We reported 2 cases of descending neerotizing mediastinitis (DNM) and reviewed the related literatures. The etiology, clinical manifestations, imaging manifestations, diagnostic criteria and therapeutic strategies of DNM were discussed. It is concluded that descending necrotizing mediastinitis is a life-threatening disease with high mortality and is prone to be misdiagnosed. Early diagnosis, prompt application of sensitive broad-spectrum antibiotics and abscess drainage with proper surgical medality may improve the prognosis of DNM.

Objective To discuss the influence on peripheral circulation and oxygenation of different colloid osmotic pressure (COP) in pediatric cardiac surgery under cardiopulmonary bypass (CPB).Methods Sixty cases of non-cyanotic congenital heart disease patients under 10 kg were randomly selected and divided into 3 groups(n =20) according to the different COP level.COP values was adjusted by the ultrafiltration technique and colloid addition.The perioperative(T1-T6) arterial lactate level,different value between skin and rectal temperature,peripheral oxygen saturation (SpO2) and oxygenation index (OI) were observed in order to determine the different effect on peripheral circulation and oxygenation.Meanwhile,mechanical ventilation time and ICU time were recorded.Results The variation tendency of arterial lactate level was similar in each group,the value in the COP ＞ 18 mmHg (1 mmHg =0.133 kPa) group(group C) was significantly higher than COP 10-15 mmHg group (group A) and COP 16-18 mmHg group (group B) in T3 and T4,after CPB weaned,the values of Group A (1.25 ± 0.42) and Group C (1.33 ± 0.51) were higher than Group B (0.71 ± 0.29) at T6 point (P ＜ 0.05);the variation tendency of SpO2 was similar in each group too,the value of group C was significantly lower than group A and B at T5 point,the values of group A and C were significantly lower than group B at T6 point,P ＜ 0.05;the different value between skin and rectal temperature in group A was significantly higher than group B and C from T1 to T2 point(P ＜0.05),but not in T3 to T6 point;The minimal OI values of all the groups were appeared in T4 point,group B value was significantly higher than A and C in all time point,group C value was the lowest(P ＜0.05);the mechanical ventilation time in group B(2.13 ± 1.36) days and group C (2.93 ± 1.69) days were significantly lower than group A (3.83 ± 1.47) days,P ＜ 0.05.ICU time of group B (3.9 ± 1.1) days was significantly lower than group A (5.7 ± 2.5) days and C (6.0 ± 1.5) days.Conclusion During the pediatric CPB,the improper COP level will lead to bad oxygenation and poor peripheral circulation,got different prognosis ultimately.A reasonable COP level(16-18 mmHg) will do benefits to all the pediatric patients.

Objective To investigate the distribution and antibiotic resistance of isolated pathogens in neonatal sepsis. Methods The results of blood culture and drug susceptibility test in neonates sepsis from January 2012 to June 2013 were retro-spectively analyzed. Results One hundred and thirty-two strains were detected in the blood samples, with 100(75.76%)Gram-positive bacteria, 30 (22.73%) Gram-negative bacteria and 2 (1.52%) fungus. Staphylococcus epidermidis, Escherichia coli and Staphylococcus aureus were the three most common pathogens. Gram-positive cocci was strongly resistant to penicillin (100.00%), erythromycin, selectrin and ampicillin/sulbactam (62.50%-100.00%), but still sensitive to vancomycin and teico-planin. The resistance rate of Gram-negative bacilli to ampicillin was 100.00%, and the resistance rate to cefatriaxone, selectrin and cefuroxime was 61.54%-100.00%. The resistance rate to imipenem and piperacillin/tazobactam was lower. Conclusions The selection of sensitive antibiotics should be based on the pathogens and drug resistance testing for the treatment of neonatal sepsis.

Objective To explore the diagnosis and treatment of isolated dissection of the superior mesenteric artery (SMA).Methods From Feb 2006 to July 2010,15 patients with isolated SMA dissection were treated in our center,there were 13 males,2 females,the mean age was(53 ± 8) years (range 43 -63).Among them,1 was caused by trauma,14 had unknown etiology,and 9 cases had a history of hypertension.Diagnosis was made by contrast-enhanced computed tomography (CT) in all cases.Management strategies inlcuded placement of self-expanding bare stent,medical treatment,and transperitoneal SMA fenestration.Results Endovascular stenting was attempted in 14 cases,with a success in 5 and a failure in 9 cases who were then given medical treatment with antiplatelet agents.One case with critical intestinal ischemia underwent open exploration and SMA fenestration.Blood vessel patency resumed.Follow-up with duplex and CT was accomplished in 13 cases,time ranging from 12 to 60 months (mean 28 ± 14mos).There was no recurrent abdominal pain or chronic intestinal ischemia developed during the follow-up.In medically treated patients,there was no aneurismal enlargement of SMA,while in the endovasculartreatmentgroup,allstentsremainedpatentthroughoutthefollow-up.Conclusions Endovascular treatment of isolated dissection of SMA appears to be feasible and effective,despite its relatively low technical success rate.For asymptomatic patients,medical treatment is the treatment of choice.In case of critical intestinal ischemia and with a suspected intestinal gangrene,emergency surgical exploration and fenestration should be performed.

Adult ; Arsenic ; pharmacology ; Chromosome Aberrations ; chemically induced ; Dose-Response Relationship, Drug ; Female ; Humans ; Lymphocytes ; drug effects ; metabolism ; Male ; Middle Aged

The contribution of particles to cardiovascular mortality and morbidity has been enlightened by epidemiologic and experimental studies. However, adverse biological effects of the particles with different sizes on cardiovascular cells have not been well recognized. In this study, sub-cultured human umbilical vein endothelial cells (HUVECs) were exposed to increasing concentrations of pure quartz particles (DQ) of three sizes (DQPM1, <1 μm; DQPM3-5, 3-5 μm; DQPM5, 5 μm) and carbon black particles of two sizes (CB0.1, <0.1 μm; CB1, <1 μm) for 24 h. Cytotoxicity was estimated by measuring the activity of lactate dehydrogenase (LDH) and cell viability. Nitric oxide (NO) generation and cytokines (TNF-α and IL-1β) releases were analyzed by using NO assay and enzyme-linked immunoabsorbent assay (ELISA), respectively. It was found that both particles induced adverse biological effects on HUVECs in a dose-dependent manner. The size of particle directly influenced the biological activity. For quartz, the smaller particles induced stronger cytotoxicity and higher levels of cytokine responses than those particles of big size. For carbon black particles, CB0.1 was more capable of inducing adverse responses on HUVECs than CB1 only at lower particle concentrations, in contrast to those at higher concentrations. Meanwhile, our data also revealed that quartz particles performed stronger cell damage and produced higher levels of TNF-α than carbon black particles, even if particles size was similar. In conclusion, particle size as well as particle composition should be both considered in assessing vascular endothelial cells injury and inflammation responses induced by particles.

Objective To investigate the correlation of the anti-cardiolipin(aCL) antibodies and anti-β2 glycoprotein Ⅰ(anti-β2GPI) antibodies in missed abortion women.Methods Fourteen patients diagnosed missed abortion were chose as trial group,while 20 normal females received induced abortion in the same time as control group.Chemiluminescence method was used to measure the serum levels of IgG/IgM aCL and IgG/IgM anti-β2GPI antibodies in the two groups.Results The median levels of serum IgM aCL antibodies and serum IgM anti-β2GPI antibodies in trial group were significantly higher than those of control group(21.3(2.2-39.4)KU/L vs.6.0(1.5-10.7) KU/L,11.9(1.2-25.4) KU/L vs.1.9(1.1-4.0) KU/L;u=2.031,2.912;P ＜0.05).There were no significant differences in terms of the levels of serum IgG aCL antibodies and serum IgG anti-β2GPI antibodies between trial group and control group (P＞0.05).Conclusion There is correlation between IgM aCL as well as IgM anti-β2GPI antibodies and missed abortion,so in reducing the incidence of missed abortion,early and dynamic detection of anti-cardiolipin and anti-β2 glycoprotein I antibodies in childbearing women has a certain clinical significance.

AIM:To explore the role of sphingosine 1-phosphate (S1P) in the dysfunction of vascular endo-thelial cells exposed to high glucose.METHODS: In human aortic endothelial cells cultured under high-glucose ( 22 mmol/L glucose) medium, nitric oxide ( NO) level, polymorphonuclear neutrophil-endothelial cell adhesion rate, protein level of intercellular adhesion molecule-1 ( ICAM-1) , migration of endothelial cells and Akt/endothelial nitric oxide syn-thase ( eNOS) pathway activation were observed after S1P, sphingosine kinase-1 inhibitor and/or Akt inhibitor treatments. RESULTS:S1P decreased NO level, increased polymorphonuclear neutrophil adhesive rate, enhanced ICAM-1 protein level, and inhibited migration of endothelial cells and activation of Akt/eNOS pathway in endothelial cells cultured under high-glucose condition.Sphingosine kinase-1 inhibitor, which reduced S1P content, significantly improved the above endo-thelial cell function indexes and restored the activation of Akt/eNOS pathway.CONCLUSION: S1P promoted high glu-cose-induced dysfunction of endothelial cells probably by inhibiting the activation of Akt/eNOS signal pathway.Targeting S1P is expected to become one of potential treatment strategies to reduce endothelial cell dysfunction.

Objective To compare the results of susceptibility testing by European Committee on Antimicrobial Susceptibility Testing (EUCAST)and Clinical and Laboratory Standards Institute (CLSI)broth microdilution methods against Aspergillus isolates.Methods The susceptibilities of 116 Aspergillus isolates were determined for amphotericin B, voriconazole, itraconazole,caspofungin and micafungin according to EUCAST (E.DEF 9.1 )and CLSI (M38-A2)methods.The essential agreement (EA),categorical agreement (CA),very major errors (VME)and major errors (ME)of the two methods were compared.Results The EA was 96.3%-100% between the two methods.The CA ,ME,and VME were 98.8%,0-1.2% and 0 respectively for the susceptibility of Aspergillus fumigatus to voriconazole.The CA,ME and VME was 1 00%,0 and 0 respectively for the susceptibility of Aspergillus fumigatus and Aspergillus niger to amphotericin B,or the susceptibility of Aspergillus fumigatus and Aspergillus flavus to itraconazole.Conclusions The results of susceptibility testing by EUCAST and CLSI broth microdilution methods are well consistent against Aspergillus isolates.

Objective To evaluate the influence of blood transfusion or pregnancy on blood cross-matching results.Methods 1 000 specimens with blood transfusion or pregnancy history were collected and performed the blood group typing,blood cross matching,irregular antibody screening and identification by the micro-gel method with the specimens of first time transfuse blood and without pregnancy history as the control.The inconsistency rate of positive negative blood grouping,unqualified rate of blood cross matching and the positive rate of irregular antibody were compared between the two groups by the t-test.The causes influen-cing the blood cross-matching results were analyzed.Results The inconsistency rate of blood cross-matching in the blood transfu-sion or pregnancy group was significantly higher than that in the control group(P <0.05);the inconsistency rate of positive nega-tive blood grouping was similar in the two groups(P >0.05);the positive rate of irregular antibody screening in the blood transfu-sion or pregnancy group was also significantly higher than that in the control group(P <0.05),indicating that the main causes in-fluencing blood cross matching was the existence of irregular antibodies in the patients in vivo.Conclusion Blood transfusion or pregnancy may stimulate the body to produce the irregular antibodies.Therefore the irregular antibody screening should be per-formed before blood transfusion and blood without corresponding antigen will be selected for transfusion according to the antibody identification results for ensuring safe and effective blood transfusion.