Volume 96  ·  Issue 20  ·  2016

Organ transplantation is the most effective method for treating various end-stage diseases of organs. However, in recent years, the shortage of organs for transplantation has become increasingly serious, which makes expanded criteria donor (ECD) organs more and more widely used in clinical practice. Thermal ischemic injury of ECD organs is more severe, organ viability is reduced, and the probability of primary non-function (PNF) of organs after transplantation is significantly increased. extracorporeal membrane oxygenation (ECMO) can effectively shorten the time of organ thermal ischemia and promote the recovery of organ function through mature cardiopulmonary bypass support measures^[1]。 At present, ECMO technology has gained more and more experience in the process of ECD organ protection, effectively expanding the donor utilization rate, improving the success rate of transplantation and the long-term quality of life of patients after transplantation.

To assess the effectiveness and safety of the conversion therapy from traditional cyclosporine (CsA) triple immunosuppression therapy to sirolimus (SRL) combined with low dose CsA and prednisone (Pred) in renal transplantation recipients in a five-year follow-up period.

A prospective, open-label non-randomized study was performed with 46 renal allograft recipients who visited Tongji Hospital regularly for follow-up visits between January 2007 and May 2011 and were taking CsA+ mycophenolate mofetil (MMF)+ Pred. Conversion therapy to SRL+ low dose CsA+ Pred was initiated after renal transplantation. The recipients were allocated to 2 groups according to their renal function and proteinuria before the conversion: active conversion group [n=27, serum creatinine (SCr) ≤ 140 μmol/L with no or minimal proteinuria] and passive conversion group [ n=19, SCr>140 μmol/L with less than moderate proteinuria]. After conversion, dosages of SRL and CsA were adjusted for trough levels of 5-7 μg/L and 20-60 μg/L, respectively. SCr and urine protein were compared before and after the conversion in five-year follow-up. Incidence of acute rejection, renal graft survival and SRL-related adverse effects of the immunosuppressive regimen were also observed.

After conversion, an average 63% dose reduction of CsA was achieved in all the patients. In the active conversion group, the mean SCr level was (110±19) μmol/L at the time of conversion. Eight patients in this group withdrew from the study during the follow-up period for the following reasons: arthralgia (1 case), deteriorated proteinuria (2 cases), chronic diarrhea (2 cases), mild or suspicious acute rejection (2 cases), and recurrent fever (1 case). The rest patients (19/27) with a mean follow-up time of 5 years had a stable SCr level [(103±12) μmol/L] and a 100% 5-year graft survival. In the passive conversion group, the mean SCr level was (205±45) μmol/L at the time of conversion. There were 4 patients quitting the study, 2 for deteriorated proteinuria and 2 for lost to follow-up. Chronic allograft failure developed in 10 patients in this group 1-50 months after conversion, while the remaining 5 patients had a stable SCr during the 5-year follow-up period [(218 ±46) μmol/L before conversion vs (205±73) μmol/L 5 years after conversion]. The overall 5-year graft survival after the conversion therapy in the passive conversion group was 33.3%, significantly lower than that of the active conversion group ( P<0.001). Acute rejection was observed in 2 cases in the active conversion group, while not observed in the passive conversion group. None of the patients developed leukopenia, thrombocytopenia, oral ulcer, or pneumonia in the follow-up.

The combination therapy of SRL and low dose of CsA is overall a safe and effective maintenance immunosuppressive regimen, but it is important to initiate at an appropriate stage. More favourable long-term benefits may be obtained from the conversion therapy in patients with normal or only slightly impaired renal graft function. It may offer an option of individualized immunosuppressive therapy after renal transplantation.

To study the expression and its diagnostic significance of neutrophil surface adhesion molecules including CD11b, CD15 and CD62L after renal transplantation in recipients with cytomegalovirus (CMV) infection.

Blood samples were collected from 142 kidney transplant recipients, including 95 males and 47 females, who received allogeneic renal transplantation between September 2009 and January 2015 in 309th Hospital of the PLA. Healthy volunteers (22 males and 9 females) were recruited from physical examination center in 309th Hospital of the PLA from September 2009 to January 2015 as healthy control group. Renal transplant recipients were divided into high active CMV infection group, active CMV infection group and CMV negative control group according to CMV-pp65 antigen detection. Neutrophil surface adhesion molecules CD11b, CD15 and CD62L were detected by flow cytometry and their mean fluorescence intensity compared among the groups. Receiver operating characteristic (ROC) curves of CD11b, CD15 and CD62L in detecting active infection in renal transplant recipients were made.

The mean fluorescence intensity of CD15 in high active CMV infection group(n=17) and active CMV infection group(n=65)were 776.31±89.53 and 554.39±67.89, respectively, with significant differences compared with CMV negative control group (n=60, 334.92±44.69) and healthy control group (n=31, 310.56±39.67) (all P<0.05); the expression proportions of CD11b and CD62L in high active CMV infection group and were 42.31%±6.11% and 40.35%±6.47%, respectively, with significant differences compared with active CMV infection group(62.45%±5.67% and 65.65%±5.33%), CMV negative control group(70.74%±6.55% and 70.37%±6.71%) and healthy control group(72.52%±6.48% and 72.43%±6.51%) (allP<0.05). The optimal cut-off values of CD11b and CD62L in diagnosing active CMV infection group were 56.61% and 44.35%, respectively, with the sensitivity being both 100.00%, the specificity being 76.67% and 58.06% respectively, and the area under the curve (AUC) being 0.851 and 0.628 respectively; the optimal cut-off values of CD11b and CD62L in diagnosing high active CMV infection group were 66.57% and 69.56% respectively, with the sensitivity being 81.54% and 87.69% respectively, the specificity being 100.00% and 98.33% respectively, and the AUC being 1.000 and 0.991 respectively; the optimal cut-off values of mean fluorescence intensity of CD15 in diagnosing high active CMV infection group and active CMV infection group were 542.71 and 408.03 respectively, the sensitivity in the two groups being 100.00% and 98.46% respectively, the specificity being both 100.00%, and the AUC being 1.000 and 0.999 respectively.

Neutrophils CD15 expression may be up-regulated in renal transplantation recipients with CMV infection, while neutrophils CD11b and CD62L expressions are down-regulated. Such changes in CD15, CD11b and CD62L expression can be used as a basis for laboratory diagnosis of active CMV infection.

To evaluate the safety and effectiveness of retroperitoneoscopic donor nephrectomy in elderly donors for renal transplantation.

A retrospective analysis was conducted with 123 cases of retroperitoneoscopic living donor kidney transplantation in 309th Hospital of PLA from March 2011 to March 2014, including 44 elderly donors (age≥55 years) and 79 young to middle-aged donors (age <55 years). Comparisons were made in terms of postoperative complications in both donors and recipients, renal function recovery in the donors and function of graft in the recipients.

The clinical baseline data of the two groups shows that glomerular filtration rate (GFR) of donors in the elderly donor group was lower than the young donor group (P=0.04). The 123 donors all underwent retroperitoneoscopic donor nephrectomy successfully. Postoperative complications in donors and recipients of both groups had no significant differences (P=0.60; P=1.00). In the elderly donor group, the mean serum creatinine level of donors was significantly higher than that in the young donors group [(115.8±22.3) vs (102.5±16.3) μmol/L, P<0.01] 3 days after operation; and estimated GFR (eGFR) was lower [(53.0±9.1)vs(59.6±8.3)ml·min^-1·(1.73 m²)^-1,P<0.01]. Serum creatinine and eGFR of the two groups showed no significant differences one week and six months after surgery (allP>0.05). Four recipients in the elderly donor group had delayed graft function (DGF), 3 had acute rejection; 8 recipients in the young donor group had DGF, 5 had acute rejection; no statistically significant differences were observed between the 2 groups (bothP=1.00). Recipients' eGFR were higher in the young donor group than in the elderly donor group at 1 week, 1 month, 3 months, 6 months and 12 months after surgery, but with no statistically significant differences(allP>0.05). After (27.8±12.6) months follow-up, 1 recipient in the elderly donor group died from pulmonary infection; two recipients in the young donor group had kidney dysfunction. Graft survival in the two groups showed no significant difference(P=0.95).

Retroperitoneoscopic donor nephrectomy is safe and feasible for elderly donors. With careful preoperative evaluation, precise operation, and close postoperative monitoring and follow-up, it could provide satisfactory clinical outcome.

To study the characteristics and prevention and treatment strategies of massive hemorrhage caused by fungal infections after donation-after-cardiac-death (DCD) kidney transplantation.

A total of 91 cases of DCD kidney transplantation between August 25, 2013 and June 30, 2015 in Third Affiliated Hospital of Sun Yat-sen Univservity were retrospectively analyzed. The characteristics of and prevention and treatments strategies for postoperative massive hemorrhage caused by fungal infections were summarized.

Ninety-one cases of DCD kidney transplantation were divided into 2 groups based on regimens for preventing postoperative fungal infections: fluconazole prophylaxis group: a total of 26 cases of renal transplant before June 11, 2014 received fluconazole regimen, from postoperative day 0 to 2 weeks; micafungin prophylaxis group: a total of 65 cases of renal transplant after June 11, 2014 received micafungin regimen, also for 2 weeks from postoperative day 0. Two cases in fluconazole group developed postoperative massive hemorrhage. In case 1, the hemorrhage occurred at 2 weeks after transplantation. Graft nephrectomy was performed during surgical exploration for hemostasis, yet the massive hemorrhage relapsed 2 weeks later. Endoluminal exclusion of external iliac artery using endovascular covered stent-graft at the anastomosis site was performed and the massive bleeding was successfully stopped. The patient was restored to hemodialysis and waited for second kidney transplantation. Candia albicans was detected in the culture of blood and drainage liquid from incision. The other case of hemorrhage occurred at 3 weeks after transplantation. Graft nephrectomy plus endovascular exclusion using covered stent-graft were also performed to stop the massive bleeding. Massive fungal hyphae and spores were observed at the stump of renal graft artery under microscope. The patient received second kidney transplantation after 6 months successfully. No massive hemorrhage caused by fungal infections occurred in micafungin prophylaxis group.

Massive hemorrhage cased by fungal infections after DCD kidney transplantation is usually characterized by delayed and recurrent course, and may result in graft nephrectomy or even death of patients. Endovascular exclusion using covered stent can successfully stop bleeding and rescue life of patients. Two-week preemptive prophylaxis of fungal infections using micafungin can effectively prevent delayed fungal massive hemorrhage in DCD kidney transplantation.

To study the effect of metanephric mesenchymal stem cells (MMSCs ) after renal ischemia reperfusion injury (IRI).

C57BL/6J male mice were divided into control group (n=5) and experimental group (n=30). The control group was given a sham operation, while in the experimental group, a model of renal IRI was established. The experimental group was further divided into two groups according to the material injected through the femoral vein: IRI group (injected with normal saline, 10 ml/kg) and cell therapy group (injected with normal saline containing 5×10⁵ MMSCs, 10 ml/kg). Samples of blood and kidney tissues were collected from five mice from each group at 12 h, 24 h and 72 h after IRI. The serum creatinine (SCr) level was detected, and the results of kidney tissue pathological staining and Paller score of renal tubules were analyzed to assess the effect of MMSCs after renal IRI. In addition, the expression of microRNA-26a(miR-26a)in kidney tissues was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and compared among the groups.

(1) In both IRI group and cell therapy group, the levels of SCr at 12 h, 24 h and 72 h after operation were all significantly higher than those of the control group, besides, the level of SCr at 24 h was significantly higher than that at 12 h and 72 h (all P<0.05). The levels of SCr at 12 h, 24 h and 72 h were of no significant differences between IRI group and cell therapy group(allP>0.05). (2)Paller scores of renal tubules at 12 h, 24 h and 72 h in both IRI group and cell therapy group were significantly higher than those in the control group, and the scores at 24 h were significantly higher than that at 72 h, while the latter were in turn higher than the scores at 12 h (allP<0.05). In the cell therapy group, Paller score of renal tubules at 24 h(57.2±6.3)was significantly lower than that in IRI group(70.8±14.8) (P<0.05). Histological examination showed renal tubular epithelial cell atrophy, swelling and protein cast in kidney tissues from IRI group at 24 h, compared with the control group and the cell therapy group at the same time.(3) In IRI group and cell therapy group, the levels of miR-26a in the kidney tissues at 12 h and 24 h were significantly lower than those of the control group (P<0.05). In the cell therapy group, the level of miR-26a in the kidney tissues at 24 h (0.416±0.139) and 72 h (1.152±0.239)were significantly higher than that in the IRI group(0.244±0.067, 0.855±0.038, bothP<0.05). A negative correlation between the levels of miR-26a and SCr level were found (r=-0.5, P<0.05).

MMSCs have a certain repairing effect on renal IRI, accompanied by an increase in miR-26a expression.

To explore short-term outcomes obtained with Laparoscopic-assisted Natural Orifice Specimen Extraction for left colorectal cancer radical resection.

A total of 123 patients with left colorectal tumor who had undergone laparoscopic surgery between Jan.2014 and Jun.2015 were reviewed. According to surgical approach, transanal specimen extraction using the Cai Tube (study group, n=29) and trans-abdominal incision specimen extraction (control group, n=123) were studied. Propensity score matching was applied at a ratio of 1∶1 comparing the study (n=23) and control (n=23) groups.

The two matched groups had similar baseline characteristics. There was no significant difference in the length of distal or proximal resection margin, the rate of circumferential resection negative margin, the estimated blood loss, the levels of C-reactive protein on 2nd day after surgery, the postoperative time to take liquid, the postoperative hospital day, the hospital fee and the postoperative anal function. The study group presented longer operative time[(237.8±68.1)min vs (168.9±47.5)min, P<0.05], less number of lymph nodes dissected (12.4±5.4 vs 16.4±7.2,P<0.05), higher white cell count on 2nd day after surgery[(11.7±3.4)×10⁹/L vs (9.4±2.6)×10⁹/L, P<0.05], but quicker postoperative recovery of bowel function[(2.6±0.7)d vs (3.4±0.7)d,P<0.05], shorter postoperative ambulation time[(2.3±0.6)d vs (3.6±0.7)d,P<0.05], lower rate of postoperative complications (0/23 vs 6/23,P<0.05) and lower rate of utilization of painkillers in addition to postoperative analgesia pump (1/20 vs 9/23,P<0.05).

Laparoscopic-assisted left colorectal cancer radical resection using the Cai Tube is in line with oncologic principle, less pain, quicker recovery and better cosmetic results.

To study the survival situation of gastric cancer patients with pathological complete response (pCR)following neoadjuvant chemotherapy (NAC).

The clinical data of patients with gastric cancer treated with NAC following by surgical resection between Jan 2011 and Dec 2013 at General Hospital of Chinese People's Liberation Army was analyzed retrospectively.

A total of 23 patients (16.0%, 23/144)achieved pathologic complete response. The median follow-up time of the survivors was 42.8 (range 16.0-58.7)months. All patients underwent R0 resection and D2 lymphadenectomy. The overall survival and recurrence-free survival rates at 3 years were 95.7% and 90.3%.

The patients with advanced gastric cancer after neoadjuvant chemotherapy have good prognosis. Modified chemotherapy regimens may further improve the pathological complete response rate.

To investigate the clinical and pathological characteristics, as well as the diagnosis and treatment of primary bladder adenocarcinoma in the early stage.

The clinical features, pathological results, diagnosis and treatment profiles of 7 cases of primary bladder adenocarcinoma admitted in Affiliated Hospital of Nantong University from January 2010 to July 2015 were analyzed ret rospectively.

All seven cases were diagnosed pathologically as primary bladder adenocarinoma.Histological staging T1 was revealed in six cases, while T2 in one case after the first resection.After four weeks, all patients received the second resection while one patient underwent immediately radical cystectomy. Multimodality therapy such as radiotherapy or chemotherapy was performed for longer postoperative survival.only one man died while another patient had been healthy for 6 years till January 2016.

Primary bladder adenocarcinoma is a highly malignant disease in bladder cancer.According to the results of the second resection, multimodality therapy for patients in early stage with no lymph node or other organs metastasis can improve the quality of life without affectiong their lives.

To explore the surgical techniques and the clinical efficacy of laparoscopic transabdominal preperitoneal repair (TAPP) for recurrent inguinal hernia.

Clinical data of 367 patients with recurrent inguinal hernia who underwent TAPP repair from Mar. 2009 to Mar. 2015 in Beijing Chao-Yang Hospital of Capital Medical University were analyzed retrospectively.

Laparoscopic operations were completed successfully in 365 cases, however, 2 cases were converted to open surgery.The operation time was (55.7±19.3) min (30-100 min) and the hospital stay was (4.9±2.7) d (2-12 d). The incidences of postoperative pain, hydrocele, and urinary retention were 4.1%(15/367), 13.1%(48/367), and 1.3%(5/367) respectively.Other complications such as foreign body sensation, wound infection, and intestinal obstruction.All cases were followed up from 3 to 72 months ((36.5±14.7) months), 2 recurrent cases was observed and no mesh infection and long-term chronic pain were observed.

Laparoscopic TAPP repair has advantages of minimal invasion and few complications, which is safe and effective for recurrent inguinal hernia.

To investigate the protective effects of Notch1 on myocardial ischemia reperfusion injury and explore underlying molecular mechanism.

H9c2 cells were exposed to hypoxia/reoxygenation (H/R), ischemic preconditioning (IPC) and ischemic postconditioning (IPost) treatment following infection with lentiviral vector-Notch1 intracellular domain (Lv-N1ICD) or Lv-N1ICD-shRNA, and divided into control group, H/R group, H/R+ N1ICD group, IPC group, IPC+ N1ICD-shRNA group, IPost group, IPost+ N1ICD-shRNA group, respectively. Apoptosis was detected by Annexin V/propidium iodide (PI), and reactive oxygen species (ROS) was detected by 2', 7'dichlorofluorescin-diacetate (DCFH-DA). The expression of p-glycogen synthase kinase-3β (p-GSK-3β)/GSK-3β were detected by Western blot analysis.

The apoptosis rate of cardiomyocytes in control group, H/R group, H/R+ N1ICD group, IPC group, IPC+ N1ICD-shRNA group, IPost group, IPost+ N1ICD-shRNA group was (5.34±1.70)%, (47.03±4.10)%, (33.89±12.25)%, (35.85±3.17)%, (51.12±8.22)%, (37.35±3.82)%, (47.90±3.08)%, respectively, showing significant differences in all group (F=18.47, P<0.05). ROS in control group, H/R group, H/R+ N1ICD group, IPC group, IPC+ N1ICD-shRNA group, IPost group, IPost+ N1ICD-shRNA group was 624.66±79.52, 1 221.87±63.66, 913.12±115.82, 935.85±201.62, 1 204.03±113.82, 967.15±106.11, 1 296.59±222.38, respectively, showing significant differences in all group (F=8.77, P<0.05). The ratio of p-GSK-3β to GSK-3β in control group, H/R group, H/R+ N1ICD group, IPC group, IPC+ N1ICD-shRNA group, IPost group, IPost+ N1ICD-shRNA group was 0.58±0.12, 0.62±0.20, 1.24±0.09, 1.16±0.12, 0.72±0.15, 1.16±0.12, 0.75±0.12, respectively, showing significant differences in all group (F=11.21, P<0.05).

As an endogenous cardioprotective factor, Notch1 reduces myocardial ischemia reperfusion injury by promoting GSK-3β phosphorylation, inhibiting cardiomyocyte apoptosis and reducing ROS formation.

To explore the effect of CD40 knock out on the cytotoxic function of CD8⁺ T cell of mice with cigarette smoke-induced emphysema.

A total of 40 male C57 mice were divided into four groups according to the random number table, including CD40^{+ /+} control group, CD40^{+ /+} smoke-exposure group, CD40^-/-control group, CD40^-/-smoke-exposure group. The smoke-exposure groups were exposed to cigarette smoke for 24 weeks to establish emphysema model. Morphological changes were evaluated by linear intercepts. The percentages of CD8, perforin, granzyme B positive cells were evaluated by immunohistochemistry. The mRNA expressions of perforin, granzyme B, interleukin (IL) -27 were measured by fluorescent real time quantitative polymerase chain reaction (RT-PCR). The IL-27 cytokine level was tested by enzyme-linked immunosorbent assay (ELISA).

The mean linear intercepts in CD40^{+ /+} smoke-exposure group was significantly higher than CD40^{+ /+} control group, CD40^-/-control group, and CD40^-/-smoke-exposure group [(37.2±3.6) vs (24.0±3.4), (22.5±2.4), (29.9±1.7) μm] (all P<0.05). CD40^-/-smoke-exposure group was higher than CD40^{+ /+} control group, CD40^-/-control group (all P<0.05). The percentages of CD8 positive, perforin positive and granzyme B positive cells in CD40^{+ /+} smoke-exposure group [(16.3±2.3)%, (11.4±2.1)%, (10.7±1.9)%] were significantly higher than CD40^{+ /+} control group [(8.3±1.6)%, (5.1±1.2)%, (4.6±1.0)%], CD40^-/-control group [ (6.4±1.5)%, (4.3±1.0)%, (4.2±1.0)%] and CD40^-/-smoke-exposure group [(8.6±1.7)%, (5.6±1.3)%, (5.5±1.3)%] (all P<0.05). RT-PCR results showed that the mRNA expressions of perforin, granzyme B and IL-27 in CD40^{+ /+} smoke-exposure group [(20.3±7.3), (18.3±12.3), (2.2±0.7)] were significantly higher than CD40^{+ /+} control group [(9.4±4.8), (10.6±3.8), (1.3±0.6)], CD40^-/-control group [ (8.1±3.1), (7.7±3.5), (1.1±0.5)] and CD40^-/-smoke-exposure group [(12.9±6.2), (10.4±4.6), (1.5±0.4)] (all P<0.05). ELISA results showed that the level of IL-27 in CD40^{+ /+} smoke-exposure group was significantly higher than CD40^{+ /+} control group, CD40^-/-control group and CD40^-/-smoke-exposure group [(3 242±754) vs (1 627±710), (1 600±680), (1 850±583) ng/L] (all P<0.05).

Knockout the CD40 gene can inhibit the cytotoxic effector function in CD8⁺ T cells of mice with cigarette smoke-induced emphysema, and alleviate the degree of emphysema.

To explore the role of mitochondrial apoptosis on pulmonary fibrosis in rats with severe scald injury.

According to the random digital table, a total number of 32 Wistar rats were divided into 4 groups: sham burn (group A), burn group (group B), 12-week post burn recovery group (group C), and 12-week post burn recovery plus a second burn injury group (group D). In group A and group B, lung tissues were harvested on post burn day 4. After received first burn injury 12 weeks, the group C and group D received separately a second sham burn injury and burn injury. Lung tissues were harvested on post burn day 4 after the second burn injury. All tissues were examined for cells apoptosis by Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL). Pulmonary fibrosis was assessed by Masson trichrome staining and Sirius red staining. The protein expression levels of cleaved Caspase-3, Bax and Bcl-2 were assessed by Western blot.

Both Masson trichrome staining and Sirius red staining showed obvious pulmonary fibrosis in group C and group D. The apoptosis rates of group B, C and D were significantly higher than that in group A ((15.50±3.30)%, (7.88±3.10)%, (15.88±3.23)% vs (2.10±1.07)%, all P<0.05). Compared to group A, cleaved Caspase-3 levels were significantly higher in group B, C and D ((0.59±0.11), (0.33±0.08), (0.73±0.13) vs (0.16±0.05), allP<0.05). The ratio of Bax/Bcl-2 in group B, C and D also increased significantly ((2.08±0.30), (0.83±0.09), (1.54±0.12) vs (0.64±0.05), allP<0.05).

Severe burn injury can induce pulmonary fibrosis and mitochondrial apoptosis may play an important role in the development of pulmonary fibrosis.

To systemically analyze the effect of perioperative hyperoxia for the surgical site infections in patients with general surgery.

Electronic databases consisting of Pubmed, Embase, Cochrane Library, Wanfang Database, CNKI and VIP were systemically searched from established time to November 18, 2015. The randomized controlled trials about perioperative high and low-concentration oxygen for the surgical site infections in patients with general surgery were screened strictly and analyzed by the software of Revman 5.3. The included trials were stratified according to the colorectal or non-colorectal surgery, the duration of oxygen inhalation and the kinds of mixed gas to perform subgroup analyses. Sensitivity analysis was conducted by removing the low-quality trials, etc. The outcome was the surgical site infections.

There were 989 relevant articles were searched out. At last, 9 randomized controlled trials consisting of 3 281 patients were included. The 80% oxygen group and 30% oxygen group consists of 1 644 and 1 637 patients, respectively. The rates of surgical site infection were 15.1% (248/1 644) and 17.5% (286/1 637) in the two group. Heterogeneity existed between the included trials and random-effect model was used, the RR=0.80, 95%CI: 0.60-1.08, P=0.15. Therefore, statistically significant difference was not found for the surgical site infections in the general surgery between the perioperative high and low-concentration oxygen. However, the results of subgroup analyses showed that the perioperative hyperoxia decreaced the surgical site infections significant in the subgroups of colorectal surgery and intraoperative plus postoperative 6 h oxygen inhalation.

Perioperative hyperoxia does not reduce surgical site infections in patients with general surgery. However, the results of two subgroup analyses (colorectal surgery and intraoperative plus postoperative 6 h oxygen inhalation trials) show a significantly benefit for perioperative hyperoxia in decreasing surgical site infections.

To evaluate and characterize the certified reference materials for coagulation factor Ⅷ (FⅧ) and factor Ⅸ (FⅨ) activity testing.

The homogeneity and stability of three lots of certified reference materials (F01-F03) with different factor concentrations were evaluated according to guidelines"Reference materials-general and statistical principles for certification","Guidance on evaluating the homogeneity and stability of samples used for proficiency testing"and"Technical Norm of Primary Reference Material". The certified reference materials were characterized by eight laboratories using one-stage method, which were calibrated by the coagulation standard provided by the National Institute for Biological Standards and Control (NIBSC) in UK.

The Coefficient of Variation (CV) of homogeneity test of FⅧ activity of three lots of certified reference materials were 3.9%, 3.3% and 3.4%, respectively. While that of FⅨ activity were 3.7%, 3.0% and 1.8%, respectively. The results of one-way ANOVA showed that all certified reference materials had good homogeneity (P>0.05), and the between-bottle homogeneity uncertainties (u_bb) of FⅧ and FⅨ activity were 0.5%-2.9% and 0.1%-3.9%, respectively. All certified reference materials stored in -80 ℃ remained stable in 9 months by trend analysis, and the long-term stability uncertainties(u_lts) of FⅧ and FⅨ activity were 0.5%-5.1% and 1.3%-4.4%, respectively. The characterization uncertainties (u_char) of FⅧ and FⅨ activity testing were 0.9%-2.4% and 1.1%-2.4%, respectively. The combined uncertainties and extended uncertainties (coverage factor k=2) were calculated. The assigned values of each lot of certified reference materials for FⅧ activity were (85±13)%, (36.0±3.4)% and (20.5±2.3)%, and that were (102±13)%, (47.8±6.9)% and (29.3±3.8)% for FⅨ activity, respectively.

The certified reference materials for FⅧ and FⅨ activity testing have good homogeneity and stability. The results of the characterization are accurate and reliable.

A 39-year-old male was admitted to the hospital on October 9, 2014 due to "erythematous papules and pustules in the limbs for 2 months, swelling and pain in the right lower limb with fever for 1 week". The patient self-complained that in August 2014, there was erythema, papules and pustules on the skin of the limbs without obvious inducement, accompanied by itching, and ulceration, erosion and exudation after scratching. Treated as eczema in the local hospital, the rash improved after treatment with dexamethasone 10 mg/d, vitamin C and calcium gluconate. On September 26th, I began to have repeated fever, with the highest body temperature of 39.8℃, accompanied by general swelling, which was obvious in the limbs. At the same time, the swelling of the right ankle joint was aggravated with flushing pain, and the right foot was difficult to walk. After attending the emergency department of our hospital, he was admitted to the dermatology department. Considering the possibility of vasculitis, he was given dexamethasone 10 mg/d to suppress the immune response, and piperacillin and sulbactam combined with levofloxacin to fight infection. On the third day of admission, the patient developed obvious chest tightness and chest pain. Emergency blood gas analysis: PO₂65.2 mmHg (1 mmHg =0.133 kPa), PCO₂36.3 mmHg. CT pulmonary angiography (CTPA) showed multiple embolism in both pulmonary arteries (Figure 1)； Mild inflammation of the posterior basal segment of the lower lobes of both lungs; The pleura was mildly thickened on both sides, and pulmonary embolism was diagnosed and transferred to respiratory medicine. Smoking for more than 20 years, about 40 cigarettes/d.

A 26-year-old female developed reddish pimples on both sides of her face and nose at the age of 3, involuntary laughter at primary school, and epileptic symptoms at the age of 17, which showed brief loss of consciousness and limb twitching. After taking sodium valproate regularly for treatment, 0.4 g three times a day, self-complaint epilepsy symptoms still have irregular seizures. Polycystic kidney was discovered in 2008. On April 9, 2008, he underwent decompression and decompression of right polycystic kidney in our hospital. Postoperative pathology showed fibrous adipose tissue and smooth muscle bundle under the microscope (right polycystic kidney), with cyst wall-like changes in some areas and cubic epithelial covering, which can conform to benign cystic lesions, but angiomyolipoma cannot be completely excluded. Results of enzyme-labeled immunohistochemical staining: smooth muscle actin (SMA) positive (+), desmin (DES) (+), CD68 negative (-), S-100 (-), CD117 (-), CD34 vessel (+), vimentin (VIM) (+). Regular follow-up after surgery, creatinine increased to 800 μ mol/L 1 1/2 years ago, considering renal insufficiency, uremic stage. Maintenance hemodialysis treatment in local hospital every Tuesday, Thursday and Saturday. In 2013, the creatinine was maintained at about 800 μ mol/L before hemodialysis, and there was anuria. He was admitted to hospital for renal allograft.

A 19-month-old male was admitted to another hospital due to "painless mass on the left side of the scrotum for 1 month". B-ultrasound showed left testicle occupying space, right testicle cystic-solid occupying space, and magnetic resonance image (MRI) showed left testicle occupying space lesion, considering tumor of reproductive origin (FIG. 1A)。 Laboratory examination showed that alpha-fetoprotein (AFP) was 2 122.3 μ g/L (normal range: 0-5.3 μ g/L), and the preoperative diagnosis was "yolk sac tumor of left testis, occupying space of right testis". The parents requested that only the left side be operated and the right side be observed for treatment. Radical left orchiectomy was performed, and paraffin section revealed "yolk sac tumor of left testis" (FIG. 2A，Figure 2B), postoperative diagnosis of "left testicular yolk sac tumor (stage I), right testicular occupying space", no further treatment such as chemotherapy. After 1 month of follow-up visit, AFP returned to normal. After that, AFP and B-ultrasound were followed up in local hospitals every 45 days or so, and AFP examinations were all in the normal range; B-ultrasound examination showed no obvious changes in the right testicular mass.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive pulmonary fibrotic disease with an irreversible course and is the most common and severe type of idiopathic interstitial pneumonia^[1]。 According to the statistics of Europe, America and Japan, the incidence of IPF is (0.22~17.40) /100,000^[2]。 The disease is more common in people aged 50-70, and is more common in men than in women; The main clinical manifestation is progressive dyspnea, and the histopathological and imaging manifestations are common interstitial pneumonia; A definitive diagnosis requires the exclusion of pulmonary fibrosis secondary to known etiology, combined with clinical manifestations, pulmonary function and imaging findings, sometimes with the help of pathology. The pathogenesis of IPF is unclear, the treatment is limited, and the prognosis is poor^[3]。 At present, it is believed that the disease is caused by repeated epithelial cell damage and dysregulation of repair process, fibrosis of lung tissue and excessive extracellular matrix deposition, resulting in the loss of normal structure of lung parenchyma, decreased lung compliance and impaired gas exchange function. The primary link may be the damage and abnormal activation of alveolar epithelial cells (AEC). The role of AEC in the pathogenesis of IPF is summarized as follows.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonatal period. The disease has acute onset, rapid progression and poor prognosis. It is one of the main causes of death of premature infants, and has become a difficult disease in neonatology. With the increase of the number of premature infants and the prolongation of survival time, the incidence of NEC increases. Some multi-center studies in the United States have shown that the incidence of NEC in very premature infants and ultra-premature infants is 7% ~11%^[1,2]It is lower in Canada and some European countries^[3,4,5]。 The mortality rate of NEC reaches 20% ~40%^[1,6,7]。 Even if they survive, complications such as intestinal stenosis, short bowel syndrome, repeated sepsis, dependence on parenteral nutrition may occur, and the mortality rate of severe cases and the incidence of long-term neurodevelopmental disorders are higher^[8]。 Therefore, it is of great significance to prevent NEC in premature infants. Breastfeeding, prevention and control of infection, scientific enteral feeding, etc. have good effects on the prevention of NEC. The imbalance of intestinal flora is an important cause of NEC^[9]Oral probiotics in premature infants may have important implications for the prevention of NEC.