OBJECTIVE: To review systematically the efficacy and safety of echinocandins to invasive candidiasis in pediatric patients. METHODS: Databases including multiple databases were searched electronically for randomized controlled trials (RCTs) of echinocandins to invasive candidiasis in pediatric patients up to September 2018. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using Rev Man 5.3 software. RESULTS: A total of 5 RCTs involving 1 190 patients were included. There were 598 patients in the echinocandins group and 592 patients in the control group. Micafungin and caspofungin were retrieved. Fluconazole, and amphotericin B liposome and amphotericin B deoxycholate were used to treat the patient in control group. The RESULTS: of Meta-analysis showed that there was significant difference between experimental group and control group on the overall effectiveness. Subgroup analysis showed that there were significant difference between caspofungin and control group, also between micafungin and control group. There was significant difference between echinocandins and control group on the subgroup analysis of empiric therapy. There were significant difference between experimental group and control group on the discontinuation due to adverse events. Subgroup analysis showed that there was significant difference between caspofungin and control group. CONCLUSION: According to recent analysis, the efficacy and safety of echinocandins in children with invasive candidiasis infections is superior to fluconazole and/or amphotericin B.

Epigenetics refers to the heritable changes of gene expression without altering DNA sequence.Epigentic mechanism involves DNA methylation, microRNA, histone modification and so on.Tetralogy of Fallot(TOF)is a common congenital heart disease characterized by ventricular septal defect, pulmonary stenosis, aortic straddling and right ventricular hypertrophy.Many experimental investigations indicate that epigentics plays an important role in the development of the heart.It will be an important research field in the future showing important clinical significance to study the etiology of tetralogy of Fallot.

AIM: To detect the expression of erythropoietin(EPO)and hypoxia-inducible factor-1α(HIF-1α)in serum and aqueous humor of patients with acute anterior uveitis(AAU), and to explore their clinical significance.

METHODS: From January 2018 to December 2020, 60 patients with AAU in our hospital were prospectively selected as the research objects, and 60 patients with proliferative vitreoretinopathy in the same period were taken as control(control group). The serum and aqueous humor of two groups were collected, enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of EPO and HIF-1α in serum and aqueous humor; the self-rating anxiety scale(SAS)and the self-rating depression scale(SDS)were used to evaluate the AAU patients, and the severity of the disease was scored; Pearson method was used to analyze the correlation between SAS score, SDS score and levels of EPO and HIF-1α in serum and aqueous humor, and the correlation between levels of EPO and HIF-1α in the serum and aqueous humor. Spearman was used to analyze the correlation between the disease severity score of AAU patients and the levels of EPO and HIF-1α in serum and aqueous humor.

RESULTS: Compared with the control group, the levels of EPO and HIF-1α in the serum and aqueous humor of the study group were higher(P<0.01). Among AAU patients, 23 were negative of SAS score and 37 were positive, and 29 were negative of SDS score and 31 were positive. Compared with patients with negative SAS score, the level of HIF-1α in serum and the level of EPO in the aqueous humor were higher in patients with positive SAS score(P<0.05); compared with patients with negative SDS score, the level of EPO in serum and the levels of EPO and HIF-1α in aqueous humor were higher in patients with positive SDS score(P<0.01). There were 26 mild patients and 34 severe patients with AAU. Compared with mild patients with AAU, the levels of EPO and HIF-1α in serum and aqueous humor were increased in severe patients(P<0.01). Pearson analysis showed that the SAS and SDS scores of AAU patients were not significantly correlated with the levels of EPO and HIF-1α in serum and aqueous humor(P>0.05), there was a positive correlation between EPO and HIF-1α in serum(P<0.05), and between EPO and HIF-1α in aqueous humor(P<0.05). Spearman analysis showed that the disease severity score of AAU patients was positively correlated with the levels of EPO and HIF-1α in serum and aqueous humor(P<0.05).

CONCLUSION: EPO and HIF-1α are highly expressed in serum and aqueous humor of AAU patients, and they are closely related. The two are closely related to the disease severity score, and should be paid attention to clinically.

ObjectiveTo explore the methods for prevention and treatment of endotoxemia and multiple organ failure in patients with severe hepatitis. MethodsA total of 61 patients with severe hepatitis and toxic enteroparalysis were randomly assigned to three groups. The first group was treated with plasmapheresis, the second group with plasmapheresis and colon dialysis, and the third group with plasmapheresis, colon dialysis, and oral probiotics. Analyses were performed on the clinical symptoms and physical signs, hepatic function, endotoxin level, and clinical outcome in each group. Comparison of continuous data between groups was performed by analysis of variance, and further pairwise comparison by SNK test; comparison of categorical data between two groups was performed by chi-square test. ResultsThe liver function improved in all groups after treatment. The endotoxin level was significantly lower in the third group than in the other two groups (P＜005). The symptom improvement rates in the three groups were 35.3%, 64.7%, and 81.5%, respectively; the recurrence rates were 833%, 727%, and 364%, respectively; the clinical remission rates were 5.9%, 17.6%, and 48.1%, respectively, and the third group had a significantly higher rate than the first group (χ2=8.59, P＜0.05). ConclusionA combination of plasmapheresis, colon dialysis, and oral probiotics can effectively improve the prognosis of patients with severe hepatitis and toxic enteroparalysis, and can help prevent and treat multiple organ failure in such patients.

ObjectiveTo investigate the identification and treatment of variation of extrahepatic bile duct in laparoscopic cholecystectomy (LC), and to reduce the occurrence of bile duct injury. MethodsThis study included 60 patients who received LC in the People′s Hospital of Caidian District in Wuhan and had structural variation of extrahepatic bile duct found during the operation from January 2012 to January 2014. The clinical data were retrospectively analyzed, and the intraoperative and postoperative conditions were summarized. ResultsDuring operation, cystic duct variation was found in 32 cases, abnormal position of the point where the cystic duct joins the extrahepatic bile duct in 20 cases, the cystic duct and the common hepatic duct having the common wall before joining the common bile duct in 2 cases, aberrant bile duct in the gallbladder bed in 2 cases, and accessory hepatic duct in 4 cases. Fifty-one patients (85%) successfully underwent LC; 9 patients (15%) were converted to open surgery. All patients finished surgery successfully. There were 2 cases of postoperative complications; one patient developed residual stones in the bile duct, and bile leakage occurred in the other patient at one week after LC, who recovered after reoperation. All patients were cured and discharged, without severe complications such as intraperitoneal hemorrhage, infection, and intestinal injury. ConclusionIdentifying the structural variation of extrahepatic bile duct, dissecting the Calot′s triangle meticulously, and determining the type of variation of extrahepatic bile duct play important roles in LC and significantly reduce the incidence of bile duct injury.

Autoimmune liver diseases mainly include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and various types of overlap syndromes and are often associated with extrahepatic autoimmune diseases. However, few studies have described the association of autoimmune liver diseases with rheumatic disease and/or skin disease. For this purpose, this article reviews the rheumatic and skin manifestations associated with autoimmune liver diseases in detail and the clinical significance of non-specific antibodies. It is pointed out that individualized treatment should be given to patients with rheumatic disease and/or skin disease.

AIM:To observe the effect of internal limiting membrane exfoliation in the treatment of PVR-C retinal detachment.

METHODS: A total of 37 cases(37 eyes)of PVR-C retinal detachment were collected from August 2015 to July 2018.All eyes were treated with 25G invasive vitrectomy combined with silicone oil filling. The internal limiting membrane was removed after indocyanine green staining,and the removal size of the inner boundary membrane to the upper and lower vascular arch. Silicone oil was taken out of the retina in 3-6mo. Followed up for 12mo after the first operation, the visual acuity, intraocular pressure, retinal reattachment and the formation of the macular membrane were observed and analyzed retrospectively.

RESULTS: The vision of all patients was improved. The intraocular pressure of 6 eyes increased within 2wk after operation, and the intraocular pressure returned to normal after treatment. All patients were followed up for 1a, macular membrane did not occur. Retinal detachment occurred again in 2 eyes due to PVR of the anterior retina. The remaining 35 eyes, silicone oil were successfully removed.

CONCLUSION: 25G micro-invasive vitrectomy combined with internal limiting membrane peeling is safe and effective in the treatment of this kind of disease, and effectively prevent the appearance of the macular anterior membrane.

Neonatal neutropenia is classified into early-onset and late-onset neutropenia. Causes of neutropenia include decreased production, increased destruction, margination in the microvascular endothelium, sequestration in the spleen, or a combination of mechanisms. Neutropenia often accompanied by an increased risk of bacterial infection, and sometimes it may be a hint of some rare severe diseases. In this article, we review advances in classification, pathogenesis, diagnosis and treatment of neonatal neutropenia.

Bronchial asthma in children attacks or exacerbates at night and/or in the early morning.Sleep disorders are common concomitant symptoms of nocturnal asthma, including prolonged sleep onset latency, frequent wake-ups at night, daytime sleepiness, and sleep-disordered breathing, especially in children with poor asthma control.Asthma and sleep apnea share similar risk factors, and the interaction of potential causes promotes the disease progression.When it comes to treating children with asthma, it is necessary to clear whether sleep apnea exists or not.Sleep hygiene management and the treatment of obstructive sleep apnea play an important role in the standardized treatment of childhood asthma, which could improve asthma control and the sleep quality, thereby enhancing the quality of life in children with asthma.

Objective: This study was designed to evaluate the therapeutic efficacy of bronchial arterial infusion with VDS＋ DDP or MMIC＋ ADM＋ DDP in patients with locally advanced nonsmall cell lung cancer(NSCLC). Methods: From June 1992 to October 1998,102 patients with locally advanced NSCLC were enrolled in this study. Of them,8 cases in Stage Ⅱ , 72 cases in Stage Ⅲ a, 22 cases in Stage Ⅲ b, central type: 75 cases,peripheral type:27 cases;preliminary group 64 cases, secondary group 38cases. The patients were treated one to four times by bronchial arterial infusion of the chemical drugs Results: There were 3 complete responses and 66 partial responses for an overall responses rate of 67.65％ (69/102) including responses rate of 72.00％ (54/75) in central type and 55.56％ (15/27), the 1-year and 2-years survival rate was 67.64％ (69/102)and 36.28％ (37/102) respectively. Conclusions: The therapeutic efficacy of bronchial arterial infusion with chemical drugs was excellent to locally advanced non small cell lung cancer, it′ s toxicity were acceptable. The efficacy on central was much better than for peripheral type