ObjectiveTo explore the relationship between dynamic lactic acid monitoring and pediatric critical illness score (PCIS) and clinical significance.MethodsPCIS of 77 critically ill children admitted into pediatric intensive care unit (PICU) were recorded after hospitalization.According to PCIS,all the children were divided into extremely critical group (23 cases),critical group (32 cases),non-critical group (22 cases),according to prognosis,all the children were divided into surrival group (55 cases) and death group (22 cases).Blood concentration of lactic acid were detected.Differences in their lactic acid indexes (including lactic acid level after admission to PICU,peak lactic acid level) and PCIS were compared,their correlation and prognosis of critid death group(22 cases) cally ill children were analyzed.Results Lactic acid level after admission to PIC U [ (5.28 ± 3.69) mmol/L ] and peak lactic acid level [(8.54 ± 4.32 )mmol/L] in extremely critical group were significantly higher than those in critical group and non-critical group (P ＜ 0.05 ),but PCIS [ (65.79 ± 2.34) scores ] was significantly lower than that in critical group and non-critical group(P ＜0.05).Lactic acid indexes in death group were significantly higher than those in survival group (P ＜ 0.05 or ＜ 0.01 ),but PCIS was significantly lower than that in survival group (P ＜ 0.05 ).PCIS was negative correlated with lactic acid level (P ＜ 0.01 ).ConclusionsCritically ill children with elevated lactic acid indexes are worse and poorer prognosis.PCIS score can effectively evaluate children's condition and prognosis,and compared with lactic acid level linear correlation is existed.Dynamic lactic acid monitoring indexes are the good factors for the severe degree and predicting the prognosis of the critically ill children.

Objective To explore nursing methods of postoperative patients with brain stem tumor complicated with stress hyperglycemia. Methods The medical and nursing measures of 56 postoperative patients with brain stem tumor complicated with stress hyperglycemia were analyzed retrospectively. Results Among 56 cases, 48 cases were clinically cured, 6 cases was improved, 2 cases died of multiple organ failure. Conclusions It is especially important to intensify insulin therapy, necessary to closely observe the patients' consciousness, pupils and the change of vital signs. Meanwhile, strengthening nursing on common complications such as infection and gastrointestinal hemorrhage, and paying more attention to patients' dietary, mental state and rehabilitation are also important measures.

Objective To evaluate the capability of internal transcribed spacer (ITS) region sequencing analysis to identify clinical isolates of filamentous fungi.Methods A total of 267 filamentous fungi isolates collected from clinical specimens were analyzed by ITS region sequencing analysis.Alignment of acquired sequences with known sequences in GenBank and MycoBank was conducted to identify the species of those isolates.Results ITS sequences of the 267 isolates were amplified successfully.Among these isolates, 53.9％ (144/267) were identified to species level and 44.2％ (118/267) to genus level.Only five isolates were failed to be identified at genus level as they shared >95％ homology in ITS sequence with multiple genera.Conclusion ITS region sequencing analysis is preferred for identification of clinical isolates of filamentous fungi at genus level for its high universality and great capability.When species-level identification is required, some informative DNA markers besides ITS region should be included accordingly.

Objective To investigate tumor lymphatic and mircovascular densities as prognostic markers in 69 cases of invasive breast cancer treated with partial or total mastectomy and lymph node dissection.Methods 69 cases of untreated primary unilateral invasive ductal breast carcinomas were selected.All cases were immunostained with D2-40 and CD31.Positively stained microvessels were counted in densely vascular/lymphatic foci (hot spots).The relationship between lymphatic vessel density (LVD),microvessel density(MVD) and prognosis was analyzed.Results The mean ± SD peritumoral lymphatic vessel density (P-LVD) was significantly higher than intratumoral LVD(I-LVD) (P ＜ 0.01).There was a positive correlation of D2-40 LVD(peritumoral) counts with lymph node metastasis (P =0.003) and clinical stage (P =0.026),and CD31 microvessel density was found significantly associated with clinical stage(P =0.038).No significant association was found between above variants with I-LVD (P ＞ 0.05).Univariate analysis showed that survival time was impaired by higher MVD and higher peritumoral LVD(P =0.007,P =0.008,P =0.014,P =0.024,log-rank test),but not I-LVD.Multivariate survival analysis showed that MVD,peritumoral LVD,TNM stage and lymph node metastasis were independent prognostic factors for overall survival.Conclusions Peritumoral LVD and MVD were significantly correlated with survival status of patients with breast cancer.This is the first attempt to predict prognosis of breast cancer patients by quantifying the peritumoral LVD and MVD.

Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection(HAI)and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,contin-uous quality improvement was carried out based on 5 terminal factors,the rate of rusting,stain,repeated cleaning, damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from 94.24% before implementing measures to 97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from 3.39%, 2.37%,5.76%,and 2.08% to 1 .55%,0.85%,2.40%,and 0.48% respectively,there were significant difference among different groups(all P <0.001 );the score of satisfaction rate to central sterile supply department elevated from(93.87±3.87)before implementing measures to (98.08 ±0.59)after implementing measures(t =6.80,P <0.001).Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continu-ously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.

Objective To investigate ectopic pregnancy from embryo transfer (ET)of in-vitro fertilization (IVF) cycle and intracytoplasmic sperm iujection (ICSI) cycle and frozen-thawed (FET) cycle.Methods From Jan.2005 to Dec.2010,a total of 9037 IVF-ET or ICSI-ET cycles and 4034 FET cycles were performed in our reproductive medicine center,Affiliated First Hospital of Zhengzhou University.The incidence of ectopic pregnancy rate was studied in fresh cycles IVF-ET (5998) and ICSI-ET (3039) cycles,and natural FET (2198) and hormone replacement (E-P) FET (1836) cycles.ResultsOf 4034 FET cycles,1090 clinical pregnancies and 26 ectopic pregnancies were observed,the incidence of ectopic pregnancy was 2.38％ (26/1090).Of 9037 fresh cycles,3602 cycles were clinical pregnancy,and 133 cycles were ectopic pregnancy,and the incidence of ectopic pregnancy was 3.69％ (133/3602).The ectopic pregnancy rate in FET cycles was lower than in fresh cycles significantly (P ＜0.05).Of 3039 fresh ICSI-ET cycles,the incidence of ectopic pregnancy was 2.62％ ( 34/1298 ) in 1298 clinical pregnancies.Of 5998 IVF-ET cycles,2304 clinical pregnancies were observed,the incidence of ectopic pregnancy was 4.30％ (99/2304).Ectopic pregnancy rate in the fresh ICSI-ET cycles was lower than that of IVF-ET group significantly (P ＜ 0.01 ).The ectopic pregnancy rate in the natural FET cycles was 1.46％ (8/547),which was significantly lower than 3.31％ ( 18/543 ) in E-P group ( P ＜ 0.05 ).ConclusionsThe incidence of ectopic pregnancy of FET cycles was significantly lower than that of fresh embryo transfer cycles.The application of exogenous sex hormones in assisted reproductive cycles might increase occurrence of ectopic pregnancy.

Objective To investigate the diversify and clinical significance of tumour necrosis factor-alpha (TNF-α), immune globulin (Ig), adenosine deaminase (ADA) in cercbrospinal fluid (CSF) of patients with intracranial infection. Method The levels of TNF-α,Ig and ADA in CSF of 25 cases of purulent meningitis ,30 eases of cerebral tuberculosis ,28 cases of virus meningitis and 24 cases of controls were detected by ELISA, immunity velocity scattering nepbelometry and enzyme coupling method respectively. Results The levels of IgA, IgM, IgG, ADA, TNF-α were (41.72±11.31) mg/L(18.11± 2.62)mg/L, (181.60±41.19)mg/L, (13.41±3.42)U/L, (418.62±43.16)ng/L in cerebral tuberculosis patients. The levels of IgA, IgM, IgG, ADA and TNF-αwere (20.65±8.85)mg/L, (93.20±4.30)mg/L, (92.77±35.09)mg/L, (3.32±2.41) U/L, (476.93±45.16) ng/L in purulent meningitis patients, and those were (7.11±2.23)rag/L,(5.81±1.19)mg/L,(20.71±10. 54)mg/L,(2. 36±0. 44)U/L,(375.06±45.21) ng/L in virus meningitis patients. The levels of IgM,IgG and IgA in cerebral tuberculosis patients and purulent meningitis patients were significantly higher than those in virus meningitis patients and controls (P< 0.01). The levels of IgG,IgA heightened most markedly in cerebral tuberculosis patients. The activity of ADA in cerebra] tuberculosis patients was higher markedly than that in controls and the other patients(P< 0.01). The levels of TNF-α in purulent meningitis patients were higher than those in controls and virus meningitis patients(P< 0.05). The levels of TNF-α in purulent meningitis patients were the highest, and the next was in cerebral tuberculosis patients. But there was no significant difference of each index between viral meningitis patients and controls. Conclusions Detecting the activity of ADA in CSF is the most valuable in diagnosing cerebral tuberculosis. Synchronized detection of TNF-α,Ig, ADA may be have better clinical application in diagnosing intracranial infection.

Objective To compare the advantages of three-dimensional(3D) and two-dimensional(2D) ultrasound in embryo transfer. Methods A total of 319 patients accepted embryo transfter were included in this study. 2D and 3D ultrasound were used to investigate the uterine cavity and transfer distance from the fundus (TDF),respectivly. They were divided into four groups according to TDF difference(D-TDF) between 2D and 3D ultrasound(group of DTDF<3mm,group of DTDF3～5mm,group of 6～9 mm,group of DTDF≥10 mm. Pregnancy outcomes among the four groups were compared. Results Of the 319 patients, 41 were observed to have abnormal uterine cavity. For 140 patients, the TDF measured by 2D ultrasound were different from that measured by 3D ultrasound. Clinical pregnancy rate and implantation rate were found lowest in group of TDF≥10 mm mm (7.7% vs 34.1%,38.1% ,40.0% and 3.6% vs 18.2% ,21.2% ,20.0%, P <0.05). Conclusions 2D ultrasound is limit and deficient for embryo transfer, especially for the visualization of uterine cavity and location of catheter tip, however, it may be better achieved with 3D ultrasound. It is helpful to use the 3D ultrasound to place the catheter tip accurately and improve the pregnancy rate of embryo transfer.

Objective: To investigate the effect of hydrogen sulifde (H2S) on the expression of CSE, NF-κB, and IL-8 mRNA in GES-1 cells withHelicobacter pylori (H. pylori) infection and to explore its mechanism on gastric mucosa inlfammation caused byH. pylori.
Methods: GES-1 cells were cultured for 24 h and divided into a control group (neitherH. pylori nor NaHS), anH. pylori group, a NaHS group (which was further divided into 4 groups at 50, 100, 200, or 400 μmol/L NaHS), andH. pylori + NaHS group (which was further divided into 4 groups at 50, 100, 200, or 400 μmol/L NaHS). Each group was then cultured for 3, 6, or 12 h. The expression of CSE, NF-κB, and IL-8 mRNA was measured by RT-PCR, and their correlation was analyzed. Results: The expression of CSE, NF-κB, and IL-8 mRNA in GES-1 cells in theH. pylori group was higher than that in the control group. The expression of CSE in the 200 μmol/L NaHS group and 400 μmol/L NaHS group was lower than that of the control group (P<0.05), whereas the expression of NF-κB and IL-8 in all NaHS groups had no statistical differences compared with the control group (P>0.05). The expression of CSE, NF-κB, and IL-8 mRNA in all groups of NaHS,H. pylori + 200 μmol/L NaHS group, andH. pylori + 400 μmol/L NaHS group was lower than that in theH. pylori group (P<0.05). There was positive correlation among the expressions of CSE, NF-κB, and IL-8 mRNA in theH. pylori group, theH. pylori + 200 μmol/L NaHS group, and theH. pylori +400 μmol/L NaHS group (P<0.05).
Conclusion:H. pylori can induce NF-κB and IL-8 mRNA expression and upregulate CSE mRNA expression. At 200 and 400 μmol/L, NaHS can suppressH. pylori-induced NF-κB and IL-8 mRNA expression and ameliorate the morphology ofH. pylori-induced GES-1 injury, which may protect gastric epithelial cells byH. pylori infection.