Background and purpose:Arsenic trioxide,verified as a breakthrough in the management of acute promyelocytic leukemia,has been applied to a variety of solid tumors.Gall bladder carcinoma,lacking specific clinical manifestations,is usually diagnosed at advanced stages of the diseases and few cases can be resected by operation.Chemotherapy has not shown significant activity in gall bladder carcinoma.This study was to investigate the biological effect of As2O3 on the growth of human gall bladder carcinoma cell and its mechanism.Methods:GBC cells were cultured with different concentrations of As2O3,the proliferative activity of the cells was detected by MTT methods,and the cell cycle status was carried out by flow cytometry(FCM).Western blot and RT-PCR were performed to analyse the expression of cyclin D1,D2,D3,CDK4 and CDK6.GBC cells were transient transfected with cyclin D1 promoter construct pGL3 and then treated by different doses of As2O3.The luciferase activity was measured.Results:The treatment of As2O3 in gall bladder carcinoma cells could inhibit the growth of cells in a time and dose dependent manner,make cells arrest in G1 phase and down regulate the expression of cyclin D1.In addition,the activity of cyclin D1 promoter was down-regulated by As2O3 in a dose-dependent manner and decreased about 70 percent when treated with 4 ?mol/L As2O3.Conclusions:As2O3 can significantly inhibit the growth of human gall bladder carcinoma cells as well as down-regulate the expression of cyclin D1 in vitro.

Taking Naegleria australiensis, a species of pathogenic free-living amoeba (isolated in Shanghai in 1986), as antigen, two cell lines which provided potentially permanent source of monoclonal antibodies were established by lymphocytic hybridoma technique. The results of identification showed that: (1) the two cell lines could secret two different kinds of McAbs; (2) both of the McAbs were IgG (by gel diffusion); (3) McAbs produced in BALB/c mice were at high concentrations. One of them had a titer of ≥1 : 8 192 and the other≥l : 1 024 (by enzyme linked immunosorbent assay). A decline of the titers after purification by salting-out method was shown. One of the purified McAbs had a titer of≥1: 2 024 and the other≥l : 128.We have adopted two ways of recovering cryopreserved cells : ordinary recovering and "direct" recovering. The latter way was more practical because it could reduce the cycle of antibody production, and avoid contamination and chromosome variation. Experiments with different doses of cells revealed that, if the latter way was used, the optimal dose was 3 to 5 ? 106 cells per mouse.

Objective To establish a novel method for detecting circulating tumor cells (CTCs) in phripheral blood of lung cancer patients with high sensitivity and specificity.Methods Experimental study.42 cases of initial treatment patient who underwent resection and diagnosed to be non-small cell lung cancer by biopsy were studied,including 7 patients at stage Ⅰ,9 patients at stage Ⅱ,16 patients at stage Ⅲ and 10 patients at stage Ⅳ.As a control group,20 cases of healthy volunteers were selected.A series of experiments was conducted to determine the efficiency of tumor cells isolation,in which varied concentration (50,100,200,500,1000 cells) of A549 cells spiked into 2 ml peripheral blood drawn from healthy donors.The blood was removed of unwanted erythrocytes by lysis buffer,and made the rest of nucleated cells incubate with anti-EpCAM magnetic beads,then separated and enriched by a specific detector.All epithelia cells were retained on a slide because of a magnetic force and identified by H&E staining protocol.On the basis of cell recovery rate we calculated the sensitivity of tumor cells isolation.20 blood samples taken from healthy individuals were also detected to validate the specificity of this method.Samples of 42 patients with lung cancer were assayed for CTCs detection by above method.The correction of CTCs quantity with the patients' clinical features,for example,ages,gender,clinical stage,tumor size was analyzed in lung cancer patients by chi-square statistics.The correction of recovery cells with the spiked cells were assayed by linear correlation.Results The recovery rate was ranging from 68％ to 82％ by spiking varying numbers of A549 lung cancer cells into 2ml blood samples of healthy volunteers.Regression analysis of number of recovered vs.spiked A549 cells yielded a regression equation of Y =0.6419X + 8.8875.The number of CTCs detected has signification correlate with the cells spiked (R2 =0.9916,P ＜ 0.05),Eighteen of the 42 patients (43％) were found have CTCs in peripheral blood.The detection rate of lung cancer cells was 0 at stage Ⅰ,the detection rate of lung cancer cells was 11.1％ at stage Ⅱ,the detection rate of lung cancer cells was 62.5％ at stage Ⅲ and the detection rate of lung cancer cells was 70％ at stage Ⅳ.The positive rate of CTCs has no signification correlate with ages and gender of patients and tumor size (P ＞ 0.05),has signification with the clinical stage (P ＜ 0.05).None of the peripheral blood samples of the 20 healthy subjects analyzed was found to have CTCs.Conclusions This novel immunomagnetic separation technology is a sensitive and specific method,which provides a new tool allowing for feasible and specific detection of CTCs in lung cancer patients.The level of CTCs increases with the clinical stage and tumor size increased,which has important value to discover the early stage micrometastasis and redefine the clinical stage.But further multicenter and large sample clinical research are needed to confirm its clinical value.

Objective To understand the cognition about healthcare-associated infection(HAI) management among directors in secondary and above hospitals in Shaanxi Province.Methods Questionnaire survey was adopted to investigate hospital directors who participated in The third session of Shaanxi Provincial HAI management training course for hospital directors.Results A total of 181 questionnaires were distributed, 173 (95.58％) were qualified.74.57％ of surveyed hospitals were secondary hospitals, 61.85％ were comprehensive hospitals, 67.05％ of respondents received HAI training in recent 3 years, 81.50％ and 55.49％ of hospital directors thought the main factors influencing the HAI management were health care workers'' awareness on HAI and leaders'' attention respectively.58.96％, 60.12％, and 46.82％ of hospital directors thought the director of HAI management department should have intermediate and above professional title, bachelor degree or above education, and preventive medicine professional requirements respectively.The awareness rate of HAI management-related knowledge was 86.71％, difference in awareness rate of HAI management-related knowledge among respondents of different job, gender, and HAI training in recent 3 years were all significantly different(all P<0.05).Conclusion Hospital directors'' cognition on HAI management affect the development of HAI work, strengthen the training on HAI knowledge among administrators can improve hospital administrators'' awareness on HAI prevention and control.

Objective To review the diagnosis and treatment of extra-adrenal pheochromocytoma with a 34cases report. Methods Thirty-four cases of extra-adrenal pheochromocytoma were retrospectively analyzed. Hypertension was observed in 27 cases. Abdominal pain was seen in 10 patients and intermittent hematuria in 2 patients. Serum and urinary catecholamine and urinary VMA were measured in 34 cases. The level of serum or urinary catecholamine elevated in 20 cases and urine VMA elevated in 24 cases. Thirty-four cases had ultrasound examination,25 cases underwent CT scan and 6 cases underwent MER scan.Results Pheochromocytomas of 12 cases were located in the renal hilum, 2 in the lower pole of the left kidney, 1 in the posterior aspect of the inferior vena cava, 3 in the interaortocaval region, 2 in the anterior aspect of the abdominal aorta, 1 in the anterior of the right common iliac artery, 1 in the hilum of the liver, 1 in the posterior o{ the pancreas, 2 in the bladder wall, 1 in the posterior of the descending colon, and 8 cases of multifoci. Twenty-two cases of extraadrenal pheochromocytoma were benign and 12 cases were malignant. Thirty cases were followed up from 6 months to 13 years. Among 27 cases with hypertension, the blood pressure of 22 patients returned to normal and 5 cases were still hypertensive. Nine cases of malignant pheochromocytoma all had tumor recurrence or metastases at one year postoperatively. Six patients died during followed-up from 6 months to 3 years, including 3 cases died of cerebral hemorrhage and 3 cases of tumor metastases. Three cases got stable with 131Ⅰ-MIBG radiotheraphy.Conclusions The accurate detecting extra-adrenal pheochromocytoma is difficult. CT scan could be reliable in localizing the lesions. Surgical resection of the tumor could be the best therapy. Patients of malignant extra-adrenal pheochromocytoma may be treated with 131Ⅰ-MIBG after surgical therapy.

This study was aimed to establish the method of quantitative PCR (q-PCR) of fungi in peripheral blood for diagnosis of invasive fungal infections in patients with hematologic malignancies, and to preliminarily assess the diagnostic value of this method. The 18S rDNA-ITS1 area of high consensus sequence of fungi was selected to design primer and probe, the DNA of fungal species was extracted and q-PCR was performed to evaluate the sensitivity and specificity of the primer and probe. The standard product of fungal DNA was prepared by using pGEM-T plasmid and the fungal DNA in blood of patients was quantitatively detected. The results showed that the positive was found in 12 Aspergillus and 14 Candida species according to q-PCR detection, while there was no significant difference of fungal distribution between plasma, mononuclear cells and leukocytes (p<0.05). Receiver-operating characteristic analysis of q-PCR showed that the cut-off value for clinical diagnosis of invasive fungal infection was 8 copies/ml whole blood, its sensitivity, specificity, positive and negative predictive value and kappa were 0.84, 0.9, 0.955, 0.692 and 0.679 respectively. It is concluded that the fungal q-PCR assay may be used as an early diagnostic method for invasive fungal infections in patients with hematologic malignancies.
Aspergillus ; isolation & purification ; Candida ; isolation & purification ; Female ; Hematologic Neoplasms ; complications ; microbiology ; Humans ; Male ; Mycoses ; complications ; diagnosis ; Polymerase Chain Reaction ; methods ; Sensitivity and Specificity

Objective To explore the application effect of formative assessment on the standardized training in pediatric residents.Methods A total of 36 pediatric residents who attended the standardized training in affiliated hospital of Nantong university were randomly divided into 2 groups (18 in the experimental group and 18 in the control group) and trained in accordance with the standardized training content and standard of the national resident of pediatrics.Residents in the experimental group received formative assessment,with total score including process assessment (35％),graduation examination (50％),medicalethics (5％),reading report (5％) and work attendance (5％).While the other 18 residents in the control group received traditional assessment,with final score of graduation examination.The effectiveness of formative assessment was conducted via analysis of test score and self evaluation.The SPSS 17.0 was used for statistics,independent sample t test was used to perform inter-group comparison and Pearson correlation coefficient was used to demonstrate the correlation.P＜0.05 signifies statistically significant differences.Results In the experimental group,the process evaluation and the graduation examination were both positively related with the total score (r=0.953,r=0.966,P=0.00).In the graduation examination,the scores of clinical practice skills test and case analysis in the experimental group were both higher than those in the control group [(12.03 ± 1.51) vs.(10.83 ± 1.42),(12.03 ± 1.40) vs.(10.83 ± 1.29),P＜0.05],with statistically significant differences.The self evaluation of trainees showed that the clinical-inference and decisionmaking ability,the self-study ability,scores of attitudes and professionalism and total scores in the experimental group were higher than those in the control group,with statistically significant differences (P＜0.05).Conclusion The application of formative evaluation on the standardized training in pediatric residents is beneficial to improve the training effect and is worth popularizing.

Objective To understand the occurrence of surgical site infection(SSI)following caesarean section,analyze risk factors,implement intervention measures,and evaluate intervention efficacy. Methods All puerperas who underwent caesarean section in the obstetric department of a hospital from January to December 2013 were mo-nitored,investigation were performed in two stages:evaluation stage(January-June,2013)and intervention stage (July-December,2013). Targeted intervention and clinical intervention were combined to intervene the risk factors. Occurrence of SSI,length of hospital stay,and hospitalization expense before and after intervention were compared. Results A total of 1 593 patients with caesarean section were monitored,31(1.95%)had SSI,incidence of SSI in evaluation stage and intervention stage were 3.40% and 0.95% respectively;incidence of SSI before and after inter-vention was significantly different(χ2= 12.02,P<0.01). Univariate analysis on evaluation stage showed that risk factors for SSI in patients with caesarean section were duration of operation≥1 hour,body mass index≥26 kg/m2,intraoperative blood loss ≥300 mL,underlying diseases,premature rupture of membranes,and without antimicro-bial prophylaxis(all P<0.05). In evaluation stage,648 patients received post-operative antimicrobial prophylaxis for>48 hours(n= 395,60.96%);in intervention stage,945 patients received post-operative antimicrobial prophy-laxis for<24 hours(n= 776,82.12%),different time distribution of post-operative antimicrobial prophylaxis in two stages after intervention was compared,difference was statistically significant(χ2= 673.26,P<0.01). The mean length of hospital stay of 31 SSI patients were(13.83±3.26)days,non-SSI patients were(7.06±1.66) days,difference was statistically significant(t= 7.86,P<0.01);the average hospitalization expenses for patients with SSI were(9 044.77±2 649.19)yuan,non-SSI patients were(6 254.73±638.52)yuan,difference was statis-tically significant(t= 4.344,P<0.01).Conclusion Intervention measures for risk factors of SSI after caesarean section can effectively reduce the incidence of SSI in caesarean section.

In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.

OBJECTIVETo evaluate the diagnostic efficiency of colloidal gold and dot ELISA rapid tests in clinical screening of influenza A virus.

METHODSThe pharyngeal swabs were collected from 297 outpatients suspected of influenza between June and October, 2009 for detection with colloid gold and dot ELISA rapid test, with real-time PCR as the golden methods. The discrepant results of colloid gold and dot ELISA methods were confirmed by sequencing, and the diagnostic efficiency of the two methods was evaluated.

RESULTSAmong the 166 samples with influenza A virus infection as confirmed by real-time PCR and sequencing, the diagnostic sensitivity of dot ELISA and colloid gold methods was 54.82% (91/166) and 4.22% (7/166), respectively. The total concordance rate with PCR was 66.67% (Kappa value of 0.35). Among the 133 samples negative for influenza A virus, the specificity of dot ELISA and colloid gold methods was 81.68% (107/131) and 98.47% (129/131), respectively, with a total concordance rate with PCR of 45.79% (Kappa value 0.02). Of the 99 H1N1 influenza samples confirmed by real-time PCR, the detection rate of dot ELISA was 67.3%, whereas that of colloid gold was 5.1%. Out of the 107 dot ELISA-positive but colloid gold-negative samples, 84 were confirmed to be influenza A virus-positive by real-time PCR and sequencing. One sample negative for dot ELISA but positive for colloid gold test was confirmed to be influenza A virus-negative. The detection rate and diagnostic concordance rate for influenza A virus by dot ELISA were significantly higher than those of colloid gold (P<0.05).

CONCLUSIONDot ELISA is better than colloid gold in influenza A virus detection and shows great prospect in clinical screening.