2012年 · 第125卷第17期

Lower respiratory tract infections (LRTI),such as community-acquired pneumonia (CAP) and influenza,still are the major leading causes of morbidity and mortality,and the third most common cause of death globally although it fluctuates among different stratified countries.1 As reported by WHO in 2008,the cause of death for LRTI is at tier 1 in low-income countries,tier 4 in middle-income countries,and tier 5 in high-income countries respectively.1 However,due to the technic or societal factors the infectious pathogens resulting in CAP could not be detected well in many clinical scenarios,especially in developing countries and fundamental or community hospitals。

Abstract：Background Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens.We performed a prospective observational study of adult with CAP in 36 hospitals in China.Methods Etiological pathogens were isolated in each of the centers,and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.Results A total of 593 patients were enrolled in this study,and 242 strains of bacteria were isolated from 225 patients.Streptococcus pneumoniae (79/242,32.6％) was the most frequently isolated pathogen,followed by Haemophilus influenzae (55/242,22.7％) and Klebsiella pneumoniae (25/242,10.3％).Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9％)and 60 (11.4％) patients respectively.Legionella pneumophila infections were identified in 4.0％ (13/324) of patients.The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2％ and 19.1％respectively.Six patients died from the disease,the 30-day mortality rate was 1.1％ (6/533).Conclusions The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia,Haemophitus influenza and Klebsiella pneumonia.There was also a high prevalence of atypical pathogens and mixed pathogens.The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae。

Abstract：Background Chronic obstructive pulmonary diseases (COPD) is an emerging population at risk for invasive infection of Aspergillus.Isolation of Aspergillus from lower respiratory tract (LRT) samples is important for the diagnosis of invasive pulmonary aspergillosis (IPA).The purpose of this study was to investigate the value of Aspergillus isolation from LRT samples for the diagnosis and prognosis of IPA in COPD population.Methods Clinical record with Aspergillus spp.isolation in COPD and immunocompromised patients was reviewed in a retrospective study.Patients were categorized and compared according to their severity of illness (admitted to general ward or ICU) and immunological function (COPD or immunocompromised).Results Multivariate statistical analysis showed that,combined with Aspergillus spp.isolation,APACHE Ⅱ scores ＞18,high cumulative doses of corticosteroids (＞350 mg prednisone or equivalent dose) and more than four kinds of broad-spectrum antibiotics received in hospital may be predictors of IPA in COPD (OR=9.076,P=0.001; OR=4.073,P=-0.026; OR=4.448,P=0.021,respectively).The incidence of IPA,overall mortality,mortality of patients with IPA and mortality of patients with Aspergillus spp.colonization were higher in COPD patients in ICU than in general ward,but were similar between COPD and immunocompromised patients.Conclusions Aspergilltus spp.isolation from LRT in COPD may be of similar importance as in immunocompromised patients,and may indicate an increased diagnosis possibility of IPA and worse prognosis when these patients received corticosteroids,antibiotics,and need to admit to ICU.Aspergillus spp.isolation from LRT samples combined with certain risk factors may be useful in differentiating colonization from IPA and evaluating the prognosis of IPA in COPD patients。

Abstract：Background The computed tomography (CT) findings of invasive pulmonary aspergillosis (IPA) are unclear in nonhematological patients.The present study was a retrospective evaluation of CT images in non-hematological patients with IPA.Methods All adult patients who met the 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria for proven or probable IPA were included during a 5-year study at our institutions.Initial CT findings in our cohort were retrospectively reviewed by two independent thoracic radiologists blinded to patient demographics and clinical outcomes.The presence,pattern,and distribution of abnormalities were recorded.Results Twenty-three non-hematological patients with pathologically confirmed IPA were included in our study.Areas of ground-glass opacities were present in 14 patients (61％),which were bilateral in 10 patients and unilateral in four.This pattern mainly involved the middle and upper lung zones.Air-space consolidation was identified in 12 patients (52％),and the areas were distributed along the bronchus or subpleura in most cases.Other findings,including five small nodules (22％),three macronodules (13％),and one halo sign (4％),were less common.Conclusions CT findings of IPA in non-hematological patients frequently manifested as acute bronchopneumonia,and ground-glass opacities and air-space consolidations were the most common CT findings of IPA in these patients。

Abstract：Background The performance of asthma control test (ACT) at baseline for predicting future risk of asthma exacerbation has not been previously demonstrated.This study was designed to explore the ability of the baseline ACT score to predict future risk of asthma exacerbation during a 12-month follow-up.Methods This post hoc analysis included data from a 12-month prospective cohort study in patients with asthma (n=290).The time to the first asthma exacerbation was analyzed and the association between baseline ACT scores and future risk of asthma exacerbation was calculated as adjusted odds ratio (OR) using Logistic regression models.Further,sensitivity and specificity were estimated at each cut-point of ACT scores for predicting asthma exacerbations.Results The subjects were divided into three groups,which were uncontrolled (U,n=128),partly-controlled (PC,n=111),and well controlled (C,n=51) asthma.After adjustment,the decreased ACT scores at baseline in the U and PC groups were associated with an increased probability of asthma exacerbations (OR 3.65 and OR 5.75,respectively),unplanned visits (OR 8.03 and OR 8.21,respectively) and emergency visits (OR 20.00 and OR 22.60,respectively) over a 12-month follow-up period.The time to the first asthma exacerbation was shorter in the groups with U and PC asthma (all P＜0.05).The baseline ACT of 20 identified as the cut-point for screening the patients at high risk of asthma exacerbations had an increased sensitivity of over 90.0％ but a lower specificity of about 30.0％.Conclusion Our findings indicate that the baseline ACT score with a high sensitivity could rule out patients at low risk of asthma exacerbations and oredict future risk of asthma exacerbations in clinical practice。

Abstract：Background Many studies have shown the superior efficacy of budesonide (BUD)/formoterol (FORM) maintenance and reliever therapy,but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group.We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol (SALM)/fluticasone (FP) maintenance plus an as-needed short-acting β2-agonist in Chinese patients with persistent uncontrolled asthma.This was a post hoc analysis based on a 6-month,multicenter,randomized,double-blind study (NCT00242775).Methods A total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM+as-needed BUD/FORM (160/4.5 μg/inhalation) (640/18 pg/d; n=111),or SALM/FP+as-needed terbutaline (0.4 mg/inhalation)(100/1000 μg/d; n=111 ).The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function,symptom control and quality-of-life.Results Time to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment (risk ratio=0.52,95％ CI 0.22-1.22),but the difference did not achieve statistical significance (P=0.13).The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group (7.2％ vs.13.5％; risk ratio=0.45,P=0.028).BUD/FORM produced significantly better improvements in reliever use,cumulative mild exacerbations,symptom-free days (％),and morning/evening peak expiratory flow (PEF) than SALM/FP (P＜0.05 in all cases).The two groups achieved similar improvements in their time to first mild exacerbation,forced expiratory volume in one second (FEV1),asthma control questionnaire and asthma symptom scores,and percentage of nights with awakening(s).Both treatments were well tolerated.Conclusions In Chinese patients with persistent asthma,BUD/FORM decreased severe and mild exacerbations,decreased reliever use,increased symptom-free days,and improved morning/evening PEF compared with SALM/FP.There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP.BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the original study.(Clinical Trial Registry Number:NCT00242775)

Abstract：Background It is the first multicenter clinical study in China to investigate zanamivir use among Chinese adolescents and adults with influenza-like illness (ILI) since 2009,when inhaled zanamivir (RELENZA(R)) was marketed in China.Methods An uncontrolled open-label,multicentre study to evaluate the antiviral activity,and safety of inhaled zanamivir (as Rotadisk via Diskhaler device); 10 mg administered twice daily for 5 days in subjects ≥12 years old with ILl.Patients were enrolled within 48 hours of onset and followed for eight days.Patients were defined as being influenza-positive if the real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test had positive results.Results A total of 400 patients ≥12 years old were screened from 11 centers in seven provinces from March 2010 to January 2011.Three hundred and ninety-two patients who took at least one dose of zanamivir were entered into the safety analysis.The mean age was 33.8 years and 50％ were male.Cardiovascular diseases and diabetes were the most common comorbidities.All the reported adverse events,such as rash,nasal ache,muscle ache,nausea,diarrhea,headache,occurred in less than 1％ of subjects.Mild sinus bradycadia or arrhythmia occurred in four subjects (1％).Most of the adverse events were mild and did not require any change of treatment.No severe adverse events (SAE) or fatal cases were reported.Bronchospasm was found in a 38 years old woman whose symptoms disappeared after stopping zanamivir and without additional treatment.All the 61 influenza virus isolates (43 before enrollment,18 during treatment) proved to be sensitive to zanamivir.Conclusions Zanamivir is well tolerated by Chinese adolescents and adults with ILls.There is no evidence for the emergence of drug-resistant isolates during treatment with zanamivir.(ChiCTR-TNRC-10000938)

Abstract：Background Patients with central tracheobronchial benign or malignant lesions who have not recieved surgical treatment can be treated by interventional techniques,such as laser,afterloading radiotherapy,cryotherapy,photodynamics treatment,radiofrequency ablation and stenting,etc.The accuracy of the invasive depth of central lesion in tracheobronchial wall plays an important role in making interventional treatment plan.This study used radial probe endobronchial ultrasound (RP-EBUS) scanning to evaluate the accuracy of the invasive depth of central lesions in tracheobronchial wall,and the influence of RP-EBUS scanning in treatment plan making and guidance.Methods This was a prospective study of consecutive patients with central tracheobronchial lesions found by CT or bronchoscopy.We performed EBUS scanning after common bronchoscopy under local anesthesia.A radial ultrasonic probe (2.0 mm in diameter with 20-MHz frequency) with a balloon sheath was introduced through the 2.8-mm-diameter channel of a flexible bronchoscope.The balloon at the tip of the probe was inflated with distilled water until coupling with the airway wall under endoscopic control.The circular image of EBUS,which revealed the layered structure of the tracheobronchial wall,could be achieved.Results Total of 125 patients were enrolled in the study.Thirty patients underwent surgical operation and pathologically proved the RP-EBUS diagnosis accuracy of tumor invasive depth in tracheobroncial wall was 90％ (27/30),sensitivity and specificity were 88.89％ (24/27) and 100％ (3/3),respectively.In response to EBUS images,40 approaches were altered or guided:lymph-node metastasis and compressive lesions was diagnosed by EBUS-guided transbronchial needle aspiration (TBNA) (n=8); Lesions ablation with laser or electricity were stopped when EBUS demonstrated close range with vessels or perforation possibility (n=13),stents size were changed (n=14),operation was canceled (n=3) and foreign body was removed (n=2).No complication associated with the use of EBUS was observed.Conclusion RP-EBUS can be a useful tool in assessing the central lesion invasive depth to the tracheobronchial wall。

Abstract：Background The condition of concomitant upper lobe emphysema and lower lobe fibrosis as identified by computer tomography is known as combined pulmonary fibrosis and emphysema (CPFE).CPFE has distinct clinical characteristics compared with emphysema alone (EA) and idiopathic pulmonary fibrosis (IPF) without emphysema.However,the pulmonary inflammation characteristics of CPFE are not well known,and the differences between CPFE and the other two diseases with regards to pulmonary inflammation need to be explored.The pulmonary inflammatory characteristics were investigated in CPFE patients and compared with EA and IPF.Methods Fraction exhaled nitric oxide (Fe,NO) and differential cell counts,the concentrations of monokine induced by interferon gamma (MIG/CXCL9),interferon-inducible protein 10 (IP-10/CXCL10),and interferon-inducible T cell alpha chemoattractant (I-TAC/CXCL11) were measured in induced sputum obtained from subjects with CPFE (n=22),EA (n=22),IPF (n=14),and healthy volunteers (HV,n=12).In addition,immunohistochemistry was used to quantify the expression of nitric oxide synthases in alveolar macrophages in 23 lung tissues from patients and control subjects.Results The CPFE group had higher alveolar NO than subjects in the EA and HV groups (P=0.009,P=0.001,respectively) but not than the IPF group (P ＞0.05).Numbers of sputum eosinophils were significantly elevated in CPFE and IPF groups compared with the HV group (P=0.001,P=-0.008).In contrast,eosinophil counts in EA group did not differ from those in the HV group.Compared with the EA and HV groups,the CPFE group had a lower concentration of Ⅰ-TAC/CXCL11 in sputum supernatants (P=-0.003,P=0.004).Immunoreactivity for inducible nitric oxide synthase (iNOS)was higher in the CPFE group than in the EA group (P=-0.018,P=0.006,respectively).Conclusions The pulmonary inflammation of CPFE group is more similar to IPF group,while the distal airway inflammation is more significant in CPFE and IPF groups than in EA group.Lung eosinophil cell infiltration and high NOS expression in alveolar macrophage might participate in this pathogenesis。

Abstract：Background Bronchial carcinoids are rare malignant neuroendocrine neoplasms.Some issues regarding surgical treatment of bronchial carcinoids remain controversial,including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy.Methods This retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010.Results Eighty-nine (67.9％) of the patients were male,and the mean age was 46 years,ranging from 17 to 81 years.Preoperative fiberoptic bronchoscopy was performed in all patients.Endoscopic biopsy was performed in 100 patients with central tumors,and 70 (70％) patients were diagnosed as bronchial carcinoid.The resections performed consisted of 31 pneumonectomie,32 Iobectomies,26 bilobectomies,34 sleeve Iobectomies,six bronchoplastic procedures without lung resection,and two segmentectomies.During a median of 87 months follow-up,there were nine recurrences including three local recurrences and 6 distant recurrences.No bronchial recurrences were observed.The 3-,5-and 10-year overall survival rates of pneumonectom and bronchoplastic surgery (including sleeve Iobectomy and bronchoplastic procedure without lung resection) were 93.2％,81.0％ and 69.4％,97.5％,91.9％ and 70.0％,respectively.Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors.Conclusions Bronchoplastic surgery should be considered whenever possible for central carcinoids.Systematic lymphadenectomy is recommended for bronchial carcinoid patients.Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid。

Abstract：Background Smoking is the leading cause of death in the world.This study focused on the difference of the serum proteomic profiling between healthy smokers and nonsmokers in order to find smoking-specific serum biomarkers.Methods Pattern-based proteomic profiling of 100 serum samples (from 50 Chinese male smokers and 50 matched nonsmokers) was performed through magnetic bead fractionation coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis (MALDI-TOF-MS) and resulting data were statistically analyzed by Ciphergen ProteinChip software 3.0.2.Results We found 72 serum peaks were significantly different between smokers and nonsmokers (P ＜0.05).Marker peaks of mass-to-charge ratio (m/z) 3159.13,7561.03 and 9407.32 were smoking-specific.Conclusion The preliminary data suggested that smoking-specific serum biomarkers could be detected in humans。

To the editor:We particularly appreciated the article by Jin QH et al1 on the risk of lethal outcome,and the need for more careful treatment,in patients with low plasma cholinesterase (ChE).It brings important information on the assessment of severity of illness and risk of death in critically ill patients.To broaden the advantages of their findings,the authors should indicate the normal range for ChE measurement in their institution。

Abstract：Background Endometrial carcinoma is one of the most common female tract genital malignant tumors.Nifedipine,an L-type calcium channel antagonist can inhibit cell proliferation of carcinomas.Recent studies indicated that a rise in the free cytosolic calcium ([Ca2+]c) was a potent inducer of autophagy.Here,we investigated the relationship between nifedipine and autophagy in Hec-1A cells.Methods Cells were cultured with nifedipine (10 μmol/L) and harvested at different times for counting cell number.MTT assay was applied to evaluate the cell viability and transwell assay to reveal cell migration.Apoptotic cells were detected with annexin V/PI assay.Then cells were treated with 3-methyladenine (3-MA) (2.5 mmol/L) for 0,5,15,30,60,and 120 minutes and the expression of the L-type calcium channel alpha1D (Cav1.3) protein was detected.At last,cells were cultured and assigned to four groups with different treatment:untreated (control group),10 pmol/L nifedipine (N group),2.5 mmol/L 3-MA (3-MA group),and 10 μmol/L nifedipine plus 2.5 mmol/L 3-MA (N+3MA group).Autophagy was detected with GFP-LC3 modulation by fluorescent microscopy,and expression of the autophagy-associated proteins (LC3,Beclin1 and P70s6K) by Western blotting and monodansylcadaverine (MDC) labeled visualization.Results Proliferation of Hec-1A cells was obviously suppressed by nifedipine compared with that of the untreated cells for 24,48,and 96 hours (P=0.000 for each day).The suppression of migration ability of the nifedipine-treated cells (94.0±8.2) was significantly different from that of the untreated cells (160.00±9.50,P=0.021 ).The level of early period cell apoptosis induced by nifedipine was (2.21±0.19)％,which was (2.90±0.13)％ in control group (P=0.052),whereas the late period apoptosis level reached (10.38±0.96)％ and (4.40±0.60)％ (P=0.020),respectively.The 3-MA group induced a slight increase in the Cav1.3 levels within 15 minutes,but significantly attenuated the Cav1.3 levels after 30 minutes.There were more autophagic vacuoles labeled by MDC in the N group (20.63±3.36) than the control group (6.29±0.16,P=0.015).GFP-LC3 localization revealed that the LC3 levels of cells in 3-MA group,N+3MA group,3-MA group were 2.80±0.29,2.30±0.17,and 1.80±0.21,respectively.Cells in the N group showed significant augmentation of autophagy (P＜0.05).Western blotting analysis confirmed the down-regulation of LC3 levels in 3-MA group (0.85±0.21) and N+3MA group (1.21 ±0.12) compared with nifedipine treatment (2.64±0.15,P ＜0.05).The annexin-V-FITC/PI assay showed that the level of early period cell apoptosis induced in the N+3-MA group ((11.22±0.91)％) differed significantly from that of the control group ((2.51±0.70)％) and N group ((3.47±0.39)％).Similarly,the late period level of the N+3-MA group ((55.19±2.51)％) differed significantly from that of the control group((15.81±1.36)％) and the N group ((22.09±2.48)％,P＜0.05).The down-regulated expression of P70s6k and up-regulated expression of the Beclin1 revealed significant differences between the N+3-MA group and control group (=0.025; Beclin1:P=0.015).Conclusions Proliferation and migration in vitro of endometrial carcinoma Hec-1A cells are significantly suppressed by nifedipine.The nifedipine leads autophagy to oppose Hec-1A cells apoptosis.Autophagy inhibition by 3-MA leads down-regulation of Cav1.3 and enhances nifedipine-induced cell death.The nifedipine-induced autophagy is linked to Beclin1 and mTOR pathways。

Abstract：Background Can single-agent maintenance therapy be considered as an ideal strategy for non-small cell lung cancer (NSCLC) treatment to achieve prolonged survival and tolerated toxicity? A systematic review and meta-analysis was performed to elucidate this issue.Methods The electronic databases were searched for RCTs comparing single-agent maintenance therapy with placebo,best support care or observation.The required data for estimation of response,survival and toxicity were extracted from the publications and the combined data were calculated.Results Eleven RCTs involving 3686 patients were identified.We found a statistically significant higher probability of tumor response for patients with maintenance therapy versus control patients (OR:2.80,95％ CI:2.15-3.64).Patients receiving maintenance therapy had significantly longer progression-free survival (PFS) (HR:0.67,95％ CI:0.62-0.71)and overall survival (OS) (HR:0.84,95％ CI:0.78-0.90).However,maintenance therapy was associated with more severe toxicities (OR:6.45,95％ CI:4.61-9.01).Conclusion In patients with advanced NSCLC,the use of single-agent maintenance therapy is associated with higher response rate and significantly prolongs PFS and OS despite of the risk of additional toxicity。

Abstract：Objective To review the current evidence that links smoking to obstructive sleep apnea (OSA) and to discuss some potential mechanisms proposed for these links.Data sources We searched PubMed and Medline to identify studies investigating the interaction between smoking and OSA.Study selection Articles regarding the relationship between smoking and OSA were selected.Studies considered smoking as a confounding factor were excluded.Results The association of smoking and OSA has been confirmed in several studies.The effects of smoking on the pathophysiology of OSA may include smoking-induced upper airway inflammation,stimulant effects of nicotine on upper airway muscles,and a "rebound effect" due to nightly short-term nicotine withdrawal,or all of the above.In addition,the coexistence of OSA and smoking may have more widespread implications for cardiovascular dysfunction in patients with OSA.Finally,OSA might be responsible for the addiction to nicotine.Conclusions Smoking may act as a risk factor for OSA and join with OSA in a common pathway to increase the risk of systematic injury.OSA,in turn,may be a predisposing factor for smoking.Thus,smoking cessation is recommended when considering treatment for OSA,and treating OSA may be a necessary precondition for successful smoking cessation。

Abstract：Background The airway inflammation could be assessed by some noninvasive approaches.To investigate the value of eosinophil counts in induced sputum and fractional concentration of exhaled nitric oxide (FENO) for the regimen adjustment in patients with asthma,the correlation was analyzed between the two parameters and lung function parameter (forced expiratory volume in one second (FEV1)).Methods Sixty-five outpatients with mild to moderate non-exacerbation asthma from Beijing Chao-Yang Hospital were enrolled as treatment group.Combined medications of inhaled corticosteroids plus long-acting beta-2 agonist were administered for one year.Lung function parameters,eosinophil counts in induced sputum,concentration of exhaled nitric oxide and the Asthma Control Test scores were recorded,at regular intervals in the follow-up period.Twenty-one healthy volunteers were enrolled as control group and underwent examination of eosinophil counts in induced sputum,lung function and concentration of exhaled nitric oxide.Results Sixty-three subjects from treatment group completed follow-up period for one year or longer.Mean FEV1 value of the 63 subjects was (2.75±0.54) L at baseline,(2.97±0.56) L and (3.07±0.52) L at month 3 and month 6,respectively,and maintained as (3.14±0.51) L in the following six months.Mean FENO decreased from (61±25) parts per billion (ppb) at baseline to (32±19) ppb at month 3 (P ＜0.05),and continued to decrease to (22±12) ppb at month 6,the difference being significant when compared to both baseline and control group ((13±8) ppb).Mean eosinophil counts decreased to (0.032±0.011) ×106/ml at month 3,which was significantly different from baseline ((0.093±0.023)×106/ml) and the control group ((0.005±0.003) ×106/ml (both P ＜0.05).The eosinophil counts in induced sputum correlated positively with concentration of FENO in the first six months (all P ＜0.05).The concentration of FENO had a significant negative correlation with FEV1 value (all P ＜0.05) in any time point in the follow-up period.The Asthma Control Test scores were 18±5,19±7,23±2,24±1 and 24±1 at months 1,3,6,9 and 12,respectively,which were significantly different from the score at baseline (14±3) (P ＜0.05 ).The most rapid clinical effect was observed at the second month after treatment.Conclusion Eosinophil counts in induced sputum and FENO are sensitive parameters to detect airway inflammation and may be useful in evaluating the efficacy of treatment and adjusting medication regimens。

Abstract：Background CD44v6 plays an important role in invasion and metastasis of tumor,Livin has anti-apoptotic effects.The present study aimed to explore the expression and clinical significance of CD44v6 and Livin in gastric cancer tissue.Methods Streptavidin-peroxidase linked immunohistochemical method was used to determine the expression of CD44v6 and Livin in gastric cancer tissue and adjacent normal gastric tissues from 59 patients with histopathologically confirmed gastric cancer,and in gastric tissue specimens of 15 patients with gastric polyps,and 15 patients with chronic non-atrophic gastritis.The chi-square test was used for comparison of the relevant factors,Spearman's rank correlation test was applied for relationship among positive expression of the proteins.Results The expresion of CD44v6 was positive in 64.4％ of the gastric cancer patients; 5.1％,0 and 13.3％ in specimens of normal tissues adjacent to the cancer tissues,in gastric tissue specimens of patients with gastric polyps,and patients with chronic non-atrophic gastritis,respectively.The expression of Livin was positive in 52.5％ of the gastric cancer tissues,6.8％,0 and 6.7％ in the adjacent normal gastric tissue,specimens of patients with gastric polyps and chronic non-atrophic gastritis,respectively.The expression of CD44v6 was significantly correlated with the depth of invasion,the degree of differentiation,and lymphnode metastasis of gastric cancer (P ＜0.05).The positive expression rate of Livin protein was also significantly correlated with degree of differentiation of gastric cancer cells and metastasis to lymphnodes (P ＜0.05),but not correlated with the depth of invasion and pathological types (P ＞0.05).The expression of CD44v6 and Livin in the gastric cancer tissue was positively correlated (rs=0.286,P=-0.028).Conclusions The increased expression of CD44v6 and Livin in gastric cancer tissue may be closely related with development and progression of gastric cancer.CD44v6 and Livin may be new biological markers of gastric cancer。

Abstract：Background Volatile anesthetics (VAs) may affect varied and complex physiology processes by manipulating Ca2+-calmodulin (CaM).However,the detailed mechanism about the action of VAs on CaM has not been elucidated.This study was undertaken to examine the effects of VAs on the conformational change,hydrophobic site,and downstream signaling pathway of CaM,to explore the possible mechanism of anesthetic action of VAs.Methods Real-time second-harmonic generation (SHG) was performed to monitor the conformational change of CaM in the presence of VAs, each plus 100 μmol/L Ca2+. A hydrophobic fluorescence indicator,8-anilinonaphthalene-1-sulfonate (ANS),was utilized to define whether the VAs would interact with CaM at the hydrophobic site or not.High-performance liquid chromatography (HPLC) was carried out to analyze the activity of CaM-dependent phosphodiesterase (PDE1) in the presence of VAs.The VAs studied were ether,enflurane,isoflurane,and sevoflurane,with their aqueous concentrations 7.6,9.5,11.4 mmol/L; 0.42,0.52,0.62 mmol/L; 0.25,0.31,0.37 mmol/L and 0.47,0.59,0.71 mmol/L respectively,each were equivalent to their 0.8,1.0 and 1.2 concentration for 50％ of maximal effect (EC50) for general anesthesia.Results The second-harmonic radiation of CaM in the presence of Ca2+ was largely inhibited by the VAs.The fluorescence intensity of ANS,generated by binding of Ca2+ to CaM,was reversed by the VAs.HPLC results also showed that AMP,the product of the hydrolysis of cAMP by CaM-dependent PDE1,was reduced by the VAs.Conclusions Our findings demonstrate that the above VAs interact with the hydrophobic core of Ca2+-CaM and the interaction results in the inhibition of the conformational change and activity of CaM.This in vitro study may provide us insight into the possible mechanism of anesthetic action of VAs in vivo。

Abstract：Background Optical coherence tomography (OCT) is a new imaging technique capable of obtaining high-resolution intravascular images of small vessels and has been widely used in interventional cardiology.However,application of OCT in peripheral pulmonary arteries in patients has been seldom documented.Methods Three patients who were highly suspected peripheral pulmonary arteries thrombi and had undergone CT pulmonary angiography but tested negative for thrombi in peripheral pulmonary arteries were enrolled.Subsequently,OCT imaging was performed in peripheral pulmonary arteries.The patients received more than three-month anticoagulative treatment if thrombi were detected by OCT.Thereafter,OCT re-evaluation of the thrombolized blood vessels detected earlier was performed.The changes of thrombi before and after anticoagulative treatment were compared.Results Three patients underwent OCT imaging of peripheral pulmonary arteries.Thrombi were found in most of imaged vessels in these patients.Red and white thrombi can be differentiated,according to features of the thrombus on OCT images.After anticoagulation treatment,these patients' symptoms and hypoxemia improved.Repeated OCT imaging showed that most thrombi disappeared or became smaller.Conclusion OCT may be used as a potential tool for detecting peripheral pulmonary artery thrombi and differentiating red thrombi from white ones。

As one of common physical and mental ailments,insomnia may cause serious adverse effects on a patient's daily life.And serious accidents occur in long-term cases.1 Despite comprehensive treatments,9.38％-17.0％ of the treated insomniacs fail to benefit at all.Thus the term of "refractory insomnia" has been coined.2-4 At present,there is no literature reporting the roles of estazolam plus alternating current magnetic field (ACMF) for treating insomnia.In the present study,estazolam plus ACMF was employed for the patients with refractory insomnia so as to explore the clinical efficacies of such a combined modality。

Abstract：Anhidrotic ectodermal dysplasia (EDA) is a relatively rare congenital hereditary disease.Because of a reduced number of sweat glands,patients are unable to perspire and consequently suffer from hyperthermia and infection.This is a potential cause of death in childhood.Domestic prenatal diagnosis methods focus on genetic diagnosis.But for some conditions,because of the uncertain molecular pathology,we need other methods to assist to in prenatal diagnosis.Here,we report one case of a new mutation locus which may be associated with EDA and the prenatal diagnosis of EDA by fetal skin bioosv under fetoscopy in mid pregnancy,combined with a review of the literature。

Abstract：Anterior megalophthalmos (AM) is an uncommon developmental anomaly of the anterior segment of the eye with a constellation of findings that includes enlarged cornea,deep anterior chamber,posterior positioning of the iris and lens,iris stroma atrophy,hypoplasia of iris dilator,pupil displacement,large capsular bag,lens subluxation,prematurely cataract and the tendency to retinal detachment.AM,especially when symptoms are mild,is not an easy disease to diagnose.We present 3 AM cases that were misdiagnosed as congenital cataract with weak zonule and megalocornea.Intraocular lenses (IOLs) dislocated after standard cataract surgeries and subsequent surgery (replacing the dislocated IOLs with iris-claw intraocular lenses) achieved satisfactory outcome.Although rare,AM should be included in the differential diagnosis of enlarged cornea and we recommend implanting Artisan lens in AM patients。

Abstract：Pulmonary sparganosis mansoni is rare in humans and bronchial sparganosis mansoni has not been reported.We reported a patient with a soft-tissue mass in the right hilum area on a chest computed tomography (CT) scan that was suspected of being lung cancer.Bronchoscopy identified sparganum larvae.Bronchial sparganosis mansoni accompanied by abnormal hyperplasia was diagnosed by histopathology.We introduced our experience and reviewed the clinical characteristics of three pulmonary sparganosis mansoni cases and three pleural cavity sparganosis mansoni cases that have been reoorted。

Abstract：Extra-adrenal myelolipomas are extremely rare,especially in bronchus and lung.Up to now,only nine cases of intra pulmonary lesions have been reported all over the world.Here we describe a new discovered pulmonary-bronchus myelolipoma in a 53-year-old man,which is different from the previously reported ones.And we mainly comment on the pathology and diagnosis,comparing with the findings of the extra-adrenal cases reported in Chinese literature。

Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease,characterized by accumulation of surfactant-associated phosphor lipoproteinaceous material in the alvoli.Finding the periodic acid-Schiff (PAS)positive substance in the alveolar lavage can help to make the diagnosis。

Although lung metastasis is common in renal cell carcinoma (RCC),only a few cases of pleural metastasis without lung involvement have been reported.We present here not only a special case of pleural metastases from RCC without lung involvement,but also discussion about the specific metastatic pathway and the treatment of sole pleural metastasis。

Common variable immunodeficiency (CVID) is a rare disease characterized by recurrent pulmonary infections, hypogammaglobulinemia, and diminished specific antibody response to immunization.The estimated prevalence rate of CVID ranged from 1/50 000 to 1/200 000.1 The common clinical manifestations of CVID are repeated and prolonged respiratory infections.Thus,bronchitis,bronchiectasis,and pneumonia are all well recognized,whereas diffuse interstitial lung disease (ILD) has not been comprehensively investigated in CVID.Organizing pneumonia (OP), one of the phenotypes in ILD,is rarely associated with CVID.There are only two cases reported in English literature searched in Pubmed.2,3 We herein present the first case of OP related to CVID in China,who was successfully treated with corticosteroid therapy。

Renal cell carcnoma (RCC) metastasizes to the duodenum is extremely rare.There are only few cases reported to date.Most authors recommended aggressive surgery to improve survival.However,it is dependent on medical and technical feasibility.Herein,we report a case of a 72-year-old woman with duodenum metastasis from RCC 10 years after radical left nephrectomy and hepatocellular cancer (HCC) resection who simultaneously underwent local resection of duodenal mass,and evaluate the isolated surgical management for the unusual condition。