Objective: To obtain chimeric antigen receptor macrophages ( CAR-M) targeting HER2 stably transfected． Methods : CAR lentivirus vector targeting HER2 was constructed and infected with human monocytic leukemia cell line (THP-1) ．CAR THP-1 cells with green fluorescent labeling were selected by sorting flow cytometry and continued to be cultured in vitro．The CAR THP-1 cells targeting HER2 were co-cultured with the endometrial cancer cell line Ishikawa with negative and positive HER2 expression，and their targeted phagocytosis of CAR-M to HER2 positive tumor cells was detected by imaging flow cytometry ，and the targeted phagocytosis efficiency of CAR-M to HER2 positive tumor cells was detected by flow cytometry. Results : CAR lentivirus infection with THP- 1 cells was less efficient ; After co-culture with cancer cells，flow cytometry and imaging flow cytometry showed that CAR THP-1 cells had enhanced phagocytosis of HER2 positive Ishikawa cells compared with the empty body group (P＜0. 01) ． Conclusion In this experiment，CAR THP-1 cell line targeting HER2 was established by constructing CAR lentivirus vector and transfecting THP-1 cells ，and it was proved that CAR THP-1 could phagocytize HER2 positive Ishikawa cells through specific targeting.

Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.

Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 ％ (91/93),avoid reoperation rate was 94.6％ (88/93).The incidence of moderate or severe mitral regurgitation was 11.8％ (11/93).Midtcrm survival rate was 96.4％ (53/55),avoid reoperation rate was 94.6％ (52/55),moderate or severe mitral regurgitation rate was 18.2％ (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 ％ (24/26),mitral valve moderate and above reflux rate was 7.7 ％ (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) ％ and (77.7 ± 6.4) ％ at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.

Objective To investigate the clinical and MRI features and pathogenic mechanism of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE).Methods Six cases of PRES in SLE proved by integrated clinical diagnosis were collected from January 2008 to December 2013.The clinical and MRI features of these patients were studied retrospectively and the related literatures were reviewed.Results The initial episode of nervous system was involved in 4 cases.The clinical presentations were headache (2 cases),seizures (4 cases),acute confusion state (2 cases),altered mentation (1 case) and vision change (1 case).All cases had lupus nephritis and hypertension,in which 4 cases had renal failure;6 cases were treated with immunosuppressive agents and 4 cases with cyclophosphamide for lupus nephritis when they developed PRES.The vasogenic edema lesions were distributed in the parietal or occipital lobe (5 cases),the frontal lobe (4 cases),temporal lobe (4 cases),basal ganglia (3 cases),splenium (1 case) and cerebellar hemispheres (2 cases).Three major patterns of PRES included dominant parietal-occipital (2 cases),the holohemispheric watershed (3 cases),and superior frontal sulcal (1 case).Conclusions The clinical and MRI findings of PRES in patients with SLE are typical.Awareness of this entity as early as possible can help to improve curative effect and prognosis.

Aged, 80 and over ; Carcinoma, Merkel Cell ; diagnosis ; Diabetes Mellitus ; Female ; Humans ; Skin Neoplasms ; diagnosis

Objective To explore the characterization of antibiotic resistance in hospitalized elderly patients with lower respiratory tract infection caused by Pseudomonas Aeruginosa ,and provide scientific basis for clinical ra-tional use of antimicrobial drugs and prevent the emergence of pan-drug resistant bacteria .Methods The drug sensi-tive tests of 347 hospitalized elderly patients with lower respiratory tract infection caused by Pseudomonas Aeruginosa in Shandong provincial hospital affinited to Shandong university from May 2010 to June 2012 were analyzed retrospec-tively.Results The antimicrobial resistance of the 347 cases was rather serious .The resistant rates of ampicillin and cefazolin were both 100.0%.Followed by ampicillin/sulbactam,tobramycin,sulfamethoxazole/trimethoprim,the re-sistant rates were 95.1%,86.8%and 83.6%respectively.The resistant rate of imipenem has reached 19.6%,and the detection rate of pan-drug bacteria was 4.9%.Conclusion The antibiotic resistance in hospitalized elderly pa-tients with lower respiratory tract infection caused by Pseudomonas Aeruginosa has become more and more serious .In order to prevent the emergence and prevalence of pan-drug resistant bacteria , antibacterial agents should be chosen reasonably according to the results of drug sensitive tests .

Objective To observe the effects of aerobic exercise on low-and high-density lipoprotein cholesterol,and to investigate the relationship between exercise intensities and high-density lipoprotein cholesterol (HDL-C) changes.Methods Sixty patients with low HDL-C were randomly allocated into a high intensity exercise group,a moderate intensity group or a low intensity group with 20 in each group.According to each patient's maximal heart rate in a restrictive electrocardiogram exercise test,the different aerobic exercise intensities were formulated as follows.The target heart rate of the high-intensity training group was 90％ of each subject's maximum heart rate; in the moderate-intensity group it was 70％ ; in the low-intensity group it was 50％.All 3 groups jogged on a medical treadmill for 20 minutes every other day with their heart rates monitored at all times.They maintained the target heart rate for 20 minutes.The experiment lasted 2 months.Results In the high intensity group HDL-C increased from 0.81 ± 0.22 to 1.04 ± 0.33 mmol/L after training; in the moderate intensity group it increased from 0.82±0.20 to 1.03 ±0.37 mmol/L; in the low intensity group it increased from 0.79 ±0.25 to 0.82 ± 0.27 mmol/L.That increase in the low intensity group was not statistically significant.After high intensity or moderate intensity training the HDL-C increases were statistically significant,but the difference between the groups was not.After training,in 15 cases among the high intensity group,13 cases from moderate intensity group and in 1 case from the low intensity group the HDL-C level achieved a normal value (≥ 1.04 mmol/L).Comparing the high intensity group to the low intensity group or the moderate intensity group to the low intensity group,there were significant differences in the number of patients who achieved normal HDL-C readings,but there was no significant difference between high intensity group and the moderate intensity group.Conclusion Low intensity aerobic exercise has no obvious effect on low HDL-C levels.High or moderate intensity aerobic exercise can effectively raise the HDL-C level,but there is no significant difference in the fraction of patients reaching normal values between high and moderate intensity aerobic exercise.So moderate intensity is recommended for improving low levels of HDL cholesterol.

Objective To evaluate the clinical significance of thyroid stimulating hormone (TSH) and thyroid autoantibodies (anti-TGAb and anti-TPOAb) in cord blood of infants of mothers complicated with hypothyroidism and the influencing factors of neonatal thyroid function. Methods Clinical data of 67 singleton pregnant women complicated with hypothyroidism in Peking Union Medical College Hospital were analyzed retrospectively. Thyroid function and its autoantibody levels in maternal, cord blood and neonatal serum at 5-7 d after birth were compared. Umbilical TSH level and its affecting factors were also investigated. The results of TSH was expressed as median (25th-75th percentile). Results (1) Umbilical TSH levels were elevated in 9. 0% (6/67) of all infants born to mothers complicated with hypothyroidism. (2) No correlation was found in TSH levels between cord blood and venous blood in neonates 5-7 d after birth. Umbilical TSH levels were significantly higher in infants born vaginally than in those born abdominally [10. 20(6. 10-12. 80) mU/L vs 5. 86(4.02-7.74) mU/L,P=0.001]. Higher umbilical TSH levels were also detected in those complicated with fetal distress and preterm birth compared with those withoutere [fetal distress: (10. 36(6. 61-13. 37) mU/L and 6. 89(4. 18-9. 70) mU/L, P = 0. 046; preterm birth: 8. 90(7. 60-10. 33) mU/L and 6.84(4.17-9. 80) mU/L,P=0. 046,0. 049)]. (3) The anti-TGAb levels in cord blood were positively correlated with that in neonatal serum at 5-7 d after birth (r=0. 960, P = 0. 000), and the same was true for anti-TGPOAb levels (r= 0. 975, P = 0. 000). Maternal thyroid autoantibody levels (anti-TGAb and anti-TPOAb) had significant effect on umbilical antibody levels (P = 0. 003 and 0. 000, respectively), but not on the neonatal TSH levels (P>0. 05). Conclusions Umbilical TSH levels are affected by many delivery factors which may limit its prediction role on congenital hypothyroidism. However, there is an increased risk of elevated umbilical TSH, anti-TGAb and anti-TPOAb levels among these patients which may increase the risk of congenital hypothyroidism. Further follow up of these infants is warranted.

Objective To establish a distinct linked emergency rescue network system in Shenzhen. Methods The current status of emergency network system in Shenzhen was studied, and some related publications in the recent years were reviewed. Results The emergency network system in Shenzhen is characterized by the following aspects: there is an effective emergency dispatch system with high authorities; the network covers every corner of Shenzhen; series of laws have been issued to ensure the proper operation of network. Conclusion The medical rescue system has developed in depth. The combination of community-based, pre-hospital and hospital rescue is effective in the whole process of emergency rescue, and shortens the rescue distance. The community-based rescue is the basic part of the system that can use the medical resources efficiently.

Objective To study the protection of Kangnaoling capsule to free radical injury and influence on the expression of caspase-3 and Bcl-2 in neuron of VD rat. Methods VD rat model was duplicated. Using spectrophotometry to detect contents of SOD, MDA and NO, spectro-fluorimeter to detect the expression of caspase-3, spectrophotometric method to detect the expression of Bcl-2 after traditional Chinese medicine interference. Results Kangnaoling capsule can markedly reduce the contents of MDA, raise contents of SOD and NO, degrade the expression of caspase-3, enhance the expression of Bcl-2. Conclusions Kangnaoling capsule can markedly protect VD rat from free radical injury, which probably correlated with increasing expression of Bcl-2, decreasing expression of caspase-3.