Objective To explore clinical value of tumor specific growth factors (TSGF) in serum and bronchoalveolar lavage fluid (BALF) on differential diagnosis of benign and malignant periphery solitary pulmonary nodules (PSPN). Methods Serum and BALF from both normal and afflicted side were collected from 211 patients with PSPN(case group) and from 196 patients without any type of tumor (control group). TSGF and carcinoembry-onic antigen (CEA) in serum and BALF were measured in both groups. Results In the malignant PSPN patients, CEA in serum, normal and afflicted side were 28.73 (SD: 15.61) μg/L,63.31 (SD:21.28) μg/L and 85.54(SD: 26.19)μg/L,respectively, which was significantly higher than that of the benign PSPN patients (7.21(SD:2.43) μg/L, 12.36(SD:6.93)μg/L and 14.65 (SD:8.07)μg/L,respectively), as well as that of the control group (4.68 (SD: 1.25) μ/L and 11.06(SD:8.03) μg/L in serum and BALF, respectively (P < 0.05). TSGF in the serum and BALF from the normal and afflicted side of malignant PSPN patients was 88.73 (SD:13.51)μg/L, 110.73 (SD: 18.64) μg/L and 162.80(SD:58.89) μg/L, respectively, which were significantly higher than that of the benign PSPN patients (56.31(SD: 2.43) μg/L, 79.25 [SD: 36.86] and 86.29 (SD: 37.07) μg/L, respectively) (P <0.05). Furthermore, in the malignant PSPN patients, TSGF and CEA in the afflicted side were significantly higher than that of the normal side. Sensitivity, specificity and accuracy of TSGF in BALF from the afflicted side for malig-nant diagnosis were 86.6%,100.0% and 98.6%,respectively,which was higher than that of CEA (70.2% ,78. 9% and 76.5% respectively) and that of serum TSGF (73.1% ,88.9% and 85.7% respectively). Conclusions TSGF in bronchoalveolar lavage fluid and serum has a significant role in differential diagnosis of benign and malig-nant periphery solitary pulmonary nodules. Furthermore, measurement of TSGF in bilateral BALF is helpful in diag-nosis of tumor location.

Objective To observe the correlation of histologicalactivity(HAI) of chronic hepatitis B (CHB) with CCL20 expression, and to investigate the impact of CCL20 expression in CHB infection. Methods On the basis of established competitive quantitative RT-PCR with an internal standard, the expression of the CCL20 in the hepatocytes in different infected patterns of HBV infected cells and liver biopsies were quantified and at the same time its correlation to HAI were explored. Results In the cell levels, the expression quantity of CCL20 in control cells (HepG2), persistent HBV infected hepatocytes( HepG2. 2. 15) are (2. 65 ± 0. 02) pg/106 cells, ( 1.22± 0. 04) pg/106 cells, respectively. There were significantly differences between them ( t = 39. 66, P < 0. 01 ). The expression of CCL20 was enhanced in hepatocytes stimulated by PMA but their expression pauern was not changed. Moreover, CCL20 expression in liver biopsies with CHB was (3.54 ± 0. 65 ) pg/20 mg and CCL20 expression in control groups was ( 8. 74±0. 56) pg/20 mg. The expression of CCL20 between two groups was different (t =30. 09,P <0. 01 ) and correlation lied in between HAI and CCL20 expression in liver biopsies of CHB patients ( r = 0. 675, P =0. 023 ). Conclusion CCL20 expression was down-regulated and it was correlated to HAI of liver biopsies in CHB patients.

Objective To determine the concentration of soluble PD-1 (sPD-1) in the sera of patients with recurrent genital herpes (RCH), and to explore the significance of abnormal expression of sPD-1 in RCH. Methods Serum samples were obtained from 88 healthy blood donors, 74 patients with RCH including 34 cases of outbreak-stage RCH and 40 cases of stable-stage RCH. The serum level of sPD-1 was measured by monoclonal antibody labeling and enzyme linked immunosorbent assay (ELISA). Results A significant difference was observed in the serum level of sPD-1 between the patients with RGH and the blood donors (33.06 ± 17.5 μg/L vs. 53.07 ± 26.3μg/L, P < 0.01) and between the patients with outbreak-stage RGH and those with stable-stage RGH (27.47 ± 12.9 μg/L vs. 37.71 ± 19.6 μg/L, P< 0.01). Conclusions There is a low expression of sPD-1 in patients with RGH, which may be one of the mechanisms underlying the escape of HSV- Ⅱ from immunologic surveillance and development of immunological tolerance.

Objective To explore the anatomic characteristics of the peroneal perforator branches and its clinical application as vascularized flap transfer. Methods Twenty fresh cadaver specimen with 40 sides lower limbs were used in this study.Lead oxide gelatin was injected to the whole body,lower extremity radiaograph, spiral CT scan was then used to construct three demention visual model. The peroneal artery and its perforators were dissected,number of peferators,distance to fibular head,diameter and the length of the vascular pedicles were measured and analyzed. From July 2005 to October 2009, forty-three cases with skin defects were performed vascularized transfer in our study,surviving rate and postoperative function were followed up for 6 months to 2 years.Results Perforators were seen most at (9.80 ± 0.93)cm,(13.40 ±0.90) cm,(17.20 ± 1.13)cm,and (21.30 ± 0.77)cm beneath the fibular head with the artery branch diarneter(1.33 ± 0.39) mm,(1.30 ± 0.46)mm,(1.17 ± 0.30)mm,and (1.22 ± 0.23)mm,respectively,while the pedicle length was (5.87 ± 0.73)cm,(5.83 ± 1.73)cm,(5.44 ± 1.09)cm,and (5.10 ± 1.93) cm respectively.In clinic,42/43 free flaps survived.Postoperative outlook were satisfied except in 7 cases,the flaps looked bulky and needed secondary revision.All the donor calves showed good apperaence and function.Conclusion There are 4 regular perferators in lateral calf, while perforators in the middle 1/3 are bigger with relatively longer vascular pedicles which are appropriate for vascularized transfer.

Objective:This study aimed to achieve the early diagnosis and active treatment of adult hemophagocytic syndrome (HPS) and investigate the clinical characteristics and prognostic factors of this syndrome. Methods:A single-center retrospective analysis was performed to analyze clinical characteristics, laboratory findings, and survival data. Results:In 58 patients, the most common clinical manifestations were fever (100%) and splenomegaly (89.7%). The most common laboratory parameters were serum ferritin 500 g/L (100%) and peripheral cytopenia in two or more lineages (96.6%). platelet count, fibrinogen, and lactate dehydrogenase in the death group were significantly lower than in the survival group (P=0.000, 0.001, and 0.000). Survival analysis results showed that infections in the rheu-matological group exhibited good prognosis [the overall survival (OS) time was not reached in 190 d]. Patients with unexplained causes had moderate prognosis (OS time was 60 d);tumor-associated HPS patients had poor prognosis (the OS time was only 30 d). Univariate analysis results showed that patients with Fbg<1.5 g/L, PLT<40×109/L, and LDH≥2000 U/L also exhibited poor prognosis (P=0.000). Multivariate analysis results showed that PLT<40 × 109/L was an independent adverse factor (HR=6.472, 95%CI:1.526-26.065, P=0.011). Conclusion:HPS exhibits complex clinical manifestations and varied etiology. Patients with infection and rheumatism-related HPS had good prognosiss compared with those manifesting tumor-associated HPS. Fbg<1.5 g/L, PLT<40×109/L, and LDH≥2 000 U/L were the univariate factors that affected the survival time of patients. PLT<40×109/L is an independent adverse factor. These patients need systemic treatments as early as possible.

Objective To investigate the clinical effects of reparing the complicated soft tissue defects of limbs with free thoracodorsal artery perforator (TDAP) flaps.Methods From April,2009 to March,2014,19 limbs (including 8 upper limbs and 11 lower limbs) soft tissue defects with bone and tendon exposure were repaired with free TDAP flaps in the secondary stage.There were 12 thoracodorsal artery perforator flaps,5 polyfoliate perforator flaps,1 chimeric muscle flap,and 1 chimeric muscle polyfoliate flap.The sizes of the flaps ranged from 5.0 cm×6.0cm-20.0 cm×l 1.0 cm.Seventeen wounds of the dornor site were closed directly,and the other 2 were closed with skin grafts.Results Sixteen flaps survived successfully.Two flaps had venous congestion and survived at last after taking the stitches out.One flap had partial necrosis and repaired by skin graft finally.The clinical results were satisfactory after 12-18 months following-up,and the scars of the dornor sites of all but 3 patients were not obvious.All the shoulder function were normal.Conclusion The TDAP flap has dependable blood supply,good texture,less dornor site morbility.The polyfoliate TDAP flap can be used for repairing irregular defect.The chimeric latissimus TDAP flap can be used for the function reconstruction.The free TDAP flap is suited for repairing soft tissue defects of the limbs.

ObjectiveTo explore the relationship among the aggressive behavior,hostile attribution bias and childhood trauma in schizophrenic patients.Methods 135 schizophrenic patients were tested with Modified Overt Aggression Scale (MOAS),the Chinese-version of the Ambiguous Intentions Hostility Questionnaire (AIHQ-C) and Childhood Trauma Questionnaire (CTQ).According to the score of the MOAS,the patients were divided into the aggressive group ( n =58 ) and the non-aggressive group ( n =77 ).The hostile attribution bias and the childhood trauma were compared between the two groups,and correlation and hierarchical regression analysis were used to investigate the relationships of the variables.ResultsCompared with the non-aggressive patients,the aggressive patients had significantly higher AIHQ-C total hostility bias score (6.27 ± 1.20 vs 5.90 ± 0.97,P ＜0.05 ),total blame bias score (8.04 ± 1.97 vs 6.91 ± 2.10,P ＜ 0.01 ) and total aggression bias score ( 6.17 ±1.02 vs 5.59 ± 1.04,P ＜ 0.01 ).Correlation analysis showed that the MOAS score,AIHQ scores and the total score of CTQ were significantly positively correlated with each other ( r =0.171 ～ 0.350,P ＜ 0.05 ～0.01 ).Regression analysis indicated the hostile attribution bias directly predicted the aggressive behavior( β =0.342,P ＜0.05) and completely mediated the relationship between the childhood trauma and the aggressive behavior.ConclusionThe aggressive behavior in schizophrenic patients is associated with the experience of childhood trauma and the attribution style.The childhood trauma indirectly influences the aggressive behavior by the mediating of the hostile attribution bias.

ObjectiveTo investigate the role of protein kinase C-epsilon (PKCε) gene silenced by small interfering ribonucleic acid (siRNA) in inhibiting the development of cholangiocellular carcinoma and its mechanism.MethodsHuman cholangiocellular carcinoma QBC939 cells were respectively transfected using PKCε-siRNA and negative control (NC)-siRNA to establish PKC group and NC group. And untransfected control (CTRL) group was established. Cell counting kit (CCK)-8 assay was used to define the cell proliferation inhibition rate. Cell apoptosis rate was detected by flow cytometery. The expressions of protein PKCε and survivin were detected by Western blot. The comparison of three groups was conducted using one way analysis of variance and pairwise comparison using LSD-t test.ResultsThe cell proliferation inhibition rates at 24, 48, 72 h [(7.52±0.33)%, (15.28±0.20)%, (37.12±0.45)% ] increased gradually in PKC group, where significant difference was observed compared with those in CTRL group (LSD-t=15.37, 27.12, 35.05;P<0.05). The cell apoptosis rate was (56.9±6.1)% in PKC group, which was significantly higher compared with that in CTRL group [(12.5±1.3) % ] (LSD-t=28.55,P<0.05). The expressions of protein PKCε and survivin decreased in PKC group compared with those in NC group and CTRL group.ConclusionPKCε gene silenced by siRNA may inhibit the development of cholangiocellular carcinoma through down-regulating the expression of protein survivin and promoting cell apoptosis.

Objective To study the analysis of ureteroscopy for the treatment of urinary calculi holmium laser combined with the clinical efficacy and complications. Methods Clinical data of 162 cases with urinary calculi from January 2011 to December 2012 were studied,they were divided into the observation group 81cases and control group of 81 cases,the observation group of holmium laser combined with ureteroscopy,the control group used conventional shock wave lithotripsy in the treatment of urinary calculi,compared the clinical efficacy of the two groups. Results About 93.8%stones were fragmented in one treatment session;The time of surgery was 25~125 min(average 57 min);After the opera-tion, length of hospital was 2~10 d (average 6.0 d); Row of net stones in time was 2~6 w(average 3 w). The experimen-tal group were 81 cases,the total effective rate was 100.0%;The control group were 70 cases,the total effective rate was 86.4%,had significant difference(P<0.05). Conclusion Holmium laser combined with ureteroscopy clinical curative effect of treatment of urinary calculi is safe and effective,with less complications,is worth the clinical promotion.

Objective To explore how to achieve isolation of clinical trial fees and general medical expenses of hospitalized subjects through information technology.Methods This article analyzed various methods for separating clinical trials fees from medical insurance and suggested that all methods need to protect subjects'medical insurance reimbursement rights and ensure that they do not occupy medical insurance funds.Based on this principle,A clinical trial cost segregation information module was developed based on inpatient's workstation.Results Through this information module,subjects could choose their medical status according to the actual medical situation.Doctors could issue medical orders in hospital information system(HIS)according to normal medical or trail needs,change the nature of the orders by adding or deleting clinical trial tags.The system automatically intercepts the clinical trial orders for reimbursement of medical insurance,while other expenses are reimbursed according to rules of medical insurance.Conclusion The application of this information module has improved the subjects'enthusiasm and compliance to participate in clinical trials,reduced their economic burden,and ensured their rights to enjoy reimbursement of medical insurance,which can be used as a reference example for newly registered clinical trial institution.