Objective:In investigate the status quo of current physician-patient relationship.Method:A self-designed questionnaire is conducted among the medical staff and patients in 40 hospitals(20 grade 3 hospitals and 20 grade 2 hospitals) located in 10 cities of China.Result:9.3% of the total patient responders consider the current physician-patient relationship dissatisfying,with a counterpart ratio of 31.2% in responders of medical staff.Conclusion:Currently in China,main-stream of physician-patient relationship is harmonious,but it can not be denied that medical staff are suffering tremendous stress from the ever tenser physician-patient contradictions.

Objective To investigate the changes of Treg cells,Th17 cells and related cytokines in pe?ripheral blood of patients with severe hand?foot?mouth disease( HFMD) in the initial stage of infection caused by Enterovirus 71 virus. Methods Thirty?five cases of severe HFMD children in the Fifth Hospital of Shijiazhuang from May 2013 to December 2013 were selected as the research subjects,including 27 cases of severe formed group and 8 cases of danger severe formed group. The frequencies of Th17 cells ( CD3+CD8?IL?17+) and Treg cells( CD4+CD25+Foxp3+) in peripheral blood were detected by flow cytometry in patients with severe HFMD and 31 healthy children(control group). Moreover the serum levels of interleukin 6(IL?6),interleukin 17(IL?17) ,interleukin 10( IL?10) ,interleukin 23( IL?23) ,and human transforming growth factorβ1 ( TGF?β1) were measured by ELISA. Results As compared with those in control group,the frequencies of Treg cells,ratio of Treg/Th17,serum levels of TGF?β1, IL?10 in severe HFMD groups were significantly decreased ( F=23. 23, 30. 88,10. 766,11. 680 respectively;P<0. 05) . However the frequency of Th17 cells,serum levels of IL?6,IL?17,IL?23 in severe HFMD groups were significantly increased( F=646. 81,5. 904,10. 557,3. 490 respectively;P<0. 05) . Conclusion The changes of Treg and Thl7 cells and related cytokines appear in peripheral blood of patients with HFMD in the initial stage of infection caused by Enterovirus 71 virus. The frequency of Treg cell is decreased,however,the frequency of Thl7 cells frequency is increased,as a result,which may spread inflammato?ry reaction and cause complication.

AIM: To study the possibility and conditions of transplacental infection of coxsackievirus B3(CVB 3) from pregnant mice to their fetuses and newborns. METHODS: Coxsackievirus B 3 strain causing balb/c mice myocardial injury(CVB 3m )was inoculated with 10 5 TCID 50 in dose into the mother mice at 6-7 days (early gestation),9-10 days (middle gestation) and 17-18 days (late gestation) of gestation, in contrast with non pregnant mice. Some placentas and fetuses were removed by caesarean section before mothers partusing; some mothers and their babies were sacrificed after parturition, and virus isolation, serological and pathological tests were performed. RESULTS: Viramiae was observed in mother mice of late gestation inoculated with CVB 3m at a fit amount on the second day after inoculation, while no newtralizing antibody to CVB 3m was detected in blood. The virus was isolated from cardiac muscles of inoculated mother mice in different gestation and the controls. The virus was also isolated from some placentas and fetuses, and both sera and cardiac muscles of infants in the late gestation (virus titer were all 10 -2 -10 -3 ). On d 7 of inoculating virus, pregnant and non pregnant mice titers of neutralizing antibody to CVB 3m in sera were all between 1160 and 1320. Under the electromicroscopy, some cardiac muscle cells of mother or infant mice appeared with morphological changes and little hollow bubbles occured in cytoplasm. The fibers broke off, and the bright and dark belts became indistinct. CONCLUSION: The amimal model, intraplacental passage of CVB 3 from pregnant mother in late gestation to fetus in mice, is a benefitial tool to study enterovirus diseases in human perinatal period.

Objective To study the clinical application value of long term home noninvasive positive pressure ventilation in the therapy of silicosis patients with type 2 respiratory failure. Methods A total of 85 silicosis patients with type 2 respiratory failure were enrolled, and their clinical data were retrospectively analyzed. According to the therapeutic method, they were divided into noninvasive positive pressure ventilation group (group A) and basic therapy group (group B). The various indicators of the patients were analyzed before and after the treatment including vital signs, laboratory indicators, 6-minute walking distance (6MWD), and modified dyspnea index (mMRC). The admission times, length of hospital stay and annual mortality of the patients were also recorded by follow-up after the treatment for one year. Results After the one year follow-up, the heart rate, respiratory rate, PaO2, PaCO2, SO2％, 6MWD, and mMRC of group A were significantly improved than those of group B (all P<0.05). The admission times and the length of hospital stay of group A were lower than those group B (all P<0.05). There was no difference in the annual mortality between the two groups (P>0.05). Conclusions The therapeutic method of home noninvasive positive pressure ventilation has significant effects on silicosis combined with type 2 respiratory failure. It can improve clinical symptoms and the quality of life, and reduce the length of hospital stay and admission times, and reduced medical insurance burden.

Objective:To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods:A retrospective analysis of 13 patients (16 feet) who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study. 9 males and 4 females; aged 39-77 years (average 66 years); left foot 7 cases, right foot 9 cases. 5 cases were patients with diabetic foot, 1 case was diabetic foot with arteriosclerosis obliterans, 2 cases were thromboembolic vasculitis, and 5 cases were arteriosclerosis obliterans. The tibial periosteum was dissected and a distraction device was placed. In the 3 patients with foot ulcers, tibial periosteum distraction devices were placed on the severer side. The periosteal distraction began on the third day after surgery, about 0.75 mm/d, the adjustment was done usually in two weeks. Two weeks later, the stretch plate was removed surgically. The followings were evaluated: visual analogue scale (VAS) pain score, foot peripheral oxygen saturation, foot capillary filling test, lower extremity arterial CT angiography (CTA), etc.Results:All 13 patients were followed up for 2-12 weeks, with an average of 3.85 weeks. VAS pain score: the average pain score of 13 patients with preoperative foot pain was 5.31±1.84 (range, 2-9) points, and 2 weeks after surgery, the average value was 2.46±1.39 (range, 1-6) points with statistical significance ( t=6.124, P<0.001) ; peripheral foot oxygen saturation: the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83% (range, 50%-98%), 1 patient was not detected before surgery, and 2 weeks after operation, the average blood oxygen saturation was 92.33%±7.91% (range, 75%-99%). There was no significant difference between them ( t=1.124, P=0.285). The foot skin temperature of 10 patients was 35.68±0.85 ℃ (range, 34.00-36.60 ℃) before surgery and 36.23±0.46 ℃ (range, 35.50-36.90 ℃) after surgery, and the difference was statistically significant ( t=3.197, P=0.008) . Capillary filling test: 2 weeks after operation, the capillary filling response was significantly improved. All 13 patients had improved CTA of both lower extremity arteries before operation, and 11 patients had CTA taken back after two weeks of operation. Compared with preoperative CTA, new vascular network was found in the operation limb. In addition to 1 patient with thromboangiitis obliterans (mainly suffering from foot pain, no wound symptoms), 2 of 12 patients with heart failure, renal failure and other basic diseases did not heal, and the wounds of the other 10 patients had improved significantly 1 month later. Conclusion:Lateral tibia periosteum distraction can be used to treat chronic ischemic diseases of lower extremities with satisfactory postoperative results.

Streptomyces aureofaciens DM-1 is a high-yielding 6-demethylchlortetracycline producer. The genome sequencing of DM-1 reveals a linear chromosome containing 6 824 334 bps nucleotides with GC content of 72.6%. In this genome, a total of 6 431 open reading frames were predicted by using glimmer 3.02, Genemark and Z-Curve softwares. Twenty-eight secondary metabolite biosynthetic gene clusters were uncovered by using AntiSMASH gene prediction software, including the complete 6-demethylchlortetracycline biosynthetic gene cluster. A frame-shift mutation in methyltransferase coding region was detected, which may result in the demethylation of chlortetracycline. The complete genome sequence of S. aureofaciens DM-1 provides basic information for functional genomics studies and selection of high-yielding strains for 6-demethylchlortetracycline.
Base Sequence ; Chlortetracycline ; Demeclocycline ; Multigene Family/genetics* ; Streptomyces aureofaciens/genetics*

Objective:To evaluate the degree of anxiety and depression of medical staff during the epidemic period of the COVID-19, and to provide theoretical basis for the pertinence psychological intervention timely.Methods:The investigation about the psychological status of 183 medical staffs on duty during the epidemic period was conducted using Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) from 18th to 20th February, 2020, who came from Tianjin and other provinces. The respondents were divided into first-line and non-first-line groups according to their jobs, and local and non-local groups according to their work places, respectively. The data was collected by "Star Questionnaires" using the mobile terminal, and the statistical analysis was carried out to compare whether there were differences in depression and anxiety among medical staff of different groups.Results:The total SAS score (48.96±9.21) and SDS score (56.69±7.57) of all medical staff were higher than those of the national norm SAS (33.80±5.90) and SDS (41.88±10.57) from 1158 individuals ( P<0.01) . Among 183 medical staff, the anxiety was found in 87 individuals and the rate of anxiety was 47.5%. The depression was found in 134 individuals and its rate was 73.2%. The anxiety combined with depression was found in 69 individuals and its rate was 37.7%. The scores of SAS and SDS of first-line group were (49.40±9.77) and (55.76±6.86) , respectively. And those of non-first-line group were (48.69±8.87) and (57.29±7.96) . They were higher than those of the national norm, and the differences were both statistically significant ( P<0.01) , but there was no difference between the first-line group and non-first-line group. The scores of SAS and SDS of local group were (48.23±9.04) and (56.76±7.05) , while those of non-local group were (50.63±9.45) and (56.54±8.71) , respectively. The differences were statistically significant ( P<0.01) , compared with the national norm respectively. But there was no difference between the local group and non-local group. No matter which classification criteria were used, there was no statistically significant difference in the severity distribution of anxiety and depression among different groups ( P>0.05) . Conclusion:The anxiety and depression exist obviously among the medical staff during the epidemic period of the COVID-19, and the psychological intervention should be taken out in time.

Objective:To evaluate the degree of anxiety and depression of medical staff during the epidemic period of the COVID-19, and to provide theoretical basis for the pertinence psychological intervention timely.Methods:The investigation about the psychological status of 183 medical staffs on duty during the epidemic period was conducted using Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) from 18th to 20th February, 2020, who came from Tianjin and other provinces. The respondents were divided into first-line and non-first-line groups according to their jobs, and local and non-local groups according to their work places, respectively. The data was collected by "Star Questionnaires" using the mobile terminal, and the statistical analysis was carried out to compare whether there were differences in depression and anxiety among medical staff of different groups.Results:The total SAS score (48.96±9.21) and SDS score (56.69±7.57) of all medical staff were higher than those of the national norm SAS (33.80±5.90) and SDS (41.88±10.57) from 1158 individuals ( P<0.01) . Among 183 medical staff, the anxiety was found in 87 individuals and the rate of anxiety was 47.5%. The depression was found in 134 individuals and its rate was 73.2%. The anxiety combined with depression was found in 69 individuals and its rate was 37.7%. The scores of SAS and SDS of first-line group were (49.40±9.77) and (55.76±6.86) , respectively. And those of non-first-line group were (48.69±8.87) and (57.29±7.96) . They were higher than those of the national norm, and the differences were both statistically significant ( P<0.01) , but there was no difference between the first-line group and non-first-line group. The scores of SAS and SDS of local group were (48.23±9.04) and (56.76±7.05) , while those of non-local group were (50.63±9.45) and (56.54±8.71) , respectively. The differences were statistically significant ( P<0.01) , compared with the national norm respectively. But there was no difference between the local group and non-local group. No matter which classification criteria were used, there was no statistically significant difference in the severity distribution of anxiety and depression among different groups ( P>0.05) . Conclusion:The anxiety and depression exist obviously among the medical staff during the epidemic period of the COVID-19, and the psychological intervention should be taken out in time.

Objective:Surgical site infection (SSI) can markedly prolong postoperative hospital stay, aggravate the burden on patients and society, even endanger the life of patients. This study aims to investigate the national incidence of SSI following abdominal surgery and to analyze the related risk factors in order to provide reference for the control and prevention of SSI following abdominal surgery.Methods:A multicenter cross-sectional study was conducted. Clinical data of all the adult patients undergoing abdominal surgery in 68 hospitals across the country from June 1 to 30, 2020 were collected, including demographic characteristics, clinical parameters during the perioperative period, and the results of microbial culture of infected incisions. The primary outcome was the incidence of SSI within postoperative 30 days, and the secondary outcomes were ICU stay, postoperative hospital stay, cost of hospitalization and the mortality within postoperative 30-day. Multivariable logistic regression was used to analyze risk factors of SSI after abdominal surgery.Results:A total of 5560 patients undergoing abdominal surgery were included, and 163 cases (2.9%) developed SSI after surgery, including 98 cases (60.1%) with organ/space infections, 19 cases (11.7%) with deep incisional infections, and 46 cases (28.2%) with superficial incisional infections. The results from microbial culture showed that Escherichia coli was the main pathogen of SSI. Multivariate analysis revealed hypertension (OR=1.792, 95% CI: 1.194-2.687, P=0.005), small intestine as surgical site (OR=6.911, 95% CI: 1.846-25.878, P=0.004), surgical duration (OR=1.002, 95% CI: 1.001-1.003, P<0.001), and surgical incision grade (contaminated incision: OR=3.212, 95% CI: 1.495-6.903, P=0.003; Infection incision: OR=11.562, 95%CI: 3.777-35.391, P<0.001) were risk factors for SSI, while laparoscopic or robotic surgery (OR=0.564, 95%CI: 0.376-0.846, P=0.006) and increased preoperative albumin level (OR=0.920, 95%CI: 0.888-0.952, P<0.001) were protective factors for SSI. In addition, as compared to non-SSI patients, the SSI patients had significantly higher rate of ICU stay [26.4% (43/163) vs. 9.5% (514/5397), χ 2=54.999, P<0.001] and mortality within postoperative 30-day [1.84% (3/163) vs.0.01% (5/5397), χ 2=33.642, P<0.001], longer ICU stay (median: 0 vs. 0, U=518 414, P<0.001), postoperative hospital stay (median: 17 days vs. 7 days, U=656 386, P<0.001), and total duration of hospitalization (median: 25 days vs. 12 days, U=648 129, P<0.001), and higher hospitalization costs (median: 71 000 yuan vs. 39 000 yuan, U=557 966, P<0.001). Conclusions:The incidence of SSI after abdominal surgery is 2.9%. In order to reduce the incidence of postoperative SSI, hypoproteinemia should be corrected before surgery, laparoscopic or robotic surgery should be selected when feasible, and the operating time should be minimized. More attentions should be paid and nursing should be strengthened for those patients with hypertension, small bowel surgery and seriously contaminated incision during the perioperative period.

Objective:Surgical site infection (SSI) can markedly prolong postoperative hospital stay, aggravate the burden on patients and society, even endanger the life of patients. This study aims to investigate the national incidence of SSI following abdominal surgery and to analyze the related risk factors in order to provide reference for the control and prevention of SSI following abdominal surgery.Methods:A multicenter cross-sectional study was conducted. Clinical data of all the adult patients undergoing abdominal surgery in 68 hospitals across the country from June 1 to 30, 2020 were collected, including demographic characteristics, clinical parameters during the perioperative period, and the results of microbial culture of infected incisions. The primary outcome was the incidence of SSI within postoperative 30 days, and the secondary outcomes were ICU stay, postoperative hospital stay, cost of hospitalization and the mortality within postoperative 30-day. Multivariable logistic regression was used to analyze risk factors of SSI after abdominal surgery.Results:A total of 5560 patients undergoing abdominal surgery were included, and 163 cases (2.9%) developed SSI after surgery, including 98 cases (60.1%) with organ/space infections, 19 cases (11.7%) with deep incisional infections, and 46 cases (28.2%) with superficial incisional infections. The results from microbial culture showed that Escherichia coli was the main pathogen of SSI. Multivariate analysis revealed hypertension (OR=1.792, 95% CI: 1.194-2.687, P=0.005), small intestine as surgical site (OR=6.911, 95% CI: 1.846-25.878, P=0.004), surgical duration (OR=1.002, 95% CI: 1.001-1.003, P<0.001), and surgical incision grade (contaminated incision: OR=3.212, 95% CI: 1.495-6.903, P=0.003; Infection incision: OR=11.562, 95%CI: 3.777-35.391, P<0.001) were risk factors for SSI, while laparoscopic or robotic surgery (OR=0.564, 95%CI: 0.376-0.846, P=0.006) and increased preoperative albumin level (OR=0.920, 95%CI: 0.888-0.952, P<0.001) were protective factors for SSI. In addition, as compared to non-SSI patients, the SSI patients had significantly higher rate of ICU stay [26.4% (43/163) vs. 9.5% (514/5397), χ 2=54.999, P<0.001] and mortality within postoperative 30-day [1.84% (3/163) vs.0.01% (5/5397), χ 2=33.642, P<0.001], longer ICU stay (median: 0 vs. 0, U=518 414, P<0.001), postoperative hospital stay (median: 17 days vs. 7 days, U=656 386, P<0.001), and total duration of hospitalization (median: 25 days vs. 12 days, U=648 129, P<0.001), and higher hospitalization costs (median: 71 000 yuan vs. 39 000 yuan, U=557 966, P<0.001). Conclusions:The incidence of SSI after abdominal surgery is 2.9%. In order to reduce the incidence of postoperative SSI, hypoproteinemia should be corrected before surgery, laparoscopic or robotic surgery should be selected when feasible, and the operating time should be minimized. More attentions should be paid and nursing should be strengthened for those patients with hypertension, small bowel surgery and seriously contaminated incision during the perioperative period.