Objective To investigate the clinical manifestations, auxiliary examination, diagnosis and therapy of Aspergillus tracheobronchitis (ATB).Methods Clinical data of 4 ATB patients treated in Qingdao Municipal Hospital from June 2012 to September 2015 were analyzed retrospectively. The related literature was also reviewed.Results The main clinical manifestations were cough, sputum production, short of breath, fever and hemoptysis. All the four patients had predisposing factors. The ifndings of CT scan mainly included bronchial wall thickening, obstruction of bronchial lumen or no significant abnormality. Bronchoscopy showed mucosal erosion, necrosis, tracheal stenosis and obstruction of airway by pseudo-membrane. The diagnosis was confirmed by histopathology in all the four cases. They were treated with anti-Aspergillus therapy. The two patients with airway stenosis were treated with interventional therapy via bronchoscope. As for the outcome, one patient was improved after therapy. Another was cured. The remaining two patients died.Conclusions The clinical manifestations and chest imaging of ATB are nonspecific. Bronchoscopy is an important tool for diagnosis of ATB. Early diagnosis and proper anti-Aspergillus treatment are critical for improving prognosis.

BACKGROUND:An ideal scaffold material needs appropriate degradation rate and certain mechanical properties, but the traditional colagen sponge scaffold has rapid degradation velocity and low mechanical strength, which is easy to colapse and difficult to maintain its natural form. Traditional cross-linking methods also have the problems of cytotoxicity or colagen denaturation, severely limiting the application of colagen. OBJECTIVE:To design a new cross-linking method for colagen and to optimize the self-assembly process so as to develop a colagen sponge scaffold with good mechanical properties and resistance to degradation. METHODS:Colagens were modified by self-assembly technology to prepare colagen fibrils which were then freeze-dried into fibrilar colagen sponges. Meanwhile, we optimized the conditions of self-assembly by using orthogonal experiment based on univariate analysis of the effect of initial colagen mass concentration, final phosphate concentration and pH value on the conversion yield of colagen self-assembly. RESULTS AND CONCLUSION:We optimized the conditions of self-assembly revealed that the optimum conditions to prepare colagen fibrils were determined as pH=8.0, initial colagen concentration=2 mg/mL, and final concentration of phosphate=15 mmol/L. The results of scanning electron microscope showed that fibrilar colagen sponges were characterized by refined porous structure which was connected by colagen fibrils. In addition, the fibrilar colagen sponges showed better equilibrium-sweling ratio, water retaining property and mechanical strength compared with unmodified colagen spondages (P < 0.05), to solve the problems in rapid degradation.

Objective To investigate the clinical characteristics and prognosis in the patients with type 2 diabetes mellitus and invasive pulmonary aspergillosis(IPA) for better management of the disease .Methods Clinical data of 9 cases of type 2 diabetes associated with IPA treated in Qingdao Municipal Hospital from January 2008 to December 2013 were analyzed retrospectively . Results The diagnosis of IPA was proven in 5 and probable in 4 of the 9 patients .The main clinical manifestations were fever , cough and expectoration .The findings of CT scan mainly showed pulmonary nodules along the bronchovascular bundle and cavity signs .Bronchoscopy showed congestion ,edema ,and erosion of bronchial mucosa covered with yellow‐white or brown pus ,partially or completely blocking the lumen .Antifungal treatment was effective for 4 patients .The other five patients died . Conclusions Type 2 diabetes mellitus is a risk factor for developing invasive pulmonary aspergillosis .Early diagnosis and proper treatment are critical for improved prognosis .

Objective To summarize our experience of harvesting and using the organs of donors after cardiac death.MethodsForm March 2010 to October 2011,56 potential donors were diagnosed with cardiac death,who conformed to the classification of Maastricht Ⅲ criteria.There were 40 failure cases whose family refused to donate,and one failure case who suffered from serious infection.Finally,the success ratio of donation after cardiac death was 26.8％ (15/56).Twelve livers and 22 kidneys were transplanted into 12 and 20 recipients respectively.ResultsTwelve cases of liver transplantations had acceptable outcomes. The grafts of 4 cases out of 20 cases of kidney transplantations were removed after transplantation,and other recipients had acceptable outcomes.ConclusionCitizens organ donation after cardiac death can expand the number of suitable organs,but we need to strictly control the criteria for potential donors.

Objective To study the prognosis of patients with end-stage liver cirrhosis who using controlled cardiac death liver donor in situ liver transplantation. Methods Seven cases of transplants which used liver donated after cardiac death were done in our center. The preoperative and postoperative data were analyzed. The prognosis of these patients was observed. Results Except one recipient died of upper gastrointestinal bleeding at the 9th day after surgery, the remaining 6 patients were followed up for more than 12 months (mean 15.7 months) and the prognosis was satisfactory.Conclusion Patients can get good prognosis after the liver transplants with donated liver after cardiac death which meets the Maastricht Classification type Ⅲ.

Objective To investite the effect of endotoxin pretreatment on lung injury induced by hepatic ischemia reperfusion in rabbits and its mechanism. Method Forty-eight New Zealand white rabbits were randomly divided into4 groups with 12 rabbits each group:routine control group,pretreatment control group,ischemia reperfusion group (IR group), and preperfusion group( LPS + IR group). Rabbits of routine control group received operative dissector only, and those of pretreatment control group received pretratment of daily intraabdominal injection of lipopo|ysaccharide(O.5,0.5,and 1.0 mg/kg,respectively)in the 3 days before operative dissector.Livers of IR group were rendered and ischeraic for 30 minutes, and repeffused for up to 4 hours. Rabbits of LPS +IR group received the preueaunent before heretic ischemia repeffusion. Four hours after reperfusion, serum endotoxin,tumor necrosis factor-α(TNF-α), wet/dry ratio and broncho-alveolar lavage fluid protein content of lung,malondialdehyde(MDA) and mpenrxide dismutase(SOD) in lung homogenate, lung injury ratio, and activity of Nuclear factor-kB(NF-kB) in alveolar macrophage wene examined. Differences within the groups were analyzed using One way ANOVA. Results Between the two control groups,there were no significant differences in all indexes(P>0.05). The TNF-α[ (48.31±5.31)pg/ml vs.(56.47±5.09)pg/ml, P<0.01],wet/dry ratio [(4.98±0.33)vs. (5.22±0.31), P = 0.03],broncho-alveolar hvage fluid protein content[(0.68±0.11)g/L vs. (0.76±0.10)g/L, P =0.04],MDA[(0.86±0.06)nmol/mg vs. (0.93±0.07)nmol/mg, P =0.02],lung injury ra-tio[(13.4±4.3)% vs. (17.4±4.1)%, P = 0.03],and the activity of NF-gB[(5.82±1.12)OD/mm2 vs.(7.40±1.26)OD/mm2, P<0.01] in alveolar macrophage of the LPS+ IB group were all significantly lower than those of IB group, while the SOD[ (90.30±7.38 )U/rag vs. (84.44±7.90 )U/rag, P = 0.04]of LPS + IR group was significantly higher than that of IR group. Conclusions Endotoxin pretrealment may ameliorate the lung injury induced by hepatic isehernia reperfusion. The mechanism may be that endotoxin pretreatment deoreases production of serum TNF-α and the activity of NF-kB in alveolar maerophage.

Objective To investigate the effect of axial load test in Taylor spatial frame treatment of external fixation for tibia and fibula fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 36 patients with open fracture of tibia and fibula admitted to Tianjin Hospital from March 2015 to June 2017.There were 22 males and 14 females,aged 21-71 years[(46.1±14.2)years].All patients received Taylor spatial frame external fixation for tibia and fibula fracture within 1 week after injury.After operation,18 patients received axial load test(experiment group),and the other 18 did not(control group).When the value of axial load test was less than 5% in experiment group,the Taylor spatial frame was removed.The control group used traditional method to remove the Taylor spatial frame.Comparisons were made between the two groups in terms of treatment duration,total cost,re-fracture after Taylor spatial frame removal and incidence of stent-tract infection.Results All patients were followed up for 3-14 months with an average of 8.6 months.Compared with control group,the treatment duration[(36.17±11 .44)weeks vs.(44.50±9.16)weeks]and total cost[(93.7±7.9)thousand yuan vs.(120.1±10.6)thousand yuan]of experiment group were significantly lower(P＜0.05).In the experiment group,there was 0 patient with re-fracture and two patients with stent-tract infection,with the complication incidence of 11%,while there were two patients with re-fracture and three patients with stent-tract infection,with the complication incidence of 28% in the control group(P＞0.05).Conclusions After Taylor spatial frame external fixation for tibia and fibula fractures,regular axial load test can safely and timely guide the removal of Taylor spatial frame.It can reduce the treatment duration and cost compared with the traditional removal method,being safe and reliable.

Adult ; Aged ; Aspergillosis ; epidemiology ; Female ; Humans ; Lung Diseases, Fungal ; epidemiology ; Male ; Middle Aged

Objective    To investigate the surgical methods and efficacy of myocardial infarction combined with ventricular septal perforation. Methods    The clinical data of 60 patients with myocardial infarction combined with ventricular septal perforation admitted to the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, from 2009 to 2018 were retrospectively analyzed. There were 39 males and 21 females, aged 63.3±8.3 years. Results    Among the 60 patients, 43 (71.7%) patients were perforated in the apex, 11 (18.3%) in the posterior septum and 6 (10.0%) in the anterior septum. There were 24 (40.0%) patients of single coronary artery disease. Fourteen (23.3%) patients received intra-aortic balloon counterpulsation before surgery. The waiting time from ventricular septal perforation to surgery was 48.3 (3-217) d. All patients underwent ventricular septal perforation repair, among whom 53 (88.3%) patients received ventricular aneurysm closure or resection, and 49 (81.7%) patients received coronary artery bypass graft with an average of 2 distal anastomoses during the same period. Perioperative complications in the hospital included 8 (13.3%) deaths, 8 (13.3%) heart failure, 5 (8.3%) ventricular fibrillation, 3 (5.0%) pericardial tamponade, and 11 (18.3%) secondary thoracotomy and 11 (18.3%) residual shunt. Except for 8 patients who died in the hospital, the other 52 cured and discharged patients were followed up. The median follow-up time was 4.9 years. The 2-year and 5-year survival rate of the patients was 95.8%, and the 8-year survival rate was 89.0%. Major adverse cardiovascular events incidence was 19.2%, including 3 (5.8%) deaths, 5 (9.6%) heart failure, 2 (3.8%) myocardial infarction, and 4 (7.7%) cerebrovascular events. Conclusion    For patients with ventricular septal perforation after myocardial infarction, surgery is an effective treatment method. Although the perioperative mortality rate is high, satisfactory long-term results can be achieved by carefully choosing the operation timing and methods.