Objective To investigate the effect of ulinastatin in adjuvant treatment of ventilator-associated pneumonia(VAP)and preliminary clinical efficacy of the therapy mechanism.Methods 76 patients with ventilator-associated pneumonia from January 2015 to February 2016 in Qingyuan People's Hospital of Zhejiang Province were selected and randomly divided into control group and observation group,38 cases in each group.Two groups were given mechanical ventilation,phlegm,anti infection,rehydration,nutritional support and other conventional treatment,the observation group on the basis of routine treatment for ulinastatin adjuvant therapy,comparison of two groups of treatment,the simultaneous determination of serum interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)and tumor necrosis factor alpha(TNF-alpha)levels were measured before and after treatment.Results The total efficiency of the observation group was 94.74％,significantly higher than the control group 78.95％,the difference was statistically significant(P<0.05),the two groups after treatment of serum CRP and PCT levels were decreased significantly compared with before treatment,the observation group after treatment,serum CRP and PCT levels were(45.19+5.79)mg/L and(1.08+0.36)μg/L was significantly lower than that before treatment and control group after treatment,the difference was statistically significant(P<0.05),the two groups after treatment of serum IL-6 and TNF-α levels were decreased significantly compared with before treatment,the observation group after treatment,serum IL-6 and TNF-α levels were(165.29+19.23)pm/mL and(1.16+0.25)pm/mL,was significantly lower than that before treatment and control group after treatment,the difference was statistically significant(P<0.05).Conclusion The inflammatory reaction in patients with ventilator-associated pneumonia ulinastatin can effectively reduce auxiliary patients,reduce inflammatory factors on lung injury,can alleviate the disease progression and to improve its prognosis.

Objective To compare the efficacy of intralesional glucocorticoid injection with a needle-free injector versus an ordinary injector for the treatment of keloid. Methods A total of 60 patients with keloid were enrolled and randomly divided into two groups by using a random number table to receive intralesional injection of compound betamethasone with a needle-free injector(n=31)or an ordinary injector(n=29). The injection was given at a dose of 0.2 ml/cm3 once every 3 weeks for 3 sessions. Parameters for therapeutic efficacy were assessed, adverse reactions were recorded, and clinical pictures were taken before and after each treatment. Statistical analysis was carried out by the Mann-Whitney U test and chi-square test with the SPSS 19.0 software. Results Compared with the ordinary injector group, the needle-free injector group showed significantly different injection time during the first and second treatment (U=299.000, 773.500, respectively, both P=0.000), as well as duration of pain after the first injection(U=730.000, P=0.003). After three sessions of treatment, there was a significant difference in the volume, height, hardness of keloid, scores for pain, itching and appearance, and number of injection points between the needle-free injector group and ordinary injector group (U=295.000, 336.500, 264.000, 464.000, 451.500, 308.000, 233.500, P=0.001, 0.007, 0.000, 0.041, 0.043, 0.003, 0.001, respectively). No significant differences were observed in the incidence of adverse reactions between the two groups(all P>0.05). Moreover, the interval for lesion recurrence was significantly shorter in the needle-free injector group(11.8 days, 95%CI:10.96-12.6 days)than in the ordinary injector group(21.2 days, 95%CI:13.96-28.45 days). Conclusion Compared with the ordinary injector, the needle-free injector shows better efficiency for the treatment of keloid with decreased difficulty in injection and improved compliance in patients.

Objective: To objectively evaluate the short-term and long-term efficacies of arthrolysis under brachial plexus anesthesia in treating adhesive capsulitis of the shoulder (ACS). Methods: One hundred patients diagnosed with ACS were divided into two groups using the random number method. The two groups both received same active rehabilitation exercises. Besides, 55 cases in the treatment group were given one session of arthrolysis under brachial plexus anesthesia, and 45 cases in the control group were given tuina treatment. Changes in the visual analog scale (VAS) score, Melle score and pressure pain index were observed 1 month and 3 months after treatment. The therapeutic efficacies were also compared. Results: The total effective rate was 96.4％ at the 1-month follow-up and 96.4％ at the 3-month follow-up in the treatment group. The total effective rate was 33.3％ at the 1-month follow-up and 28.9％ at the 3-month follow-up in the control group. There were significant differences between the two groups comparing the total effective rate at the two time points (both P<0.05). The scores of VAS, Melle and pressure pain were significantly different at the 1-month and 3-month follow-ups from those before treatment in the treatment group (all P<0.05); the three scores did not show significant differences at the 1-month and 3-month follow-ups compared with those before treatment in the control group (all P>0.05). Conclusion: Based on the active rehabilitation exercises, one session of arthrolysis under brachial plexus anesthesia can release the adhesion and restore the range of motion and function of shoulder joint in ACS patients. It is superior to rehabilitation exercises plus tuina treatment comparing both short-term and long-term efficacies.

In order to study genetic variation diversity of porcine circovirus type 2 (PCV2) strains in Shanxi,the genomic sequences of nine PCV2 strains including SXQX,SXCZ,SXTY2,SXJC,SXJX,SXLL,SXPY,SXPG and SXXY recently isolated from some areas of Shanxi from 2013 to 2016,was cloned,sequenced and received by GenBank.The amplified PCV2 genomic sequences,ORF2 sequences and Cap protein amino acid of these nine strains were analysed and compared with those of published 28 PCV2 strains by DNAStar,drawing phylogenetic tree.The results showed that the genomic sequences of SXJX,SXJC and SXXY PCV2 strains were 1 768 bp,and the others were 1 767 bp,which accounted for 33％ and 67％,respectively.The homologies of nucleotide sequences of the nine strains were 94.7％-99.8％,the homologies of nucleotide sequences of the nine strains with the 28 isolates from different regions of the world PCV strain were 93.9％-99.9％,and the homologies of nucleotide sequences of the nine strains with the domestic vaccine strains were 95.1％-99.8％.The phylogenetic analysed that SXJX,SXJC and SXXY belonged to genotype PCV-2D,SXLL,SXPY and SXCZ belonged to genotype PCV-1C,and SXTY14,SXPG and SXQX belonged to genotype PCV-1A/1B.Thus it proved that the epidemic strain of PCV2 was mainly PCV-2b in Shanxi.The homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains were 90.0％-100.0％ and 87.1 ％-100.0％ respectively,the homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains with the 28 isolates from different regions of the world PCV strain were 87.6％-100.0％ and 84.1％-100.0％ respectively,and the homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains with the domestic vaccine strains were 91.0％-100.0％ and 89.3％-100.0％ respectively.The Cap amino acids of SXQX,SXJX,SXTY14,SXPG,SXJC and SXXY PCV2 were 233,ORF2 of SXQX,SXTY14 and SXPG located at 1 033-1 734 bp,ORF2 of SXXY,SXJX and SXJC located at 1 033-1 734 bp,and the Cap amino acids of SXCZ,SXLL and SXPY PCV2 were 234,ORF2 of them located at 1 030-1 734 bp,in addition,the positions of 1 030-1 734 bp were more three bases TCA than other ORF2 genome sequence of 1 767 bp,resulting in increasing a K (Lys) of amino acid sequencein at the 234 position.Also Cap protein of 9 PCV2 strains showed more amino acid variation in addition to the only high-ly conserved glycosylation sites (NYS) (pp.143-145 amino acid).It provided theoretical basis for the PCV2 immune prevention of research in Shanxi,and the data of basic theory of molecular pathogenesis of PCV2.

Objective To evaluate the effectiveness of lamivudine in preventing liver damages and HBV DNA reactivation in anti-HBc positive lymphoma patients after chemotherapy.Methods Seventy-nine lymphoma patients who were negative in HBsAg and positive in anti-HBc were enrolled and were divided into lamivudine group (n=37) and control group (n=42).Both groups received chemotherapy.Liver damages and HBV reactivation were observed, and the data were analyzed with software SPSS 13.0.Results In lamivudine group, liver damages Ⅰ or Ⅱ was observed in 11 patients (11/37, 29.7%), and liver damages Ⅲ or Ⅳ was observed in 2 (2/37, 5.4%); two patients (2/37, 5.4%) developed HBV reactivation, and both of them had HBV YMDD mutations.In control group, 19 (19/42, 45.2%) patients experienced liver damages Ⅰ or Ⅱ, 7 (7/42, 16.7%) experienced liver damages Ⅲ or Ⅳ; 12 (12/42, 28.6%) patients experienced HBV reactivation, the differences between the two groups were of statistical significance (χ2=79.0, 8.7 and 79.0, P ＜ 0.05 or ＜ 0.01).Conclusion Lamivudine can reduce liver damages and HBV reactivation in HBsAg negative and anti-HBc positive patients with lymphoma during chemotherapy.

Objective To investigate the diagnosis and treatment of hepatic metastasis from gastrointestinal stromal turnor(GIST).Methods The clinical data of 16 patients with GIST who had been admitted to our hospitalfrom December 1993 to May 2007 were retrospectively analyzed.Results Of all patients,14 underwent radical resection and 2 underwent palliative operation.Two patients with palliative operation and 3 with radical resection were administered with imatinib postoperatively. All patients were followed up for 3-161 months,and GIST metastasis and invasion was observed in 8 of the 14 patients who received radical resection.Of the 7 patients with hepatic metastasis.3 were treated with hepatic artery chemoembolization,1 was administered with imatinib,2 received reoperation and 1 did not receive any treatment. Reoperation was carried out on 1 patient who had abdominal wall metastasis.The 1-and 3-year survival rates of the 16 patients were 92%and 74%,respectively.Conclusions The recurrence rate of GIST after hepatectomy is high.Complete surgical resection is the best curative treatment for hepatic metastasis from GIST and GIST recurrence.The combination of surgical resection and imatinib administration may help to improve the prognosis of patients with hepatic metastasis from GIST.

Objective To investigate the effects of preventive chemotherapy for hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation. Methods The clinical data of 243 patients who had undergone orthotopic liver transplantation for HCC exceeding Milan criteria from April 2001 to July 2007 were retrospectively analyzed. Of all patients, 162 received preventive chemotherapy after transplantation. Results The 1- and 3-year survival rates and disease-free survival rates were not statistically different between patients who had received chemotherapy (78.5%, 63.7% ; 76.8%, 52.5% ) and those without chemotherapy (56.6%, 39.1%; 69.3%, 64.7% ) (X2 = 3.084, 0.444, P > 0.05). Cox regression analysis demonstrated that postoperative chemotherapy was not an independent factor affecting the survival rates of HCC patients without vascular invasion, but an independent factor affecting the survival rates of HCC patients with vascular invasion. Conclusions Early preventive chemotherapy could obviously increase the survival rate and delay the tumor recurrence of patients with HCC exceeding Milan criteria, especially for HCC patients with vascular invasion.

Objective To evaluate the feasibility of diffusion kurtosis imaging (DKI)in the diagnosis and aggressiveness assessment of prostate cancer.Methods The MR data with multi-b-value diffusion-weighted imaging (DWI)of 30 male patients with prostate cancer were retrospectively analyzed.D maps and K maps were generated from the DKI model and ADC maps were obtained using the conventional monoexponential model.Differences in the D,K and ADC values between prostate cancer and benign peripheral zone (PZ)tissues,among tumors with different Gleason scores were analyzed.P<0.05 was considered statistical significance.Results ADC and D values were significantly lower in the prostate cancers than in the benign PZs (P <0.001).K values were significantly greater in the prostate cancers than in the benign PZs (P <0.001).ADC,D and K values were different significantly among the tumors with Glea-son scores of 6,7 and ≥8 (P <0.001,P =0.01 5 and P <0.001,respectively).Conclusion The DKI model can better describe the signal intensity attenuation with b values increasing,which is helpful for diagnosing and grading prostate cancer.K value may be used to quantitatively evaluate the complicated microstructure of prostate cancer.

Aged ; Breast Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; methods ; Metaplasia ; pathology ; Papilloma, Intraductal ; pathology ; surgery ; Sebaceous Glands ; pathology

Objective To investigate the expression levels of tumor necrosis factor alpha (TNF-α),interleukin-6(IL-6) and the change of serum ferritin in patients with intracranial aneurysm and its clinical significance.Methods 22 patients with intracranial aneurysm and 16 cases of traumatic brain injury who recevied operation in Department of Neurosurgery in Quzhou People's Hospital from Jan.2014 to Jan.2015 were enrolled as observation group and control group.The intracranial aneurysm tissues and normal cerebral vascular tissues were collected respectively to detect the situation of inflammatory cell infiltration,and the expression of TNF-α and IL-6 was detected by HE staining and immunohistochemical staining.The serum was collected on hospitalized,postoperative 3 days and postoperative 7 days to detect serum ferritin.Results The positive cells were observed in the observation group after immunohistochemical staining,in which the expression levels of TNF-α [(0.194 ± 0.074) vs.(0.135 ± 0.047),t =2.799] and IL-6 [(0.152 ± 0.057) vs.(0.103 ± 0.028),t =3.494] were significantly higher than those in the control group(P =0.008,0.001).The serum ferritin level in the observation group was significantly higher than that in the control group at postoperative 3d [(232.25 ± 105.26) ng/mL vs.(169.51 ± 66.24) ng/mL,t =2.097] and postoperative 7d[(263.39 ± 114.73) ng/mL vs.(166.57 ± 73.71) ng/mL,t =2.955] (P =0.043,0.005).The difference of serum ferritin on different day in the observation group also was statistically significant(F =8.625,P =0.003).Conclusion The expression levels of TNF-α and IL-6 in intracranial aneurysms were high,which may be one of the important factors in the formation of intracranial aneurysms,and it provides an important reference of early prevention and drug treatment for patients with intracranial aneurysm.The serum ferritin is related to the rupture and hemorrhage of intracranial aneurysm,which can be used to judge prognosis and guide rational treatment,and worth further study to confirm.