Objective To evaluate the effectiveness of noninvasive positive pressure ventilation(NPPV) as a weaning strategy in patients with acute respiratory failure after failure to wean from invasive positive pressure ventilation(IPPV). Method A prospective randomized and controlled clinical trial of weaning of IPPV was carried out in patients mechanically ventilated in mode of IPPV for more than 48 hours with failure in a spontaneous breathing trial(SBT: PSV 6 cmH_2O). Patients with contraindications to NPPV were excluded. After failure the SBT, patients were randomly divided(random number) in two groups. Patients in NPPV group were extubated after being ventilated with high pressure support for 30 minutes and then placed on NPPV. Patients in IPPV group were weaned following conventional procedure. Arterial blood gases, maximal inspiratory pressure, respiratory rate,tidal volume, rapid shallow breathing index, heart rate, arterial blood pressure, and peripheral oxygen saturation were measured before and after failing the SBT. The rate of complications, including pneumonia and tracheotomy duration mechanical ventilation, days of hospital stay and outcome were observed. Findings of the two groups were vompared using the Student t test and the chi-square test. Results The percentage of complications in the NPPV group was lower(22.9% versus 72.2%, P <0.01) ,with lower incidences of pneumonia(6.1%,36.1%; P <0.01) and tracheotomy. Compared between the two groups, days of ICU stay( 14.16(3.45) d vs. 22.57( 7.71 ) d; P <0.01) and total days of mechanical ventilation(14.88±3.76 days vs. 20.68± 2.79 days, P <0.01) of NPPV group are shorter than IPPV group. Conclusions NPPV is a good alternative to the mechanically venti-lated patients who fail in initial weaning attempts. The key to successful NPPV weaning is the proper selection of weaning candidates and using NPPV as soon as possible after extubation.

This study was aimed to collect relevant provisions of bulging disease medical records in the Ming and Qing dynasties to excavate the syndrome differentiation, drug law and medication frequency analysis. A database was established to analyze relevant provisions. The results showed that the syndromes of liver stagnation and spleen deficiency, dampness-heat accumulation, spleen-yang deficiency are the most common type. The mainly used drugs are from the category to eliminate dampness and water, and to tonify the deficiency. The top three used drugs are poria, atractylodes, and dried citrus peel. It was concluded that medications used in the Ming and Qing dynasties were mainly targeted to the disordered zangfu-organ, which was mainly about the spleen and the stomach. The syn-drome differentiation is the mixture of deficiency and excess. And deficiency is the main part. The medication should combine tonification and reducing. And tonification should be paid attention to. The syndrome differentiation and treatment should be coordinated and the primary and secondary aspect should be identified. These rules provide ref-erence effect for the clinical practice and scientific research of bulging disease treatment.

Objective:To explore the histogenesis and differentiation of dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP). Methods: Clinical information and microscopic characteristics of 26 cases of DF and 26 cases of DFSP were investigated. The immunohistochemical study was performed on microarray sections by a panel of antibodies including FactorⅩⅢa, HLA-DR, CD34, CD14, S-100, MSA, and Ki67. Probe was labeled by in vitro transcription. The mRNA expression levels of TGF-? and bFGF were investigated by in situ hybridization. Results: All cases showed positive for Factor ⅩⅢa,HLA-DR and CD34 to different extent. The medians of positive rates in DF were FactorⅩⅢa 90%, HLA-DR 70%, and CD34 5%, and in DFSP were FactorⅩⅢa 10%, HLA-DR 5%, and CD34 80%. CD14 was positive in 3 cases of DF and 1 case of DFSP. S-100 was positive in 6 cases of DFSP and 2 cases of DF. MSA was positive in 5 cases of DFSP and 3 cases of DF. In all cases, positive rate of Ki67 was less than 5%. The mRNA expression levels of TGF-? was elevated in DF in comparison with DFSP. Conclusion: Both DF and DFSP can differentiate to dendritic cells (DC) in different degree. Considering the character of microscopic features and immunohistochemical phenotype, cells of DF are much similar to mature DC, while those of DFSP much similar to immature dermal reserve cell (DRC). The differences of cell differentiation between DF and DFSP result in different prognosis. DF is a benign tumor, while DFSP a low grade malignant tumor. The different expression of FactorⅩⅢa and CD34 may be helpful to differential diagnosis of DF and DFSP.

Objective:Since malignant fibrous histiocytoma (MFH) may be taken as an undifferentia-ted pleomorphic sarcoma (UPS), this study was conducted to reassess 33 previously diagnosed MFH cases in the past 10 years based on the latest WHO concept. And then to search for the clinicopathological features, probably tumorigenesis, and the line of differentiation of the remaining MFH/UPS cases.Methods: Thirty-three cases in tissue microarray were studied by immunohistochemistry with panels of neurogenic, myogenic, and lipogenic antibodies. Three expertise pathologists reevaluated the slides separately. Results: Among the 33 cases, 17 cases (51.5%) of MFH had their diagnoses changed, including 5 leiomyosarcomas, 3 malignant peripheral nerve sheath tumors, 1 fibrosarcoma, 1 inflammatory myofibrosarcoma, 1 giant cell tumor and 1 angiomatoid fibrous histiocytoma. The remaining 16 cases (48.5%) were finally diagnosed as MFH/UPS, among which patients were mainly old adults (median age: 63 years; range: 38 to 76 years). The median tumor size was 6.0 cm (range: 3.0 to 14.0 cm), 8 cases (50%) located in lower limb and 5 cases (31.3%) located in thigh. These tumors had marked cytological and nuclear pleomorphism. Immunohistochemistry showed that Vimentin was strongly positive in all 16 MFH/UPS (100%), Muscle-specific actin was variously positive in 8 cases (50%) and 1 case focally expressed Desmin. Eleven cases (68.8%) variously expressed CD68 (KP1) and 7 cases (43.8%) expressed CD68 (PG-M1), which were much higher than leiomyosarcoma, malignant peripheral nerve sheath tumor and liposarcoma with significant difference. Moreover, Ki67 expression rates were from 10% to 100%, including 14 cases more than 50% and 11 cases more than 70%. However, only 2 cases (12.5%) showed P53 positive. Conclusion: MFH/UPS often show marked histological pleomorphism, and the diagnosis must be made by exclusion of other definitive sarcomas, especially myogenic and neurogenic sarcoma. Only Vimentin was always expressed in MFH/UPS, while some of the tumors were positive for myogenic antigen and CD68. It was suggested that MFH/UPS might arise from primary mesenchymal cells, and some cases exhibited fibroblastic and/or myofibroblastic features. In addition, histiocytic phenotypic marker did have more expression in MFH/UPS than in other sarcomas. MFH/UPS still had certain clinicopathological characteristics.

Purpose To investigate the value of real-time three-dimensional contrast-enhanced ultrasound (RT3D-CEUS) for the evaluation of blunt renal trauma hemorrhage. Materials and Methods Nine healthy New Zealand white rabbits were randomly divided into three groups, and after heparinization, the models of ongoing hemorrhage of blunt renal trauma were developed by self-made minitype striker in the three groups with different force levels:77.2 N (group A), 106.2 N (group B), 135.1 N (group C). All rabbits were performed ultrasonography (US), color Doppler flow imaging (CDFI) and RT3D-CEUS before and after strike (within 20 minutes). The results achieved by US, CDFI, 2D-CEUS (A-plane results in RT3D-CEUS) and RT3D-CEUS were compared with each other, and further compared with the pathological results of the executed animals after blood pressure decreased lower than 40 mmHg. Results All rabbits showed traumatic renal lesions and it proved that the bigger the force the heavier the injury (group A: 1 case of levelⅠ, 2 cases of levelⅡ;group B:3 cases of levelⅢ;group C:1 case of levelⅢ, 2 cases of level Ⅳ ). After strike, US identified the presence of increasing hematoma under the capsule but could not detect active bleeding. In CDFI, only 1 case was detected ongoing hemorrhage. 2D-CEUS clearly presented the bleeding in all cases. RT3D-CEUS presented a vivid real-time and stereoscopical image of active hemorrhage in all cases and also showed that the wider the bleeding area was shorter than the shock duration time. Conclusion RT3D-CEUS can present a real-time dynamic bleeding and locate headstream of blood in renal trauma vividly and stereoscopically, and can be used to preliminarily evaluate the degree of ongoing hemorrhage in traumatic kidney.

We reported a case of pulmonary capillary hemangiomatosis (PCH) and introduced its diag-nosis, differential diagnosis, pathogenesis and development of treatment based on the review of Dana Point 2008 Classification of Pulmonary Hypertensiona and current literatures .A 43-year-old female presented progressive dyspnea, elevated pulmonary arterial pressures and CT pulmonary angiography (CTPA) imaging of main pulmonary arterial enlargement and wide spread ill -defined centrilobular nodules of ground-glass opacity.Her histologic features were proliferation of capillary channels within alveolar walls as well as muscularization of arterioles and medial hypertrophy of muscular pulmonary arteries.The treatment with diuretics and warfarin was used promptly , but unfortunately was ineffective. The patient died three months after diagnosis .PCH is a very rare vascular disease with poor prognosis . The diagnosis of PCH rests on the integration of clinical and radiographic information with pathologic fea -tures, however pathology is the most reliable means .Because clinical symptoms, imaging and histological features of pulmonary veno-occlusive disease (PVOD) and PCH broadly overlap, differential diagnosis should be made carefully.Among the various pathologic features proliferation of capillaries within alveolar walls is the key point for diagnosing PCH , which is also the most critical criteria for differentiating PCH from PVOD.So far the only definitive treatment for PCH is lung transplantation , without which the pa-tient will die several months after diagnosis .

A novel hydrophobic ferrocene polymer ( P-Fc) was synthesized successfully. Taken the advantage of 2-hydroxypropyl-β-cyclodextrin ( HP-β-CD ) with hydrophilic outside and hydrophobic inside, P-Fc was successfully enveloped in the cavity of HP-β-CD to form macromolecular vesicle by a self-assembly process. The structure and morphology of the macromolecular vesicle was characterized by FTIR, 1HNMR, SEM and CV. Rhodamine 6G (R6G) and doxorubicin hydrochloride (DOX) was used as target drugs and loaded in the vesicles successfully. After added the oxidant, ferrocene was oxidized to dicyclopentadienyl iron, which destroyed the vesicles successfully. The rapid directional release of the drugs was realized. The maximum loading values of R6G and DOX were 6. 89 and 39. 06 μg/mg, respectively. The release rates were 73. 7%and 88. 2%, respectively. It would increase the utilization level of the drugs and enhance their efficiency.

A 57-year-old man was admitted to the hospital for a 7-year progressively spreading plaques involving the entire body surface, and multiple irregularly sized red nodules and infiltrated patches on the face, trunk and limbs. Histopathological examination showed pleomorphic tumor cells diffusely dis-persed throughout the dennis, giving an appearance of low proliferation. Some cells with cytoplasmic pro-cesses appeared multiangular in shape, lmmunohistochemically, tumor cells were negative for CDla or S-100, but positive for CD45, FXIIIa, CDl4, MHC- Ⅱ, CD68 and lysozyme with extracellular interstitial expression. Ultrastructurally, the cells exhibited cytoplasmic processes and irregularly sized nuclei; no Birbeck granules were observed. Vesicules of low electron-density were seen diffusely in cytoplasm and extracellular matrix. The case is herein diagnosed as cutaneous non-Langerhans cell histiocytosis, which presents with a chronically invasive clinical course. These cells may develop from immature dermal dendritic cells.

OBJECTIVETo study the histologic features and immunohistochemical findings of interfollicular stromal cells in hyaline-vascular Castleman's disease (HVCD), and to explore the role of these stromal cells in the pathogenesis of this disease.

METHODSThe clinical findings and microscopic features of 23 cases of HVCD cases were reviewed. Immunohistochemical study for CCL21, MSA, CD21, CD35, S-100 and CD34 was carried out.

RESULTSAccording to the criteria proposed by Danon et al., stroma-rich variant of HVCD contained prominent interfollicular zone which occupied at least 50% of the lymph node area. In the current study, there were 14 cases of stroma-rich HVCD and 9 cases of conventional HVCD. Eleven of the stroma-rich HVCD had paraneoplastic pemphigus and contrastly, no pemphigus lesion obtained in all the 9 cases of conventional HVCD. The association between stromal cell hyperplasia and paraneoplastic pemphigus was statistically significant (P < 0.01).In all the conventional HVCD cases studied, CCL21 and MSA were positive in the stromal cells.The stromal cells in 13 of the 14 cases of the stroma-rich HVCD were also positive for CCL21 and MSA, however, staining for CD21, CD35, S-100 and CD34 was negative in both groups. There was no statistical significance obtained (P > 0.05) between the differences of the staining results.

CONCLUSIONSStroma-rich HVCD and conventional HVCD represent two distinctive histologic variants and have a different association with paraneoplastic pemphigus. Most of the stromal cells locating in the interfollicular areas are fibroblastic reticular cells in origin, with the immunophenotype as CCL21(+)/MSA(+)/CD34⁻/CD21⁻/S-100⁻. The stromal cells proliferation correlate with the occurrence of paraneoplastic pemphigus, nevertheless, more cases are expected for a further study of the underlying pathogenesis.

Actins ; metabolism ; Adolescent ; Adult ; Blood Vessels ; pathology ; Castleman Disease ; complications ; metabolism ; pathology ; Chemokine CCL21 ; metabolism ; Female ; Follow-Up Studies ; Humans ; Hyalin ; cytology ; Lymph Nodes ; blood supply ; pathology ; Male ; Middle Aged ; Pemphigus ; complications ; metabolism ; pathology ; Stromal Cells ; pathology ; Young Adult

OBJECTIVETo explore the correlation between Pi and Shen by observing the relationship between the metabolism of aristolochic acid (AA) and mRNA and protein expression levels of organic anion transporting polypeptide (oatp) superfamily member 2a1 and 2 b1 (oatp2al and oatp2bl) in renal, small intestinal, and large intestinal tissues of Pi deficiency syndrome (PDS) model rats.

METHODSTotally 46 Sprague-Dawley (SD) rats were randomly divided into four groups, i.e., the blank group (n = 12), the PDS group (n = 22), the AA-I group (n = 6), and the PDS AA-I group (n = 6). PDS model was established by subcutaneously injecting Reserpine at the daily dose of 5 mg/kg for 16 successive days. Carotid intubation was performed in 6 rats selected from the blank group and the PDS group. Pharmacokinetics of AA-I were detected at 5, 15, 30, 45, and 60 min after gastrogavage of AA-I. AA-I concentrations in renal, small intestinal, and large intestinal tissues of 10 rats selected from the PDS group were determined. Normal saline was administered to 6 rats selected from the PDS group and the blank group by gastrogavage. Renal, small intestinal, and large intestinal tissues were collected in the AA-I group and the PDS AA-I group at 60 min after gastrogavage of AA-I. mRNA and protein expression levels of oatp2a1 and oatp2b1 in each tissue were detected using real-time polymerase chain reaction (RT- PCR) and Western blot.

RESULTSCompared with the blank group, plasma concentrations of in vivo AA-I were obviously higher in the PDS group at 15, 30, 45, and 60 min after gastrogavage of AA-I with statistical difference (P < 0.05). Plasma concentrations of AA-I were obviously decreased at 60 min after gastrogavage of AA-I; AA-I concentrations in renal and large intestinal tissues were elevated; AA-I concentrations in small intestinal tissues were obviously reduced in the PDS group. There was no statistical difference in mRNA expression levels of oatp2a1 and oatp2b1 in the aforesaid three tissues of rats between the blank group and the PDS group. Compared with the blank group, mRNA expression levels of oatp2a1 and oatp2b1 decreased in small intestinal tissues of the AA-I group, and the mRNA expression level of oatp2a1 in large intestinal tissues significantly decreased (P < 0.05, P < 0.01). Compared with the PDS group, mRNA expression levels of oatp2a1 and oatp2b1 increased in renal tissues of the PDS AA-I group (P < 0.05); mRNA expression levels of oatp2b1 increased in large intestinal tissues of the PDS AA-I group (P < 0.05).

CONCLUSIONSThe difference in AA-I metabolism might be associated with changed expression levels of oatp2a1 and oatp2b1 in renal, small intestinal, and large intestinal tissues under Pi deficiency induced loss of transportation. Shen and Dachang played important roles in substance metabolism under Pi deficiency state, which proved Pi-Shen correlated in Chinese medical theories.

Animals ; Anions ; Aristolochic Acids ; metabolism ; Drugs, Chinese Herbal ; Kidney ; Medicine, Chinese Traditional ; Organic Cation Transport Proteins ; metabolism ; Peptides ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley