Correlation between tumor necrosis factor-α and interleukin-1β in exhaled breath condensate and pulmonary function in chronic obstructive pulmonary disease / 中国热带医学

@#Abstract: Objective To explore the correlation between lung function in patients with chronic obstructive pulmonary disease (COPD) and tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) levels in exhaled breath condensate (EBC), and to provide a convenient methodological basis for the diagnosis and treatment of COPD and the determination of its efficacy. Methods A total of 81 COPD patients and 40 healthy controls were selected from the respiratory department of the Fourth Affiliated Hospital of Guangzhou Medical University from August 2020 to February 2022 as the research subjects. The COPD patients were divided into 41 cases in the acute exacerbation group and 40 cases in the remission group according to their status. All participants underwent lung function detection, venous blood and EBC collection, and the levels of TNF-α and IL-1β in EBC and venous blood were analyzed by enzyme-linked immunosorbent assay (ELISA), and correlation analysis was performed by Pearson correlation analysis method. Results The levels of TNF-α and IL-1β in EBC of in the acute exacerbation group, the healthy control group, the remission group were (5.16±0.18) pg/μL and (7.75±0.27) pg/μL, (2.66±0.31) pg/μL and (2.41±0.24） pg/μL, (3.61±0.29) pg/μL and (3.17±0.38) pg/μL, respectively. Compared with the healthy control group, the levels of TNF-α and IL-1β in EBC in the COPD acute exacerbation group were significantly higher than those in the healthy control group and the COPD remission group (F=9.451, 8.217, P<0.001). Serum tests were consistent with this result. Correlation analysis showed that the levels of TNF-α and IL-1β in EBC were significantly positively correlated with the level of serum inflammation levels (P<0.001), while significantly negatively correlated with lung function (P<0.001).  Conclusions TNF-α and IL-1β in EBC are potential biomarkers of inflammation in patients with COPD, and their detection can be used to effectively assess lung function in patients with COPD. 

Comparison between pathology and computer for quantitative determination of femoral head necrosis / 中国骨伤

OBJECTIVE@#To compare computer measurement semi automatic quantitative detection software system with ultra thin layer pathological section to confirm the avascular necrosis percentage of the femoral head, and provide reference for clinical treatment options.@*METHODS@#From June 2012 to December 2013, the X-ray and MRI of 24 patients(24 hips on unilateral) were reviewed, who had avascular necrosis of the femoral head at late stage (stage III and IV) according to the ARCO international staging system, and performed by total hip arthroplasty. There were 15 males and 9 females, with an average age of (65.1±8.8) years old ranging 33 to 74 years old. Based on imaging system combined with computer aided technology(CAD) system and postoperative ultrathin slice, the volume of the area of femoral head necrosis were calculated. Then combining with the total volume of the femoral head was calculated by X-ray, the percentage of each femoral head necrosis area was calculated as a percentage of the whole ball head in both methods.@*RESULTS@#For 24 hips, the normal femoral head volume was (39.58±3.29) cm³ on average of X-ray film, the necrotic volume was (20.00±3.04) cm³ on average of MRI by the calculation of computer. The necrotic volume occupying in the volume of the normal femoral head was (42.92±6.09)% on average ranged. The necrotic lesion size was larger than 40% in 16 hips, 30% to 40% in 8 hips, 1 ess than 30% in 0 hip. Under the pathological section, the necrosis volume was (19.89±3.17) cm³, the necrotic volume occupying in the volume of the normal femoral head was (40.33±6.36)%. The necrotic lesion size was larger than 40% in 12 hips, 30% to 40% in 11 hips, 1 ess than 30% in 1 hip. In computer and general measurement, the two entire femoral head volume difference was (0.113±0.466) cm³, there was no significant difference using these measurements(=-1.186, =0.248). After the linear correlation statistics analysis, there was a positive correlation relationship in necrotic volume between computer software and pathology measurement(γ=0.980, =0.000).@*CONCLUSIONS@#The severity of the necrotic femoral head is closely related to the percentage of necrotic area. When the ratio of necrotic lesions and the whole femoral head is greater than 30%, the patients' clinical symptoms tend to aggravate, the probability of total hip arthroplasty increased significantly. It have great significances in femoral head necrosis installment, judge the prognosis, guide the selection of treatment and monitoring curative effect.

Floating-Harbor syndrome: a case report and literature review / 中国当代儿科杂志

Floating-Harbor syndrome (FHS) is an autosomal dominant genetic disease caused by SRCAP mutation. This article reports the clinical features of a boy with FHS. The boy, aged 11 years and 7 months, attended the hospital due to short stature for more than 8 years and had the clinical manifestations of unusual facial features (triangularly shaped face, thin lips and long eyelashes), skeletal dysplasia (curvature finger), expressive language disorder, and retardation of bone age. Genetic detection revealed a novel heterozygous mutation, c.7330 C>T(p.R2444X), in the SRCAP gene. The boy was diagnosed with FHS based on these clinical manifestations and gene detection results. FHS is rare in clinical practice, which may lead to missed diagnosis and misdiagnosis, and gene detection may help with the clinical diagnosis of FHS in children.

Yoonho Lee, M.D., Ph.D., 1949 to 2019

No abstract available.

Soft tissue reconstruction in wide Tessier number 3 cleft using the straight-line advanced release technique

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.

Limonoids from seeds of Azadirachta indica and their cytotoxic activity / 中国中药杂志

Eight limonoids were isolated from 95% ethanol extracts of neem(Azadirachta indica) seeds by various chromatographic methods. By comparison of their spectroscopic data with those reported in the literatures, these limonoids were determined as salannin(1), 1-detigloyl-1-isobutylsalannin(2), salannol-3-acetate(3), salannol(4), spirosendan(5), 1-detigloyloxy-3-deacetylsalannin-1-en-3-one(6), nimbin(7) and 6-deacetylnimbin(8). Compounds 2 and 5 were firstly isolated from this genus and 5 represented the only example of its type. And 6 is a new natural product. 6 showed inhibitory activity against HeLa and HL-60 cells, with IC₅₀ of(21.61±4.37) and(27.33±5.74) μmol·L⁻¹, respectively. Both 7 and 8 mildly inhibited the growth of HeLa cells, with IC₅₀ of (33.15±5.24) and (38.56±6.41) μmol·L⁻¹, respectively.

Swimming plus medication reduces the expressions of cytokines in rats with chronic abacterial prostatitis / 中华男科学杂志

Objective@#To observe the effects of swimming plus medication on the expressions of cytokines in rats with chronic abacterial prostatitis (CAP).@*METHODS@#Forty healthy adult male SD rats were randomly divided into five groups of equal number, normal control, CAP model control, medication, exercise therapy, and exercise + medication. The CAP model was made by Xiaozhiling injection, and at 7 days after modeling, the rats in the medication and exercise + medication groups were treated intragastrically with Qianlie Shutong Capsules (0.016 g/ml) at 20 ml per kg of the body weight qd, those in the exercise therapy and exercise + medication groups were made swim at a regular time once a day, 35 minutes on the first day and 5 minutes more on the second until 50 minutes once, for 4 successive weeks, and those in the normal control, model control and exercise therapy groups received normal saline only. After 14 and 28 days of treatment, all the rats were killed and their prostates harvested for observation of histopathological changes and determination of the expressions of TNF- α, IL-1β and IL-6 in the prostatic tissue homogenate by ELISA.@*RESULTS@#After 14 days of treatment, the expression levels of TNF-α, IL-1β and IL-6 were significantly elevated in the groups of CAP model control (［183.08±8.07］ pg/ml, ［57.55±3.53］ pg/ml and ［256.15±13.95］ ng/L), medication (［118.49±8.06］ pg/ml, ［42.64±4.64 ］ pg/ml and ［200.74±9.33］ ng/L), exercise therapy (［169.63±10.64］ pg/ml, ［50.45±5.71］ pg/ml and ［245.23±6.49］ ng/L), and exercise + medication (［107.82±7.81］ pg/ml, ［40.35±6.93］ pg/ml and ［187.04±10.85］ ng/L) as compared with those in the normal control (［20.36±1.82］ pg/ml, ［14.64±1.91］ pg/ml and ［70.58±2.09］ ng/L) (P<0.05). At 28 days, the levels of TNF- α, IL-1β, IL-6 were remarkably lower in the exercise + medication group (［29.30±3.78］ pg/ml, ［16.91±1.24］ pg/ml and ［ 88.65±6.74］ ng/L) than in the medication group (［39.67±3.19］ pg/ml, ［26.27±3.49］ pg/ml and ［110.26±6.33］ ng/L) (P<0.05) and close to those of the normal control group (［19.34±1.76］ pg/ml, ［13.68±1.06］ pg/ml and ［71.34±2.50］ ng/L). During the treatment, no obvious pathological changes were found in the prostate tissue of the normal control rats, while significant chronic prostatic inflammation was observed in the CAP models, and the inflammation was relieved in different degrees after intervention, most significantly in the exercise + medication group.@*CONCLUSIONS@#Swimming can relieve prostatic inflammation and swimming plus medication can effectively reduce the expressions of cytokines and alleviate histological damage in the prostatic tissue of CAP rats.

Changes in 25-hydroxyvitamin D3 level in children with Henoch-Schönlein purpura / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine the changes in 25-hydroxyvitamin D[25-(OH)D] level in children with Henoch-Schönlein purpura (HSP) and its clinical significance.</p><p><b>METHODS</b>A total of 92 HSP children were included in this study, and were divided into HSP nephritis (HSPN) group (31 cases) and HSP group (61 cases) based on the presence or absence of HSPN. Alternatively, the patients were divided into purpura alone group (22 cases), purpura with joint symptoms group (joint symptom group, 24 cases), purpura with gastrointestinal symptoms group (gastrointestinal symptom group, 20 cases), and purpura with joint and gastrointestinal symptoms (mixed group, 26 cases) based on their clinical symptoms. In addition, 42 healthy children were selected as healthy control group. The level of 25-(OH)Din each group was measured using enzyme-linked immunoassay.</p><p><b>RESULTS</b>The 25-(OH)Dlevel in the HSP and HSPN groups was significantly lower than that in the healthy control group (P<0.05), and the 25-(OH)Dlevel in the HSPN group was significantly lower than that in the HSP group (P<0.05). Although there was no significant difference in the 25-(OH)Dlevel between the joint symptom, gastrointestinal symptom, and mixed groups (P=0.22), the 25-(OH)Dlevel in the three groups was all significantly lower than that in the purpura alone group (P<0.05).</p><p><b>CONCLUSIONS</b>The level of 25-(OH)Dis reduced in children with HSP, particularly those with HSPN or with joint and gastrointestinal symptoms. Therefore, the reduction in 25-(OH)Dlevel may serve as a predictor of whether HSP is associated with other impairments.</p>

Clinical value of polymerase chain reaction in diagnosis of bacterial and fungal infection of central nervous system / 中国感染与化疗杂志

Objective To examine the clinical value of polymerase chain reaction (PCR) in rapid diagnosis of bacterial and fungal infection of central nervous system.Methods The cerebrospinal fluid (CSF) samples were collected from 137 patients for DNA extraction.PCR was used to amplify the DNA of pathogenic bacteria and fungi using universal primers.The PCR products were subjected to DNA sequencing analysis for identifying microbial species.The conventional culture of pathogens was carried out simultaneously as control.Results PCR revealed bacterial pathogen in 50 of the 137 CSF samples,fungal pathogen in 6 of the 137 CSF samples.Conventional culture of CSF reported positive bacterial infection in 38 cases,fungal infection in 5 cases.PCR provided diagnostic sensitivity of 40.9％,specificity 100％,positive predictive value 100％,negative predictive value 38.2％.The diagnostic efficiency was 56.7％.In contrast,the conventional culture achieved the results of 31.4％,100％,100％,34.7％,44.4％,respectively.The sensitivity,negative predictive value,and diagnostic efficiency of PCR were significantly better than conventional culture method.The coincidence rate between PCR and conventional culture was 97.7％.Conclusions Universal primer-based PCR is characteristic of short turnaround time,specificity,sensitivity and accuracy,which is very useful for rapid diagnosis of the pathogenic bacteria and fungi in central nervous system infections.

Value of 16S rRNA gene amplification for identification of clinical rare pathogens / 中国感染控制杂志

Objective To evaluate the value of amplification and sequencing of 16S rRNA gene in the identification of clinical rare pathogenic bacteria,and guide the diagnosis and treatment for related clinical infection.Methods 12 bacterial isolates that were difficult,or unable to be identified with conventional laboratory methods,or with special phenotypes were collected. The 16S rRNA gene was amplified by polymerase chain reaction (PCR),then sequenced for identifying bacterial species through BLAST comparison,clinical characteristics of related infection were ana-lyzed.Results 12 clinical isolates were all positive for PCR amplification (about 1500 bp),species were all identi-fied (similarity≥99% ),the identified strains were Listeriamonocytogenes(n= 2),Brucellamelitensis(n= 2),Fu-sobacteriummortiferum(n= 1),Rothiaaeria(n= 1),Nocardiafarcinica(n= 1),Staphylococcussaccharolyticus (n= 1 ),Rhizobiumradiobacter(n= 1 ),Prevotellabivia(n= 1 ),Ralstoniamannitolilytica(n= 1 ),and Atopobium vaginae(n= 1 ). The sensitivity of 16S rRNA gene amplification was high,and the minimum detection limit of Escherichiacoli ATCC 25922 was 1.5×101 CFU/mL. Clinical data of 12 patients revealed that these strains can cause multi-sites and multi-types of infection,after patients received targeted antimicrobial therapy,11 improved, and 1 died.Conclusion Sequencing for 16S rRNA gene can rapidly and accurately identify rare,anaerobic,and difficult cultured bacteria,provide laboratory evidence for etiological diagnosis and treatment of different types of infection.

Changes in 25-hydroxyvitamin D3 level and its significance in children with Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the changes in the serum level of 25-hydroxyvitamin D3 [25-(OH)D3] and its significance in children with Kawasaki disease (KD).</p><p><b>METHODS</b>The clinical data of 242 KD children were collected. According to the presence or absence of coronary artery lesion (CAL), these children were classified into CAL group (63 children) and non-CAL (NCAL) group (179 children). According to the efficacy of intravenous immunoglobulin (IVIG), these children were classified into IVIG-sensitive group (219 children) and no-IVIG-response group (23 children). A total of 40 healthy children (control group) and 40 children with acute upper respiratory tract infection (AURI group) were enrolled as controls. Enzyme-linked immunosorbent assay was applied to measure the serum level of 25-(OH)D3.</p><p><b>RESULTS</b>Before IVIG treatment, the AURI, NCAL, and CAL groups had significantly lower serum levels of 25-(OH)D3 than the control group (P<0.05); the CAL group had a significantly lower serum level of 25-(OH)D3 than the AURI and NCAL groups (P<0.05); the AURI, IVIG-sensitive, and no-IVIG-response groups had significantly lower serum levels of 25-(OH)D3 than the control group (P<0.05); the no-IVIG-response group had a significantly lower serum level of 25-(OH)D3 than the AURI and IVIG-sensitive groups (P<0.05). After IVIG treatment, the CAL group had a significantly lower serum level of 25-(OH)D3 than the NCAL and control groups (P<0.05); the no-IVIG-response group had a significantly lower serum level of 25-(OH)D3 than the IVIG-sensitive and control groups (P<0.05).</p><p><b>CONCLUSIONS</b>KD children may experience a reduction in the serum level of 25-(OH)D3. With a greater reduction in the serum level of 25-(OH)D3, the possibility of CAL and KD with no response to treatment increases.</p>

Distribution and antimicrobial resistance of pathogens isolated from sur-gery patients with infection / 中国感染控制杂志

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from surgi-cal patients with infection.Methods Distribution and antimicrobial resistance of 1 208 pathogens isolated from sur-gical patients with infection from January 2013 to January 2014 were analyzed retrospectively.Results Of 1 208 pathogenic isolates,gram-negative bacteria,gram-positive bacteria and fungi accounted for 64.57% (n = 780 ), 24.92%(n = 301 )and 10.51 % (n = 127 )respectively.The main specimens were sputum (44.78%),urine (21 .11 %),blood(11 .51 %),and pus(10.26%).Antimicrobial susceptibility testing results showed that the produ-cing rate of extended-spectrumβ-lactamases (ESBLs)of Escherichia coli and Klebsiella pneumoniae was 62.60%and 33.61 % respectively,resistant rate to imipenem was 0.76% and 15.57%,respectively.The resistant rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem was 38.93% and 75.80% respectively.Methi-cillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus was 71 .68% and 87.93% respectively.Conclusion The major pathogens isolated from surgical patients with infection are gram-neg-ative bacteria,the main infection sites are respiratory tract and urinary tract in this hospital;multidrug resistance is serious,especially carbapenem resistance,which should be paid attention.

Protective effect and action mechanism of petroleum ether extracts from Saussurea involucrate on brain tissues of hypoxia rats / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the protective effect and action mechanism of petroleum ether extracts from Saussurea involucrate on brain tissues of hypoxia rats under constant pressure and closed conditions.</p><p><b>METHOD</b>The PESI dosage-dependent experiment for hypoxia rats was conducted under constant pressure and closed conditions by intraperitoneally injecting 125, 250, 500 mg x kg(-1) to finalize that the optimum dosage is the high dose of PESI. Afterwards, 90 Wistar rats were randomly divided into the hypoxic model group, the acetazolamide 250 mg x kg(-1) group and the PESI high dose group. Each group was further divided into three subgroups according to different hypoxia times, with 10 rats in each subgroup. Under the same hypoxia and administration conditions, the rats were sacrificed after 0, 3, 6 h respectively. Their brain samples were collected for common pathological observation and immunohistochemical staining of HIF-1alpha. Real-time RT-PCR was used to detect HIF-1alpha, EPO, HO-1 and Caspase-3 gene expressions. And the Western blot assay was adopted to detect HIF-1alpha protein expression.</p><p><b>RESULT</b>The brain tissues of the hypoxia model group were severely damaged with the increase in the hypoxia time. The acetazolamide group and the PESI high does group were damaged in a much lower degree. According to the gene expression and the Western blot assay, high dose of PESI could inhibit HIF-1alpha expression. According to the pure gene expression test, high dose of PESI could increase EPO and HO-1 mRNA expressions, but inhibit Caspase-3 mRNA expression.</p><p><b>CONCLUSION</b>PESI's protective mechanism for brain tissues of hypoxia rats under constant pressure and closed conditions may be related to its effects in inhibiting HIF-1alpha expression, increasing EPO expression and resisting cell apoptosis.</p>

Treatment of flexion-distraction thoracolumbar fractures by postural reduction with instrumental reduction / 中国骨伤

<p><b>OBJECTIVE</b>To study the curative effect of postural reduction with instrumental reduction in treatment of flexion-distraction thoracolumbar fractures.</p><p><b>METHODS</b>A retrospective study was performed on 43 patients with single thoracolumbar flexion-distraction fractures admitted from August 2009 to August 2011, included 28 males and 15 females with an average age of 44 years old (34 to 56 years old). All patients were treated with postural reduction with instrumental reduction. The kyphosis (Cobb angle) recovery of injured vertebral height and complication were analyzed. The visual analogue scale(VAS) and com-plications were followed up and recorded.</p><p><b>RESULTS</b>There was no difference in recovery of injured vertebral posterior height among preoperative, 1 week and 1 year after operation (P > 0.05). There were significantly difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between preoperative and postoperative at 1 week (P < 0.05). There was no difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between 1 week and 1 year after operation (P > 0.05). VAS significantly improved from preoperative (7.2 +/- 1.2) to (0.8 +/- 0.7) at 1 year after operation (t = 18.47, P < 0.001).</p><p><b>CONCLUSION</b>Postural reduction with instrumental reduction is effective for thoracolumbar flexion-distraction fractures and it is beneficial to the recovery of vertebral height and saggital alignment.</p>

Clinical significance of human epidermal growth factor receptor family molecules expression in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the association of human epidermal growth factor receptor family molecules expression in gastric cancer tissues with the prognosis of patients with gastric cancer.</p><p><b>METHODS</b>Clinical data of 161 patients with gastric cancer undergoing gastrectomy in Jiangsu Cancer Hospital between January 2006 and January 2007 were analyzed retrospectively. The expression of HER1, HER2, HER3 and HER4 was detected by immunohistochemistry. Association of the expression of HER family with the prognosis of patients was examined. Kaplan-Meier method was used to analyze the survival.</p><p><b>RESULTS</b>High expression rates of HER1, HER2, HER3 and HER4 were 46.0% (74/161), 10.6% (17/161),55.9% (90/161) and 68.3% (110/161) respectively. Univariate analysis revealed that high expression of HER3 was associated with tumor invasion depth, lymph node metastasis, stage, neurovascular invasion, and overall 4-year survival. High expression of HER4 was associated with tumor distant metastasis and stage. High co-expression of HER2 and HER3 was associated with overall 4-year survival (P=0.023). Multivariate analysis revealed that high expression of HER3 and stage were prognostic independent factors.</p><p><b>CONCLUSION</b>Up-regulated expression of HER3 is associated with the poor prognosis in gastric cancer patients.</p>

Screening for virulence strains of Metarhizium against Dorysthenes hydropicus pascoes / 中国中药杂志

<p><b>OBJECTIVE</b>The aim of the present study was to screen the Metarhizium strains with high virulence against the larvae of Dorysthenes hydropicus, a serious pest of Citrus grandis.</p><p><b>METHOD</b>Thirty six strains of Metarhiziums were isolated from the soil of C. grandis GAP base and collected from other institutions, and the pathogenicity of these strains against 1st instar larvae of D. hydropicus was detected at concentration of 1 x 10(8) conidia/g. The high violence strains against D. hydropicus were cultivated in sabouraud dextrose yeast medium at first, then transfer to rice grain. And the sporulations of these violent strains against D. hydropicus were detected.</p><p><b>RESULT</b>Twenty-eight strains showed virulence against D. hydropicus by preliminary study, and 7 strains of them were collected for further study, 6 of the 7 showed high virulence, the highest cadaver rate was higher than 74%. The conidia production of strain 1 and strain 4 were 2.35 +/- 0. 25 (1 x 10(9) conidia/g), 2.21 +/- 0.27 (1 x 10(9) conidia/g), respectively, showed significantly higher than other strains.</p><p><b>CONCLUSION</b>Strain 1 and strain 4 of the 36 Metarhiziums strains showed high virulence against D. hydropicus, and the highest sporulation ability, so they have a best application prospect.</p>

Rat Hindlimb Allotransplantation with Short-term Immune Suppressants and Dendritic Cell Pretreatment

Prevention of acute rejection in composite tissue allotransplantation without continuous immunosuppression lacks reports in worldwide literature. Recently dendritic cells (DC) gained considerble attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effect of alloantigen-pulsed dendritic cells in induction of survival in a rat hindlimb allograft. We performed hindlimb allotransplantation between donor Sprague-Dawley and recipient Fischer344 rats. Recipient derived dendritic cells were harvested from rat whole blood and cultured with anti-inflammatory cytokine IL-10. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subcutaneous tissue before limb transplantation. Groups: I) untreated (n=6), II) DC injected (n=6), III) Immunosuppressant (FK-506, 2 mg/Kg) injected (n=6), IV) DC and immunouppressant injected (n=6). Graft appearance challenges were assessed postoperatively. Observation of graft appearance, H-E staning, immunohistochemical (IHC) study, and confocal immunofluoreiscece were performed postoperatively. Donor antigen pulsed host dendritic cell combined with short-term immunosuppression showed minimal mononuclear cell infiltration, regulator T cell presence, and could prolong limb allograft survival.

Effect of intraoperative intraperitoneal chemotherapy and postoperative nutritional support on intestinal permeability and cellular immune function in patients with advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of hyperthermic intraoperative intraperitoneal chemotherapy(HIIC) and postoperative nutritional support on the intestinal permeability and the cellular immunity function in patients with advanced gastric cancer.</p><p><b>METHODS</b>All the patients diagnosed as advanced gastric cancer in the Gastric Tumor Diagnosis and Treatment Center of Jiangsu Cancer Hospital were randomly divided into three groups using random digit table:(1)EN group treated with enteral nutrition during postoperative period; (2)HIIC+EN group treated with HIIC combined with postoperative enteral nutrition;(3)HIIC+PN group treated with HIIC combined with postoperative parenteral nutrition. Index of lactulose/mannitol(L/M) ratio was used to evaluate the permeability of intestinal mucosa. The percentage of CD4(+), CD8(+) and NK cell, the ratio of CD4/CD8 T cell in peripheral blood were tested by flow cytometry. The time points of these measurements were the day before surgery, postoperative days (POD) 3, 7, and 12.</p><p><b>RESULTS</b>Compared with the day before surgery(POD-1), the ratio of L/M on POD+3 increased significantly in all the three groups(0.1235±0.0611 vs. 0.0280±0.0183, 0.1648±0.0571 vs. 0.0305±0.0208, 0.1702±0.0628 vs. 0.0298±0.0229)(P<0.05) and then decreased gradually. The L/M ratio of EN(0.0278±0.0217) and HIIC+EN(0.0336±0.0235) groups recovered to the baseline on POD+12, however HIIC+PN group still had elevated L/M ratio(0.0616±0.0430). The percentage of CD4(+)T cell and the ratio of CD4/CD8 in HIIC+EN group and HIIC+PN group were significantly lower than those in EN group(P=0.033, P=0.002, respectively). Compared with the POD-1,the percentage of CD4(+)T cell and the ratio of CD4/CD8 in HIIC+EN group and EN group on POD+12 were increased significantly(P<0.05).</p><p><b>CONCLUSIONS</b>HIIC may cause significant increase in intestinal permeability and inhibit cellular immunity in patients undergoing radical resection for advanced gastric cancer. Mucosal permeability can be reversed by enteral nutrition.</p>

Comparing the Certification Criteria for CCHIT-Certified Ambulatory EHR with the SNUBH's EHR Functionalities / 대한의료정보학회지

OBJECTIVES: This study aims to investigate the suitability of electronic health record (EHR) systems in Korea for global certification and to propose functions for future global systems by comparing and analyzing the certification criteria for Certification Commission for Health Information Technology (CCHIT) Certified Ambulatory EHR with BESTCare, which is the EHR system at Seoul National University Bundang hospital. METHODS: Domain expert groups were formed to analyze the inclusion of BESTCare functions and the types of differences for each of the CCHIT Certified 2011 Ambulatory EHR Certification Criteria. The types of differences were divided into differences in functions (F), differences in business processes (B), and differences in government policies (P). RESULTS: Generally, the criteria that showed differences in functions pertained to the connection between the diagnosis/problem list and order, the alert and warning functions for medication-diagnosis interactions, and the reminder/instruction/notification messages related to the patient's immunization status; these absent functions were enhanced clinical decision support system (CDSS) functions related to patient safety and healthcare quality. Differences in government policies were found in the pharmacy's electronic prescription functions, while differences in business processes were found in the functions constrained by the local workflow or internal policy, which require some customization. CONCLUSIONS: Functions that differed between the CCHIT certification criteria and the BESTCare system in this study should be considered when developing a global EHR system. Such a system will need to be easily customizable to adapt to various government policies and local business processes. These functions should be considered when developing a global EHR system certified by CCHIT in the future.

Pitfalls and Security Measures for the Mobile EMR System in Medical Facilities / 대한의료정보학회지

OBJECTIVES: The goal of this paper is to examine the security measures that should be reviewed by medical facilities that are trying to implement mobile Electronic Medical Record (EMR) systems designed for hospitals. METHODS: The study of the security requirements for a mobile EMR system is divided into legal considerations and sectional security investigations. Legal considerations were examined with regard to remote medical services, patients' personal information and EMR, medical devices, the establishment of mobile systems, and mobile applications. For the 4 sectional security investigations, the mobile security level SL-3 from the Smartphone Security Standards of the National Intelligence Service (NIS) was used. RESULTS: From a compliance perspective, legal considerations for various laws and guidelines of mobile EMR were executed according to the model of the legal considerations. To correspond to the SL-3, separation of DMZ and wireless network is needed. Mobile access servers must be located in only the smartphone DMZ. Furthermore, security measures like 24-hour security control, WIPS, VPN, MDM, and ISMS for each section are needed to establish a secure mobile EMR system. CONCLUSIONS: This paper suggested a direction for applying regulatory measures to strengthen the security of a mobile EMR system in accordance with the standard security requirements presented by the Smartphone Security Guideline of the NIS. A future study on the materialization of these suggestions after their application at actual medical facilities can be used as an illustrative case to determine the degree to which theory and reality correspond with one another.