OBJECTIVE:To compare the healing effect of traditional therapy versus the traditional therapy in combination with additional externally applied agent on the traumatic tympanic membrane perforation with a focus on the effect of recombinant human epidermal growth factor(rhEGF) in promoting healing of tympanic membrane perforation.METHODS:A total of 90 patients with traumatic tympanic membrane perforation were randomly divided into two groups:one group received traditional therapy in which the anti-inflammatory drug was given plus nasal administration with water not allowed entering in the external acoustic meatus;another group was treated with traditional therapy plus rhEGF cotton applied externally.The healing of the tympanic membrane perforation and the auditory acuity improvement in two groups were monitored.RESULTS:In rhEGF group(58 cases),the cure rate reached 100%,with an average healing time of 5.3 days;Of the 32 cases in the traditional therapy group,7 were not failed,and 25(78%) healed,with an average healing time of 28.4 days.The healing time of tympanic membrane perforation in rhEGF group was significantly shorter than in traditional group,showing significant difference(P

Non-alcoholic fatty liver disease(NAFLD) has become the main cause of chronic liver disease in children worldwide, and the incidence of NAFLD shows an increasing trend year by year. The risk factors leading to the onset of NAFLD in children are diversified and different from those in adults. At present, most medical institutions still pay little attention to NAFLD in children. This paper summarizes the risk factors and mechanisms for NAFLD in children, including gene polymorphism, maternal and fetal conditions, diet and living habits, environmental exposure, metabolic syndrome, endocrine-related mechanisms and intestinal microecology, in order to provide reference for the prevention and management of childhood NAFLD.

Objective: To investigate the factors associated with CD4⁺ /CD8⁺ T lymphocyte ratio normalization in acquired immunodeficiency syndrome (AIDS) patients after antiretroviral therapy (ART). Methods: The data of 1 188 human immunodeficiency virus (HIV)/AIDS patients from the national ART reporting system in Yuxi City, Yunnan Province between January 1, 2006 and December 31, 2016 were retrospectively collected and analyzed. The rate of CD4⁺ /CD8⁺ T lymphocyte ratio normalization after ART was calculated by lifetable. Cox proportional hazard models were used to analyze the factors associated with CD4⁺ /CD8⁺ T lymphocyte normalization in AIDS patients after ART. The Wilcoxon rank sum test was used for comparison between groups. Results: The follow-up time was 3.8 (1.0-10.8) years. CD4⁺ /CD8⁺ T lymphocyte ratio normalization was documented in 95 patients with the rate of 1.89 per 100 person-years (95% confidence interval(CI) 1.52-2.27) after ART. The average time from ART to CD4⁺ /CD8⁺ T lymphocyte ratio normalized was 9.4 years. The cumulative normalization rate was 0.02 for the first year, 0.06 for the third year, 0.11 for the fifth year, 0.19 for the seventh year and 0.37 for the ninth year. By Cox proportional hazard models, the probability of CD4⁺ /CD8⁺ T lymphocyte ratio normalization in patients infected HIV by heterosexual contacts was 3.709 (95%CI 1.781-7.726) times higher than those by intravenous injection. The probability of CD4⁺ /CD8⁺ T lymphocyte ratio normalization in patients with baseline CD4⁺ T lymphocytes of 350-499 and more than 500 cell/μL groups were 2.792 (95%CI 1.196-6.519) and 3.832 (95%CI 1.648-8.913) times higher than those with baseline CD4⁺ T lymphocytes less than 200 cell/μL, respectively. The probability of normalization after ART in patients with higher baseline CD4⁺ /CD8⁺ T lymphocyte ratio was higher than those with baseline CD4⁺ /CD8⁺ T lymphocyte ratio≤ 0.20 (hazard ratio>1, all P<0.01). Conclusion The CD4⁺ /CD8⁺ T lymphocyte ratio normalization in AIDS patients after ART is associated with baseline CD4⁺ T lymphocyte counts, baseline CD4⁺ /CD8⁺ T lymphocyte ratio and HIV transmission mode.

Objective: To compare the differences and caused of patients' utilization of Traditional Chinese Medicine service under three basic medical insurance systems.Methods: Using self-developed questionnaire,random sample survey was conducted among the basic medical insurance outpatients in five hospitals in Nanjing and Lanzhou.The survey content included the basic information of the patients,the utilization of Traditional Chinese Medicine outpatient clinics,the utilization of Traditional Chinese Medicine service items,and the suggestions for the Traditional Chinese Medicine service.Results:①The utilization rate of the Traditional Chinese Medicine out-patient clinics in new rural cooperative medical system patients was much lower than that in urban basic medical in-surance patients.②The utilization rate of Traditional Chinese Medicine service projects in patients under basic medical insurance for urban employees was higher than those under medical insurance for urban residents and new rural cooperative medical system patients.In all Traditional Chinese Medicine service projects,the utilization rate of cupping project was the highest(48.3％).③ The gap between urban and rural areas made the utilization rate of Traditional Chinese Medicine service projects different among patients participating in basic medical insurances.④ The most expected suggestion of patients was the improvement of the efficacy of Traditional Chinese Medicine(68.5％),followed by the improvement of medical insurance-related reimbursement ratio(65.2％)and the in-crease of reimbursement items(64.3％).Conclusion: The government should increase the financial input in new rural cooperative medical system and improve the basic medical insurance system.Traditional Chinese Medicine medical institutions should improve the quality of services in order to achieve the fairness in the provision of health services.

OBJECTIVETo investigate the effect of environmental risk factors on the development of stroke.

METHODSWith the use of cold-stimuli plus high-salt intake as environmental risk factors, a hypertension model with the complication of stroke was established in rats, then, a new technique, suppression subtractive hybridization (SSH), was used to identify the differential genes which specifically expressed in total cerebrum tissue of rat in each group. Comparison was made between control group and stroke group.

RESULTSBy the application of SSH, a total of 576 clones were generated in this study from two subtractive libraries, among them 456 clones were usable and were analyzed. Genes for cell/organs defense were down-regulated in stroke group and metabolism transcripts were shown to be up-regulated (P<0.01).

CONCLUSIONCell/organs defense genes may play important roles in the development of stroke. The above findings suggested that environmental risk factors could genetically alter individual sensitivity to stroke.

Animals ; Brain ; metabolism ; pathology ; Cell Division ; genetics ; Cold Temperature ; DNA, Complementary ; chemistry ; genetics ; Expressed Sequence Tags ; Gene Expression Regulation ; drug effects ; Immunity, Innate ; genetics ; Male ; RNA, Messenger ; drug effects ; genetics ; metabolism ; Rats ; Rats, Wistar ; Sequence Analysis, DNA ; Signal Transduction ; genetics ; Sodium Chloride, Dietary ; administration & dosage ; Stroke ; genetics

Objective To analyze the drug resistance phenotype and genetic background of New Delhi metallo-β-lactamase (NDM)-producing bacterial strains in Lishui area of Zhejiang province.Methods The imipenem-resistant Enterobacteriaceae strains were isolated from January 2012 to December 2016 in Lishui Municipal Central Hospital of Zhejiang Province.Mrieux Vitek 2 Compact system was used to identified strains and PCR was used to screen for blaNDMgene.Susceptibility was detected by K-B method and MICs were obtained by Vitek 2 with GN13 cards.Plasmids typing was carried out by DNA sequencing of the replication initiator with the transconjugates as templates.The blaNDMgenetic contexts were detected by PCR and complete genome sequencing.Results A total of 102 strains of carbapenem-resistant enterobacteria (CRE), mainly Escherichia coli and Enterobacter cloacae, were isolated, of which 15 were positive for blaNDMwith a positive detection rate of 14.7%.The resistance rate to β-lactam antibiotics was 100%, and the resistance rates to aztreonam, compound sulfamethoxazole , tobramycin and gentamicin were all ＞80%;and the resistance rate to quinolones was ＞50%.Among the 15 NDM-producing strains , 12 strains were positive for Hodge test, and 2 strains of Enterobacter cloacae and 1 strain of Escherichia coli were negative. There were 11 strains of blaNDM-1and 4 strains of blaNDM-1.A variety of plasmid types such as IncX 3, IncFIIγ and IncA/C were detected, and 4 blaNDM-5genes were located in the IncX3 plasmid.Four blaNDMsurrounding gene structures were found, of which 8 blaNDM-1genes were located in ISAb125-hyp-blaNDM-1-bleMBL-TrpF-DsbC-IS26, while blaNDM-5was located in IS3000-IS5-blaNDM-5-bleMBL-TrpF-DsbC-IS26 structure, and the former was reported for the first time in China.Conclusion NDM-producing bacterial strains in Lishui area are prevalent at a low level and have high sensitivity to fosfomycin and polymyxin .The blaNDMgene may have multiple sources, but IncX3 plasmid is still the main source for gene transfer.Some new types of blaNDM-1 gene structure have been also found in this study.