Exudative erythoma multiforme is a related to the immune function of children with skin and mucosa,damage to its diversity of characteristics of acute non suppurative inflammation,one of the aller-gic diseases.The disease and its pathogenesis is complex,the body can cause multi system and multi organ damage,the cause has not yet entirely clear.In recent years,due to our understanding of the exudative erytho-ma multiforme gradually thorough,both domestic and abroad on the level of diagnosis and treatment of the disease have greatly improved,the prognosis of patients with exudative erythoma multiforme has improved significantly.The progress of the pathology,clinical manifestation,diagnosis and treatment of exudative ery-thoma multiforme were summarized.

Objective To investigate the correlationbetween thecarcinoembryonic antigen ( CEA) level and hypoxic status of breast cancer, and itspotential of being a prognostic factor in breast cancer. Methods Breast cancer cell line MDA-MB-231 was cultured under hypoxic or normoxic condition to determine the protein level of CEA using Western blotting.30 breast cancer tissue sections were collected in Tianjin Medical University Cancer Institute and Hospital from April 2013 to June 2015.and were detected the expression of CEA, hypoxia-inducible factor-1α( HIF-1α) and carbonic anhydrase-9 ( CA-9 ) by immunohistochemistry.Serum CEA were detected by immunofluorescence assay of 166 breast cancer patients collected from April 2009 to June 2011.The correlation between the expression levels of CEA and breast cancer patients'clinical data was analyzed by Logistic univariate analysis.Kaplan-Meier method was employed to calculate the progression-free survival of patients with breast cancer. Log-rank test was conducted to compare the difference between groups.Results CEA levels were significantly higher in breast cancer cells under hypoxic condition in a time-dependent manner, compared to normoxiccontrol. Immunohistochemical staining indicated that CEA was coexpressed with HIF-1αand CA-9 in breast cancer and linear regression analysis revealed that CEA expression correlated with HIF-1α( P =0.0096 );Preoperative serum levels of CEA were closely related with tumor size ( P =0.015 ) andLymph node metastasis(P=0.032); CEA positive patients achieved a progression-free survival of 29.85months(versus 39.08 months in CEA negative patients, P=0.003).Conclusions Hypoxia upregulates CEA expression in breast cancer and the levels of preoperative serum CEA is a potential prognostic factor ofbreast cancer.

BACKGROUND:Although cementation of polyethylene liner into a wel-fixed metal shel during the revision surgery has several advantages compared to total acetabular revision, there are some disputes about its clinical outcomes, especialy regarding the re-revision rate and the prosthetic survivorship. OBJECTIVE:To evaluate the clinical outcomes and safety of cementation of polyethylene liner into a wel-fixed acetabular cup in the revision after total hip arthroplasty with retained stable cup. METHODS:Between March 2012 and November 2014, nine patients underwent revision after total hip arthroplasty with cementation of polyethylene liner into a wel-fixed acetabular cup. There were 1 male and 8 females, aged 43.7 years on average. The time was 9.4 years on average from the primary total hip arthroplasty to revision. Harris Hip Score and prosthesis X-ray films were compared after revision. The effects and safety of cementation of polyethylene liner into a wel-fixed acetabular cup were further evaluated. RESULTS AND CONCLUSION:Nine patients were folowed up for 8-37 months. The Harris hip scores before revision was (49.54±18.28) points previously, and (84.82±10.59) points during final folow-up (t=6.377, P < 0.05). One patient had re-revision surgery because of recurrent dislocation. There were not complications in other patients, resulting in failure rate of 11%. These results indicated that polyethylene liner cementation technique is safe and effective when the wel-positioned and wel-fixed acetabular cup retained.

Objective To observe and analyze the changes of prostaglandin E2 (PGE-2)and elastase (EA)levels in the pulp blood of the patients with carious tooth complicated with exposed pulp and its influence on the curative effects of direct pulp capping treatment.Methods 80 cases of the patients with carious tooth complicated with exposed pulp treated with direct pulp capping treatment were selected as the observation group and 40 cases of the patients treated with normal removal of impacted third molar were selected as the control group.The levels of PGE-2 and EA in the pulp blood of the patients in the two groups before the treatments were detected and compared.A one-year follow-up was employed for the patients in the observation group and the curative effects were evaluated and compared.Results The levels of PGE-2 and EA in the pulp blood of the patients in the observation group were 132.28±63.55 ng/ml and 114.36±19.57μg/ml respectively,and the levels of PGE-2 and EA in the pulp blood of the patients in the control group were 0.61±1.26 ng/ml and 19.38±6.34μg/ml respectively.There were statistically significant differences between the two groups (t=43.129,29.675,P<0.05). There was a positive relationship between the PGE-2 level and EA level in the pulp blood of the patients in the observation group (r=0.782,P<0.05).The levels of PGE-2 and EA in the pulp blood before the treatment of the patients with suc-cessful effects were 84.63±13.17 ng/ml and 68.25±8.16μg/ml,and the levels of PGE-2 and EA in the pulp blood before the treatment of the patients with failed effects were 177.35±41.42 ng/ml and 152.36±16.28μg/ml.There were statisti-cally significant differences between the two types of patients (t=31.578,21.556,P<0.05).Conclusion The patients with carious tooth complicated with exposed pulp show the significantly increased expression levels of PGE-2 and EA in pulp blood.The higher expression levels of PGE-2 and EA before the treatment could put adverse influence on the curative effects of direct pulp capping treatment.The clinicians should give the comprehensive consideration to the specific condition of pa-tients to choose the proper treatment methods.

Esophageal cancer is one of the most common malignant tumors in China.At present, the best treatment of esophageal cancer is surgery.For the patients with cervical lymph nodes metastases, three-field lymph nodes dissection is the main solution.Ultrasonography and computed tomography (CT) of the neck play a decisive role in the preoperative examinations for patients with esophageal cancer, and should be used as routine examinations before surgery at the qualified hospital in order to improve the accuracy of preoperative assessment of cervical lymph nodes metastases of esophageal cancer and screen potential patients with esophageal cancer undergoing three-field lymph nodes dissection.

Objective To investigate the safety and clinical effect of Ⅰ-stage resection of colon cancer and synchronous liver metastasis after conversion therapy.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with sigmoid cancer with synchronous multiple liver metastases who was admitted to the Zhongshan Hospital of Fudan University in April 2013 were collected.The patient was diagnosed as sigmoid cancer with multiple lymph nodes surrounding colon and 5 metastatic lesions found in liver by preoperative imaging examination,and the maximum diameters of 2 metastatic lesions were 4.5 cm and 3.6 cm.The pathological results of colonoscopy indicated adenocarcinoma.After discussion of the multidisciplinary team,liver metastatic lesions were significantly reduced through mFOLFOX6 chemotherapy combined with bevacizumab treatment,and then patient underwent Ⅰ-stage resection of colon cancer with synchronous liver metastasis by the surgical procedures of partial hepatectomy + 3D laparoscopy-assisted radical resection of sigmoid cancer.The patient received convention treatment of antibiotic,nutrition support therapy and mFOLFOX6 adjuvant chemotherapy.The changes of lesions in liver and tumor markers were observed by tumor marker test,abdominal/pelvic CT and MRI in the upper abdomen after conversion therapy.The operation time,volume of intraoptrative blood loss,number of lymph nodes dissected and vital sign were observed in the operation.The liver function,time for out-off-bed activity,time to anal exsufflation,time of drainage tube removal,duration of hospital stay,complications,results of pathological examination and recurrence and mnetastasis of tumor were observed after operation.After discharge from hospital,the patient underwent monthly tumor marker test,B ultrasound and chest X-ray examination till January 2014 and abdominaL/pelvic CT,magnetic resonance imaging (MRI) in the upper abdomen and colonoscopy every 6 months.The follow-up of outpatient examination and telephone interview was performed to detect the recurrence and metastasis of tumor up to September 2015.Results After preoperative 4-cycle chemotherapy,the diameters of 2 metastatic lesions in liver reduced to 3.2 cm and 2.0 cm,the levels of carcinoembryonic antigen(CEA) and CA19-9 (tumor marker) were reduced to 95.9 μg/L and 252.4 kU/L.The patient underwent successful Ⅰ-stage resection of colon cancer and synohronous liver metastasis.The operation time,volume of intraoperative blood loss,numbers of lymph nodes dissected and cancerous nodes were 208 minutes,250mL,14 and 1,respectively.The patient had no blood transfusion and metastasis,with the stable vital signs and good postoperative recovery.The levels of alanine transaminase (ALT) and aspartate transaminase (AST) were 1 147 U/L and 2 631 U/L at postoperative day 1,101 U/L and 37 U/L at postoperative day 7,respectively.The out-off-bed activity,anal exsufflation,drainage tube removal and discharge from hospital were occurred at postoperative day 2,3,7 and 9,respectively.No anastomotic fistula,bleeding and infection were occurred aftcr operation.The patient was diagnosed as with ulcerated sigmoid adenocarcinoma in T3N1cM1 stage (combining with liver metastasis).The patient received adjuvant therapy of mFOLFOX6 and oral capecitabine at postoperative day 40,and was followed up for 30 months with a good quality of life and without metastasis and recurrence.Conclusion Ⅰ-stage resection of colon cancer with synohronous liver metastasis can be used for initial unresectable colon cancer with liver metastasis after conversion therapy,and it is safe and feasible,with a good therapeutic effect.

Objective:To provide ideas for the participation of clinical pharmacists in clinical individualized medication.Methods:Clinical pharmacists participated in the clinical consultation for one senior patient with acute cholangitis treated with biapenem.Results:The consultation comments and suggestions proposed by clinical pharmacists were accepted by clinics,which played an important role in assisting doctors in the rational drug use and significantly improved the medical treatment.Conclusion:Clinical pharmacists should participate in individualized medication and help clinicians optimize drug therapy,which can improve the safety and efficacy of medication.

BACKGROUND:Physical structure and inorganic composition of composite calcium phosphate bone implants are similar to human bone, and the implants have good bioabsorbable ability and biocompatibility. Studies have confirmed that Dipsacus powder can significantly improve the speed of bone defect repair.
OBJECTIVE:To study the effects of Dipsacus asperoides/composite calsium phosphate bone implant material in the repair of bone defects.
METHODS:Bone defects of 1.0 cm×0.5 cm×0.3 cm were made on the bilateral mandibular bodies. The right side was implanted with Dipsacus asperoides/composite calsium phosphate bone implant as experimental group and the left side implanted with calcium phosphate bone material served as control group. Samples were col ected at 4, 8, 12 weeks after implantation for gross observation, cone beam CT, scanning electron microscope observation and histological observation.
RESULTS AND CONCLUSION:(1) Gross observation:the osteogenic speed, degradation rate and hardness in the experimental group were higher than those in the control group. (2) Cone beam CT detection:the implant in the experimental group was more tightly integrated with the surrounding tissues than that in the control group, and the degradation speed in the experimental group was higher than that in the control group. (3) Scanning electron microscope observation:there were many fibrous connective tissues between the implants and the surrounding tissues in the two groups, which was more obvious in the experimental group than the control group. With time gone, the implants were combined with the surrounding tissues more tightly. (4) Histological observation:the osteogenic speed and activity in the experimental group were superior to those in the control group. These findings indicate that Dipsacus asperoides combined with composite calcium phosphate bone implant can accelerate bone repair.

The Many experiments show that pH affect the growth of romastigotes of L donovani. But the control tests with Acid - base scale have not been reported on the growth of promastigotes from different genesis. This paper reports that pH has different nfluence on several kinds of promastigotes from different genesis. We obseved that the growth of promastigotes of L. doncvani is inhibited when pH is 4.6 and 8.6.

As the burden of anesthesiology teaching is heavy in undergraduate course, teachers can communicate with the students by nonverbal behaviors, such as eye contact, silent language, facial expression, paralanguage, which can make class atmosphere active, develop harmonious teacher-student relationship, and improve the quality of class teaching. Teachers of anesthesiology should take some measures, such as rehearsing lessons, summing up the experience of the lessons in time, accu-mulating the experience of nonverbal behaviors, and doing some exercise for the nonverbal behavior as much as possible, so as to set up an excellent atmosphere for teaching ,and meanwhile improve the quality of anesthesiology teaching.