Objective To investigate the etiologies of spontaneous pneumothorax in flat-chest teenagers. Methods 139 teenagers with flat chest and spontaneous pneumothorax were designed as the study group, while 152 teenagers without spontaneous pneumothorax during the same period were taken as control. The ratio of thoracic transverse diameters to anterior-posterior diameters, and the ratio of tracheal length to transverse diameters were measured respectively by CT scan. The resected pulmonary tissues in 47 cases with spontaneous pneumonthorax and in 47 cases without spontaneous pneumonthorax underwent various examinations, including tension, compression, and bending tests. Student t-test was employed to perform the statistical analysis. Results The ratios of thoracic transverse diameters to anterior-posterior diameters and the ratios of tracheal length to transverse diameters in the study group were remarkably higher than those were in the control group, with significant statistical difference (P

BACKGROUND: The cell growth, proliferation and differentiation caused by p38 mitogen-activated protein kinase (p38MAPK) might act as the common pathway in the onset and development of diabetic vascular complication.OBJECTIVE: To investigate the effect of atorvastatin on p38MAPK signal pathway and the influence of atorvastatin on cell proliferation and expression of transforming growth factor-β1 (TGF-β1) at transcriptional level in human glomerular mesangial cells (HGMCs) cultured with oxidative modification of low-density lipoprotein (ox-LDL).DESIGN: A randomized, parallelized, controlled and open trial.SETTING: Endocrinology Department, First Hospital Affiliated to China Medical University; Endocrinology Department,Respiratory Department, Urology Department, the General Hospital of Shenyang Military Area Command of Chinese PLA.MATERIALS: The experiment had been done in the laboratories for Pharmaceutical Department of China Medical University and Respiratory Department of Shenyang Military Area Command of Chinese PLA from May 2004 to May 2005. The sample was cut from renal cortex from the healthy segment of nephroectomy from a tumor patient (Provided by Xiang Jun, Urology Department, the General Hospital of Shenyang Military Area Command of Chinese PLA; Informed consent was obtained). OX-LDL was purchased from biochemistry institute of Peking Union Medical College (Batch No.20040711 ). ox-LDL was 5.3±1.0 nmol in 100 μg protein. Atorvastatin was purchased from Pfizer Pharmaceutical Co. Ltd (No. 45837088); p38MAPK monocloncal antibody was purchased from Santa Cruz.METHODS: ① 6.0-8.0 cm3 blocks of cortex were cut from renal cortex from the healthy segment of nephroectomy from a tumor patient, glomerular mesangial cells were isolated. When grew into 80% confluent monolayer, the cells were digested and performed passage. After the first two passages, the cells were pure based on morphology and characterized by DAB staining for Vimentin antigen and actin antigen was positive, whereas cytokeratin antigen was negative. Oil red "O" staining confirmed that ox-LDL was intaken by HGMCs. The 4-8th passages of cells were used to study. ②HGMCs were seeded into 96-well plates with 5×103 cells per well and grown in 200 μL culture medium. The study was divided into 5 groups (6 wells each group): 1.2, 6,12 mg/L atorvastatin group, ox-LDL group and blank control group. The cells were pre-incubated with atorvastatin for 30 minutes, then exposed to 80 mg/L ox-LDL. The cells in blank control group were untouched. After 24 hours, MTT was added. The absorbance of each sample at the wavelength of 492 nm was measured with immunosorbant assay system. The inhibitory rate of cell proliferation was calculated. ③1×106 to 3×106 cells were seeded into six 200 mL flasks. The trial was divided into 5 groups randomly:control group, 10, 40, 80 mg/L ox-LDL groups and atorvastatin group (12 mL/g). The cells in each group were pre-incubated for 30 minutes, then exposed to 80 mg/L ox-LDL for 24-routine culture. The expressions of TGF-β1mRNA of harvested cells were detected with semi-quantitative reverse transcription-polymerase chain reaction and p38MAPK signal pathway activation was detected by Western blot.MAIN OUTCOME MEASURES: ①Identification results of HGMCs. ② Proliferation of HGMCs. ③ TGF-β1 expression of HGMCs. ④p38MAPK signal pathway activation of HGMCs.RESULTS: ①When the cells were sub-cultured to the second generation, cell volume was big. Most of the cells were spindle-shaped, irregular stellate or branch-like, filled with microfilaments which paralleled axis. Cells overlapped in the intensive area. After DAB staining, cytoplastic actin and vimentin were positive and keratin was negative. Oil red "O"staining confirmed that ox-LDL was intaken by HGMCs with red granules in the cytoplasma, while control group did not.It was proved that the cells cultured for passage were HGMCs. ② As compared with control group, the inhibitory rate of cell proliferation in ox-LDL group was significantly decreased, but that in atorvastatin 1.2, 6 and 12 mg/L groups was significantly increased (0, -17.4%, 6.4%, 22.5%, 61.5%, respectively, P ＜ 0.05 or 0.01) on concentration-dependent manner. ③ As compared with control group, ox-LDL (10, 40, 80 mg/L) increased the expression of TGF-β1 and activation of p38MAPK in concentration-dependent manner, the effect of 80 mg/L ox-LDL group was the most significantly (P ＜ 0.01). Atorvastatin decreased the increment of TGF-β1 expression and the activation of p38MAPK pathway induced by ox-LDL significantly. There was significant difference when compared with 80 mg/L ox-LDL group (P ＜ 0.01).CONCLUSION: Atorvastatin can antagonize the activation of p38MAPK pathway, decrease the secretion of TGF-β1 and inhibit mesangial cell proliferation induced by ox-LDL, suggesting that it may exert beneficial effect in the prevention and treatment of diabetic nephropathy with dyslipidemia.

Objective To investigate the clinical features and risk factors of primary Sjogren's syndrome (pSS) patients with malignancies.Methods The clinical features of 29 pSS patients with malignancies from January 1985 to March 2008 were retrospectively analyzed.Results The ratio of pSS with malignancies to all hospitalized pSS patients from January 1985 to March 2008 was 2.2%.In these patients,8 were lymphoma,4 were breast cancers,2 were myeloma,2 were thymoma,2 were lung cancer,2 were gastric carcinoma,2 were hepatoma,2 were colon carcinoma and 2 were tongue cancer.Uterine cervix cancer,renal carcinoma,thyroid carcinoma and carcinoma of parotid gland each were fund in this series of patients.Conclusion The most common malignancy in pSS is lymphoma and the major of pathological type is B cell non-Hodgkin's lymphoma.

Purpose To investigate the clinicopathological features of the adult rhabdomyoma (A-RM) in the oral and maxillofacial region.Methods Three cases of A-RM in the oral and maxillofacial region were analyzed for the clinical symptoms,imaging data,pathological features,differential diagnosis,treatment,and prognosis with the literatures review.Results The age arranged from 4 yea~ to 83 years in three A-RM cases.Two cases were male and one case was female.Two cases occurred in the mouth floor and one case in the tongue.Three A-RM cases presented as slowly growing,painless masses clinically.The masses were lobular,red-brown nodules with clear boundary.Histologically,they consisted of densely packed,large,round and polygonal cells with abundant granular eosinophilic cytoplasm.Cross striations and vacuoles were seen in the cytoplasm.Tumor cells expressed desmin and myoglobin,partially expressed SMA,MyoD1 and S-100 protein.PAS was also positive among tumor cells and could be digested by the diastasum diastace.Conclusion Histological examination is the main diagnostic basis for A-RM.For accurate diagnosis,cross striations and immunohistochemistry for myogenic proteins in cytoplasm are of pivotal importance.Radical resection is the main treatment with generally promising prognosis.

Abstract A new method was established to determine the free inorganic cadmium ion ( Cd2+) in marine bivalves using high performance liquid chromatography and inductively coupled plasma mass spectrometry ( HPLC-ICP-MS) . The free Cd2+ in shellfish was ultrasonic extracted for 40 min by 10 mmol/L Tris buffer solution ( with 0. 1 mol/L NaCl, pH=7. 5), and the separation of Cd2+ was achieved using an IonPac CS5A analytical column with an IonPac CG5A guard column. The mobile phase consisted of 50 mmol/L C2 H2 O4 and 95 mmol/L LiOH. The new method had a good linear relationship with the correlation coefficient of 0. 999 and the standard recoveries of Cd2+ were all above 84. 6%. The free Cd2+ content in several kinds of marine bivalves was determined using the method and the results showed that the percentage of free inorganic Cd2+ to the total Cd content in samples with high Cd content was higher than those with low Cd content.

Objective To evaluate the role of (99)Tc(m)-MDP SPECT/CT bone fusion imaging in diagnosis and treatment strategy establishment of patients with bone metastatic malignancy.Methods Retrospective study was carried out on 66 patients (55 patients with primary malignant tumors,11 patients with primary benign bone disease) chosen from 117 patients who had undergone whole body bone scintigraphy and SPECT/CT fusion imaging examination.Comparison was carried out on diagnostic efficacy for bone metastases and changes of treatment between SPECT/CT fusion imaging and other anatomical imaging (CT and/or MR).Cases excluded are extensive bone metastases and no final diagnosis of patients.Results For diagnosis of patient with bone metastasis and bone metastasis lesion,the sensitivity of SPECT/CT fusion imaging was (90.62％,93.88％),specificity (79.41％,89.47％) and accuracy (84.84％,90.97％),while sensitivity of simple anatomical imaging was (59.38％,51.02％),specificity (94.11％,94.73％) and accuracy (77.27％,79.86％),with a significant difference (P ＜ 0.05).SPECT/CT fusion imaging changed 30.31％ (20/66) the patient's treatment plan,while 16.67％ (11/66) for simple anatomical imaging,with a significant difference (P ＜ 0.05).Conclusions SPECT/CT fusion imaging could increase the accuracy of diagnosis of bone metastases and have an important role in establishing the treatment strategy.

Phthalic acid esters (PAEs) are commonly used plasticizers and solvents. Human body is exposed and absorbed mainly through diet, skin and air inhalation. The biological samples such as urine, blood, saliva, semen and breast milk generally contain PAEs and their metabolites, but the concentrations of PAEs metabolites vary in different samples. In the general population, the levels of PAEs are higher in children than in adults, and higher in women than in men; the levels of PAEs are higher in the occupational population than in the general population. In this paper, the research of PAEs related human biomonitoring in the general population and occupational population at home and abroad is reviewed, so as to provide the basis for reducing the exposure of PAEs and related health risk.

Objective To investigate the clinical efficacy and prognostic factors of radical hepatectomy of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 760 HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from August 2003 to June 2015 were collected.Surgical procedures were determined according to the location,number and size of tumors and anatomical relations among vessels.Observation indicators included:(1)intra-and post-operative situations:surgical procedures,operation time,volume of intraoperative blood loss,cases of intraoperative blood transfusion,postoperative complications,duration of postoperative hospital stay and pathological examination;(2) follow-up:1-,3-,5-year overall and tumor-free survival situations;(3) prognostic factors analysis of HCC patients.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to January 2016.Measurement data with normal distribution were represented as-x±s.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Intra-and post-operative situations:all the 760 patients underwent successful operations,including 419 undergoing anatomical hepatectomy and 341 undergoing non-anatomical hepatectomy.R0 and R1 resections were respectively applied to 742 and 18 patients.Two patients were combined with portal vein resection and reconstruction and 1 was combined with resection and reconstruction of inferior vena cava.Operation time,volume of intraoperative blood loss and cases of intraoperative blood transfusion were (226± 115) minutes,(714±706) mL and 88,respectively.Fifty-five patients had postoperative complications,including 20 with abdominal effusion or abscess,16 with pleural effusion,9 with recurrent fever,8 with incisional infection,7 with intra-abdominal hemorrhage,6 with liver failure,3 with pyloric or intestinal obstruction and 2 with renal failure (some patients with multiple complications).Of the 55 patients with postoperative complications,7 with hemorrhage underwent reoperation or interventional therapy and other patients underwent conventional symptomatic treatment.Of 55 patients,5 patients died and other 50 patients were improved.Duration of postoperative hospital stay was (14±6) days.There were 457 patients with minimum margin of tumors ≤ 1.0 cm and 303 with minimum margin of tumors ＞ 1.0 cm.(2) Followup:all the 760 patients were followed up for 1-139 months,with a median time of 25 months.The overall and tumor-free median survival times were 59 months and 31 months,respectively.The 1-,3-,5-year overall and tumor-free survival rates were 81.7％,63.4％,47.9％ and 68.7％,44.9％,29.6％,respectively.(3) Prognostic factors analysis of HCC patients:results of univariate analysis showed that clinical symptoms,alpha-fetoprotein (AFP),Barcelona clinic liver cancer staging,surgical procedures,intraoperative blood transfusion,minimum margin of tumors,number and diameter of tumors,tumor capsule,tumor differentiation,vascular cancer embolus,macrovascular invasion and tumor staging of American Joint Committee on Cancer (AJCC) were related factors affecting prognosis of HCC patients after radical hepatectomy [HR =1.39,1.50,1.92,0.65,1.45,1.68,1.96,1.66,2.26,1.50,2.68,3.37,2.00,95％ confidence interval (CI):1.08-1.79,1.16-1.94,1.68-2.20,0.50-0.84,1.04-2.02,1.28-2.20,1.54-2.49,1.42-1.94,1.69-3.02,1.22-1.85,1.99-3.60,2.61-4.36,1.77-2.27,P＜0.05].Results of multivariate analysis showed that AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC were independent factors affecting prognosis of HCC patients after radical hepatectomy (HR=1.61,1.62,1.31,1.40,1.78,95％CI:1.14-2.26,1.22-2.14,1.06-1.63,1.10-1.79,1.27-2.51,P ＜ 0.05).Conclusions The anatomical and non-anatomical hepatectomies are safe and feasible for optional HCC patients,with a good long-term outcome.AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC are independent factors affecting prognosis of HCC patients after radical hepatectomy.

Bacterial Proteins ; chemistry ; Bacterial Secretion Systems ; Crystallography, X-Ray ; Legionella pneumophila ; metabolism ; Models, Molecular ; Protein Structure, Tertiary

ICU acute respiratory distress syndrome has a high morbidity and mortality rate, and these patients usually need mechanical ventilation to maintain their respiratory function during treatment. However, improper setting of mechanical ventilation parameters may lead to ventilator-induced lung injury (VILI). In order to effectively prevent the occurrence of VILI, ARDSnet recommends the use of a protective ventilation strategy with low tidal volume and limited airway plateau pressure. However, from the perspective of ventilator energy transfer, VILI is actually the result of a combination of respiratory parameters such as tidal volume, airway pressure, and respiratory rate. The mechanical power well reflects the combined effect of the above parameters and is increasingly becoming a hot topic in clinical research. In this review paper, the definitions of mechanical energy and mechanical power were introduced, and the calculation methods of mechanical power under different respiratory modes are summarized. Moreover, the clinical studies related to mechanical power and VILI and further exploration of the safety threshold of mechanical power are reviewed. It is expected to provide new ideas for the future clinical development of personalized mechanical ventilation strategies and the effective prevention of VILI.