Perianal necrotizing fasciitis is a serious soft tissue infectious disease of perianal and perineal regions, where a synergistic action of multiple bacteria (including aerobic bacteria and anaerobic bacteria) results in suppurative necrosis of the skin and soft tissue. The disease progress may rapidly cause systemic sepsis through blood circulation, often with complicating shock and MODS, or death. Any delay in diagnosis and treatment of early acute infections may lead to higher mortality because of lack of standardized treatment. The Clinical Guidelines Committee aims to formulate expert consensus on the treatment of perianal necrotizing fasciitis in terms of etiology and pathology, clinical manifestations, laboratory and imaging study, preoperative preparation, surgical treatment (the application of antibiotics, the timing and key points of debridement, assistant therapy), postoperative wound care, nutritional support, surgical reconstruction and rehabilitation. This consensus is a reference for clinicians based on patient conditions.

Objective Alarge-scale prospective multicenter randomized controlled tial was conducted to evaluate the efficacy and safety of Yinzhihuang oral solution for the treatment of neonatal indirect hyperbilirubinemia in term newborn infants. Yinzhihuang oral solution is a herbal extract with the main components of Herba Artemisiae Scopariae, Scutellaria, Lonicera Japonica and Gardenia jasminoides. Methods A total of 16 hospitals participated in this study. From March to September 2010, the term infants whose bilirubin level ≥ 40 th percentile for age in hours were enrolled, except for those who received exchange transfusion or had signs of bilirubin encephalopathy. All the 1177 cases were divided randomly into three groups: phototherapy group (409 cases ), phenobarbital combined with phototherapy group (373 cases) and Yinzhihuang oral liquid combined with phototherapy group (395 cases). Phenobarbital and Yinzhihuang oral liquid was started once the infants participated the study, and persisted for 5 days. Phototherapy was added as soon as the bilirubin level reached the lowest threshold ( the threshold for infants at higher risk). The demographic data of infants in each group were recorded, the serum bilirubin level before treatment, after treatment for 72 hours and after the treatment completion were checked. The reduction rate of serum bilirubin and the phototherapy rate in different groups were compared. The adverse events were assessed as well. Results Of the total of 1177 cases, 707 (60. 1％ ) were male, 1119 cases (95. 1％ ) were of Han ethnicity. The average total bilirubin level before treatment was ( 282. 0 ± 70. 9) μmol/L and the highest level was 626 μmol/L The severe hyperbilirubinemia (total bilirubin level at 342 μmoL/L to 427 μmol/L) accounted for 15.8％ (186 cases), and the extremely severe hyperbilirubinemia (total bilirubin ＞427 μmol / L) accounted for 2. 5％ (30 cases). After treatment for 72 hours, the reduction of bilirubin was not significantly different among three groups ( F =2. 89, P =0. 056). After completion of treatment, the reduction rate of bilirubin in Yinzhihuang group was higher than that of the other two groups (F =5.55, P =0. 004). The rate of infants who did not receive phototherapy in Yinzhihuang group was higher than that in phenobarbital group (x2 =47. 38, P=0. 000). In Yinzhihuang group, more infants had bowel movements more than five times a day. The incidence of rashes was higher than that in phenobarbital group (P =0. 019), but no significant difference was found as compared with that in phototherapy group (P =0. 339). Conclusions About 18％ of the term infants who were admitted for jaundice had severe or extremely severe hyperbilirubinemia. Yinzhihuang oral solution combined with phototherapy is effective in bilirubin reduction. Early treatment with Yinzhihuang oral solution may inhibit further increase in bilirubin levels, reduce the phototherapy requirement.

Perianal necrotizing fasciitis is a serious soft tissue infectious disease of perianal and perineal regions, where a synergistic action of multiple bacteria (including aerobic bacteria and anaerobic bacteria) results in suppurative necrosis of the skin and soft tissue. The disease progress may rapidly cause systemic sepsis through blood circulation, often with complicating shock and MODS, or death. Any delay in diagnosis and treatment of early acute infections may lead to higher mortality because of lack of standardized treatment. The Clinical Guidelines Committee aims to formulate expert consensus on the treatment of perianal necrotizing fasciitis in terms of etiology and pathology, clinical manifestations, laboratory and imaging study, preoperative preparation, surgical treatment (the application of antibiotics, the timing and key points of debridement, assistant therapy), postoperative wound care, nutritional support, surgical reconstruction and rehabilitation. This consensus is a reference for clinicians based on patient conditions.

To investigate the relationship of biofilm-forming ability of (PA) with swimming motility, twitching motility and virulence gene distribution. A total of 192 clinical isolates of PA were collected consecutively. Microtiter plate method was used to evaluate the ability to form biofilm. The swimming and twitching motilities were detected by plate method. Polymerase chain reaction (PCR) was used to detect virulence genes. Of the 192 PA clinical isolates, 186 (96.9%) showed biofilm-forming ability. Among them, 36 isolates showed weak biofilm-forming ability, 84 exhibited moderate biofilm-forming ability and 66 showed strong biofilm-forming ability. The diameters of the swimming ring for PA with none biofilm-forming ability, weak biofilm-forming ability, moderate biofilm-forming ability, strong biofilm-forming ability were (9.12±6.76), (18.42±7.51), (19.10±4.77) and respectively. The diameters of the twitching ring for PA in above groups were (8.38±1.50), (17.21±7.42), (18.49±5.62) and respectively. The swimming motility and twitching motility of none biofilm-forming ability group were weaker than biofilm-forming ability groups (all <0.05). Among 192 PA strains, 163 were positive (84.9%), 40 were positive (20.8%), 183 were positive (95.3%), and 189 were positive (98.4%). The positive rate of PA virulence gene , and were different in strains with different biofilm-forming abilities (<0.05). The rate of in the strong biofilm-forming ability group was lower than that in the moderate biofilm-forming ability group (=9.293, <0.01) and the weak biofilm-forming ability group (=9.997, <0.01). The rate of in the strong biofilm-forming ability group was higher than that in the weak biofilm-forming ability group (=10.803, <0.01). Most clinical isolates of PA can form biofilm. Swimming and twitching motilities are related to the formation of biofilm, but not significantly related to strength of biofilm-forming ability. The virulence genes of type Ⅲ secretion system for PA may be related to the biofilm-forming ability.
Biofilms ; Humans ; Swimming ; Virulence/genetics*

Inflammation reaction and immune response are inseparable at the levels of system, tissue, cell and molecule. Inflammatory immune responses (IIR) is defined a moderate or abnormal system responses of inflammatory immune related cells in responding to the internal and external environ-ment changes of body. Inflammatory immune related cells (traditionally, eg, macrophages, dendritic cells, T cells and B cells, etc, and non- traditionally, eg, glial cells, endothelial cells, epithelial cells, fibroblasts, synovial cells and liver cells, etc), and cytokines/receptor signal transduction involved in IIR. In current clinic drugs, such as inhibitors of COXs, inhibitors of TNF-alpha, IL-6, IL-17, BAFF etc, tradi?tional immunosuppressive drugs (eg, methotrexate, leflunomide) and novel kinase inhibitor (eg, JAKs inhibitor), suppress enzyme activity, gene synthesis and transcription, cytokines and receptor signal, etc, respectively. These drugs restrain the excessive activation function of inflammatory immune related cells, but at the same time, also inhibit the physiological response of these cells to signaling molecules, which cause physiological function disorder of cells and tissues, increase the risks of serious adverse drug reaction including infection and cancer. Soft regulation of inflammatory immune responses (SRIIR), that is regulating the activity of key molecules or interaction between molecules in cells and resulting in making excessive activation function back to normal physiological levels, is a novel direction of discovery and development of new drugs for the treatment of IIR related diseases.

The indigenous populations of high altitude, physiologically with lower concentration of hemoglobin and higher level of nitric oxide, can be well-adapted to hypoxia and cold environment. Recent studies have revealed that these adaptive highland population possessed genetic bases, which involved a number of genes, such as EPAS1, EGLN1, CBARA1, VAV3, PPARA, and eNOS, associating with hypoxia-inducible pathway, production of red blood cells and vasodilator substances, etc. These findings provided new insights and strategies from genetics to uncover the unique natural environment selection, to understand the mechanisms of plateau diseases, finally to better prevent and treat them.

Molecular targeted therapy has recently become a focus of study for non-small cell lung cancer. The drugs for molecular targeted therapy mainly include monoclonal antibodies against the epidermal growth factor receptor (EGFR), against vascular endothelial growth factor receptor (VEGFR), and EGFR tyrosine kinase inhibitors. These drugs have achieved positive outcomes in clinic, but they also have toxic effects such as rash, diarrhea, and hypertension. Some new agents in clinical development, such as sorafenib, sunitinib, vorinostat, vandetanib, also showed toxic effects, which greatly influence the patients quality of life and reduce the compliance for the drugs. This paper reviews the toxicities and the managements of molecular targeted drugs during treatment of non-small cell lung cancer.

Objective To study the synergistic effect of NKX6. 1 and PDX1 in inducing differentiation of fetal liver-derived mesenchymal stem cells(FL-MSCs) into the pancreatic B cells and to explore the underlying mechanisms, so as to obtain enough islet-like body for transplantation. Methods Recombinant adenovirus vector harboring both PDX1 and NKX6. 1 genes was constructed, and the vector was used to infect FL-MSCs. Then a series of cytokines were used to induce the differentiation of infected FL-MSCs into pancreatic B cells. The expressions of PDX1, NKX6.1 gene, transcription factors NGN3, NeuroDl/Beta2, MafA as well as C-peptide were examined. Results PDX1 and NKX6. 1 were detected in FL-MSCs cells 24 h after infection; cells began to express NGN3, NeuroDl, and MafA and stably expressed pancreatic B cell related factors including insulin after induction. The expression of these molecules was in a certain order. Conclusion PDX1, NKX6. 1 combined with a series of cytokines can effectively induce FL-MSCs to differentiate into pancreatic islet B cells in vitro, which might be through activation of transcription factors NGN3, NeuroDl, and MafA in turn, inducing FL-MSCs to differentiate towards endocrine precursor cells, B endocrine precursor cells and B cells in turn.