Objective To systematically review the Helicobacter pylori eradication efficacy with ranitidine bismuth citrate(RBC) and two antibiotics,and to conduct a meta-analysis of randomized clinical trials comparing the efficacy of proton pump inhibitor(PPI)vs RBC with two antibiotics for 1 week.Methods Selection of studies:studies evaluating RBC plus two antibiotics were considered.For the meta-analysis,randomized controlled trials comparing PPI vs.RBC plus two antibiotics for 1 week were included.Data Source:RCTs were identified from CBM,handsearching,and personal contact with pharmaceutical companies.Inclusion criteria:data were extracted independently by two reviewers.The methodological quality of trials was assessed by the Jadad-scale.Statistics analysis was managed by using RevMan 4.2.Results Twelve randomized clinical trials including 1254 patients were included.The meta-analysis showed comparable efficacy with RBC and PPI (OR=1.30,95% CI:0.94～1.81,P=0.12).Conclusion The efficacy of RBC and PPI-based triple regimens were comparable.

BACKGROUND:The umbilical cord blood is rich in hematopoietic stem/progenitor cel s that have strong proliferation and differentiation ability as wel as ability to form colonies, and exert important roles in stimulating bone marrow function, improving blood cel viability and quantity, promoting immune cel maturation, and maintaining immune balance.
OBJECTIVE:To evaluate the clinical effects of autologous umbilical cord blood mononuclear cel transplantation on the immunologic function and prognosis for premature infants.
METHODS:Sixty-two preterm infants who entered into NICU immediately after birth, weighing ≤ 1 500 g, were divided into treatment group and control group according to parent’s wil ingness. In the treatment group, the umbilical cord blood was extracted from the umbilical vein and re-infused into the preterm infants after density gradient centrifugation within 4 hours. The cel ular immunity levels, humoral immunity levels and clinical parameters were monitored before and after treatment.
RESULTS AND CONCLUSION:After 1 week of treatment, the CD4, CD4/CD8 levels were significantly increased compared with the control group (P=0.01, 0.03), but CD8 level had no changes. At 1 week after treatment, IgM levels were both increased in the two groups, especial y in the control group (P=0.00);IgA levels had no changes;IgG levels were decreased, especial y in the control group (P=0.02). The incidence of severe infection during hospitalization was 13%in the treatment group, which was lower than the control group (16%), but there was no difference between the two groups. The proportion of infants undergoing mechanical ventilation and average length of stay had significant differences between the two groups (P<0.05). After 12 months, the incidence of recurrent respiratory tract infections was zero in the treatment group and one case in the control group, and there was a significant difference between the two groups. These findings indicate that autologous umbilical cord blood mononuclear cel transplantation can improve the immunologic function, slower the reduction of IgG levels, reduce the usage of breathing machine, shorten the length of stay, and reduce the incidence of recurrent respiratory tract infections in preterm infants.

BacKground:AchaIasia of cardia is categorized into 3 subtypes by Chicago cIassification criteria defined by high-resoIution manometry( HRM). These different subtypes present different cIinicaI and esophageaI dynamic characteristics. Aims:To study the cIinicaI and esophageaI dynamic characteristics of patients with achaIasia of cardia categorized by Chicago cIassification criteria. Methods:Twenty-five untreated achaIasia of cardia patients from January 2012 to ApriI 2014 at Beijing Friendship HospitaI,CapitaI MedicaI University were enroIIed. CIinicaI data incIuding cIinicaI symptoms, manifestations of endoscopy and barium meaI radiography and data of HRM were anaIyzed retrospectiveIy. Results:Of the 25 patients,5 patients(20. 0%)were cIassified as type Ⅰ,15(60. 0%)as type Ⅱ and 5(20. 0%)as type Ⅲ. AII patients compIained as having dysphagia,and 26. 7%( 4/15 ) of type Ⅱ patients had chest pain. Incidences of regurgitation in typeⅠ,ⅡandⅢwere 60. 0%(3/5),53. 3%(8/15)and 20. 0%(1/5),respectiveIy,no significant difference was found among the three types(P>0. 05). Incidences of diIatation of esophagus in type Ⅰ,ⅡandⅢwere 60. 0%(3/5),73. 3%(11/15)and 20. 0%(1/5),respectiveIy,no significant difference was found among the three types (P=0. 11). No differences in Iength of Iower esophageaI sphincter(LES),abdominaI LES Iength,LES resting pressure, upper esophageaI sphincter( UES)resting pressure and integrated reIaxation pressure( IRP)among the three types were found(P>0. 05). Incidences of muItipIe swaIIowing and spontaneous UES reIaxation were 32. 0%(8/25)and 24. 0%(6/25),respectiveIy,no significant difference was found among the three types(P>0. 05). Conclusions:Of the patients with achaIasia of cardia ,typeⅡis more common. Large-sampIe muIticenter studies are needed for further research.

Objective To evaluate a method named “one-step procedure”,i.e.,combined duode-noscopy,laparoscopy and choledochoscopy for choledocholithiasis accompanied with cholecystolithiasis.Meth-ods Fifty-three cases with gallbladder stones combined with common bile duct stones diagnosed from February 2012 to February 2014 were assigned to two groups,29 cases in “one-step procedure”group,who underwent duodenoscopy,laparoscopy and choledochoscopy in one operation,and 24 cases in the control group,who first-ly underwent endoscopic sphincterotomy to remove common bile duct stones,and then LC was performed after several days.The rate of complications related to the procedure,success rate of complete stone removal,length of hospital stay and hospitalization expenses were compared between the two groups.Results All 53 patients underwent the surgery and ERCP procedure successfully.There were no significant differences between the“one-step procedure”group and the control group in complication rates[3.4%(1 /29)VS 12.5%(3 /24),P =0.21],complete stone removal rates[96.6%(28 /29)VS 100.0%(24/24),P =0.37].Differences were sig-nificant in length of hospital stay (6.7 ±1.3d VS 10.9 ±1.6d,P <0.01 )and hospitalization expenses (15 724 ±1 613 yuan VS 19 829 ±2 433 yuan,P <0.05)between the “one-step procedure”group and the control group.Conclusion The “one-step procedure”,the combined duodenoscopy,laparoscopy and chole-dochoscopy,is safe,effective,and has smaller length of hospital stay and lower hospitalization expenses.

Objective To explore the clinical manifestations of hypermastigote detected from bronchoalveolar lavage fluid in children with mycoplasma pneumoniae pneumonia (MPP).Methods The clinical data from 18 cases (7 male cases,11 female cases;the age raged from 5 months to 13 years;13 case lived in rural cottage,5 cases lived in town building;the course ranged from 2 to 60 days) of MPP coinfected with hypermastigote were retrospectively analyzed,including the symptomatic and physical examination data, laboratory test, chest imaging features, bronchoscopic manifestation imaging,treatment and prognosis.The clinical characteristics and treatment of MPP coinfected with hypermastigote were analyzed.Results Clinical symptoms showed that 18 cases had cough, 14 cases had fever and 4 cases had asthma;laboratory blood routine test detected that 13 cases had increased leukocytes,5 cases with increased eosinophils;11 cases with increased C reactive protein and 8 cases with increased erythrocyte sedimentation rate.Eleven of 18 cases received immunological examination,which showed that 3 cases had increased IgG,2 cases with increased IgM,5 cases with increased IgA,and 11 cases with decreased ratio of CD4 and CD8;bronchoalveolar lavage fluid test showed that 1 case had increased eosinophils and hypermastigote were detected in 18 cases.High density spotty shadow were seen in chest imaging.Mucosal congestion, attached with white sputamentum, longitudinal folds, floc floating and sputum bolt obstructing within the lumen were seen under the bronchoscopy.The macrolides antibiotics combined with metronidazole (5 cases received metronidazole lung lavage) were effective.Conclusions Hypermastigote is a new type pathogen isolated from the lower respiratory tract in Liaocheng.For patients with MPP who have unsatisfactory response, hypermastigote should be taken into account and combined with metronidazole in therapy for better effect.

Objective To explore the value of SpyGlass (direct visualization system) guided laser lithotripsy for large bile duct stones in ERCP.Methods Thirty-three patients with large bile duct stones were randomly assigned to two groups: SpyGlass guided laser lithotripsy group (n =16) and mechanical lithotripsy group (n =17).All patients underwent ERCP procedures for stones extraction.The success rate of complete stone removal, the early complication rate related to the procedure and procedure time were compared between the two groups.Results The success rate of complete stone removal in SpyGlass guided laser lithotripsy group was higher than that of the mechanical lithotripsy group [75.0％ (12/16) VS 41.2％ (7/17) ,P ＜ 0.05].There were no significant differences between two groups in either procedure time [(51.6 ± 18.6) min VS (60.4 ± 12.3) min, P ＞ 0.05] or the early complication rate related to the procedure (18.8％ VS 5.9％ ,P ＞ 0.05).Conclusion SpyGlass guided laser lithotripsy is safe and effective for large bile duct stones.

Objective To investigate the hygienic status of large bottles of medical ultrasonic coupling gel in medical institution.Methods From February 2012 to April 2016, microbial contamination of large bottles of medical ultrasonic coupling gel in a women and children''s hospital was investigated and analyzed through on-the-spot random sampling and detection method.Results A total of 170 large bottles of medical ultrasonic coupling gel specimens were collected, 25 specimens were qualified, the qualified rate was 14.71％.Specimens were mainly from inpatient wards(58.24％) and operating departments(21.76％);there was no statistical difference in the qualified rate of specimens in each department(P>0.05).Contamination rates of coupling gel before and after the opening were both>80％, difference was not significant(P>0.05).A total of 145 strains of pathogenic bacteria were isolated, 18 of which were from unopened bottles, and 127 from opened bottles.Burkholderia cepacia was the main strain in both unopened and opened bottles, which accounting for 83.33％ and 54.33％ respectively,in addition, Pseudomonas aeruginosa and Serratia marcescens were also isolated from opened bottles, both were 15.75％, mixed contamination bacteria all included Serratia marcescens Conclusion The total bacteria counts in medical ultrasonic coupling gel in large bottles exceed the standard seriously, the manufacturer should strictly observe the quality control standards, medical institutions should adopt effective cleaning and disinfection measures.

Objective To investigate the prevalence of healthcare-associated infection(HAI)in a children's spe-cialty hospital in Guangzhou in 2014.Methods A cross-sectional survey was undertaken to investigate the preva-lence of HAI among all hospitalized patients on September 17,2014.Results A total of 997 patients were investiga-ted,30 patients developed 32 times of HAI,HAI rate and HAI case rate were 3.01% and 3.21% respectively. The main infection sites were upper respiratory tract(n= 11,34.38% );the departments with higher HAI prevalence rates were intensive care unit(ICU,3 .99% )and pediatric internal medicine department(3 .60% );the rate of etio-logical examination in patients with HAI accounted for 93 .33% ,a total of 24 strains of pathogens were isolated,6 of which were virus (25 . 00% ),6 were fungi (25 . 00% ),11 were bacteria (45 . 83% ),and 1 was Chlamydia (4.17% ). The main bacteria were Staphylococcusaureus (n= 3,27.27% )and Staphylococcusepidermidis (n= 3, 27.27% );a total of 451 (45.24% )patients received antimicrobial agents on the investigation day,67.41% of whom received therapeutic use of antimicrobial agents,19.73% received prophylactic use,and 12.86% received both therapeutic and prophylactic use;mono-drug application accounted for 82 .26% ,the percentage of bacterial de-tection among patients with therapeutic antimicrobial use (including combination of therapeutic and prophylactic use)was 82.60% .Conclusion Management of key departments and key sites of HAI should be strengthened in children's specialty hospital,antimicrobial agents should be used rationally,so as to protect the safety of children.

OBJECTIVE: To evaluate the safety of the circular round window and discus anatomic landmarks of posterior wall of internal auditory canal by investigating the microscopic anatomy of internal auditory canal area of the retrosigmold approach, which can provide the anatomical basis for acoustic neutrinomas surgery. METHOD: Fifteen adult cadaver heads (30 sides) fixed with formalin were used in the study. The retrosigmold approach operations were imitated to dissect the blood vessels and nerves in internal auditory canal area by opening round bony window and removing posterior wall of internal auditory canal. RESULT: Fifteen specimens of 30 sides circular bone window were opened without injury with transverse sinus and sigmoid sinus. The vertical distance between the highest point of bone window margo superior and the lowest point of transverse sinus margo inferior was (4.02 ± 0.32) mm. The vertical distance from the most anterior point of bone window leading edge to the most posterior point of sigmoid sinus trailing edge was (6.31 ± 0.43) mm. The internal auditory canal tubercle located in the anterior superior position of internal auditory canal. The vertical distance from the highest point of internal auditory canal tubercle to the upper margin of internal auditory canal was (2.31 ± 0.32) mm. To expose the whole internal auditory canal, the length and width of the internal auditory canal posterior wall removal was (7.29 ± 0.32) mm, (4.12 ± 0.29) mm. Within this removal range, no case of cochlea, semicircular canal or venous was injured in 30 specimens. CONCLUSION The method of opening round window through retrosigmold approach is simple, practial and convenient. With little variation and easiness of location, the sinternal auditory canal tubercle can be used in the identification of the internal auditory canal. When exposing the whole internal auditory canal, the removal scope of the posterior wall should be paid more attention to, in order to avoid the damage of cochlea, semicircular canal and jugular bulb.
Adult ; Cranial Sinuses ; Ear Canal ; Ear, Inner ; Humans ; Round Window, Ear ; anatomy & histology ; Semicircular Canals ; anatomy & histology ; Temporal Bone

Objective: To investigate the recurrence of pulmonary tuberculosis patients 5 years after successful treatment in Hengyang City, Hunan Province, and to analyze its influencing factors. Methods: The data of pulmonary tuberculosis patients who were successfully treated in Hengyang City in 2014 were collected through the tuberculosis management information system. The recurrence of pulmonary tuberculosis was defined as the endpoint, and all patients were observed for five consecutive years. Factors affecting recurrence of pulmonary tuberculosis were identified using Kaplan-Meier estimates, log-rank test and multivariable Cox proportional hazards regression analysis. Results: A total of 6 626 patients with successfully treated pulmonary tuberculosis were included, including 4 961 males and 1 665 females, with a median age of 54 years. There were 536 cases with recurrence of pulmonary tuberculosis within five years, with a 8.09% cumulative proportion of recurrence and annual recurrence rate of 1.75 per 100 person-years. Multivariable Cox proportional hazards regression analysis showed that men ( HR=1.592, 95%CI: 1.256-2.019 ), age of 40 years and greater ( age of 40 to 59 years, HR=7.025, 95%CI: 1.739-28.377; age of 60 years and greater, HR=8.175, 95%CI: 2.024-33.023), farmers ( HR=1.379, 95%CI: 1.070-1.778 ), retreatment ( HR=6.398, 95%CI: 5.163-7.929 ) and positive etiology ( HR=1.255, 95%CI: 1.042-1.511 ) were risk factors for five-year recurrence of pulmonary tuberculosis among successfully-treated patients. Conclusions High recurrence rate is found among pulmonary tuberculosis patients within five years after successful treatment in Hengyang City. There is a high risk of pulmonary tuberculosis recurrence among male, etiologically positive, retreated farmers at ages of 40 years and older, and targeted interventions are recommended.