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

Objective To assess the effect of intraarterial washout with UW solution and tanshinone Ⅱ A for skeletal muscle preservation during ischemia and reperfusion.Methods Ischemic rat limbs were perfused with UW solution or UW solution plus tanshinone Ⅱ A (0.05,0.1 and 0.2 mg/ml) for 0.5 h before reperfusion; controls received no perfusion.Serum CPK,LDH,and AST were measured pre-ischemia and after reperfusion (2 h,4 h,and 6 h).Muscle water content,MDA,SOD,ATPase were assessed pre-reperfusion and after 6 h reperfusion.ICAM-1 was detected after 6 h reperfusion.Results Intraarterial washout with UW and UW + T could inhibit the express of ICAM-1 in skeletal muscle.The serum levels of CPK,AST,and LDH in UW group were significant lower than those in control group after 2 h of reperfusion,but no difference was observed between UW group and control group after 4 h and 6 h of reperfusion.After 4 h of ischemia,there were significant differences in water content,MDA,SOD,and ATPase in skeletal muscle between UW group and control group,but no difference was found after 6 h of reperfusion.In contrast,all parameters of laboratory test and biochemical analyzing in UW + T(0.05,0.10,and 0.20 mg/ml) groups were significantly different from those in control group at corresponding reperfusion period.Conclusion Intraarterial washout with UW solution is effective in preserving skeletal muscle integrity against I/R insult.Tanshinone Ⅱ A as a beneficial adjunct to UW solution improves the protective effect of UW solution for ischemic skeletal muscle.To better preserve ischemic skeletal muscle,an appropriate dose of tanshinone Ⅱ A (0.1 or 0.2 mg/ml)added to UW solution is required.

Objective To evatluate the effect of dexmedetomidine on intraoperative wake-up test during cerebral functional area operation performed under combined iv propofol-remifentanil anesthesia.Methods Twenty-seven ASA Ⅰ or Ⅱ patients (both sexes) aged 17-43 yr with a body mass index of 20-24 kg/m2 undergoing op-eration on cerebral functional area during which intraoperative wake-up test was performed were randomly divided into control group (group C,n =13) and dexmedetomidine group (group D,n =14).Anesthesia was induced with midazolam,sufentanil,etomidate and rocuronium and maintained with TCl of propofol (Cp =3-5 μg/ml) and remifentanil (Ce =2-6 ng/ml).BIS value was maintained at 55-65.In group D after dura of brain was opened,a loading dose of dexmedetomidine 0.3 μg/kg was administered iv over 15 min followed by continuous iv infusion at 0.2 μg· kg-1 · h-1 while TCI of propofol and remifentanil were suspended.In group C after opening of dura,Cp of propofol TCI was reduced to 0.5 μg/ml and Ce of remifentanil to 0.5 ng/ml.The wake-up time and development of hypertension,tachycardia,headache,dysphoria,delirium and awareness were recorded.Results All patients were successfully awakened.There was no significant difference in wake-up time between the 2 groups (P ＞0.05).The incidences of hypertension,tachycardia,headache and awareness were significantly lower in group D than in group C (P ＜ 0.05).Conclusion Dexmedetomidine does not affect intraoperative wake-up time during operation on cerebral functional area performed under iv propofol-remifentanil anesthesia,but can significantly reduce the incidence of adverse effects.

Objective To investigate the etiological and epidemiological factors of critical and severe burn injuries,in tending to provide a theoretical basis for the prevention of critical and severe burn injury.Methods The clinical data of a total of 1 043 patients with critical and severe burn injury hospitalized from 1982 to 2006 were retrospectively analyzed,and the sex ratio,age distribution,etiological factors,injury sites,seazonal distribution,duration before hospitalization,complications and fatality of these patients were statistically analyzed.Results From 1982 to 2006,the number of burn patients admitted to our hospital presented an increasing trend,and the number of critical and severe burn patients increased obviously.The sex ratio(male/female) was 3.3∶1,and it obviously declined during the last 5 years.The proportion of infant and childhood patients presented a significantly increasing trend,occupying 41.2% of critical and severe burn patients in the last 5 years.Summer was the predominating season for occurrence of burn injury(40.3%),followed by spring(23.5%),autumn(22.4%) and winter(13.8%).54.8% of burn injury occurred in daily life,the remaining 45.2% of patients got burn injury in work,but the former reached 63.3% in the last 5 years.Heat was the main etiological factor,occupying 85.5%,of which flame was the most important cause,and hot fluid scald was increasing in recent years.Only 51.2% of the patients went to visit doctor within 6h after injury.21.0% of the patients were complicated with inhalation injury,and 17.7% was in shock when they came to the hospital.The fatality rate of critical and severe burns was reduced from 16.3 %(1982-1986) to 4.2%(2002-2006).Conclusions It is urgent to prevent critical and severe burns,especially in the youth and childhood.Information regarding prevention,self-aid and self-protection in fire accident should be actively spread among both the workers in industrial and mining enterprises and community inhabitants.The methods easy to use for shock prevention before hospitalization should be explored as early as possible.

Objective: To evaluate the effect of Twin-block function al appliance in the treatment of transmissible obstructive sleep apnea syndrome (O SAS). Methods: 7 cases of OSAS, aged 8.6～13.2 years, with sk e letal Angle II malocclusion were treated with Twin-block fuctional appliance fo r 13 months on an average. The position of the mandible, tongue, soft palate,hyo id bone and the radius vector of the upper airway was measured by lateral cepha lometric radiographs, the indexes of sleep condition, breath function and cardio vascular system were measured by polysomnography before and after treatment. Results: At the end of the treatment, the average increase in the radius of upper airway was 4.84 mm (P

Calcium-sensing receptor(CaSR)is expressed in human parathyroid cells and renal tubular epithelial cells mainly.CaSR could control parathyroid hormone(PTH)secretion and the renal tubular's handing of the electrolytes and water.This receptor plays a central role in extracellular calcium homeostasis,and involves in the process of bone remodeling.The change of CaSR function,including anti-CaSR antibodies,CasR gene mutations or any part impairment in CaSR signaling pathway,not only results in the imbalaance of PTH and calcium homeostasis.but also relates to disorders of bone remodeling and renal tubular's mishandling in the electrolytes and water,which contribute to hyperparathyroidism.It makes possible clinical Use of cinacalcet in hyperparathyroidism in theory.

Objective To evaluate the accuracy of different methods for estimating blood loss during burn wound excixion and skin grafting in pediatric patients with severe burn. Methods Twenty pediatric patients of both sexes aged 7 days-8 yr weighing 4-22 kg undergoing burn wound excision and skin grafting were enrolled in this clinical study. Two methods were used for estimating blood loss during operation: Method Ⅰ: surgical surface area (SSA). MethodⅡ: the product of SSA and blood volume (BV). Total blood loss was calculated: total blood loss = BV ( Hct0 - Hctx ) ÷ Hct0 + Tx. Hct0 =Hct before operation. Hctx =Hct at the end of operation. Tx =total amount of blood transfusion. Results The correlation between the total blood loss and SSA was 0.776. The correlation between the total blood loss and the product of SSA and BV was 0.889. The difference was statistically significant. Conclusion The product of SSA and BV is more accurate in estimating blood loss during burn wound excision and skin grafting in children with severe burn.