Patients with acute stroke are easily complicated with infection.It may seriously affect the prognosis.With the constantly in-depth study of the pathogenesis of stroke-related infections,its associated risk factors also become increasingly clear,including stroke severity,stroke types and location,malnutrition,diabetes,dysphagia,disturbance of consciousness,invasive operation,and the use of antacid,etc.This article reviews the major risk factors for stroke-related infections.

Objective To analyse the clinical features,predisposing risk factors and treatment of hematologic diseases complicated by pulmonary fungal infection(PFI).Methods The medical records of 97 cases of PFI were retrospectively analyzed.Results Totally 201 fungal strains were obtained from 97 cases of hematologic diseases.The candida strains were 147(73.1%).Two-fungal infection was 17.5%,and secondary bacterial infection was 71.8%;relative death rate was 23.4%.Cure rate of Amphotericin B deoxycholate and Itraconazole was 67.7% and 63.7%.Conclusion Fungal infection is one of the main pathogens in hematologic diseases complicated by infection.Early diagnosis and treatment is the key to beneficial release and long time survival.Amphotericin B deoxycholate and Itraconazole were effective medicines for treated fungal infection.

Objective To understand the typing and clinical significance of M-protein,to raise the understanding and diagnostic level through analysis of 639 patients with M-protein.Methods To analysis age,sex and disease of M-protein positive patients,charateristic and content difference of multiple myeloma(MM)and monoclonal gammopathy of undeterminal significance(MGUS).Results In 639 patients with M-proteinemia,there were 409 patients with IgG-type(64%),80 IgA-type(12.5%),79 IgM-type(12.4%),4 IgD-type(0.6%),9 ? light chain(1.4%),18 ? light chain(2.8%),27 double clone(4.2%),oligoclone(2.0%).There were 115 MM(18.0%),13 Waldenstrm's macroglobulinemia(2.0%),1 primary amyloidosis of kidney,19 non-Hodgkin's lymphoma(NHL)(3%),5 chronic lymphocytic leukemia(CLL)(0.8%),473 MGUS(74.0%).Conclusion M-proteinemia is a clinical phonomenon,mainly in MM and lymphocytic proliferative disease.There is an improving tendency in MGUS detectable rate.

Objective:To vealuate the effect of percutaneous transhepatic insertion of biliary setents(PTIBS) and arterial chemoenbolization for treatment of malignent biliary obstruction(MBO).Methods:Twelve patients with MBO were treated with PTIBS,following by arterial chemoenbolization in two weeks,one time each months.Results:Fourteen stents were placed in 12 cases.The total serum bilirubin level declined from 534?120 umol/L to 45?23 umol/L in 11 patients.The survival rate of 6 and 12 monthes were 83.3% and 50% respectively.Two cases were reobsturcted after 5 months of first stent implacemnt and were retreated by insertion of second stents.The total thirty-five times arterial chemoembolization was performed in 12 cases with remarkable effect.Conclusion:PTIBS combined arterial chemoembolization was an safe ;effective interventional treatment for MBO. [

OBJECTIVE:To detect and analyze the safety signals of pemetrexed in post-marketing,and provide references for rational drug use in the clinic. METHODS:A form of data mining techniques was used to detect the safety signals of pemetrexed in American adverse events reporting system and the analysis of signal effect factors i.e.,gender,age,dosage and indication was per-formed by SPSS 19.0. RESULTS:173 signals related to pemetrexed were excavated in 5 397 235 reports,and the number of report-ed adverse event in blood-lymphatic system was the most(491)and the number of signals in gastrointestinal system was the most (17). There was no statistical significance in the distribution of blood-lymphatic system and gastrointestinal system in gender(P=0.075) and age (P=0.726) compared to other system adverse event,but there was statistical significance in dosage (P=0.007) and indication(P=0.001). CONCLUSIONS:Adverse events induced by pemetrexed in blood-lymphatic system and gastrointestinal system should be monitored at the same time,especially combined with non-steroidal anti-inflammatory drugs.

Gastrointestinal bleeding is common in children. The causes of hemorrhage is numer-ous and varies with age. Most of them can be identified by conventional endoscopy and imaging examina-tion. For unexplained bleeding,especially repeated bleeding which failed to conservative therapy,a one-stop hybrid procedure of gastrduodenoscopy,colonoscopy and laparoscopy showed great clinical application value. Endoscopic hematischesis is widely used for minimally invasiveness,effectiveness,and recognition of biopsied lesions. With the progress of laparoscopic technology,single-port transumbilical laparoscopy is increasingly applied in pediatric gastrointestinal bleeding. While surgical exploration is still mandatory for massive hemorrhage in emergency circumstances.

Objective To find out a scientific,practical,standard method suitable for comprehensive assessment on environmental quality of public places in China Methods The data on the indoor temperature,the concentrations of carbon dioxide and carbon monoxide,the total count of bacteria and illumination collected from 6 hotels of Taiyuan and 7 hotels of Tangshan were comprehensively assessed by using YAO Zhi qi index,Nemerow Index,Equal Quality Demotion Method and Osculation Value Method respectively.The identity and difference of this assessment results obtained by four methods were compared and analyzed at last Results This assessment results of four methods revealed better identity ( r s=0 600~0.971,P

Objective To evaluate the inflammatory response and the expressions of peroxisome proliferator-activated receptor(PPAR)isoforms(PPARα,PPARβ/δ,and PPARγ)in the brain(cortex,striatum,cerebellum)of spontaneously hypertensive rats(SHR).Methods Brain tissues(cortex,striatum,and cerebellum)were dissected from SHR and age-matched control Wistar-Kyoto rats.Myeloperoxidase(MPO)activity was measured in brain tissues as an index of neutrophil accumulation and the carbonyl protein content was analyzed by spectrophotometry to evaluate the protein oxidation.RT-PCR and Western blotting were performed to examine the expressions of inflammatory mediators(IL-1β,TNFα,ICAM-1,and iNOS)and nuclear factor PPARs(PPARα,PPARβ/δ,and PPARγ),respectively.Results(1)Systolic blood pressure of SHR was significantly higher than that of Wistar-Kyoto rats,(205.4±9.4)mm Hg versus(130.4±7.9)mm Hg(t=14.96,P＜0.01).(2)MPO activity of cortex,striatum,and cerebellum were markedly higher in SHR than in Wistar-Kyoto rats.Carbonyl protein levels of cortex,striatum,and cerebellum in Wistar-Kyoto rats and SHR were(3.27±0.43)nmol/mg versus(11.87±1.11)nmol/mg,(4.02±1.04)nmol/mg versus(14.06±1.36)nmol/mg,(5.94±0.71)nmol/mg versus(14.95±1.82)nmol/mg,indicating significantly higher levels of protein oxidation in SHR than Wistar-Kyoto rats(t=17.70,14.36,11.30,P＜0.05).Consistently,the expression of pro-inflammatory mediators(IL-1β,TNFα,ICAM-1,and iNOS)was upregulated when compared with Wistar-Kyoto rats.The difference between SHR and control Wistar-Kyoto rats was statistically significant except the mRNA expression of IL-1β in striatum,cerebellum and TNFα in cerebellum of SHR.All the above experimental data indicated the occurrence of inflammatory status in the brain tissue of hypertension.(3)mRNA and protein levels of brain PPAR isoforms(PPARα,PPARβ/δ,and PPARγ)of SHR increased significantly when compared with Wistar-Kyoto rats.Specifically.protein levels of PPARα in cortex.striatum,and cerebellum of SHR increased by 644.78%,791.95%,and 42.85%;PPARβ/δ increased by 106.72%,94.12%,and 161.44%;PPARγ was up-regulated by 2700.16%,790.81%,and 875.00%compared with that of Wistar-Kyoto rats,respectively.Conclusions The brain(cortex,striatum,and cerebellum)from SHR shows marked inflammatory status and increased expression of all PPAR isoforms.Increases in PPARs expression may play a compensatory role in the inflammatory response of the brain in SHR.

Objective To evaluate the maternal and fetal outcomes of pregnant women with lupus nephritis (LN) and the risk factors.Methods Ninety-three patients with 97 pregnancies from January 1st,1990 to December 31st,2012 in Peking Union Medical College Hospital were evaluated retrospectively.Objects of study were divided into three groups:stable lupus before pregnancy (stable group,52 cases),active lupus before pregnancy (active group,26 cases),and newly diagnosed LN during pregnancy (19 cases).Adverse maternal outcomes included exacerbated disease during pregnancy,preeclampsia,increased proteinuria and impaired renal function during pregnancy or postpartum,maternal death,thrombocytopenia and hypocomplementemia.Adverse fetal or neonatal outcomes included therapeutically termination of pregnancy,fetal loss,neonatal death,preterm labor,small gestational age and asphyxia.Statistical analysis was performed by Chi-square test or Fisher's exact test.A binary logistic regression model was used to evaluate the risk factors for adverse maternal and fetal outcomes.Results (1) Adverse maternal outcomes:There was no significant difference between exacerbated cases during pregnancies in stable group and that in active group [53.8 ％ (28/52) vs 61.5 ％ (16/26),x2 =0.417,P＞0.05].After deleting abortions before 20 weeks of gestation (5 cases in stable group and 4 cases in active group),there was no significant difference between preeclampsia incidence in stable group and that in active group [36.2％ (17/47) vs 59.1％ (13/22),x2 =3.204,P＞0.05].In nineteen newly diagnosed LN women,eighteen cases were over 20 weeks of gestation,during which preeclampsia incidence was 6/18.(2) Adverse fetal or neonatal outcomes:Therapeutically termination of pregnancy rate was higher in active group than that in stable group[42.3％(10/26) vs 7.7％(4/52),Fisher's exact test,P＜0.01].After deleting patients who required termination of pregnancy (three cases in stable group) and therapeutically termination of pregnancy (four cases in stable group and ten cases in active group),the rate of fetal loss and neonatal death was higher in active group than that in stable group [5/16 vs 6.7％(3/45),Fisher's exact test,P＜0.05].The rate of adverse fetal or neonatal outcomes was higher in active group than that in stable group [92.3％(24/26) vs50％(26/52),x2=13.483,P＜0.001].Among the nineteen newly diagnosed LN cases during pregnancy,the numbers of therapeutically termination of pregnancy and fetal loss were five and three cases respectively; among eleven live birth cases,two newborns died from severe asphyxia,and nine cases were preterm birth.(3) Binary logistic regression analysis showed that the independent risk factors for exacerbated lupus during pregnancy were hypocomplementemia (OR =0.300,95％ CI:0.104-0.863) and thrombocytopenia (OR =0.054,95％CI∶0.007-0.439).The independent risk factors for preeclampsia in LN pregnant women were thrombocytopenia (OR=0.151,95％CI:0.046-0.499) and LN recurrence or first diagnosed during pregnancy (OR=0.135,95％CI:0.027-0.679).The independent risk factors for adverse fetal or neonatal outcomes were preeclampsia (OR=0.134,95％CI:0.028-0.637) and lupus active during pregnancy (OR =0.026,95 ％ CI:0.005-0.138).Conclusions Active lupus before pregnancy is associated with poor maternal and fetal outcomes in lupus nephritis pregnancy.All pregnancies with LN should be planned,preferably after more than six months of quiescent disease.Blood pressure,renal function,proteinuria and level of platelet and serum complements should be closely monitored.