Objective To evaluate the effectiviness and safety of rituximab in the treatment of immune thrombocytopenia .Meth-ods Standard doses and small doses of rituximab alone or combined therapy with other methods were used in 2 cases with immune thrombocytopenia who diagnosed and treated for the first time ,and 6 cases who diagnosed with refractory recurrent immune throm-bocytopenia .The recent curative effect ,adverse reactions were analyzed .Results The recent curative effect was well in the 2 cases who diagnosed and treated for the first time ,but 1 case recurrenced after 6 months .4 cases of effective in the 6 cases who diagnosed with refractory recurrent ,in which 1 case recurrenced after 2 years ,2 cases had no effect .All of the patients have no obvious adverse reaction in the near future .Conclusion Rituximab treatment of immune thrombocytopenic ,it is of good curative effect ,good safety and tolerability .

Objective To investigate the methods of nursing safety management for indwelling catheters. Methods The nursing safety management measures included the establishment of three-level monitoring network of safety management for indwelling catheters,standardization of 25 kinds of catheter identification cards,formulation of prevention procedure and reporting system of catheter extrusion,design of catheter management handbook,organization of training and examination on the relative skills for nurses. Results Nurses' safety awareness of indwelling catheters was strengthened. And nurses could distinguish different catheters promptly and provide efficacious and safe nursing services. There was no nursing error,nursing dispute and patient complaints towards nursing care of indwelling catheters. Conclusion The implementation of nursing safety management for indwelling catheters can ensure medical and nursing safety,and promote the continuous improvement of quality of nursing.

BACKGROUND: Denddtic cells (DCs) constitute the dominant population of antigen presenting cells (APCs) by possessing potent ability to initiate T cell immunity. The ultrastructure study of DCs is less reported. OBJECTIVE: To investigate the ultrastructure of DCs from mice bone marrow at different maturation stages, and the morphology of DCs between CD40 ligation and tumor necrosis factor-alpha (TNF-α) stimulation in vitro. METHODS: Mice myeloid DCs were generated from bone marrow in vitro using granulocyte-macrophage colony-stimulating factor (GM-CSF)and interleukin-4 (IL-4). Immature DCs were loaded with apoptotic tumor cells (AP-DC), and AP-DC was then stimulated with CD40L-CHO cells and TNF-α for 48 hours, respectively. DCs were routinely sectioned, and ultrastructure was observed under transmission electron microscope. RESULTS AND CONCLUSION: Immature DCs showed a few short and blunt cytoplasmic processes, there were specific morphology lysosomes that liked earphone in some cells; DCs engulfing the apoptotic bodies were observed; sub-cellular structures between CD40 ligation and TNF-α stimulated DCs were different, the former had typical morphology of mature DCs which exhibited many dendritic protrusions, however, some DCs displayed apoptosis and autophagy after TNF-α stimulation. In a conclusion, CD40 ligation plays an essential role in myeloid DCs differentiation and maturation, TNF-α can mediate apoptosis and autophaqy of DCs.

ObjectiveTo investigate the effect of Glutamine (Gln) on the expression of PCNA in intestinal tissue of neo-natal rats with necrotizing enterocolitis (NEC), and to explore the protective mechanism of Gln in intestinal mucosa.Methods Forty-eight neonatal rats at the age of 48 hours were selected, and divided into 4 groups, control group, Gln group, NEC group, NECGln group. Each group had 12 rats. Control group were fed mice milk substitutes; Gln group were fed mice milk substitutes mixed with Gln; NEC group were fed mice milk substitutes and had cold/ hypoxia exposure twice a day for 3 days; NECGln group were exposed to cold stress, hypoxia and treated with Gln mixed in the milk. The expression of PCNA was detected using immunohistochemical method.Results Compared with control group were and Gln group, the general condition was worse, and the weight was decreased in NEC and NECGln group. The inifltrated inlfammatory cells, congestion, edema, intrinsic layer separation were observed in intestinal mucosa in NEC and NECGln group. The intestinal villus was lost in severe in NEC and NECGln group. The PCNA index was 34.17±5.78, 34.42±5.38, 15.00±1.94, 30.67±3.14 in control, Gln, NEC and NECGln group respectively, with signiifcant difference between each groups (H=24.32,P=0.000). The expression of PCNA in NEC group was lower than that in normal, Gln, and NECGln group (P<0.008). The expression of PCNA had no signiifcant difference among normal, Gln, and NECGln group (P>0.008).Conclusions The expression of PCNA in intestinal mucosa was decreased in NEC rats. Gln supplement could raise the expression of PCNA in intestinal mucosa of NEC rats, and accelerate the speed of intestinal mucosa repair.

Objective To explore the influence of Clostridium butyricum on the expression of vascular endothelial cell growth factor (VEGF) and its receptor 2 (VEGFR-2), proliferating cell nuclear antigen (PCNA), and tight junction protein claudin-2 in intestinal tissue in newborn rat with necrotizing enterocolitis (NEC). Methods Forty-eight-hour-old Sprague-Dewley (SD) rats were randomly divided into model group, control group, low-dose group, mid-dose group, and high-dose group, 12 rats each. Rats in each group were fed with milk substitute. The NEC model were created by hypoxia and cold stimulation for 3 consecutive days in model group, low-dose group, mid-dose group, and high-dose group. Meanwhile, low-dose group, mid-dose group, and high-dose group were intervened by being fed with Clostridium butyricum 0.2, 0.4, and 0.8 g/(kg·d), respectively. All rats in each group were sacriifced on day 4 and the intestines tissue was obtained. The pathological changes had been observed. The expression of VEGF, PCNA, and claudin-2 were detected by immunohistochemistry. The expression of VEGFR-2 was detected by RT-PCR. Results The intestines pathological scores was signiifcantly different among ifve groups (P?0 . 05 ). Conclusion The expression of VEGF, VEGF-2 , and claudin-2 were higher in rats with NEC, while the expression of PCNA was lower. Supplementation of Clostridium butyricum may protect newborn rats by its act on these factors.

Objective:To study the pathogenic distribution of bronchoalveolar lavage fluid in children with severe pneumonia from Children′s Hospital Affiliated to Soochow University, and to investigate the drug resistance of major pathogenic bacteria.Methods:A total of 177 children with severe pneumonia undergoing fiberoptic bronchoscopy in Children′s Hospital Affiliated to Soochow University from January 2014 to December 2018 were enrolled.Their bronchoalveolar lavage fluid was collected for pathogen identification, pathogen culture and drug sensitivity analysis.The pathogens were detected by direct immunofluorescence quantitative PCR.Results:Of 177 cases enrolled, 100 children had at least one pathogen detected, and the positive rate was 58.13%.Among all the pathogens detected, Mycoplasma pneumonia (MP) had the highest detection rate, which was found in 41 cases.The top three bacteria detected included Streptococcus pneumoniae (9 cases, 10.59%), Staphylococcus aureus (8 cases, 9.41%), and Pseudomonas aeruginosa (6 cases, 7.06%). The top three viruses detected were cytomegalo virus (CMV) (14 cases, 33.33%), human bocavirus (HBoV) (10 cases, 23.81%), and respiratory syncytial virus (RSV) (8 cases, 19.05%). The drug sensitive test indicated that main kinds of Gram-negative bacteria had low resistance to quinolones, aminoglycosides, carbapenems, and enzymatic beta-lactams.Main kinds of Gram-positive bacteria had low resistance to Linezolid and vancomycin.The virus detection rate and MP detection rate in severe pneumonia children under 5 years old were about 30.00% and 20.00%, respectively.The MP detection rate in children above 5 years old exceeded 30.00%.The bacteria detection rates in children under and above 2 years old were over 20.00% and about 15.00%, respectively.Airway abnormalities were common in children with severe pneumonia, mainly including tracheobronchial malacia and stenosis. Conclusions:The most common pathogen of bronchoalveolar lavage fluid in severe pneumonia children under 5 years old in Suzhou is viruses.The bacteria detection rate is high in children under 2 years old.Common Gram-positive bacteria show high susceptibility to vancomycin and Linezolid. Pseudomonas aeruginosa is highly sensitive to quinolones, aminoglycosides, carbapenems, and enzymatic beta-lactams.Importance should be attached to the airway abnormalities in children, especially infants, with severe pneumonia.

Objective To explore the risk factors for childhood death from pneumococcal meningitis.Methods The data of 32 hospitalized children were retrospectively analyzed,who were diagnosed as pneumococcal meningitis and enrolled in the Affiliated Children′s Hospital of Soochow University from November 201 0 to December 201 5.The subjects were divided into the death group and survival group according to their prognosis.The clinical characteristics and laboratory data were compared between 2 groups.Results Between the death group and survival group,there were significant statistically differences in shock within 24 hours after admission(63.6% vs 1 4.3%,P =0.01 3),as well as endotracheal tube intubation(1 00.0% vs 23.8%,P <0.001 ),the levels of cerebrospinal fluid(CSF)IgG[(491 .27 ± 203.53)mg/L vs (267.24 ±1 88.07)mg/L,P =0.006],IgM[(1 1 5.72 ±79.1 9)mg/L vs (32.80 ±28.52)mg/L, P =0.006],IgA[59.52(1 5.51 ,75.69)mg/L vs 1 8.77(9.33,27.54)mg/L,P =0.023],CSF leukocyte[330.00 (1 50.00,380.00)×1 06 /L vs 870.00 (403.00,6 1 60.00)×1 06 /L,P =0.009 ],CSF protein [(4 047.00 ± 1 942.1 6)mg/L vs (2 470.62 ±1 259.94)mg/L,P =0.009],CSF adenosine deaminase (ADA)[35.20(1 8.90, 87.20)U /L vs 8.80(3.05,23.78)U /L,P =0.001 ],serum sodium[(1 30.21 ±2.85)mmol/L vs (1 32.83 ±3.69) mmol/L,P =0.049],serum lactic acid (LA)[4.40 (2.60,5.70)mmol/L vs 2.40 (1 .75,4.50)mmol/L,P =0.01 3],serum C -reactive protein (CRP)[(95.87 ±65.40)mg/L vs (1 65.61 ±83.05)mg/L,P =0.022],serum lactate dehydrogenase (LDH)[81 3.40(465.20,2 31 0.70)U /L vs 359.20(257.85,405.90)U /L,P =0.001 ], platelet[(1 63.82 ±1 64.86)×1 09 /L vs (295.71 ±1 30.29)×1 09 /L,P =0.01 9]and positive rate of blood culture (90.9% vs 47.6%,P =0.023)between the death group and survival group.Conclusions The risk factors associated with mortality in pediatric SPM include shock within 24 hours after admission,endotracheal intubation,hyponatremia, thrombocytopenia,as well as high serum LA level,high serum LDH level,lower serum CRP level or cultures of blood and CSF double positive.

Objective To evaluate the therapeutic efficacy and adverse reactions of raltitrexed plus oxaliplatin (RALOX project) and S1 in patients with advanced primary liver cancer.Methods Seventy-one patients with advanced primary liver cancer admitted to 6 cancer centers from July 2013 to July 2015 were divided into 2 groups according to the wishes of the patients and their families:RALOX group (34 patients) and S1 group (37 patients).The therapeutic efficacy such as objective remission rate (ORR),disease control rate (DCR),median overall survival (mOS),median progression free survival (mPFS),one year survival rate (SR),and adverse reactions in these patients were evaluated.Results Thirty-one patients could be evaluated in RALOX group,and 6 patients obtained partial response (PR),10 stable disease (SD) and 15 progressive disease (PD).Thirty-three patients could be evaluated in S1 group,and 3 patients obtained PR,8 patients SD and 22 PD.The ORR,DCR,and one year SR were 19.4％ vs.9.1％,51.6％ vs.33.3％,and 22.6％ vs.12.1％ respectively,and there were no statistically significant differences in the two groups (x2 =1.393,P =0.238;x2 =2.190,P =0.139;x2 =1.229,P =0.268).The mOS and mPFS were 7.2 months vs.6.1 months and 3.4 months vs.2.8 months,and there were statistically significant differences in the two groups (x2 =6.433,P =0.011;x2 =4.078,P =0.043).There was more serious peripheral nerve toxicity (29.0％ vs.3.0％,x2 =6.344,P =0.012) and lighter hand-foot syndrome (9.7％ vs.30.3％,x2 =4.201,P =0.040) in RALOX group than S1 group.But the incidences of other adverse effects were similar in the two groups.Condnsion RALOX project is safe and effective to the patients with advanced primary liver cancer.Compare with S1 project,RALOX project has better curative effects and the majority of adverse reactions are tolerable.The patients have good condition control and survival benefit.

Objective:To evaluate the efficacy and safety of intravitreal ranibizumab combined with laser (IVR+ Laser) and the intravitreal ranibizumab (IVR) monotherapy for the treatment of diabetic macular edema (DME).Methods:A meta-analysis was conducted on randomized controlled trial (RCT) literature related to IVR+ Laser therapy and IVR alone for DME.Databases including Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, VIP and WanFang Data were searched from their inception to April 2022.Literature screening, data extraction, quality evaluation and cross-checking were conducted independently by two researchers according to inclusion and exclusion criteria.Then a meta-analysis was conducted using RevMan 5.4.1 software.The two therapies were compared in terms of best corrected visual acuity (BCVA), central macular thickness (CMT), mean number of injections and adverse events.Results:Twelve RCTs involving 1 695 eyes were included in the study.Meta-analysis showed that at the end of follow-up, IVR+ Laser demonstrated better improvement in BCVA and CMT than IVR alone, and there were significant differences in the changes in BCVA and CMT between the two groups (weighted mean difference[WMD]=-0.66, 95% confidence interval[ CI]: -1.11--0.21, P<0.01; WMD=-5.05, 95% CI: -9.21--0.89, P=0.02).IVR+ Laser required significantly fewer injections than IVR alone (WMD=-1.16, 95% CI: -2.07--0.25, P=0.01).There were no significant differences in the adverse events incidence between the two therapies (all at P>0.05). Conclusions:The safety of IVR+ Laser is comparable to IVR alone, and it requires fewer injections for the treatment of DME.

Objective To establish a project team to assess and manage the risk of out-of-town transport of extracorporeal membrane oxygenation(ECMO)patients using the healthcare failure mode and effects analysis(HFMEA),analyze the effectiveness of its application,and develop targeted improvement measures and processes.Methods Patients with ECMO who were treated in the department of intensive care unit(ICU)of Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine March 2020 to September 2021 were selected as the study subjects.By comparing the differences in the accuracy of ECMO transport risk assessment,the rate of fixation against catheter slippage,the incidence of adverse transport events between the two groups before and after HFMEA,and the application effect of this model in ECMO transport adverse event risk management was evaluated.Results A total of 48 ECMO patients were enrolled,and 42 times of out-of-home transfers were performed,including 22 before HFMEA and 20 after HFMEA.Compared with pre-HFMEA,the accuracy of ECMO transport risk assessment[95.00%(19/20)vs.54.55%(12/22),P＜0.05]and the compliance rate of catheter slip fixation[100.00%(20/20)vs.68.18%(15/22),P＜0.05]in patients after HFMEA were significantly increased,the incidence of adverse events in transport was significantly lower[5.00%(1/20)vs.40.91%(9/22),P＜0.05].Conclusion The application of HFMEA in the risk management of ECMO transshipment adverse events is beneficial to standardize the prevention of ECMO transshipment accidents,effectively reduce the incidence of transshipment adverse events,and ensure patient safety.