The paper investigates 31 foreign representative clinical knowledge base,analyzes development status including the establishment and maintenance institutions,user version control,localization application,clinical evidence resources,clinical specific content representation,evidence quality evaluation criteria and so on,summarizes revelation for domestic clinical knowledge base construction.

Sentinel lymph node biopsy has been proved to be the standard treatment for early breast cancer patients with negative axillary lymph node. The study related to the tracer has become one of the hottest topics in breast cancer research. At present, the biopsy is often performed using the tracer of isotope, blue dye or both of them. However, some deifciencies of the 2 tracers restrained their applications, which resulted that the rate of the procedure is limited to only about 60% of patients in developed countries and less than 5% of patients in China and other developing countries. In recent years, a variety of new tracers have emerged, such as indocyanine green, contrast-enhanced ultra-sound using microbubbles, superparamagnetic iron oxide nanoparticles. In this article, we introduced the characteristics of these 3 substances and reviewed the related research on the new tracers. In conclusion, the new tracers are still in the preliminary stage of research, and further research is needed for clinical application.

In vitro fertilization and embryo transfer(IVF-ET) technology is one of the important means to treat infertility in recent years,although it had made remarkable progress in the field of reproductive medicine,but IVF-ET pregnancy success rate is not very ideal,the reasons that influent the success of IVF-ET include both parents donor of various unfavorable factors and stimulate ovulation itself produces all sorts of malpractices,its influence factors are complicated.In recent years,how to reduce the adverse factors affecting IVF-ET,to improve the success rate of pregnancy of IVF-ET has become the hot topics in the study of domestic clinical intervention in IVF-ET,and the domestic research shown that the quality of the follicle and endometrial environment is the key to determine the success of IVF-ET.

Objective To explore the C-type fixation in the application of the catheter tunnel peritoneal dialysis. Methods One hundred and twenty patients undergoing peritoneal dialysis were selected from January to December 2014 in Xijin Hospital and were randomly divided into the control group and experiment group. The peritoneal dialysis catheters of the control group were fixed vertically at the tube orifice with surgical tape, while the peritoneal dialysis catheters of the experiment group were fixed horizontally first and then placed with a shape ofC and fixed at the tube orifice with surgical tape. The two groups were compared in terms of tunnel score, infection, tube shedding and pulling-induced stimuli. Result The tunnel score and the cases of infection rate, tube shedding and pulling-induced stimuli in the experiment group were lower and fewer than those of the control group with statistical significance (all P <0.05). Conclusion The type C fixation of tube for peritoneal dialysis can effectively reduce the incidence of infections in patients with peritoneal dialysis tunnel, reduce pulling-induced stimuli, and improve comfort of the patients.

Gastric neuroendocrine neoplasms (G- NEN) is a type of relatively rare and heterogeneous tumors mainly derived from enterochromaffin-like cells (ECL-cells) localized in the gastric mucosa. The incidence of G-NEN has increased over the past few decades, which may contribute to factors such as improved clinical and pathological experience in diagnosing this disease, as well as increased access to endoscopy. The biological behavior, clinicalpathological features and treatment response of G-NEN are different from those of pancreatic or intestinal neuroendocrine neoplasms. The diagnosis of G-NEN mainly depends on endoscopy and pathology. Conventional imaging and somatostatin receptor imaging may help to diagnose the disease stage. Treatment requires a multidisciplinary approach that may include endoscopic resection, surgery, chemotherapy, somatostatin analogues, intervention, PRRT, etc. The present study reviews the relevant guidelines in combination of our experience and research and aims to elaborate the epidemiology, clinical classification, diagnostic modalities and treatment options.

Humans ; Hypertension ; Occupational Diseases ; Stress, Psychological

BACKGROUND:Although increasing studies have shown that autologous bone marrow stem celltransplantation can treat myocardial infarction, but there is a lack of large-scale multi-center randomized control ed trials to il ustrate the therapeutic effectiveness of autologous bone marrow stem celltreatment for myocardial infarction. OBJECTIVE:To systematical y evaluate the improvement of heart function in patients with myocardial infarction undergoing autologous bone marrow stem celltransplantation. METHODS:Cochrane Central Register of Control ed Trials (Central), MEDLINE, EMbase, PEDro (www.pedro.org.au), OpenSIGLE, National Technical Information Service (NTIS), CNKI, VIP database (VlP), Wanfang Data and Chinese biomedical literature database (CBM) were searched for the randomized control ed trials addressing bone marrow stem celltransplantation for heart function in patients with myocardial infarction. The bibliographies of the included studies were also searched. The time span was from database establishment to November 2012. The extracted data were analyzed by RevMan5.1. RESULTS AND CONCLUSION:A total of 14 randomized control ed trials were included. Results from the meta-analysis showed that the ejection fraction and cardiac output of patients undergoing bone marrow stem celltransplantation was significantly different from those of patients without celltransplantation (WMD=5.23, 95%CI (0.73, 9.72), P<0.01;WMD=1.69, 95%CI (1.23, 2.16), P<0.000 01). Current evidence has demonstrated that bone marrow stem celltransplantation can remarkably improve the ejection fraction and cardiac output of myocardial infarction patients, which can be clinical y recommended for improvement of heart function. Due to the limitations of the included studies, more large-sample, multi-center high-quality randomized control ed trials are required to further verify the therapeutic methods and effectiveness.

BACKGROUND:Methylprednisolone has been used for the treatment of acute spinal cord injury but there is a dispute about the efficacy and safety of methylprednisolon. OBJECTIVE:To evaluate the efficacy and safety of methylprednisolon based on system review. METHODS:PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to December 2014 for relevant randomized clinical trials on the treatment of acute spinal cord injury with methylprednisolon. RESULTS AND CONCLUSION:Twelve randomized clinical trials with 642 acute spinal cord injury patients were included. The results of the Meta analysis showed: methylprednisolone+conventional therapy was better to improve American Spinal Injury Association (ASIA) motor function score, ASIA touch sensation score, ASIA pinprick sensation score and the overal Frankel score than the conventional therapy alone (control group) with statistical significance (P < 0.05). In the aspect of safety, the methylprednisolone group had higher death ratio, digestive tract reaction ratio and urinary infection ratio than the control group but with no statistical significance. The gastrointestinal bleeding ratio and lung infection ratio was significantly higher in the methylprednisolone group than the control group (P < 0.05). We conclude that methylprednisolone has protective effect on acute spinal cord injury, but the main side effects are gastrointestinal bleeding and lung infection. There is a need for high-quality randomized controled trials to prove the efficiency and safety of methylprednisolone.

Objective To describe the imaging findings of pancreatic and extra-pancreatic lesions of autoimmune pancreatitis (AIP),to improve the imaging diagnostic accuracy of AIP.Methods From 2011 to June 2014,38 AIP patients according to 2010 international consensus diagnostic criteria for AIP were included.Thirty-six patients underwent contrast enhanced CT scan,17 patients underwent contrast enhanced MRI,15 underwent MRCP,and the imaging data were retrospectively reviewed.Results In the 38 patients,the pancreas showed diffuse enlargement in 23,focal enlargement in 9,mixed enlargement in 6.All the patients demonstrated as progressive enhancement and gradually delayed enhancement.Fourteen cases showed diffusely irregular narrowing of the main pancreatic duct.Pseudo-capsule like structure was presented around the lesions in 24 cases.Extra pancreatic lesions included biliary duct involvement in 24 cases,renal lesions in 4 cases,peri-pancreas vessels involvement in 20 cases,8 cases with enlargement of lymph nodes.Conclusions AIP presents with characteristic imaging features in pancreas and extra pancreatic organs.Imaging tests are helpful in the early diagnosis of AIP.

Objective To analyze the nutritional status of premature neonates first fed with extensively hydrolyzed protein formula.Methods From January 2013 to December 2014, 157 premature neonates hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Medical Center who were first fed with extensively hydrolyzed protein formula were enrolled.Clinical data were recorded, including related diseases, birth weight and gestational age, nutrients intake, and growth charts.Two groups were divided according to the existence or absence of feeding intolerance, and three groups were divided based on birth weight (＜ 1 500 g, 1 500 ～ 2 500 g,and ≥2 500 g).Results A total of 60 (38.2％) premature infants had feeding intolerance.The lower the birth weight and gestational age, the higher the frequency of feeding intolerance, and the incidence of feeding intolerance in ＜ 1 500 g group was 71.1％.Compared with the feeding tolerance group, the feeding intolerance group had significantly smaller birth weight [(1 620 ±440) g vs.(1 980 ±421) g, P =0.000], gestatonal age [(31.3 ±2.6) weeks vs.(33.0 ±2.1) weeks, P =0.000], birth head circumference [(28.9 ±2.2) cm vs.(30.4±1.9) cm, P=0.000], and birth length [(41.1 ±3.9) cmvs.(43.2±3.4) cm, P=0.000],but significantly longer time before transfer formula [(26.4 ± 17.6) d vs.(7.9 ± 5.3) d, P =0.000] and time before reaching sufficient feeding [(21.5 ± 10.0) d vs.(13.8 ± 6.2) d, P =0.000].The time of first feeding [＜ 1 500 g group (6.1 ±5.1) d, 1 500 ～2 500 g group (3.8 ±2.5) d, ≥2 500 g group (3.3 ± 1.2) d,P =0.002], time before transfer formula [＜ 1 500 g group (28.7 ± 18.3) d, 1 500 ～ 2 500 g group (9.7 ± 8.1) d, ≥2 500 g group (7.0 ±3.8) d, P =0.000] and time before reaching sufficient feeding [＜ 1 500 g group (24.0±10.4) d, 1 500～2 500 g group (14.3±6.0) d, ≥2 500 g group (11.4±3.5) d, P=0.000] increased along with the decrease of birth weight.The proportions of infants receiving parenteral nutrition in the feeding intolerance group (93.3％) and ＜ 1 500 g group (97.8％) were higher, with more calorie intake from parenteral nutrition [＜ 1 500 g group (325.9 ± 59.4) kJ/ (kg · d), 1 500 ～ 2 500 g group (281.2±64.8) kJ/ (kg·d), ≥2 500 g group (269.9 ±43.9) kJ/ (kg·d),P=0.001] and longer duration [＜ 1 500 g group (27.1 ± 14.5) d, 1 500 ～2 500 g group (13.0 ±7.0) d, ≥2 500 g group (8.7 ± 3.4) d, P =0.000].In terms of growth indicators, the increase in head circumference was significantly higher in the feeding intolerance group than in the feeding tolerance group [(0.7 ± 0.6) cm/week vs.(0.6 ± 0.5) cm/week, P =0.045].The increases in body weight and head circumference in the ＜ 1 500 g group were significantly higher than in the other 2 birth weight groups [body weight: ＜ 1 500 g group (21.8 ± 9.5) g/d, 1500～2500ggroup(4.2±7.6) g/d, ≥2 500 g group (4.9 ±11.9) g/d,P=0.000;head circumference : ＜ 1 500 g group (0.8 ± 0.4) cm/week, 1 500 ～ 2 500 g group (0.5 ± 0.4) cm/week, ≥ 2 500 g group (0.6 ± 0.8) cm/week, P =0.005].After controlling the variable of feeding intolerance,weight gain was negatively associated with gestational age (r =-0.666, P =0.035), birth weight (r =-0.700, P =0.024), head circumference (r =-0.846, P =0.002), and the day of returning to birth weight (r =-0.697, P =0.025), while positively associated with head circumference gain (r =0.672, P =0.033).There were no relationship between weight gain and birth length, the day of first feeding, time before transfer formula, time before reaching sufficient feeding, parenteral nutrition calorie and duration, days of hospital stay and complications.Conclusions First fed with extensively hydrolyzed protein formula, the growth in feeding intolerant premature infants may be similar to the feeding tolerant ones, which is associated with parenteral nutrition support.Premature infants with lower gestational age, birth weight, and head circumference may be more suitable for extensively hydrolyzed protein formula feeding.