TG drop rate was more obvious than that of TC [(51.92±14.18)% vs. (30.09±10.01)%, P < 0.05], an average of (2.58±1.45) days and (2.38±0.98) times of combined blood purification could restore the TG to its safe level (TG < 5.65 mmol/L), the time of disease situation tending to be stable was (7.46±3.05) days and the time of staying in hospital was (20.00±2.12) days. Systemic inflammatory response syndrome (SIRS) related vital signs and inflammatory response indicators were also improved obviously after the combined therapy (all P < 0.05), after treatment for 72 hours, various vital signs and Ca2+reached to their normal reference ranges, after treatment for 24 hours IL-6 began to decline significantly compared with that before treatment (ng/L: 120.85±16.45 vs. 151.05±18.19), and AMS and WBC returned to their normal reference ranges after treatment for 1 week. Conclusion CVVH combined with HP can quickly and effectively eliminate TG in blood in patients with HTGP and in the mean time it may ameliorate and block the early progression of SIRS, resulting in good therapeutic effect on alleviating the disease development and improving its prognosis.

Objective To study the effects of hemodialysis (HD) combined with hemoperfusion (HP) on sleep quality in maintenance hemodialysis (MHD) patients. Methods Sixty MHD patients admitted to Department of Blood Purification of Wuhan General Hospital of PLA from January to December 2016, 30 cases were treated with HD, and the other 30 cases were treated by HD+HP, the course of treatment was 12 weeks in both groups. The changes of serum β2-microglobulin (β2-MG) and parathyroid hormone (iPTH) were observed before treatment and 12 weeks after treatment; the sleep quality of all patients in the two groups were evaluated by Pittsburgh Sleep Quality Index (PSQI) Scale, and the correlations between the sleep quality of MHD patients andβ2-MG level, iPTH level were analyzed by Pearson linear correlation analysis. Results All the 60 patients completed the treatment. The serum β2-MG, iPTH levels and PSQI score after treatment were decreased obviously in HD+HP group compared with those before treatment, and the degrees of decrease in HD+HP group were more significant than those in the HD group [β2-MG (mg/L): 12.34±2.12 vs. 20.27±3.15, iPTH (ng/L): 224.54±100.28 vs. 398.42±155.37, PSQI score:8.56±0.86 vs. 12.45±0.88, all P < 0.05]. Pearson linear correlation analysis showed that the PSQI score was significantly positively correlated with serum β2-MG, iPTH level (r respectively was 0.416 and 0.462, both P < 0.01). Conclusion HD+HP therapy can significantly improve the sleep quality of MHD patients, and the mechanism may be related to the elimination of serum iPTH and β2-MG from the body of MHD patients.

Objective To observe the clinical curative effect of cinacalcet combined with activated vitamin D for treatment of patients with secondary hyperparathyroidism (SHPT) undergoing maintenance hemodialysis (MHD).Methods Eighty-six patients with SHPT undergoing MHD admitted to the Blood Purification Center of Wuhan General Hospital of Chinese People's Liberation Army from April 2014 to April 2016 were enrolled, and they were divided into an observation group and a control group by random number table, 43 cases in each group. The patients in control group were given cinacalcet whose initial dose was 25 mg/d and maximum dose should not exceed 75 mg/d, and the calcium acetate orally; on the basis of control group, the patients in observation group were additionally given activated vitamin D therapy, and both groups were treated for consecutive 12 weeks. After treatment, the clinical therapeutic effect, serum calcium, serum phosphorus, calcium phosphorus product, intact parathyroid hormone (iPTH) levels and the incidence of adverse reactions were compared between the two groups.Results The total effective rate in observation group was higher than that of the control group [90.70% (39/43) vs. 74.42% (32/43),P < 0.05]. After treatment, the difference of the serum calcium, calciumphosphorus product were higher than those before treatment in both groups [serum calcium (mmol/L): the control group was 2.24±0.25 vs. 1.99±0.26, observation group was 2.60±0.21 vs. 2.03±0.24; calcium phosphorus product (mmol2/L2): the control group was 4.05±0.34 vs. 3.79±0.35, observation group was 4.25±0.37 vs. 3.86±0.36, allP < 0.05], serum phosphorus, iPTH were lower than those before treatment in both groups [phosphorus (mmol/L): the control group was 1.69±0.14 vs. 2.09±0.12, observation group was 1.15±0.18 vs. 2.03±0.16; iPTH (ng/L): the control group was 297.36±59.73 vs. 499.54±69.32, observation group was 198.53±57.32 vs. 492.92±67.54, allP < 0.05], the degrees of changes in observation group were more significant than those in control group [serum calcium (mmol/L): 2.60±0.21 vs. 2.24±0.25, serum phosphorus (mmol/L): 1.15±0.18 vs. 1.69±0.14, calcium phosphorus product (mmol2/L2): 4.25±0.37 vs. 4.05±0.34, iPTH (ng/L): 198.53±57.32 vs. 297.36±59.73, allP < 0.05]; and the incidence of adverse reactions was significantly lower in observation group than that of the control group [4.65% (2/43) vs. 20.93% (9/43),P < 0.05].Conclusion Cinacalcet combined with activated vitaminD for treatment of SHPT patients undergoing maintenance hemodialysis shows obvious curative effect, reduces the whole segment of iPTH, and simultaneously has less adverse reactions.

Objective: To explore the application effect of Mini-Clinical Evaluation Exercise(Mini-CEX) in clinical teaching rounds of nursing students, and to provide reference for improving the quality of clinical teaching. Methods: A total of 120 nursing students from June 2017 to June 2018 were divided into control group and intervention group by the time of practice with 60 cases each. The control group adopted traditional nursing teaching rounds, while the intervention group adopted Mini-CEX-based nursing teaching rounds. The comprehensive results of nursing students′practice, Mini-CEX and autonomous learning ability of the two groups were compared and analyzed. Results: The overall evaluation of Mini-CEX of nursing students was (7.23 ± 0.51) in the intervention group and (5.27 ± 1.12) in the control group, and the difference was statistically significant (t=12.337, P <0.01). The excellent rate of nursing students was 58.3%(35/60) in the intervention group and 30.0%(18/60) in the control group, and the difference was statistically significant (χ²=10.914, P <0.01). The total score of autonomous learning ability was (114.85 ± 6.27) in the intervention group and (90.78 ± 8.22) in the control group, and the difference was statistically significant (t=18.034, P < 0.01). The comprehensive results of nursing students′ practice was (87.04 ± 6.46) in the intervention group and (74.35 ± 6.04) in the control group, and the difference was statistically significant (t=11.115, P< 0.01). Conclusions Clinical teaching rounds based on mini-clinical exercise assessment scale can improve the clinical comprehensive service ability, self-learning ability and humanistic care ability of intern nurses.