Objective Acute lung injury induced by variety causes can be reduced by mesenchymal stem cells.Some studies have shown that mesenchymal stem cell-derived exosomes have similar features with mesenchymal stem cell,but its role in acute lung injury is less studied.The study was to investigate the protective role and underlying mechanisms of bone marrow mesenchymal stem cell-derived exosomes (BMSC-DEs) on smoke inhalation injury (SⅡ) in rats.Methods Thirty Wistar rats were randomly divided into 3 equal groups:normal control group,smoke inhalation injury (SⅡ) model group and bone marrow mesenchymal stem cell-derived exosomes (BMSC-DEs) treated group.12 h after establishing the SⅡ model,BMSC-DEs treated group was injected with 0.5 mL BMSC-DEs (derived from 4× 106 BMSCs),and normal control group and SⅡ model group were injected with equivalent volume of normal saline.7 days later,samples were collected.The histopathologic changes of lung were observed after HE staining;BCA was used to test the amounts of total protein in bronchoalveolar lavage fluid (BALF);Enzyme linked immunosorbent assay was used to test the levels of tumor necrosis factor-α (TNF-α) and keratinocyte growth factor (KGF) in the lung tissue;Immunohistochemical was used to test the levels of pulmonary surfactant protein C(SP-C).Results The BALF levels of total protein of SⅡ group was significantly higher than those of normal control group (P＜0.01) and BMSC-DEs groups(P＜0.05);Compared with normal group [(0.164±0.021) ng/L],the levels of tumor necrosis factor-α of SII and BMSC-DEs groups [(0.355±0.106)、(0.234±0.024) ng/L] (P＜ 0.05) were significantly higher,and SⅡ group was higher than that of BMSC-DEs group(P＜0.01);Compared with normal group,the KGF protein expression level in lung tissue of SⅡ group was significantly lower (P＜0.05),but BMSC-DEs group was higher (P＜0.05).BMSC-DEs group was higher than SⅡ group (P＜0.01);Immunohistochemistry showed that the SP-C expression level in lung tissue of SⅡ group was significantly lower than those of other groups (P＜0.05).There was no statistically difference between BMSC-DEs group and control group (P＞0.05).Conclusion BMSC-DEs has a protective effect of smoke inhalation injury rats,the underlying mechanism may be related to BMSC-DEs to reduce inflammation and promote restoration of the alveolar epithelial type Ⅱ.

Objective To study the infection of MP-Ab IgM (MP) in serum,bronchial lavage fluid,pleural effusion and cere brospinal from pediatric patients with Mycoplasma Pneumoniae Pneumonia (MPP).Methods From March to June 2013,278 cases of patients suspected MP infection in Children's Hospital Affiliated to Capital Medical University were selected and the MP-Ab IgM of thcire serum,bronchial lavage fluid,pleural effusion and ccrebrospinal fluid specimens were detected with the method of particle agglutination test.Results 181 cases (104 cases of boys,77 cases of girls) of different specimens in (MP) were positive.All the serum samples,278 cases were detected positive serum specimen of 170 cases,the overall detection rate was 61.2％ (170/278),144 cases of bronchial lavage fluid was investigated at the same time,check out the posi rive 62 cases,and the detection rate was 43.1％ (62/144).19 cases for pleural effusion samples at the same time,checked out the positive 13 cases,and detection rate was 68.4％ (13/19).15 cases of cerebrospinal fluid specimens was investigated at the same time,checked out the positive in 1 case,and the detection rate was 6.7％ (1/ 15).Positive rate between different age groups was respectively:6 months～1 year group 29.0％ (9/31),～3 year group 51.0％ (25/49),～5 year group 56.1％ (23/41),～16 year group 79.0％ (124/157),6 months～1 year witb other age groups was statistically significant difference (P＜0.05).In 0.5～1 year,～3 year,～5 year,16 year～four age groups,different types of MP-Ab IgM positive specimens of the same patients,the corresponding results for A:serum type (111 cases) 7,21,13,70.B:serum and bronchoalveolar lavage fluid type (45 cases) 0,2,5,38.C:Serum pleural effusion (7 cases) 0,1,2,4.D:serum and cerebrospinal fluid (1 cases) 0,0,0,1;E:serum and bronchoalveolar lavage fluid and pleural effusion type (6 cases):0,0,2,4.F:bronchoalveolar lavage fluid type (11) 2,1,1,7.Conclusion MP infection varied,have atrend of younger age,and has a tendency to increase year by year,and the patient's infection rates have different characteristics.Positive serum of different age groups was gradually increased with age,infants and young children positive detection rate increased significantlychildren with severe multiple in older children.

Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.

Objective To analyze the related pathogenicity gene mutations in a sudden death of hypertrophic cardiomyopathy (HCM) on whole exome level.Methods Whole exome sequencing (WES) was been performed on a sudden death case sample with pathological features of HCM by Illumina(R) Hiseq 2500 platform.Using hgl9 as the reference sequences,the sequencing data were analyzed.Suspicious single nucleotide variants (SNV) were screened,and the conservatism and function were analyzed by the software such as PhyloP,PolyPhen-2,SIFT,etc.Results After screening,a heterozygous mutation C719R was finally identified in the gene MYBPC3 of this case.Conclusion The molecular anatomy on whole exome level by second generation sequencing technology can help to define the molecular mechanism of HCM and provide a new mothed and thought for analysis of death cause.

Objective:To investigate the lipid levels of maintenance hemodialysis (MHD) patients from single center and to explore the related risk factors.Methods:MHD patients (dialysis duration ＞3 months) in blood purification center of Zhongshan Hospital,Fudan University were enrolled in the research.Fasting blood lipid including triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),glycosylated hemoglobin (HbA1c),serum albumin and other indicators were tested,and dialysis adequacy evaluation was made.At the same time,patients' general information and medical history were collected.Results:The average levels of TC,TG,HDL-C and LDL-C in 203 patients were (4.45 ± 1.16) mmol/L,(1.93 ± 2.18) mmol/L,(1.16 ± 0.34) mmol/L,(2.51 ± 0.93) mmol/L,respectively.132 patients (65％) were bothered by lipid abnormalities.Proportions of serum high TC and LDL-C abnormality were higher in women than in men while low HDL-C abnormality proportion was lower in women than in men (P＜0.05).Serum TG level was higher in patients over 60 years old than those under 45 years old and among 45-59 years old (P＜0.05).However,patients under 45 years old had the highest prevalence of dyslipidemia (P＜0.05).Patients with dialysis duration ＞60 months had lower proportion of TG abnormality than patients with duration ＜12 months and among 12 60 months (P＜0.05).Prevalence of dyslipidemia was highest in the group with duration ＜12 months (P＜0.05).Serum TG level was lower in patients with HbA1c≤6％ than in patients with HbA1c＞6％ (P＜O.05). Higher prevalence of dyslipidemia occurred in patients with HbA1c＞6％ (P＜O.05).Conclusions: Lipid metabolism disorder is common among MHD patients.Female, dialysis duration＜12 months, younger than 45years old, and HbA1c＞6% are risk factors of lipid metabolism abnormality in such patients.

Objective:To compare the surgical procedures and postoperative effects of PFNA and DHS in the treatment of intertrochanteric fracture in elderly patients.Methods:The clinical data of 30 elderly patients with intertrochanteric fracture treated in our department from March 2013 to March 2017 were retrospectively analyzed.15 cases were treated with PFNA internal fixation and 15 cases with DHS internal fixation.The average length of operation,the amount of bleeding during operation,the time of hospitalization and the difference of postoperative functional recovery were compared between the two surgical procedures.Results:The intraoperative bleeding of the DHS group was more than that of the PFNA group,and the difference was statistically significant (P＜0.05).There was no significant difference in length of operation,time of hospitalization or postoperative hip function between the two groups.Conclusions:DHS is similar in clinical efficacy to PFNA in the treatment of intertrochanteric fracture in elderly patients,especially for intertrochanteric fractures with simple fracture types and intact lateral wall of the femur.DHS has the advantages of anatomical reduction and simple operation,which is worthy of clinical promotion.

Objective To investigate the antibacterial resistance in nationwide's tietiary hospitals and understand the trend of antimicrobial resistance.Methods All the clinical isolates were collected from 18 hospitals and the minimal inhibitory concentrations (MICs) were tested using agar dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2017 guideline.Results A total of 4333 pathogenic isolates from 18 tertiary hospitals in 18 cities nationwide over the period from July 2015 to June 2016 were studied.Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase (ESBLs) phenotype rates of 59.4％ and 27.5％,respectively;decreased by 7 to 10 percentage points comparing the last time.Carbapenems,amikacin,moxalactam,β-lactam/β-lactamase inhibitor combinations,tigecycline,and fosfomycin displayed desirable antibacterial activity against Enterbacteriaceae,but a significant increasing of carbapenems resistance Klebsiella pneumoniae were noted.For non-fermenting Gram-negative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 29.5％ and 69.8％ and multidrug-resistant (MDR) detection rate were 35.6％ and 78.3％,extensively drug-resistant (XDR) were 10.2％ and 72.5％,respectively.Klebsiella pneumoniae isolated from children were more resistant to β-lactam than those from adults and the old people,so bacterial resistance in children is an important problem in China.Conclusion Though the decline of ESBLs detection rate,carbapenem non-susceptible Klebsiella pneumoniae rates continued to increase,which should be paid more attention.

Objective To investigate the gram-positive coccus resistance in nationwide's tietiary hospitals and understand the trend of antimicrobial resistance.Methods All the clinical isolates were collected from 18 hospitals and the minimal inhibitory concentrations (MICs) were tested using agar/broth dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2017 guideline.Results A total of 2301 Gram-positive cocci isolated from 18 hospitals in 18 cities nationwide were studied.Based on the MIC results,the prevalence of methicillin resistant Stapylococcus aureus (MRSA) and methicillin resistant Stapylococcus epidermidis (MRSE) were 39.9％ and 86.6％ respectively.No vancomycin insensitive Staphylococcus was detected.Staphylococcus aureus were 100％ susceptibile to linezolid and teicoplanin,but resistant or insensitive for drugs other than vancomycin were observed among Coagulase Negative Staphylococci (CoNS).Antibiotic resistance rate of Enterococcus faecalis and Enterococcusfaecium to ampicillin were 4.5％ and 85.1％.The detectation rate of vancomycin resistant Enterococcus(VRE) was 2.1％.Nonsusceptibility rate of Enterococcus faecalis to linezolid was 7.8％,showing slight increase than last time.The prevalence of penicillin nonsusceptible Streptococcus pneumoniae (PNSSP) was 6.6％ based on non-meningitis and parenteral administration criterion;while for cases of oral penicillin,the rate was 70.0％,was as flat as last time.There were no significant differenees of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis Enterococcus faecalis and Enterococcus faecium among various groups such as different department,age,or specimen source.Conclusion Compared with past surveillance result,VRE detection ratio was steady,while MRSA detection ratio decreased.The emergence of resistance and non-susceptible strains to new antibiotics such as linezolid,tigecycline and daptomycin should be payed more attention.

Objective To investigate the expression changes of myeloid-related protein-8 (MRP-8) and myeloid-related protein-14 (MRP-14) in children with Kawasaki disease (KD) and to obtain laboratory diagnostic serum markers and new targets for its drug therapy.Methods A total of 46 patients with KD(KD group) were enrolled from Jul.2009 to Dec.2010 and divided into the coronary artery dilatation(CAD) group(n =15) and the normal coronary artery group(n =31) ;Meanwhile,25 febrile patients with acute respiratory tract infection but without disease in the circulatory,blood,immune systems formed the non-KD febrile group.Twenty healthy children from the out-patient department formed the healthy control group.Peripheral venous blood was collected in the acute and subacute stage of KD.Levels of MRP-8/MRP-14 were detected with enzyme-linked immunosorbnent assay (ELISA).Gene expressions of MRP-8,MRP-14 in leukocytes were analyzed by semi-quantitative reverse transcription-polymerase chain reaction(RTPCR).Results The serum levels of MRP-8/MRP-14 along with mRNA expressions of MRP-8 and MRP-14 in the leukocytes in the out-patient acute and subacute stage of KD were significantly higher than those in the non-KD febrile group and the healthy control group(all P ＜ 0.05) ;There was no significant difference between non-KD febrile group and healthy control group (P ＞ 0.05).The serum levels of MRP-8/MRP-14 along with mRNA expressions of MRP-8 and MRP-14 in leukocyte in actue stage of KD were significantly higher than those in subacute stage(all P ＜ 0.001).The serum levels of MRP-8/MRP-14 as well as mRNA expressions of MRP-8 and MRP-14 in the acute and the subacute stage of CAD group were significantly higher than those in the normal coronary artery group(P ＜ 0.05).Conclusions MRP-8/MRP-14 may probably play a role in the pathogenesis of KD and can be used as a diagnostic indicator for KD;MRP-8/MRP-14 may be involved in the formation of coronary artery lesion and can be used as an effective predictor for the coronary artery lesion.

Background Currently,the recommendation when treating acute biliary or pancreatic disease during pregnancy is to perform endoscopic retrograde cholangiopancreatography (ERCP) without radiation exposure,either empirically (with no radiographic guidance) or with ultrasound guidance.However,few published studies compared these two ways.This study aimed to compare ultrasound-guided ERCP with the procedure without radiographic guidance in the treatment of acute pancreaticobiliary disease in pregnant patients.Methods The clinical data of 68 pregnant patients with acute pancreaticobiliary disease admitted to our hospital between January 2004 and May 2010 were reviewed retrospectively.ERCP was performed without radiographic guidance in 36 cases (group A) and with ultrasound guidance in 32 cases (group B).Data on the following variables were compared between the two groups:surgical success rate,rate of complete stone removal,time to resolution of clinical manifestations and laboratory indicators,length of hospital stay,complications,outcome and differences in efficacy of ERCP during different stages of pregnancy.Results In group A,the rates of surgical success and complete removal of stones were 69％ and 60％,respectively; the corresponding values were 91％ and 89％ in group B (P ＜0.05).Postoperatively,clinical manifestations improved rapidly in all patients; there was no statistically significant difference between the groups (P ＞0.05).Leukocyte counts and liver function had improved significantly after one week in all patients; they recovered more quickly in group B ((8.64±1.83)days vs.(14.57±3.74) days,(14.29±4.64) days vs.(20.00±5.40) days,P ＜0.01).The hospital stay was shorter in group B ((16.28±7.25) days vs.(28.00±6.83) days,P＜0.001).The complication rate was 14％ in group A and 3％ in group B (P ＜0.05).There were no significant differences between the two groups in the procedure's efficacy during different stages of pregnancy.Conclusions In the treatment of acute pancreaticobiliary disease during pregnancy,ultrasound-guided ERCP is safer and more effective than performing the procedure empirically without radiographic guidance when performed by experienced practitioners.Its more widespread use is recommended.