[A case report of bronchial granular cell tumor]

Granular cell tumor (GCT) is a relatively rare tumor that develops in soft tissues at various sites in the body, and GCT originating in the bronchus is rather rare. Here, we reported a case of primary GCT of the bronchial to improve the understanding of this disease.

[Effect and safety of endobronchial placement of vaseline gauze in the treatment of patients with bronchial fistula]

Objective: To investigate the application of vaseline gauze to occlude the bronchial fistulas and its clinical effectiveness and safety in this retrospective study. Methods: This study retrospectively reviewed the clinical records of 14 patients with bronchial fistulas at Department of Respiratory and Critical Care Medicine, Shanghai Dongfang Hospital affiliated to Tongji University between June 2019 and June 2022. Seven of the 14 patients were female, and the age ranged from 16 to 74 years. We retrieved all the clinical records of all the enrolled patients during the 6 to 12 months follow-up after the operation, including the information for removal of chest drainage pipe, the failure of endobronchial blockage using vaseline gauze, as well as the complications (migration of the vaseline gauze, obstructive pneumonia, pulmonary atelectasis, et. al.) after the operation. Results: Of the 14 patients, 3 patients had fistula located in main or lobar bronchi; 10 patients had fistula located in distal airways; and 1 patient had fistula located both in main bronchi and distal airways. Ten patients were complicated with pneumonia or pleural cavity infections; Five were complicated with pneumothorax or hydropneumothorax. All of the 14 patients achieved successful airway occlusion after the placement of vaseline gauze in the responsible bronchial airways or stumps for the fistulas. Eleven of the 14 patients successfully removed the drainage tube for the residual cavity, 3 of the 14 patients successfully removed the vaseline gauze for the fistula which was healing during the follow up of 6-12 months. No one of the patients had severe complications or treatment failure. Conclusion: Bronchial placement of vaseline gauze might be a feasible and effective technique for treatment of bronchial fistulas.

[Application of cluster randomization design in vaccine clinical trials]

When the coverage of the vaccinated people reaches a certain percentage of the population, the herd protection will protect the unvaccinated persons. However, the traditional clinical evaluation of vaccines performing individual randomized design fails to evaluate the herd protection of vaccines. Compared with the individual randomized design, the cluster-randomized design can determine the overall protection by the vaccine more comprehensively. It has become increasingly common to perform a cluster-randomized design in clinical trials of vaccines in Phase Ⅲ and Ⅳ clinical trials. However, little is known about the application of cluster randomized design in vaccine clinical trials in China. We, at this moment, do a review of the application of random cluster design in vaccine clinical trials and provide references for future research in China.

[Efficacy of mini nutritional assessment short-form in predicting the risk of acute exacerbation in old chronic obstructive pulmonary disease patients]

Objective: To evaluate the diagnostic efficacy of Mini Nutritional Assessment Short-form (MNA-SF) in predicting acute exacerbation of old chronic obstructive pulmonary disease (COPD) patients. Methods: The clinical data and Nutritional assessment of 202 outpatients who were given treatment in the Second Affiliated Hospital of Soochow University from January 2017 to May 2019 were analyzed. According to the frequency of acute exacerbation in the last year, patients were divided into high-risk group and low-risk group. The dependent variable was the risk of the acute exacerbation of COPD while the predicting model was established by using multivariate Logistic regression. Finally, the accuracy, sensitivity and specificity of the model was evaluated by the receiver operating characteristic (ROC) curve. Results: Among the 202 COPD patients, 131 patients (64.9%) were brought into the high-risk group and 71 patients (35.1%) were brought into the low-risk group. MNA-SF scores in high-risk group were significant lower than those in low-risk group [(9.4±2.1) vs (11.6±1.9), P<0.001]. The logistic regression analysis showed that MNA-SF score [OR=0.556(95%CI: 0.445-0.695), P<0.05] was an independent factor of acute exacerbation. The obtained model was Logit(P)=4.413-0.586×MNA-SF scores. The accuracy of model for the risk of the acute exacerbation of COPD was 77.4%, with a sensitivity of 79.7%, a specificity of 72.1%. Conclusion: MNA-SF is qualified for predicting the acute exacerbation of COPD patients in stable stage.

[Effect of sacubitril/valsartan on cardiac function in heart failure rabbits with preserved ejection fraction]

Objective: To investigate the effect of sacubitril/valsartan on cardiac function in heart failure rabbits with preserved ejection fraction. Methods: Forty-five healthy adult male New Zealand rabbits were divided into sham operation group (n=12) and model group (n=33) by random number table method. HFpEF model was constructed by abdominal aortic constriction in model group. In sham operation group, 1 rabbit died due to anesthesia accident, and 1 rabbit in model group died of acute left heart failure. At 8 weeks of modeling, 3 rabbits were excluded due to the failure to establish the successful model. At the 8th week of modeling, 2 rabbits in sham operation group were selected and sacrificed by random number table method, and 3 rabbits in model group were selected and sacrificed for myocardial histological examination. Then, 9 rabbits in sham operation group and 26 rabbits in model group entered the subsequent experiment. The model group was randomly divided into untreated group (n=8), valsartan intervention group (n=9), and sacubitril/valsartan intervention group (n=9), respectively, drugs were applied per gavage. The feeding and exercise activity of rabbits in each group were evaluated by simple cardiac function classification at baseline, 4 and 8 weeks post intervention. Echocardiography was used to detect interventricular septal thickness at diastole(IVSd), interventricular septal thickness at systolic(IVSs), left ventricular posterior wall of diastolic(LVPWd), left ventricular internal diameter at diastolic(LVIDd), left ventricular internal diameter at systolic(LVIDs), and calculate the left ventricular ejection fraction(LVEF), mitral valve's early diastolic flow velocity(E)/late mitral diastolic maximum flow rate ratio(A) and heart rate at baseline, 4 and 8 weeks post intervention. Serum N terminal B-type natriuretic peptide (NT-proBNP) and angiotensin (Ang)Ⅱ and soluble matrix lysin 2(sST2) content was determined by ELISA at baseline, 4 and 8 weeks post intervention. Eight weeks after intervention, the hearts of rabbits were taken and weighed, and heart mass index (HMI) and left ventricular mass index (LVMI) were calculated. Results: (1) Evaluation results of cardiac function: there were 2, 5, and 2 rabbits with cardiac function grade Ⅰ,Ⅱ and Ⅲ before the drug intervention, and 4, 4, and 1 rabbits with respective cardiac function grade after 8 weeks of intervention in valsartan group (P>0.05). There were 2, 4, and 3 rabbits with heart function gradeⅠ,Ⅱ and Ⅲ before the drug intervention, and 7, 2, and 0 rabbits with respective heart function grade after 8 weeks of intervention in sacubitril/valsartan group(P<0.05). (2) Echocardiographic results: at 8 weeks after drug intervention, IVSd and IVSs of rabbits in untreated group were significantly higher than those in sham operation group, and the ratio of E/A was significantly lower than that in sham operation group(all P<0.01). IVSs of the valsartan group was significantly higher than that of sham operation group, and the ratio of E/A was significantly lower than that of sham operation group(all P<0.01). The E/A ratio in the sacubitril/valsartan group was significantly lower than that in sham operation group(P<0.01). IVSd and IVSs in valsartan group were significantly lower than those in untreated group(all P<0.05), and IVSd in sacubitril/valsartan group was significantly lower than that in untreated group(P<0.01). The IVSd, IVSs, LVPWd, LVIDd, LVIDs, LVEF, E/A ratios were similar between sacubitril/valsartan group and valsartan group(all P>0.05). There was no significant difference in heart rate between the groups(P>0.05). (3) Serum NT-proBNP, Ang Ⅱ and sST2 levels: 4 weeks after drug intervention, untreated group, valsartan group, and sacubitril/valsartan group's serum NT-proBNP levels were significantly higher than that of sham operation group(all P<0.01); serum NT-proBNP was significantly lower in sacubitril/valsartan group than that in untreated group(P<0.01). Four weeks after intervention, serum AngⅡ levels were significantly higher in untreated group, valsartan group, sacubitril/valsartan group than in sham group(all P<0.01), but there was no statistically significant difference between the modeling groups(P>0.05). Four weeks after drug intervention, the serum sST2 contents in untreated group, valsartan group, and sacubitril/valsartan group were significantly higher than in sham operation group(all P<0.01), and which was significantly lower in valsartan group and sacubitril/valsartan group than in untreated group(all P<0.01), which were significantly lower in sacubitril/valsartan group than in valsartan group(P<0.01). Eight weeks after drug intervention, serum NT-proBNP levels were significantly higher in untreated group, valsartan group, and sacubitril/valsartan group than in sham operation group(all P<0.01), which were significantly lower in valsartan group and sacubitril/valsartan group than in untreated group(all P<0.01), which were significantly lower in valsartan group than in sacubitril/valsartan group(P<0.01). Eight weeks after drug intervention, Ang Ⅱ levels were significantly higher in valsartan group and sacubitril/valsartan group than in untreated group(all P<0.01), which tended to be higher in untreated group and valsartan group, tended to be lower in sacubitril/valsartan compared to value at 4 weeks(all P>0.05). Eight weeks after drug intervention, serum sST2 was significantly higher in untreated group and valsartan group than in sham operation group(all P<0.01), which tended to be higher in sacubitril/valsartan group compared to sham operation group(P>0.05), which were significantly lower in valsartan group and sacubitril/valsartan group than in untreated group(all P<0.01), which was significantly lower in sacubitril/valsartan group than in valsartan group(P<0.01). (4) Comparison of whole-heart mass, left ventricular mass, HMI and LVMI: 8 weeks after drug intervention, the whole-heart mass, left ventricular mass, HMI and LVMI were significantly higher in untreated group than in sham operation group(all P<0.01), and the above indexes were also significantly higher in valsartan group than in sham operation group(all P<0.05), tended to be lower in valsartan group compared to untreated group (all P>0.05). HMI and LVMI were lower in sacubitril/valsartan group than in untreated group(all P<0.05). All the above indexes tended to be lower in sacubitril/valsartan group than in valsartan group(all P>0.05). Conclusion: Sacubitril/valsartan is superior to valsartan alone on improving cardiac function in HFpEF rabbits.

[Individual dose monitoring and health status of radiation workers in some Three A hospitals of Zhejiang province]

Objective: To investigate the individual irridiateddose levelandhealth statusofoccupational externalexposureamong radiationworkers inThreeA hospitals ofZhejiangprovince,andprovideevidence for occupationalhealthmanagement. Methods: 367 different typesof radiationworkerswereexperienced thedose monitoring and health examination from January toDecember, 2015, according to the requirements of"SpecificationsofIndividualMonitoring forOccupationalExternalExposure"and"Specifications forOccupational healthsurveillance forradiationworkers".The resultsofdosemonitoring,chromosomeaberration rate, lensopacity rate,hemogramand thyroid functionwerestatisticallyanalyzed. Results: Theannualeffectivedoseamong radiation workers fromZhejiangprovince in2015was0.13mSv,98.91%of them less than1mSv,whichunder the limit standardofstate(20mSv/a).Thechromosomeaberration(dicentric)detection rateswere7.41%and4.35%, from nuclearmedicinegroupand interventionalgroup respectively,whichhigher thandiagnostic radiologygroup, the differencewasstatisticallysignificant(χ(2)=13.686,8.092,P<0.01).Besides,1caseofsuspiciouschronic radiation dermatitiswas found in the interventiongroup.Radiation lengthhadsignificanteffecton lensopacity rate(P<0.01), lensopacity increasedwith the increasing lengthof the linear trend (χ(2)trend=16.363,P<0.01),and the incidence ofabnormalthyroid function theabnormalrateof lymphocyte ratiohad significantdifferenceamong theagegroups (P<0.05). Conclusion: Although, theoccupationalexternalexposureamong radiationworkersinThreeAhospitals ofZhejiangprovince issafe, long-term lowdosesofionizing radiation stillhascertainhealtheffectson the fieldof nuclearmedicineand interventionalradiologystaff,suchaseye lens,cytogenetics,nailsandskin.

[Non-Hodgkin's lymphoma mimicking Mikulicz disease: a case report]

IgG4-related disease is a systemic disorder involving a spectrum of multiple indications, and various histopathological features are shared among different IgG4-related disease subtypes, which challenge diagnosis, although certain syndromes have organ-specific involvement. Among them, Mikulicz's disease affecting the salivary and lacrimal glands, distinguished by often elevated levels of serum IgG4, infiltration of IgG4⁺ plasma cells into target tissues, and diffuse swelling, mass formation, or fibrosis of affected organs. However, there are several diseases, which could manifest as salivary gland swelling, mimicking Mikulicz's disease, such as Sjogren's syndrome, mumps virus infection, obstruction of parotid duct, non-Hodgkin's lymphoma (NHL), and so on. So differential diagnosis is important and essential as to the salivary gland swelling. In this paper, we analyzed a case of a 59-year-old male with symmetric salivary gland swelling. Mikulicz's disease was misdiagnosed at the beginning without biopsy. Prednisone treatment ever seemed to be effective and antibiotics had no effect. Besides salivary involvement, the patient also manifested as testicle swelling and severe pancytopenia with the development of the disease, which rarely appeared in Mikulicz's disease. Physical examination showed skin, sclera yellow dye, swollen submandibular, sublingual and lacrimal gland and splenomegaly. As a result, biopsy of right submandibular gland was made, and mucosa-associated lymphoid tissue lymphoma was confirmed by morphology and immunohistochemistry. Bone marrow biopsy also confirmed that lymphoma cells were found in the bone marrow. Finally, the diagnosis of mucosa-associated lymphoid tissue lymphoma (Phase IVE, Group A) was made on the patient, who was transferred to the hematology department for the treatment. NHL, especially, primary extranodal lymphoma usually involves the salivary gland, and painless swelling of the salivary gland is a common manifestation, similar with Mikulicz's disease. So although salivary gland swelling is often associated with autoimmune diseases such as Sjogren's syndrome and IgG4-related disease, the awareness and suspicion of a possibility of NHL are essential for rheumatologists. Biopsy is a necessary examination to decrease or avoid misdiagnosis.

Induction of apoptosis in HepG2 cells by solanine and Bcl-2 protein

The nightshade (Solanum nigrum Linn.) has been widely used in Chinese traditional medicine as a remedy for the treatment of digestive system cancer. The anti-tumor activity of solanine, a steroid alkaloid isolated from the nightshade has been demonstrated. To observe the effect of anti-tumor and mechanism of solanine. The MTT assay was used to evaluate the IC(50) on the three digestive system tumor cell lines. The effect on the morphology was observed with a laser confocal microscopy; the rate of apoptosis and the cell cycle were measured using flow cytometry (FCM); the expression of Bcl-2 protein was measured by Western blot. The results show that the IC(50) for HepG(2), SGC-7901, and LS-174 were 14.47, >50, and >50 microg/ml, respectively; the morphology of cells in the negative control was normal; for the treated groups, typical signs for apoptosis were found. The rate of apoptosis in HepG(2) cells induced by solanine was found to be 6.0, 14.4, 17.3, 18.9, and 32.2%, respectively. Observation of the cell cycle showed that cells in the G(2)/M phases disappeared while the number of cells in the S phase increased significantly for treated groups. Western blot showed that solanine decreased the expression of Bcl-2 protein. Therefore, the target of solanine in inducing apoptosis in HepG(2) cells seems to be mediated by the inhibition in the expression of Bcl-2 protein.

Monitoring of human exposure to radiation with the binucleated lymphocyte micronucleus assay

The micronuclei (MN) of peripheral blood lymphocytes from radiation-exposed people were monitored with the binucleated lymphocyte micronucleus assay (CBMN). MN rates in people with radiation-disease, radiation exposed and a control group were 12.57/1000, 4.20/1000 and 3.26/1000, respectively. The MN rate of patients with radiation-disease was significantly higher than those of other groups (P < 0.01). The difference between the radiation-exposed group and control group was not significant (P > 0.05). Meanwhile, chromosome aberrations (CA) of 3 groups were determined. The results were similar to those seen while the MN assay. CA rates were 2.06%, 0.93% and 0.69%, respectively. CA rate of the radiation-disease group was significantly higher than that of other groups (P < 0.05, P < 0.01). The difference between the radiation-exposed group and the control group was not significant (P > 0.05). The study indicates that the CBMN assay is a rapid, sensitive and accurate method which can be used to monitor a large population exposed to radiation.

[Non-conditional logistic regression analysis of affecting factors in patients with NIDDM]

According to the data of investigation, country from the southern part of Jiangsu Province, we analyzed 88 patients with non-insulindependent diabetes mellitus (NIDDM) through a case-control study. Simple and multiple logistic regression analysis demonstrated that the rates of history of hypertension, history of cardiovascular diseases, over nutrition or obesity in patients with NIDDM were significantly higher than those in controls (P < 0.01):OR of hypertension was 4.50, and it was still 2.94 when excluding other factors. These results indicated that hypertension might serve as one of the independent predicting factors. The model of multiple factors non-conditional logistic regression sholwed that NIDDM directly effected on the development of cardiovascular disease.

A natural vaccine candidate strain against cholera

E1 Tor Vibrio cholerae (EVC) strains may be classified into two kinds-epidemigenic (EEVC) strains and non-epidemigenic (NEEVC) strains-based on a phage-biotyping system. A large number of EEVC strains have been screened for toxigenic and putative colonization attributes. One such naturally occurring strains (designated IEM101) has been found which is devoid of genes encoding cholera toxin (CT), accessory cholera enterotoxin (ACE), zonula occludens toxin (ZOT), but possesses RS1 sequences and toxin-coregulated pilus A gene (icpA) although icpA is poorly expressed. It expresses type B pili but does not possess type C pili. It is an E1 Tor Ogawa strain and does not cause fluid accumulation in rabbit ilcal loop tests. Active immunization of rabbits with strain IEM101 elicited good protection against challenge with virulent strains of V. cholerae O1. Oral administration caused no side effects in 15 human volunteers, colonized the gut for four to ten days and elicited good immune responses.

[The use of color Doppler flow imaging in diagnosis and differential diagnosis of some pulmonary masses]

The status of blood supply was examined in twenty-nine patients with pulmonary masses with color doppler flow imaging. The results showed that there are no significant blood signals in 5 benign masses. One patient with pulmonary arterio-venous fistula can be diagnosed. Pulmonary inflammatory pseudotumor and 20 lung cancers have rich blood supply. The peak forward velocity and resistance index between them have obvious difference statistically (P < 0.05, P < 0.01). It is concluded that color doppler can be regarded as an useful and noninvasive method before operation in diagnosing some pulmonary masses.

Echocardiographic estimate of left atrial pressure in children

Echocardiographic estimates of left atrial pressure (LAP) using the Q-C/A2-E ratio were obtained from 40 patients and compared with directly recorded mean LAP and/or pulmonary wedge pressure (PWP). The best correlation was obtained between LAP and the Q-C/A2-E (gamma = 0.95, P < 0.01); a good one between PWP and the Q-C/A2-E in normal and moderate pulmonary hypertension (gamma = 0.82, P < 0.01), but a poor one in severe pulmonary hypertension (gamma = 0.61, P > 0.05). Consequently, echocardiography provides a useful noninvasive method for the estimation of the LAP and PWP, particularly appropriate for children Intensive Care Unit.

Effects of nifedipine on diastolic function in hypertensive patients--an echocardiographic study

This study was undertaken to observe the changes in heart function and evaluate the effects of nifedipine on diastolic function in 70 patients with uncomplicated hypertension by M-mode and Doppler echocardiography. The results showed that diastolic abnormalities in hypertensive patients may precede systolic dysfunction and that nifedipine can improve diastolic function. It is easy and quick to estimate the diastolic function by measuring the EF slope, EA and EPSS, especially the E wave velocities. This method proved to be applicable to clinical practice.

Epidemiological studies on hemorrhagic fever with renal syndrome in China

Hemorrhagic fever with renal syndrome (HFRS) has been reported from greater than 20 provinces in China. The number of reported cases has increased markedly in recent years and surpassed 80,000 human cases in 1983. All of the cases reported before 1981 were from rural areas and were attributed to Apodemus rats. In 1981, outbreaks of cases associated with house rats were first reported. Cases associated with Apodemus agrarius were more severe than those associated with the house rat Rattus norvegicus. The rate of inapparent infection in the rural population of areas endemic for Apodemus-associated disease was lower than that of Rattus-associated urban disease. After the onset of the disease, IgG antibody levels increase rapidly, peak after one week, and persist for as long as 25 years. Lung tissues from 16 species of rodent, from two species of sorex, and from cats and weasels in the epidemic areas have been found to carry antigen. A. agrarius, Apodemus peninsulae, and R. norvegicus serve as the main reservoirs of HFRS in rural areas, forest areas, and urban areas, respectively.

Characteristics of Crimean-Congo hemorrhagic fever virus (Xinjiang strain) in China

Virus strains isolated from blood of patients during a hemorrhagic fever outbreak in 1968 in southern Xinjiang, China, from Hyalomma asiaticum and from sheep, were found to be identical or closely related to Crimean-Congo hemorrhagic fever (C-CHF) virus by complement fixation and indirect immunofluorescence tests with convalescent sera of patients and with C-CHF reference antibody. The virus was inactivated by ether and acid. Viral synthesis was not suppressed by 5-iododeoxyuridine suggesting an RNA-containing genome. The buoyant density in sucrose was 1.16-1.18 g/cm3. The particle weight was estimated at 3.26 +/- 0.46 X 10(8). The diameter of the virus particles was 85-105 nm.