Objective To investigate static closure functional characteristics of lower urinary tract in continence in late pregnancy of primigravida through perineal ultrasound and urodynamieal measurement. Methods From January of 2003 to December of 2005,83 primigravida undergoing antenatal health care in Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital were randomly enrolled in the study, while 28 nulliparous women were recruited as control.The perineal ultrasound and urodynamical measurement were performed at the gestation age of 36-40 weeks,in both groups.We analysed the parameters of lower urinary tract function in late pregnancy compared with nullipara,such as maximal urethral closure pressure(MUCP),functional urethral length(FUL),maximal urethral pressure(MUP), valsalva leak point pressure(VLPP),postvoid residual bladder volume(PVRBV)and volume of first desire to voiding(VFDV).Results The average weight of 83 neonates was(3504?404)g.In all of 83 primigravida PVRBV was less than l0 ml.MUP(110 + 22)cm H_2O(1 cm H_2O=0.098 kPa),MUCP (96?22)cm H_2O and FUL(44?9)mm were significantly increased in the third trimester compared with nullipara(P0.05). There were 33 pregnant women suffering from urinary leakage throughout the terms.The data showed that MUCP was significantly lower in the pregnant women with symptoms of leaking than without leaking. Conclusion The static closure function increased significantly compared with nulliparous women.The VLPP was decreased and had relationship with symptoms of leakage.The results suggest that the function of lower urinary tract in continence in late pregnancy of primigravida is complex.

Objective To compare the functional and radiographic outcomes of modified dual plating and less invasive stabilization system(LISS)in treatment of patients with complex tibial plateau fractures.Methods From November 2003 to November 2004,84 patients with complex tibial plateau fracture were treated with modified dual plating or LISS fixation.Their functional and radiographic outcomes were reviewed to compare the differences in bone union time,full weight-bearing time,knee joint's HSS(The Hospital for Special Surgery)scores,complications, tibia plateau angle(TPA)and posterior slope angle(PA).Results The 84 cases had complete follow-up records and a mean tollow-up of 16.2 months(range,12 to 23 months).Nine complications occurred in the modified dual plating group.The mean full weight-bearing time and radiographic bone union time were 16.8 and 15.1 weeks respectively for this group which had a mean HSS score of 87.4 points.Six complications were found in the LISS group.The mean full weight-bearing time and radiographic bone union time were 14.1 and 13.8 weeks respectively for this group which had a mean HSS score of 89.6 points.There were no significant differences between the two groups in changes of TPA and PA.Conclusion LISS can provide as good fixation as modified dual plating can for most complex tibial plateau fractures,but additional medial plate fixation may be necessary for some special cases.

Objective To study the detection rate of early esophageal carcinoma using magnifying endoscopy,and to evaluate the relationship between the imaging patterns of microvasculature change and his- tological diagnosis.Methods Two hundred and fourteen patients with esophageal mucosa roughness,ero- sion,plaque,abnormal color and indentation in conventional endoscopy and 16 healthy volunteers were en- rolled.The magnifying endoscopy images were graded as four patterns by intraepithelial papillary capillary loop(IPCL)changes after iodine dyeing.The biopsies underwent pathologic evaluation.The comparison be- tween the imaging patterns of endoscopy and histological diagnosiswas was evaluated.Results 80.4%(90/ 112)esophagitis was type 2,and 85.7%(12/14)early esophageal carcinoma was type 3 and type 4.The difference was significant between early esophageal carcinoma and normal mueosa(?~2=27.32,P

Postoperative pancreatic leakage remains a persistent problem after pancreaticoduodenectomy.For patients with a soft and nonfibrotic pancreas,double binding continuous hemstitch suture is an optimal method for anastomosis.From January 2011 to June 2012,92 cases of periampullary carcinoma with a soft pancreas underwent pancreaticoduodenectomy,and then a modified technique of pancreaticogastrostomy was performed with 2 continuous hemstitch sutures placed in the mucosal and seromuscular layers of the posterior gastric wall,respectively.The median time for pancreaticogastrostomy was 12 minutes,and only 15 patients had postoperative complications.Two patients developed pancreatic leakage(1 grade A and 1 grade B)postoperatively.Pancreaticogastrostomy with double binding continuous hemstitch sutures is a simple and safe reconstruction procedure for patients with a soft and fragile pancreas who received pancreaticoduodenectomy.

Objective To synthesize 99Tcm-TP5-3 and evaluate its biodistribution and kinetics as a molecular probe for the detection of apoptosis,and evaluate tumor apoptosis after a single dose of paclitaxel chemotherapy in MDA-MB-231 breast tumor model.Methods TP5-3 was labeled with 99Tcm directly,and analyzed with HPLC.The radioactivity in tissues was measured and expressed as ％ID/g and T/NT (tumor/muscle).The mice bearing MDA-MB-231 breast tumor were divided into two groups:the treatment group which was given a single dose of paclitaxel (40 mg· kg-1,via tail vein),and the control group which was injected with the same volume of normal saline.After therapy,99Tcm-TP5-3 was injected via tail vein in both groups (100 μ1 for each mouse).MicroSPECT/CT was performed at 3 h postinjection.Radioactivity in different tissues was determined after imaging.Apoptotic cells were measured with flow cytometry.The morphological changes of the apoptotic cells were observed by light microscopies.One-way analysis of variance,two-sample t test and linear correlation analysis were used to analyze the data.Results The radiolabeling efficiency was ＞ 95％ and the radiochemical purity of 99Tcm-TP5-3 was (96.0± 1.5)％ at room temperature for 4 h.The predominant uptake was found in the kidneys at 30 min postinjection ((8.48± 1.07) ％ID/g),with rapid tracer clearance from the circulation.By comparison with activity at 5 min postinjection ((13.74± 4.21) ％ID/g),85％ of the initial activity reduced in blood at 4 h ((2.07±0.35) ％ID/g; F=11.310,P＜ 0.05).99Tcm-TP5-3 was mainly accumulated in the kidneys,liver and stomach,and excreted via the kidneys.T/NT in the treated group was 4.21±0.06,which was significantly higher than that of the control group (1.57±0.67; t =12.820,P＜0.05).The radioactivity of tumor tissue in the treatment group was much higher than that in the control group (4.82±0.54) ％ID/g vs (1.44±0.38) ％ID/g,t=0.679,P＜0.05).The tumor uptake of 99Tcm-TP5-3 in the treatment group positively correlated well with the apoptotic cells (r =0.985,P＜0.05).Histopathology further confirmed that a large number of apoptosis had occurred in the tumor after paclitaxel treatment.Conclusion 99Tcm-TP5-3 appears to have potential to be a useful molecular probe for imaging tumor cell apoptosis.

Objective To investigate the impact of sputum suction under laryngoscope in stroke patients on the occurrence and prognosis of ischemic stroke-associated pneumonia (SAP).Methods A total of 127 cases with acute ischemic stroke (AIS) with Glasgow Coma Scale 6-12 scores,non-artificial airway and need for intensive care were enrolled.According to the suction practice,the cases were divided into laryngoscope euthyphoria group (practice group,PG,n =59),and conventional oral or nasal sputum suction group (control group,CG,n =68).The PG was perspectively studied,while the CG were analyzed retrospectively.All patients were cared with the Guidelines for the management of adult with hospitalacquired ventilator-associated and healthcare-associated pneumonia set by American Thoracic Society/Infectious Diseases Society of America in 2005 and the Guidelines for the early management of patients with acute ischemic stroke set by American Heart Association/American Stroke Association in 2013 including patting on the back of patients in prone position routinely in order to facilitating expectoration,phlegm elimination with physical vibration and apophlegmatic agent application during their stay in ICU.Incidences of SAP and 28-day mortality were calculated.Levels of inflammatory markers (white blood cell,WBC;highsensitive C-reaction protein;procalcitonin,PCT) in serum were detected.Adverse events related to laryngoscopy were documented.Results There were no significant differences in incidences of SAP and 28-day mortality between PG and CG groups (32.20％ vs.41.18％,P ＞ 0.05;47.37％ vs.53.57,P ＞ 0.05,respectively).However,there was statistically significant difference (P ＜ 0.05) in the ICU stay length and inflammatory markers,and the sputum suction process in PG did decrease the incidence of artificial airway establishment and mechanical ventilation (18.64％ vs.35.29％,P ＜ 0.05),and the laryngoscope euthyphoria method was proved to be a protective factor (HR =0.515;95％ CI 0.281-0.057,P =0.038).WBC and PCT were lower in PG group than in CG group (P ＜ 0.05).Conclusion Sputum suction under laryngoscope can reduce the probability of artificial airway establishment and invasive ventilator employment in patients with AIS,shortening ICU stay length and down-regulating levels of WBC and PCT.

Objective · To identify broad-spectrum bacteriophages against extensively drug-resistant Klebsiella pneumonia and analyze their characteristics by biological and genomic methods. Methods · Multi-drug resistant Klebsiella pneumonia strains collected from a hospital were used as host bacteria to isolate and purify broad-spectrum phages in the wastewater at the same hospital area. The size and shape of phages were observed by transmission electron microscope. Titer, host range, pH stability and thermal stability were measured. Moreover, the DNA extracted from the phage SH-Kp152234 was sequenced and analyzed. Results · One strain of bacteriophage against Klebsiella pneumonia was isolated and named as SH-Kp152234. The electron microscope revealed it belongs to Podoviridae family. Moreover, genome of SH-Kp152234 showed to be a linear double-stranded DNA of 40578 bp with the GC content of 52.85%. It was predicted to have 49 open reading frames with related known functions.Conclusion · SH-Kp152234, with a broad host range and a short latent period, which could exert its activity in a wide range of temperature and pH, is a promising candidate to be exploited in the treatment of multiple drug-resistant Klebsiella pneumonia.

Objective: To analyze the strengths, weaknesses, opportunities and threats of the construction on intelligent vaccination clinics in Zhejiang Province, so as to provide countermeasures for promoting the construction of intelligent vaccination clinics in Zhejiang Province. Methods: By reviewing the annual reports of Zhejiang immunization planning, survey data from Zhejiang Centers for Disease Control and Prevention and Immunization Intelligent Service System, data of human resources of immunization planning, vaccine procurement, construction progress of intelligent vaccination clinics and vaccination were collected. The relevant literature was searched to gather information on the construction standards and norms of intelligent vaccination clinics. The analysis of the strengths, weaknesses, opportunities and threats (SWOT) of the construction of intelligent vaccination clinics was conducted, and corresponding countermeasures and suggestions were proposed. Results: The National Immunization Program reported vaccine rate in Zhejiang Province is more than 99%, and standardized vaccination clinics have been popularized throughout the province. The vaccination staff are professional, and a province-wide intelligent immunization service information system has been established, providing the resources and conditions for the construction of intelligent vaccination clinics. However, there are problems such as low data quality and matching efficiency in vaccination, insufficient data interoperability and sharing, unbalanced regional capabilities in intelligent transformation, and uneven distribution of talent and resources. It is crucial to seize the opportunities presented by the development of big data and artificial intelligence, rely on the regional development of the Internet and health industry, seize the opportunity of rapid growth in demand for intelligent vaccination services and high public acceptance, accelerate the construction of intelligent vaccination clinics, and establish intelligent vaccination service standards as soon as possible. Conclusion We should seize the opportunities presented by the digital reform and development, fully utilize the existing vaccination resources and strengths, address the shortcomings, and accelerate the construction of intelligent vaccination clinics in Zhejiang Province.

OBJECTIVETo study the immunophenotype and gene rearrangement pattern of pulmonary lymphomatoid granulomatosis.

METHODSNine cases of pulmonary lymphomatoid granulomatosis, included 5 cases of open lung biopsy, 3 cases of lobectomy specimen and 1 case of autopsy, were retrospectively analyzed by immunohistochemistry, in-situ hybridization for Epstein-Barr virus-encoded RNA, immunoglobulin and T-cell receptor gene rearrangement studies.

RESULTSThe age of patients ranged from 3 to 59 years. The male-to-female ratio was 3: 6. Histologically, all cases showed lymphocytic infiltration surrounding the blood vessels and in the perivascular areas. Most of these lymphoid cells expressed T-cell marker CD3. There were also variable numbers of CD20-positive B cells. The staining for CD56 was negative. According to the WHO classification, there were 4 cases of grade I , 1 case of grade II and 4 cases of grade III lesions. Six cases had gene rearrangement studies performed and 3 of them demonstrated clonal immunoglobulin gene rearrangement (including 1 of the grade II and 2 of the grade III lesions). No T-cell receptor gene rearrangement was detected.

CONCLUSIONSPulmonary lymphomatoid granulomatosis may represent a heterogeneous group of lymphoproliferative disorders. Some of the cases show B-cell immunophenotype and clonal immunoglobulin gene rearrangement, especially the grade II and grade lesions. They are likely of lymphomatous nature.

Adult ; Antigens, CD20 ; metabolism ; CD3 Complex ; metabolism ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Gene Rearrangement, B-Lymphocyte, Heavy Chain ; Humans ; Immunohistochemistry ; Lung Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Lymphomatoid Granulomatosis ; genetics ; metabolism ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Grading ; Pneumonectomy ; methods ; Retrospective Studies ; Young Adult

Single particle inductively coupled plasma mass spectrometry (SP-ICP-MS) is a new tool that can provide the element composition, size distribution, and number concentration of nanoparticles. Here we discussed the effects of dwell time and settling time on analysis of nanoparticles by SP-ICP-MS. We analyzed standard materials of gold nanoparticles (30, 40 and 60 nm AuNPs, from NIST and NCNST), showing that better signal-to-noise ratio and higher determination efficiency could be achived when using shorter dwell time and settling time. We utilized a nano mode for SP-ICP-MS, in which the dwell time was set as 0. 05 ms and the settling time was 0. The size of NIST AuNP standard material determined here was in accord with the certified size using the developed method. The detection limits of size and number concentration of AuNPs were 8 nm and 1. 1×105 particle / L, respectively.