Objective To investigate the application of blood purification for critical disease with non-renal indications in PICU. Methods We retrospectively analyzed the clinical data of 10 critical disease cases with non-renal indications in PICU admitted from Jan to Dec 2009. Five cases were with acute liver failure,2 with autoimmune disease (1 with Guillaln-Barre syndrome, 1 with systemic juvenile rheumatoid arthritis with macrophage activation syndrome) ,2 with severe sepsis,one with metabolic diseases. Results Four cases were treated with plasma exchange combined with continuous veno-venous hemmofiltration. Three cases were treated with continuous veno-venous hemmofiltration. Three cases were treated with plasma exchange.Conclusion CBP is an effective and safe method in the treatment of critical diseases with non-renal indications in PICU.

Objective To investigate the influence of intermittent catheterization methods on the urinarytract infection in patients with spinal cord injury. Methods Thirty-one cases of spinal cord injury and urinarytract infection were recruited. By use of intermittent catheterization, the bladder function was trained. Bacteria cul-ture and identification of in urine from the patients were conducted before the training (indwelling catheterization)and after 15 or 30 days of intermittent catheterization. Results The rates of urinary tract infection (colony count≥1?10~5cfu/ml) after 15 or 30 days of intermittent catheterization were 38. 7% and 35. 5%, respectively, whichwere significantly lower than those of indwelling catheterization (100%), P

Objective To investigate the application of continuous blood purification in the children with critical diseases. Methods Eighteen critical patients aged 1 ～ 15 years in PICU underwent continuous blood purification(CBP). Fourteen with acute renal failure (ARF) were treated with continuous veno-venous hemmofiltration(CVVH) ,2 with Guillain-Barre syndrome and 2 with Raye's syndrome were treated with plasma exchange(PE). The changes of clinical symptoms, blood biochemistry , blood gas, and oxygenation were analyzed before and after CBP. Results After CVVH treatment, the BUN and creatinine of 14 patients with ARF were decreased from (48.6 ± 14. 8) mmol/L to(28. 9 ±5.4) mmol/L and (634. 3 ±258. 2) μ mol/L to (318.4 ± 143.5) μmol/L,K+ and pH of serum were maintained in the normal range,oxygenation was significantly improved. Breathing difficulties and muscle strength in 2 patients with GBS were ameliorated and successfully weaned from ventilator after PE. Serum ALT,AST and ammonia of 2 cases with Raye's syndrome decreased significantly and they discharged after comprehensive treatment including PE. Bleeding in puncture region were found in 3 patients, hypothermia in 2 patients. During the treatment, vital signs of patients were stable,blood pressure and pulse were not fluctuated. Conclusion CBP is an effective and safe method in the treatment of critical diseases in children.

Objective To analyze clinical diagnosis and management of 5 patients with actinomycete keratitis.Design Retro- spective case series.Participants 5 patients (5 eyes) with actinomycete keratitis.Methods The clinical features and microbiologic da- ta of 5 culture-proven cases of actinomycete keratitis recorded between October 2004 to March 2006 were analyzed.Main Outcome Measures clinical characteristics,isolations identification,drug susceptibility test and treatments.Results All patients were males and farmers.Of the 5 cases presented in this study,4 cases were followed by minor trauma as a predominant risk factor,and were pre- sented by a chronic progressive corneal ulcer with a wreath pattern of infiltrate.The diagnosis of all cases was based on laboratory in- vestigations,by which 4 cases of nocardia and one case of streptomyce were identified.A variable drug sensitivities were presented in nocardia isolates,which including TMP-SMZ,amicasin,gentamicin and fluorine-quinolones.Conclusions Nocardia keratitis is mainly followed by a minor trauma.It is identified predominantly by laboratory investigations.Tropical and systemically sensitive biotic are the initial choice,while debridement and amnionic transplantation could be an effective alternative.

Objective To determine the expression of membrane-bound B lymphocyte stimulator (BLyS) protein and its mRNA in vitro of peripheral blood mononuclear cells (PBMCs) from individuals with systemic lupus erythematosus (SLE),and to investigate the role of interferon-?(IFN-?) on the expression of BLyS.Methods PBMCs were obtained from 25 SLE patients (mean age of 31+14) and 20 healthy volunteers (mean age of 28?10).They were randomized into IFN-?(5 ng/ml) group and control group.PBMCs were col- lected at 0,6,12 and 24 h for BLyS mRNA assessment using semi-quantitative reverse transcription-PCR (RT-PCR).PBMCs were also collected at 72 h for membrane-bound BLyS protein detection using flow cy- tometry (FACS) and direct immunofluorescence.Results①The expression of BLyS mRNA and membrane- bound protein in PBMCs was significantly higher in individuals with SLE compared with healthy controls (P＜0.05);②IFN-?enhanced BLyS mRNA expression in PBMCs in both healthy controls and SLE patients,with the greatest effect at 6 h (stimulated vs unstimulated,0.42?0.19 vs 0.25?0.14,P＜0.01;0.59?0.28 vs 0.44?0.21,P＜0.01 );③IFN-?also increased the expression of membrane-bound BLyS protein in both healthy con- trols and individuals with SLE (FACs,mean fluorescence intensity,4.5+3.0 vs 3.7~2.6,P

This study was purposed to explore the effect of different cytokine combinations on the expansion of the mononuclear cells drived from umbilical cord blood (CB) ex vivo and expression of CXCR4 and CD49d on CD34+ cells after expansion. Human fresh CB mononuclear cells were cultured in serum-free and stroma-free medium containing different combinations of cytokine for 7 days. At day o and 7, the total cells were counted, CD34+ cells and CD34+CXCR4+, CD34+CD49d+ cells were assayed by flow cytometry, and CFU were determined. According to the different combinations of cytokine, experiments were divided into four groups: control, SF group (SCF + FL), SFT group (SCF + FL + TPO) and SFT6 group (SCF + FL + TPO + IL-6). The results showed that the SF (SF group) combination supported only low expansion of total cells, CD34+ cells and CFU. The addition of TPO in SF group restored UCB stem/progenitors expansion to a higher level than that in SF group, while there was no difference between groups SFT and SFT6 (P > 0.05). The cytokine combinations in groups SF, SFT and SFT6 all could upregulate the expression levels of CD49d and CXCR4 on expanded cord blood CD34+ cells, but there were no significant differences between groups SF, SFT and SFT6 (P > 0.05). It is concluded that SCF + FL has no strong synergistic effects on primitive hematopoietic cells. TPO plays an important role in enhancing expansion of umbilical cord blood hematopoietic cells, while IL-6 only shows a neutral effect on it. SCF + FL + TPO combination not only promotes progenitor cells expansion but also upregulates the expression of CD49d and CXCR4 on CD34+ cells from cord blood.
Antigens, CD34 ; biosynthesis ; genetics ; Cytokines ; pharmacology ; Drug Synergism ; Fetal Blood ; cytology ; Humans ; Integrin alpha4 ; biosynthesis ; genetics ; Leukocytes, Mononuclear ; cytology ; Membrane Proteins ; pharmacology ; Receptors, CXCR4 ; biosynthesis ; genetics ; Stem Cell Factor ; pharmacology ; Thrombopoietin ; pharmacology

This study was aimed to detect the methylation status of FHIT gene promoter region in the DNA from plasma of patients with myelodysplastic syndrome (MDS), and to investigate the demethylating effect of decitabine. Methylation-specific PCR method was used to detect the methylation status of FHIT gene promoter region in the DNA from plasma of 4 patients with MDS before and after treatment with decitabine plus semis CAG therapy (among them, 1 case of newly diagnosed MDS, 3 cases progressed into acute leukemia). The results indicated that 3 cases were found to have an increased methylation in the promoter region. After treatment with decitabine plus semis CAG, increased methylation was reversed in 2 cases. In 4 cases, 2 cases displayed clinical response. It is concluded that FHIT gene hypermethylation is associated with MDS pathogenesis. Decitabine has demethylating effect on the FHIT gene hypermethylation of plasma from MDS patients. Detecting the methylation status of FHIT gene in DNA from plasma may play a role in MDS auxiliary diagnosis or prognosis.
Acid Anhydride Hydrolases ; genetics ; Adult ; Aged ; Azacitidine ; analogs & derivatives ; therapeutic use ; DNA ; blood ; DNA Methylation ; Female ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes ; blood ; drug therapy ; Neoplasm Proteins ; genetics ; Promoter Regions, Genetic

OBJECTIVETo explore the treatment and prognosis on patients with tracheal invasion by papillary thyroid carcinoma (PTC).

METHODSForty-five patients treated for PTC with tracheal invasion between 1980 and 1995 were retrospectively analyzed. The different kinds of surgical modalities were performed according to the extent and degree of tracheal invasion by PTC. Neck dissect was performed in 39 patients. External beam radiotherapy was used postoperatively in patients with gross residual tumor or microscopic residual tumor in pathologic margins after resection. Survival was evaluated using the Kaplan-Meier method.

RESULTS(1) Twenty-eight patients with limited tracheal invasion were treated with shave excision, the 5- and 10-year survival rates were 85.0% and 62.6%, respectively. After a shave excision, the differences of 5- and 10-year survival rates between irradiated and nonirradiated patients were not statistically significant (P > 0.05). (2) Ten patients were radical excision for intraluminal involvement extending through the tracheal cartilage, including circumferential sleeve resection (4 cases), tracheal window resection (5 cases) and total laryngectomy (1 case), the survival rate was 80.0% for five years and 58.3% for ten years. After a radical excision, the differences of 5- and 10-year survival rates between irradiated and nonirradiated patients were not statistically significant (P > 0.05). (3) For 7 patients performing the palliative operation, the 5-and 10-year survival rates were 42.9% and 28.6%, respectively. For 4 patients received postoperative radiotherapy, the 5-and 10-year survival rates were 50.0% and 50.0%, respectively. Three patients didn't received postoperative radiotherapy, the 5-year survival rate was 33.3%, no patient survived for ten years. In these patients of incomplete resection, the differences of 5-and 10-year survival rates between irradiated and nonirradiated patients were not statistically significant (P > 0.05).

CONCLUSIONSPTC with limited involvement of the trachea could be treated successfully by shaving tumor off the tracheal cartilage. Intraluminal involvement extending through the tracheal cartilage could be resected radically in patients with PTC. Postoperative radiotherapy could improve the survival of the patients with PTC with tracheal invasion who have been performed incomplete resection.

Adult ; Aged ; Carcinoma, Papillary ; diagnosis ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Prognosis ; Retrospective Studies ; Survival Rate ; Thyroid Neoplasms ; diagnosis ; pathology ; therapy ; Trachea ; pathology ; Tracheal Neoplasms ; diagnosis ; secondary ; therapy

Objective To evaluate the reliability, validity and sensitivity of a Family Burden Scale (FBS) of disease used on schistosomiasis. Methods 224 schistosomiasis patients were investigated, using the FBS. Reliability was estimated by Cronbach's α coefficient and split-half reliability. Validity was tested by factor analysis. Sensitivity was evaluated by comparison of patients with different income levels. Results The Cronbach's α coefficient was 0.874 and split-half reliability was 0.939 for FBS, respectively. Most values of Cronbach's α and split-half reliability for each component of scale were above 0.70. Construct validity was appraised by factor analysis, and 6 factors were identified. These factors could explain 66.76 % of the total variance. Patients with different income levels showed significant difference in terms of family burden for schistosomiasis (P<0.001 ). Conclusion This FBS appeared to have satisfactory reliability, validity and sensitivity and could be used in evaluating family burden of schistosomiasis patients.

Objective To compare real-time PCR and gomori-methenamine silver stain in the diagnosis of pneumocystis peumonia (PCP).Methods 2 525 unrepeated specimens from suspected PCP patient admitted in Peaking Union Medical College Hospital were collected in 2014.2 492 samples were detected by gomori-methenamine silver stain,33 samples were detected by real-time PCR,and 429 samples were detected by both methods at the meanwhile.With clinical diagnosis as reference standard,the sensitivity,specificity,positive predictive value and negative predictive value of the two methods were analysised.Results Positive rate of gomori-methenamine silver stain was 1.2 ％ (30/2 492).The first three specimen types were sputum,tracheal intubation suction and bronchoalveolar lavage fluid,the positive rate was 0.70 ％ (13/1 845),4.00％ (10/250) and 2.72％ (7/257) respectively.Positive rate of realtime PCR was 34.20％ (158/462),and the positive rate of sputum and bronchoalveolar lavage fluid was 30.61％ (105/343) and 44.54％ (53/119) respectively.The sensitivity were 13.97％ vs 72.07％,specificity were 100％ vs 94.24％,positive predictive value were 100％ vs 92.14％ and negative predictive value were 55.36％ vs 78.26％ for gomori-methenamine silver stain and real-time PCR respectively.All of which were statistically significant analysed by x2 test for paired data.The x2 value and P alue were x2 =68.625,P＜0.01;x2 =4.296,P＜0.05;x2 =6.380,P＜0.01 and x2 =11.873,P＜0.01.Conclusion The real-time PCR had higher sensitivity,fewer interference factors and more clinical diagnostic value,so clinicians should make more use of real-time PCR to diagnose PCP earlier.