Objective To understand the effect of health management to enhance the community hypertensive patients' self-efficacy. Method With the method of stratified random sampling, 347 patients who come from communities were diagnosed as hypertension were selected as research subjects from the range of Yingze in Taiyuan of Shanxi province. There were 191 males and 156 females, the age ranged from 38 to 72 (55.90±9.60) years. The self efficacy promotion plan was conducted on high blood pressure patients. A comparison before and after six months of health management was made among the self efficacy scores, daily life scores, health behavior scores, drug behavior scores, medical compliance behavior scores by using self-efficacy scale. Excel 2007 and SPSS 19.0 were used for data analyses. Result Before the implementation of health management, the self efficacy scores of research subjects were 26.96 ± 0.77. After the implementation of health management, the value increased to 29.51 ± 0.86 (t=-41.23, P<0.05). In four dimensions, daily life (before and after management 6.85 ± 0.20 and 7.49 ± 0.31, t=-40.66), drug behaviors (before and after management 7.52 ± 0.21 vs. 7.98 ± 0.23, t=-26.93) and medical compliance behavior scores (before and after management 5.26±0.15 vs. 6.78±0.19, t=-115.97) were higher than those before the health management except health behaviors (before and after management 7.25 ± 0.40 vs. 7.26 ± 0.40, t=-1.94, P<0.05). Conclusion Health management regulated the self care behavior of patients with hypertension, improved the patients' compliance and enhanced self efficacy, which played an important role in controlling the development of disease.

Objective To develop a complete set of medical water processing and supply system to meet the needs of water in field operations for emergency rescues and disaster relief work, filed advance drill, etc. Methods A complete set of medical water processing and supply system was composed of two parts, including water processing system and water supply system. The means of filtrating, precipitating, sterilizing, adsorbing and ion regulating were adopted in water processing system to purify the water from primitive and to pure state for living or medical treatment. The techniques and equipments such as pressurizing, buffering, current regulating and special pipes, valves, fast joints, etc, were adopted in water supply system, and high performance water-pipe network were established. Results The water processing and supply system has some disadvantages, such as water quality guarantee, water quantity abundance, water flow stabilization, water pressure qualification, and system safety, credibility, low failure-ratio, energy saving etc, and can meet the needs of medical water in field operations. Conclusion The water system can be carried out by design optimizing and can realize mobile and emergencies.

Objective To understand the quality of sleeping in medical students, and provide a reference basis for designing sleep health management program for college students. Methods The survey was conducted at a medical college in Shanxi province with stratified random sampling and Pittsburgh Sleep Quality Index (PSQI) scale. Totally 210 individuals were enrolled, 199 completed the questionnaire, with a response rate of 93.5%. SPSS 21.0 statistical software was used for data analysis. Descriptive statistical analysis was carried out for socio-demographic data. Independent t-test, one-way analysis of variance and non-parametric test were used to compare the scores of PSQI between participants. Multiple stepwise linear regression was used to determine influencing factors of sleep quality. Results The average score of PSQI for the 199 medical students interviewed was (6.74±2.42), the incidence of sleep disorder was 50.25%, the overall sleep quality was not high. Learning pressure of medical student had statistically significant in PSQI (Completely unmatched, 5.14 ± 2.32, Mostly unmatched, 5.93 ± 2.73, Mostly matched, 6.70 ± 2.42, Absolutely matched, 7.39 ± 2.10, F=3.366, P=0.020), employment pressure of medical students in PSQI (Completely unmatched, 6.50 ± 0.71, Mostly unmatched, 6.80 ± 3.24, Mostly matched, 5.98 ± 2.14, Absolutely matched, 7.14 ± 2.35, F=3.134, P=0.027). Grade (β=-0.172, P<0.05) and learning pressure (β=0.210, P<0.01) were the main influence factors for students. Conclusion Sleep quality of medical students was not high, upper grade was worse than low grade, the incidence of sleep disorder had increasing trend as learning pressure and degree of employment pressure worsen.

Objective To explore the risk of tuberculosis infection in patients with malignant tumors.Methods The sputum samples and blood samples from 396 patients with malignant tumor and 80 healthy subjects were detected by modified Roche cul-ture,real-time fluorescence quantitative PCR,colloidal gold,T cell spots(TSPOT.TB)and single immunodiffusion(SRID).Results The positive rate of the experimental group of 396 cases of malignant tumor patients with five kinds of methods for detection of Mycobacterium tuberculosis were improved Lowenstein Jensen 12.1%(48/396),real-time PCR(169/396)42.7%,colloidal gold 38.9%(154/396),TSPOT.TB 44.9%(178/396),SRID 10.4%(41/396).In the control group,the positive result was detected only by real-time fluorescent PCR 8.7%(7/80),colloidal gold 6.3%(5/80),and TSPOT.TB 27.5%(22/80).The differences of the results of the same detection method were statistically significant(P<0.01).The experimental group was grouped according to the location of the lesion,and there was no statistical difference between the indexes of each group(P>0.05).In comparison with other types of tumor,there were no statistical differences in every index of every group(P>0.05).But the positive rates of liver cancer patients were lower than those of other types of tumor,and all the positive rates of lung cancer patients were higher than those of other types of tumor.Conclusion Patients with malignant tumor is a high-risk group of TB infection.It is suggested that early screening and regular monitoring of TB infection should be done for patients with malignant tumor,so as to achieve early de-tection and early treatment.

Objective: To present the evolutionary path of Chinese Medical Ethics, analyze the development vein of periodical, explore the journal' s research focuses, and provide reference for related personnel to understand the development of the current research status in the field through visualization technology. Methods:Using biblio-metric method,taking "China National Knowledge Infrastructure" as source of data collection, we used the visual-ization software CiteSpace to draw scientific knowledge maps and analyzed literatures published from 1990 to 2014 in Chinese Medical Ethics. Results:The annualvolume of journal articles fluctuated upwards,with peaks in 1992, 2000 and 2009, and of which the most was in 2009, with 393 articles. "Medical Ethics" and "Doctor-patient Relationship" were hotwords in this field. The publications of domestic and foreign scholars promoted the interna-tional exchange and the development of Chinese medical ethics, and the most productive institutions were often col-leges or universities. Conclusion:Chinese Medical Ethics has effectively promoted the development of bioethics in China, more and more scholars are involved in the relative research of medical ethics, and the old, middle and young scientists and research teams inherit, cooperate and develop with each other. The cross-regional, inter-a-gency and interdisciplinary collaboration remains very limited, whichwill become the important factorinfluencingthe development of the field of Chinese medical ethics in the future.

Objective: To analyze the hints role of surveillance cultures of Carbapenem-resistant Enterobacteriaceae (CRE) by perianal swabs in patients with hematological diseases, and seek risk factors of CRE bloodstream infection. Methods: The resistance of CRE from 2 914 patients with hematological diseases who cultured perianal swabs, CRE bloodstream infection and risk factors were analyzed during January 2016 to December 2017. Results: In this study, perianal swabs from 2 914 patients with hematological diseases were cultured, 74 patients were CRE positive, and bloodstream infection with CRE was found in 13 of these patients. A total of 87 CRE strains were isolated (The same patient only keep the first one for the same location), including 31 Klebsiella pheuminiae, 43 Escherichia coli, 8 Enterobacter cloacae and 6 other Enterobacteriaceae. The resistance rates to piperacillin / tazobactam, imipenem, meropenam, amikacin, levofloxacin, tigecycline were 91.9%, 74.4%, 98.8%, 17.6%, 74.4% and 8.0%, respectively. Resistance to carbapenem, aminoglycoside, quinolones and tegacycline were highly consistent between two sites from 13 patients, whose both perianal swabs and blood were positive in CRE cultures. Febrile neutropenic time, digestive tract symptoms and perianal infection were independent risk factors for bloodstream infection in patients with perianal swabs positive results, the odds ratios (OR) were 1.10 (P=0.029), 1.13 (P=0.005) and 1.23 (P=0.016), respectively. Conclusion Perianal swabs surveillance cultures of CRE can be hints for CRE bloodstream infection in patients with hematological diseases, and also can provide suggestions for antibiotics. Long time of febrile neutropenic, digestive tract symptoms and perianal infection can be the early warning for CRE bloodstream infections.

OBJECTIVETo analyze the R1 rate of the pancreatic head carcinoma resection specimens which delt with a unified protocol by two different R1 criteria.

METHODSBetween November 2011 and October 2013, a unified pathological protocol was prospectively used to handle 70 consecutive pancreatioduodenectomy specimens for pancreatic ductal adenocarcinoma. Apart from the pancreatic transection margin, the bile duct and stomach/jejunum margins, different colors were used to stain the anterior surface, the superior mesenteric vein (SMV) groove margin, the superior mesenteric artery (SMA) margin, and the posterior surface. Axial slicing technique was used to dissect the pancreatioduodenectomy specimens.

RESULTSAmong the 70 patients, 3, 30 and 37 patients were classified as well, moderately and poorly differentiated respectively;7, 15 and 48 patients were classified as pT1, pT2 and pT3 respectively.Forty patients (57.1%) had metastases in regional lymph nodes (pN1) , and 16 patients (22.9%) had metastases in para-aortic nodes.Resection of the portal vein and/or the superior mesenteric vein was performed in 13 patients (18.6%) .When applying the UICC criteria, 26 cancer resections were classified R1 (37.1%) , 33 margins were turned out to be R1. The SMV groove margin and SMA margin were infiltrated in 13 specimens (13/33, 39.4%) respectively.When applying the Royal College of Pathologist's criteria, 39 cancer resections were classified R1 (55.7%) , 51 margins were turned out to be R1. The SMV groove margin and SMA margin were infiltrated in 18 (18/51, 35.3%) and 19 (19/51, 37.3%) specimen respectively.Until April 2014, the median follow-up was 18(range 6-42) months.

CONCLUSIONSApplying the unified protocol for pancreatic head ductal adenocarcinoma specimens results in an significant R1 rate of the resection margins, and the R1 rate is related to the R1 criterion. The SMV groove margin and SMA margin are the two most frequent sites of R1.

Adenocarcinoma ; pathology ; Carcinoma, Pancreatic Ductal ; pathology ; Diagnostic Techniques and Procedures ; Humans ; Lymph Nodes ; pathology ; Mesenteric Artery, Superior ; surgery ; Pancreas ; pathology ; Pancreatic Neoplasms ; pathology ; Portal Vein ; surgery

Chronic inflammation induced by Helicobacter pylori is considered to be one of the main causes of gastric cancer,and CagA is a main virulence factor of H.pylori.The study aimed to investigate the role and mechanism of CagA in host inflammatory response.Mass spectrometry was used to identify the interacting proteins of CagA in AGS cells.By immunoprecipitation and immunofluorescence,the interaction was validated.Pathway expression was detected by immunoblotting after knockdown by using siRNA,and mRNA levels of inflammatory cytokines were detected by quantitative PCR.CagA-induced inflammatory responses were detected in clinical samples using hemoglobin-eosin staining(H&E).Data showed that CagA interacted with SHARPIN.And CagA activated the NF-κB signaling pathway and upregulated the mRNA and protein levels of the inflammatory cytokines IL-6,IL-8,and TNF-α,as compared with the CagA knockout strain(all P<0.05).Knockdown of SHARPIN by siRNA reduced inflammation levels and partially inhibit NF-κB signaling.In clinical samples,CagA-positive samples exhibited stronger inflammatory responses.To sum up,CagA promoted the host inflammatory response,and CagA-induced inflammatory response was reduced when SHARPIN was partially inhibited,suggesting that CagA activates the NF-κB signaling pathway through binding to SHARPIN.

Background: Helicobacter pylori (Hp) infection is related to the occurrence of many upper digestive tract diseases, and the eradication rate has been decreasing year by year. Aims: To investigate the risk factors affecting initial eradication rate of Hp infection. Methods: Clinical data of 428 patients with Hp infection were retrospectively analyzed. Four regimens (14-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 10-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 14-day esomeprazole 20 mg + amoxicillin 1 000 mg, tid; 14-day esomeprazole 20 mg + bismuth 220 mg + amoxicillin 1 000 mg + clarithromycin 500 mg, bid) were given, and effect of antibiotic resistance on Hp eradication was analyzed, the relevant risk factors affecting the eradication rate of Hp were investigated. Results: The eradication rate of ITT analysis was 86.4%, PP analysis was 87.6%. The eradication rates of 4 regimens for ITT analysis were 90.8%, 79.8%, 82.7%, 91.9%, respectively, and were 90.8%, 81.2%, 85.1%, 92.7% for PP analysis, respectively. The antibiotic resistance rate was 30.3%, 97.4% and 36.8% for clarithromycin, metronidazole and levofloxacin, respectively. The recurrence rate of 116 patients was 4.3% after one year of eradication. Smoking, poor compliance, CYP2C19 gene polymorphism were risk factors for eradication rate of Hp (P<0.05). Conclusions: Smoking, poor compliance and ultra-rapid metabolizers, extensive metabolizers of CYP2C19 gene polymorphism can reduce Hp eradication rate. In clinical practice, patient education should be strengthened to urge patients to quit smoking. The quality of follow-up should be improved and proton pump inhibitor that has less impact on CYP2C19 gene polymorphism should be used, thereby increase the Hp eradication rate.

Background: The benefits and risks of eradicating Helicobacter pylori (Hp) should be balanced in aged people. Aims: To investigate the efficacy, safety and antibiotic resistance status of Hp eradication treatment in the elderly. Methods: Four cohorts of subjects who received Hp eradication treatment in randomized controlled trials conducted in Chongqing Daping Hospital were reviewed; the demographic and clinical data were extracted and recorded. Propensity score matching was performed to select comparable elderly group (≥60 years old) and non-elderly group (<60 years old). The eradication rate, compliance, adverse events, antibiotic resistance, and the influencing factors of eradication were analyzed in these two groups. Results: A total of 994 subjects receiving Hp eradication treatment were enrolled initially, among them, 224 were categorized as elderly group and non-elderly group by propensity score matching, with 122 subjects in each group. The Hp eradication rates were higher than 90% in both elderly and non-elderly groups, and no significant differences were observed in compliance, drug-related adverse events, and antibiotic resistance rates between these two groups (all P>0.05). Furthermore, there were no significant differences in the Hp eradication rates in terms of gender, cigarette smoking, alcohol consumption, comorbidities (hypertension, diabetes, surgical history, and inflammation), compliance, etc. in the elderly group (all P> 0.05). But in retreated elderly subjects, the resistance rate of clarithromycin was higher than that in naïve elderly subjects (P<0.05). Smoking and poor compliance were identified as independent risk factors for Hp eradication by multivariate Logistic regression analysis. Conclusions: Hp eradication in the elderly demonstrates comparable efficacy and safety with non-elderly subjects. Clarithromycin-containing regimens are not recommended for empirical retreatment in aged people.