OBJECTIVE To investigate the clinical and etiologic characteristics and treatment of central venous catheter-related(sepsis).METHODS Forty cases of patients with central venous catheter-related sepsis and their clinical manifestation,etiologic profiles and outcome of treatment were retrospectively analyzed.RESULTS Forty six strains were isolated including 23 strains of Gram-positive cocci,19 of Gram-negative bacilli and 4 of fungi.The most frequent(isolates) were Staphylococcus epidermidis.CONCLUSIONS The most common organism causing CRS is S.epidermidis;the key preventive measure is to avoid inner and outer pollution of catheter;antibiotic lock-technique can be taken for the treatment of uncertain CRS.If it is no effect after 24-48 hours,it is necessary to remove venous catheter promptly.

A combination vaccine which consists of ≥2 immunogens is intended to provide protection against two or more diseases or against multiple serotypes of a single disease. The use of combination vaccines decrease the number of vaccine injections in the regular immunization schedules. However,the development of combination vaccines is more complicated than monovalent vaccines,preservatives and adjuvants used with one component may alter the potency of other components. Physical,chemical,and biological interactions between the components of combination vaccines must be considered to avoid detrimental effects on safety or efficacy. Therefore combination vaccines present unique challenges for product evaluation. This paper presents a review of research application status,the evaluation of effectiveness and safety,as well as development prospects on combination vaccines.

Aim To study the distributive character of mitomycin(MMC) magnetic nanoparticles and MMC normal saline solution in mice.Methods A HPLC method for the determination of MMC in tissues and serum were established and applied to determine MMC in biological samples.Results Under the guidance of an external magnetic field,targeting rates of MMC to liver viscus are 82.72% after 30 minutes tail vein administration of(1 mg?kg~(-1)) mitomycin magnetic nanoparticles,it was 2.37 times larger than targeting rates of MMC normal saline solution group.The distributions of heart and kidney of mitomycin magnetic nanoparticles were less than that of MMC normal saline solution group.Compared with the results of tail vein administration mitomycin nanoparticles,interaction between the external magnetic field and magnetic nanoparticles is significantly effective to increase targeting rates of MMC to liver.Compared with the results of tail vein administration mitomycin magnetic nanoparticles without the external magnetic field,Mitomycin magnetic nanoparticles under the guidance of an external magnetic field is significantly effective to increase targeting rates of MMC to liver.Conclusions Mitomycin magnetic nanoparticles under the guidance of an external magnetic field is significantly effective to increase targeting rates of MMC to liver and prolonging effect on the action in vivo.

Objective Evaluate the outcome of aortic root reconstruction on the analysis of the risk factors influencing surgical results. Methods Between August 1996 and November 2009, 92 patients(56 men, 36 women) aged from 14 to 77years [mean (44.8 ±1.4) years] with aortic root aneurysm underwent aortic root reconstruction. 72 patients had over moderate aortic valve insufficiency. 47 patients suffered from Marfan syndrome. The aortic pathology was aortic dissection in 45. Bentall technique was used in 59 patients, the button technique in 13, the David I with the Valsalva graft in 6 patients and the aortic valve resuspension in 14 patients. Results The hospital mortality rate was 8.7%. The major complications 31. 7%. 18patients died during the period of follow-up. Late complications among 55 survivors were 12. Univariate predictors of the morbidity were the presence of male, non-Marfan, concomitant procedure, deep hypothermia cardiac arrest, aortic cross clamp time and blood infusion. Risk facts for mortality were emergent or urgent operation, aortic dissection, concomitant procedure, aortic cross clamp time and blood infusion. Multivariate analysis revealed risk factors of concomitant procedure and blood infusion were responsible for both morbidity and mortality. The overall long-term survival rate is (97.1 ±2.0)% at 1-year, (88.1 ±4.7)% at 5-year, (54.0 ±9.2)% at 10-year. The mean for survival time is (9.9 ±0.59) years, 95% confidence interval 8.70 -11.01. Conclusion The aortic root restitution procedures are safe and effective in general. The short and long-term outcome is satisfactory. The button technique is the first choice for reimplantation coronary patch. Valve-sparring aortic root reconstructions show promise in safety and applicability.

Objective To observe the clinical characteristics of gestational diabetic retinopathy (DR)of 13 pregnants with vitreous hemorrhage.Methods The clinical data of 26 eyes retinopathy with 13 cases of gestational diabetes were retrospectively analyzed.After bilateral eyes were mydriatic by Pyrazole MAO amine compound,ophthal-mologist used fundus camera to check bilateral fundus.B ultrasonic was used to examine vitreous hemorrhage and the surfaces of vitreous and retinal.Results In 13 cases,26 eyes vision were between hand motion-0.6.Sudden vitre-ous hemorrhage in 13 eyes,accounted for 50.0%(13/26).Among them,the classⅠvitreous hemorrhage in 10 eyes, 76.9%(10/13).Ⅱ,Ⅲ grade vitreous hemorrhage in 2 eyes,15.4%(2/13).LevelⅣvitreous hemorrhage in 1 eye, accounted for 7.7%(1/13).26 eyes were diagnosed with stage IV(early or fiber hyperplasia period)DR.The fundus photography:the size,number of retinal neovascularization were found in 13 eyes without vitreous hemorrhage.Ultra-sound confirmed that the 13 eyes vitreous hemorrhage were fresh bleeding,and found 4 eyes with fiber membrane, accounted for 30.8%(4/13).The eyes without vitreous hemorrhage were timely treated by laser,and the eyes with vitreous hemorrhage were treated by stage laser treatment according to the condition of vitreous hemorrhage absorp-tion.Followed up for 4 to 6 months,in a stable condition.Conclusion Obstetrics and gynecology doctors and oph-thalmologists should pay attention to pregnancy DR with vitreous hemorrhage.Because they are all early or fiber hyper-plasia period.Timely and reasonable laser treatment can prevent permanent damage of visual function.

Aims Tocomparethepharmacokineticsof ephedra alkaloids,cinnamic acid and cinnamic alcohol in Ephedrae, Cinnamomi and Ephedrae-Cinnamomi herb couple through UPLC-MS/MS in rats respective-ly,and to investigate the effect of combination on phys-iologicaldisposition.Methods Plasmasampleswere collected at different times after oral administration of Ephedrae,Cinnamomi and Ephedrae-Cinnamomi herb couple extracts.The concentrations of ephedra alka-loids,cinnamic acid and cinnamic alcohol in plasma samples were determined by UPLC-MS/MS.DAS 3. 0 was used to calculate pharmacokinetic parameters.The differences of samples in two groups were conducted with univariate statistical analysis using SPSS 13. 0. Results ComparedwithEphedraegroup,theCmaxof norephedrine hydrochloride, norpseudoephedrine hydrochloride,ephedrine hydrochloride,pseudoephed-rine hydrochloride,and methylephedrine hydrochloride in Ephedrae-Cinnamomi herb couple group were signif-icantly greater (P<0. 05 );the AUC0-t of norpseudo-ephedrine hydrochloride was significantly greater (P<0. 05 );the MRT0-t of norephedrine hydrochloride, phedrine hydrochloride, pseudoephedrine hydrochlo-ride,and methylephedrine hydrochloride were signifi-cantly less (P <0. 05 );the T1/2z of norephedrine hydrochloride,phedrine hydrochloride,and methyl-ephedrine hydrochloride were significantly less (P <0. 05 ).The AUC0-t and MRT0-t of cinnamic acid and cinnamic alcohol were significantly greater than those inCinnamomigroup(P<0.05).Conclusion The combination of Ephedrae and Cinnamomi improves the absorption concentration of five ephedra alkaloids, Slows down the elimination of norephedrine hydrochlo-ride,phedrine hydrochloride,pseudoephedrine hydro-chloride,and methylephedrine hydrochloride,and in-creases the bioavailability of cinnamic acid and cin-namic alcohol.

Objective To evaluate the prevalence of macrosomia in Beijing in 2013 and identify its risk factors. Methods Retrospective six months analysis of 14 188 full-term singleton pregnant women from 15 hospitals with different levels in Beijing in 2013. Each participant′s demographic data and medical information were collected individually by questionnaires. Multiple logistic regression analysis was used to examine the associations between variables and the risk of macrosomia. Results (1)The total prevalence of macrosomia was 7.069%(1 003/14 188) in Beijing in 2013. (2)The prevalence varied between the 15 hospitals, the lowest was 5.36%(89/1 659), while the highest reached 8.80%(46/523). Furthermore, the incidence of macrosomia was 1.284 times (95%CI: 1.114-1.480, P=0.001) higher in the second graded hospitals than that in the tertiary hospitals. (3) Multiple logistic regression analyses showed that risk factors for macrosomia were maternal height≥160 cm (adjusted OR=1.875, 95%CI: 1.559-2.256), pre-pregnant body mass index (p-BMI) ≥24.0 kg/m2 (24.0-27.9 kg/m2:adjusted OR=1.696, 95%CI: 1.426-2.018; p-BMI≥28.0 kg/m2:adjusted OR=2.393, 95%CI: 1.831-3.127), gestational weight gain (GWG)≥15.9 kg (adjusted OR=2.462, 95%CI: 2.125-2.853), gravidity>1 (adjusted OR=1.408, 95%CI: 1.224-1.620), gestational weeks≥40 (adjusted OR=2.007, 95%CI:1.745-2.308) and gestational diabetes mellitus (adjusted OR=1.522, 95%CI:1.298-1.784). GWG≥15.9 kg, p-BMI≥28.0 kg/m2 and gestational weeks≥40 were three risk factors that had the strongest associations with macrosomia (all P<0.01). Conclusions The prevalence of macrosomia in hospitals with different levels is obvious different. Gestational weeks, p-BMI and GWG are three main controllable risk factors for macrosomia, thus should receive more attentions.

BACKGROUND:It has been confirmed that carboxymethylated chitosan has an promoting effect on Schwann cel proliferation and secretion, but its impact on the cyclic adenosine monophosphate-mediated protein kinase A signaling pathway in schwann cel stil needs further study. OBJECTIVE:To investigate the effect of carboxymethylated chitosan on cyclic adenosine monophosphate/ protein kinase A signaling pathway in rat schwann cels. METHODS:The Schwann cels of the second generation neonatal rats were obtained and seeded in 6-wel plate at a concentration of 1×109/L. These Schwann cels were cultured and divided into four groups. The Schwann cels in the control group were cultured by adding PBS. The Schwann cels in the experimental groups were cultured by adding 50, 100 and 200 mg/L of carboxymethyl chitosan solution, respectively. After 24 hours, the concentration of cyclic adenosine monophosphate, protein kinase A activity and cyclic adenosine monophosphate response element binding protein mRNA expression were detected. RESULTS AND CONCLUSION:Compared with the control group, carboxymethyl chitosan increased cyclic adenosine monophosphate concentrations, the activity of protein kinase A and cyclic adenosine monophosphate response element binding protein mRNA expression within the Schwann cels in a dose-dependent manner (P < 0.05). These results demonstrate that carboxymethyl chitosan can increase the concentration of cyclic adenosine monophosphate within the Schwann cels and promote protein kinase A activity, thereby activating cyclic adenosine monophosphate/protein kinase A signaling pathway.

Objective To analysis the spiral CT scan diagnosis value of lymph node metastasis in thoracic esophageal carcinoma and investigate the rules of lymph node metastasis distributions.Methods 117 patients with surgically and pathologically proved esophageal carcinoma underwent CT scans of the chest before the surgical operation to identify the presence of lymph node metastasis and evaluate the diagnosis value of spiral CT in lymph node metastasis.CT imaging which was detected by CT and histopathological analysis performed with attention to the distribution characteristics.Results In 117 cases of esophageal patients,the diagnosis of sensitivity,specific and accuracy degree on lymph node metastasis were 86.0 ％,80.6 ％,84.6 ％.The most lymph node metastasis in the upper thoracic esophagus is the mediastinum group[8/14(57.1％)]and the trachea group[4/14(28.6 ％)].the middle is on the trachea surrounding group[21/41(51.2 ％)],the main pulmonary artery window group[17/41(41.5 ％)]and subcarinal group[15/41(36.6 ％)].the lower thoracic esophagus is around the side of preventriculus[7/19(36.8 ％)]and the left gastric artery[5/19(26.3 ％)]respectively.Conclusion Spiral CT imaging can accurately evaluate the lymph node metastasis of esophageal and distribution characteristics.

Objective To investigate the peripheral blood Th17 and CD4 + CD25 + regulatory T cell levels and their correlations in patients with primary hepatocellular carcinoma (PHC).Methods Peripheral blood samples were collected from 30 PHC patients and 25 healthy controls in the First Affiliated Hospital of Zhejiang University from June 2008 to May 2009.Mononuclear cells were isolated and the Th17 and CD4 + CD25 + regulatory T cells were detected by flow cytometry and compared between patients and controls by t test.Spearman test was performed to analyze the correlation of Th17 with CD4 + CD25 +regulatory T cell concentrations.Results The levels of Th17 and CD4 + CD25 + regulatory T cells in peripheral blood in healthy controls were (2.10 ± 0.87) ％ and (7.10 ± 2.32) ％ ; while those in PHC patients were (3.38±1.68)％ and (11.78±5.62)％ (t=3.640 and 4.162,P＜0.01).The level of Th17 cells was positively associated with that of CD4 + CD25 + regulatory T cells in PHC patients (r =0.821,P ＜0.01).Conclusion The levels of Th17 and CD4 + CD25 + regulatory T cells in peripheral blood are high in PHC patients and positively correlated with each other,which indicates that CD4 + CD25 + regulatory T cells may contribute to the disease progression and pathogenesis of carcinoma through inducing Th17 cells differentiation.