As the most common pathogen for healthcare -associated infection in European and American countries, Clostridium difficile has become increasingly popular in China and has posed a great threat to public health.Based on evidences retrieved from the PubMed and CNKI databases , this article reviews biological characters and dissemination patterns of C.difficile, epidemiology, burden and risk factors of C.difficile infection, and the surveillance, contact precaution, hand hygiene, antimicrobial stewardship, environment cleaning, use of probiotics and vaccine for the prevention of C.difficile infection.

Purpose To study the expression of zeb-1 and c-jun in gastric cancer and its influence of occurrence and development of tumor. Methods The expression zeb-1, c-jun and E-cadherin were assessed in 100 specimens of gastric cancer and their tissue adja-cent to cancer by immunohistochemistry. Results The positive rates of zeb-1,c-jun and E-cadherin expression in gastric cancer were 81%, 70%, 35%, and in tissue adjacent to cancer were 17%, 25%, 100%. The expression of zeb-1 and c-jun in gastric cancer were higher than those in their tissue adjacent to cancer (P<0. 05). zeb-1 expression was closely correlated with the degree of tumor differentiation, depth of invasion, lymph node metastasis and TNM stage (P<0. 05), which were not correlated with patient s age, sex and tumor size. c-jun expression was closely correlated with the degree of tumor differentiation (P<0. 05), which were not correlated with other pathological features. The expression of zeb-1 was negatively correlated with the expression of E-cadherin and was positively correlated with the expression of c-jun in gastric cancer. Patients with high expression of zeb-1 and c-jun had lower five-year survival rate than patients with negative expression. Conclusion zeb-1 and c-jun are closely correlated with occurrence and development of gastric cancer. They can be a index of judging prognosis of gastric cancer.

Objective: To conduct systematic evaluation on the dermatologic toxicity caused by targeted anti-cancer drugs in children and teenager to provide reference for future studies and clinical practice.Methods: Pubmed(http:∥www.ncbi.nlm.nih.gov/pubmed/), American Society of Clinical Oncology Annual Meetings' Online Abstracts Database(http:∥www.asco.org/) and ClinicalTrials.gov(http:∥www.clinicaltrials.gov) were searched for the clinical trials on the use of targeted anti-cancer drugs (single or combination) in children and teenager complicated with dermatologic toxicity.Methodological quality assessment was performed for the included studies, using Cochrane's risk of bias assessment tool for randomized controlled trials and methodological index for non-randomized studies (MINORS).Meta-analysis was performed for the outcomes including adverse event rate of skin rash, xerosis, pruritis and mucositis.Results: A total of 24 studies with 960 patients were included in this study.Various solid tumors and leukemia were investigated in the studies.The quality assessment revealed that the majority of included studies were with high quality.According to the results of meta-analysis, the pooled event rate and 95% confidence interval were 0.19[0.12-0.28],0.24[0.06-0.51],0.12[0.04-0.24] and 0.21[0.07-0.39] for skin rash, xerosis, pruritis and mucositis, respectively.Publication bias analysis indicated potential reporting bias for skin rash (Egger's P=0.007).Conclusion: Dermatologic adverse events occur in a part of children and teenager with cancer treated with targeted therapy, which may cause impaired quality of life and disability.Adequate attention should be paid to these events during clinical trials and real life practice.

Objective To study the content changes of ET and CGRP in MID patients and investigate the effect of cluster needling on scalp point about intelligence of MID patients. Methods Sixty MID patients were divided into cluster needling group and medicine group which was treated by hupperzine. HDS,ADL,MMSE score and ET,CGRP content was assayed before and after treatment. Results After treated for 8 weeks,CGRP content of cluster needling group was increased and ET was decreased significantly compared with medicine group (P

Calcium-sensing receptor(CaSR)is expressed in human parathyroid cells and renal tubular epithelial cells mainly.CaSR could control parathyroid hormone(PTH)secretion and the renal tubular's handing of the electrolytes and water.This receptor plays a central role in extracellular calcium homeostasis,and involves in the process of bone remodeling.The change of CaSR function,including anti-CaSR antibodies,CasR gene mutations or any part impairment in CaSR signaling pathway,not only results in the imbalaance of PTH and calcium homeostasis.but also relates to disorders of bone remodeling and renal tubular's mishandling in the electrolytes and water,which contribute to hyperparathyroidism.It makes possible clinical Use of cinacalcet in hyperparathyroidism in theory.

Objective To evaluate the accuracy of different methods for estimating blood loss during burn wound excixion and skin grafting in pediatric patients with severe burn. Methods Twenty pediatric patients of both sexes aged 7 days-8 yr weighing 4-22 kg undergoing burn wound excision and skin grafting were enrolled in this clinical study. Two methods were used for estimating blood loss during operation: Method Ⅰ: surgical surface area (SSA). MethodⅡ: the product of SSA and blood volume (BV). Total blood loss was calculated: total blood loss = BV ( Hct0 - Hctx ) ÷ Hct0 + Tx. Hct0 =Hct before operation. Hctx =Hct at the end of operation. Tx =total amount of blood transfusion. Results The correlation between the total blood loss and SSA was 0.776. The correlation between the total blood loss and the product of SSA and BV was 0.889. The difference was statistically significant. Conclusion The product of SSA and BV is more accurate in estimating blood loss during burn wound excision and skin grafting in children with severe burn.

Objective To verify the traditional serrated pathway by comparing microsatellite instability(MSI) status among traditional serrated adenoma, traditional adenoma, serrated colorectal cancer and non-serrated coloreetal cancer. Methods Seventy-five paraffin-embedded tissue samples, including 15 with serrated adeneearcinoma (Sca), 20 with non-serrated adenocareinoma (N-Sca), 20 with traditional serrated adenoma(TSA) and 20 with villous adenoma(AD) were collected from the pathology department of our hospital. Genomic DNA was extracted from these samples and then amplified with fluorescently-labeled primer specific for BAT25 and BAT26. The MSI status was detected with DNA automatic sequencer. Results Six of 18 samples with TSA harbored MSI-H and twelve MSI-L/MSS; 18 samples with conventional adenoma were exclusively of MSS; 3 of 13 samples of serrated carcinoma harbored MSI-H and ten MSI-L/MSS; 18 of 19 N-Sca samples harbored MSI-L/MSS and only one MSI-H. With Chi-square test, the MSI frequency in AD group and N-Sca group was significantly lower than that in TSA group and Sca group ( P < 0. 05 ) ; but with no statistical difference between the TSA group and Sca groups ( P > 0. 05 ). Conclusion MSI-H frequency in AD group and N-Sca group was obviously lower than that of TSA group and Sca group. It is concluded that there might be a new traditional serrated neoplasia pathway which is different from the conventional adenoma-carcinoma carcinogenesis pathway, but we still need prospective follow-up studies to verify its existence.

Objective To investigate the pathological significance of expression of IL-23 in colon tissues of patients with steroid-dependent uncreative colitis at remission.Methods Expression of IL-23 was measured by means of Western Blot and immunohistochemistry SABC in inflammation repairing areas from 15 patients with steroid-dependent ulcerative colitis at remission, 30 patients with common ulcerative colitis at remission (15 treated with SASP and 15 with prednisone) and 10 normal colon tissues.The results were analyzed by SPSS 16.0.Results Compared with normal control, expression of IL-23 in patients of SASP maintenance therapy and prednisone with common ulcerative colitis were slightly increased ( P > 0.05), which was significantly lower that of steroid-dependent specimens ( P < 0.01).Conclusion Over-expression of IL-23 may plas a key role in the pathogenesis of steroid-dependent ulcerative colitis.

Patients with ischemic stroke is often accompanied by inflammtory response. Studies have suggested that toll-like receptor 4 (TLR4) has induced the occurrence,development and of ischemic stroke and secondary brain injury. This article reviews the toil-like receptor 4 signal transduction pathway and its roles in ischemic stroke in order to provide certain basis for the development of TLR4-targeted medication.

BACKGROUND: Dynamic balance of endothelin (ET) and calcitonin gene-related peptide (CGRP) plays an important role in occurrence and development of cerebral infarction.OBJECTIVE: To observe the effects of thromboiytic therapy with batroxobin(DF-521) on the levels of plasma ET and CGRP after cerebral infarction.DESIGN: Randomized controlled study.SETTING: Fourth Department of Gereology, General Hospital of Guangzhou Military Area Command of Chinese PLA.MATERIALS: The experiment was performed at the Fourth Department of Gereology, General Hospital of Guangzhou Military Area Command of Chinese PLA. Totally 15 New Zealand rabbits aged from 18-20 months, of common grade and either sex, with the mean body mass of (3.5±0.5) kg were selected.METHODS: A total of 15 rabbits were established into cerebral infarction models with modified autogeneic thrombus method. One rat died when selecting models. Other 14 rats were randomly assigned into control group and treatment group. DF-521 was slowly injected into vein of ear edge of rats in the treatment group at hour 2 after embolism. Saline of the same volume was slowly injected into rats of the control group. Changes of concentrations of plasma ET and CGRP in the treatment group and control group were observed before and after cerebral infarction.MAIN OUTCOME MEASURES: Changes of ET and CGRP contents 1 hour before operation, 2 hours after operation (before drug injection) and 6 hours after operation (4 hours after drug injection).RESULTS: Of the 15 included rabbits, 1 rat died when establishing model, so 14 rabbits were involved in the result analysis. ET level significantly increased at hour 2 after acute cerebral infarction operation in the treatment group and control group (P ＜ 0.05, P ＜ 0.01), and then decreased at hour 6 after operation (P ＜ 0.01 ,P ＜ 0.01 ). The decrease in the treatment group was larger than that in the control group (P ＜ 0.01 ). The level of CGRP markedly reduced at hour 2 after acute cerebral infarction operation in the two groups, and than increased at hour 6 after operation. The increase in the treatment group was larger than that in the control group, but there was no statistical difference (P ＞ 0.05).CONCLUSION: Body with cerebral infarction during acute stage has selfregulative mechanism on dysequilibrium of ET and CGRP. Early-used thrombolytic therapy with DF-521 can markedly increase the ET level,which may be one of the protective mechanisms of cerebral ischemical reperfusion injury.