Objective To compare the effect of Baikerui compound lysostaphin (FE complex phosphoesterasum) disinfectant and povidone iodine in treatment of burn wound infection resulted from gram-positive (G ±) coccus.Methods The study involved 60 patients with superficial second degree burns (1％-5％ TBSA； age range of 18-50 years).All the patients received bacterial culturing of wound secretions prior to treatment.Every 20 patients were indentified with infection of staphylococcus aureus (SA),staphylococcus epidermidis (SE),and enterococcus (EC) respectively and randomized into control group and experiment group,with 10 patients per group.Patients allocated to the experiment group were covered with four-layer sterile gauze soaked into the Baikerui compound lysostaphin disinfectant,while the patients in the control group were treated with four-layer sterile gauze soaked into the povidone iodine.Dressing was changed once a day.Wound culturing was performed again at each day of the 5-day treatment.Wound healing was compared among each group.Results SA wound infection turned negative for all the 10 patients in experimental group and three patients in control group (P ＜ 0.01).SE wound infection turned negative for all the 10 patients in experimental group and six patients in control group (P ＜ 0.05).EC wound infection turned negative for nine patients in experimental group and seven patients in control group (P ＞ 0.05).Mean wound healing time was (10.87 ± 1.93) days for experimental group and (13.31 ± 2.89) days for control group (P ＜ 0.05).Conclusion Baikerui compound lysostaphin disinfectant can effectively prevent burn wound infection with common G + coccus and accelerate wound healing.

Objective To explore the underlying mechanism of respiratory syncytial virus-related asthma .Methods Totally 30 sprague-dawley rats were randomly divided into control group ,respiratory syncytial virus (RSV) group ,and anti-NGF group ,with 10 in each group .RSV infection model was established by nasal drip once a week .In anti-NGF antibody intervention group ,each rat was given intraperitoneal injection of anti-NGF for 3 h before identical RSV infection .transmission electron microscopy(TEM) were performed to observe the ultramicro-structure changes in adrenal medullary cell .The concentrations of adrenaline and NGF in serum were measured by ELISA .The NGF expression was assayed by immunohistochemistry .The expression difference of neurofilament protein mRNA was detected by RT-PCR .Results (1) Electron microscope showed ,medullary cells riched in mitochondria ,Chro-maffin granule concentration decreased obviously ,and membrane could saw clubbing phenomenon of neurite outgrowth clearly in RSV infection group .Meanwhile ,NGF expression was significantly increased in RSV infection group .(2) ELISA results showed that the concentrations of NGF in the RSV group was significantly increased compared with control group and anti-NGF group(P<0 .05) ,while the concentrations of NGF showed no difference between control group and anti-NGF group(P> 0 .05) .Compared with control group ,the adrenaline concentration of RSV group and anti-NGF group was significantly decreased(P<0 .01) ,and the adrenaline concentration of RSV group was significantly decreased compared with anti-NGF antibody group(P<0 .05) .(3) NF-LmRNA expression was significantly increased in RSV group .However ,compared with control group ,the NF-LmRNA expression was significantly decreased in anti-NGF group .(4) RT-PCR results show that ,Compared with control group ,adrenal medullary cells NF-LmRNA expression of RSV group and the anti-NGF group was significantly increased .Compared with RSV group ,NF-LmRNA adrenal medulla cells in Anti-NGF group was significantly decreased .Conclusion RSV infection may induce the adrenal medullary cell differentiation to nerve cell by over-expressed NGF ,and result in the decrease of adrenaline in serum to involve in asthma progression .

Objective To analyze the prevalence and economic burden of diabetes in Guandu district of Kunming. Methods We used probability proportional to size (PPS) sampling method to select representative sample of 4595 residents aged 18 or over from this district. Each participant received face to face questionnaire interview and physical examination. We applied different methods to measure the direct,indirect and intangible costs of diabetes. Results In the study population, the overall prevalence of diabetes was 6.2%,and females had higher prevalence of diabetes than males (6.2%vs. 5.6%, <0.05) . The DALY/1000 population of diabetes was 3.52, among which males and females were 5.18 and 6.70, respectively. Mean unit direct costs, indirect costs and intangible costs of diabetes were 3464.49 Yuan,84.48 Yuan and 4 045.97 Yuan,respectively. The total economic burden of diabetes was 401.84 million Yuan. Intangible costs represented the largest component of economic burden of diabetes,followed by direct costs. Conclusion The huge economic burden of diabetes has become the cause for concern in Guandu district. Effective measures are needed to reduce the economic burden of diabetes.

Objective To investigate the life quality and influencing factorin stroke patient.MethodTotally 205 hospi-talized stroke patientin the neurology departmenwere investigated with SF-36 scale .The datwere performed the descriptive sta-tistic,t-tesand multiple linearegression analysi.ResultThe scoreof general healthy statu,physiological function ,physiolog-ical role ,somatipain and social function in the patientwith stroke were significantly lowethan thain the national norm (P＜0 . 01) .The recurrence frequency ,age ,comorbidity ,education level and income were significanfactoraffecting the life quality in the stroke patien.Conclusion The level of general health statu,physiological function ,physiological role ,somatipain and social function are decreased significantly .Therefore iirecommended to perform the pertinenintervention in the clinical work .

Objective To explore the diagnosis and treatment of tumor associated gastrocolic fistula (GCF).Methods The records of the 4 patients with GCF between August 2008 to February 2014 were retrospectively analyzed.Three female and one male patients,those whose average age were 61 years,have been pathologically diagnosed postoperatively as gastrocolic fistula caused by malignant diseases.The main clinical symptoms were diarrhea (3 cases),fecal vomitus (3 cases),weight loss (4 cases),and abdominal pain (4 cases).Positive diagnostic tests for GCF included gastroscope (3 cases),colonoscope (1 case),barium enema (1 case),upper gastrointestinal contrast (2 cases).Results En-bloc resection of the involved gastrocolic region have been performed for all,2 patients underwent radical gastrectomy and colon resection and 2 patients were taken on palliative procedure.Pathology indicated adenocarcinoma all,Immunohistochemical detection for CK20,CDX-2 were applied for identifying the originations of tumors.Delayed gastric emptying and DIC occurred in one patient who died in 3 months after the operation,anastomotic leakages were found in 2 cases.The survival patients were all discharged and taken capecitabine combined with Oxaliplatin for chemotherapy.Conclusions Endaoscopy and gastrointestinal imaging are main evidences for diagnosis of GCF.En-bloc resection of the involved gastrocolic region were recommended,enterostomy was safer than entero-anastomosis in one stage procedure.The originations of tumors may be identifying according to the pathological characteristic and CDX-2,CK20 staining.Adjuvant chemotherapy should be applied.

Objective To analyze the related rules and prognosis analysis for lymphatic metastasis in patients for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Methods This study retrospectively reviewed 65 patients who underwent radical surgery for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction in Beijing Friendship Hospital between July 2013 and March 2017.The primary indicators were sex,age,tumor site,tumor size,macroscopic type,histological type,depth of invasion,operation,tumor emboli and carcinoma nodes.The clinical characteristics and pathological features were analyzed by using Logistic regression and Kaplan-Meier survival analysis.Follow-tup using outpatient examination and telephone interview was performed to detect patients' diseases and postoperative survival up to April 2017.Results Lymph node metastasis was observed in 41 of 65 patients (63.1％).Lymph node metastasis frequency was found in No.1,No.2,No.3,No.7,No.11 and No.110 lymph nodes.The incidences of those lymph node metastasis were 45.3％,32.5％,28.8％,22.5％,19.4％ and 8.2％.The metastasis rate of the tumors with diameter over 2 cm was higher than the tumors which were less than 2 cm (71.9％ vs 0;P =0.000);The observed rate of lymph node metastasis was 0,12.5％,69％,95.2％ in early cancer (T1) and advanced cancer (T2-T4) (P=0.000) respectively.The metastasis rate of highly differentiated Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction was 45.2％ lower than poorly differentiated tumors 79.4％ (P =0.009).Thirty-three cases were found with lymphatic embolus,28 of them (84.8％) were found to be combined with lymph node metastasis among them (P =0.001).All the differences were statistically significant (P ＜ 0.05).The results of multivariable analyzed by binary logistic regression analysis revealed that neoplasms histologic type and lymphatic embolus were independent risk factors for lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Sixty-five patients were followed up for 1-45 months,with a median time of 18.81 months.Although there was no statistically significant difference,3 years-overall survival rate showed tumor without lymph node metastasis has better prognosis than with lymph node metastasis and early stage tumor also has better prognosis than advanced tumor.Conclusions Lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction is related with histological type of tumor and lymphatic embolus.For Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction,the incidence of lymphatic metastasis were higher appear in abdominal cavity,which included No.1,No.2,No.3,No.7 and No.11;Meanwhile,the metastasis of mediastinal lymph node is given priority to No.110 lymph node.Therefore,radical total gastrectomy combined with standard D2 lymphadenectomy and No.110 lymphadenectomy are performed in order to improving the prognosis.For patients with lymph node metastasis and tumor in advanced stage,long-term prognosis remains to be further study.

Hepatoid adenocarcinoma of the stomach (HAS) is defined as a special type of gastric cancer characterized by low incidence rates and high degree of malignance with an extremely poor prognosis.As it is characterized by morphological similarities to general alimentary cannal symptoms with unclear etiology and pathogenesis,diagnostic errors can always be made.The alpha-fetoprotein (AFP) and carcino-embryonic antigen (CEA) are helpful with diagnosis.However,histopathological examination is the gold standard for diagnosing HAS.So far,radical operation,adjuvant chemotherapy,interventional therapy with immune-biological treatment are the main approaches for HAS treatment.

Objective To investigate the clinical features and prognostic factors of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) in adults.Methods Clinical data of 40 adult patients with EBV-HLH admitted in the First Affiliated Hospital of Nanjing Medical University during January 2010 and September 2013 were retrospectively analyzed.The patients were divided into fatal group or survival group based on the results of 1-month follow-up.Logistic regression analysis was performed to identify risk factors of early death.Results EBV-HLH in clinic were characterized by fever,hepatosplenomegaly and lymphadenopathy.The incidences of peripheral blood cytopenias in 2 or 3 lines,hepatic dysfunction and hyperferritinemia in EBV-HLH patients were 60.0％ (24/40),95.0％ (38/40) and 94.9％ (37/39),respectively.Hemophagocytic phenomenon in bone marrow was observed in 83.8％ patients (31/37).Soluble CD25 (sCD25) was detected in 12 patients,and all were higher than 2 400 pg/mL.Nineteen patients died 1 month after fiual diagnosis with a fatality rate of 47.5％.Univariate logistic regression analysis indicated that EBV-DNA ＞ 105 copies/mL (OR =4.85,95％ CI:1.14-25.83,P ＜ 0.05),PLT ＜ 50 × 1012/L (OR =6.81,95 ％ CI:1.41-32.83,P ＜ 0.05),total bilirubin ＞ 50 μmol/L (OR =6.91,95％ CI:1.24-38.52,P ＜0.05),albumin ＜ 30 g/L (OR =7.50,95％ CI:1.80-31.28,P ＜ 0.01),serum ferritin ＞5 000 μg/L (OR =8.75,95％ CI:2.03-37.67,P ＜0.01) and polyserositis (OR =5.40,95％ CI:1.18-24.64,P ＜0.05) were risk factors of death within 1 month after final diagnosis,while chemotherapy was a protective factor of early death (OR =0.15,95％ CI:0.03-0.81,P ＜ 0.05).Conclusions EBV-HLH in adult has a poor prognosis.Significant elevated EBV-DNA,total bilirubin or serum ferritin,and notable decrease of peripheral blood platelet count or albumin level may indicate a poor prognosis,while chemotherapy may reduce the risk of early death.

Objective To evaluate systematically whether administration of hypertonic saline transfusion affects clinical outcomes with compared to standard fluid in the early stage of resuscitation for traumatic shock patients.Methods Seven English and Chinese routine biology and medicine databases were searched for randomized controlled trials (RCTs) published from January 2002 to August 2012,and established inclusion and exclusion criteria to evaluate these RCTs.The quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and Jadad' s score scale.RevMan 5.0 statistical software was used for meta-analysis.Results After evaluated 211 related literatures,five RCTs met all the inclusion criteria and were enrolled for meta-analysis.The meta-a nalysis demonstrated that early hypertonic transfusion did not decrease short-term (first 48 hours after admission) mortality (RR =1.04,P =0.74); nor did it decrease later-term (7day to 3month after injury) mortality (RR =0.97,P =0.72).It also did not decrease the total volume of fluid and blood transfusion required during the first day (P =0.38).Similarly,it did not affect the incidents of infections (RR =1.04,P =0.70),the length of stay in ICU (P =0.2) and total length of stay in the hospital.Conclusions Compared to standard fluid,there was no advantage on mortality and hospital infection by using hypertonic supplement transfusion in the early stage of resuscitation for traumatic shock patients.Hypertonic transfusion did not have any significant effect on the volume of total fluid and blood transfusion required the first day,and no trend of reduction for the length of ICU and hospital stay.Further well-designed randomized controlled trials are needed to demonstrate the cost effectiveness of hypertonic transfusion to traumatic shock patients while in ICU.

Objective To evaluate the colonoscopy surveillance in colorectal cancer patients after surgical removal of the tumor.Methods From June 1986 to June 2007,2762 asymptomatic patients who had underwent operation for colorectal cancer were put into colonoscopy surveillance.They had the first examination 3-6 months after the operation,and were re-examined once a year thereafter for 3 years.The follow-up findings were compared with those from the 218 symptomatic patients who had colorectal cancer surgery from September 1981 to May 1986.Results In 2762 asymptomatic patients,48 cases of multiple primary cancer were detected,in which 39 cases(1.4%) were found at one examination and 9 cases(0.3%)at different examination.The TNM staging of these lesions included stage Ⅰ in 6,stage Ⅱ in 31 and stage Ⅲ in 11.During the surveillance,583 cases(21.1%) of adenoma were detected and endoscopically resected,in which 17(3.2%) were invasive early cancer and 58(9.9%) were high grade dysplasia.In 218 patients with symptoms,29 cases(13.3%) of adenoma and 27 cases( 12.4%) of cancer were detected,including 4 cases of stage Ⅰ cancer,6 of stage Ⅱ and 16 of stage Ⅲ.Conclusion Colonoscopy surveillance in colorectal cancer patients after surgery is important in finding precancerous lesion and early stage cancer,and is recommended in all patients.