Objective To explore and describe the sampling methods for aerosol from cooling towers in the centralized air conditioning system, early-warning indicators, the effect factor and present status of contamination by Legionella.Methods Air-conditioning systems were sampled two rounds in 13 guesthouses, markest and bathing spots of Maanshan City in June-August, 2008.Aerosols were collected by fluid-striking microbial aerosol sample collector, while water samples from cooling tower and swelling box were obtained.Legionella were determined respectively for 67 samples by germiculture and polymerase chain reaction.Results The positive rate of Legionella in aerosols by germiculture was 0, meanwhile it was 50.0% by polymerase chain reaction for Legionella pneumophila.The positive rate in aerosols was 90.0% as the air-sampling volume exceeded 400 L.The positive rate of aerosols increased while the operating-time of cooling tower increased.The relative humidity in Legionella positive groups was higher than that in Legionella negative groups.Conclusion The positive result for Legionella pneumophila by polymerase chain reaction should be an important indicator for early-warning for the occurrence and spreading of Legionnaires' disease.The air-sampling volume of over 400 L is available by sampling collector for the detection of Legionella pneumophila by polymerase chain reaction.Risk of Legionella contamination in aerosol would be raised in high-humidity environment.

Objective To assess the long-term efficacy and safety of mid-dosage (13～15 mg?kg-1?g-1) ursodeoxycholic acid (UDCA) treatment for primary biliary cirrhosis (PBC). Methods A systematic review of all randomized controlled trials (RCT) comparing UDCA with placebo was performed. Results Seven trials including 1038 patients were assessed. UDCA could significantly improve liver biochemistry, but had no effect on pruritus and fatigue. In the patients with initial stage Ⅰ-Ⅱ, there was a significant decrease in the histologic progression after treatment with UDCA for 2 years compared with the placcebo group(P=0.03), but there was no significant difference between the two groups when considering overall patients with initial stage Ⅰ-Ⅳ (P=0.08). Meta-analysis showed no significant difference in the incidence of death (odds ratio 0.99, 95% confidence interval 0.62-1.58), liver related death (1.05, 0.53-2.05), liver trans-plantation (0.87, 0.53-1.41), death and/or liver transplantation (0.92, 0.64-1.31) and liver decompensation (0.94, 0.60-1.49) between the UDCA and placebo groups. Conclusions The analysis of RCTs of UDCA versus placebo shows improvement of liver biochemistry, but not improvement of clinical symptoms and survival. UDCA may slow down liver histologic progression in the early-stage patients with PBC.

Objective To explore the application effect of Sandwich teaching method in clinical teaching in the department of neurosurgery.Methods Totally 144 clinical medicine students were divided into 2 groups:Sandwich teaching group (n=72) and traditional teaching group (n=72).The analysis of test and the questionnaire of the students were conducted after the course.Comparison between the two groups was made using independent sample t test and measurement data were expressed as as ± s.P＜0.05 signifies statistically significant differences.Rank sum test was used to compare the distribution of the test scores.Results The test score was statistically higher in Sandwich teaching group than control group [(76.38 ± 10.84) vs.(69.67 ± 10.50)].And the main distribution of the test scores was 70～90 in Sandwich teaching group while 60～80 in control group.Questionnaire showed that the scores of Sandwich teaching group were statistically higher than those ofthe control group in five aspects such as enhancing self-learning ability,improving the ability to analyze and solve problems,and so on.Conclusions Sandwich teaching method achieves good teaching effect and it is worth recommending in clinical teachifig.

Objective To discuss the relationship between prognosis and different surgical procedures for gallbladder cancer in different stages. Methods The clinical data of 107 patients with gallbladder cancer from January 2001 to May 2007 were retrospectively analyzed. The surgical procedure was chosen according to different stages. Results Eighty-one of the 107 patients (75.6%) were followed up with the median time of 5 years. Of the 10 patients with stage Ⅰ gallbladder cancer who had underwent simple cholecystectomy, 9 survived. Of the 8 patients with stage Ⅱ gallbladder cancer, 3 received palliative cholecystectomy and the median survival time was 12 months, which was significantly shorter than 24 months of the remaining 5 patients who received radical operation (X2= 5.698, P <0.05). Of the 42 patients with stage Ⅲ gallbladder cancer, 18 received radical operation, and the median survival time was 24 months, which was not significantly different from 18 months of the 5 patients who received extended radical operation (X2=0.238, P>0.05). The remaining 19 patients received palliative operation, and the median survival time was 6 months, which was significantly shorter than those of patients received radical operation or extended radical operation (X2=5.772, 6.318, P <0.05). There were 47 patients with stage Ⅳ gallbladder cancer. Seventeen patients received extended radical operation and 30 received palliative operation, and no significant difference upon the median survival time was observed among different surgical procedures (X2=0.001,0.694, P>0.05). The complication recurrence after the extended radical operation was significantly higher than palliative operation (X2=6.039, P<0.05). Conclusions For patients with stage Ⅰ gallbladder cancer, simple cholecystectomy is preferred. Radical operation is good for patients with stage Ⅱ gallbladder cancer. The choose of radical operation or extended radical operation for patients with stage Ⅲ gallbladder cancer should be based on the condition of invasion. Palliative operation could be used to patients with stage Ⅳ gallbladder cancer.

OBJECTIVE:To evaluate therapeutic efficacy of Xuebijing injection in the treatment of severe craniocerebral trau-ma. METHODS:67 patients with severe craniocerebral trauma selected from neurosurgery department of our hospital were Treat-ment method divided into treatment group(33 cases)and control group(34 cases). Observation group was given conventional treat-ment,i.g. oxygen inhalation,dehydration,nourish cranial nerve,anti-infection. Treatment group On the basis of the control group was given Xuebijing injection 50 ml/time,tid,ivgtt. PT,TT,PLT,FIB,CK,LA, D-D,blood gas index (PaCO2,PaO2, HCO3-)of 2 groups were observed after 7 days of treatment,and prognosis of 2 groups were evaluated after 6 months as well as therapettin efficacy. RESULTS:After treatment,PT,TT,PLT,FIB,CK,LA, D-D,PaCO2,PaO2 and HCO3- of 2 groups were all better than before,and the treatment group was better than the control group,with statistical significance (P<0.05). The rate of good prognosis in treatment group (78.79%) was significantly better than in control group (55.88%) after 6 months of treat-ment,with statistical significance(P<0.05). CONCLUSIONS:Xuebijing injection in the treatment of severe craniocerebral trau-ma can improve coagulation function,blood gas levels and the inflammatory reaction,and is conducive to improve the patient's prognosis.

Aim To study the inhibitory effects of gambogenic acid in combination with miR-218 on cervical cancer HeLa cells and its mechanisms.Methods Eukaryotic expression vector of miR-218(pmi8-218) was transfected into HeLa cells.Transcript levels of miR-218 were quantified by real-time quantitative PCR.HeLa cells were incubated with different concentrations of gambogenic acid alone or in combination with pmiR-218.The cell growth inhibiting ratio of HeLa cells was assessed by MTT assay.Cell apoptosis was measured by fluorescence activated cell sorting.The expression levels of Bcl-2, Bax and E-cadherin were measured by Western blot and qRT-PCR.Results Levels of miR-218 transcript significantly increased in pmiR-218 transfected HeLa cells.Overexpression of miR-218 may enhance the sensitivity of HeLa cells to gambogenic acid.Over expression of miR-218 could enhance the effect of gambogenic acid on inhibition cell proliferation, promoting apoptosis of HeLa cells.pmiR-218 could enhance the regulation of Bax expression and decrease the expression of Bcl-2 in HeLa cells.Conclusions Over expression of miR-218 may enhance the sensitivity of HeLa cells to gambogenic acid;miR-218 can enhance the effect of gambogenic acid on inhibition cell proliferation and promote the apoptosis of HeLa cells, and the mechanism may be related to down-regulation of Bcl-2/Bax expression.

Objective:To explore the clinical effect of prostatil combined with diosmin on the elderly patients with chronic prostatitis (CP) and the macrophage inflammatory protein-2 (MIP-2) and macrophage inflammatory protein-lα (MIP-lα) in prostate fluid and serum.Methods:126 cases of elderly patients with CP in our hospital fiom January 2015 to September 2016 were selected and randomly divided into two groups.Prostatil combined with diosmin were provided to the patients in observation groups (63 cases) while the control group (63 cases) was treated by prostatil alone.The clinical effect,MIP-2,MIP-1α levels in the prostate fluid and serum before and after therapy as well as the incidence of adverse reactions were observed and compared between two groups.Results:At 12 weeks after treatment,the total effective rate of observation group was 93.7％,which was obviously higher than that of the control group (81.0％,P＜0.05).The MIP-2 and MIP-1α levels in prostate fluid and serum of both groups at 12 weeks after therapy were significantly lower than those before therapy (P＜0.01),which were significantly lower in the observation group than those of the control group at the same time (P＜0.01).There was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion:Prostatil combined with diosmin could more safely and effectively improve the clinical efficacy in the treatment of elderly patients with CP/CPPS,which might be related to reduce the levels ofMIP-2,MIP-lα in serum and prostatic fluid.

Purpose To investigate the clinicopathologic characteristics of colorectal metastatic tumors. Methods Cases which were clinically diagnosed as metastatic tumors to the colorectum were retrieved from the data base of the Department of Pathology, Peking U-niversity Third Hospital. The clinicopathologic features were studied and immunohistochemical stains were performed on some of the ca-ses for differential diagnosis. Results Fifty three cases which showed intestinal wall involvement were studied. In 43. 4% (23/53) of them, only serosa/subserosa was involved and mucosal involvement was observed in 37. 7% (20/53) of the cases. Sigmoid colon and rectum were the most frequently involved intestinal segments (24/53, 45. 3%). Female reproductive system was the most common ori-gin of the metastatic tumors (33/53, 62. 3%), followed by the digestive system (15/53, 28. 3%). The most common histological type was ovarian serous carcinoma (22/53, 41. 5%). 96. 2% (51/53) of the metastatic tumors were centrally located at the serosa/subserosa or the muscular propria and prominent lymphovascular invasion was observed in 26. 4% (14/53) of the cases. In cases with mucosal involvement, 35% ( 7/20 ) had foci that were lack of desmoplastic reaction, 20% ( 4/20 ) exhibited in-situ growth and/or paradoxical maturation of tumor cells which led to misdiagnosis in 2 of the 17 pre-operative biopsies. Conclusions Metastatic carcino-ma in the colorectum can be highly informed by predominantly involving the serosa/subserosa or muscular propria and prominent lym-phovascular invasion. In-situ growth and paradoxical maturation of tumor cells in the mucosa are diagnostic pitfalls in pre-operative co-lonic biopsy and should be aware in practice.

Medical imaging teaching depends on support from multimedia database which is constructed with image information provided by PACS/HIS ( Picture archiving and communication system/Hospital information system ).This paper evaluated construction,administration and application of the multimedia database,and illustrated the importance of PACS/HIS in construction of the database,as well as of the database in medical imaging teaching.

BACKGROUND:Traditional core decompression and al ograft fibula supporting can reduce the stress load within femoral head and improve mechanical properties of femoral head. However, it cannot provide supports for maintaining the stability of five pathological areas fol owing femoral head necrosis. OBJECTIVE:To observe the clinical effect of fan-shaped decompression and al ograft fibula supporting internal fixation in treatment of early femoral head necrosis in adults, taking al ograft fibula grants as the control. METHODS:Forty patients with early femoral head necrosis were randomly divided into treatment group and control group, receiving fan-shaped decompression plus al ograft fibula supporting internal fixation and traditional decompression plus al ograft fibula grafting, respectively. The therapeutic effects in two groups were observed and compared. After treatment, patients were detected by bilateral hip anteroposterior films, Harris scoring and X-ray ARCO staging to evaluate the col apse severity and restoration of necrosis. RESULTS AND CONCLUSION:At the last fol ow-up, Harris scores in the treatment group were significantly higher and the repairing effect was better than control group (P<0.05). In treatment group, 18 hips restored wel (72%) and 7 hips delayed or failed to restore (28%);in control group, 9 hips restored wel (60%) and 6 hips delayed or failed to restore (40%). Our findings indicate that, fan-shaped decompression plus al ograft fibula supporting internal fixation yields a more complete decompression, a higher stability of femoral head and a more reliable supporting, compared with traditional decompression plus al ograft fibula grafting.