Objective: To summarize the measures and experience of treatment in mass extremely severe burn patients. Methods: The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment. Results: Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients. Conclusions Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.

Objectives To identify and characterize 10 strains of Francisella philomiragia-like organisms isolated from blood samples and environmental water.Methods The 10 clinical and environmental isolates were identified by traditional morphological examination and biochemical characterization,matrix-assisted laser desorption/ionization time of flight(MALDI-TOF) mass spectrometry(MS) systems and sequencing based on 16S rRNA gene.The minimum inhibitory concentrations were tested by E-test methods.Results All the 10 isolates were gram-negative coccobacilli appearing tiny and faint counterstain of safranin,negative for urease,nitrate reduction and X and/or V factor requirement,but positive for oxidase and catalase.The isolates grew rapidly in sheep blood agar,chocolate agar and BCYE plate forming white opaque,colorless transparent or gray smooth colonies with about 2-mm diameters,but did not grow in M-H agar and MacConkey agar.The sequencing for 16S rRNA gene indicated that the 10 isolates shared more than 99.6％ similarity to Francisella philomiragia,and fell into the same clusters of Francisella philomiragia on phylogenetic tree.The MALDI-TOF MS analysis also showed the typical peaks with 6 153 m/z,5 180 m/z,7 757 m/z and 9 392 m/z which were similar to Francisella philomiragia ATCC 25015.However,they may be misidentified to be Sphingomonas paucimobilis by using Vitek 2 GN cards,Neisseria cinerea by using Vitek 2 NH cards,Myroides odoratimimus by using API 20NE strips and Haemophilus by using API NH cards.The results of antimicrobial susceptibility showed that they were all sensitive to chloramphenicol,doxycycline,tetracycline,gentamicin,ofloxacin and ciprofloxacin.Conclusion The 10 isolates could be identified as Francisella philomiragia,so we should pay more attention to the infrequent pathogen for its inactive biochemical reaction and the misidentification by commercial detection systems.

Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.

Objective To assess the levels of nucleosomes released from peripheral blood mononu-clear cells(PBMC)of patients with systemic lupus erythematosus(SLE),and their relationship with auto-antibodies as well as disease activity.Methods Levels of both nucleosomes released from PBMC and vari-ous auto-antibodies were detected by ELISA in sera from SLE patients.The disease severity was evaluated using SLEDAI(systemic lupus erythematosus disease activity index)system.Results Levels of nucleosomes released from PBMC were significantly higher in patients with active SLE than those of patients with inactive disease and normal controls(39.39?25.70,13.44?8.82,and11.73?7.87IU/mL,respectively).There was a significant positive correlation between nucleosome levels and SLEDAI scores,serum ds-DNA auto-an-tibody levels,and low C3levels.Conclusion Nucleosomes released from apoptotic PBMC of patients with SLE is closely correlated to disease activity,which implies that nucleosomes may play an important role in the pathogenesis of SLE.

Objective To investigate the prevalence of systemic fungal infection in patients at auto-psy and its association with clinical data.Methods The materials from unselected adult patients were exa-mined at necropsy in our hospital from1971to2000,and the fungal species were identified by their mor-phologies in pathology.The clinical and pathological data were compared.Results The rate of fungal infec-tion was7.8%(31/396)among396cases.Seventeen(54.8%)of the31cases were infected with as-pergillus.The frequencies of organs involved with fungal infection were83.87%in lungs,48.39%in kid-neys,35.48%in brain and29.03%in heart,respectively.The fungal infection attributed directly to death in21cases.Conclusion Systemic fungal infection is one of the most common fatal causes among the critically ill patients,and aspergillosis becomes a major pathogenic fungus for patients with systemic fungal infection at autopsy.

Objective To screen and analyze genes differentially expressed within dermal papillae cells(DPC)with aggregative behavior.Methods Total RNA was extracted from DPC with and without ag-gregative behavior,and double-stranded cDNA were synthesized by using SMART cDNA synthesis.The cD-NA fragments of differentially expressed genes in dermal papillae cells with aggregative behavior were isolat-ed by suppression subtractive hybridization,sequencing,and then subtracted library was set up.Positive clones were screened by PCR method and verified by cDNA dot blot and then analyzed through homologous retrieving.Results A subtractive cDNA library of DPC with aggregative behavior was successfully construct-ed.The results of screening and cloning of the library showed that DPC with aggregative behavior could ex-press genes related to homologous aggregation,regnlation of growth,differentiation and development,and sig-nal transduction proliferation and cycle control,which included known genes(capping protein,paladin,vas-cular endothelial growth factor),hematopoietic stem/progenitor cells(HSPC)related genes(HSPC011and HSPC016)and a new gene.Conclusions The construction of subtractive library of DPC lays solid founda-tion for screening and cloning new and specific genes related to aggregative behavior of DPC.Several genes may cooperatively involve in homologous aggregation,and regnlation of growth of DPC.Among these genes,capping protein and palladin may be closely related to aggregative behavior of DPC,and VEGF and HSPC re-lated clones may be responsible for the status of higher proliferation of DPC.

Objective To investigate the role of IL-2,IFN-? and IL-10 in pemphigus acantholysis. Methods Acantholysis was observed histopathologically in the skin organ culture model of pemphigus after interacting with different concentrations of IL-2, IFN-? and IL-10 for 24 h?48 h and 72 h. Results The acantholysis was promoted by IL-2 and IFN-?, and the severity of acantholysis was related to the concentrations of IL-2 and IFN-?. The effect of IFN-? was weaker than that of IL-2. IL-10 could inhibit the acantholytic effect of IFN-? significantly, and inhibit the acantholytic effect of IL-2 when its concentration was higher than 100 pg/mL. Conclusions Th1 cytokines can promote acantholysis induced by antibody of pemphigus (Pab) while Th2 cytokines can inhibit the acantholysis induced by Pab, and the effect of Th1 cytokines. Th2 lymphocytes may play an important role in the pathogenesis of pemphigus.

Objective To investigate whether the sort of drugs causing drug eruptions complicated with drug-induced liver dysfunction are the same as those causing drug eruptions. Methods Sixty-one cases of drug eruption complicated with drug-induced liver dysfunction in 261 cases confirmed as drug eruptions from January 1998 to March 2003 were analyzed retrospectively. Results The major hepatotoxic drugs in these cases were antivirus drugs (60%, 9/15), antituberculosis drugs (66.67%, 8/12), zyloric (55.56%, 5/9), and some traditional Chinese medicines (31.58%, 6/19). Conclusion The sort of drugs causing drug eruptions complicated with drug-induced liver dysfunction are the same as those causing drug eruptions, which should be taken into consideration in clinical medication.

Objective To establish a new method for detecting pemphigus antibody (PAb). Methods PI 1 anti idiotype monoclonal antibodies against pemphigus and purified PAb from the serum of a patient with active pemphigus were used to establish an ELISA system for detecting the PAb. Results The result showed the purified PAb was IgG4 subclass, the sensitivity and specificity for the detection of PAb were high in the ELISA system, the sensitivity and specificity were not significantly different among the IIF, indirect ELISA and ABC ELISA. The standard curve for detecting the concentration of the purified PAb was primarily obtained in the study. Conclusion The ELISA system for the detection of PAb in the sera of patients is a good qualitative method, it might be of value in the clinical diagnosis of pemphigus. It is expected to quantitatively detect PAb of pemphigus patients in the future with the ELISA system established, which is directed to the IgG4 subclass of PAb, so it may be of value in the study of IgG4 subclass in the pathogenesis of pemphigus.

Objective To investigate the status of expression and gene polymorphism of cytotoxic T lymphocyte-associated molecule4(CTLA4)on peripheral blood mononuclear cells(PBMCs)from patients with psoriasis.Methods Expression of CTLA4mRNA/antigen and polymorphism of CTLA4gene were analyzed in33and133patients with psoriasis confirmed clinically and/or pathologically,respectively.Expression of CT-LA4mRNA and antigen was detected by in situ hybridization and immmunohistochemistry.CTLA4exon1and3'untranslated region were amplified by polymerase chain reaction(PCR)and the amplified products were identified by single-stand conformation polymorphism(SSCP),restriction fragment length polymorphism(RFLP)or sequencing.Results Expression of both mRNA and antigen of CTLA4was significantly weaker on PBMCs induced by staphytococcal enterotoxin B(SEB)in patients with psoriasis than that in normal con-trols,without a regular pattern.The guanine49on exon1in association with fragment106bp of3'untranslat-ed region was shown to be linked to the susceptibility of psoriasis.Conclusion Defective translation and ex-pression of CTLA4take place in patients with psoriasis,which is possibly related to the polymorphism of CT-LA4.Our results suggest that CTLA4may be one of the candidate genes which cause autoimmunity in psoria-sis.