As the most common pathogen for healthcare -associated infection in European and American countries, Clostridium difficile has become increasingly popular in China and has posed a great threat to public health.Based on evidences retrieved from the PubMed and CNKI databases , this article reviews biological characters and dissemination patterns of C.difficile, epidemiology, burden and risk factors of C.difficile infection, and the surveillance, contact precaution, hand hygiene, antimicrobial stewardship, environment cleaning, use of probiotics and vaccine for the prevention of C.difficile infection.

Purpose To study the expression of zeb-1 and c-jun in gastric cancer and its influence of occurrence and development of tumor. Methods The expression zeb-1, c-jun and E-cadherin were assessed in 100 specimens of gastric cancer and their tissue adja-cent to cancer by immunohistochemistry. Results The positive rates of zeb-1,c-jun and E-cadherin expression in gastric cancer were 81%, 70%, 35%, and in tissue adjacent to cancer were 17%, 25%, 100%. The expression of zeb-1 and c-jun in gastric cancer were higher than those in their tissue adjacent to cancer (P<0. 05). zeb-1 expression was closely correlated with the degree of tumor differentiation, depth of invasion, lymph node metastasis and TNM stage (P<0. 05), which were not correlated with patient s age, sex and tumor size. c-jun expression was closely correlated with the degree of tumor differentiation (P<0. 05), which were not correlated with other pathological features. The expression of zeb-1 was negatively correlated with the expression of E-cadherin and was positively correlated with the expression of c-jun in gastric cancer. Patients with high expression of zeb-1 and c-jun had lower five-year survival rate than patients with negative expression. Conclusion zeb-1 and c-jun are closely correlated with occurrence and development of gastric cancer. They can be a index of judging prognosis of gastric cancer.

Objective: To conduct systematic evaluation on the dermatologic toxicity caused by targeted anti-cancer drugs in children and teenager to provide reference for future studies and clinical practice.Methods: Pubmed(http:∥www.ncbi.nlm.nih.gov/pubmed/), American Society of Clinical Oncology Annual Meetings' Online Abstracts Database(http:∥www.asco.org/) and ClinicalTrials.gov(http:∥www.clinicaltrials.gov) were searched for the clinical trials on the use of targeted anti-cancer drugs (single or combination) in children and teenager complicated with dermatologic toxicity.Methodological quality assessment was performed for the included studies, using Cochrane's risk of bias assessment tool for randomized controlled trials and methodological index for non-randomized studies (MINORS).Meta-analysis was performed for the outcomes including adverse event rate of skin rash, xerosis, pruritis and mucositis.Results: A total of 24 studies with 960 patients were included in this study.Various solid tumors and leukemia were investigated in the studies.The quality assessment revealed that the majority of included studies were with high quality.According to the results of meta-analysis, the pooled event rate and 95% confidence interval were 0.19[0.12-0.28],0.24[0.06-0.51],0.12[0.04-0.24] and 0.21[0.07-0.39] for skin rash, xerosis, pruritis and mucositis, respectively.Publication bias analysis indicated potential reporting bias for skin rash (Egger's P=0.007).Conclusion: Dermatologic adverse events occur in a part of children and teenager with cancer treated with targeted therapy, which may cause impaired quality of life and disability.Adequate attention should be paid to these events during clinical trials and real life practice.

Objective To study the content changes of ET and CGRP in MID patients and investigate the effect of cluster needling on scalp point about intelligence of MID patients. Methods Sixty MID patients were divided into cluster needling group and medicine group which was treated by hupperzine. HDS,ADL,MMSE score and ET,CGRP content was assayed before and after treatment. Results After treated for 8 weeks,CGRP content of cluster needling group was increased and ET was decreased significantly compared with medicine group (P

BACKGROUND: Dynamic balance of endothelin (ET) and calcitonin gene-related peptide (CGRP) plays an important role in occurrence and development of cerebral infarction.OBJECTIVE: To observe the effects of thromboiytic therapy with batroxobin(DF-521) on the levels of plasma ET and CGRP after cerebral infarction.DESIGN: Randomized controlled study.SETTING: Fourth Department of Gereology, General Hospital of Guangzhou Military Area Command of Chinese PLA.MATERIALS: The experiment was performed at the Fourth Department of Gereology, General Hospital of Guangzhou Military Area Command of Chinese PLA. Totally 15 New Zealand rabbits aged from 18-20 months, of common grade and either sex, with the mean body mass of (3.5±0.5) kg were selected.METHODS: A total of 15 rabbits were established into cerebral infarction models with modified autogeneic thrombus method. One rat died when selecting models. Other 14 rats were randomly assigned into control group and treatment group. DF-521 was slowly injected into vein of ear edge of rats in the treatment group at hour 2 after embolism. Saline of the same volume was slowly injected into rats of the control group. Changes of concentrations of plasma ET and CGRP in the treatment group and control group were observed before and after cerebral infarction.MAIN OUTCOME MEASURES: Changes of ET and CGRP contents 1 hour before operation, 2 hours after operation (before drug injection) and 6 hours after operation (4 hours after drug injection).RESULTS: Of the 15 included rabbits, 1 rat died when establishing model, so 14 rabbits were involved in the result analysis. ET level significantly increased at hour 2 after acute cerebral infarction operation in the treatment group and control group (P ＜ 0.05, P ＜ 0.01), and then decreased at hour 6 after operation (P ＜ 0.01 ,P ＜ 0.01 ). The decrease in the treatment group was larger than that in the control group (P ＜ 0.01 ). The level of CGRP markedly reduced at hour 2 after acute cerebral infarction operation in the two groups, and than increased at hour 6 after operation. The increase in the treatment group was larger than that in the control group, but there was no statistical difference (P ＞ 0.05).CONCLUSION: Body with cerebral infarction during acute stage has selfregulative mechanism on dysequilibrium of ET and CGRP. Early-used thrombolytic therapy with DF-521 can markedly increase the ET level,which may be one of the protective mechanisms of cerebral ischemical reperfusion injury.

BACKGROUND:There are many multimodal analgesia schemes in perioperative period of total knee arthroplasty, but there is no ideal scheme. OBJECTIVE:To explore the effects of multi-mode and preemptive analgesia on analgesic effect after total knee arthroplasty. METHODS:120 patients with severe osteoarthritis who underwent unilateral knee arthroplasty were enroled in this study. According to different analgesic effects, the patients could be divided into four groups (n=30). In the control group, no corresponding analgesic measures were found before and during replacement. In the preemptive analgesia group, celecoxib was oraly taken before replacement. In the cocktail analgesia group, cocktail was periarticularly injected during replacement. In the multimodal combined analgesia group, celecoxib was oraly taken before replacement + cocktail was periarticularly injected during replacement. After replacement, intravenous patient-controled analgesia pump was applied in each group. Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were measured at various time points after total knee arthroplasty in four groups. Adverse reactions were recorded after replacement. RESULTS AND CONCLUSION:Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were better in the preemptive analgesia, cocktail analgesia and multimodal combined analgesia groups than in the control group at various time points after replacement (alP < 0.05). Above indexes were better in the multimodal combined analgesia group than in the preemptive analgesia and cocktail analgesia groups (alP < 0.05). No significant difference in above indexes was detected between the preemptive analgesia and cocktail analgesia groups (alP > 0.05). No significant difference in the number of cases affecting nausea and vomiting was detected at 2 weeks after replacement in the four groups (P > 0.05). There was no deep venous thrombosis of double lower limbs or necrosis and infection of incision. These findings suggest that the effects of preemptive analgesia before total knee arthroplasty, local injection analgesia during replacement, and the combined analgesia of intravenous patient-controled analgesia pump after replacement were ideal. Adverse reactions did not increase, and the operation was safe. At present, multimodal combined analgesia has been accepted by us, but to achieve truly painless results after total knee arthroplasty stil needs more efforts.

With the aggravation of aging of the population,the incidence of Alzheimer's disease (AD)has been steadily increasing,mild cognitive impairment (MCI)is considered as a cognitive state between aging and dementia.However,the diagnosis of AD and MCI is difficult and mainly depends on the clinical symptoms and the corresponding assessment scales,lacking of the application of biological markers.In this paper,we presented a general review of the biological markers related to AD and MCI,so as to provide reference for their clinical use.

Objective To investigate the effects of lanthanum(La)subchronic exposure on the metabolism of calcium(Ca),magnesium(Mg)and iron(Fe)in the liver tissue and serum in rats.Methods 36 Wistar rats were treated with lanthanum chloride(LaCl3)through oral exposure at 0.1,2 and 40 mg/kg respectively.After 90 days of treatment,the rats were sacrificed and the La,Ca,Mg and Fe in the liver tissue were determined,the serum was collected for analysis of Ca,phosphorus(P),Mg,Fe,unsaturated iron-binding capacity(UIBC)and total iron binding capacity(TIBC).Results The La levels in the liver tissue in all LaCl3 exposed dose groups rats were higher obviously than those in the control group(P0.05).Conclusion The result suggests that La subchronic exposure may have some effects on the level and distribution of Ca,Mg and Fe in the liver tissue and serum,which may be a part of its biological effects.

Objective To evaluate the urethra lengthening technique in the management of stricture of the external orifice and navicular fossa of urethra. Methods From June 1995 to April 1999,15 cases of severe stricture of the external orifice and navicular fossa of urethra were treated by the urethra lengthening technique and the therapeutic effect was evaluated. Results The patients have been followed up for 3～36 months with a mean of 21 months.Satisfactory results with normal voiding and good apearence of the penis have been observed in all but 2.Slight stricture of the external orifice has been noted in 2 patients and has been relieved after 3～6 times of urethral sounding. Conclusions Urethra lengthening technique yields a high success rate with consistant normal voiding and is compliant with the normal anatomy and physiology of the urethra.

OBJECTIVE:To discuss drug quality management practice in medical institutions.METHODS:The status quo of pharmaceutical administration and its trend of development were analyzed based on national laws and regulations for the drug control,the contents on drug quality management practice in medical institutions were presented.RESULTS:The management system,operation criteria,record system should be formulated respectively in drug quality management of medical institutions aimed directly at drug supply and drug use.CONSLUSION:The formulation of drug quality management practice in medical institutions is essential in the efforts to ensure safety,effectiveness and economy of drug use.