Objective To analyze the clinical features and risk factors of invasive fungal infections (IFI) in children with acute leukemia.Methods Ninety-six acute leukemia children complicated with IFI admitted in Guangzhou Women and Children's Medical Center during January 2005 and February 2017 were retrospectively reviewed, and 96 cases of acute leukemia without IFI admitted at the same period were randomly selected as control group.The clinical manifestations of IFI were analyzed, multivariate Logistic regression was used to study risk factors of the complication of IFI in pediatric acute leukemia.Results Among 96 children complicated with IFI, fungus were detected in samples from sputum, bronchoalveolar lavage fluid, or blood in 78 cases, in which 42 cases (43.75％) were oral infection, 36 cases (37.50％) were pulmonary infection.Candida albicans (33.33％, 26/78) was the most commonly isolated pathogen, followed by Candida parapsilosis (20.51％, 16/78) and Candida tropicalis (20.51％, 16/78).Univariate analysis revealed hormone-containing chemotherapy, neutropenia (＜ 0.5 × 109/L), time duration of neutropenia ≥ 10 days, usage of carbapenem antibiotics and combined drug administration ≥2 types were associated with fungal infection (P ＜ 0.05 or ＜0.01).Multivariate Logistic regression showed that the time duration of neutropenia ≥ 10 days (OR =11.390, 95％ CI 4.145-55.263, P ＜ 0.01),usage of carbapenem antibiotics (OR =4.825, 95％ CI 1.681-13.842, P ＜ 0.01) and hormone-containing chemotherapy (OR =2.220, 95％ CI 1.542-8.246, P ＜ 0.05) were the independent risk factors of IFI.Conclusion Rational usage of antibiotics and effective measures taken to restore the granulocytes can help to reduce the incidence of IFI in children with acute leukemia.

Objective To investigate the self-efficacy levels and its influencing factors of community-based patients with chronic obstructive pulmonary diseases (COPD).Methods From October 2008 to March 2009,320 community COPD patients were recruited from a Shanghai community.They undertook questionnaires,scale survey and pulmonary function testing so as to investigate the influencing factors of self-efficacy.Results The total scale of self-efficacy was 74.24 ± 9.50 and the level of selfefficacy in 286 cases( 89.4％ )was intermediate.The knowledge of COPD,social supports,forced expiratory volume at 1 second (FEV1)/forced vital capacity (FVC) and self-management level were entered into regression equation and could explain 57.1％ of the total variance of independent variables.Conclusions The knowledge of COPD,social supports,FEV1/FVC and self-management level are the major influencing factors of self-efficacy in the COPD patients.We should improve the knowledge of disease and strengthen the psychological care and social supports so as to improve their quality of life.

Objective To study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.Methods Intestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. Results All operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leak age, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of follow up. Conclusion Compared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.

Objective To explore the relationship between self-efficacy and self-management behaviors of patients with chronic obstructive pulmonary disease (COPD).Methods A total of 350 COPD patients form 5 residents' committees in shanghai were recruited by using a convenient sampling method and were scored using Chinese Self-efficacy Scale (CSES)and the self-management behaviors scale.Spearman's correlation analysis was performed to detect the relation of self-efficacy with self-management behaviors.Results Three hundred and twenty adults were included in this investigation,and their average FEV1/FVC was (57.86 ± 7.06)％,average score of self-efficacy was 74.2 ± 9.5.In self-management behaviors,time spent on physical exercise was (16.2 ± 33.9) minutes per week,and endurance exercises accounted for (109.0±49.0) minutes per week.The score of cognitive symptom management practice was 0.9 ± 1.0 and communication with physicians was 0.7 ± 0.8.Total score of self-efficacy was positively correlated with self-management behavior in each dimension (r values were 0.522,0.407,0.330 and 0.044,respectively ; all P ＜ 0.01).Conclusions Self-efficacy and self-management behaviors of COPD patients need to be improved,and self-efficacy may be related to self-management behaviors.

Objective To investigate the value of endoscopic ultrasonograghy (EUS) in diagnosis and treatment of gastrointestinal neuroendocrine neoplasm (GI-NEN).Methods We retrospectively summarized the clinical data of 44 patients with GI-NEN which were confirmed by pathology and immunohistochemistry,and analyzed the EUS features and the follow-up data of patients who received EUS exam and EUS-assisted endoscopic resection.Results A total of 47 neoplasms were detected in 44 patients,in which 41 were confirmed as neuroendocrine tumors (NET) and 6 were neuroendocrine carcinoma (NEC).Under EUS,all 41 NET appeared as hypoechoic lesions with regular edge and homogeneous echographic pattern,and 18 were originated from mucosal layer and 23 from submucosal layer,which was all confirmed by pathological evaluation.All 41 NET lesions received EUS-assisted endoscopic resection,in which 17 were treated by ESD/EMR and 24 by high frequency electrotomy.Follow-up endoscopy was performed at 3-6 and 12 month after operation,which showed no residual or recurrence.Conclusion EUS may accurately determine the invasion depth of GI-NEN lesions,and provide important information for adapting appropriate treatment strategies,which has highly clinical practice value in the diagnosis and treatment of GI-NEN.

OBJECTIVETo investigate the main factors that influence measles morbidity and the genotype of measles virus, so as to provide evidence for scientific decision making to further control the prevalence of measles.

METHODA retrospective analysis included 182 children in Children's Hospital of Fudan University, diagnosed with measles from January 1, 2012 to December 31. The clinical and epidemiological characteristics, including the gender, age, the incidence of seasonal trends, measles vaccine vaccination history, contact history and other clinical manifestations, laboratory test results, and so on were analyzed. And the reverse transcription PCR (RT-PCR) was adopted to detect sputum specimens from suspected patients with measles,who were selected randomly,the sequence of the part of the PCR products was analyzed.

RESULT(1) Clinical and epidemiological data: Totally were 182 children with measles (125 males, 57 females) were enrolled into this study. The age of the patients ranged from 3 months to 89 months, 127 cases were younger than 9 months (69. 8%). The prevalence season was from April to August, while the peak month was April and May (22. 5%, 23. 1%). Among 182 hospitalized children, only 11 cases underwent measles vaccination (6. 0%), and among them 5 cases were within 2 weeks before disease onset. A total of 167 cases (91. 8%) had not been vaccinated, most of whom were immigrants, and the measles vaccination history of the remaining 4 cases were unknown. There was a positive correlation between the measles vaccination ratio in children of the floating population (8. 45%, 6/71) and the settled children (29.4%, 5/17, χ =8. 11 P =0. 004). In total, 24 cases (13. 2%) had definite measles exposure history, with 153 cases (84. 1%) of unknown origin,5 cases (2.7%) without any history of contact. (2) Clinical manifestations: All the 182 patients had fever (100%) and obvious rashes (100%), among them 145 cases had body temperature higher than 39 °C (79. 7%). The fever period ranged from 2 to 38 days. Among 182 hospitalized children,165 cases (90. 7%) had typical measles,17 cases had atypical measles. Among the 17 cases, two had severe measles, one had heterotypic measles. (3) The common complica tions: 96 cases had pneumonia (52. 8%), 80 had laryngitis (44. 0%), 38 had bronchitis (20. 9%),15 had hepatic dysfunction (8. 2%), 11 had myocardial damage (6. 0%), 3 had febrile seizures (1. 6%), and no patient had encephalitis. Of the 96 cases with pneumonia, 92 received sputum test; 38 were sputum culture positive (41%). The dominant pathogens were Streptococcus pneumoniae(11/38,29%), Haemophilus influenzae (6/ 38,16%), Moraxella catarrhalis (4/38, 11%), Escherichia coli (4/38, 11%), Candida albicans (4/38, 11%), Mycoplasma pneumoniae (4/38, 11%) and Staphylococcus aureus (3/38, 8%). (4) The H1a genotype was the only one genotype in the detected sequence of 54 measles virus strains.

CONCLUSIONMeasles was more often seen in the children under the age of 9 months from the floating population. The morbidity peak month was from April to May in Shanghai. The H1a genotype was the only one genotype. We should try to improve vaccination coverage rate in the children who are at the age for vaccination, so as to prevent measles outbreak.

Child ; Child, Hospitalized ; Child, Preschool ; China ; epidemiology ; Disease Outbreaks ; Female ; Genotype ; Humans ; Infant ; Male ; Measles ; epidemiology ; Measles Vaccine ; administration & dosage ; Measles virus ; classification ; Retrospective Studies ; Vaccination ; statistics & numerical data

ObjectiveTo explore the correlation between butylphthalide and plasma brain-type creatine kinase isoenzyme (CK-BB),endothelin (ET),calcitonin gene related peptide (CGRP) in patients with acute cerebral infarction (ACI).MethodsSixty patients with ACI were divided into treatment group and control group with 30 cases each by random digits table method.Both groups received normal treatment continuously for 7 days,and butylphthalide of 200 mg was added to treatment group for 3 times per day.The levels of plasma CK-BB,ET and CGRP of two groups before and after treatment were measured and compared.ResultsThe levels of plasma CK-BB,ET of two groups both decreased significantly after treatment,but CGRP rose obviously.It showed significant differences before and after treatment of both groups (P ＜0.01 or ＜ 0.05).The levels of plasma CK-BB,ET of treatment group after treatment were lower than those of control group in the same period [(216.48±36.95) U/L vs.(333.07±54.03) U/L,(83.33±26.48)ng/L vs.(98.46±31.46) ng/L,P ＜ 0.05 ].The level of plasma CGRP of treatment group after treatment was significantly higher than that of control group in the same period [ (44.16±13.28 ) ng/L vs.(36.42±12.31 )ng/L,P ＜ 0.05 ].ConclusionButylphthalide can reduce the plasma enzyme activity,balance ET and CGRP,extend the cerebral arteries to antagonize ET,improve cerebral ischemia and cerebral hypoxia,which can protect brain cells and endothelial cells.

Objective To analyze the differences in endoscopic and pathological features between colorectal serrated adenoma (SA) and colorectal traditional adenoma.Methods The endoscopic and pathological features of 80 cases of SA and 160 cases of traditional adenoma diagnosed from June 2008 to October 2013 were retrospectively analyzed.Results The SA patients were younger than the traditional adenoma patients (57.5 VS 62.3,P =0.003 8).The lesions of SA were mostly located in rectosigmoid colon (60％),while the traditional adenoma could be found in rectosigmoid colon (45％),ascending colon (20％) and descending colon (19％).There were significant differences in the lesion's location between two kinds of adenoma (P ＜ 0.05).There were no differences in gender,the size of lesion or endoscopic classification.In terms of the pathological features,SA had the serrated structure,whereas tubular,tubulovillous and villous structure were found in traditional adenoma.Cancer could be found in 1.9％ of SA,which was lower than that of traditional adenoma (P ＜ 0.05).Conclusion Serrated adenoma is different from traditional adenoma on the patient's age,lesion's location and pathological features.It is an unique kind of adenoma with potential malignancy,which should be emphasized in clinical practice.

Objective:To observe the clinical efficacy of treating somatoform pain disorder(SPD)with electroacupuncture(EA)at the Governor and Conception Vessel points plus duloxetine.Methods:Eighty-two SPD patients were randomly allocated to an observation group and a control group,with 41 cases in each group.The control group was intervened by oral administration of duloxetine hydrochloride enteric capsules at a dose of 60 mg per time once a day;based on the medication,the observation group received additional EA treatment by selecting points from the Governor and Conception Vessels.Clinical efficacy was evaluated after 8 weeks of treatments;changes in the scores of the short-form McGill pain questionnaire(SF-MPQ),self-report symptom inventory,symptom check list-90(SCL-90),Pittsburgh sleep quality index(PSQI),and generic quality of life inventory-74(GQOLI-74)were also compared.Results:After the intervention,the observation group surpassed the control group in comparing the total effective rate(P＜0.05).The SF-MPQ score,SCL-90 somatization score,and PSQI score dropped notably in both groups after treatment,and the intra-group differences were statistically significant(P＜0.05);the three scores were significantly lower in the observation group than in the control group(P＜0.05).The GQOLI-74 score got an increase in each dimension in both groups after treatment,and the intra-group differences were also statistically significant(P＜0.05);the GQOLI-74 dimension scores were all significantly higher in the observation group than in the control group(P＜0.05).Conclusion:For patients with SPD,combining EA at the Governor and Conception Vessel points and duloxetine hydrochloride enteric capsules can markedly improve their clinical symptoms and quality of life.

Objective To determine the affinities of five oligopeptides specifically binding with DNA binding domain of NF-?B p65 subunit and identify their inhibiting effect on DNA binding activity of NF-?B. Methods By using biosensor the affinities were measured by means of kinetic analysis, and the inhibiting effects were determined by competitive ELISA. Results The results of biosensor showed that all of five oligopeptides really possessed the capability of specific interacting with NF-?B p65 subunit. The affinity constants of these oligopeptides were 2.67?10~ -7 mol/L, 9.02?10~ -6 mol/L, 1.07?10~ -6 mol/L, 8.03?10~ -6 mol/L, 9.83?10~ -7 mol/L respectively. The results of competitive ELISA indicated that five oligopeptides could inhibit NF-?B from binding with ?B motif, and their inhibiting effect depended on their concentration. Conclusion Five oligopeptides that were screened by yeast two-hybrid system method can really interact with p65, and possess the inhibiting effect on DNA binding activity of NF-?B. So it will be possible that these oligopeptides are regarded as model to design and develop novel anti-inflammatory peptide drug targeting NF-?B.