Objective To explore the compliance and withdraw factors of sublingual immunotherapy (SLIT) with dermatophagoides farinae drops in patients with allergic rhinitis (AR). Methods A retrospective analysis was conducted in 652 AR patients with dermatophagoides farinae drops for SLIT, and the withdraw time and reasons were recorded. Results Of the 652 patients, 516 cases were successfully followed up, and 291 dropped out halfway, with an overall compliance rate of 43.60%. Among the patients with successful follow up, those aged < 14 years old had better compliance than those aged ≥14 years old, and there was no significant difference in the withdraw rate according to factor of gender. The months with the highest withdraw rate were the fifth, the sixth and the seventh months after administration of drugs. Conclusion The overall compliance of AR patients with SLIT is poor, and children aged < 14 years old have better compliance than those aged ≥14 years old. Strengthening patient's education, increasing the frequency of follow-up, and building an effective communication platform can help improve patient's compliance.

Objective:To investigate the clinical efficiency of gastrocnemius muscle flap combined with antibiotics loaded calcium sulfate in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.Methods:From January, 2015 to May, 2019, 21 elderly patients with postoperative infection and plate exposure of tibial plateau fracture were treated, including 14 males and 7 females with an average age of 72.6 years, ranging from 61 to 82 years. The average course of disease was 22.7 days, ranging from 6 to 91 days. The site of wound infection was at medial in 8 cases, lateral in 9 cases and bilateral in 4 cases. The size of wound ranged from 2.0 cm×3.5 cm to 5.0 cm×12.0 cm. All wounds were implanted with antibiotics loaded calcium sulfate and repaired by gastrocnemius muscle flap combined with skin graft after debridement. Muscle flap survival, wound healing, inflammatory index, fracture healing and knee joint function were recorded. The curative effect was evaluated by McKee infection treatment criteria and the knee joint function was evaluated by HSS scoring criteria.Results:All 21 muscle flaps survived. In 1 case, skin graft necrosis occurred in a small area, and the wound healed well after dressing change. One case had exudation which was clear and the bacterial culturing was negative, and the wound healed after 2 weeks of dressing change. The other incisions were healed in stage I, and the healing rate was 90%. All patients were followed-up for an average of 28.7(16-39) months. The redness and swelling occurred in 1 case without exudation after 2 months which disappeared after anti-infection treatment and didn't recur again. The infection recurred in 1 case after 5 months, and it which was controlled after debridement and plate removal. According to McKee criteria, 19 cases were cured, 1 improved and 1 recurred with an effective rate of 95.2%. The fracture healing time was from 3 to 7 months, with an average of 4.6 months. According to HSS scoring criteria, the knee joint function was excellent in 12 cases, good in 7 cases and moderate in 2 cases.Conclusion:After thorough debridement, gastrocnemius muscle flap combined with antibiotic loaded calcium sulfate can effectively control the infection, repair the wound, promote fracture union and restore limb function in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.

December 2019 witnessed the outbreak of COVID-19 in Wuhan and spread of the epidemic across the country. As a provincial designated hospital for critical patients, the First Affiliated Hospital of Zhejiang University responded rapidly since then by advocating the four-concentration principles, namely " concentrating patients, experts, resources and treatment" . In its rescue of critical patients, the hospital formulated comprehensive emergency plans, optimized hospital-wide resources, effectively arranged rescue spacing, established medical echelons, and implemented multi-disciplinary strategy. These efforts ensured efficient rescue and treatment, achieving a cure rate up to 98.7% of such patients, with no deaths.

Objective To evaluate the change of clinicopathological features and prognosis of papillary thyroid cancer over a 15-year period.Methods The clinicopathological features and outcomes of papillary thyroid cancer patients were analyzed in three groups according to the time of diagnosis:group Ⅰ (1997-2001),group Ⅱ (2002-2006),and group Ⅲ (2007-2011).Results As time advanced,the average age of papillary thyroid cancer patients increased,tumor stage,like size,extrathyroid invasion and lymph node metastasis decreased dramatically (P ＜ 0.01).The percentage of multifocality and bilaterality increased.The long-term follow up data (median follow up time was 6.6 years),indicated that the 15-year over all survival was 97.8％ and the 15-year disease-free survival was 90.2％.Tumor ≥3 cm,bilaterality,extrathyroid invasion,lymph node metastasis and AJCC stage were correlated with tumor recurrence.By multivariate COX-regression analysis only lymph node metastasis and bilaterality were independent risk factors.Conclusion The clinicopathological features of papillary thyroid cancer changed over 15 years,with the percentage of early-staged patients increased.Lymph node metastasis and bilaterality are two risk factors for tumor recurrence.

Objective To investigate the application value of lung ultrasonic on severe high altitude pulmonary edema.Methods A prospective, single-blind, case-control study was conducted. Sixty patients with severe high altitude pulmonary edema admitted to Qinghai University Affiliated Hospital from February 2015 to May 2017 were enrolled. The patients were divided into 2500-3000 m group, 3000-3500 m group and 3500-4200 m group according to different altitudes,with 20 patients in each group. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) score was recorded before and 12 hours and 24 hours after treatment. The arterial partial pressure of oxygen (PaO2) was determined by blood gas analysis, and the oxygenation index (PaO2/FiO2) was calculated. Bedside ultrasound scanning was used to determine B line number and pulmonary artery pressure (PAP), and B line score was calculated to reflect lung water content. The correlation between B line score and PaO2/FiO2, PAP and APACHEⅡ scores at each time point was analyzed by Pearson correlation analysis.Results None of 60 patients died or exited, all of them were enrolled in the final analysis. There was no significant difference in PaO2/FiO2, PAP, APACHEⅡ score or B line score among different altitudes groups (allP > 0.05). Repeated measurement variance analysis showed that the effects of different altitudes on PaO2/FiO2, PAP, APACHEⅡ score and B line score were not statistically significant (F value was 0.312, 0.014, 1.098, 0.236, andP value was 0.340, 0.791, 0.733, and 0.986, respectively). The PaO2/FiO2, PAP, APACHEⅡ score and B line score in all groups were improved obviously from 12 hours after treatment, and the improvements at 24 hours were more than those at 12 hours (allP < 0.05). Repeated measurement variance analysis showed that the effect at different time points on PaO2/FiO2, PAP, APACHEⅡ score and B line score was statistically significant (F value was 1844.270, 121.690, 1173.175, 19426.968, allP < 0.001). The interaction effects of different altitudes and different time points on PaO2/FiO2, PAP, APACHEⅡ score and B line score were not statistically significant (F value was 0.304, 0.404, 1.172, 1.403, andP value was 0.875, 0.805, 0.327, and 0.591, respectively). Pearson correlation analysis showed that there was a significant negative correlation between B line score and PaO2/FiO2 before and after treatment (r value was -0.579, -0.522, and -0.386, allP < 0.01), indicating that the more the B line, the more severe the pulmonary edema, and the worse the oxygenation; with the decrease in B line after treatment, the pulmonary edema was gradually alleviated, and oxygenation was gradually improved. There was a significant positive correlation between B line score and APACHEⅡ score before and 24 hours after treatment (r value was 0.484 and 0.536, bothP < 0.01), indicating that the more the B line, the more severe the patient; with the decrease in B line after treatment, the patient's condition improved after treatment. There was only a weak correlation between B line score and PAP at 24 hours after treatment (r = 0.317,P = 0.014), indicating that PAP was not a sensitive indicator in the degree of pulmonary edema in patients.Conclusions The more the B line in patients with severe high altitude pulmonary edema,the more severe of the pulmonary edema, and the more severe of the patient. There was no significant correlation between the B line score and PAP. Pulmonary ultrasonography can still be used not only in the plain and low elevation areas, but in the high altitude areas, as a reliable method to evaluate the severity of pulmonary edema.

Objective To explore the distribution change and antimicrobial resistance of pathogens causing catheter associat‐ed urinary tract infection in ICU .Methods 500 cases of patients received by emergency department ICU in our hospital from 2012 April~ 2014 June were collected ,urine samples were collected by closed drainage bag after indwelling catheter in 3 ,7 ,14 ,21ds .By culture ,separation ,purification ,screening and identification and antimicrobial disc diffusion experiments ,distribution changes and resistantance of pathogens causing catheter related infections were analyzed .Results 358 strains were found in catheter associated urinary tract infections ,in which 175 strains were Gram‐positive bacteria ,mainly were Staphylococcus aureus (48 .57% ) and en‐terococci (46 .86% ) ,137 were Gram‐negative bacteria ,mainly were E .coli (56 .93% ) ,46 fungi ,mainly were Candida albicans (47 .83% );Gram‐positive bacteria showed a decreasing trend ,while Gram‐negative bacteria increased every year;resistance rates of Staphylococcus aureus and enterococci to penicillins ,cephalosporins and quinolones were more than 50% ;Escherichia coli and Kleb‐siella pneumoniae had strong resistance to penicillins ,cephalosporins and quinolones ;resistance rate of Pseudomonas aeruginosa to ampicillin ,sulbactam and ampicillin cefazolin up to 100% .Conclusion Escherichia coli is the major pathogens causing ICU catheter associated urinary tract infections;pathogens resistance are strong ,clinical monitoring should be strengthened .

BACKGROUND:Three-dimensional finite element simulation has been widely used in biomechanics. However, there is little research in knee joint replacement. The study of femoral prosthesis is less.
OBJECTIVE:To analyze the optimal positioning parameters of knee replacement and femoral prosthesis implantation, and to verify the efficacy of Gemini-PS knee prosthesis in total knee arthroplasty.
METHODS: (1) Knee finite element model in total knee replacement was constructed. Orthogonal experiment was performed in femoral osteotomy positioning parameters. The shift amount A, external rotation degree B, and valgus degree C of femoral prosthesis were selected as the relevant factors for orthogonal experiment. Three values were taken for each parameter to establish orthogonal tables. Nine experimental combined knee replacement finite element models were created and analyzed with finite element. Analysis of variance and range analysis were used by optimization. (2) Totally 42 patients (47 knees) with knee osteoarthritis received total knee arthroplasty with Gemini-PS knee joint prosthesis. Knee joint function was evaluated after replacement with Hospital for Special Surgery knee score and American Knee Society knee score. Knee pain was assessed with Visual Analogue Scale score.
RESULTS AND CONCLUSION:(1) Minimal polyethylene substrate surface compressive stress peak was translation 0 mm, external rotation of 3°, valgus 6°; the peak stress was 15.9 MPa. Among the influential factors, the effects of internal and external translation were larger than that of external rotation angle, and greater than that of valgus angle. The optimal positioning parameter combination was pan 0 mm, external rotation 3°, valgus 6° by range analysis and variance analysis. Orthogonal experiment was valid by simulation. (2) 42 patients were folowed up for 12-36 months. One patient affected subcutaneous fat liquefaction of the lower segment of the incision. Hospital for Special Surgery knee score and American Knee Society knee score were significantly higher after implantation (P < 0.05). Visual Analogue Scale score was significantly lower after replacement (P < 0.05). X-ray films showed that osteolysis, dislocation or loosening was not found. The recovery of knee joint was good after operation. (3) These findings

The paper elaborates on the construction concept ofHealthy Henan Health Service Cloud and introduces the project goals and system architecture.This platform effectively promotes the application and popularization of achievements in health informatization in Henan,enables the basic mass to experience the efficiency and convenience brought about by health informatization,and facilitates the monitoring and management by health administrative departments.

Objective To evaluate the feasibility to screen donor with hepatitis C virus (HCV) infection by HCV core antigen ELISA (HCV-cAgELISA).Methods 183 anti-HCV positive,6370 anti-HCV negative (including 120 specimens with HbsAg +) serum specimens by using HCV-cAgELISA and HCV RT-PCR methods.Results Comparing with HCV RT-PCR,the detection results of HCV-cAgELISA consistency were 92.34％ in anti-HCV positive serum specimens and 99.97％ in anti-HCV negative serum specimens,respectively.In 6370 anti-HCV negative specimens,1 serum sample was positive HCV RNA identification in 3 serum specimens which were positive for HCV-cAgELISA.HCV RNA copies and HCV-cAg positive rate was a positive correlation.Conclusion Sensitivity of HCVcAg ELISA is silllilar to HCV RT-PCR.HCVcAgELISA is a simple,fast,and reliable memod to screen donor with HCV infection in blood transfusion medicine.

Based on quantum mechanics, rotational spectroscopy is a branch of fundamental science to study the rotational spectra of molecules, free radicals and ions, and has great applications on radio astronomy and many analytical fields such as atmospheric remote sensing. In this paper we reviewed the basic theory of rotational spectroscopy, two different types of Fourier transform microwave spectrometers, some typical spectroscopic analysis, and future prospect of the microwave spectroscopic techniques as well.