Objective To analyze the risk factors and prognosis of Clostridium difficile infection (CDI) among hospitalized patients with inflammatory bowel disease (IBD).Methods From March 2014 to February 2015,216 first-time hospitalized patients with IBD were enrolled.Once hospitalized,stool samples were obtained for Clostridium difficile culture immediately,and at the same time toxins of Clostridium difficile (tcd) A and tcdB were detected by polymerase chain reaction(PCR).The incidence and risk factors of CDI in enrolled patients were analyzed.Chi square test and nonparametric test were performed for statistical analysis.Results Among the 216 IBD patients,there were 73 patients with ulcerative colitis(UC) and 143 patients with Crohn's disease(CD).The positive rate of CDI was 13.9 ％ (30/216) in IBD patients.The positive rate of CDI was 24.7 ％ (18/73) in UC patients,which was higher than that of CD patients (8.4％,12/143),and the difference was statistically significant (x2 =10.690,P＜0.01).As the severity of the disease increased,the rate of CDI positive patients in UC patients increased.Among three patients at remission period,17 patients at mild active stage,23 patients at moderate active stage and 30 patients at severe active stage,the CDI positive patients were zero,two,five,11,respectively,and the difference was statistically significant (x2 =4.820,P=0.028).In UC patients,the incidences of patients with hospitalization history in other hospitals within three months before admission in CDI positive group and negative group were 6/18 and 7.3％ (4/55),respectively,and the difference was statistically significant (x2 =5.740,P=0.020).In 30 days before admission,the rates of patients with proton pump inhibitor (PPI) taking history of two groups were 7/18 and 7.3％ (4/55),and the difference was statistically significant (x2=8.270,P=0.004).The length of hospital stay in CDI negative UC patients was 7.0 d (5.0 d,12.0 d),which was shorter than that of CDI positive patients (10.5 d (8.8 d,18.2 d)),and the difference was statistically significant (U=277.000,P=0.005).The rate of patients underwent intestinal operation in CDI negative CD patients within three months after CDI examination was 10.7 ％ (14/131),which was significantly lower than that of CDI positive patients (5/12) (x2 =4.520,P=0.010).Conclusions The incidence of CDI in hospitalized IBD patients was high,especially in UC patients;the risk factors included disease severity,prior hospitalization history within three months before admission and PPI taking history within 30 days before admission.CDI was correlated with poor prognosis.

Objective To investigate changes in glucocorticoid receptor (GR) expression and activity in lung tissue of acute lung injury induced by lipopolysaccharide (LPS) within 24h in rat. Methods A total of 70 Wistar rats were divided randomly into LPS treatment group and LPS+ Dexamethasone (Dex) treatment group. The GR mRNA and GR protein expressions in the lung tissue of LPS challenged rats were assessed by RT-PCR and Western blot at different time points. Electrophoretic mobility shift assays (EMSA) were used to determine the GR activity in the lung tissue. Results The expression level of GR mRNA was depressed, but it returned to normal level at 24h after LPS challenge. The expression level of GR was also lowered, reaching the lowest level at 8h. GR activity was decreased, reaching the lowest level at 1h, and remaining lower than that of normal control at 24h. Dex treatment showed no obvious effect on GR activity during the late period of treatment. Conclusion The GR protein expression decreases in lung tissue of acute lung injury in rats, and it maybe associated with the decreased expression of mRNA and accelerated degradation of GR protein. The activity of GR is inhibited sharply, resulting in glucocorticoid resistance.

Objective To explore the value of ultrasound-guided core needle biopsy (CNB) in diagnosis of thyroid nodules.Methods The clinical data of 395 patients with thyroid nodules who underwent ultrasound-guided CNB were retrospectively analyzed,and the results of CNB pathology of 278 patients who endured surgery were compared with postoperative wax pathology results.Results All patients completed CNB successfully and satisfaction rate for tissue samples was 100％.Local hematoma occurred in one case and relieved by conservative therapy.The CNB pathology results of 278 cases of patients were as follows:92 cases were malignancy,including 91 cases of papillary thyroid carcinoma,lcase of medullary thyroid carcinoma; 182 cases were benign,including lcase of parathyroid adenoma,48 cases of adenoma,and 133 cases of nodular goitre and other nodular affection.In 278 patients who underwent surgery,the CNB pathology results in 273 cases,including 90 malignancy cases and 183 benign cases,were consistent with postoperative wax pathology results and false positive occurred in 1 cases,ambiguous occurred in 4 cases.So the accuracy,sensibility,specificity,missed diagnosis rate,and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 98.20％ (273/278),95.79％ (91/95),99.45％ (182/183),4.21％ (4/95) and 0.55％ (1/183).Conclusion Ultrasound-guided CNB has important value on differential diagnosis of thyroid nodules.It is safe and effective.

Objective To assess the clinical value of ultrasound-guided popliteal vein puncture in the treatment of lower extremity deep venous thrombosis.Method We performed ultrasound-guided catheterization through popliteal vein in 71 patients with lower extremity deep venous thrombosis who were supposed to receive catheter-directed thrombolysis.Results Catheter sheathes were successfully inserted in 69 patients.No severe complication was observed.and a good curative effect after the treatmeut of thrombolysis and anticoagulation was found.Insertions of guide-wires failed in 2 patients because of organizatioo of the thrombus.Conclusion Ultrasound-guided popliteal vein puncture is safe and easy to operate,and is worth popularizing.

Objective To investigate the clinical value of contrast-enhanced ultrasonography(CEUS) in evaluating treatment response of hepatocellular carcinoma after interventional therapy. Methods One hundred and three patients with 136 lesions of hepatocellular carcinoma confirmed by pathology were examined by common color ultrasound (US), contrast-enhanced CT, CEUS and DSA pre- and post-interventional treatment respectively. Results The sensitivity,specificity and accuracy of CEUS for focus judgment after interventional therapy were 95.8%, 95.6% and 98. 5% respectively. The sensitivity, specificity and accuracy of US in detecting tumor deactivation and residue were 92.3% ,77.4% and 83.1% respectively. CEUS were highly consistent with the results of enhanced CT/DSA (Kappa = 0.93) and significantly higher than those of US (Kappa = 0.66). Conclusions CEUS is useful to monitor the efficacy and guide treatment after interventional therapy.

Objective:To investigate the clinical diagnosis and treatment of idiopathic subglottic stenosis.Methods:From May 2012 to January 2014,four patients with idiopathic subglottic stenosis admitted in the Department of Otolaryngology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,Jiangsu,China were selected for review.Results:All the four patients with idiopathic subglottic stenosis were resolved after the resection of the pathological tissues and subsequent hormone treatment.Conclusions:The confirmed diagnosis of idiopathic subglottic stenosis mainly relied on the medical history and pathological examination.Favorable treatment effects might be obtained by combining surgical resection and hormone treatment.

Objective: To investigate the difference between the uptake of different hydrophobe drugs into the O/W microemulsion systems and micellar solutions. Methods:Based on the phase diagram,the incorporation of 3 poorly water soluble drugs into Cremophor RH-40-alchohol-isopropyl myristate-water microemulsions and Cremophor RH-40 surfactant systems were examined. Results: There was no significant difference between miconazole nitrate and indometacin into the O/W microemulsion systems and micellar preparation.There was,however,a significant increase in the micellar solutions of ibuprofen amount than in the microemulsion systems. Conclusion:Improvement of solubility by O/W microemulsion and micellar system depends on the solubility of the drug in the dispersed oil phase and is significant only for high lipophilic drugs.

Objective To evaluate the value of serum procalcitonin(PCT ) and C-reactive protein(CRP) analysis in the differenti-ation of the cause of fever in cancer patients .Methods 218 cases with fever enrolled were divided into three groups ,including bacte-rial infection group ,viral infection group and tumor related fever group .The positive rates of white blood cell(WBC) count ,percent-age of neutrophil ,PCT and CRP were determined and there correlations were analyzed .Results The positive rates of WBC count , percentage of neutrophil ,PCT and CRP in bacterial infection group were significantly increased compared to viral infection group and tumor related fever group(P<0 .05) .The positive rate of PCT in tumor related fever group was also statistically significant difference compared to viral and bacterial infection group(P<0 .05) .The sensitivity of PCT was 97 .83% and the specificity of PCT was 83 .33% .Conclusion PCT and CRP can help identify causes of fever in cancer patients .PCT has better sensitivity and specific-ity ,it can help anti-infective and provide experimental evidence for tumor treatment ,and also help determine the disease outcome and clinical deterioration .

Objective To explore the procedures of 3Q validation for blood coagulation analyzer under the good laboratory prac‐tice(GLP) system based on the Sysmex CA7000 automatic blood coagulation analyzer .Methods Four test indicators of PT ,APTT , TT and FIB were chosen to conduct the performance verification in the within‐run precision ,between‐day precision ,accuracy ,linear‐ity ,carry‐over contamination rate of the automatic blood coagulation analyzer .They were prothrombin time(PT) ,activated partial thromboplastin time(APTT) ,thrombin time(TT) ,and fibrinogen(FIB) .Results The within‐run precision CV values of PT , APTT ,TT and FIB were 1 .33% ,1 .57% ,1 .47% and 1 .90% ,respectively ;the inter‐day precision CV values of PT ,APTT ,TT and FIB were 1 .73% ,1 .52% ,1 .55% and 2 .14% respectively ;in terms of accuracy ,the normal quality control CV values were 7 .45% ,3 .88% ,-4 .98% and 4 .36% respectively ;the abnormal quality control CV values of PT and APTT were 8 .11% and 8 .77% respectively ;the r value of FIB linear correlation coefficient was 0 .999 3 ,the a value was 1 .02 ;the highest CV value of car‐ry‐over contamination rate was 2 .15% ;the detected results all conformed to the general industry standards and requirements of in‐strument manufacturer .Conclusion The 3Q validation under the GLP system proves that the Sysmex CA7000 automatic blood co‐agulation analyzer is good in performance and is appropriate for the laboratory work of clinical laboratory department .

Objective To investigate the characteristics of breast neoplasms on contrast-enhanced ultrasonography(CEUS) and its clinical value.Methods Two hundred and twenty-five patients with breast masses unable to be diagnosed by conventional ultrasonography were examined with CEUS.The characteristics of these masses on CEUS were analyzed and compared with the results of pathology examination.Results The typical features of breast cancers on CEUS were enlarged maximum diameter of the lesions on CEUS compared to pre-contrast ( P ＜0.05),irregular shapes,heterogeneous distribution of contrast enhancement with perfusion defect or local retention of contrast signals,tortuous,massive or penetrating vessels rapidly entering and exporting from the lesions.The sensitivity and specificity of perfusion defect for breast cancer on CEUS were 89.0％ and 91.8％,respectively; the sensitivity and specificity of local retention of contrast signals for breast cancer on CEUS were 93.4％ and 92.5％,respectively.Conclusions It is valuable for CEUS in the diagnosis and differential diagnosis of breast neoplasms clinically.