Mycoplasma, Chlamydia, Rickettsia, Spirochetes and Actinobacteria were generally called "four pathogens and one bacterium". It was always difficult to be denominated and classified rightly in textbooks, while it was also a key interfering with students to grasp the concept of bacteria exactly. So we raise the question and hope to learn from each other by an exchange of views here.

Objective To observe the effect of exclusive pregnancy food exchange method on biochemical index and pregnancy outcome on pregnant women with abnormal glycometabolism,and evaluate its effectiveness on dietary guidance.Methods Sixty-seven pregnant women with abnormal glycometabolism who accepted physical examination and gave birth,were divided into traditional food exchange group (control group,33 cases) and exclusive pregnancy food exchange group (observation group,34 cases),and were given respective intervention until the childbirth.The blood biochemical indexes and the pregnancy outcome between two groups were compared.Results Fasting blood glucose (FBG),2 h postprandial blood glucose (PBG),glycosylated hemoglobin (HbA1c) and triglyeride (TG) in observation group after treatment were significantly lower than those before treatment (P ＜ 0.05 or ＜ 0.01).PBG,HbA1c and TG in control group alter treatment were significantly lower than those before treatment (P ＜ 0.01).After treatment,PBG,HbA1c and TG in observation group were significantly lower than those in control group (P＜ 0.01),after 3 months follow-up,differences still existed (P ＜ 0.01).The total incidence of pregnant women complications in observation group was much lower than that in control group [14.71％(5/34) vs.36.36％(12/33),P ＜ 0.05],there was no significant difference between two groups on neonatal complications (P ＞ 0.05).Conclusions Exclusive pregnancy food exchange method can improve pregnant glycometabolism and lipid metabolism of pregnant women with abnormal glycometabolism,and reduce the incidence of pregnant women and infant adverse pregnancy outcome.It is great worthy to popularize and apply in dietary guidelines.

Objective To observe the outcome of patients with ocular cicatricial pemphigoid (OCP) after amniotic membrane grafting or penetrating keratoplasty.Design Retrospective,noncomparative case series.Participants 3 consecutive OCP patients (4 eyes),were included.Methods For 3 patients (4 eyes) in this study,preoperative visual acuity was from HM/5 cm to HM/10 cm.The symblepharon (gradeⅢ) of 2 patients (3 eyes) were detached and amniotic membrane was transplanted,and bandage contact lens were used till 2 months after operations.The other patient (1 eye) was undergone penetrating keratoplasty with glycerol-cryopreserved cornea because of corneal ulcer and perforation.Main Outcome Measures Visual acuity,recovering of conjunctiva and cornea.Results Am- niotic membrane dissolved about 1 month after operation in 2 patients (3 eyes).Symblepharon changed from gradeⅢto gradeⅡ,visual acuity increased to 0.04-0.05,central corneal epithelium was regenerated significantly,and a little new vessel appeared at corneal lim- bus in 2 patients (2 eyes).The graft deliquesced in the patient with penetrating keratoplasty at 20 days after operation and undergone penetrating keratoplasty again after 1 month.In this patient,the graft molten induced the ocular contents run-off and became eyeball at- rophy eventually.Conclusion Our small sample study shows that the symblepharon detachment and amniotic membrane transplantation is effective for improving visual acuity in OCP with ocular surface dysfunction.However,because of various factors,penetrating kerato- plasty is ineffective for OCP with perforating corneal ulcer.

Acupuncture Therapy ; Adult ; Behcet Syndrome ; therapy ; Female ; Humans

BACKGROUND:Chitosan has good filming and viscosity, it contains free amido, and can coordinate and cross-link with gelatin, thus natural semi-interpentrating polymer network structure can be formed among molecules through hydrogen bonds.OBJECTIVE: To prepare sponge-like wound-healing dressing of good porosity, hydrophilia and air permeability by means of frozen chitosan-gelatin mixture induced phase separation.DESIGN: A comparative observation.SETTING: Laboratory of the College of Science, Guangdong Ocean University. MATERIALS: Chitosan was deacetylated by 97.55%, Mη=1.85×106; Gelatin (CP grade) was produced by Shanghai Chemical Dispensing Factory; Glacial acetic acid, NaOH, formaldehyde and glycerin were all CP grade. XL30-EDAX scanning electron microscope (Philips, Dutch); 3365-type universal material testing machine. METHODS: ① By means of frozen chitosan-gelatin mixture induced phase separation chitosan solution of 0.2, 0.4, 0.5, 0.6 and 0.8 (mass fraction) was mixed with gelatin solution, then a small amount of glycerin to prepare sponge-like wound-healing dressing of good porosity, hydrophilia and air permeability. then a small amount of glycerin, and stayed quietly to deaerate. The samples were plated with gold as routine methods, and then the surface and sectional structures were observed under the scanning electron microscope. The effects of different proportion of chitosan and gelatin on the performance parameters (water retention, moisture absorption, avulsion intensity, air permeability rate) of the sponge-like materials were observed. ② Chitosan-gelatin mixtures of 18, 20, 22, 25, 24, 26 and 28 g/L (mass fraction) were used to prepare sponge-like materials, and the effects of different contents on the performances of the materials were observed. ③ The effects of cross-linking agent (formaldehyde) of different dosages (0.002, 0.004, 0.006, 0.008, 0.010, 0.012 and 0.014 in volume fraction) on the avulsion intensity of the materials were observed.MAIN OUTCOME MEASURES: ① Surface and sectional structures of the sponge-like wound-healing dressing; ② Effects of different proportion of chitosan and gelatin on the performance parameters of the sponge-like materials; ③ Effects of different contents on the performances of the chitosan-gelatin sponge-like materials; ④ Effects of cross-linking agent of different dosages on the avulsion intensity of the materials.RESULTS: ① It could be clearly seen from the surface that the chitosan-gelatin sponge-like materials were porous structure, whereas seen from the section, the pores were honey-comb formation or three-dimensional lamellar structure accumulated by porous lamellars. ② When the content of chitosan was greater, the section looked like honey comb;Whereas as the content of chitosan decreased and gelatin content increased, the section tended to parallel lamellar structure, the water content and water retention of corresponding samples had an ascending trend, but the alvusion iintensity increased at first, and then decreased. The mass fraction of 0.5 was suitable for chitosan in the prepared solution by comprehensively analyzing the performance parameters. ③ The lower the total concentration of chitosan and gelatin, the higher the water content, the easier for the formation of bigger self-chips on the surface, the porosity of the prepared materials increased, hydrophilia and water retention ability were increased, but greater cracks formed on the material surface, and avulsion intensity was smaller. As the concentration became higher, the viscosity of the mixture became greater, the excessive viscosity was not good for mixing uniform, thus the material surface was not plain enough, and the porosity was smaller, the hydrophilia and water retention ability were relatively decreased, and the materials were harder. The total concentration should be 22-25 g/L. ④ Once the dosage of cross-linking agent was too low, very few cross-linking points generated, and the intensity was too low; Once the dosage of cross-linking agent was too high, too many cross-linking points generated, and the net space was reduced, then water content and water retention value were decreased; Whereas overdosage cross-linking agent could increase the fragility of the sponge-like materials, manifested as the decrease of avulsion intensity. When formaldehyde of 0.01 in volume fraction, the avulsion intensity was the maximal, thus the dosage of 0.01 in volume fraction was the most suitable.CONCLUSION: The main factors that affect the structures and performances of the sponge-like wound-healing dressing are the proportion of chitosan and gelatin in the mixture, total concentration of the prepared solution, amount of powder and dosage of cross-linkage agent, etc. The best matching iss chitosan of 0.05 (volume fraction)/gelatin of 0.05 (volume fraction), total mass concentration of 22-25 g/L, amount of chitosan-gelatin powder mixture is 1∶1, and the dosage of cross-linking agent is 0.01 (volume fraction).

Animals ; Betaine-Homocysteine S-Methyltransferase ; therapeutic use ; Homocysteine ; blood ; Hyperhomocysteinemia ; blood ; therapy ; Male ; Rats ; Rats, Wistar ; Recombinant Proteins ; therapeutic use

ObjectiveTo investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU).Methods A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled. They were randomly divided into two groups by computer generated random numbers table, eachn = 70. The patients in observation group received midazolam 1μg·kg-1·min-1 for sedation, and 1 mg/mL remifentanil for analgesia with 0.05 mg/kg intravenous bolus, then continuous infusion of 0.02-0.10 mg·kg-1·h-1. The patients in control group received midazolam for sedation only. The data were recorded as follows: the main indices for observation included the occurrence of delirium and its duration; the second item for observation was consumption of drug for sedation, followed by the mean arterial pressure (MAP) before and after sedation, the time of wake-up, duration of mechanical ventilation, the length of ICU stay, and 28-day fatality rate. The 28-day survival was analyzed by Kaplan-Meier survival curve.Results The dosage of remifentanil used in observation group was (98.6±24.9) mg/d, the dosage of midazolam was significantly lower than that of the control group (mg/d: 160.6±33.3 vs. 178.9±43.4, t = 2.829,P = 0.005), the incidence of delirium was obviously lower than that of the control group [22.9% (16/70) vs. 57.1% (40/70),χ2 = 15.700,P< 0.001], and the time of delirium was slightly shorter than that of the control group (hours: 162.9±78.0 vs. 194.8±117.3,t = 0.947,P = 0.348). Among the patients with delirium, the dosage of dexmedetomidine used in observation group was significantly less than that of the control group (mg/d: 0.54±0.11 vs. 0.64±0.14,t = 2.112,P = 0.041). The MAP before sedation was similar as the MAP after sedation in both groups, and there was no significant difference between observation group and control group [mmHg (1 mmHg = 0.133 kPa), before treatment: 84.7±16.2 vs. 89.5±37.7, after treatment: 82.3±10.7 vs. 80.8±13.9, bothP> 0.05]. There was no significant difference in the time of waking-up between observation group and control group (hours: 2.3±0.9 vs. 2.4±0.8,t = 0.487,P = 0.627). The duration of mechanical ventilation (hours: 143.4±138.3 vs. 163.9±158.9, t = 0.812,P = 0.418), the length of ICU stay (days: 8.8±7.7 vs. 10.0±7.8,t = 0.917,P = 0.361) and 28-day fatality rate [11.4% (8/70) vs. 20.0% (14/70),χ2 = 1.941,P = 0.245] in observation group were slightly lower than those of the control group without significant difference. Kaplan-Meier survival curve showed that the cumulative 28-day survival rate in observation group was slightly higher than that of control group (χ2 = 1.647,P = 0.199). ConclusionAnalgesia based on sedation may reduce the occurrence of delirium and its severity, furthermore, even if delirium occurs, it may be less severe.

Objective To explore the risk factors of severe hand,foot and mouth disease(HFMD) that progressed to critical illness among children.Methods The clinical data of 100 cases with severe and critical HFMD(82 cases were severe HFMD and 18 cases were critical)treated in the First Affiliated Hospital of Guangxi Medical University from January 2009 to September 2010 were analyzed retrospectively.We used univariate and multiple non-conditional Logistic regression analysis to compare the differences of the clinical features and laboratory examination between two groups,survey the risk factors of severe HFMD progressing. Results Most of the patients in both groups were under 5 years old,mainly under 3 years old which accoun-ted for 85.4% of severe HFMD cases and 88.9% of critical HFMD cases.The dominant sex was male in both groups,the sex ratio were 2.28∶1 and 8.00∶1 .The main pathogen was enteral virus 71 .Fever and rash were found in most of the severe and critical patients.The main neurological symptoms were myoclonus, tremors,limb asthenia,somnolence,vomiting and convulsion.Nervous system symptoms in critical cases were even worse to develop to coma and accompany with serious respiratory and circulatory manifestations.Univa-riate analysis showed that age ﹤2 years,tachycardia,tachypnea,elevated leukocyte count,platelet count and blood glucose level,persistent high fever,limb asthenia,pulmonary moist rales and changes on chest radio-graph were the risk factors that progressed to critical illness.The multiple non-conditional Logistic regression analysis showed that age ﹤2 years,tachycardia,limb asthenia and pulmonary moist rales were independent risk factors for severe HFMD cases progressing to critical illness.Conclusion The patients aged ﹤2-year-old,tachycardia,limb asthenia and pulmonary moist rales are closely related to severe HFMD cases progress-ing to fatal condition.

Sinus histiocytosis with massive lymphadenopathy( SHML) is also called Rosai-Dorfman disease.It is a kind of benign lymphoid tissue proliferative diseases with unknown etiology.SHML appeared mostly in children and adolescent.It has diverse clinical manifestations accompanied with multiple organ inju-ry,and no clear laboratory indicators could support the disease,being a rare disease in pediatrics,easyot miss diagnosis.Thsi article reviewde the latest progress on diagnostis and treatment of SHML,to improve teh un-derstanding of the disease.