Objective To understand the cleaning status of hospital environment,and evaluate the effect of fluo-rescence labeling method plus feedback and training on hospital environmental cleaning effectiveness.Methods A total of 27 departments in a hospital were investigated,1 cleaning staff and 2 inpatients were selected from each de-partment,cleaning staff’s knowledge about cleaning and disinfection of environmental object surfaces,as well as cleaning status of inpatients’wards were surveyed,cleaning efficacy of hospital environmental object surfaces were detected with fluorescence labeling method,the surveyed results were performed timely feedback to clinical depart-ments,training on cleaning and disinfection knowledge was conducted,the effective cleaning rate of environmental object surface before and after the training was compared.Results A total of 27 cleaning staff were surveyed,the correct response rate for cleaning frequency was 96.30% ,awareness rate for section concept was 96.30% ,accuracy rate of cleaning order was 92.59% ,accuracy rate of post-cleaning immersion time of sanitary wares in disinfectant was 85.19% ,accuracy rates of replacing,drying,and repeated immersing wiping cloths were 81.48% ,48.15% ,and 25.93% respectively,rates of correct disinfectant formulating method and mop drying time were both 0. Among 54 investigated patients,bed units and ground of wards of 28 patients were cleaned both 1-2 times/day;bed units of 8 patients had never been wiped,18 patients in 9 departments cannot be conducted statistics due to completely in-consistent responses with the other patients of the same departments. The effective cleaning rates of environmental object surfaces before and after the training were 34.62% and 64.96% respectively,difference was significant(χ2=21.81,P<0.01).Conclusion Fluorescence labeling method plus feedback and training can improve cleaning efficacy of hospital environmental object surfaces.

Objective:To assess the application value of reflectance confocal microscopy (RCM) in evaluating clinical efficacy of hemoporfin-mediated photodynamic therapy for purple-type port-wine stain.Methods:From April 2018 to January 2020, a total of 39 patients with centrofacial purple-type port-wine stains were enrolled from Department of Dermatology, Wuhan No.1 Hospital, and received 3 sessions of hemoporfin-mediated photodynamic therapy. Before the first treatment, and 3- 6 months after 3 sessions of hemoporfin-mediated photodynamic therapy, skin lesions were photographed, and RCM was conducted to measure the diameter and density of blood vessels at a depth of 100 μm in the lesions. Clinical efficacy was evaluated based on the clinical photos, and the average diameter of blood vessels and density of blood vessels per square millimeter of lesion area were calculated. Measurement data were compared among different groups by using one-way analysis of variance, multiple comparisons were performed using least significant difference test, and comparisons of parameters before and after treatment were conducted by using paired t test. Results:After 3 sessions of hemoporfin-mediated photodynamic therapy, 1 (2.56%) patient was nearly completely cured, 16 (41.03%) received marked improvement, 20 (51.28%) received improvement, and 2 (5.13%) showed no response to the treatment. In the patients receiving marked improvement or improvement, the average diameter and density of blood vessels significantly decreased after treatment compared with those before treatment (all P < 0.05) , while no significant difference was observed before and after treatment in the patients with no response (both P > 0.05) . The average difference in the blood vessel diameter before and after treatment was significantly higher in the patients receiving marked improvement (48.56 ± 17.87 μm) than in those receiving improvement (31.15 ± 21.09 μm, P < 0.05) and those with no response (12.00 ± 2.83 μm, P < 0.05) . The average difference in the blood vessel density before and after treatment was 7.13 ± 3.44, 5.00 ± 2.22 and -0.50 ± 3.54 vessels/mm 2, respectively, in the patients receiving marked improvement, improvement and those with no response, and pairwise comparisons between the 3 groups all showed significant differences (all P < 0.05) . Conclusion:RCM can be used to assess the average diameter and density of blood vessels in the port-wine stain lesions before and after hemoporfin-mediated photodynamic therapy, and is helpful in quantitatively evaluating the therapeutic effect of hemoporfin-mediated photodynamic therapy.

The expression of Survivin, CDK4 and Ki-67 and the clinical significance in pediatric acute leukemia (AL) were investigated. The expression of Survivin, CDK4 and Ki-67 proteins was detected by using immunohistochemical assay in 37 children with AL and 10 children with normal bone marrow as controls. The positive expression rate of Survivin, CDK4 and Ki-67 was 45.9 %, 56.8 %, and 40.5 % respectively in 37 AL children, which was significantly higher than in control group accordingly (P<0.05). The expression of Survivin was positively correlated with CDK4 (P=0.007) and Ki-67 (P=0.008). In conclusion, all Survivin, CDK4 and Ki-67 proteins are over-expressed in pediatric AL and involved in the modulation of apoptosis and proliferation in pediatric AL.

The expression of silence of death domains (SODD) and its clinical significance and relationship with phospho-NF-kappaB-p65 proteins in bone marrow cells of childhood acute lymphoblastic leukaemia (ALL) were explored, and the expression of SODD and phospho-NF-kappaB-p65 in Jurkat cells treated with chemotherapeutic drugs was detected in order to find a new chemotherapeutic target. The expression of SODD and phospho-NF-kappaB-p65 proteins in bone marrow cells was detected by immunohistochemistry in 25 children with ALL. The apoptosis rate was measured by Annexin-V-Fluorescence/PI double-labeling flow cytometry and the expression of SODD and phospho-NF-kappaB-p65 proteins determined by Western blotting in the Jurkat cells. It was found that the expression of SODD and active P65 in ALL was significantly higher than that in normal control group (P<0.05). The expression of the SODD and phospho-NF-kappaB-p65 proteins in the high-risk (HR) group was significantly higher than that in the standard-risk (SR) group (P<0.05). The Pearson rank correlation analysis revealed that there was a positive correlation between SODD and phospho-NF-kappaB-p65 expression (P<0.01, r=0.69). VCR could effectively induce the apoptosis of Jurkat cells, and down-regulate the expression of SODD and phospho-NF-kappaB-p65 proteins in a time-dependent manner, but DNR could not down-regulate the expression of SODD effectively. It was concluded that SODD may be closely related to the clinical classification and prognosis of ALL in children. The expression of SODD and phospho-NF-kappaB-p65 had a definite synergistic relationship with the onset and development of ALL. VCR could down-regulate the expression of SODD and inhibit the NF-kappaB activation, which could recover the sensibility of apoptosis in leukemic cells.

Objective To analyze the clinical features of pediatric patients with acute lymphoblastic leukemia(ALL) with bcr-abl fusion gene transcript,and discuss the treatment,prognosis factors of this kind of ALL.Methods Clinical features,treatment and prognosis were studied retrospectively in 7 bcr-abl fusion gene positive ALL patients.bcr-abl fusion gene was detected by reverse transcription polymerase chain reaction (RT-PCR).Results The average age of the 7 patients was 8 years and 1 month old.All of them were common B-immunology ALL.The rate of complete response was 50 ％ after 33 days' treatment.Conclusions The incidence rate of bcr-abl fusion gene positive ALL in pediatric is low.This type of ALL has poor remission,high relapse rate and poor prognosis.

Objective To investigate the clinical value of the massive transfusion protocols (MTP) in abdominal surgical patients with traumatic shock.Methods An analysis was made on the clinical data of patients before and after the use of MTP,including the general condition,amount of blood transfusion,transfusion components and ratio,blood and coagulation function test,and blood transfusion related complications and mortality.Results Before implement of MTP,the average RBC transfusion in the first 24 hours was 19.5U,FFBwas 12.6U,and the ratio ofRBC ∶ FFB was 1.55 ∶ 1.After implement of MTP,the average RBC transfusion in the first 24 hours was 17.3 U,and the ratio of RBC:FFB was 1 ∶ 1.There were no significant statistical differences between the two groups about PT,APTT,Hb and PLT on admission.After 24 hours of admission,there was no significant difference in Hb between the two groups,there were significant differences of PT,APTT and PLT.Blood transfusion related complications were 11 (14.9％) in control group and 7 (11.9％) in MTP,group,and the mortality was 9.46％ and 6.78％ respectively.Conclusions MTP improves blood coagulation function,reduces blood transfusion and enhances survival rate of abdominal surgical patients with traumatic shock.

Objective To introduce the application of multiplex ligation-dependent probe amplification (MLPA) assays in the diagnosis of patients with hereditary neuropathy with liability to pressure palsies (HNPP).Methods Copy numbers of the exons in peripheral myelin prolein 22 (PMP22) gene,tektin 3 (TEKT3) gene and cytochrome c oxidase assembly protein 10 (COX10) gene were analyzed by MLPA in 8 patients diagnosed with HNPP clinically and 5 normal controls.Results Among the 8 patients,7 patients were identified to have deletion mutations according to their reduced peak area of PMP22 gene,TEKT3 gene and COX10 gene compared with that of normal controls.One patient with normal peak area of PMP22 gene,TEKT3 gene and COX10 gene showed no deletion of these genes.Conclusions MLPA assays can detect the copy numbers of genes in HNPP region through semi-quantitative analysis in a rapid,accurate way,which may be utilized widely in the genetic diagnosis among HNPP patients.

Objective To study the molecular mechanism of berberine induced apoptosis in chemoresistant EU-4 acute lymphocytic leukemia cells.Methods EU-4 cells were treated with 0,10 and 100 μmol/L berberine for 72 h.The apoptosis induced by berberine was detected by flow cytometry.The expression of Caspase-3,PARP and X-linked inhibitor of apoptosis protein (XIAP) were determined by Western bolt assay.Caspase-3 activity was measured using microplate reader.After transfected with XIAP siRNA,the apoptosis was detected by flow cytometry.Results After treated with 0,10 and 100 μmol/L berberine for 72 h,the apoptosis rates of EU-4 cells were (9.08±1.20) ％,(22.36±2.16) ％ and (59.81±4.17) ％,respectively.Berberine induced potent apoptosis in a dose-dependent manner.The apoptosis involved activation of Caspase-3.The Caspase-3 activities were 1.70±0.25,1.92±0.10 and 2.89±0.25,respectively.Berberine inhibited XIAP expression in a dose-and time-dependent manner (P ＜ 0.05).Down-regulation of XIAP by siRNA increased apoptosis of EU-4 cells.The apoptosis rates were (9.23±1.66) ％ and (22.15±0.63) ％.Conclusion Berberine could induce apoptosis of EU-4 cells,and inhibition of XIAP leading to Caspase-3 activation is responsible for the apoptotic effect on EU-4 cells.

Objective To investigate the association of genetic polymorphisms of ATIC and GSTP1 with plasma concentrations and adverse reactions of high-dose methotrexate( HD-MTX)in children with acute lymphoblastic leukemia (ALL). Methods A total of 70 peripheral blood samples were obtained from ALL children for extraction of genome DNA.The gene polymorphisms of ATIC T26293C and GSTP1 A313G locus were examined by using PCR and direct sequencing.Enzyme multiplied immunoassay technique(EMIT)was employed to determine the plasma concentration of MTX in 48 h.Clinical data of patients were collected during HD-MTX chemotherapy,and the adverse reactions were statistically analyzed.The associations of ATIC and GSTP1 genotypes with MTX plasma concentration and adverse reactions were investigated. Results There were genetic polymorphisms at the SNP of ATIC T26293C and GSTP1 A313G.At the SNP of ATIC T26293C,the percentages of TT, CT and CC genotypes in ALL children were 4.35%,39.13% and 56.52%,respectively,and the frequencies of T and C alleles were 23.91% and 76.09%.At the SNP of GSTP1 A313G,the percentages of AA,GA and GG genotype were 68.57%,28.57%and 2.86%,respectively,in ALL children. The frequencies of A and G alleles were 82. 86% and 17. 14%,respectively. No statistically significant difference was found in the ratio of blood MTX concentration to MTX dose at 48 h between children with different genotypes(P>0.05).In the GSTP1 A313G site,genotypes that induced the gastrointestinal reactions in the order from low to high were AA,GA,GG,and there was a significant association between gene polymorphism and gastrointestinal side effects(P<0.05).In the GSTP1 A313G site,genotypes that induced myelosuppression in the order of low to high were GG,AA, GA,and a significant association was noted between gene polymorphism and myelosuppression(P<0.05). Conclusion There are significant associations between GSTP1 A313G polymorphism and gastrointestinal side effects or myelosuppression after HD-MTX chemotherapy in ALL children.

A 9-year-old boy presented with pruritic erythema and erosions of the scalp for 1 month, which spread all over the body for 1 week. Histopathological examination of the skin lesions showed blisters forming under the granular layer of the epidermis, a large number of acantholytic cells in the blisters, and perivascular infiltration of lymphocytes and eosinophils in the superficial dermis. Direct immunofluorescence study showed reticular deposition of IgG and complement C3 between epidermal cells, and negative staining for IgM and IgA. Enzyme-linked immunosorbent assay showed the presence of serum anti-Dsg1 antibody (157.00 U/ml) . The patient was diagnosed with pemphigus foliaceus. After admission, the patient showed poor response to the treatment with prednisone at a dose of 40 mg/d. After the treatment with low-dose rituximab (100 mg per week, 4 weeks) combined with prednisone (20 mg/d) , her condition was well controlled. The dosage of prednisone gradually decreased to 7.5 mg/d for maintenance treatment, and no recurrence was observed during 24-month follow-up.