Objective To evaluate the value of low-dose lung screening with 16-slice CT scanner in physical examination.Methods Lung screening was performed in 114 cases with a 16-slice spiral CT scanner.The scan parameters were 120KV,20~50mA.The reconstructive modes were standard mode and lung mode.Results 41 cases with lung diseases were detected with low-dose 16-slice spiral CT.Conclusion Low-dose 16-slice spiral CT is good for lung scanning in physical examination.

Objective:To explore the association between Toll-like receptor (TLR) gene polymorphism and susceptibility to non-human immunodeficiency virus (HIV)-related cryptococcal meningitis in patients from Fujian Province.Methods:A total of 101 non-HIV patients with cryptococcal meningitis and 270 healthy controls in Huashan Hospital, Fudan University and Cangshan Hospital District, The 900th Hospital of the Joint Logistics Support Force from Fujian Province were prospectively enrolled in this case-control study. Genomic DNA was extracted. Genotyping was performed by multiplex SNaPshot technology on eight TLR single nucleotide polymorphism (SNP) which were reported to be related to cryptococcal meningitis but still lacking validations. The differences of gene polymorphism distributions were compared between all patients and healthy controls, and between patients without predisposing factors and healthy controls. Data were analyzed by chi-square test or Fisher exact test.Results:Except for TLR1 rs5743563, the distributions of allele frequency in seven tested TLR SNPs (TLR1 rs5743604, TLR2 rs3804099, TLR4 rs1927907, TLR6 rs3796508, TLR6 rs5743794, TLR9 rs164637 and TLR9 rs352140) were in Hardy-Weinberg equilibrium. Comparisons between cases and controls found that TLR2 rs3804099 T/T genotype (52.5%(53/101) vs 40.4%(109/270), odds ratio ( OR)=1.63, χ2=4.378, P=0.036) and TLR6 rs5743794 G/G genotype (44.6%(45/101) vs 32.2%(87/270), OR=1.69, χ2=4.877, P=0.027) were correlated with high risks of cryptococcal meningitis, while TLR6 rs3796508 G/G genotype ((83.2%(84/101) vs 92.6%(250/270), OR=0.40, χ2=7.271, P=0.007) and TLR9 rs164637 C/C genotype (96.0%(97/101) vs 100.0%(270/270), Fisher exact test , P=0.005) were found to be protective factors. Seventy out of 101 patients had no predisposing factors. Comparison between patients without predisposing factors and healthy controls also found similar results. TLR6 rs5743794 G/G genotype (52.9%(37/70) vs 32.2%(87/270), OR=2.36, χ2=10.216, P=0.001) was risk factor, while TLR6 rs3796508 G/G genotype (81.4%(57/70) vs 92.6%(250/270), OR=0.35, χ2=7.906, P=0.005) and TLR9 rs164637 C/C genotype (97.1%(68/70) vs 100.0%(270/270), Fisher exact test, P=0.042) were protective factors. Conclusion:TLR gene polymorphism is significantly associated with non-HIV-related cryptococcal meningitis, which indicates that TLR might play an important role in the pathogenesis of cryptococcal meningitis.

Objective To discuss the value of 16-slice spiral CT urography in clinical diagnosis.Methods To compare the images between CR excretory urography,CT and MPR,which are the results of 26 cases who were examined by both CR and 16-slice spiral CT urography.Results From the comparison,it is found that the spiral CT urography images are better than that of the CR excertory urography,and at the same time,the relationship between the parenchyma of the renal,renal pelvis,ureter,bladder and the urinary organs and adjacent structures can be demonstrated clearly.Conclusion The scanning time of the spiral CT is shorter.The machine can not only reconstruct powerfully but also work out better images,and the result is better than CR excretory urography which can not detect some details in its images.Therefore CR excretory urogaphy can be replaced by 16-slice spiral CT urography regardless of its cost.

Objective To report the clinical result of repairing complex tissue defect in limb caused by traffic accident using both tissue flap transplantation and external fixer. Methods The vascular tissue flap including bone flap and muscular flap to repair the complex tissue defection(soft tissue, bones, joints) in forearm, hand, leg, ankle and foot were applied in 36 cases. At the same time in surgery, injured bones and joints were fixed by external fixer for stabilizing and accelerating cure. Results All 56 eases were applied successfully with transplanted tissue combined with external fixation. The external fixers were moved away about 10-16 weeks(upper extremity) or 6-8 months(lower extremity) later and all the cases recovered satisfactorily. Conclusion It is a reliable method for repairing the complex tissue defection in the limb caused by traffic accident by external fixer of traumarology and microsurgery technique. And it is also characterized as a minor injury method on transplanted bones, enables early exercise for joints, convenient observation of flap circulation and easy nursing.

Objective To discuss the problems of using high pressure injector in the 16-detector-row CT. Methods Reviewed and analyzed the courses of using high pressure injector in the 16-detector-row CT for 799 patients. Results 774 patients obtained successful infusion,contrast medium hydrops were occurred in 20 patients,2 patients were infusion failure and 3 patients were redid for misoperation. Conclusion Master the details of operating high pressure injector can alleviate the pain of patients,and then obtain the satisfactory effect.

Objective To investigate the clinical efficacy and safety of high-dose caspofungin (70 mg/d)as initial or salvage treatment for invasive pulmonary aspergillosis.Methods Twenty-one patients with proven or probable invasive pulmonary aspergillosis from June 2014 to October 2017 in Huashan Hospital,Fudan University were retrospectively reviewed.According to the anti-fungal treatment before high-dose caspofungin application,patients were divided into initial treatment group and salvage treatment group.Patients' clinical data and laboratory data were collected.The characteristics,clinical efficacy,adverse reactions,one-year survival rate and the overall effective rate were evaluated.The prognosis of the two groups was compared by Kaplan-Meier analysis.Results Twenty of the 21 patients opportunistic acquired invasive pulmonary aspergillosis during the treatment of underlying diseases.Five patients were initially treated with high-dose caspofungin for 68 (62) days.At week 12,one patient achieved complete response,3 patients achieved partial response,and the overall effective rate was 80％ (4/5).Sixteen patients received caspofungin as salvage therapy for 66.50 (58) days,of which one patient got complete response at week 12,10 had partial response,and the overall effective rate was 68.75％ (11/16).One-year follow-up showed that no patient died in the initial treatment group,and the one-year survival rate was 100％ (5/5).In salvage treatment group,3 patients died of pulmonary bacterial infections and the one-year survival rate was 81.25％ (13/16).During treatment,one patient had elevated total bilirubin,which was possibly associated with high-dose caspofungin.Conclusions High-dose caspofungin regimen has good efficacy and safety,both for initial treatment and salvage therapy in patients with invasive pulmonary aspergillosis.

Objective:To investigate the clinical characteristics and prognosis of cryptococcal meningitis patients with anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies.Methods:A total of 216 non-acquired immunodeficiency syndrome (AIDS) related cryptococcal meningitis cases with positive cultures of Cryptococcus, hospitalized at Huashan Hospital, Fudan University during January 2014 and December 2021, were retrospectively included. The serum anti-GM-CSF autoantibodies were detected by enzyme linked immunosorbent assay, and the clinical characteristics and prognosis were compared between patients with and without anti-GM-CSF autoantibodies. Statistical comparisons were mainly performed using the chi-square test or Fisher′s exact test. Cox proportional-hazards model was used to analyze the risk factors associated with prognosis. Results:Among 216 enrolled patients, 23 patients were positive of anti-GM-CSF autoantibodies, with a positive rate of 10.6%. Among 23 patients, seven cases were infected with Cryptococcus gattii, and 16 cases were infected with Cryptococcus neoformans. In the group with positive anti-GM-CSF autoantibodies, 30.4%(7/23) of the patients were infected with Cryptococcus gattii, which was higher than that of 1.6%(3/193) in the group with negative anti-GM-CSF autoantibodies, and the difference was statistically significant ( χ2=38.82, P<0.001). In the group with positive anti-GM-CSF autoantibodies, 30.0% (6/20) had mass lesions with a diameter greater than three centimeters in the lungs, and the one-year all-cause mortality rate was 50.0% (10/20), which were both higher than those of 3.4%(5/145) and 16.1% (29/180) in the negative group, respectively. The differences were both statistically significant (both Fisher′s exact test, P<0.01). Age≥60 years (hazard ratio ( HR)=4.146, P=0.002), predisposing factors ( HR=3.160, P=0.021), epilepsy ( HR=6.129, P=0.002), positive anti-GM-CSF autoantibodies ( HR=2.675, P=0.034), white blood cell count of cerebrospinal fluid (CSF)<100 ×10 6/L ( HR=2.736, P=0.039), the titers of cryptococcal capsular polysaccharide antigen of CSF≥1∶1 280 ( HR=4.361, P=0.009) were independent risk factors for one-year all-cause mortality in patients with cryptococcal meningitis. Conclusions:In non-AIDS related cryptococcal meningitis patients, the positive rate of serum anti-GM-CSF autoantibodies is as high as 10.6%. Patients with anti-GM-CSF autoantibodies could be infected with both Cryptococcus neoformans and Cryptococcus gattii, and they have higher proportion of lung mass lesions than patients with negative anti-GM-CSF autoantibodies. The one-year survival rate decreases significantly in patients with anti-GM-CSF autoantibodies, which is an independent risk factor for the prognosis of cryptococcal meningitis.

Objective To provide the experimental basis for the subsequent genetic diversity research through establishing and optimizing the inter-simple sequence repeat PCR (ISSR-PCR) reaction system of Gnaphalium affine. Methods The single-factor experimental method and full experimental method were used to optimize the ISSR-PCR reaction system of Gnaphalium affine. Under the optimal system, after screening primers and corresponding annealing temperatures, the systematic feasibility was verified. Results The optimal ISSR-PCR reaction system was consisted of 10 μl Premix Taq DNA polymerase, 0.3 μmol/L primer, 10 ng DNA template, and sterilized water added to 20 μl. Finally, 10 primers were screened from 100 universal primers, and verification results indicated the system had high stability, good reproducibility, and the selected primers had good polymorphism. Conclusion The ISSR-PCR amplification system of Gnaphalium affine was established for the first time and the primers with appropriate annealing temperatures were filtered out, which provided a reference for the subsequent genetic diversity research of Gnaphalium affine.