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

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.

Nerve agents (NAs) belong to the class of organic phosphorus compounds which are acetylcholinesterase ( AChE) inhibitors, including soman, sarin, tabun,VX, etc.NAs are extremely toxic and considered as the most danger-ous chemical warfare agents.The current standard treatment for poisoning by nerve agents consists of the combined adminis-tration of anticholinergic drugs such as atropine sulphate, AChE reactivators such as pralidoxime, obidoxime and HI-6 and diazepam for anticonvulsant effects, but oximes are therapeutic antidotes against nerve agent intoxications which exert the therapeutic purposes primarily by reactivating the NAs-inhibited AChE.In this paper, the mechanism of nerve agents, the main working procedure of anti-NAs drugs, the chemical structure of classic reactivator, the corresponding antitoxic action, in vivo and in vitro effects and metabolic kinetics are reviewed.

Objective To report the experience in diagnosing gastroenteric tuberculosis under en-doscopies, and arose enough attention to avoid missed or mis-diagnosis. Methods Biopsy is taken when lesions, such as gastroenteric mucosal protrusions, nodule, erythema and ulcer are found under endoscopies. Results In 7 cases studied, 2 of them are the gastric tuberculosis (1 ulceration, 1 proliferation) , the rest, colonic tuberculosis (4 proliferation and 1 mixed). Distribution of lesions: gastric antrum 2, each one in terminal ileum, ileocecal valve, terminal ileum plus ileocecum, terminal ileum plus pan colon, and ascending colon. Endoscopic diagnosis: colonic tuberculosis with infiltrative tuberculosis in both lungs 1; colonic malignant tumors 2, mucosal protrusions and ulcerative lesions with undefined nature 4. Caseous necrotic granu-lomas are found in all cases on pathological examination. Conclusion The various appearances of gastroenteral tuberculosis under endoscopies are hard in differentiating from those of colonic carcer, inflammatory bowel diseases ( Crohn' s disease etc. ) , gastric benign or malignant ulceration. The definite diagnosis of gastroenteral tuberculosis is greatly depended on pathological results.

High-mobility-group B1 (HMGB1), an abundant, highly conserved cellular protein, is widely known as a nuclear DNA-binding protein that stabilizes nucleosome formation, and facilitates gene transcription. Recent studies suggested that HMGB1 could be overexpressed and released from cellular nucleosome upon endotoxin and cytokine stimulation, or other stress challenge including burns, shock, as well as infection. Therefore, extracellular HMGB1 might be involved in the pathogenesis of sepsis and subsequent multiple organ dysfunction syndrome. Moreover, experimental data showed that extracellular HMGB1 might play vital roles in nerves development, tumor metastasis, atherosclerosis and restenosis after vascular damage.

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.

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.