Objective To investigate the training methods of urine and feces incontinence. Method 77 children aged 4 to 14 years with urine and feces incontinence induced by operation received induced training for pelvic floor muscle and related mescles. Abodominal muscles were trained. Regular defecation training, dilation of anus and urine tract, crede methods, Vslsava and Kegel training were conducted. Result The rehabilitation of defecation was found in 67.53% children, the urination was found in 83.12 children. Conclusion The above methods are effective in restoring defecation and urination function.

BACKGROUND: Myelodysplasia induced by spina bifida is one of the common developmental malformations of the nervous system in children, and neurogenic urinary incontinence induced by it can affect the children' s quality of life.OBJECTIVE: To observe the effects of surgical therapy and rehabilitation training for children with hyper-reflexic neuropathic urinary incontinence.DESIGN: A controlled follow-up observation.SETTING: Department of Pediatric Surgery, First Hospital Affiliated to Zhengzhou University.PARTICIPANTS: A total of 81 children(54 males and 27 females), aged 4 to 14 years treated for hyper-reflexic neuropathic urinary incontinence between January 1992 and October 2000 were selected. All the cases were confirmed loose pelvic floor muscle and smaller bladder capaeity before operation. Moreover, all cases with neuropathic urinary incontinence were proved to be hyper-reflexic neurogenic bladder by urodynamic examination.METHODS: Pelvic muscles of the 81 patients were strengthened with bilateral iliopsoas and the bladder was augmented on the basis of ileocystoplasty. Five patients had an additional bladder neck suspension. Wound healing was satisfactory after 3 weeks; therefore, rehabilitative exercise for coordination was performed. The improvements in symptoms and urodynamic results were followed up.RESULTS: Urinary catheters were removed in the 81 patients 2 weeks after operation. Forty patients had voiding desire before micturition, with linear urine current, more than 60 minutes' interval between micturitions, and almost normal or normal maximal bladder capacity and pressure and residual urine volume, which was regarded as significantly improved. Twenty-three patients had voiding desire before micturition, with linear urine current, more than 40 minutes' interval between micturitions, and reduced maximal bladder capacity and residual urine volume, but increased bladder pressure, which was regarded as improved. However, 18 patients were improved after regular bladder training. The postoperative urodynamic results in 9 patients showed that the average bladder pressure, average urethra pressure, residual urine volume and maximal bladder capacity were 1.2 kPa, 1.15 kPa, 30 - 50 mL and 300 -600 mL, respectively. Of the 81 cases, 63 cases were followed up completely for 6 months whereas the others had no complete follow-up data. The follow-up results showed significant outcomes in 56 cases, improvement in 5 and no effect in 2, with the total effective rate of 97%.CONCLUSION: Satisfactory results can be obtained by combined augmentative ileocystoplasty with strengthening of pelvic floor by iliopsoas for children with hyer-reflexic neuropathic urinary incontinence. The combination of micturition reflex and control training after operation produces obvious therapeutic effects.

Objective:To understand knowledge, belief, practice level of insulin injection and influencing factors of behavior of clinical nurses in tertiary general hospitals, so as to provide the basis for formulating targeted training programs for insulin injection.Methods:Using the convenient sampling method, a total of 169 clinical nurses in the adult ward of a tertiary general hospital were selected as the research objects in May 2020. The self-made basic information questionnaire and Insulin Injection Knowledge, Belief and Practice Questionnaire were used for investigation. Binary Logistic regression analysis was used to investigate the influencing factors of insulin injection behavior of clinical nurses.Results:Among 169 clinical nurses, the awareness rate of guidelines was 82.84% (140/169) , 95.86% (162/169) of nurses had patient education experience, the incidence rate of insulin injection needle stab injury was 14.79% (25/169) , and 90.53% (153/169) of nurses had the need to receive insulin injection system training. The total scores of knowledge, belief and practice dimensions of the Insulin Injection Knowledge, Belief and Practice Questionnaire for clinical nurses were respectively 60.00 (45.00, 70.00) , 50.00 (49.00, 50.00) and 85.00 (82.00, 85.00) , and the total score of the questionnaire was 189.00 (178.50, 200.50) . The results of binary Logistic regression analysis showed that knowing the guidelines, receiving insulin injection operation training and insulin injection needle stick experience were the influencing factors of insulin injection behavior ( P<0.05) . Conclusions:Clinical nurses in tertiary general hospitals have a high level of insulin injection beliefs and behaviors and there are still deficiencies in insulin injection knowledge. In the training work related to clinical insulin injection, attention should be paid to strengthening and maintaining the belief and behavior of standardized insulin injection, emphasizing the safety of insulin injection, and combining with the technical guidelines and specifications of insulin injection, improving the knowledge reserve and application ability of insulin injection of clinical nurses.

Objective: To explore the psychological status and related factors in patients with precancerous of esophageal and gastric cardia in Linzhou of Henan. Methods: Clinical psycho-rating scale of Social Support Rating Scale (SSRS), Self-Rating Anxiety Scale (SAS, score ≥50 points with symptoms of anxiety) and Self-Rating Depression Scale (SDS, score ≥53 points with the symptoms of depression) were applied to survey life events and psychological status of subjects who aged 40-69 years old and participated in"The Early diagnosis and Early Treatment"program in Linzhou cancer hospital from July 2015 to Jan 2016. Patients with lower intraepithelial neoplasia or high-grade intraepithelial neoplasia were selected as precancerous lesions (n=118), and patients with normal grade were selected as healthy controls (n=210). Compare the differences of the scores between the two groups, and the logistic regression model was used to analyze the related factors of precancerous lesions and psychological status of the study subjects. Results: Precancerous lesions included esophageal (72 cases), gastric cardia (40 cases), esophageal and cardia dual source (6 cases); Precancerous lesions and healthy controls aged (57.17±7.71) and (53.12±7.99) years old, the difference was statistically significant (P<0.001). The anxiety and depression scale showed that the scores of SAS and SDS scores in the precancerous lesions were (37.18±10.01), (40.44±8.37) points, and (34.02±6.63), (38.49±8.73) points in control group, the difference was statistically significant (P=0.002, 0.032). While the social support total score (38.26±5.26), and subjective support score (24.08±3.83) and objective support score (7.50±1.89) in control group were all higher than those of precancerous group (36.80±6.18, 23.01±3.93, 6.93±1.57), and the difference were statistically significant (P=0.024, 0.016, 0.004). In addition, the Logistic analysis showed that subjects with low objective social support, subjective social support and anxiety symptoms were more likely to develop precancerous lesions, and the OR were 0.81, 0.72 and 1.05, respectively (P=0.028, 0.005, 0.009). Conclusion Social support, anxiety and depression status may be related to the occurrence and development of esophageal and gastric cardia precancerous lesions.

Objective: To evaluate effect of screening of esophageal cancer though comparing difference of survival level between screening and non-screening patients in Linzhou city. Methods: The records pathologically diagnosed as serious hyperplasia/carcinoma and esophageal cancer were drawn from database of first round screening in Linzhou city from 2005-2013 and were assigned to the screening group. The records of new esophageal cancer cases which diagnosed within 2 years before, screening from the same village aged from 40 to 69, were drawn from database of cancer registry in Linzhou city and were assigned to the non-screening group. Five or 10 year survival rate with 95%CI of patients with different malignant degree diseases in the screening group and the patients with esophageal cancer in the non-screening group was calculated respectively. The survival curves between the screening and non-screening group were compared by Log rank method. Results: All 26 908 persons were examined in first round screening in Linzhou city from 2005 to 2013. There were 374 persons with serious hyperplasia/carcinoma in situ, 157 persons with esophageal cancer (141 intramucosal carcinomas/submucosal cancers, 16 invasive cancers). The 5 year survival rate of serious hyperplasia/carcinoma, intramucosal carcinoma/submucosal cancer and invasive cancer were 95.0% (95%CI: 91.7%-97.0%) , 72.0% (95%CI: 62.7%-79.3%) and 41.7% (95%CI: 17.4%-64.6%) separately. The 5 year survival rate of esophageal cancer in screening and non-screening group were 68.7% (95%CI:59.9%-75.9%) and 40.8% (95%CI: 36.4%-45.2%). The 10 year survival rate of esophageal cancer in screening and non-screening group were 58.0% (95% CI: 44.6%-69.3%) and 34.3% (95% CI:29.1%-39.5%). The 5 or 10 year survival rate of esophageal cancer in the screening group were higher than that in the non-screening group in whatever sex or age. The survival distribution of the screening group was better than non-screening group (χ²=38.88, P<0.001). Conclusion More precancerous lesions and early esophageal cancer can be detected and patients' survival level was improved through organized esophageal cancer screening, which provided support to evaluate value of organized screening.

OBJECTIVETo understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high-risk areas.

METHODSEndoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005-2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded. 15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer. 95% CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions.

RESULTSThe compliance rate of screening endoscopy of this study was 49.36% (15 709/31 826) of all, and female's compliance (54.05%, 8 447/15 628) was much higher than that of male (44.83%, 7 262/16 198) (χ(2) = 88.14, P < 0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17% (302/7 246), 17.22% (1 248/7 246), 1.67% (121/7 246), 0.83% (60/7 246), and were higher than that of females (3.45% (290/8 417), 14.82% (1 247/8 417), 1.41% (119/8 417), 0.48% (40/8 417), respectively). Except for high-grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018, < 0.001, 0.960, 0.006). The detection rates of all grades of precursor lesions increased with age rising (all P values < 0.001), among which the detection rates of the mentioned four lesions for 40-44 years old were 2.69% (94/3 500), 8.11% (284/3 500), 0.40% (14/3 500), 0.14% (5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were < 0.001, < 0.001, < 0.001, 0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90% (504/10 287), 17.37% (1 787/10 287), 1.79% (184/1 0287), 0.60% (62/10 287) and 1.64% (88/5 376), 13.17% (708/5 376), 1.04% (56/5 376), 0.71% (38/5 376). The 95% CI of detection rates of various lesions were, 3.78% (3.48%-4.08%) for basal cell hyperplasia, 15.93% (15.37%-16.50%) for low-grade intraepithelial neoplasia, 12.31% (11.79%-12.82%) for mild dysplasia and 3.62% (3.33%-3.91%) for moderate hyperplasia, 1.53% (1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64% (0.51%-0.76%) for esophageal squamous cell cancer, respectively.

CONCLUSIONUp to 21.88% residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.

Adult ; Age Distribution ; Aged ; Carcinoma, Squamous Cell ; epidemiology ; China ; epidemiology ; Endoscopy ; Esophageal Neoplasms ; epidemiology ; Female ; Humans ; Iodides ; Male ; Middle Aged ; Precancerous Conditions ; epidemiology ; Sex Distribution

Objective To understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high-risk areas. Methods Endoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005-2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded.15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer.95%CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions. Results The compliance rate of screening endoscopy of this study was 49.36%(15 709/31 826) of all, and female's compliance (54.05%,8 447/15 628) was much higher than that of male(44.83%,7 262/16 198)(χ2=88.14, P<0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17%(302/7 246),17.22%(1 248/7 246),1.67%(121/7 246),0.83%(60/7 246),and were higher than that of females(3.45%(290/8 417),14.82%(1 247/8 417),1.41%(119/8 417),0.48%(40/8 417), respectively). Except for high-grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018,<0.001,0.960,0.006) . The detection rates of all grades of precursor lesions increased with age rising(all P values <0.001), among which the detection rates of the mentioned four lesions for 40-44 years old were 2.69%(94/3 500),8.11%(284/3 500),0.40%(14/3 500), 0.14%(5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were<0.001,<0.001,<0.001,0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90%(504/10 287),17.37%(1 787/10 287),1.79%(184/1 0287),0.60%(62/10 287) and 1.64%(88/5 376),13.17%(708/5 376),1.04%(56/5 376),0.71%(38/5 376).The 95%CI of detection rates of various lesions were, 3.78%(3.48%-4.08%) for basal cell hyperplasia, 15.93%(15.37%-16.50%) for low-grade intraepithelial neoplasia,12.31% (11.79%-12.82%)for mild dysplasia and 3.62% (3.33%-3.91%) for moderate hyperplasia, 1.53%(1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64%(0.51%-0.76%) for esophageal squamous cell cancer, respectively. Conclusion Up to 21.88%residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.

Objective To understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high-risk areas. Methods Endoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005-2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded.15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer.95%CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions. Results The compliance rate of screening endoscopy of this study was 49.36%(15 709/31 826) of all, and female's compliance (54.05%,8 447/15 628) was much higher than that of male(44.83%,7 262/16 198)(χ2=88.14, P<0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17%(302/7 246),17.22%(1 248/7 246),1.67%(121/7 246),0.83%(60/7 246),and were higher than that of females(3.45%(290/8 417),14.82%(1 247/8 417),1.41%(119/8 417),0.48%(40/8 417), respectively). Except for high-grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018,<0.001,0.960,0.006) . The detection rates of all grades of precursor lesions increased with age rising(all P values <0.001), among which the detection rates of the mentioned four lesions for 40-44 years old were 2.69%(94/3 500),8.11%(284/3 500),0.40%(14/3 500), 0.14%(5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were<0.001,<0.001,<0.001,0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90%(504/10 287),17.37%(1 787/10 287),1.79%(184/1 0287),0.60%(62/10 287) and 1.64%(88/5 376),13.17%(708/5 376),1.04%(56/5 376),0.71%(38/5 376).The 95%CI of detection rates of various lesions were, 3.78%(3.48%-4.08%) for basal cell hyperplasia, 15.93%(15.37%-16.50%) for low-grade intraepithelial neoplasia,12.31% (11.79%-12.82%)for mild dysplasia and 3.62% (3.33%-3.91%) for moderate hyperplasia, 1.53%(1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64%(0.51%-0.76%) for esophageal squamous cell cancer, respectively. Conclusion Up to 21.88%residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.

OBJECTIVETo estimate the cost-effectiveness of esophageal cancer endoscopic screening once-in-a-lifetime and to predict the optimal screening age for people in high-risk areas of rural China.

METHODSA Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long-term epidemiological effectiveness and cost-effectiveness were predicted by simulation of the model.

RESULTSCompared with the control group, strategies starting at 40, 45, 50 and 55 year-old had saved life-years of 629.51, 769.88, 738.98 and 533.21 years per 100 000 people, respectively, of which the strategy starting at 45 year-old saved the maximum life years. All strategies were cost-effective and starting at 40 year-old cost the most per life-year saved. Among all alternatives, strategies starting age at 45 year-old and 50 year-old were incremental cost-effective, and the incremental cost-effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively.

CONCLUSIONSThe strategy starting at 40 year-old implemented at present and other strategies were cost-effective in high-risk areas of rural China. However, the 45-year-old group is more aligned with the principle of cost-effectiveness. Considering the cost-effectiveness of different strategies and social economic status, 45 year-old is regarded as the optimal starting age of esophageal cancer once-in-a-lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year-old which could obtain better screening effects would be preferable in wealthy regions.

Adult ; Age Factors ; Case-Control Studies ; China ; Cost-Benefit Analysis ; Early Detection of Cancer ; Esophageal Neoplasms ; diagnosis ; Esophagoscopy ; economics ; Humans ; Markov Chains ; Middle Aged ; Rural Population

Objective To estimate the cost?effectiveness of esophageal cancer endoscopic screening once?in?a?lifetime and to predict the optimal screening age for people in high?risk areas of rural China. Methods A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long?term epidemiological effectiveness and cost?effectiveness were predicted by simulation of the model. Results Compared with the control group, strategies starting at 40, 45, 50 and 55 year?old had saved life?years of 629. 51, 769. 88, 738.98 and 533. 21 years per 100 000 people, respectively, of which the strategy starting at 45 year?old saved the maximum life years. All strategies were cost?effective and starting at 40 year?old cost the most per life?year saved. Among all alternatives, strategies starting age at 45 year?old and 50 year?old were incremental cost?effective, and the incremental cost?effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively. Conclusions The strategy starting at 40 year?old implemented at present and other strategies were cost?effective in high?risk areas of rural China. However, the 45?year?old group is more aligned with the principle of cost?effectiveness. Considering the cost?effectiveness of different strategies and social economic status, 45 year?old is regarded as the optimal starting age of esophageal cancer once?in?a?lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year?old which could obtain better screening effects would be preferable in wealthy regions.