Objective To study the clinical characteristics of healthcare-associated pneumonia (HCAP).Methods A retrospective cohort study was conducted on consecutive hospitalized pneumonia cases from January 2007 through April 2008.Results HCAP group of 75 patients was compared with 133 patients of community-acquired pneumonia (CAP) and 76 patients of hospital-acquired pneumonia (HAP). Most of HCAP patients had a history of recent hospitalization (47 cases), clinical IV infusion (27 cases), and prior chemotherapy or antibiotic therapy (27 cases). Underlying diseases were identified in 71 (94.7%) of HCAP patients, significantly higher than that in CAP group (37.6%, P<0.01). Positive sputum culture in CAP, HCAP and HAP was 22.6%, 56.9%, 77.6% respectively. Antibiotic resistance of bacteria in HCAP (71.43%) and HAP (80%) was comparable (P>0.05). Initial antibiotic therapy was effective in 47 (62.6%) cases of HCAP. Only 52.9% of the identified pathogens were sensitive to initial antibiotic therapies. The mortality of HCAP (12%) was similar to HAP (23%, P>0.05), but significantly higher than CAP (3%, P<0.05).Conclusions HCAP is a common type of pneumonia, which is characterized by more resistant pathogens, higher mortality, more comorbidities and poor outcomes. Antibiotic therapy should cover the hospital acquired bacterial pathogens.

Objective To investigate whether the left ventricular delayed contraction site determined by tissue Doppler imaging might be an optimal left ventricular lead position for improved outcomes of cardiac resynchronization therapy (CRT) in patients with non-ischemic cardiomyopathy. Methods Thirty-three patients subjected to CRT were selected, and all were performed conventional ultrasound cardiography and tissue Doppler examinations before operation. The left ventricular delayed contraction site was determined according to the interval between the onset of QRS and the peak systolic velocity. Retrograde coronary venography was performed during operation, and the left ventricular lead site was selected according to the left ventricular delayed contraction site determined by tissue Doppler examination before operation. The coronary sinus lead site was determined under the guidance of X ray of dorsaventral, lateral, right anterior oblique and left anterior oblique positions. Patients were divided into group A(n=20, the left ventricular lead site was in line with the delayed contraction site) and group B (n=13, the left ventricular lead site was not in line with the delayed contraction site). Results There was no significant difference in age, NYHA grading, left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF), pulmonary arterial systolic pressure, QRS width and Ts-SD between the two groups before operation(P> 0.05). Six months after CRT, there was no significant difference in NYHA grading, LVESV and mitral regurgitation(MR) grading between the two groups(P>0.05), while the increase in LVEF and decrease in LVESV of group A were more significant than those of group B (P<0.01). Conclusion In patients with non-ischemic cardiomyopathy, CRT significantly improves left ventricular performance, and the more favourable outcomes are achieved in those pace at the delayed contraction site. Tissue Doppler imaging may help to guide the implant of left ventricular lead.

Objective To investigate the efficacy and safety of CT-guided radiofrequency ablation (RFA) in treating lung tumors. Methods A total of 33 patients with lung cancer (35 lesions in total), who were admitted to authors’ hospital during the period from May 2007 to August 2013 to receive treatment, were enrolled in this study. RFA was carried out in all patients. After RFA the patients were followed up regularly (once every 3 months) to evaluate the therapeutic efficacy and the adverse reaction. The deadline for the following-up was November 2013, or to the time when tumor progression occurred. Results Of the total 34 lesions in 32 patients who had received RFA and had complete follow-up data, the one-year local control rate was 85.3%. The average one-year progression-free survival rate was 75.0%, among them 15 cases with primary lung cancer had a mean one-year progression-free survival rate of 80.0% and 17 cases with metastatic lung cancer had a mean one-year progression-free survival rate of 70.6%. The overall median progression-free survival (PFS) was(18.0±1.3) months. No obvious correlation existed between PFS and age, sex, tumor size, pathological type, clinical stage (P<0.05). The main adverse reactions of RFA were pain, hydrothorax and pneumothorax; no serious life-threatening complications occurred. Conclusion RFA is a safe, effective and minimally-invasive treatment for lung cancer, regardless of early stage or late stage of the tumor.

ObjectiveTo understand the clinical and histopathologic diagnostic criteria for aneurysmal fibrous histiocytoma(AFH).MethodsThe clinical and histopathological features of 5 patients with AFH were retrospectively reviewed.ResultsThere were 3 males and 2 females in these patients.All the tumors clinically manifested as dark erythematous or brown nodules.Three cases had a recent history of rapid growth.The lesions were located on the limbs(n =3),or chest and lower mandible(n =2).Histopathological examination of skin biopsies showed typical features of dermatofibroma,accompanied by many irregular cleftlikeorcavernousblood-filledspaceswithnumeroushemosiderinpigmentsinallofthesecases.Immunohistochemically,the tumor cells were immunoreactive to vimentin and CD68 but negative for CD34 or CD31.Conclusions In view of a history of recent rapid growth,the presence of hemorrhagic pseudocysts and high vascularity,AFH should be differentiated from angiosarcoma and angiomatoid fibrous histiocytoma.

Objective To discuss the method of the surgical treatment for retained and regenerate hepaticolithiasis, and to improve the theraputic level. Methods In recent 5 years,in our hospital,136 cases of retained and regenerate hepaticolithiasis were treated by combination of hepatolobectomy with other operation, and these cases were analyzed retrospectivly. Results One patient died after operation (0. 7%),8 patients had other complications including: biliary fistuta(6 cases, 4.4%), subphrenic abscess (2 cases,1.5%). All cases were visited for 2.5 - 8.3 years, 115 (84.6%) cases had not any symptom, 6 (4.4%)cases had infection of biliary tract, 6(4.4%) cases had retained calculus, 9(6.6%) cases recurred calculus 2 -5 years after operation. Conclusion Retained and regenerate hepaticolithiasis should be treated by combination of hepatolobectomy with other operation and fiber choledochoscope and B ultrasound of operation, which can increase therapeutic effect.

Objective To assess the clinical and histopathological features as well as treatment of Wells syndrome.Methods The clinical and pathological findings from 7 patients with Wells syndrome were retrospectively reviewed.Results Lesions were located on both lower extremities in 4 patients,on the back in 1 patient,on the face and trunk in 1 patient,and on the buttocks in 1 patient.Clinical manifestations included cellulitis (n =3),urticaria (n =1 ),annular plaques (n =1 ) and papulonodules (n =2).Histopathological examination of skin biopsies showed an infiltrate of numerous eosinophils with occasional flame figures in the dermis of all the patients.Leucocytoclastic vasculitis was found in 3 cases.No triggering factors were found in any of the 7 cases.The lesions nearly subsided in 3 patients after 2-week treatment with oral small-dosage prednisone and tripterygium glycosides.Conclusions Wells syndrome shows a wide diversity of clinical manifestations with distinct histological features.Systemic glucocorticoids and tripterygium glycosides are effective for the control of this condition.

Objective To measure the expression of hypoxia-inducible factor (HIF)-1α in acral malignant melanoma (MM) tissue and to investigate its relationship with the stem cell factor (SCF)/c-kit pathway.Methods Immunohistochemical staining was performed to measure the expression of HIF-1α in tissue specimens from lesions of 93 patients with acral MM,21 with non-acral MM,39 with acral melanocytic nevi,and from the normal acral skin of 15 healthy human controls.Meanwhile,the expression of c-kit was detected by immunohistochemical staining in the 93 acral MM tissue specimens.Statistical comparisons were carried out by chi-square test and Mann-Whitney U test.The relationship of HIF-1α expression with c-kit expression as well as tumor progression and staging was assessed by Spearman correlation analysis.Results Immunohistochemistry showed that the expression rate of HIF-1α was 87.10％ (81/93) in acral MM specimens,90.48％ (19/21) in non-acral MM specimens,15.38％ (6/39) in acral melanocytic nevus specimens,but 0 (0/15) in the normal acral skin specimens.The expression of HIF-1α was significantly higher in acral MM lesions than in normal acral skin and acral melanocytic nevus lesions (both P ＜ 0.01),and significantly different between acral MM and non-acral MM lesions (P ＜ 0.01).Moreover,HIF-1α expression was positively correlated with Clark level and Breslow depth of melanoma (rs =0.442,0.368,respectively,both P ＜ 0.01),with the progression of acral MM (from in situ to aggressive and metastatic MM) (rs =0.420,P ＜ 0.01),and with the expression of c-kit (rs =0.307,P ＜ 0.01).Conclusions HIF-1α is highly expressed in acral MM,positively correlated with the staging,progression and aggression of MM,and co-expressed with c-kit in acral MM tissue,suggesting that both HIF-1α and c-kit take part in the pathogenesis of acral MM.

Objective To evaluate the safety and clinical efficacy of CT-guided 125I seeds interstitial implantation in treating the refractory liver cancers that show poor response to commonly used therapies. Methods A total of 40 patients with refractory clinically or pathologically-proved liver cancer were enrolled in this study, the diseases included primary liver cancer (n = 27, with coexisting portal vein cancerous thrombus in 2) and metastatic liver cancer (n = 13). CT-guided 125I seeds interstitial implantation was performed in all patients. Preoperative plan of seeds implantation protocol was formulated by using the treatment plan system (TPS); the 125I seed activity was 0.6 -0.8 mCi and the peripheral matching dose (MPD) was 100 -140 Gy. The procedure of 125I seeds interstitial implantation was performed under local anesthesia in all patients. By using percutaneous trans-hepatic puncturing and single-or multiple-needle technique, the 125I seeds were implanted along a line parallel to the long axis of the tumor and/or tumorous thrombus with an interval of 0.5 -1.0 cm. The short-term efficacy was evaluated by modified response evaluation criteria in solid tumors (mRECIST), and the median time to tumor progression (mTTP) and the median overall survival time (mOS) were calculated by Kaplan and Meier method. Results The technical success rate was 100%. The diameter of the tumor was 1.5 -12.0 cm (mean 4.0 cm), and a total of 1 748 125I seeds were implanted in 40 patients (mean 44 seeds per patient). The short-term effective rate was 37.5%(n = 15), including complete remission in 8 cases and partial remission in 7 cases, the stable disease was seen in 15 cases (37.5%), and the disease control rate was 75%. The mTTP was 7.0 months (95%CI:4.524-9.476 months), while mOS was 10 months (95%CI: 6.901 -13.099 months). The procedure-related adverse reactions included small amount of subcapsular hemorrhage (n =2, 5%), intrahepatic migration of 125I seeds (n=2, 5%), pain at liver area (n=1, 2.5%); and no special treatment was needed in these patients. One patient developed high fever with chills 3 hours after the procedure, which was relieved after symptomatic and antipyretic treatment. Conclusion For the treatment of refractory liver cancers, CT-guided 125I seeds permanent interstitial implantation, used as a remedial therapy, is safe and effective. This technique is worth popularizing in clinical practice.

Objective To investigate the regularity of abdominal pain and its influence factors in patients with primary hepatic carcinoma (PHC) after receiving transcatheter arterial chemoembolization (TACE).Methods A total of 121 patients with PHC were enrolled in this study.All patients were admitted to the Department of Interventional Radiology of Zhejiang Provincial Cancer Hospital from December 2012 to June 2013,and all patients were suffered from PHC.The occurrence,duration and severity of the abdominal pain as well as the used dosage of morphine within 48 hours after TACE were documented.The results were statistically analyzed.Results A total of 96 patients (96/121,78.5％) complained of different degrees of abdominal pain after interventional therapy,and 72 patients (72/121,59.5％) showed moderate to severe pain,with the VAS score being more than 4 points.The average dosage of morphine used each time for one patient was 19.7 mg.Statistical analysis indicated that these patients were more prone to develop abdominal pain after TACE if they carried more than one of the following risk factors:age ≥60 years (when compared with patients ＜60 years,OR:0.307,P=0.008),preoperative ECOG score ＞2 (when compared with a ECOG score of 0-1,OR:0.195,P=0.006),the distance between tumor and liver capsule ＞1 cm (when compared with the distance ≤ 1 cm,OR:0.296,P=0.007),the use of THP in performing chemoembolization (when compared with other chemotherapeutic drugs,OR:0.232,P＜0.003 4).Conclusion After TACE abdominal pain is a high-frequency event.The independent factors affecting the occurrence of abdominal pain are age＜60 years,preoperative ECOG score ＞2,tumor located close to liver capsule,and the use of THP-lipiodol mixture as embolic agent.Therefore,for patients carrying moderate-high risk of abdominal pain,routine use of analgesics before TACE as well as within 12 hours after TACE to prevent the occurrence of abdominal pain is quite necessary.

Background The incidence of posterior capsular opacification (PCO) is increasing with the growing of cataract surgery rate.Recent researches provend that disintegrin has inhibitory effect on PCO,and echistatin is one of the disintegrin prime families.Objective This study was to investigate the effects of disintegrin and echistatin on proliferation,adhestion and migration in human lens epithelial cells (LECs) line (SRA01/04).Methods Human LECs line at logarithmic growth phase was used in the study.Cells were cocultured with medium and different concentrations of echistatin (0,2.5,5.0,7.5,10.0,15.0,20.0 mg/L) for different time.The proliferative inhibitory rates of LECs were detected by MTT method 24,48 and 72 hours after cultured.Anti-adhesion effect of echistatin were analyzed by the same assay in 90 minutes.Cell scratching test was performed to evaluate the migration ability of LECs.The width of the scratch was recorded in the culture plate covered with cells under an inverted microscope.After being cultured for 24 hours and 48 hours with echistatin,cell migration distances was examined.Results Compared with the 0 mg/L echistatin group,cells proliferation was obviously inhibited.After cultured with 2.5,5.0,7.5,10.0,15.0,20.0 mg/L echistatin,the proliferation inhibitory rate was 2.6％,15.4％,21.2％,34.7％,46.1％,58.2％ at 24 hours;6.6％,21.9％,38.2％,50.0％,60.7％,76.9％ at 48 hours and 9.8％,29.0％,46.6％,63.4％,69.1％,92.4％ at 72 hours,respectively.The absorbance value (A) in the 5.0,7.5,10.0,15.0,20.0 mg/L groups were significantly lower than that in the 0 mg/L group (P＜ 0.05).With the prolongation of acting time of Ecs,the A value of the cells was gradually reduced,with statistically significant difference (P＜0.05).The adhesion inhibitory rate was 2.6％,15.0％,26.1％,35.3％,45.2％ and 54.5％ in the 2.5,5.0,7.5,10.0,15.0,20.0 mg/L group,respectively.Compared with the result in the 0 mg/L group,the A value in the 5.0,7.5,10.0,15.0,20.0 mg/L group was statistically significant (P＜0.05).After cultured for 24 hours and 48 hours,cell migration distance shortened in the 5.0,7.5,10.0,15.0,20.0 mg/L group,showing a statistically significant difference among them (P＜0.05).Cell migration distance was gradually shortened with the lapse of action time of Ecs with the significant difference (P ＜ 0.05).Conclusions echistatin has inhibitory effects on proliferation,adhestion and migration for human LECs in vitro in time-and dose-dependent manner.It is inferred that echistatin may play a role in the prevention and treatment of PCO.