SUMMARY To demonstrate the clinical manifestation, diagnosis and treatment of myoclonus epilepsy with ragged-red-fibers ( MERRF) , a case of MERRF was presented with review of the literature. A 4-year-7-month-old girl was diagnosed with MERRF. She had tremor, fatigue and developmental delay for more than 2 years. Laboratory tests showed that the serum and urine lactic acid and pyruvic acid increased significantly. Electroencephalogram showed diffuse and focal spike slow wave and slow wave in right central and parietal regions. Electromyogram showed neurological damage. Gene mutational analysis showed mtDNA 8344 A>G mutation. The mutational rate was 78%. Mitochondrial disease MERRF syndrome was diagnosed. Cocktails therapy with vitamins B1, B6, B12, L-carnitine, and coenzyme Q10 was administra-ted to the patient. MERRF is a rare disease. The diagnosis can be made by gene mutational analysis. Cocktail therapy may slow down the deterioration of the disease. Gene therapy is still experimental.

Objective To systematically review the effects of different delivery routes of oxytocin in preventing hemorrhage after cesarean section.Methods Databases including PubMed,Medline,Embase,Cochrane library,Wanfang Medical Database,China National Knowledge Internet (CNKI),VIP Database for Chinese Technical Periodicals were searched by computers and Conference papers were manually searched.The randomized,controlled clinical trials of oxytocin given by intramuscular injection,intravenous injection or intravenous infusion were included in elective cesarean section under spinal anesthesia.The quality of included literatures was evaluated by Cochrane systematic evaluation.The primary outcome measure was intraoperative amount of blood loss or change in Hb before and after operation.The secondary outcome measures were changes in blood pressure and heart rate,electrocardiogram,uterine contraction and other adverse reactions after using oxytocin.Results Seven studies involving 2 325 patients were included in this meta-analysis.Among the 2 325 patients,oxytocin was given through intramuscular injection in 79 cases,by intravenous injection in 1 147 cases and in the way of intravenous infusion in 1 099 cases.Compared with intramuscular injection group or intravenous infusion group,no significant change was found in the amount of blood loss during operation in intravenous injection group (P＞0.05).There was no statistically significant difference in the amount of blood loss during operation between intravenous injection group and intravenous infusion group (P＞0.05).Intravenously infusing oxytocin produced less effect on the mean arterial pressure and heart rate than intravenously injecting oxytocin (P＜0.01).Conclusion Intravenous infusion is a suitable route for oxytocin delivery in cesarean section with spinal anesthesia.

Objective To research the effect of the induced expression nursing method on anxiety and pain experience in gastroscopy patients. Methods A total of 121 patients from September to November 2012 were selected and randomly divided into the control group ( 60 patients ) and the intervention group (61 patients). The physiological indicators, anxiety score, and pain tolerance were measured and compared between the two groups. Results The systolic blood pressure, diastolic blood pressure and heart rate in the intervention group before gastroscopy were (121.64 ±11.49), (82.72 ±15.33)mmHg and (73.53 ±13.68) times/min,which were significantly better than those of the control group (t=4. 32, 3. 25, 5. 13, respectively;P<0. 05). There was no significant difference in SAS scores when making the test reservation between the two groups (P>0. 05). The SAS scores in the intervention group before gastroscopy was (52. 14 ± 2. 79), which was significantly lower than that of the control group (t=2. 96,P<0. 05). After gastroscopy, the pain tolerance grading was significantly better than that of the control group (P<0. 05). Conclusions The induced expression nursing method can effectively reduce the patients′anxiety and pain experience to gastroscopy.

Objective Monitoring and evolving the cleaning process of patient-used gastroscope by the method of Surviving Bacterial counting and ATP bioluminesece detection , in order to improve the cleaning effect and insure the success of endoscope reprocessing .Methods A total of 60 clinical used gastroscopes were randomly divided into the control group ( 30 scopes ) and the test group ( 30 scopes ) .Two kinds of testing methods was used to study the microorganism residue in the biopsy channel of patient -used gastroscope before and after normal manual cleaning .After manual cleaning process was improved , then measure the microorganism residue of gastroscope again and compared with the normal manual cleaning method .Results The results of the Bacterial counting and the ATP bioluminesece detection of patient-used gastroscope were significantly different (P>0.05).After the cleaning process, the results of bacteria count and ATP bioluminesece were 0 cfu/scope and (210 ±32) RLU/scope, which were significantly lower than (32 ±17) cfu/scope and (4 940 ±256) RLU/scope.The differences were statistically different (t=3.090,2.391, respectivley;P<0.05).Conclusions The process of endoscope cleaning is important and can significantly reduce the microorganism level of patient -used endoscope , so it qualified the disinfection of endoscope .

Objective: To study the correlation between the level of serum Chitinase-3-like protein 1 (CHI3L1) and the significant liver fibrosis and liver cirrhosis in patients with chronic liver disease, and to evaluate its diagnostic value. Methods: 165 patients with chronic liver disease were selected, liver histopathological examination was performed to detect serum CHI3L1 concentration. Four indexes of hepatic fibrosis (type III procollagen, collagen IV, laminin, hyaluronic acid), aspartate aminotransferase/platelet ratio index (APRI) and FIB-4 (fibrosis- 4) scores were based on the pathological findings of liver biopsy and compared the advantages and disadvantages of serum CHI3L1 with other methods for the diagnosis of hepatic fibrosis and liver cirrhosis. A multivariate regression analysis model was created, and receiver operating characteristic curve was analyzed. Results: The level of serum CHI3L1 increased with increase of fibrosis stage and was highest in liver cirrhosis stage. In the period of S0 to 1, the levels of S2 to 3 and S4 were 62.82 (41.40 ~ 87.20), 70.94 (48.47 to 122.60) and 141.06 (78.18 ~ 197.40), and there were statistically significant differences between the groups (P < 0.001). The area under the curve for the diagnosis of significant liver fibrosis was 0.68 (0.60 to 0.77), and 0.74 (0.65 to 0.83) for cirrhosis in CHI3L1. Multivariate regression analysis showed that CHI3L1 was an independent predictor of significant fibrosis and cirrhosis. The combined diagnostic model based on CHI3L1, collagen IV and FIB-4 scores further improved the diagnostic value. The area under the curve for the diagnosis of significant fibrosis and cirrhosis was 0.79 (0.72 to 0.86) and 0.80 (0.73 to 0.87), respectively. Conclusion CHI3L1 has a good diagnostic value in patients with chronic liver disease with significant fibrosis and liver cirrhosis. The diagnostic model in combination with other markers like Collagen IV and FIB-4 scores could further improve the diagnostic value and is worthy of further study.