Objective To systematic review the clinical efficacy and safety of infliximab in treatment of severe alcoholic hepatitis (SAH).Methods The electronic database of PubMed,EMbase,Web of Science,OVID and Cochrane systematic review database,CBM disc and CNKI from building the database until March 2013 were retrieved.With SAH,severe alcoholic hepatitis,infliximab and tumor necrosis factor as key words or free words.Randomized-controlled trials (RCT) on infliximab in treatment of SAH was selected and analyzed by Meta analysis.Results Two RCTs was enrolled,included 56 SAH patients.Infliximab (10 mg/kg) combined with glucocorticoids (40 mg/d) might accelerate death because of the high prevalence of serious infections.Infliximab (5 mg/kg) combined glucocorticoids (40 mg/d) had more tolerability and improved patient's Maddrey scores significantly.Conclusions Existing clinical evidence suggest that it is short of evidence for the clinical efficacy and safety of infliximab.It need guide by large sample of clinically and different doses RCT.

Objective To analyze the effect of clinical pathway management for capillary bronchitis in Department of Pediatrics.Methods 75 children with capillary bronchitis after the implementation of clinical pathway management were selected as the observation group,and 68 children with capillary bronchitis before the implementa-tion of clinical pathway management were selected as the control group.The hospitalization cost,average hospital stay, antibiotic use rate,cure rate,nonsocomial infection rate,rehospitalization rate within two weeks,service satisfaction and other comprehensive indices were compared.Result The total cost of drug of the observation group[(1 198.49 ± 397.48)yuan]was lower than (1 324.05 ±376.57)yuan of the control group(Z =2.00,P <0.05).The average hospital stay of the observation group[(6.99 ±2.39)d]was shorter than (8.01 ±2.22)d of the control group(Z =2.62,P <0.05).The service satisfaction rate of the observation group(95%)was higher than 82% of the control group(χ2 =5.44,P <0.05).The antimicrobial use rate of the observation group(49%)was apparently lower than 95% of the control group (χ2 =27.59,P <0.01).There were no statistically significant differences between the two groups in cure rate(hospital discharge rate),nosocomial infection rate and rehospitalization rate within two weeks(all P >0.05).Conclusion Clinical pathway management for capillary bronchitis in Department of Pediatrics of primary hospital can play a role in standardizing medical practice,reducing average hospitalization days,controlling medical cost,and improving service satisfaction under the precondition of ensuring medical quality.

OBJECTIVE To investigate conditions and features of antimicrobial resistance in Streptococcus pneumoniae clincal isolates.METHODS Totally 203 strains of S.pneumoniae were isolated from Jan 2005 to Dec 2006 in Yuying Pediatric Hospital of Wenzhou Medical College.Then the antimicrobial susceptibility test to ten drugs and the MICs of penicillin were detected.RESULTS In 203 S.pneumoniae strains,all were sensitive to vancomycin,were sensitive to 98.0%,levofloxacin,the sensitivity of penicillin,erythromycin,tetracycline,clindamycin and SMZ was lower than 15.0%.The penicillin insensitivity of 203 strains reached 86.2%.There were 24 of the 203 strains for which penicillin MICs were ≥4 ?g/ml.CONCLUSIONS S.pneumoniae clinical strains are resistant to most of the commonly used antibiotics.The percentage of high level multidrug resistant strains is very high.Vancomycin and levofloxacin are the most sensitive drugs for S.pneumoniae clinical strains,the next are chlorophenicol.Erythromycin,SMZ,tetracycline and clindamycin aren′t useful in treating S.pneumoniae infection.

Objective To discuss the potential relationship between endometrial serous carcinoma (ESC) and tubal epithelial lesions by pathologic examination of fallopian tubes with ESC. Methods A total of 30 cases of typical ESC were reexamined and chosen by the pathologist. In each case, bilateral fallopian tubes were submitted to examination of pathologic morphology and immunostaining for p53, annexin Ⅳ(ANX-Ⅳ), human epidermal growth factor receptor 2(HER2)/neu, and high-mobility group protein A2 (HMGA2). Results Fallopian tubal epithelial lesions were found in 15 cases, including 9 cases tubal serous carcinoma, 2 cases serous tubal intraepithelial carcinoma (STIC) and 2 cases epithelial hyperplasia. Both sides of tubal serous carcinoma and STIC were found in 1 case. The results showed the positive expression for p53 in 26(87%)out of 30 endometrial malignant specimens tissues and 9(30%)tubal tissues samples (P>0.05). Twenty-five(83%)endometrial malignant specimens tissues and 6(20%)tubal tissues samples showed the positive expression of ANX-Ⅳ. Twenty-one(70%)endometrial malignant tissues and 7(23%) tubal tissues showed the positive expression of HER2/neu. Twenty-five(83%) endometrial malignant tissues and 6(20%)tubal tissues showed the positive expression of HMGA2. While, there were significant differences among the expression of three proteins between endometrium and the fallopian tube site (all P<0.05). Conclusions STIC may be associated with the occurrence of ESC. The expression of p53 was positively correlated between the fallopian tube and the endometrium. ANX-Ⅳ,HER2/neu and HMGA2 were extensively expressed in ESC.

Objective To observe the efficacy of proparacaine hydrochloride in preoperative venipuncture. Methods Two hundred and furty patients hospitalized for preoperative venipuncture, between June 2015 to December 2015 in Jiangmen Central Hospital, were equally randomized into the intervention group and control group: the former was treated with proparacaine hydrochloride and the control group used traditional method. Visual analogue scale (VAS) was adopted to assess the effects of the anesthesia effect. At the same time the one-time success rate of puncturing and the adverse reactions were observed and compared between the two groups. Results Patients of the intervention group felt significantly less painful than that the control one (P<0.05). The successful rate of the intervention group was significantly higher than that of the control group (P<0.05). Conclusion Proparacaine hydrochloride is safe and effective for preoperative which reduces pain.

Objective To investigate the effects of peptide-binding domain (PBD) of heat shock protein (HSP) 72 on epithelial to mesenchymal transition (EMT) in rat renal tubular epithelial cells.Methods The expressions of wild-type HSP72,mutant of HSP72 lacking peptide binding domain (HSP72-△PBD) and HSP72-PBD were induced by plasmid transfection.NRK-52E ceils were stimulated by TGF-β1 for 48 h.The expressions of α-smooth muscle actin (α-SMA),E-cadherin,HSP72 and Smad3/p-Smad3 were detected by Western blot and immunofluorescence.Results After NRK-52E cells were stimulated by TGF-β 1 (10 μg/L) for 48 h,the expression of α-SMA was increased and the protein level of E-cadherin was decreased.Western blotting and immunofluorescence showed that over-expression of both HSP72 and PBD inhibited TGF-β1-induced up-regulation of protein α-SMA expression,down-regulation of protein E-cadherin.However,overexpression of HSP72-△PBD did not change the protein level of E-cadherin and α-SMA.In addition,over-expression of HSP72 and PBD significantly inhibited the phosphorylation of Smad3.Conclusion Inhibition of Smad3 activation and EMT by HSP72 is associated with the function of PBD.

Objective To analyze the nutritional status of patients with continuous ambulatory peritoneal dialysis and explore reasonable and effective nursing measures.Methods Nutritional assessment was performed in 60 patients with continuous ambulatory peritoneal dialysis,using subjective integrated nutritional assessment,dietary analysis,measurement of biochemical indexes of the human body to analyze the factors that might affect the nutritional status of patients.Results 60 cases of malnutrition occurrd in 20 patients (33.3per cent),mainly due to insufficient protein and energy intake,inadequate dialysis,peritoneal inflammation,metabolic acidosis,psychosocial factors and not using erythropoietin,and so on.Conclusions Measures such as emphasis paid to malnutrition status of continuous ambulatory peritoneal dialysis patients,giving guidance of rational diet,performing full implementation of nursing measures according to the related factors,can improve the nutritional status of patients and improve patients' quality of life.

Objective The cytotoxic effect of bile acids on trophoblast and fetal development in intrahepatic cholestasis of pregnancy(ICP) were studied through the observation of ultrastructure changes and expression of epidermal growth factor receptor(EGFR) of placenta. Methods Twenty two ICP (7 with FGR and 15 without FGR) and 15 normal late pregnancies were selected. The placental ultrastructure was observed with transmission electron microscope. The expression of EGFR in placenta was determined by immunohistological method and the related quantity of EGFR mRNA was analysed by reverse transcription polymerase chain reaction (RT PCR). Results The morphological changes found in syncytiotrophoblast were the following: decrease in the number of superficial microvilli, dilatation of rough endoplasmic reticulum, tumefation or myelination of the mitochondria and abnormal distribution of chromatin. These changes of syncytiotrophoblast were more obvious in ICP with FGR. In addition, decrease in the number of capillaries and proliferation of degenerated collagenous fibrils in villi interstitium were also observed. Compared with the normal pregnancies, the expression of EGFR in placenta from ICP decreased significantly and there was no significant difference of EGFR expression in ICP with and without FGR. Conclusion Bile acids cause distinct injuries on trophoblast in a dose dependent manner and that maybe account for the decreased expression of placental EGFR in ICP.

Objective To assess the value of magnetic resonance diffusion weighted imaging(DWI) and apparent diffusion coefficients(ADC) values of hepatic alveolar echinococcosis(HAE) in children.Methods 20 cases of children(≤14 years) with HAE were collected in this restrospective study.PNM staging was determined, the HAE peripheral area of DWI lesions with different P stages was observed, and the ADC value of the peripheral area was measured.The comparison of alveococcus lesions in different stages of DWI with continuous edge degree and ADC value difference was done to evaluate the growth activity.Results There were 5 cases of P1 lesions, 7 cases of P2 lesions, 2 cases of P3 lesions and 6 cases of P4 lesions.DWI features of peripheral area were as follows: High signal ring band between HAE lesion edge and adjacent normal hepatic parenchyma was observed.P1 lesions showed almost complete obviously high signal peripheral area, indicating the most active proliferation, P2 and P3 lesions of peripheral area were continuous and with high signal, and still had obvious growth activity.P4 lesions of peripheral area were not continuous, while the signal decreased, indicating the activity also decreased.The highest ADC value was detected in P1 lesions group of and the ADC value of P2 lesions group were lower than P1, and the ADC value of P4 lesions group were the lowest.P3 lesions samples were too small and thus no statistical analysis was done.Differences of ADC value between the three groups were statistically significant (P<0.05).Conclusion DWI image features could be used to assesse the growth activity of HAE in children with different stages to a certain extent.ADC values measurement provides important reference value for evaluating the growth activity at various stages of the lesions.