To improve and optimize marine antimicrobial peptide R-1 production by a newly isolated Brevibacillus laterosporus Lh-1, Plackett-Burman (PB) design and response surface methodology (RSM) using central composite design was adopted in culture conditions. MINITAB 15.0 was used for planning the experiments, data analysis, contour diagrams and response optimizations. In this study, PB design was undertaken to evaluate the effects of the fifteen factors. By the statistical regression analysis, the significant factors affecting the novel antimicrobial peptide R-1 in submerged fermentation by Br. laterosporus Lh-1 were determined as follows: glucose, peptone and CaCl2. Then a RSM was used to optimize the above critical internal factors, and the optical concentration of the variables were deter-mined as: 15.72 g/L glucose, 6.01 g/L peptone and 3.29 g/L CaCl2. The content of R-1 was increased from 82.15 kU/mL to 116.27 kU/mL.

Objective To evaluate the effect of isoflurane anesthesia on Wnt3a expression in the hippocampus of developing rats.Methods Twenty-four 7-day-old male Sprague-Dawley rats,weighing 125-155 g,were randomly divided into 3 groups (n=8 each) using a random number table:control group (group C),4 h inhalation of 2％ isoflurane group (group I4),and 6 h inhalation of 2％ isoflurane group (group I6).The rats were sacrificed at 6 h after the end of treatment in each group,and the hippocampi were removed for determination of Wnt3a mRNA expression (by real-time reverse transcriptase polymerase chain reaction) and Wnt3a expression (by Western blot).Results Compared with group C,the expression of Wnt3a and Wnt3a mRNA in hippocampi was significantly up-regulated in I4 and I6 groups (P＜0.05).Compared with group I4,the expression of Wnt3a in hippocampi was significantly up-regulated (P＜0.05),and no significant change was found in the expression of Wnt3a mRNA in hippocampi in group I6 (P＞0.05).Conclusion The mechanism of isoflurane-induced neurotoxicity is probably related to upregulation of Wnt3a expression in the hippocampal tissues of developing rats.

Objective: To study the feasibility of closed and three-dimensional reconstruction of maxillary defects with titanium mesh and free forearm flap. Methods: Maxillary defects, 3 of type Ⅱ and 7 of type Ⅲ, due to tumor or trauma were closely reconstructed with titanium mesh to restore the profile of maxilla and with radial flap to close the oral and the nasal wound surfaces following total maxillectomy (in 3 cases) and subtotal maxillectomy(in 7 cases). Results: 10 cases were followed up for 3～18 months. All the flaps were alive. The maxilla nasal and oral cavity were restored in all the cases and denture was applied in 3 cases. No neoplasm were fond by CT. Mouth opening was 2.5～4.0cm. Epithelium on the surface of the titanium mesh was found by nasopharyngoscope in 2 cases. Conclusion: The closed and three-dimensional reconstruction of maxillary defect with titanium mesh and free forearm flap can restore the shape and the function of maxilla.

Objective To analyze the imaging features of mycobacterium in AIDSpatients.Methods Twenty-three cases of mycobacterium tuberculosis and 13 patients of non-tuberculous mycobacteria were proved etiologically and included in this study.All patients underwent X-ray and CT examinations,imaging data were analyzed and compared.Results The imaging findings of mycobacterium tuberculosis in AIDS patients included consolidation (n =11),pleural effusion (n =11),mediastinal lymphadenopathy (n =11).Pulmonary lesions were always diffuse distribution,and 14 patients of extrapulmonary tuberculosis were found.Pulmonary lesions in non-tuberculous mycobacteria tend to be circumscribed.Conclusions Non-tuberculous mycobacterial infection in AIDS patients is more common and usually combined with other infections.Imaging features are atypical.

OBJECTIVETo explore the clinical application value of Provider-Initiated HIV Testing and Counseling (PITC) by analyzing the positive rate of HIV tests for people in need of PITC and that of routine HIV tests.

METHODSWe retrospectively analyzed the demographic and epidemiologic data about the patients seeking PITC services or undergoing routine HIV tests in Nanjing Drum Tower Hospital between January and December 2013.

RESULTSThe positive rate of initial HIV screening was 1.98% in the PITC group and 0.24% in the routine test group, while that of confirmed HIV was 0. 40% in the former and 0.07% in the latter, both with statistically significant differences between the two groups (P < 0.01). The positive rate of HIV was markedly higher in males than in females, particularly in the PITC group.

CONCLUSIONPITC has a high clinical value in HIV detection for targeted subjects and therefore deserves general application in dermatology.

Counseling ; Dermatology ; Female ; HIV Seropositivity ; diagnosis ; epidemiology ; Humans ; Male ; Mass Screening ; methods ; Retrospective Studies ; Sex Factors

A 69-year-old man presented with a 3-year history of scattered erythematous patches, perifollicular papules, acneiform lesions(such as milia, cysts) on the head, trunk and limbs as well as alopecia and peripheral eosinophilia. Histopathological examination revealed chronic focal dermal and perifollicular inflammatory infiltration with vascular proliferation and presence of a small number of eosinophils. He was initially diagnosed with folliculitis, and treated with antihistamines and antibiotics. Thereafter, lesional inflammation and pruritus were attenuated. However, plaques and alopecia developed in the occipital area 3 months later. The second histopathology of biopsy specimens revealed a dense dermal infiltrate of lymphoid cells and eosinophils, perifollicular infiltrate with numerous lymphoid cells, eosinophils and atypical lymphocytes migrating into hair follicles. Alcian blue stain showed epidermal mucinosis in follicles. Immunohistochemical examination showed positive staining of atypical cells for CD3, CD4, CD5, CD2, CD43 and ubiquitin carboxyl-terminal esterase L1 (UCHL1), but negative staining for CD20, CD79a, Epstein-barr virus, CD56, phosphoglucomutase-1, myeloperoxidase, CD7, or AE1 and AE3 monoclonal anti-keratin antibodies. T-cell receptor gene rearrangement was undetected. He was diagnosed with folliculotropic mycosis fungoides. Novel skin lesions still emerged after treatment with photochemotherapy (PUVA) plus acitretin. Follow up of the patient still continued.

Objective To evaluate the effect of video- assisted thoracoscopic pulmonary segmentectomy in patients with isolated pulmonary arteriovenous fistula (PAVF). Methods A retrospective analysis was performed on 10 patients with PAVF in the department of thoracic surgery of the first affiliated hospital of Nanjing Medical University between January 2010 and December 2016. Computed tomography angiography (CTA) and three-dimensional reconstruction were performed before operation, and all patients accepted video-assisted thoracoscopic pulmonary segmentectomy. Results The diagnosis of PAVF was identified by CTA, with maximum diameter of tumor of 3.0- 5.0 cm. No perioperative mortality or postoperative complications were observed including bleeding, hemoptysis, serious air leakage, and bronchopleural fistula. The lesions were completely removed in all 10 patients, and no patients converted to open surgery intraoperatively. Blood gas analysis showed that oxygen partial pressure before operation, in the first day after operation and the third month after operation was (62.5 ± 6.7), (70.2 ± 4.8) and (75.4 ± 4.8) mmHg (1 mmHg = 0.133kPa) respectively; which was significantly increased successively (P<0.05). After a follow-up time of 3-30 months, no recurrences were observed. Conclusions Video- assisted thoracoscopic pulmonary segmentectomy guided by preoperative CTA and three-dimensional reconstruction is a very effective method for the treatment of isolated PAVF.

Objective To investigate the clinicopathological characteristics and postoperative prognosis analysis of intra-thoracic localized Castleman disease (LCD).Methods The clinical data of 9 patients with intra-thoracic LCD who accepted surgical treatment were retrospectively analyzed.There were 5 males and 4 females,with age of (32.8 ± 10.9) years.Two patients complained of chest pain,1 patient suffered from paraneoplastic pemphigus,and the rest were diagnosed by physical examination.Four cases were diagnosed with LCD by preoperative CT examination.Results All patients underwent surgical resection.Four patients were performed open surgery and 5 patients had video assisted thoracic surgery.All patients accepted radical surgery.But 2 of these patients had postoperative complications.One patient was the injury of phrenic nerve and another was pericardial effusion.Patho-histological showed hyaline vascular type of Catleman disease in all patients.All patients survived without recurrence during the follow-up for 2-53 months.Conclusions Intra-thoracic is rare and liable to misdiagnosed.For increasing the preoperative diagnosis rate of LCD,the combined application of imaging tests is important,and clinicians and radiologists should also enhance the awareness of this disease.Complete surgical resection of the tumor is the best therapeutic alternative for intra-thoracic LCD.

Objective To evaluate the current status of aspirin for primary prevention in hypertensive outpatients in China,and the gap between aspirin use and guidelines.Methods This was a multi-center cross-sectional study and carried out in hypertensive patients from 46 hospitals of twenty two cities in China from June to December in 2009.At least 100 essential hypertensive outpatients were consecutively recruited from each participant hospitals according to the consistent inclusion criteria.The patients underwent physical examinations and biochemical analyses,and answered questionnaires.Based on the relevant guidelines,the risk assessment of cardiovascular disease (CVD) is a prerequisite for the proper use of aspirin in primary prevention.Results A total of 5 206 hypertensive outpatients were included.Among them,1 324 (25.4％) were with a history of CVD.Among those with no history of CVD,2 705 patients (69.7％) were at high risk of CVD,and the aspirin utilization rate for primary prevention was 29.2％,with 32.2％ patients at high risk and 22.4％ patients at low-medium risk of CVD,respectively.In the application of aspirin for CVD primary prevention,the inappropriate aspirin use rate in patients at lowmedium risk was 23.3％.Conclusions The proportion of subjects at high risk for CVD is high in hypertensive outpatients suggesting a wide range of application space for aspirin.There exists underutilization for high risk and overutilization for low-medium risk patients in current aspirin primary prevention application.

Objective To study the effect of paeonol on the proliferation and apoptosis of A375 human melanoma cells and its mechanism.Methods Cell counting kit-8 (CCK8) was used to evaluate the proliferative activity of A375 cells treated with paeonol of 0.5,1,2,4,8 mmol/L for 24,48 and 72 hours respectively.Subsequently,A375 cells were treated with paeonol of 1.25,2.5 and 5 mmol/L for 24 hours followed by double staining with annexin V and propidium iodide for the detection of cell apoptosis,fluorometric assay for the estimation of caspase 3,caspase 8 and caspase 9 activity,and Western blot for the determination of the levels of p53,nuclear factor-κB proteins and some of their target proteins.The A375 cells receiving no treatment served as the blank control group.Statistical analysis was carried out by t test.Results Within the investigated concentration and time ranges,paeonol significantly inhibited the proliferative activity of A375 cells in a concentration-and timedependent manner.Compared with the blank control group,a significant increase was observed in the early apoptosis rate in A375 cells treated with paeonol of 1.25,2.5 and 5 mmol/L for 24 hours (13.74％-± 1.73％,25.95％ ± 0.57％ and 46.44％ ± 0.81％ vs.3.11％ ± 0.53％,P ＜ 0.05 or 0.01),as well as in the activity of caspase 3,8 and 9 in A375 cells treated with paeonol of 2.5 and 5 mmol/L for 24 hours (P ＜ 0.05 or 0.01).After 24-hour treatment,the protein levels of p53 and Bax were elevated,but those of nuclear factor-κB,Bcl-2 and Bcl-XL were decreased in A375 cells with the increase of paeonol concentration.Conclusions Paeonol can inhibit the proliferation but induce the apoptosis of A375 cells,and the apoptosis-inducing effect may be realized through intrinsic and extrinsic pathways by modulating nuclear factor-κB and p53 genes.