ObjectiveTo explore the distribution of multidrug resistant organism in neonates admitted to the hospital through various ways, and analyze the risk factors in order to avoid cross infection of multidrug resistant organism in neonatology department. MethodsA total of 2 124 neonates were monitored from January 2012 to July 2013, among which 1 119 were admitted from outpatient department (outpatient group), 782 were transferred from other departments (other department group), and 223 were from other hospitals (other hospital group). We analyzed their hospital stays, weight, average length of stay, and drug-resistant strains, and their relationship with nosocomial infection. ResultsAmong the 105 drug-resistant strains, there were 57 from the outpatient group, 27 from the other department group, and 21 from the other hospital group. The positive rate in the patients transferred from other hospitals was the highest (9.42%). Neonates with the hospital stay of more than 14 days and weighing 1 500 g or less were the high-risk groups of drug-resistant strains in nosocomial infection. Drug-resistant strains of nosocomial infection detected in the patients admitted through different ways were basically identical. ConclusionWe should strengthen screening, isolation, prevention and control work in the outpatient neonate. At the same time, we can't ignore the prevention and control of the infection in neonates from other departments or hospitals, especially the prevention and control work in neonates with the hospital stay of more than 14 days and weighing 1 500 g or less to reduce the occurrence of multiple drug-resistant strains cross infection.
Collagen is a kind of natural biomedical material and collagen based three-dimensional porous scaffolds have been widely used in skin tissue engineering. However, these scaffolds do not meet the requirements for artificial skin substitutes in terms of their poor mechanical properties, short supply, and rejection in the bodies. All of these factors limit their further application in skin tissue engineering. A variety of methods have been chosen to meliorate the situation, such as cross linking and blending other substance for improving mechanical properties. The highly biomimetic scaffolds either in structure or in function can be prepared through culturing cells and loading growth factors. To avoid the drawbacks of unsafety attributing to animals, investigators have fixed their eyes on the recombinant collagen. This paper reviews the the progress of research and application of collagen-based 3-dimensional porous scaffolds in skin tissue engineering.
ObjectiveTo summarize our clinical experience of bidirectional Glenn procedure (BGP) for the treatment of complex cyanotic congenital heart disease (CHD). MethodsClinical data of 68 patients with complex cyanotic CHD who underwent BGP in People's General Hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2012 were retrospectively analyzed. There were 40 male and 28 female patients with their average age of 3.9 years (range, 3 months to 22 years) and body weight of 6.2-53.0 (13.6±8.5)kg. Preoperative diagnosis included tricuspid atresia in 20 patients, single ventricle (SV) in 11 patients, double outlet right ventricle in 10 patients, complete transposition of great arteries in 7 patients, tricuspid stenosis in 5 patients, pulmonary atresia in 5 patients, corrected transposition of great arteries in 4 patients, tetralogy of Fallot in 4 patients and Ebstein's anomaly in 2 patients. Among them, there were 14 patients with dextrocardia or dextroversion of the heart, 2 patients with SV and pulmonary hypertension after pulmonary artery banding, and 1 complete transposition of great arteries patient after aortopulmonary shunt. Twenty-three patients received BGP under cardiopulmonary bypass (CPB) and 45 patients received BGP without CPB. ResultsTwo patients died postoperatively, including 1 patient with severe low cardiac output syndrome (LCOS) and another patient with pulmonary infection. Postoperative pulse oximetry oxyhemoglobin saturation (SpO2, 89.3%±7.4%) was significantly higher than preoperative SpO2 (66.8%±11.8%, P < 0.05). In 53 patients, postoperative SpO2 was more than 10% higher than preopera-tive SpO2. Postoperative hematocrit (0.40±0.07) was significantly lower than preoperative hematocrit (0.49±0.11, P < 0.05). Postoperative complications included pleural effusion in 16 patients (23.5%), chylothorax in 7 patients (10.3%), LCOS in 5 patients (7.4%), arrhythmias in 4 patients (5.9%), and pneumothorax in 1 patient (1.5%), who were all cured after appropriate treatment. Fifty-five patients were followed up for 9 months to 6 years after discharge with satisfactory clinical results. All anastomoses remained patent without stenosis or thrombosis. Four patients successfully received total cavopulmonary connection 2 to 5 years after discharge. ConclusionBGP is safe and reliable for patients with complex cyanotic CHD who cannot undergo anatomic correlation or one-stage repair.
ObjectiveTo systematically review the value of human epididymis protein 4 (HE4) in early diagnosis of endometrial cancer. MethodsDatabases including The Cochrane Library (Issue 1, 2013), PubMed, MEDLINE (Ovid), CNKI, CBM and WanFang Data were electronically searched for relevant studies on HE4 versus the golden standard (pathological examination) in the diagnosis of endometrial cancer from inception to April 2013. Meanwhile, relevant journals were also manually searched. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies using the QUADAS items. Then, meta-analysis was performed using RevMan 5.1 and Meta-DiSc 1.0. ResultsFinally, a total of 16 studies involving 2 299 women (1 088 endometrial cancer patients diagnosed according to the golden standard, of which, 504 with benign uterine disease and 707 with normal cervical) were included. The results of meta-analysis showed that, as for HE4 in early diagnosis of endometrial cancer (SEN=57%, 95%CI 0.54 to 0.60; SPE=92%, 95%CI 0.91 to 0.94; +LR=6.92, 95%CI 5.00 to 9.58;-LR=0.46, 95%CI 0.39 to 0.55; DOR=18.38, 95%CI 12.21 to 27.69; AUC=0.881 7). ConclusionThe current study indicates that serum HE4 is more sensitive and low specific when applied in patients with endometrial cancer, which is worth of being used in clinic. Due to the limitation of low quality of the included studies, more high quality trials are required to verify the above conclusion.
ObjectiveTo study the short-term efficacy and safety of tocilizumab in treating patients with active and resistant rheumatoid arthritis (RRA). MethodForty patients with RRA treated with tocilizumab between October 2013 and October 2014 were included in our study. The combined drug treatment was continued with the addition of tocilizumab 8 mg/kg per four weeks. The clinical responses and laboratory parameters were evaluated at the baseline, week 1, 4, 12, 16 and 24, and week 4 and 8 of tocilizumab withdrawal. ResultsTocilizumab was effective for several clinical lesions and laboratorial parameters at all time points. With the extension of treatment, the effect was better. At week 1, the visual analogue scale score of pain by patients, erythrocyte sedimentation rate, C-reactive protein (CRP), disease activity score 28 (DAS28) and health assessment questionnaire (HAQ) results decreased significantly (P<0.05). At week 12, the inflammatory biomarkers of all patients were normal, and 62.9% (22/35) of the patients achieved American College of Rheumatology (ACR)20, and 28.6% (10/35) of the patients achieved ACR50. At week 24, twelve patients achieved ACR50 and low activity (DAS28 score≤3.2), and the score of HAQ was minimum (3.1±1.6). The score of HAQ was significantly different between week 24 and the baseline (20.2±6.7) (P<0.01). All parameters were not significantly changed at week 4 of tocilizumab withdrawal compared with those before the withdrawal. Most parameters increased significantly at week 8 of tocilizumab withdrawal compared with week 4 of withdrawal (P<0.01) except for swollen joints, CRP, DAS28 and HAQ. The main adverse reactions were abnormal hepatic function and dyslipidemia followed by leukopenia. Only one patient stopped treatment because of adverse reaction. ConclusionsTocilizumab has rapid efficacy onset and good safety. After tocilizumab withdrawal, the efficacy can be maintained for 4 to 8 weeks.
ObjectiveTo systematically review the effectiveness and safety of bupropion for smoking cessation in smokers with cardiovascular disease. MethodsDatabases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, WanFang Data and VIP databases were electronically searched from inception to February 23rd, 2013. Randomized controlled trials (RCTs) on bupropion versus placebo for smoking cessation in smokers with cardiovascular disease were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.1 software. ResultsIn total, 4 studies involving 1 415 patients were finally included. The results of metaanalyses indicated that, compared with placebo, bupropion significantly increased the point prevalence abstinence rate at 3 months (RR=1.79, 95%CI 1.14 to 2.83, P=0.01). However, the point prevalence abstinence rates at 6 months (RR=1.81, 95%CI 0.77 to 4.24, P=0.18) and 12 months (RR=1.46, 95%CI 0.94 to 2.27, P=0.10), and the continuous abstinence rates at 3 months (RR=1.48, 95%CI 0.89 to 2.47, P=0.13), 6 months (RR=1.41, 95%CI 0.79 to 2.51, P=0.25), and 12 months (RR=1.43, 95%CI 0.93 to 2.17, P=0.10) were similar in the two groups. The use of bupropion did not increase all-cause mortality (RR=1.13, 95%CI 0.49 to 2.56, P=0.78) and the incidence of cardiovascular events (RR=1.25, 95%CI 0.95 to 1.64, P=0.11). ConclusionBupropion is safe to use in smokers with cardiovascular disease. Although bupropion could increase the point prevalence abstinence rate at 3 months, it is not effective for long-term smoking cessation. Due to the limited quantity and quality of the included studies, more large-scale high-quality RCTs are required to verify the aforementioned conclusion.
ObjectiveTo systematically review the correlation between the expression of survivin and cervical cancer and its clinical pathologic features. MethodsSystematic and comprehensive literature was searched in The Cochrane Library (Issue 1, 2013), PubMed, MEDLINE (Ovid), CNKI, CBM and WanFang Data from inception to May 2013, to retrieve case-control studies published in the foreign and domestic areas on the correlation between the expression of survivin and cervical cancer and its clinical pathologic features. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 13 studies involving 1 530 women (658 cervical cancer patients, 563 cervical intraepithelial neoplasis (CIN), 658 normal cervical. The results of meta-analysis showed that, a) as for the positive rate of survivin expression, significant differences were found between cervical cancer and CIN (OR=4.63, 95%CI 3.49 to 6.13, P < 0.000 01), cervical cancer and normal cervical tissues (OR=38.23, 95%CI 23.92 to 61.11, P < 0.000 01), and CIN and normal cervical tissues (OR=9.61, 95%CI 6.11 to 15.09, P < 0.000 01). b) Significant differences were found between clinical stages Ⅰ-Ⅱ and clinical stages Ⅲ-Ⅳ (OR=0.17, 95%CI 0.07 to 0.41, P < 0.000 1), cervical cancer with lymph node metastasis and that without lymph node metastasis (OR=3.57, 95%CI 2.20 to 5.78, P < 0.000 01), high and moderate/low differentiated ESCC tissues (OR=0.31, 95%CI 0.13 to 0.76, P=0.01), and shallow and deep muscular infiltration (OR=0.12, 95%CI 0.02 to 0.68, P=0.02). No significant difference was found between cervical cancer with laterouterus or haemal infiltration and that without latero-uterus or haemal infiltration (OR=24.15, 95%CI 0.07 to 8 199.76, P=0.28). ConclusionCurrent foreign and domestic evidence shows that, survivin expression is significantly correlated to cervical cancer and its clinically pathologic features, which may participate in the whole course of carcinogenesis of cervical cancer, but it is not considered to be an absolute factor for estimating the survival rate of patients with cervical cancer. Due to the quality limitation of the included studies, more large scale, well-designed and high quality studies are needed for further verifying the aforementioned conclusion.
ObjectiveTo systematically review the correlation between Beclin1 protein expression and cervical cancer as well as its different clinical pathologic features. MethodsWe electronically searched databases including The Cochrane Library (Issue 1, 2014), PubMed, EMbase, Ovid, CNKI, VIP, CBM and WanFang Data from inception to February 2014, to collect the correlation between Beclin1 protein expression and cervical cancer as well as its different clinical pathologic features. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 5 case-control studies involving 637 patients were included, of which, 388 cases in the cervical cancer group, 130 cases in the cervical intraepithelial neoplasia (CIN) group, and 119 cases in the normal cervical tissue group. The results of meta-analysis showed that, a) as for Beclin1 expression, significant differences were found in cervical cancer vs. normal cervical tissues (OR=0.07, 95%CI 0.02 to 0.25, P < 0.000 1), cervical cancer vs. CIN (OR=0.37, 95%CI 0.23 to 0.59, P < 0.000 1), CIN vs. normal cervical tissues (OR=0.23, 95%CI 0.06 to 0.88, P=0.03), and cervical cancer tissues with vs. without lymph node metastasis (OR=0.29, 95%CI 0.17 to 0.49, P < 0.000 01). However, no significant difference was found in medium/low differentiation vs. well differentiation (OR=0.50, 95%CI 0.16 to 1.56, P=0.23), tumour diameter no less than vs. less than 4 cm (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), myometrial invasion depth no less than vs. less than 1/2, and FIGO Ⅰ vs. Ⅱ (OR=0.70, 95%CI 0.44 to 1.10, P=0.12). ConclusionBeclin1 protein expression is notably associated to cervical cancer. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be further verified by performing more high quality studies.
ObjectiveTo systematically evaluate the efficacy and safety of enteric-coated mycophenolate sodium (EC-MPS) versus mycophenolate mofetil (MMF) in kidney transplant recipients. MethodsWe searched MEDLINE, EMbase, PubMed, the Cochrane Library (Issue 9, 2013), CBM, CNKI, VIP and WanFang Data from their inception to November 2013, to collect randomized controlled trials (RCTs) of EC-MPS versus MMF in kidney transplant recipients. References of included studies were also retrieved. Two reviewers independently screened studies according to the exclusion and inclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.1 software. ResultsA total of 8 RCTs involving 2 400 patients were included. The results of meta-analysis indicated that there were no significant differences between the two groups at the end of 4-week, 6-month, 12-month and 48-month follow-up in the acute rejection rate (4-weeks:RR=0.33, 95%CI 0.01 to 8.05; 6 months:RR=0.94, 95%CI 0.73 to 1.22; 12 months:RR=0.88, 95%CI 0.63 to 1.24; 4 years:RR=0.93, 95%CI 0.47 to 1.84). There were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the chronic rejection rate (6 month:RR=0.66, 95%CI 0.27 to 1.58; 12 month:RR=0.57, 95%CI 0.29 to 1.15). There were no significant differences between the two groups at the end of 6-month, 12-month and 48-month follow-up in the graft loss or death rate (6-month:RR=0.79, 95%CI 0.41 to 1.50; 12-month:RR=0.76, 95%CI 0.40 to 1.43; 48-month:RR=1.38, 95%CI 0.59 to 3.23). As to the side effect, EC-MPS could significantly reduce the risk of pneumonia compared with MMF (RR=0.32, 95%CI 0.13 to 0.79). ConclusionBased on current evidences, EC-MPS is comparable with MMF for renal transplant patients in short-term effectiveness, and the incidence of pneumonia in the EC-MPS group is lower than the MMF group. Due to the limited quantity and quality of the studies, the conclusions should be validated by more high quality studies.
ObjectiveTo investigate the clinical effectiveness of high-glucose insulin mixture on the local treatment of patients with grade Ⅱ and Ⅲ pressure ulcers. MethodsA total of 124 patients with grade Ⅱ and Ⅲ pressure ulcers treated between January 2011 and June 2012 were randomly divided into three groups: saline group (group A, n=41), high-glucose insulin mixture group (group B, n=41) and modern dressing group (group C, n=42). We observed and compared the treatment effects among the three groups using both measurements of traditional evaluation criteria and pressure ulcer scale for healing (PUSH) after a week of dressing. ResultsThe overall treatment effects among the three groups were significantly different (χ2=30.453, P<0.001). The results of pairwise comparisons was that the treatment effect was significantly different between group B or C and group A (P<0.01), but the treatment effect was not statistically different between group B and C (P>0.05). Subgroup analysis for patients with grade Ⅱ or Ⅲ pressure ulcers also came to the similar results. ConclusionBoth high-glucose insulin mixture and modern dressing have significant effects on patients with grade Ⅱ and Ⅲ pressure ulcers. However, the high-glucose insulin mixture costs less and is worthy of extensive promotion.