Objective To investigate the effect of bundle strategy of diagnosis and treatment on preventing hospital acquired pneumonia in intensive cancer patients.Methods Two hundred and sixty-five patients as control group were treated by regular preventive measures,and 292 cases as intervention group were treated by bundle strategy including the control application of antibiotics,hand hygiene,oral care,isolation of multi-drug resistant,elevation of bedside,management of respiratory tract and appropriate sedation and analgesia et al.Compare the hospital acquired pneumonia incidence,attribution mortality,duration of mechanical ventilation,stay-time in ICU,hospital acquired pneumonia antibiotics defined daily doses system and positive rate of multi-drug resistant infection between two groups.Results With the bundle treatment,the decreases of the hospital acquired pneumonia Incidence,duration of mechanical ventilation,stay-time in ICU and hospital acquired pneumonia Antibiotics daily doses system were significant(P＜ 0.01),and the positive rate of hospital acquired pneumonia attribution mortality and MDR infection were no statistical significance (P ＞ 0.05).Conclusion The bundle strategy of diagnosis and treatment could reduce the hospital acquired pneumonia incidence and the length-time in hospital.

Objective: To study the effect of fish-oil fatty emulsion on immunity of post-operation patients with malignancy tumors.Methods: Forty-three post-operation patients with malignancy tumors were randomly divided into control group and study group and both groups were provided with parenteral nutrition treatment [104.6 kJ(25 kcal/kg)].Fish-oil fatty emulsion was given to the study group.The level of serum albumin,immunity function,jaundice index,aminotransferase,blood lipid and morbidity rate of infectious complications of the two groups were compared.Results: After five days of post-operation treatment,in the study group,the immunity function was significantly improved and morbidity rate of infectious complications declined.The levels of serum albumin,the blood lipid,jaundice index,and aminotransferase had no significant difference between the two groups.Conclution:Fish-oil fatty emulsion is beneficial to the immunity function and can emilsion decrease infectious complications of post-operation patients with malignancy tumors.

Objective To study the safety and feasibility of tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal-channel.Methods Eighty patients after conventional percutaneous nephrostolithotomy are selected and divided into two groups according to the principle of randomization.Control group adopts conventional percutaneous nephrostolithotomy calculi lithotripsy with renal pelvis drainage tube placement whereas the experimental group adopts tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal channel.Both experimental group and control group will be scientifically and statistically analyzed via the incidence and the dose of using sedative for alleviating pain after operation,hospital stay,level of hemoglobin,and the occurrence of complications such as continuate hemorrhage,infection,urinary extravasation,etc.Results The operation of both groups are successful in phrase Ⅰ.The incidence and the dose of using sedative in control group are obviously higher than that in experimental group(45％ vs 20％).However,the incidence of postoperative complications like infection and hemorrhage and hospital stay between two groups are undifferentiated in statistics(P ＞ 0.05).Neither the experimental group nor the control group has perinephric hematoma,and seven cases of control group have urinary leakage after remove of fistula.Conclusion Tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal-channel is safe and feasible and it can reduce the incidence of postoperative pain and avoid urinary leakage.

Objective To explore the in vivo killing effects of nanosecond pulsed electric fields on mouse breast cancer in tumor bearing BALB/c mice. Methods Twenty four BALB/c mice models with subcutaneous EMT-6 breast cancer were prepared and divided into experimental group and control group (n=12). In experimental group, the mice were treated by the pulsed electric fields with peak voltage of 700 V/cm, rise times of 57 ns, durations of 70μs and duty ratio of 50%on the tumor tissue with two parallel electrodes under anaesthesia. One hundred pulses were given and the energy was just 9.75 J with effective action period of 7 ms. Tumor volume, animal weight and histopathologic changes after 1, 3, 5 and 7 d were observed after irreversible electroporation. Results The tumor volume in experimental group increased more slowly than that in control group, especially at the 1-3 d after treatment with a standstill. Histopathological examination results showed that the tumor tissue had obvious coagulation necrosis and tissue edema after electrical stimulation treatment, and mass vacuole like structure appeared in tumor tissue from the third day after treatment and vascular injury occurred at the early stage. Conclusions In the given field conditions, steep pulsed electric field has inhibitory effect on tumor growth. In order to achieve more ideal tumor therapy effect, further studies on steep pulse dose are needed.

Hotlines ; Humans ; Influenza A Virus, H7N9 Subtype ; Influenza, Human ; prevention & control ; virology ; Internet ; Preventive Health Services ; methods

Objective To investigate the effects of intravenous immunoglobulin(IVIG)on thrombocytopenia associated with sepsis.Methods Fifty-two septic thrombocytopenia patients were randomly derided into IVIG group and control group,with 26 patients in each group.IVIG with dose of 400 mg/(kg?d)for 5 days was intravenously administered together with conventional treatment in IVIG group.Before and after IVIG treatment,platelet(PLT)counts,TNF-?,IL-6 and APACHEⅢscore were determined.Results In treatment group platelet counts were increased after IVIG treatment at 3 and 7 days in the IVIG group(P＜0.05);The bleeding rate and APACHEⅡwere significantly lower than control group,TNF-?level was lower at 3 days after treatment than cortrol group,and IL-6 level was lower at 1,3,and 7 days ( P＜0.05).Conclusion The use of IVIG to treat septic thrombocytopenia leads to a rapid and great increase in platelet count and significantly reduce the incidence of bleeding episode and TNFa,IL-6 level and APACHEⅢscore.

Objective To assess the value of 64-slice computer tomography used in the preoperative evaluation of rectal cancer to predict the operative procedures. Methods There were 51 pathologically proven rectal cancer patients recruited, undergoing multi-slice computer tomagraphy (MSCT) assessment preoperatively. Preoperative MSCT stage and predictive operative procedures were recorded to compare with postoperative pathological stage and practical operative procedures. Kappa Coefficient for Diagnosis Coherence and Spearman correlation analysis were performed. Results The overall accuracy of CT-TNM stages were 74.5% which led to high coherence to pathological TNM stage ( Kappa value = 0.658,P=0.000). The univariate analysis showed that distance from tumor to dentate line (F = 3.386, P =0.042 ) and tumor thickness (F = 4.542, P = 0.016) was a statistically risk factor for operative procedures. Moreover, the significant correlation between tumor thickness (cc =0.319, P =0.023 ), as well as CT-M stage (cc = 0.369, P = 0.008) and CT-TNM stage ( cc = 0.365, P = 0. 008), and operative procedures was observed, by means of conducting Spearman correlation. The possibility of developing palliative stoma was 75%, when sufficing both CT-MI stage and tumor thickness ≥20 mm; The possibility of performing sphincter sparing radical operation reached 86% when both CT-T stage < 4 and distance from tumor to dentate line were referred by MSCT. Conclusion The objective parameters influencing development of operative procedures, involving tumor thickness, CT-M stage and CT-T stage, can be rendered by MSCT preoperative assessment, which served as valuable reference for clinical decision of operative procedures in retal cancer.

Objective To investigate the clinical efficacy of fixation of distal radius fracture with dorsal instability with locking compression plate (LCP) via radial approach.Methods From September 2009 to October 2012, 21 cases underwent LCP fixation of the distal radius fracture with dorsal instability via radial approach.The study included 14 males and 7 females (mean age, 54.5 years;range, 38-81 years).Twelve cases were injured in traffic accidents, 7 in falls and 2 in high falls.Fracture AO classification was type A3 in 10 cases, type C1 in 8 cases and type C2 in 3 cases.Two cases (one type A3 and one type C1) had malunion.When the lateral column, intermediate column, radial edge and dorsal plane were exposed by radial incision, LCP fixation with bone grafting was performed to restore the height of radial styloid process, ulnar deviation and palmar tilt.According to the GartlandWerley score, wrist joint function was evaluated.Results Mean duration of follow-up was 13.5 months (range, 12 to 24 months).Stage Ⅰ bone union was shown on X-rays, with the healing time of 7.5 weeks.Based on the X-rays at postoperative 6 months, 1 year and 2 years, the shortening of radial styloid process was ≤ 2 mm, mean volar tilt was 12.5°(range, 8°-17°) , mean ulnar tilt was 20.5° (range, 15°-26°), and step-off or gap of the articular surface was ≤ 2 mm.In postoperative wrist motion assay, mean volar flexion was 60°(range, 30°-70°), mean dorsal flexion was 55° (range, 30°-65°), mean radial deviation was 17°(range, 10°-20°), mean ulnar deviation was 25.5° (range, 20°-30°),pronation was 65.5° (range, 60°-70°) , and mean supination was 75.5° (range, 60°-80°).Mean grip strength was 75％ (60％-95％)of the contralateral side.Two cases suffered from pain (one complained of moderate pain and one minor pain occasionally).According to the Gartland-Werley score, 16 cases were rated excellent, 2 good, 2 fair and 1 poor, with the excellent rate of 86％.No complication was found as injury of the superficial branch of radial nerve, infection, nonunion, nail loosening, medium neuritis and tendon injury.Conclusions Lateral column, intermediate column, radial edge and dorsal plane can be shown via the radial approach.LCP fixation combined with bone grafting contributes to fracture anatomical reduction.

Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

Objective To investigate the related risk factors of the previous cemented vertebral body re-wedge after percutaneous kyphoplasty (PKP).Methods In this retrospective case-control study,clinical data of 617 patients treated by PKP from December 2008 to November 2014 were analyzed.According to whether the cemented vertebra wedged again,the patients were divided into cemented vertebral re-wedge group (n =12) and non-cemented vertebral re-wedge group (n =605).The data of age,preoperative bone density,preoperative vertebral osteonecrosis,intraoperative bone cement injection amount,postoperative bone cement leakage,postoperative bone cement filling,postoperative recovery rate of vertebral wedge angle,and presence or absence of adjacent old vertebral wedging were recorded in two groups.All patients were followed up for one year,and the data were summarized and statistically analyzed.Results Single factor analysis showed the factors of whether there were adjacent old vertebral wedge,preoperative vertebral osteonecrosis,cystic bone cement filling,different wedge angle recovery rate,and emergence of previous cemented vertebral body re-wedge after PKP were statistically significant between two groups (P ＜ 0.05).There was no obvious statistical difference in age,preoperative bone density,intraoperative bone cement injection amount,and intervertebral bone cement leakage between two groups (P ＞ 0.05).Multivariate Logistic stepwise regression analysis showed cystic bone cement filling,preoperative vertebral osteonecrosis,adjacent old vertebral wedging,and higher recovery rate of vertebral wedge angle were prone to appear previous cemented vertebral body rewedge (P ＜ 0.05).Conclusions Relatively higher recovery rate of vertebral wedge angle,previous adjacent old vertebral wedge,vertebral osteonecrosis,and cystic bone cement filling are risk factors closely related to cemented vertebral re-wedge after PKP,which gives a good reference to assess surgical risk,avoid risk factors and choose right surgical techniques.