Most of Mycoplasma pneumoniae pneumonia (MPP) will be controlled after being treated with macrolide antibiotics. But in recent years refractory Mycoplasma pneumoniae pneumonia (RMPP), including severe mycoplasma pneumoniae pneumonia, are increased. RMPP often causes many severe complications and sequelae such as necrotizing pneumonia, bronchiolitis obliterans, bronchitis obliterans, atelectasis and bronchiectasis. Two main mechanisms of MPP are proposed: damages to airway directly by mycoplasma pneumonia (MP), and inflammatory reaction caused by mycoplasma pneumoniae (MP). RMPP is also associated with many other factors such as MP genotype and load, macrolide-resistant MP, airway mucus hypersecretion, hypercoagulability, combined infection with bacteria or viruses, and community acquired respiratory distress syndrome toxin (CARDS Tx). The exploration of mechanisms of RMPP helps us acquire effective treatment and prevent sequelae.

Cough ; Exanthema ; Fever ; Humans ; Respiratory Sounds

Objective To investigate the relationships of peroxisome proliferators activated receptor ?(PPAR?) and matrix metallo protease-7 ( MMP-7) with gastric cancer ( including low and high grade atypical hyperplasia). Methods One hundred and twenty gastric tissue specimens (four groups) were collected by gastroscopy or surgical operation, including 31 patients with chronic gastritis, 25 patients with low-grade atypical hyperplasia, 27 patients with high-grade atypical hyperplasia, and 28 patients with gastric cancer. The expression of PPAR? and MMP-7 were observed by immunohistochemical technique and analyzed by statistic methods. Results Both of them have high expression in the groups of gastric cancer respectively, and the high combined expressions of them were found in gastric cancer and high-grade atypical hyperplasia. Conclusion PPAR? and MMP-7 were the important differential signs of the gastric cancer and precancer by inference, the combined expression of PPAR? and MMP-7 was the evidences in differential diagnosis among gastric cancer, high and low grade atypical hyperplasia and gastritis.

Objective To evaluate the expressions of hypoxia-inducible factor-1α(HIF-1α),vescular endothelial growth factor(VEGF)and survivin in developing colorectal cancer,and the association among them.Methods The protein expressions of HIF-1α,VEGF and survivin were detected in specimens obtained from 69 patients with colorectal cancer and 20 normal controls by immunohistochemistry.The correlations of HIF-1α,VEGF and survivin with clinicopathologic features were analyzed.Results The expression of HIF-1α,VEGF and survivin proteins in patients with colorectal cancer were 56.52%,66.67% and 46.38%,respectively,and little expressed in normal controls(P＜0.01).The expressions of HIF-1α,VEGF and survivin were closely related to the differential grade of adenocarcinoma,he in volvment of penetration,lymph node metastasis and Dukes stage(P＜0.05).In addition,HIF-1α protein expression had positive correlations with both VEGF and survivin(P＜0.05),and the expression ofVEGF also had positive correlation with survivin(P＜0.05).Conclusions HIF-1α may involve in thepathogenesis of colorectal cancer through up regulating the expressions of VEGF and survivin,which mayhave synergetic effects in the pathogenesis of colorectal cancer.

Objective]To investigate the roles of IL-4 activated macrophages on Hela cells migration and invasion and the underlying mechanism.[Methods]The phenotype of IL-4 activated macrophage was assayed by morphology ,flow cytometry and Elisa. The ability of Hela cell migration and invasion was evaluated by transwell assay. The signaling proteins expression was displayed by Western blot.[Results]Il-4 activated macrophage had the phenotype of CD206high/HLA-DRlow ,and highly expressed IL-10 and CCL18 ,and decreased the expression of IL-12. The activated macrophages significantly promoted the migration and invasion of Hela cells ,while the unactivated macrophages did not had this effect. Applying anti-CCL18 antibody but not isotype IgG in the supernatant of IL-4 activated macrophage inhibited Hela cells motility. Furthermore,activated macrophages phosphorylated IKK and IκB and induced the translocation of p65 to nucleus ,eventually increased the expression of vimentin. Treatment of Hela cells with CCL18 also enhanced tumor cells migration and invasion ,as well as the NF-κB activation and vimentin expression.[Conclusion]IL-4 activated macrophages promoted Hela cells motility by secreting CCL18 and the following activation of NF-κB signaling proteins.

Objective To investigate the expression of neurokinin 1 receptor (NK 1R) in the biopsy specimens of colonic mucosa in patients with ulcerative colitis (UC). The relation between the expression of NK 1R and clinical severity of UC was also evaluated. Methods UC tissues were obtained from 38 patients (23 males and 15 females) undergoing colonoscopy. Normal human colon tissues were obtained from 15 irritable bowel syndrome (IBS) patients (8 males and 7 females). Reverse transcription polymerase chain reaction (RT PCR), western blot and immunohistochemistry were used to determine the expression of NK 1R. Results NK 1R mRNA expression level was enhanced in mucosae of UC compared with that of IBS. The overexpression of NK 1R was related to the severity of UC. Western blot analysis revealed that the overexpression of NK 1R protein level existed in UC. Immunohistochemistry showed moderate to strong NK 1R immunoreactivity which was localized in mononuclear cells and lymphoid follicles of lamina propria and in the crypt surface, epithelium, lymphoid follicles, submucosal arterioles and myenteric plexus neurones in the colonic mucosa of UC. Conclusions In patients with UC, the overexpression of NK 1R may be involved in the pathophysiological change in the disease and may contribute to the disruption of neuropeptide loop balance and deterioration of clinical condition.

Objective To evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in pediatric interstitial lung diseases.Methods Retrospective data evaluation the efficacy and application of 10 undiagnosed pediatric interstitial lung diseases patients by No-X-ray guided TBLB between December 2013 and December 2014 were investigated.Results Specimens from all cases were successfully obtained,6 patients were confirmed by pathological diagnoses,and4 patients were confirmed by pathology and clinical manifestations.Among 10 patients,3 of them had allergic alveolitis,2 cases had bronchiolitis obliterans organizing pneumonia (BOOP),1 had pulmonary vasculitis,2 cases had nonspecific interstitial pneumonia,and the other 2 had bronchiolitis obliterans.The complications include 2 pneumothorax,1 case was cured with thoracic cavity closed drainage,and the other case case did not receive special treatment and alleviated himself.No bleeding and other complications occurred.Conclusion The results suggest that TBLB is a safe and effective minimally invasive modality for the diagnosis of pediatric diffuse lung disease.

Objective To explore the clinical significance of adenosine deaminase ( ADA) in pleural ef-fusion for diagnosis of tuberculosis pleuritis in children. Methods The level of ADA in pleural effusion was ret-rospectively analyzed in 28 cases with purulent pleuritis,thirty-four cases with mycoplasma pneumoniae pleuri-tis,forty-five cases with tuberculosis pleuritis from July 2011 to January 2014 in Beijing Children′s Hospital Af-filiated to Capital Medical University. Results The level of ADA in three groups was expressed by median (range interquartile). ADA in the purulent pleuritis group [126. 35 (76. 80,178. 13)U/L]was higher than the group of mycoplasma pneumoniae pleuritis [ 55. 55 ( 42. 80, 79. 03 ) U/L ] and tuberculosis pleuritis [ 26. 50 (22. 05,50. 95)U/L]. The difference was statistically significant (P< 0. 01). The cut-off value of pleural effu-sion ADA for diagnosis of tuberculosis pleuritis is not available by application of ROC curve. Conclusion Higher ADA value is not only the characteristic of tuberculosis pleuritis,but also purulent pleuritis and mycoplas-ma pneumoniae pleuritis. ADA has no clinical value in diagnosis of tuberculosis pleuritis in children.

Objective: To establish the method of percutaneous endoscopic gastrostomy(PEC) and percutaneous endoscopic jejunostomy (PEJ) for enteral nutrition. Methodes: PEG tubes were placed in 114 patients with Pull method. On the foundation of PEG, PEJ tubes were placed in 26 patients by pushing endoscopy to send tubes through Treitz ligment with usingthe the clip. Results: All PEG insertion was performed successfully. PEJ tubes were placed successfully with a new method in 26 patients. 15 patients had a little blooding and 8 patients had slight infection. 21 patients had respiratory tract infection and had been cured by using antibiotic. There was no severe complication. Conclusion: PEG is simple、safe、efficient. The new method of PEJ is feasible.

Objective To sum up the clinical manifestations and laboratory features for the diagnosis of pediatric tuberculous pleurisy,and to improve the recognition of this disease in early stage.Methods A retrospective study of 113 children diagnosed as tuberculous pleurisy from August 2006 to September 2014 in the Second Department of Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University was conducted.Meanwhile,another 113 cases of children with mycoplasma pneumoniae pneumonia complicated with pleurisy were selected as control group.The general information,clinical symptoms,pleural effusion and imaging features between 2 groups were analyzed and compared by using SPSS 16.0 statistical software.Results The proportion of patients with cough in tuberculous pleurisy group and control group was 47.79％ (54/113 cases) and 99.12％ (112/113 cases) (x2 =76.33,P ＜ 0.01) respectively,and the proportion with severe cough was 3.70％ (2/54 cases) and 97.32％ (109/112 cases) (x2 =144.10,P ＜0.01),while the disease duration was 15.00 (10.00,30.00) days and 10.00 (8.00,14.50) days (W =8 668.00,P ＜ 0.01),respectively,and all the differences between 2 groups were significant.The proportion of patients with low fever,moderate fever,high fever and hyper fever was 8.65％ (9/104 cases),47.12％ (49/104 cases),44.23 ％ (46/104 cases) and 0,respectively in tuberculous pleurisy group,while the proportion was 0.90％ (1/111 cases),18.92％ (21/111 cases),79.28％ (88/111 cases) and0.90％ (1/111 cases) respectively in control group,and the difference between 2 groups was significant(W =9 064.00,P ＜ 0.01).The unilateral effusion ratio in tuberculous pleurisy group and the control group was 94.69％ (107/113 cases) and 71.68％ (81/113 cases),respectively (x2 =21.39,P ＜ 0.01).The monocyte ratio was higher in tuberculous pleurisy group [0.89 (0.76,0.93)] than that in the controlgroup [0.60 (0.30,0.78)] (W =888.50,P ＜ 0.01) and the level of protein in 2 groups was [51.00 (47.35,54.20) g/L] and [42.10 (37.85,46.15) g/L],respectively (W =842.50,P ＜ 0.01).The level of lactate dehydrogenase (LDH) in tuberculous pleurisy group[553.50 (358.00,749.25) U/L] was lower than that in the control group[1 189.10 (670.95,1 820.00) U/L] (W =2 186.00,P ＜ 0.01),and the differences were significant between 2 groups.In addition to pleural effusion,the high density was the main feature of imaging examination in 2 groups.The proportion of patients with atelectasis was 77.88％ (88/113 cases) and 4.42％ (5/113 cases) (x2 =125.90,P ＜ 0.01),while the proportion of patients with consolidation was 4.42％ (5/113 cases) and 72.57 ％ (82/113 cases),respectively (x2=110.80,P ＜ 0.01).All the differences between 2 groups were significant.The sputum culture-positive rate of mycobacterium tuberculosis was only 1.77％ (2/113 cases) and the other pathogen examinations were negative in tuberculous pleurisy group.Conclusions For patients with unilateral pleural effusion,when the onset only has fever (moderate-high fever),and respiratory symptoms are not clear or symptoms are not proportional to radiographic severity,or when high monocytes proportion (＞ 0.70) in pleural effusion and radiographic evidence of compression atelectasis are observed,tuberculous pleurisy should be considered and further questioning of the predisposing factors,purified protein derivative test should be taken so as to diagnose the tuberculous pleurisy at early stage.