Clostridium difficile( C. difficile)is a major nosocomial infection pathogen and the principal causative agent of antibiotic-associated diarrhea. The toxigenic C. difficile strains cause colonic injury and inflammation mainly by secreting enterotoxin A( TcdA)and cytotoxin B( TcdB). The severity of C. difficile associated disease( CDAD)is correlated to the toxin level during host infection. However,the toxigenic capacity of C. difficile varies widely among strains,which correlates with the gene regulation involved during toxin production. This article reviewed the regulatory mechanism of C. difficile toxin-associated pathogenic gene and anti-toxin treatment.

Objective To investigate the differential diagnostic values of DNA analysis for malignant and tuberculosis pleural effusion by flow cytometry (FCM), and compare with CEA assay MethodsUsing FCM to detect DNA aneuploidy in malignant and tuberculostic pleural effusion Results Both the specificity and diagnostic index of DNA analysis were better than CEA( P

Objective To observe the effect of modified Qinghao Biejia Decoction ( QBD) on Th17 cells and renal pathology of MRL/lpr mice with spontaneous systemic lupus erythematosus. Methods Thirty-two female MRL/lpr mice aged 8 to 10 weeks were divided into 4 groups: model group, Chinese medicine group, prednisone group, and combination group, 8 mice in each group. Eight female C57BL/6 mice aged 8 to 10 weeks served as normal control. Mice in Chinese medicine group were given concentrated solution of modified QBD (19.25 g·kg-1·d-1), mice in the prednisone group were given water solution of prednisone acetate (8.75 mg·kg-1·d-1) , mice in the combination group were given the above two kinds of medicine, and mice in the model group and normal control group were given physiological saline. After medication for 7 weeks, spleens and kidneys in all of the groups were taken out for the experiment. Th17 cells in splenic mononuclear cell suspension were detected by flow cytometry, the pathological changes of renal tissue were observed under light microscope, and activity index (AI) of renal tissue in lupus nephritis mice was scored. Results The proportion of Th17 cells in the model group was significantly higher than that of normal control group ( P<0.05) . The proportion of Th17 cells in Chinese medicine group and combination group was lower than that of the model group ( P<0.05) , and prednisone group had higher proportion of Th17 cells than Chinese medicine group ( P<0.05) . Compared with the model group, pathological changes of renal tissue were relieved, and AI scores were decreased in Chinese medicine group, the prednisone group and the combination group ( P<0.05) . Except for the normal control group , AI scores in all groups were positively correlated with the proportion of Th17 cells ( r=0.77, P<0.01) . Conclusion Modified QBD can inhibit the expression of Th17 cells and improve the pathological changes of MRL/lpr mice with lupus nephritis.

Progesterone has nongenomic effects on inducible nitric oxide synthase (iNOS), which is mediated by mitogen activated protein kinase (MAPK) pathways. This effect is supposed to have some potential association with asymptomatic gonococcal infections in women by immunological depression. In this study, polymorphonuclear leukocytes (PMNs) challenged by gonococci were used to study the nongenomic effects of progesterone. The activation of iNOS was assessed by measuring [(3)H] L-arginine converses to [(3)H] L-citrulline, and the activity of MAPK was detected by Western blot. It was found that the activity of iNOS and the yields of NO were enhanced significantly in gonococci-challenged PMNs compared with the controls (P<0.01). Progesterone could repress the activation of iNOS through P38MAPK pathway within PMNs (P<0.05), which could be blocked by SB203580 (P<0.01), but not by actinomycin D (P>0.05). It was also found subsequently that in the serum specimens collected from gonococci-infected but asymptomatic women, the progesterone level was higher than that in women with severe symptoms (P<0.01). Moreover, the yield of NO had an inverse correlation with progesterone. With these results it suggested that the rapid nongenomic effects of progesterone may inhibit iNOS activation and NO yields mediated by P38MAPK pathways, which were supposed to be concerned with asymptomatic women infected with gonococci.

OBJECTIVETo analyze the epidemiological characteristics of hospitalized children with burn injuries in Fujian Medical University Union Hospital, so as to provide evidence to complete an adequate, timely, and effective prevention and treatment system of children with burn injuries.

METHODSMedical records of children with burn injuries, aged 14 and under, hospitalized in the Department of Burns from July 2012 to June 2015 were collected. Data of gender and age, location and cause of injury, time of injury, state of injury, admission time after injury, first aid, length of hospital stay, and treatment and so on were recorded. They were divided into 4 age brackets: less than or equal to 1 year old, more than 1 year old and less than or equal to 3 years old, more than 3 years old and less than or equal to 7 years old, more than 7 years old and less than or equal to 14 years old, then gender and cause of injury of children in the 4 age brackets were analyzed. Admission months of the children were divided into spring (March to May), summer (June to August), autumn (September to November) and winter (December to February of the following year), and then the cause of injury of children in each season was analyzed. Severities of male and female children, length of hospital stay of children with different causes of injury were analyzed. Data were processed with chi-square test, Wilcoxon rank-sum test.

RESULTSOut of 2 608 inpatients with burn injuries, 1 407 children with burn injuries, aged 14 and under, accounting for 53.9%, were admitted in the recent 3 years. The ratio of male to female was 1.6 ∶1.0. Children more than 1 year old and less than or equal to 3 years old ranked the largest number (68.3%, 961/1 407) in the 4 age brackets. There was statistically significant difference in constituent ratios of gender of children among the 4 age brackets (χ(2)=11.00, P=0.012). One thousand three hundred and seventy-two children were burned indoors (97.5%), while 35 children were burned outdoors (2.5%). Scalding with hot fluids was the most common cause of burn (95.0%, 1 337/1 407). There was statistically significant difference in constituent ratios of injury cause of children among the 4 age brackets (χ(2)=107.23, P<0.01). There was statistically significant difference in constituent ratios of injury cause of children more than 7 years old and less than or equal to 14 years old compared with those of the other 3 age brackets (with χ(2) values from 12.88 to 119.85, P values below 0.01). Most burn accidents occurred between 17: 00-20: 59 (33.5%, 472/1 407). Burns were more likely to happen in April to October. July (10.4%, 146/1 407) and August (10.5%, 148/1 407) were the crest-time. Most of the children were burned in summer (35.3%, 496/1 407). There was statistically significant difference in the injury cause of children among each season (χ(2)=14.61, P=0.024). The burn degrees of male and female children were mainly mild or moderate, and there was no statistically significant difference in the severity (Z=-0.39, P>0.05). The trunk was the most involved anatomic site (61.1%, 859/1 407). Most of children were admitted to hospital within 2 hours post burn (79.7%, 1 121/1 407). Majority of children were taken off clothes as first aid on spot or did not receive any treatment. Most of the children were discharged within 2 weeks after admission (80.0%, 1 126/1 407). There was statistically significant difference in length of hospital stay of children with causes of hot liquid scald, flame burn, electric burn, high temperature solid burn, chemical burn (χ(2) =17.33, P=0.002). Most of the children were treated with non-surgical methods, and the majority of the children got better condition or totally recovered and then discharged.

CONCLUSIONSThe majority of hospitalized children with burn injuries in our unit are young boys in preschool period, who were burnt by hot fluid at the time of dinner and bathing at home during summer. So we should make more effort on popularization of prevention about burn.

Adolescent ; Burns ; classification ; epidemiology ; Burns, Chemical ; Burns, Electric ; Child ; Child, Hospitalized ; statistics & numerical data ; Child, Preschool ; Female ; Hospitalization ; Humans ; Infant ; Inpatients ; Length of Stay ; Male

Objective: To explore the pain experiences of adult burn patients so as to lay foundation for practical analgesic measures. Methods: Using phenomenological method in qualitative research, semi-structured interviews were conducted on 12 adult burn patients hospitalized in our burn units from May to November 2015, aiming at pain experiences from immediately after burns to 3 to 7 months after being discharged from hospital. Then the Colaizzi′s analysis method was applied to analyze, induce, and refine themes of interview data. Results: After analysis, pain experiences of adult burn patients were generalized into 6 themes: deep pain experiences, heavy psychological burden, limited daily life, poor assessment and treatment of pain, different attributions of pain, and different ways of coping of pain. Conclusions Burn pain brings harm to the patients′ physiology, mentality, and daily life. Nevertheless, pain processing modes of medical staff and patients themselves are the key factors affecting patients′ pain experiences. Therefore, according to the deficiency of current situation of pain management, the targeted analgesic intervention measures should be carried out from the perspectives of medical staff and patients.

Objective To explore the current status of hospitalized burn children's quality of life,so as to lay foundation for carrying out the related intervention in future.Methods Using qualitative research method,semi-structured interviews were conducted on 11 parents of burn children hospitalized in Department of Burns of Fujian Medical University Union Hospital from March to May 2016.Then the data were analyzed and concluded with phenomenological analysis method to refine the themes.Results Parents' description about the current status of hospitalized burn children's quality of life could be summed up into four areas:physiology,psychology,social development,and family;and in six themes:obvious itching symptom,limited movement development,night terror and constant cry because of fear,reduced social game,negative attachment type,and parents under multiple pressures.Conclusions Burn brings serious harm to children's physical and mental development,as well as negative effects on the parents,thus lowering the children's quality of life.Medical workers should increase knowledge and attention of it,and carry out targeted health management project.

Progesterone has nongenomic effects on inducible nitric oxide synthase(iNOS),which is mediated by mitogen activated protein kinase(MAPK)pathways.This effect is supposed to have some potential association with asymptomatic gonococcal infections in women by immunological depression.In this study,polymorphonuclear leukocytes(PMNs)challenged by gonococci were used to study the nongenomic effects of progesterone.The activation of iNOS was assessed by measuring[3H]L-arginine converses to[3H]L-citruiline,and the activity of MAPK was detected by Western blot.It was found that the activity of iNOS and the yields of NO were enhanced significantly in gonococci-challenged PMNs compared with the controls(P<0.01).Progesterone could repress the activation of iNOS through P38MAPK pathway within PMNs(P<0.05),which could be blocked by SB203580(P<0.01),but not by actinomycin D(P>0.05).It was also found subsequently that in the serum specimens collected from gonococci-infected but asymptomatic women,the progesterone level was higher than that in women with severe symptoms(P<0.01).Moreover,the yield of NO had an inverse correlation with progester-one.With these results it suggested that the rapid nongenomic effects of progesterone may inhibit iNOS activation and NO yields mediated by P38MAPK pathways,which were supposed to be concerned with asymptomatic women infected with gonococci.

Objective To systematically retrieve,evaluate and integrate evidences about the assessment and management of perioperative pain in patients with acute aortic dissection.Methods PIPOST model was used to identify themes of assessment and management of perioperative pain.The literatures in the themes was systematically searched through the databases of UpToDate,JBI,BMJ Best Practice,practice guide REgistration for trans RAREncy(PREPARE),Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),Scottish Intercollegiate Guidelines Network(SIGN),New Zealand Guidelines Group(NZGG),Registered Nurses'Association of Ontario(RNAO),Australian Clinical Practice Guidelines(ACPG),American Heart Association(AHA),European Society of Cardiology(ESC),the Chinese Cochrane Center,Medlive,Cochrane library,PubMed,SinoMed,CNKI,Wangfan Data,and VIP.The retrieved literatures were evaluated and the evidences that met the inclusive criteria were extracted from the literatures by researchers who had trained for evidence-based study.Results A total of 17 studies,including 5 guidelines,3 expert consensus,6 systematic reviews and 3 randomised controlled trials were included in this study.Totally,29 pieces of best evidence were extracted in the assessment and management of pain in perioperative patients with acute aortic dissection,including pain assessment,basic principles of pain management,medication intervention strategies of pain management,non-medication intervention strategies of pain management,pain evaluation,education of pain management and organising pain management.Conclusion Evidences in assessment and management of pain in perioperative patients with acute aortic dissection can provide references and guidance for clinical practice.

Objective To observe the inhibitory effect of quercetin on the biofilm formation of Streptococcus mutans(Sm),to preliminarily reveal the possible underlying mechanisms,and to evaluate the cytotoxicity of quercetion to human dental pulp cells so as to provide the theoretical basis for the application of quercetin in oral biomaterials.Methods Quercetin storage solution was diluted to 0,3.125,6.25,12.5,25,50,100,200,400 and 800 mg/L,and added into Sm medium for 4 h and 24 h,crystal violet staining was used to evaluate the biofilm volume.In subsequent detections,three groups were set:control(0 mg/L),200 mg/L quercetin and 400 mg/L quercetin.Confocal laser scanning microscopy was used to observe the morphology of the biofilm;qPCR for gtfB,gtfC,comD,comE,and luxS were assessed to preliminarily investigate the mechanisms.Finally,the methyl thiazolyl tetrazolium(MTT) test using human dental pulp cells was used to investigate cytotoxicity.Results Quercetin could significantly inhibit up to (86.16±0.45)％ of the biofilm formation of Sm (Compared with the control group P=0.00) and effectively removed (43.04±0.53)％ of the mature biofilm(Compared with the control group P=0.00).Confocal laser scanning microscopy photographs showed that after co-incubated for 24 h,the dense biofilm structures of the experimental group were destroyed by quercetin both at 200 mg/L and 400 mg/L.Quercetin suppressedover 50％ of the expression of gtfB,gtfC,comD,comE(compared with the control group P＜0.05) and promoted the expression of luxS up to 2.18 ±0.24 and 2.84±0.26 after 4 h and 24 h,respectively(compared with the control group P＜0.05).Quercetin also exhibited acceptable compatibility for human dental pulp cells.Conclusions Quercetin could effectively reduce the biofilm formation of Sm by inhibiting the expression of the related genes,and exhibited no cytotoxicity for human dental pulp cells.Quercetin has good potential to be applied in oral biological materials.