Objective To investigate the effect of donors' activating killer cell immunoglobulin-like receptor (aKIR) on recipients prognosis post haemopoietic stem cell transplantation (HSCT).Methods Fifty-nine cases of related HLA full matched HSCT were studied. Sequence specific primer polymerase chain reaction (SSP-PCR) was used to type donors' KIR. Virus,bacterium,and fungi infection as well as bleeding,relapse,survival were observed in the recipients post transplantation. Relationship between aKIR and clinical indexes mentioned above were analyzed.Results Donors' aKIR showed no beneficial effects on recipients' virus and bacterium infection. Furthermore,the incidence of fungi infection was increased in HSCT if donors expressed KIR3DS1 (?2= 4.804 ,P= 0.028 ). No significant difference was found in survival curve between donor aKIR positive HSCT or negative one (KIR2DS1+/-: P= 0.651 ; KIR2DS2+/-: P= 0.847 ; KIR3DS1+/-: P= 0.341 ). No effect of donor's aKIR on relapse was observed,too.Conclusion In Guangdong Han,so far as related HLA full matched HSCT is concerned,no improvement in recipient prognosis due to donor's aKIR is verified.

Objective To evaluate the influence of the resolution of medical grayscale LCD over the detective efficiency of pulmonary nodule.Methods By reviewing PACS, 93 on-line chest DR images were collected.These radiographs included 23 normal images that had no nodule confirmed by CT, 32 doubtful images that also had no nodule confirmed by CT,and 38 positive images that had nodules confirmed by CT.These nodules didn't show obvious calcification and their diameters were from 0.30 to 1.90 cm. Nine patients had multi-nodules.Three residents or postgraduates, three attending physicians, and three associate professors or professors interpreted the 93 chest images by using three types of displays: Barco Z-2261, Barco Z-3620 and Barco Z-5620.All observers evaluated their confidence of the presence of pulmonary nodule with five-point level rating scale : ( 1 ) definitely positive, ( 2 ) probably positive, ( 3 ) uncertain, (4) probably negative, (5)definitely negative.SPSS 11.5 software was used to analyze the results ,including to draw the ROC curves and to perform Z test.Results The areas under the ROC curves of 2 M display, 3 M display and 5 M display were 0.774,0.784,0.816 for experienced radiologists; for instructors were 0.754,0.764,0.768 ;for teaching assistants were 0.695,0.754,0.774.However, for the detection of pulmonary nodules,there was no significant difference between observers with different ranks using the same modality of display,and no significant difference was found between the different modalities of displays used by observers with the same rank.Conclusion It's equivalent for detection performance with 2,3 and 5 M medical grayscale LCD display in detecting pulmonary nodule; Experienced radiologists can get more information using 5 M display;By reasonably matching displays, we could improve the cost-efficacy.

Nasopharyngeal cancer is a low differentiated squamous cell carcinoma, and the radiation therapy is the primary choice. It's 5 year survival rate may reach 64.4%, while 10.0% cases may suffer from the local recurrence. The salvage radiation or surgery is still the main choice for recurrent cases now. However the recurrent tumor become radiation insensitive and meanwhile, morbidity and mortality become higher. The experience of open salvage surgery on the recurrent radiation insensitive tumor had been proved safely, and the related morbidity and mortality are acceptable. Recently, the endoscopic salvage surgery has been developed, some preliminary experience has been obtained and the result looks promising. In this article, the pathobiological characteristics of the postradiation local recurrent nasopharyngeal cancer, the anatomy of nasopharyngus and related skull base area, especially the petroclival region and current situation of endonasal endoscopic salvage surgery were reviewed here. Basic principle of oncological surgery that endoscopic surgery should followed and possible endoscopic surgical approaches were proposed.
Carcinoma ; Carcinoma, Squamous Cell ; radiotherapy ; surgery ; Endoscopy ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; surgery ; Neoplasm Recurrence, Local ; radiotherapy ; surgery ; Radiation Tolerance ; Salvage Therapy ; methods ; Skull Base ; Survival Rate

ObjectiveTo evaluate the clinical efficacy and safety of astragalus injection on the immune function in patients with senile sepsis.Methods Sixty patients with old age sepsis in Critical Care Medicine Department of Guangdong Provincial Traditional Chinese Medicine Hospital were enrolled and randomly assigned into control and treatment groups according to the table of random numbers, 30 cases in each group. According to 2012 sepsis guidelines for treatment, including antibacterial drug, mechanical ventilation, visceral function support, etc., the therapy was given to the control group; besides the treatment in the control group, intravenous drip of 60 mL astragalus injection(10 mL per ampoule) in 250 mL 0.9% normal saline was additionally given in the treatment group, once a day for 7 days. Before and after treatment, the immunological indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, duration of mechanical ventilation and time of stay in intensive care unit(ICU), 28-day mortality and adverse drug reactions were compared between the two groups.Results Before treatment, there were no statistically significant differences in CD3+, CD3+CD4+, CD3+CD8+ and T helper cells /T suppressor cells(Th/Ts)levels between the two groups(allP>0.05), while CD3-NK+ of the control group was significantly higher than that in the treatment group〔(10.47±6.22)% vs. (6.26±4.13)%,P<0.05〕. After treatment in treatment group, CD3+, CD3+CD4+ and CD3-NK+ were increased, CD3+CD8+,Th/Ts were decreased compared with those before treatment; in the control group after treatment, CD3+,CD3+CD8+ and CD3-NK+ were decreased and CD3+CD4+ and Th/Ts increased compared with those before treatment. In the comparisons between the treatment group and control group after treatment, the differences in CD3+, CD3+CD4+ and CD3+CD8+ had statistical significance〔CD3+:(30.30±17.17)% vs.(41.91±22.29)%, CD3+CD4+:(31.54±13.24)% vs.(40.08±15.28)%, CD3+CD8+:(14.25±8.10)% vs.(9.52±9.33)%,allP<0.05〕; while the differences in Th/Ts and CD3-NK+ had no statistical significance(bothP>0.05). After treatment in the treatment group, IgG was increased compared with that in the control group〔IgG(g/L): 13.07±5.43 vs. 10.10±3.96,P<
0.05〕. The differences in IgA, IgM, complement(C3,C4) and total serum complement activity(CH50) in the comparisons between the two groups had no statistical significance after treatment(allP>0.05). The differences in APACHEⅡ score(13.83±6.18 vs. 15.90±7.48), SOFA score(7.38±4.66 vs. 6.89±4.19), time of stay in ICU(day: 11.63±5.13 vs. 13.62±8.08), invasive ventilation time(hour: 155.44±119.68 vs. 224.08±174.15) and noninvasive ventilation time(hour: 55.55±42.24 vs. 98.57±43.17) had no statistical significance in comparisons between the treatment group and control group after treatment(allP>0.05). The difference in 28-day mortality had no statistical significance in comparison between the treatment group and control group〔16.7%(5/30) vs. 20.0%(6/30),P>0.05〕. In 60 cases, there were 2 patients with adverse drug reaction, one diarrhea and another little rashes, the rest of the patients did not appear any drug side effect.ConclusionAstragalus injection combined with conventional western medicine therapy possibly has certain effect on adjustment of disturbance of immunologic functions in old patients with sepsis, and its therapeutic safety is well.

Objective To evaluate the association between hypersensitive C reactive protein (hs-CRP) and the incidence of acute kidney injury in subarachnoid hemorrhage(SAH) patients.Methods It retrospectively recruited 213 cases of computerized tomography validated SAH patients from the neurology ICU from Beijing Tiantan Hospital between January 2012 and January 2015.The average age was (56.29±11.95) years old,and the patients were divided into AKI and non-AKI groups according to Kidney Disease: Improving Global Outcomes (KDIGO) diagnosis standards, Clinical features of AKI and Non-AKI patients including serum levels of hs-CRP were compared and multi-logistic regression was applied to find the risk factors concerning with the incidence of AKI.Receiver operating characteristics (ROC) curve was also plotted to evaluate the diagnostic value of hs-CRP towards the incidence of AKI.Results A total of 25 (11.74%) patients developed AKI.Average age of the SAH patients in both AKI and non-AKI groups were (63.60±12.21) years old vs.(55.31±11.60) years old(t=-3.33, P<0.05).The ratios of diabetics were were 28.00% vs.11.17% (χ2=5.47,P<0.05) and the ratio of proteinuria were 80.00% vs.34.57%, respectively (χ2=3.83, P<0.05).The median of serum creatinie were 63.72(51.45, 79.72)μmol/L vs.53.21(45.27, 65.62)μmol/L (P<0.05), and serum hs-CRP were (14.12±5.03)mg/L vs.(10.23±6.76)mg/L (P<0.05), and the ratios of antibiotics application were 84.00% vs.43.08% (P<0.05 for all).Multi-logistic regression analysis showed that serum hs-CRP was an independent risk factors for AKI after age, serum creatinine at admission were adjusted.[OR (95% CI) was 3.33(1.13, 9.85),P<0.05 for all].The area under curve of ROC was 0.69 (P<0.05), and the cut-off point of serum hs-CRP under the maximum Youden index was 13.85 mg/L.Conclusion Serum hs-CRP is an independent risk factor of theincidence of AKI in SAH patients, the significantly increase of serum hs-CRP might be an important predictor of the incidence of AKI in SAH patients.

OBJECTIVE To undersand neurosurgical hospital infection characteristics and bacterial resistance,and to provide reference information for the rational use of antibacterial drugs in clinics.METHODS Using the combined methods of initiative monitoring and recalling system to carry on the clinical informations' statistics,the analysis and the judgment for the 880 inpatients in the neurosurgery department in 2005.RESULTS The rate of neurosurgical hospital infection was 16.36%,significantly higher than the hospital average rate(9.18%) at the same period.Neurosurgical hospital infection pathogens were mainly Gram-negative bacteria.Infection sites occurred mainly in urinary tract(44.44%),followed by lower respiratory tract(35.42%).Sixty strains were Escherichia coli(20.2%),34 strains(11.44%) for Enterococcus faecium(D group),25 strains(8.42%) for Acinetobacter baumannii,25 strains(8.42%) for Pseudomonas aeruginosa,and 18 strains(6.06%) for Klebsiella pneumoniae.CONCLUSIONS Systematic monitoring of neurosurgical hospital infection characteristics and dynamics of bacterial resistance has important clinical reference significance to the rational use of antibacterial drugs.

OBJECTIVE To understand the characteristic of hospital infection among tumor patients and give information to reduce the tumor patients with hospital infection.METHODS Using the methods of initiative monitoring and the system review to carry on the statistics,analysis,and evaluation for the total of 2679 tumor patients occurred in Department of Oncology in Shaoxing People′s Hospital in 2005.RESULTS Among them there were 120 cases occurred hospital infection.The rate of hospital infection was 4.47%.The patients who infected one time were 179 cases,two times were 31 cases,and over three times were 10 cases.The main infected sites were respiratory tract including upper respiratory tract(38 cases) and lower respiratory tract(36 cases),followed by alimentary tract(10 cases),blood(9 cases),surgical incision infection(8 cases),urinary tract(6 cases) and the other locations(13 cases).CONCLUSIONS The main prevention and control measures of hospital infection among tumor patients are to improve the body immunity and control endogenous infections.

Since the development of civil basic medical insurance, it exerts subtle influence on medical conduct. The medical insurance economically affects the medical conduct. And medical ethics is one of the important factors which influence medical conducts greatly. Therefore, it is very important for the medical insurance enterprise's development to discipline the medical conducts by medical ethics.