Objective To research in risk factors existing in nursing of medical department and the corresponding measures.Methods 152 patients with internal disease were set as the research group from January 2009 to January 2010,147 patients from January to December 2008 were set as the control group.The control group was given routine clinical nursing,the research group was given pertinent nursing according to nursing risk factors.Results After implementation of nursing risk management,precaution consciousness greatly improved,frequency of nursing risk incidents reduced and satisfaction degree of patients with nursing service increased,the research group was better than the control group.Conclusions Risk management is an effective measure to decrease the nursing risk,and to adopt risk management is useful for elevating nursing quality and patients' satisfactory degree.

Objective The purpose of the study was to assess the quality of life in children and adolescents with type 1 diabetes.Methods 89 patients with type 1 diabetes admitted by Beijing children's hospital and 196 matched healthy children and adolescents were involved.QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scale.Results Children and adolescents with type 1 diabetes had lower general HRQOL compared with the healthy matched children and adolescents,especially in emotional functioning and school functioning,HRQOL in girls was significantly lower than HRQOL in boys regarding social functioning.Conclusions The QOL of children and adolescents with type 1 diabetes was impaired.

Objective:To study effect of cyclosporin A(CsA) on the prognosis of the abortion prone murine model.Methods:0,5,10,15 mg/kg CsA were injected intraperitoneally to CBA/J female mice at the fourth gestational day which mated to DBA/2 or BALB/c male mice as an abortion prone model and a successful pregnancy model respectively,thereafter the fetus resorption rate,weight of placenta and fetus were surveyed.Results:CsA could reduce the fetal resorption rate of pregnancy loss model significantly,meanwhile the weight of fetus and plancenta did not have notable alteration,but tendency of the weight increase exists.However,CsA did not affect the fetal resorption rate or the weight of fetus and placenta of the successful pregnancy model.Conclusion:CsA injected intraperitoneally at the early stage of pregnancy could reduce the fetal resorption rate of pregnancy loss model to that of normal pregnancy.The weight of fetus and plancenta appeared to have an increase tendency although non significantly.Therefore,CsA seems to be a potential medicine for protecting pregnancy from abortion.

Objective To investigate the incidence of newly-onset type 1 diabetes mellitus ( T1DM ) complicated with ketoacidosis(DKA) and its relevant factors in pediatrics. Methods Hospital records of 317 T1DM children below 18 years of age, diagnosed from 2010 to 2012 were reviewed. By using retrospectively analyzed data of inpatients with newly-diagnosed T1DM, the incidence of DKA was calculated. In this study, the influential factors of DKA included gender, age, residence, family history of diabetes mellitus, duration of symptoms, misdiagnosis or missed diagnosis, and delayed treatment. Patients were divided into two groups:group 1, aged<5 year and group 2, aged>5 year. Results Of all patients diagnosed with T1DM, 175 ( 55. 2%) presented with DKA, and mild, moderate, and severe DKA accounted for 26. 5%, 23. 9%, 49. 6%, respectively. The incidences of DKA in group 1 andgroup2were67.5% and48.0% (P=0.001),withthehighestfrequency(70.3%)inpatientsaged<2 years. The proportion of severe DKA in group 1 was significantly higher than that of group 2 (60. 0% vs 41. 3%, P=0. 048). The rates of misdiagnosis and missed diagnosis in the two groups were respectively 27. 4% and 12. 0%(P=0. 001), being 37. 8% in children<2 years. The HbA1C level of group 1 was lower than group 2 (11. 50% vs 12.54%,P=0.001). Intheacutemetabolicandhoneymoonperiod,Cpeptidelevelsofgroup1werebothlowerthan those of group 2 [(0. 36 vs 0. 55) ng/ml, P=0. 001;(0. 40 vs 0. 61) ng/ml, P=0. 02]. The DKA incidence of patients with misdiagnosis or missed diagnosis was significantly increased(83. 9% vs 49. 0%, P=0. 000). Compared with those without DKA, C peptide level of patients with DKA was lower in the acute metabolic period[(0. 56 vs 0.40)ng/ml,P<0. 01], but no difference in honeymoon period[(0. 67 vs 0. 59)ng/ml,P=0. 22]. Logistic regression showed that age, misdiagnosis or missed diagnosis were associated with the presence of DKA. The possibility of the occurrence of DKA in patients aged>5 years was half of patients aged<5 years ( OR=0. 448, P=0. 003), and the risk of DKA in patients with misdiagnosis or missed diagnosis was higher (OR=5. 640, P=0. 005). Conclusion DKA in patients with newly-onset T1DM is frequent and often severe. Multivariate analysis revealed that patients aged <5 years and those with misdiagnosis or missed diagnosis are encountered high risk of DKA.

Objective:To investigate the prognostic significance of D-dimer level in patients with diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of 70 newly diagnosed DLBCL patients who were admitted to Tianjin People's Hospital from January 2015 to June 2019 were retrospectively analyzed. The optimal cut-off value of D-dimer for survival was determined according to the receiver operating characteristic (ROC) curve, and the patients were grouped. The differences of coagulation related indexes and clinicopathological features between patients with different D-dimer levels were compared. Kaplan-Meier method was used for univariate analysis of overall survival (OS), and Cox regression model was used for multivariate analysis of OS.Results:According to ROC curve, the best cut-off value of D-dimer for survival was 0.75 mg/L. The proportion of patients with different clinical staging, international prognostic index score, lactate dehydrogenase level had statistically significant differences between the D-dimer ≥0.75 mg/L group (36 cases) and <0.75 mg/L group (34 cases) (all P < 0.05). The prothrombin time of D-dimer ≥ 0.75 mg/L group and < 0.75 mg/L group were (13.5±0.9) s and (13.0±0.8) s, respectively, and the activated partial thromboplastin time were (37±5) s and (34±6) s, respectively,and the differences were statistically significant (all P < 0.05). Univariate analysis showed that the 5-year OS rates of DLBCL patients with Ann Arbor stage Ⅲ-Ⅳ, international prognostic index score > 2, lactate dehydrogenase level > 240 U/L, B symptoms, D-dimer level ≥0.75 mg/L were decreased (all P < 0.05). Multivariate Cox regression analysis showed that D-dimer ≥0.75 mg/L was an independent risk factor for OS of DLBCL patients ( HR=0.368, 95% CI 0.144-0.944, P= 0.038). Conclusion:The level of D-dimer can be used as a clinical indicator to judge the prognosis of DLBCL patients, and the prognosis of patients with high D-dimer level is poor.

Objective: To investigate the prognostic value of prognostic nutritional index (PNI) in patients with diffuse large B-cell lym-phoma (DLBCL). Methods: We retrospectively reviewed the medical records of 82 patients with DLBCL treated at Tianjin Union Medi-cal Center between June 2010 and June 2016. The optimal cutoff value of PNI was determined using a receiver operating characteristic (ROC) curve and the Youden index. The relationship of high and low PNI with the clinical characteristics of the patients, therapeutic ef-ficacy, and prognosis were analyzed. Results: Overall, mean PNI of the patients was 46.17±8.8. When the PNI was 44.15, the Youden in-dex was found to be maximal, with a sensitivity of 74.6% and specificity of 67.2%. There were 38 patients (46.3%) in the low PNI group (<44.15) and 44 patients (53.7%) in the high PNI group (≥44.15). Data analysis showed that PNI was correlated with Eastern Coopera-tive Oncology Group performance status (ECOG PS), Ann Arbor stage, international prognostic index (IPI) score, and lactic acid dehydro-genase (LDH) level (P<0.05). The total effective rate of the low PNI group was significantly lower than that of the high PNI group (65.8% vs. 86.4%; χ2=4.848; P=0.028). The 3-year overall survival (OS) rate of the entire group of patients was 69.1%. The 1-, 2-, and 3-year OS rates of the low PNI group (86.8%, 67.8%, and 56.9%, respectively) were significantly lower than that of the high PNI group (96.7%, 89.5%, and 80.2%, respectively; χ2=9.421, P=0.002). Univariate analysis showed that PNI<44.15, ECOG PS≥2, IPI>2, stageⅢ/Ⅳ, and lymphocyte count<1.0×109/L had a significant impact on predicting OS (P<0.05). Multivariate analysis showed that PNI<44.15 (P=0.006) and stageⅢ/Ⅳ(P=0.011) were independent factors for predicting OS. Conclusions: PNI might be used as a simple and feasible clinical prognostic indicator in patients with DLBCL.

Objective: To analyze the clinical response in cases of multi-victims bitten by a dog in Beijing (one of whom was HIV positive), and to explore the route and prognosis of dual exposure to rabies virus and HIV. Methods: Descriptive epidemiological methods were used to analyze the exposed cases, the post-exposure prophylaxis(PEP) of rabies and HIV and the follow-up outcomes. Results: After six months-follow up, there was no rabies case was found among those nine victims bitten by the suspected dog. In addition, six HIV-negative victims who had been exposed to HIV via dog saliva were consistently tested to be HIV negative in the follow up period. Conclusions In cases with multi-victims bitten by one dog, except exposure to rabies virus, it is necessary to be alert to the presence of HIV, HBV or HCV infection in sequential victims. Therefore, the risk of the potential spreading of other blood-borne infectious pathogens should be assessed. It is important to initiate PEP as early as possible.

Objective: To understand the prophylaxis of population exposed to rabies, and provide a basis for prevention and control of rabies. Methods: The registration data of 1 019 cases with rabies exposure in Beijing Ditan Hospital Affiliated to Capital Medical University from Mar, 2017 to Feb, 2018 were analyzed using the descriptive epidemiologic method. Results: Among the 1 019 cases of rabies exposure, the sex ratio of men to women was 0.90∶1, with the highest proportion of them were between 26 and 46 years of age old, accounting for 46.5%. Rabies exposure reached its peak (46.9%) between June and September. In addition, 63.3% of the injuries were caused by dogs and 36.7% by cats. Most of the wounds (55.1%) occurred in hands; and the second was lower limbs (26.6%). Most of the cases (60.7%) had grade II wounds; followed by grade III wounds (39.1%); 69.3% of the cases completed immunization with rabies vaccine. In grade III exposure, 73.7% of the patients were immunized with rabies immunoglobulin. Most of the persons of grade III exposure (73.7%) received inoculation with human rabies immunoglobulin (HRIG). Conclusions Measures to control rabies should be focused on the management of dogs and cats and the standardization of rabies post-exposure prophylaxis.

Objective:To explore the key genes and its biological functions of aldosterone producing adenoma (APA) using bioinformatics analysis.Methods:Differentially expressed genes of APA were identified from two training datasets GSE60042 and GSE64957 in GEO database. Function and pathway enrichment analyses for differentially expressed genes were performed and transcriptional regulation network among these genes were determined. Hub genes were extracted by node analysis from the protein-protein interaction (PPI) network. The expression of key genes was verified by a testing dataset GSE8514. Receiver operating characteristic(ROC) curve analysis was applied to assess the diagnostic efficiency of key genes in APA. The biofunction of each key gene were determined by gene set enrichment analysis (GSEA).Results:A total of 68 differentially expressed genes, including 33 up-regulated genes and 35 down-regulated genes, were detected from the training datasets. These genes were mainly enriched in aldosterone biosynthetic process, calcium signaling pathway, serotonin receptor signaling pathway, transcriptional activator activity, and regulation of transcription. JUN and VDR were at the center of the transcriptional factor-gene network. Furthermore, we identified nine Hub genes from the PPI network. In testing dataset, CYP11B2 and VDR showed the higher expression, while JUN, NFKBIZ, EGR3, and KLF6 showed lower expression in APA (all P<0.05), and the value of area under ROC curve analysis was 0.936, 0.833, 0.953, 0.854, 0.868, and 0.929, respectively. GSEA indicated the alter of key genes in APA led to up-regulation of the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway, and complement and coagulation cascades [all normalized enrichment score (NES)>1.5, P<0.05], but down-regulation of the DNA replication, ribosome, and autophagy (all NES<-1.5, P<0.05). Conclusion:Results of bioinformatics indicate that JUN and VDR are key transcriptional factors, and CYP11B2, NFKBIZ, EGR3, and KLF6 are the key genes for APA, which are involved in the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway in APA.

OBJECTIVETo explore the genetic cause for a child with developmental delay.

METHODSThe karotypes of the child and her parents were analyzed with G-banding analysis. Their genome DNA was analyzed with low-coverage massively parallel copy number variation sequencing (CNV-seq) and verified by single nucleotide polymorphism array (SNP-array).

RESULTSThe karyotype of the child was ascertained as 46,XX,r(15)(p13q26.3), while both parents showed a normal karyotype. CNV-seq and SNP-array have identified a de novo 15q26.2-q26.3 deletion in the child with a size of approximately 3.60 Mb.

CONCLUSIONThe abnormal phenotype of the patient carrying the ring chromosome 15 may be attributed to the presence of the 15q26.2-q26.3 microdeletion. The deletion and haploinsufficiency of the IGF1R gene probably underlie the main clinical features of the patient.

Child, Preschool ; Chromosome Banding ; Chromosomes, Human, Pair 15 ; genetics ; DNA Copy Number Variations ; Female ; Humans ; Karyotyping ; Mosaicism ; Ring Chromosomes ; Sequence Deletion