Objective: To construct and validate a clinical diagnostic model to differentiate between pulmonary tuberculosis and non-tuberculous lung diseases. Methods : Information was collected from 258 patients with respiratory system diseases, and they were divided into a training set of 152 cases and a test set of 106 cases with a ratio of 6 ∶4 using the random number seed method in R software. The training set was further divided into a tuberculosis group of 95 cases and a non-tuberculosis group of 57 cases, and the test set into a tuberculosis group of 65 cases and a non-tuberculosis group of 41 cases based on the diagnosis of pulmonary tuberculosis. A diagnostic model was constructed using multivariate logistic regression analysis to determine the influencing factors of pulmonary tuberculosis. The diagnostic value and clinical utility of the model were assessed using the receiver operating characteristic(ROC) curve, calibration curve, and decision curve analysis(DCA). Results : CD161+%(OR=0.768; 95%CI0.697-0.845;P<0.001), AST(OR=0.961; 95%CI0.930-0.993;P=0.019), and smoking history(OR=3.181; 95%CI1.149-8.804;P=0.026) were identified as independent risk factors for the occurrence of pulmonary tuberculosis. In both the training and test sets, the area under the ROC curve(AUC) reached 0.870(95%CI0.816-0.924) and 0.887(95%CI0.827-0.948), respectively. The Hosmer-Lemeshow goodness-of-fit test showed a good fit(training set χ2=6.213,P=0.623; test set χ2=6.197,P=0.625). DCA indicated that the model had good reference significance for the diagnosis of the probability of pulmonary tuberculosis occurrence. Conclusion The diagnostic model constructed using the percentage of CD161+%, AST levels, and smoking history has certain diagnostic performance, facilitating rapid clinical differentiation between pulmonary tuberculosis and non-tuberculous lung diseases.

Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension.Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy.Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days.Patients were divided into experimental group and control group according to thetype of fat emulsion used.43 patients in experimental group were applied for fish oil fat emulsion injection (10％ Omegaven) + medium long chain structure fat emulsion (20％STG) and 42 patients in control group were applied for medium long chain structure fat emulsion (20％STG).Liver function (total bilirubin and alanine aminotransferase),nutrition index (serum albumin and prealbumin),inflammatory mediators (TNF-α,IL-6 and IL-10) were measured before and after the operation,and the clinical outcomes were observed.Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P＞0.05).The inflammatory mediators like TNF-u,IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78) vs.(61.49±16.47),(74.94±6.36) vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13) ng/L;control group:(229.26±62.15) vs.(63.48±13.76),(77.23±7.83)vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72) ng/L;P＜ 0.01].With the progress of time,the proinflammatory factors like TNF-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-56.88± 31.63) vs.(-35.96±20.02),(-13.52±5.20) vs.(-6.38±2.84) ng/L;d7-d1:(-150.67±42.58) vs.(-132.79±53.35),(-27.04±8.97) vs.(-20.85±6.38) ng/L;P＜ 0.05].The range of increase in anti-inflammatory media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.

Objective To study the clinical use of indocyanine green (ICG) fluorescence imaging in laparoscopic liver surgery.Methods The clinical and pathological data of 68 patients who underwent laparoscopic hepatectomy using the ICG fluorescence imaging technique during the study period from September 2016 to October 2018 in Zhongnan Hospital,Wuhan University were retrospectively analyzed.Analysis was carried out on the surgical methods,fluorescence navigation methods,ICG injection time and dose,tumor characteristics,and pathological studies of the resected specimens.Results Of 68 patients,3 patients were converted to open surgery,and the remaining 65 patients completed the ICG fluorescence laparoscopic hepatectomy.Thirty-two of these 65 patients underwent ICG fluorescent guided laparoscopic anatomical resection of lower hepatic segment / hepatic hemilivers (positive staining in 17 patients,negative staining in 15 patients),with 19 patients successfully staining with ICG(19 / 32,59.4％).Postoperative histopathology showed primary hepatic solid tumors (n=31),secondary liver tumors (n=12),hepatic cysts (n=4),hepatic hemangiomas (n =5),hepatolithiasis (n =12) and hepatic focal nodular hyperplasia (n =1).These lesions were combined with hepatitis B liver fibrosis in 29 patients.Conclusions ICG fluorescence imaging positively impacted on laparoscopic liver surgery.Proper preoperative ICG injection was helpful for the identification,localization and intraoperative surgical guidance of tumors,especially for patients with deep-seated and central tumors.As a consequence,oncological and surgical safety of laparoscopic liver surgery was improved.Targeted visualization of liver segments and surgical navigation using intraoperative ICG injections facilitated accurate and precise resection of anatomical liver segments or hemi-hepatectomies.The use of intraoperative ICG fluorescence technology for hepatic hemangioma,hepatic cyst,intrahepatic bile duct stones and other benign liver lesions,helped to improve safety of surgery.

Objective: Vascular endothelial growth factor A (VEGFA) was investigated as the key protein which might promote the specific metastasis progress of nasopharyngeal carcinoma. Methods: Sixteen specimens of pulmonary metastasis carcinoma and counterparts in primary nasopharyngeal carcinoma tissue were collected from patients. The expression of VEGFA through immunohistochemistry was investigated.VEGFA was knocked down by siRNA in two cell lines of nasopharyngeal carcinoma (CNE-1 and 5-8F), MTT and Transwell test were used to explore the role of VEGFA in praxiology. Then shRNA was used to cultivate the stable CNE-1 cell line with down-regulated-expression of VEGFA. The nude mice models were built through tail vein injection of specific nasopharyngeal carcinoma cells, and lungs were collected to perform further metastasis analysis. Results: Previous genetic studies showed that VEGFA had higher expression in metastasis tissue, and the result was validated in the present study using immunohistochemistry. The percentage of positive cells was 84.8% in pulmonary metastasis group, 51.5% in primary tissue group (t=8.639, P<0.05), average optical density was 0.154 in pulmonary metastasis group, 0.061 in primary tissue group (t=18.791, P<0.05). Low expression of VEGFA inhibited cell viability of optical density value of CNE-1 in siRNA gourp was 0.715, 0.902 in control group (t=7.274, P<0.05); 5-8F in siRNA group was 0.715, 0.935 in control group (t=7.751, P<0.05). Number counting suppressed migration of CNE-1 in siRNA group was 52 per high-power lens, 124 per high-power lens in control group (t=29.380, P<0.05), 5-8F in siRNA group was 65 per high-power lens, 155 per high-power lens in control group (t=18.181, P<0.05). Number counting invasion of CNE-1 in siRNA gourp was 38 per high-power lens, 86 per high-power lens in control group (t=27.665, P<0.05), 5-8F in siRNA group was 52 per high-power lens, 116 per high-power lens in control group (t=40.972, P<0.05) in vitro. Furthermore, knock-down of VEGFA in nasopharyngeal carcinoma reduced the pulmonary metastasis in vivo. Number counting of tumor volumes in shRNA group was 2.4, and 11.0 in control group (t=6.143, P<0.05); average optical density of immunohistochemistry in shRNA group was 0.033, and 0.176 in control group (t=15.734, P<0.05). Conclusions Results above reveal the overexpression of VEGFA in nasopharyngeal carcinoma can facilitate the pulmonary metastasis. Targeting VEGFA may provide a new biomarker of clinical study.

OBJECTIVE To determine the distribution of allergens in patients with allergic rhinitis in Wenzhou area. METHODS Patients with AR symptoms from January 2013 to December 2014 were given skin prick test (SPT). The clinical data about SPT was retrospectively colleceted to analyze SPT results. RESULTS 1. Among 2991 individuals, the total positive rate of SPT was 82.0%, with Dermatophagoides farinae (Der. f) and Dermatophagoides pteronyssinus (Der.p) as the most common allergens; the positive rate of inhalant allergen was obviously higher than that of ingestive ones, with significantly statistical difference(χ2=2006.557,P<0.01). Most of patients were allergic to double allergens; the intensity of Der.f and Der.p mainly presented as (++++), with no significant difference(Z=-0.391, P=0.696). 2. There was significant difference of variation with seasons(χ2=34.254, P<0.01). 3. No significant difference of positive rate were observed in different AR-courses(χ2=16.102, P<0.01). 4. Significant difference of positive rate was found among different age-groups; The positive rate was increased along with growing age, got peak at group of 10-12 years old, and then got down after that. CONCLUSION Dust mite was the main allergen coursed AR in Wenzhou area. Seasons and age were two important factors effecting on positive of SPT and onset of AR. The positive rate of allergens was related to age.

Objective To explore the effect of azelastine hydrochloride nasal spray combined with desloratadine to inflammatory factors, cell function and IgE of patients with allergic rhinitis.Methods 92 cases of allergic rhinitis patients treated in the first affiliated hospital of wenzhou medical college hospital from June 2014 to December 2015 were divided into experimental group(n=46) and control group(n=46) according to the random number table method.The control group was given oral loratadine tablets, one piece per time, one time per day, while the experimental group was given azelastine hydrochloride nasal spray on the basis of the control group,each nostril one spray, one time in the morning and night.The clinical efficacy of two groups of patients would be observed after 4 weeks,ELISA would be used to detect serum levels of IFN-γ, IL-4, IL-8 and IgE level, and IFN-γ/IL-4 was the value of Thl/Th2,flow cytometry instrument was used to the determination of T cell subgroup CD4 +,CD8 + cells.Results 4 weeks after treatment,stuffy nose, nasal itching, runny nose, sneezing and nasal cavity change points are lower than before the treatment in both the two groups.Experimental group obviously lower than the control group, the difference was statistically significant ( P <0.05 ).The total effective rate of treatment group is higher than the control group,the difference was statistically significant(χ2 =4.389,P=0.036).The serum level of IFN-γis higher than before treatment in both the two groups.IL-4, IL-8 inflammatory factor levels were lower than before treatment,the experimental group was better than control group,the difference was statistically significant(P<0.05).CD4 +,CD8 +of T cells and Thl/Th2 values are higher than before the treatment in both the two groups,the experimental group was higher than control group, the difference was statistically significant ( P<0.05 ).Serum IgE levels were lower than before the treatment in both the two groups,the experimental group was lower than control group,the difference was statistically significant (P<0.05).Conclusion The therapy of azelastine hydrochloride nasal spray combined with desloratadine can improve the clinical effect of the treatment of allergic rhinitis,reduce inflammation,strengthen the body's immune function, improve thelevel of serum IgE.

Hepatolithiasis is a kind of mixed stone disease which mainly depends on pigment stone.However,the etiology is not clear and the pathogenesis is very complex.A lot of studies confirmed that helicobacter pylori played an important role in the occurrence and development of disease.This paper mainly expounds the problems concerning the characteristic of helicobacter pylori and its connection with hepatolithiasis, its state in the formation of hepatolithiasis.

OBJECTIVE: To evaluate the efficacy of combined modality therapy for advanced hypopharyngeal carcinoma in order to improve the curative effect of hypopharyngeal carcinoma. METHOD: Seventy-six male patients with the stage III - IV hypopharyngeal carcinoma were treated with postoperative combined modality. Of all the 76 cases, 44 were treated with postoperative radiotherapy, and the other 32 treated with chemoradiotherapy concurrently. RESULT: Kaplan Meier analysis indicated that the overall 5 survival rates of patients treated with postoperative radiotherapy was 25.9%, and that of patients treated with postoperative chemoradiotherapy was 27.8%. There was no significant difference between the two groups (P>0.05). Three and five years relapse-free survival rates of the patients treated with postoperative radiotherapy were 36.0%, 22.5%, and those of the patients treated with postoperative chemoradiotherapy were 68.0%, 45.3%. Significant difference was calculated between the two groups (P<0.05). According to the NCI CTC3.0 criteria, the toxicities on grade 3 or above of the two groups showed no significant difference (P>0.05). CONCLUSION For advanced hypopharyngeal carcinoma, postoperative chemoradiotherapy yielded satisfactory relapse free survival and laryngeal function preservation rate which was superior to that of postoperative radiotherapy. Also the treatment toxicities were not increased.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; mortality ; surgery ; therapy ; Chemoradiotherapy ; Combined Modality Therapy ; Humans ; Hypopharyngeal Neoplasms ; mortality ; surgery ; therapy ; Male ; Middle Aged ; Neoplasm Staging ; Survival Rate

Objective To investigate the underlying neural mechanism of left hemiparalexia and left hemialexia in reading Chinese characters. Methods A patient with reading disorders caused by brain infarctions at the left ventralis medialis occipitotemporal lobe and the splenium of the corpus callosum was studied. A series of neuropsychological tests, such as reading Chinese characters presented in the central foveal field or in the left and right half of the foveal field, were conducted with the patient, and neuroimaging techniques including high spatial resolution 3D-MRI and diffusion tensor tractography (DTT) were used to examine whether or not there were lesions of the neural pathway. Results The patient showed left hemiparalexia, which was characterized by making substitution or omission mistakes, mostly in the left parts of Chinese characters, and also left hemialexia(alexia for characters presented in left visual field). 3D-MRI demonstrated infarctions in the left ventral mesial occipitotemporal area and in the left side of the splenium of the corpus callosum. The left lateral mid-fusiform cortex, which has been identified as the visual word form area(VWFA), was almost intact. DTT indicated the major forceps fibers running through the splenium were all disconnected due to the infarction of the left splenium. Conclusion As a result of disruption of the splemium-major forceps pathway, visual character information in the left visual field which is initially projected to the right occipital cortex cannot be transferred from the right visual cortex to the left VWFA. This mechanism of left hemiparalexia and left hemialexia in reading Chinese characters is similar to that in reading English words.

Objective To obsrve the effects of thalidomide on angiogenesis, growth and metastasis of human hepatocellular carcinoma (HCC) in nude mice. Methods The model bearing HCC was set up in 24 nude mice, and then the rats were randomly divided into therapy group and control group, each containing 12 animal. Thalidomide (200mg/kg/d) dissolved in 0.5% CMC suspension was administered intraperitoneally in the therapy group, and equivalent 0.5% CMC was administered in the control group. Mice were sacrificed at the 30th day after administration, the size and weight of tumors and metastatic condition in liver and lung were determined, levels of CD34 and VEGF mRNA in tumor tissues were detected by immunohistochemical and semi-quantitative RT-PCR, respectively, and microvessel density (MVD) in tumor tissues was also counted. Results MVD and VEGF mRNA level in therapy group were lower than those in control group (P