Objective To compare the therapeutic effect of three treatment regimens on H 22 tumor-bearing mice. Methods H22 tumor-bearing mice were treated by local injection of compound chemotherapeutic agents (5-FU, mitomy-cin and cisplatin ) , oral administration of sorafeni , or the both combined , respectively .Standardized and quantitative syn-drome differentiation methods were used to assess the syndromes and tumor-inhibition rate in the mice .Results All these three therapeutic regimens were effective in suppressing the tumor growth in mice .Among them, the combined therapeutic regimen of local injection of compound chemotherapeutic drugs plus oral administration of sorafeni was the best .Conclu-sion The effect of sorafenib combined with local injection of compound chemotherapeutic agents is better than the other two regimens used separately .

Objective To compare and analyze clinical and pathological data of autopsyconfirmed invasive fungal disease (IFD) in elderly patients in order to achieve a better understanding of the clinical and pathological characteristics of IFD.Methods A total of 18 cases of IFD were diagnosed by autopsy from 1984 to 2014 at Beijing Hospital.Clinical and pathological data of IFD,including risk factors,clinical manifestation,X-ray and pathological characteristics,were analyzed retrospectively.Results The 18 cases were all male wvith an average age of (83.7±7.2) years and each patient had at least one risk factor for IFD.Of them,14 patients (77.8％) suffered malignancies of various origins.With respect to the pathogens,Mucor (6 cases) was the most common one,followed by Aspergilla (4 cases),Mycotoruloides (4 cases) and Cryptococci (2 cases).The lung was the most frequently implicated organ wvith 13 cases (72.2％),followed by the gastrointestinal tract.Vascular erosion was an important pathological characteristic of fungal infection,whose presentations included vasculitis,hemorrhage and embolism in tissues and organs.14 patients died from fungal infection-related causes,of which.massive hemorrhage as a result of vascular erosion by fungal infection was responsible for four patients' deaths.Conclusions Malignancies are an important risk factor for invasive fungal disease in elderly patients.Vascular erosion is a significant character of fungal infection.

Objective To explore the value of ~(18)F 2-deoxy-2-fluoro-d-glucose(~(18)F-FDG)positron e-mission tomography (PET)/computed tomographic (CT) imaging and CT perfusion in evaluating metabolic and blood flow characteristics in breast cancer.Methods 32 women with untreated breast masses were both ex-amined with ~(18)F-FDG PET/CT and CT perfusion at the same day.All the lesions were confirmed histopothologi-cally by surgery or biopsy.The PET/CT images were analyzed semi-quantitatively.CT perfusion images were analyzed using the GE perfusion 3 soft package.The findings of two modalities above were commed with patho-logical diagnosis.Results There were significant differences between standardized uptake values (SUVs) of ~(18)F-FDG of benign tumors and breast cancer (Wilcoxon test:P=0.000 3,T=15.000,u=3.433,C=1).Differ-ences of SUVs between the center and periphery of breast Inasses were also significant.In addition.the SUVs were related to the pathological type and the grading of tumors.In the CT perfnsion,the differences of perfusion including bloodflow (BF),blood volume(BV)and permeability surface area product (PS) values between tumor and normal breast tissue were statistically significant(t=8.065,P<0.000 1;t=2.769 1,P=0.011 5;T~+=253.000 0,T~- =0.000 0,P<0.000 1)respectively.The differences of BF,BV and PS values between pe-ripheral zone and central portions of tumor were also statistically significant (t=8.015 8,P<0.000 1;t=2.243 4,P=O.017 9;t=3.485 7,P=0.002 2),respectively.Conclusion ~(18)F-FDG PET/CT imaging and CT peffusion reveal the metabolic and blood flow characteristics,and reflect biological behavior of breast tumor indirectly and have important value for the diagnosis and prognosis of breast cancer.

Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S .marcescens ),and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract (70.26%),among which the majority were from sputum (64.87%).S .marcescens were primarily from intensive care unit(ICU,19.44%),department of integrated tradi-tional Chinese and Western medicine(15.46%)as well as rehabilitation department (13.58%).The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all<10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim (SMZ/TMP),and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant (P <0.05).In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.

OBJECTIVE To find a way of reserving high quality phonation function after phonomicrosurgery for premalignant lesions of the larynx.METHODS There were 77 cases with leukoplakia or atypical hyperplasia of the vocal cord included in this study.They were all treated with phonomicrosurgical techniques as mucosal epithelium ablation or mucosal stripping by using CO_2 laser.Ten patients with laryngeal papilloma were excised by CO_2 laser.RESULTS Twenty three patients with leukoplakia or mild atypical hyperplasia of the vocal cord achieved a normal phonation within 2 months.The 44 patients with moderate and advanced hyperplasia need 3～5 months to recover the normal phonation.Phonation recovery of the 10 patients with laryngeal papilloma treated with CO_2 laser was better than patients treated with transcervical approach.CONCLUSION The CO_2 laser assisted phonomicrosurgery is a reliable method for management the premalignant lesions of the larynx, which not only can remove the lesions and also can restore good voice function.

To analyze and summary the setting of admission standards, training methods and certification and assessment methods of specialized nursing teachers, in order to lay the foundation for the homogenization training of specialized nursing teachers in China, and at the same time, provide guarantee for the improvement of the homogenization level of national specialized nursing training bases.

OBJECTIVETo evaluate the clinical and pathological features of IgG4-related disease (IgG4RD).

METHODSThe clinical data, laboratory profiles, radiological, pathological and therapeutic features of eight cases of IgG4RD were analyzed. This cohort included two cases of common bile duct and partial hepatectomy specimens, two of submandibular gland excision specimens, one from lung biopsy specimen, one from open lung biopsy specimen, one from renal biopsy specimen, and one from renal excision specimen. In all cases, adequate lesion tissues were obtained. They were paraffin embedded, HE stained, and additional special stains and immunohistochemistry performed (MaxVision method).

RESULTSThis series consisted of five males and three females, with a mean age of onset of 60 years. Five cases were suspected to be malignant pre-operatively, including two cases suspected of common bile duct carcinoma, two suspected of salivary gland tumor, and one suspected of renal pelvic carcinoma. Elevated serum levels of IgG4 and IgE were detected in five cases and eosinophilia in four cases. Multi-organ involvement was noted in four cases. The major histopathological features associated with IgG4-RD were: dense lymphoplasmacytic infiltrate, with lymphoid follicle formation. Extensive eosinophilic infiltrate (> 10/HPF) was seen in four cases; fibrosis that was arranged at least focally in a storiform pattern was also noted. The numbers of IgG4 positive plasma cells were > 20-50/HPF, while the IgG4 to IgG ratio was more than 40%. Obliterative phlebitis was present in four cases. Other pathological changes such as necrotizing vasculitis or lymphoma were not found. Five patients responded well to glucocorticoids.

CONCLUSIONSIgG4RD has relatively specific histopathological features; accurate evaluation of the absolute and relative number of IgG4 positive plasma cells in lesional tissue, combining with clinical examination and exclusion of other causes of elevated IgG4, allows the diagnosis of IgG4RD. IgG4RD has complicated clinical manifestation, and glucocorticoids therapy is efficacious.

Biopsy ; Common Bile Duct Neoplasms ; blood ; pathology ; Female ; Fibrosis ; pathology ; Humans ; Immunoglobulin E ; blood ; Immunoglobulin G ; blood ; Immunohistochemistry ; Kidney Neoplasms ; blood ; pathology ; Kidney Pelvis ; pathology ; Lung ; pathology ; Male ; Middle Aged ; Plasma Cells ; Salivary Gland Neoplasms ; blood ; pathology

OBJECTIVESTo observe the changes of serum interleukins (IL), T-lymphocyte subsets, and white blood cell (WBC) count in patients with severe acute respiratory syndrome (SARS), and to investigate the relationship between injured immune function, immune response and disturbed immune adjustment in SARS patients.

METHODSThe levels of serum IL-2, IL-10, IL-12 and T-lymphocyte subset counts were measured in 35 clinically diagnosed SARS patients by using enzyme linked immunosorbant assay (ELISA). The relationship between the measured results and WBC count was further analyzed.

RESULTSThe level of serum IL was increased to a great extent in the 35 SARS patients, and the levels of serum IL-2, IL-10 and IL-12 were 242.53 (92.69) pg/ml, 77.43 (63.37) pg/ml and 65.94 (43.21) pg/ml, respectively. The level of serum IL-2 increased markedly (P < 0.01). The peripheral blood CD(3)(+), CD(4)(+) and CD(8)(+) counts were lower than normal in 23 patients (67.7%), 26 patients (74.3%) and 15 patients (42.9%), respectively. The peripheral blood WBC counts were lower than 4.0 x 10(9)/L in 10 patients, and their CD(3)(+), CD(4)(+) and CD(8)(+) counts were 583.90 (315.58) x 10(6)/L, 272.00 (94.13) x 10(6)/L and 209.00 (72.21) x 10(6)/L, respectively. The peripheral blood WBC counts were (4.0 - 10.0) x 10(9)/L in 20 patients, and their CD(3)(+), CD(4)(+) and CD(8)(+) counts were 700.00 (502.96) x 10(6)/L, 347.00 (247.58) x 10(6)/L and 322.05 (228.47) x 10(6)/L, respectively. The peripheral blood WBC counts were higher than 10.0 x 10(9)/L in 5 patients, and their CD(3)(+), CD(4)(+) and CD(8)(+) counts were 1466.00 (630.86) x 10(6)/L, 783.00 (311.14) x 10(6)/L and 640.00 (294.40) x 10(6)/L, respectively. The decreased CD(3)(+), CD(4)(+) and CD(8)(+) counts were consistent with the decreased WBC counts. The level of IL in SARS patients was significantly higher than that in patients with chronic hepatitis B (P < 0.01).

CONCLUSIONSThe level of serum IL is closely related to cell immunity in SARS patients. The level of serum IL is increased evidently while CD(3)(+), CD(4)(+) and CD(8)(+) counts decrease. Both serum IL and CD are associated with injury of immune function, and thus they could be regarded as a monitoring index for judging the condition of SARS patients and prescribing immune therapy.

Adult ; Female ; Humans ; Interleukins ; blood ; Leukocyte Count ; Male ; Middle Aged ; Severe Acute Respiratory Syndrome ; immunology ; T-Lymphocyte Subsets ; cytology

Objective:To study the learning curve and inflection point of robot-assisted L 4 and L 5 pedicle screw insertion for lumbar spondylolisthesis. Methods:A retrospective study was conducted on the data of 43 patients with L 4 and L 5 pedicle screw insertion for lumbar spondylolisthesis from January 2016 to December 2020 using surgical robot, including 19 males and 24 females, aging 59 (48, 66) years old. According to Meyerding classification, there were 23 grade I slippage, 18 grade II slippage, and 2 grade III slippage. The screw deviation and screw accuracy grade were assessed. The operation time, intraoperative blood loss, the number of intraoperative fluoroscopies, postoperative complications, and postoperative hospital stay were recorded. Cumulative Sum (CUSUM) was used to analyze the learning curve, and the learning curve is divided into early and late learning stages according to morphology. T test and Wilcoxon rank-sum test were used for statistical analysis and comparison of indicators between early and late learning stages. Results:43 patients with lumbar spondylolisthesis successfully completed the operation, with 60 L 4 pedicle screws and 70 L 5 pedicle screws inserted. The accuracy of L 4 pedicle screw placement began to improve since the 23rd placement, and the accuracy of L 5 pedicle screw placement began to improve since the 20th placement. Using the 23rd pedicle screw (the 14th patient) to divide the learning curve as the early stage and the late stage. There was no statistically significant difference in the operation time (225.0±74.0 min vs. 207.0±81.2 min, t=0.65, P=0.521), intraoperative blood loss[200 (75, 500) ml vs. 100 (60, 200) ml, Z=1.30, P=0.195], the number of intraoperative fluoroscopies[10 (6, 10) vs. 10 (6, 10), Z=-0.37, P=0.712] and postoperative complications (8% vs. 0, P=0.302) between the early stage and late stage of learning curve. In the late stage of learning, the postoperative hospital stay was shorter[4.5 (3, 6) d vs. 6.0 (5, 9) d, Z=2.00, P=0.046]and the pedicle screw insertion accuracy was higher[L 4: 1.33 (1.06, 1.79) mm vs. 2.23 (1.12, 4.55) mm, Z=2.43, P=0.015; L 5: 1.47 (0.98, 1.87) mm vs. 3.21 (1.64, 4.87) mm, Z=3.90, P=0.001]. The accuracy of screw placement was similar between the early and late stages[L 4: 95%(21/22) vs. 97%(37/38), P=1.000; L 5: 91%(20/22) vs. 96%(46/48), P=0.585]. Conclusion:Robot-assisted L 4 and L 5 pedicle screw placement in the treatment of lumbar spondylolisthesis had a relatively obvious learning curve. Starting from the placement of the 23rd screws, the accuracy of screw placement gradually increased.

The pedicle screw internal fixation system plays a crucial role in spinal surgery, with the advantage of enhancing spinal stability. However, potential complications such as internal fixation loosening and screw pullout still exist clinically. Currently, pullout of strength is commonly used to evaluate the short-term biomechanical properties of internal fixation, fatigue test is performed to evaluate the long-term biomechanical properties of internal fixation, and torque is used to evaluate the interaction between screws and spinal bone. Factors that influence the biomechanical properties of pedicle screws include spine-related factors (bone density) and screw-related factors (screw size, screw design, and screw augmentation materials). In bones with high bone density, pullout of strength is significantly increased, and fixation strength can also be improved by increasing screw diameter and length, improving screw design, and using screw augmentation materials. Biomechanical research on pedicle screw internal fixation provides key information for achieving individualized and functional optimal channel selection. Designing screw channels with optimal fixation strength is expected to reduce the risk of screw loosening and the occurrence of surgical complications, and improve surgical effects.