Objective To systematically evaluate the application effect of clinical pathways in children pneumonia patients by u-sing the system analysis .Methods Published RCT in children pneumonia patients were searched and screened in CNKI ,VIP ,CBM-disc and Wanfang datebase under present standards .The quality of the included studies were evaluated and statistical analyzed by RevMan5 .0 software .Results Total 17 literatures including 2 717 cases were eligible to the criteria (1 359 in clinical pathways group and 1 358 in control group)altogether .The system analysis showed there were significant difference between the clinical path-way group and the traditional treatment group in grasp of health knowledge [RR=1 .30 ,95% CI(1 .17 -1 .44) ,P<0 .01] ,rate of patients ,satisfaction[RR=1 .17 ,95% CI(1 .13 -1 .21) ,P<0 .01] ,length of hospital stay [WMD= -2 .90 ,95% CI(-3 .93 - -1 .86) ,P<0 .01] ,hospitalization expenses[WMD= -620 .02 ,95% CI(-838 .99 - -401 .04) ,P<0 .01] ,the body temperature to restore normal time[WMD= -1 .67 ,95% CI(-2 .10- -1 .23) ,P<0 .01] ,lung sound disappear time[WMD= -1 .80 ,95% CI(-2 .15- -1 .45) ,P<0 .01] .Conclusion Clinical pathways is superior compared with the traditional treatment for children pneumo-nia patients ,be worthy of spread in clinical .

Objective To study the mechanisms of Hydroxycamptothecin (HCPT) induced apoptosis of gastric cancer cells by detecting the expressions of p53, c myc, bcl 2, bcl xl, bcl xs genes. Methods Apoptosis of gastric cancer cells (SGC 7901,MKN 45) was measured by TUNEL and flow cytometry. The levels of mRNA and protein of p53, c myc, bcl 2, bcl xl,bcl xs genes were determined by reverse transcriptase polymerase chain reaction analysis and immunohistochemistry, respectively. Results Gastric cancer cells SGC 7901, MKN 45 presented some morphologic features of apoptosis, including cell shrinkage, nuclear condensation, DNA fragmentation, formation of apoptotic bodies, after 12 hours expourse to HCPT. Some typical subdiploid peaks before G0/G1 phase were observed. The apoptotic rates of SGC 7901, MKN 45 were 21.88% and 12.34%, respectively. The levels of p53 and bcl 2 mRNA and protein were downregulated after treated with HCPT in SGC 7901 cells. The levels proteins of c myc, bcl xl, bcl xs were unchanged after expourse to HCPT in SGC 7901 cells. The levels of p53 mRNA and protein were increased after treated with HCPT in MKN 45 cells. While the expressions of protein of bcl 2, c myc, bcl xl, bcl xs genes were not affected by HCPT in MKN 45 cells. Conclusion The results have showed HCPT induced apoptosis in gastric cancer cells might be regulated through influencing the expressions of p53 and bcl 2 genes.

Objective To assess the clinical value of low-frequency mini - probe sonography ( LFMPS) in preoperative localization of pancreatic endocrine tumors comparing with other imaging methods. Methods Twenty one cases with suspected pancreatic endocrine tumors were enrolled from June 2000 to June 2002, we compared the diagnostic results of LFMPS, transcutaneous ultrasonography ( US) , helico-computed tomography ( HCT) and magnetic resonance imaging (MRI) with surgical localization and histopathological results by using Fujinon 7. 5 MHz miniature probe and SP-701 ultrasonic system. Results Sixteen pancreatic insulinomas and 1 extra pancreatic VIPoma (vesoactive intestinal polypeptide tumor) were confirmed by surgery and histopathological examination in 17 of the 21 patients, and the rest 4 patients didn't receive surgical procedure because of the negative results in all imaging studies. Among pancreatic lesions, they located on head, body and tail in 9, 3 and 4 cases respectively; the average diameter of all 17 lesions was 2. 02cm. LFMPS correctly localized the tumor in 14 of 17 patients (82. 4% ) while CT in 15 of 17 patients (88. 2% ) , MRI in 12 of 17 patients (70. 6% ) and US in 9 of 17 patients (52. 9% ). Besides, the diagnostic accuracy of LFMPS in detection of small size (

Objective To investigate the application of colposcope in cervical cancer screening in Yunnan ethnic minority areas.Methods The questionnaire survey was conducted on 641 women,and the data of the colposcopy and biopsy were reviewed retrospectively.The colposcopy and pathological diagnosis results were compared.Results The minority women thought colposcopy more acceptable was 78.64％ (383/487).The colposcopy found suspected low-grade cervical lesions were 377 cases,high-grade cervical lesions were 245 cases,cervical condyloma were 15 cases,cervical cancer were 4 cases.The pathological results:278 cases of cervical intraepithelial neoplasia (CIN) Ⅰ,174 cases of CIN Ⅱ,55 cases of CIN Ⅲ,15 cases of cervical condyloma,4 cases of cervical cancer.The consistent rate of colposcopy and pathological examination was 68.17％ (257/377) in low-grade lesions,89.39％ (219/245) in high-grade lesions,cervical cancer and cervical condyloma was entirely consistent.Conclusions The colposcopy is more easily accepted in Yunnan ethnic minority areas,which could be a preliminary diagnosis of cervical lesions,cervical condyloma and cervical cancer.It has an important clinical application value in diagnosis of cervical diseases.

Objective To construct recombinant plasmid pEGFP C1 antisense survivin and than transfect it to MKN 45 gastric cancer cells for studying the expression of survivin mRNA and its effects on apoptosis of cancer cells. Methods Recombinant pEGFP C1 antisense survivin plasmid was cloned and transfected to MKN 45 gastric cancer cells by lipofectamine. Apoptosis of gastric cancer cells was assayed by flow cytometry. The levels of survivin mRNA before and after transfection were determined by reverse transcription polymerase chain reaction analysis. Results After recombinant pEGFP C1 antisense survivin plasmid was transfected, the apoptosis of MKN 45 cells was increase, the cell number in G 2/M phase was decreased, and the level of survivin mRNA was inhibited. Conclusions pEGFP C1 antisense suvivin can promote the apoptosis of MKN 45 gastric cancer cells, that might attribute to the inhibition on cell proliferation and expression of survivin mRNA.

Objective Through gene reconstruction we generated pcDNA 3-survivin-mutant(Cys84Ala)plasmid, then the plasmid DNA was further transfected into gastric carcinoma cells by liposomal delivery. The effects of mutant survivin on cytokinetics of the gastric carcinoma cells were obversed. Methods By using immunohistochemical staining, the expression of survivin was detected in the gastric cancer tissues, and apoptosis was detected by flow cytometry. The PARP and cytochrome C expressions were determined by Western blot, the mitotic catastrophe was determined by immunofluorescence. Results Inhibition of survivin by mutant survivin cDNA could induce apoptosis, increase caspase-3 activity, cleave PARP and promote cytochrome C release in gastric cancer cells. Inhibition of survivin also caused mitotic catastrophe in gastric cancer cells. Conclusion Inhibition of survivin may induce apoptosis and mitotic catastrophe in gastric cancer. Survivin targeting gastric cancer therapy might be of potential benefit in the future.

Objective To explore the value of EUS in the diagnosis,differential diagnosis and follow-up of primary gastric lymphoma(PGL).Methods A total of 26 patients whose endoscopic findings were highly suspected for PGL were enrolled in this study.Initial endoscopic examination anti routine biopsy were performed in all patients.EUS were undergone in all cases and its guided large piecemeal biopsy was administered in selected patients.The results of EUS,routine biopsy and routine biopsy combined with a large piecemeal biopsy were compared.Results Compared with biopsy and histopathological results,EUS made the fight diagnosis in 23 cases with overall accuracy of 88.46%,which was significantly superior to routine endoscopy and biopsy(50.0%,P=0.006),but was slightly lower than that of routine biopsy combined with large piecemeal biopsy(88.5%vs.92.3%,P=1.000).EUS can accurately differentiate gastric malignancy from benign disease with accuracy of 100.0%(23/23).Meanwhile EUS accuracy of tumor invasion(T stage)was 100.0%(12/12)as well.Conclusion EUS is valuable in the diagnosis,differential diagnosis and follow-up of PGL.

Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.

Objective To quantify the expressions of collagen metabolic markers carboxy terminal propeptide of type I procollagen(PICP),nitrogen terminal propeptide of type I procollagen (PINP),nitrogen terminal propeptide of typeⅢprocollagen(PⅢNP),type I collagen carboxy terminal telopeptide (ICTP), matrix metalloproteinases(MMPs)and the tissue inhibitor of metalloproteinases(TIMPs)in the serum of atrial fibrillation patients by enzyme linked immunosorbent assay(ELISA),and to discuss the atrial structural remodeling during atrial fibrillation(AF).Methods 71 elderly patients were enrolled,24 patients had permanent AF,24 patients had paroxysmal AF,and 23 patients were in sinus rhythm.The serum levels of all markers were measured by ELISA. Results PICP was increased in permanent AF group versus the paroxysmal AF group and sinus rhythm group by 25.4%and 42.8%(all P<0.05),respectively.PⅢNP was increased in permanent AF group versus the paroxysmal AF group and sinus rhythm group by 17.9a% and 35.6%(all P<0.05),respectively,and was increased in the paroxysmal AF group versus the sinus rhythm group by 15.0%(P<0.05).PINP and ICTP did not differ significantly between the 3 groups(all P >0.05).MMP-1 was significantly increased by 25.6%(P<0.05)in the paroxysmal AF group versus the sinus rhythm group.MMP-2 was also significantly increased in permanent AF group versus the paroxysmal AF group and sinus rhythm group by 54.9%and 37.9%(all P<0.05),respectively.MMP-7,MMp-9 and TIMP-1 did not differ significantly between the 3 groups(P>0.05).TIMP-2was significantly decreased in the permanent AF group and paroxysmal AF group versus the sinus rhythm group by 21.8%and 11.8%(P<0.05),respectively. Conclusions Disturbance in the balance of MMP/TIMP system may perturb the balance of collagen synthesis and degradation during atrial fibrillation.This may be a contributing mechanism to atrial structural remodeling in atrial fibrillation,and may correlate with the initiation and maintenance of AF.

Objective To study the differences of clinical manifestations,etiology and hospitalized outcomes of purulent meningitis in preterm and term infants.Method All preterm and term infants with purulent meningitis hospitalized in the Hospital from 2006 to 2015 were enrolled in this study.The data of neonate's condition,maternal condition,clinical manifestations,complications,etiology,treatment and outcomes of the preterm and term infants groups were compared.Result During the study period,44 preterm infants and 118 term infants were included.The time of onset for purulent meningitis of preterm infants group was statistically earlier than that of term infants group [11.2 (3.2,19.8) d vs.14.3 (5.6,23.9) d,P ＜ 0.05].The prognosis of preterm infants group was statistically worse than that of term infants group (P ＜ 0.05).Among them,the incidences of clinical manifestations in preterm infants group compared to term infants group were:fever (54.5％ vs.78.8％),seizure (11.4％ vs.26.3％),lethargy and poor response (59.1％ vs.38.1％),slow weight gain (9.1％ vs.0％),apnea (45.5％ vs.0.8％) and cyanosis (15.9％ vs.4.2％);all the differences between two groups were significant (P ＜ 0.05).The time of onset for purulent meningitis with complications was statistically earlier than those without complications [9.5 (4.1,20.5) d vs.13.8 (5.9,22.0) d,P＜0.05].The duration of treatment for purulent meningitis with complications was longer than that without complications [(42.2 ± 8.8) d vs.(28.7 ± 7.1) d,P ＜ 0.05],and the positive rate of pathogens was also statistically higher than those without complications (73.8％ vs.26.7％,P ＜0.05).Coagulase-negative staphylococcus was the main pathogen for both preterm and term infants group.Klebsiella pneumoniae was more common in preterm infants group than in term infants group (40.0％ vs.10.4％,P ＜0.05).Conclusion Preterm infants with purulent meningitis had early onset time,atypical clinical manifestations,and poor prognosis.The treatment course for purulent meningitis with complications is prolonged.The pathogens for neonatal purulent meningitis have already changed.The detection rate of conditional pathogens is increasing yearly,for which the clinicians should take note seriously.