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Objective To evaluate the value of neutrophil CD64 positive cells percentage(CD64%)detec-tion to stop using antibiotic in patients with severe pneumonia.Methods 60 accepted antibiotic therapy patients with severe pneumonia,in accordance with the random number table,were separated into observation group(n =30)and control group(n =30).Antibiotics were stopped according to CD64% in observation group,while it according to the clinical symptoms,the plasma level of white blood cell and C -reactive protein in control group.The main observation indexes included the days of antibiotics use,the length of Intensive Care Unit(ICU)stay,clinical efficacy and the case fatality rate.Results The days of antibiotics use in the observation group was (10.3 ±5.2)d,while it was (16.8 ± 5.8)d for patients in the control group,and it had significant difference(t =-4.570,P 0.05).Conclusion Stop using antibiotics according to the neutrophil CD64 % is safe,reliable,and can effectively reduce the excessive use of antibiotics and shorten the length of ICU stay in patients with severe pneumonia.
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Objective To investigate the clinical significance of pulse high-volume hemofiltration (PHVHF) on expressions of Toll-like receptor (TLR) 2 and TLR4 mRNA in peripheral blood mononuclear cells (PBMCs) in patients with severe sepsis.Methods Forty patients with severe sepsis were divided into conventional treatment group (n =20) and PHVHF group (n =20) according to random number table.Another fifteen healthy volunteers served as controls.TLR2 and TLR4 mRNA expressions in PBMCs were detected using RT-PCR and plasma concentrations of TNF-α and IL-6 were measured using ELISA method before therapy and at 24 h,48 h and 72 h after therapy.Vital signs,BIL,Cr,BUN,Lac,PaO2/FiO2,acute physiology,chronic health evaluation Ⅱ (APPACHE Ⅱ),sequential organ failure assessment (SOFA) and prognosis were compared among the groups.Besides,complications associated with PHVHF therapy were monitored.Results Expressions of TLR2 and TLR4 mRNA in PBMCs and concentrations of TNF-α and IL-6 were significantly higher in patients with severe sepsis than in the controls (P ＜ 0.01).At 72 hours after therapy,PHVHF group showed significantly lower concentrations of TNF-α and IL-6 than those before therapy (P ＜ 0.01) as well as significantly lower expressions of TLR2 and TLR4 mRNA in PBMCs than those in conventional treatment group (P ＜ 0.O1).However,no significant decline in the levels of TNF-α and IL-6 and the expressions of TLR2 and TLR4 mRNA in PBMCs were shown in conventional treatment group after therapy.At 72 hours after therapy,PHVHF group showed significant increases of MAP and PaO2/FiO2 and significant decreases of Cr,BUN,Lac,APACHE Ⅱ and SOFA as compared to those before therapy (P ＜ 0.05).Moreover,the differences of MAP,PaO2/FiO2,Cr,BUN,Lac,APACHE Ⅱ and SOFA were statistically significant between and conventional treatment group at 72 hours after therapy (P ＜ 0.05).Conclusion PHVHF achieves a reduced systemic inflammatory response,improved major organ functions,shortened length of stay in ICU and down-regulated TLR2 and TLR4 expressions in PBMCs that may be a novel mechanism of PHVHF in treatment of severe sepsis.
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The data of 6 patients with tertiary hyperparathyroidism were retrospectively analyzed.The first symptom in 3 patients was bone ache,1 with lower extremity weakness,1 with swelling of lower limbs,and 1 with increase serum alkaline phosphatase.5 patients had past history of renal failure,1 case suffered from severe intestinal malabsorption,and 4 of them had renal transplantation.X-ray showed subperiosteal bone resorption,bone demineralization,or cellulose osteitis.5 subjects presented with osteoporosis,and 1 of them had fractures.Left atrioventricular membrane calcification and gluteal calcification were found in each of 2 cases.4 patients suffered from hypercalcaemia,2 patients with normal serum calcium,4 with hypophosphataemia,and 6 with high levels of PTH.Pathological results showed adenoma in parathyroid gland in 4 patients and enlarged parathyroid glands in 2 patients.Serum calcium and PTH levels returned to normal after operation and calcium supplement.
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Objective To investigate the expression of tissue transglutaminase(tTG) and vascular endothelial growth factor(VEGF) in epithelial ovarian carcinoma and the relationship of invasion and metastance in ovarian carcinoma.Methods The expression of tTG and VEGF was detected in 55 malignant and 21 benign ovarian neoplasms by immunohistochemical SP method.The clinical significance of tTG and VEGF and their relationship were analyzed.Results The expression rates of tTG and VEGF in malignant epithelial ovarian tumors were significantly higher than in benign epithelial ovarian tumors(tTG:92.7％ vs.38.1％,x2 =32.620,P ＜0.01 ;VEGF:90.9％ vs.47.6％,x2 =19.570,P ＜0.01).In ovarian cancer,the expression of tTG in tumor cells and stromal cells was significantly related to clinical phases and the presence of ascites.The expression of VEGF in tumor cells had a significant revelance to clinical phases,pathological grades and ascites.The expression of tTG in ovarian cancer cells was positively correlated with VEGF(r =0.8856,x2 =43.14,P ＜0.01).Conclusion Tissue transglutaminase and VEGF were detected not only in tumor cells,but also instromal cells.High expression of tTG and VEGF may play an importaant role in the pathogenesis of ovarian cancer and their synergistic effect may act as an important factor in promoting the invasion and metastasis of this cancer.
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ObjectiveTo investigate the association of phosphorylation of mammalian target protein of rapamycin (pmTOR) expression with glioma malignancy grades,and the correlation of pmTOR expression with Survivin and Ki-67,which represent tumor cell anti-apoptosis ability and reproductive activity.MethodsImmunohistochemistry EliVision method was employed to detect the expression of pmTOR,Survivin and Ki-67 in paraffin tissues from 87 patients with glioma (grade Ⅰ - Ⅱ 27 cases,grade Ⅲ24 cases and grade Ⅳ 36 cases).The association between positive expression rate,level of pmTOR and malignancy grades,and the correlation of its expression level with Survivin and Ki-67 were further evaluated.Results There was no significant difference in the positive expression rate of pmTOR among grade Ⅰ - Ⅱ(77.8％,21/27),grade Ⅲ(75.0％,18/24) and grade Ⅳ (72.2％,23/36) (P ＞ 0.05).However,the significant association between pmTOR expression level and malignancy grades was observed.The expression from 87 patients with glioma was significantly positively correlated with Survivin and Ki-67 expression level (r =0.858,P ＜ 0.01 ;r =0.708,P ＜ 0.01 ).ConclusionsThe expression level of pmTOR is associated with malignancy grades,tumor cell anti-apoptosis ability and reproductive activity.pmTOR may be served as a useful marker for predicting the biological behavior of glioma and a useful target for gene therapy.
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Objective To explore rationale and clinical application of simplified modified radical thyroideetomy for differentiated thyroid carcinoma.Methods From Jan.2007 to Jun.2010,349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy.The simplified procedure took a low small collar incision(about 10-12 cm).In separating upper and lower skin flaps,subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoeleidomastoid muscle were spared to protect sensory nerves.Subtotal thyroidectomy Was performed to resect the affected lobe,isthmus,and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened.Soft tissues of the mainly metastatic areas(Ⅱ a、Ⅲ、Ⅳ、Ⅴb)were cleared.The accessory nerve was not exposed routinely to avoid stimulation.Lymph nodes metastasis in different areas was recorded respectively.Complications in different operative modes were compared.Results Compared with standard modified radical thyroidectomy,the simplified mode had shorter scar-and no limit of neck mobility.Because of muscles and nerves pemervation,movement dysfunction and abnormal sensation of neck and shoulder decreased obviously.The operation duration was shortened.Cervical lymph node status Was evaluated,which provided basis for prognosis judgment and comprehensive treatment.Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy.It improvs the life quality of patients.This procedure fits the principle of functional radical neck dissection better.
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ObjectiveTo investigate the expression of EMMPRIN and MMP-9 in epithelial ovarian carcinoma and the relationship of invasion and metastasis in ovarian carcinoma.MethodsThe expression of EMMPRIN and MMP-9 was detected in 55 malignant and 21 benign ovarian neoplasms by immunohistochemical Sp method.ResultsThe expression rate of EMMPRIN and MMP-9 in malignant, benign epithelial ovarian tumors was 89.1％, 14.3％ and 96.4％, 23.8％, respectively.There were significance different between malignant tumors and benign tumors.In ovarian cancer, the expression of EMMPRIN in tumor cells had a significant relevance to clinical phases and pathology types, while the expression of EMMPRIN in stromal ceils was associated with clinical phases, pathology types and pathological grades.The expression of MMP-9 in tumor cells had a significant relevance to clinical phases and pathology types while the expression of MMP-9 in stromal cells was associated with clinical phases, pathology types and ascites.ConclusionsEMMPRIN and MMP-9 were detected not only in tumor cells, but also in stoma cells.High expression of EMMPRIN and MMP-9 may play an important role in the pathogenesis of ovarian cancer, and their synergistic effect may act as an important factor in promoting the invasion and metastasis of ovarian cancer.
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Objective To explore the expressions of survivin and Ki-67 in breast cancer tissues after neo-adjuvant chemotherapy and their clinical significance.Methods The expressions of survivin and Ki-67 in 60 cases of breast cancer with neo-adjuvant chemotherapy(NACT) with CTF regimen and 60 cases without NACT were detected by SABC immunohistochemical technique.ResultsThe positive rates of survivin(36.7%)and Ki-67(38.3%) in neo-adjuvant chemotherapy group were significantly lower than those in control group(71.7%,61.7%)(P0.05).ConclusionsThe therapeutic effect of neo-adjuvant chemotherapy with CTF regimen can increase the remission rate of breast cancer.Neo-adjuvant chemotherapy could inhibit the expression of survivin protein,and thus further inhibit proliferation of tumor cell.