Objective:To investigate the risk factors of pulmonaryfungal infection in intensive care unit(ICU),and discuss the strategy of prevention and treatment.Methods:Thirty-four patients with pulmonary fungal infection in ICU of our Hospital from Jan.2004 to Jan. 2009 were analyzed retrospectively,including primarily diseases,application of antibiotics,adrenal cortical hormone and virulence opera-tion,therapy and turnover.Results:All patients were accepted the therapies of broad spectrum antibiotics and glucocorticoids for long time before definite diagnosis of pulmonary fungal infection.Theire average time that the patients staying in hospital was 45.6 d.The clinical symptoms and imaging examinations were untypica.l Blastomyces albicans was the main pathogen.After the antifungal agents and supportive treatment used in time,33cases(97%)were cured and 1cases(3%)died.Conclusion:The major risk factors of children pulmonary fungal infection are long-time use of broad spectrum antibiotics and glucocorticoids.The pulmonary fungal infection can decrease by rationaluse of broad spectrum antibiotics and glucocorticoids,decreasing the unnecessary invasive operations,strengthening the supportive therapies ofmicro-ecosystem,and applying the antifungal agents in time.

Objectives To investigate the etiological factors,clinical features and treatment of pediatric primary spontaneous pneumothorax (PSP). Methods The clinical data of 84 PSP patients under the age of 18 from Departments of Emergency,Respiratory Diseases and Thoracic Surgery of our hospital from June 1999 to June 2009 were collected. There were 72 males (85.7%) and 12 females (15.3%) with a ratio of 6 to 1. Their age ranged from 14 to 18 (mean 17.06). Patients with pneumothorax following trauma,pneumonia,iatrogenic and other underlying causes were excluded. Therapeutic methods included oxygen therapy for 4.8% patients,closed drainage of pleural cavity for 57.1% patients,and surgery for 38.1% patients,But there were 31 patients receiving surgical treatment after closed drainage was failed. The period of follow-up ranged from 1 to 123 months (mean 25.73 months) through telephone or outpatient. Results Eighty-four patients were included,of whom 96.4% had chest pain,7.1% had chest tightness,66.7% had dyspnea,8.3% had shortness of breath and 14.3% had cough. There were 96.4% patients having decreased breathing sound and 3.6% having absent breathing sound. Bullae or blebs occurred mostly in apex and upper lobe. Twenty-one patients suffered from recurrent pneumothorax. Smokers (66.7%,n=9) had higher recurrent rate than non-smokers (22.0%,n=75). Conclusion PSP should be considered when symptoms such as chest pain and dyspnea appear in teenagers. Closed drainage of pleural cavity combined with surgical procedure is recommended for treatment. PSP patient with a history of smoking has higher recurrent rate of PSP.

Objective To investigate the effects of Mus81 gene silencing on the chemosensitivity of human colon cancer HCT116 cells to oxaliplatin and explore the underlying mechanisms. Methods lentiviral-mediated RNAi was employed to inhibit Mus81 gene in human colon cancer HCT116 cells. MTT assay was employed to evaluate oxaliplatin chemosensitivity of HCT116. Cell apoptosis rate was detected by Annexin V-APC staining and the expression levels of p53, while Bax and Bcl-2 in HCT116 cells were detected by Real-time PCR and Western blot. Results Oxaliplatin IC50 of Mus81 depleted HCT116 cells was significantly decreased. After oxaliplatin treatment, the cell apoptosis rate of Mus81 silenced HCT116 cells was increased by 77.6% (P < 0.05), and the expression of p53 and Bax in these cells was obviously increased but the expression of Bcl-2 was significantly decreased (P < 0.01). Introducing Mus81 gene in Mus81 depleted HCT116 cells could reduce apoptosis rate. Conclusion Mus81 gene silencing can significantly improve oxliplatin chemosensitivity of HCT116 cells possibly by promoting cell apoptosis through regulating the expression of p53, Bax and Bcl-2.

Objective To investigate the effect of atorvastatin and rosuvastatin on endothelial function in diabetics with coronary heart disease. Methods A total of 73 consecutive diabetics with coronary heart disease who were not receiving statins were randomized to receive atorvastatin 20 mg/d or rosuvastatin 10 mg/d. The levels of lipids, high-sensitivity C-reactive protein(hs-CRP), monoxide nitrogen(NO), endothelin-1 (ET-1) and endothclium-dependent relaxing function(EDF) were assessed before and after 3 months of the treatment. Results The treatment with statins significantly improved endothelial function in diabetics with coronary heart disease. For both rosuvastatin group and atorvastatin group in pro-treatment versus post-treatment, EDF was higher[(5.2±2.4)% vs. (7.9±3.1)%, P=0.008; (5.0±2.8)% vs. (7.6±3.6)%, P=0.024, respectively], NO was also higher((46.6±14.5) μmmol/L vs. (73.3±18.5) μmmol/L; (51.7±14.0) μmmol/L vs. (79.8±16.0) μmmol/L,both P<0.001], ET-1 was lower[(108.2±29.6) pg/L vs. (77.5±26.4) pg/L, P =0.005;(117.1±34.5) pg/L vs. (80.7±28.2) pg/L, P= 0.003, respectively],and hs-CRP was lower[3.17(1.33～6.32) mg/Lvs. 1.39(0.81～2.58) mg/L, P=0.006; 3.43(1.51～7.02) mg/L vs. 1.63(0.69～3.11) mg/L, P = 0.001, respectively]. There were no differences in these between rosuvastatin group and atorvastatin group. Significant negative correlation existed between EDF and hs-CRP. Conclusions A 3 months treatment with either atorvastatin 20 mg/d or rosuvastatin 10 mg/d is effective in improving endothelial function in diabetics with coronary heart disease.

Objective: To investigate the diagnostic value of 64 multislice spiral CT (64-MSCT) and 1.5T MRI in nurseling with congenital vascular rings.
Methods:We retrospectively studied the diagnostic records of 64-MSCT and 1.5T MRI in 48 nurseling with congenital vascular rings. There were 42 cases received CTA, 12 received MRA and 6 received both CTA and MRA. We classiifed the types of vascular rings by Edwards sketch map of aortic arch embryonic development and trachea wrapping conditions. The diagnostic values of 64-MSCT and 1.5T MRI on vascular rings were compared.
Results: There were 25 patients with complete vascular rings including 3 of double aortic arch, 12 right aortic arch with left subclavian artery and patent ductus arteriosus (PDA), 9 combining with arterial ligament, 1 neck right aortic arch with left subclavian artery combining left PDA;and 23 patients with in-complete vascular rings including 2 pulmonary artery sling, 9 left aortic arch with right subclavian artery combining left PDA, 10 combining with arterial ligament, 1 right aortic arch with left subclavian artery combining right PDA, 1 with innominate artery compressed trachea. There were 32/48 patients combined with cardiac malformations, both 64-MSCT and 1.5T MRI may well reveal the composition and special relationship of vessel rings. The minimum intensity projection (MinIP) and air volume rendering (VR) of 64-MSCT may clearly display the morphology and development of trachea, image fusion technique could directly show the special relationships among vascular rings, trachea and esophagus. While 1.5T MRI was relatively poor to present tracheal image.
Conclusion: 64-MSCT could accurately and comprehensively display the special relationships among the vessels rings, trachea and esophagus;which was the best method for diagnosing the nurseling with vessel rings in clinical practice.

This study aims to explore the clinical value of the computer-aided diagnosis (CAD) system for early detection of the pulmonary nodules on digital chest X-ray. A total of 100 cases of digital chest radiographs with pulmonary nodules of 5-20 mm diameter were selected from Pictures Archiving and Communication System (PACS) database in West China Hospital of Sichuan University were enrolled into trial group, and other 200 chest radiographs without pulmonary nodules as control group. All cases were confirmed by CT examination. Firstly, these cases were diagnosed by 5 different-seniority doctors without CAD, and after three months, these cases were re-diagnosed by the 5 doctors with CAD. Subsequently, the diagnostic results were analyzed by using SPSS statistical methods. The results showed that the sensitivity and specificity for detecting pulmonary nodules tended to be improved by using the CAD system, especially for specificity, but there was no significant difference before and after using CAD system.
China ; Diagnosis, Computer-Assisted ; Early Diagnosis ; Humans ; Lung ; pathology ; Radiographic Image Enhancement ; Radiography, Thoracic ; Thorax

Objective To investigate the value of lower limbs fixation methods for the treatment of intussusception in children with air enema with.Methods 2 1 1 pediatric patients with intussusception who had accepted the treatment of air enema with two dif-ferent fixation methods on lower limbs were enrolled.Comparisons of median treatment duration and therapeutic effect between the two methods were investigated.Results In 32 patients with knee-joint fixation method,27 were successful with median treatment duration 4.84 minutes.Meanwhile in other 179 ones with lower limbs fixation method,152 were successful with median duration 7.96 minutes.And the duration difference between two methods was found (P<0.05).Conclusion Knee-joint fixation may help significantly shorten the median treatment duration for the treatment of intussusception with air enema in children.

Objective To observe the levels of serum VEGF in different molecular subtypes of breast cancer and explore its relationship with response to neoadjuvant chemotherapy. Methods Levels of serum VEGF in 110 cases with breast cancer underwent neoadjuvant chemotherapy were detected by ELISA prior to and after 3 cycles of neoadjuvant chemotherapy. Clinical response to neoadjuvant chemotherapy was evaluated by physical examination and ultrasonography. Results Levels of serum VEGF were significantly increased in breast cancer patients with≥4 lymph node metastasis than those with < 4 lymph node[(307.31 ± 101.42) pg/mL vs. (170.16 ± 73.07) pg/mL,P = 0.017]. Patients with positive HER-2 status had significantly higher levels of serum VEGF than those with HER-2 negative status [(235.15 ± 88.42 ) pg/mL vs. (179.82 ± 69.90) pg/mL, P = 0.024]. No significant difference was observed among age , menopausal status and hormone status. In patients with neoadjuvant chemotherapy of cCR and Cpr,the mean levels of serum VEGF were (205.75 ± 78.12) pg/mL and (226.04 ± 89.04) pg/mL, respectively. After 3 cycles of chemotherapy, levels of serum VEGF decreased to (145.15 ± 67.08) pg/mL and (161.27 ± 93.57) pg/mL. There was significant difference between two groups (P=0.009,0.014). In patients with SD or PD response, no significant difference was observed between levels of serum VEGF before and after chemotherapy (P = 0.577). Conclusions Levels of serum VEGF in breast cancer correlate with lymph nodes metastasis and HER-2 status and may decrease after neoadjuvant chemotherapy. However,whether or not the levels of serum VEGF can be used as a biomarker for response to neoadjuvant chemotherapy needs more further studies.

Objective To establish the anti-infective tissue engineered bones (TEBs) and evaluate the anti-infective and osteogenic effects of the infection-prevention TEBs on femoral large bone defects in goats.Methods Based on the controlledrelease antibiotic system fibrin gel-coated vancomycin alginate beads (FG-Vanco-AB),the infection-prevention TEBs were established and evaluated.They were transplanted into the critical-size defects in the right femurs of goats.TEBs without the controlled-release antibiotic system were used as controls and transplanted into the left femoral defects.The breakpoint sensitivity of vancomycin (5 mg/mL) for S.aureus was used as a standard concentration.Postoperatively,the vancomycin concentrations in the lesion site,in the adjacent site and in the circulation,as well as the anti-infective effects of the infection-prevention TEBs were evaluated by High-performance liquid chromatography (HPLC).Bone hcaling was assessed by histology,CT and ECT.The results were used to evaluate the osteogenic effect of the infection-prevention TEBs.Results Results from ESM,CLSM and in vivo tracing showed that the in vitro and in vivo survival conditions of seeded cells were analogous to those of TEBs.The effective concentration (over the bactericidal concentration) of vancomycin in bilateral defects and in blood lasted for 28 days,2 days and 7 days,respectively.The concentration of vancomycin in the femur decreased gradually from the grafted site to both ends.At 28 and 56 days postoperatively,the ECT results showed no significant difference between the right and left femurs.CT and histology demonstrated that at 14,28 and 112 days after surgery,bone defects in the bilateral femurs were repaired synchronously,and were completely covered by new bone tissue after 112 days.Conclusion The anti-infective TEBs were successfully established.FG-Vanco -AB in the transplanted sites provided the local bone tissues with anti-infective capability whilst not interfered the process of bone reconstnction and wound healing.

Surgical traineeship has traditionally been based on a master apprentice model where learning takes place in the operating theatre. This approach has changed over the past few years with greater emphasis on surgical training taking place within the surgical skills laboratory. We developed a high fidelity simulator, the Image-guided Robotic Assisted Surgical simulator (IRAS) with an incorporated robotic guidance feature. The robot system is developed to mimic the process of an experienced surgeon physically holding a trainee's hands to demonstrate maneuvering of the laparoscopic instruments. We aimed to assess the efficacy of incorporating robotic guidance into this high fidelity surgical simulator. Forty-two participants (13 surgical residents and 29 medical students) were recruited. Participants had one practice run for familiarisation and subsequently performed the virtual laparoscopic cholecystectomy (LC) once. Among the medical students, they were ransomised to either a control or intervention group. They were tasked to perform a second- and third-timed LC assessment. Participants were asked to rate the simulator using a 5-point Likert scale Questionnaire. IRAS rated favourably in hand-eye coordination and training bimanual dexterity (mean score: 4.1 and 4.0 among students, 3.4 and 3.4 among residents) though it faired suboptimally in realism. At baseline, residents were statistically faster compared to students (overall time: 418.9 vs 586.8 seconds,= 0.001). Participants randomised to the intervention group consistently scored better. However, their overall time were not statistically significant from the control group. The robotic guidance capability of the IRAS is a key advantage of this simulator platform over the conventional platform.