Objective To investigate the effect of modified B-Lynch suture in treatment of hemorrhage during cesarean section and its nursing. Methods Retrospective analysis was carded in the curative effect of the modified B-Lynch suture among 22 patients who suffered from postpartum hemorrhage during cesarean section. Results Postpartum hemorrhage among 22 patients was under well control and their uteruses were reserved successfully. Conclusions The modified B-Lynch suture is an effective intervention when used to treat intra- operative bleeding during cesarean section and when combined with appropriate nursing care, the patients would make an early recovery.

Objective To investigate the dynamic changes and drug resistance of fungal infection in our hospital during 2010 -2012 for guiding the clinical reasonable use of anti-fungal drugs .Methods The related clinical data and the drug sensitivity tests re-sults of fungal infection in the hospitalized patients from 2010 to 2012 were retrospectively analyzed by the WHONET 5 .6 soft-ware .Results Candida albicans was the major pathogen causing candida infection for these 3 years .The isolated specimens were mainly sputum and blood .In the departments of internal medicine ,general surgery and integrated Chinese and Western medicine ,the number of detected candida were more than that of the other departments .Five kinds of candida showed high sensitivity to ampho-tericin B and high resistance to itraconazole .Conclusion The distribution of pathogens causing nosocomial fungal infection has changed and the drug resistance rate is continuously rising .Therefore the dynamic monitoring and the study of fungal infection should be strengthened for reducing the occurrence of fungal infection in the patients with tumor .

ObjectiveTo investigate the flora distribution and drug resistance status of nosocomial fungal infection in cancer hospitals for providing the scientific basis for clinical prevention and control.Methods The related clinical data and results of drug sensitivity tests of fungal infection in hospitalized patients from April 2006 to November 2010 were analyzed retrospectively.ResultsA total of 1011 strains of candida were isolated in five years, in which, Candida albicans (41.6％ on average) were the highest detection rate strains.The proportion of Candida albicans declined from 53.8％ in 2006 to 31.7％ in 2010, while the other non-Candida albicans increased from 46.2％ in 2006 to 68.3％ in 2010.In the General surgery, the Internal medicine,the Hepatobiliary surgery, and the Chinese and Western medicine, the number of candida were more than the other departments.The specimens were mainly isolated from sputum and swab, followed by blood specimens.In vitro susceptibility test results showed that: voriconazole, amphotericin B and 5-fluorocytosine showed high sensitivity and itraconazole, fluconazole showed high drug resistance to albicans.Conclusion Distribution of pathogens causing nosocomial fungal infection has changed, and the rates of fungal resistance were rising,so this situation should arouse the clinician's attention.

Objective To study plasmid-mediated transfer,plasmid replicon typing,and genetic environment of blaNDM-1 gene in Enterobacteraerogenes(E.aerogenes).Methods E.aerogenes HN-NDM0711 was used as the subject of this research,the transferable properties of plasmid were analyzed by conjugation testing,conjugant was performed stability testing,plasmid type was determined by PCR-based replicon typing (PBRT),downstream and upstream of blaNDM-1 were sequenced using chromosome walking method,genetic context was analyzed by BLASTN and BALSTP,as well as annotated using Vector NTI 11.5.1 software,sequence pipeline graph was made,the sequence was submitted to Genbank through software Banklt.Results The conjugation testing of E.aerogenes pHN-NDM0711 was positive,after positive conjugant was conducted 4-day passage,minimal inhibitory concentrations (MICs) of imipenem and meropenem to all the cloned strains didn't change,blaNDM-1 were all positive.The replicon type was IncA/C;blaNDM-1 gene was localized between ISAba14 and IS91,at upstream of the blaNDM-1,class 1 integron and Tn3 transposon were identified,class 1 integron contained a new mosaic structure of a drug-resistant resistance gene cassette.Conclusion E.aerogenes pHN-NDM071 1,bearing blaNDM-1 gene in IncA/C plasmid,derived from gene recombination under different antimicrobial selection pressure.Antimicrobial use in clinical,industrial and agricultural area should be strictly controlled,so as to reduce the emergence of such bacteria.

AIM:To observe the Toll-like receptor 9 (TLR9) activation in microglia BV-2 cells after oxygen-glucose deprivation and reoxygenation ( OGDR) , and its effects on neuronal apoptosis.METHODS:The BV-2 cell super-natants were collected after the corresponding treatment and added to mouse primary cortical neurons after OGDR for 4 h, followed by normal culture for 24 h.The cells were divided into normal BV-2 group, NC-siRNA group, TLR9-siRNA group, OGDR group, OGDR+NC-siRNA group, OGDR+TLR9-siRNA group and control group (without adding BV-2 cell supernatant) .The changes of the neuronal morphology were observed under an inverted phase-contrast microscope, and the neuronal apoptosis was detected by TUNEL.The protein expression of cleaved caspase-3 was detected by Western blot-ting.RESULTS:After OGDR, the axon turned thin, twisted and broken, and neuronal swelling, decrease in refraction and vacuolar degeneration were observed.The green-stained apoptotic bodies in the neurons in all groups were positive. Compared with control group, the caspase-3 protein levels in other groups were increased.Compared with the normal BV-2 group, the caspase-3 protein in OGDR group and TLR9-siRNA group was increased.Compared with OGDR+TLR9-siRNA group, the caspase-3 protein in TLR9-siRNA group and OGDR group was decreased.CONCLUSION: After OGDR, TLR9 activation in BV-2 cells induces neuronal apoptosis with the increase in caspase-3 protein level.Inhibition of TLR9 expression reduces neuronal damage.

Objective:To measure the salary satisfaction level of medical staff in county-level public hospitals and provide reference for the design of policy reforms. Method:Eight county-level public hospitals were investigated. All analyses were performed using SPSS 19. 0 via statistical description and binary logistic regression. Results: The total salary satisfaction of the medical staff was 48 . 8%, and the average score was 54 . 05 ± 18 . 04 . The welfare satis-faction is the lowest (38. 8%), and the average score is 7. 98 ± 3. 51. Logistic regression analysis shows that the ac-ademic degree, department category, working hours per week, acceptance of bribes, and officially budgeted posts are the main factors affecting overall compensation satisfaction. Conclusion:The overall salary satisfaction level of medi-cal staff in county-level public hospitals is very low, and the welfare satisfaction is the lowest. Establishing the rea-sonable level of compensation, the rise of compensation, and the welfare mechanism are feasible choices to improve salary satisfaction.

Objective To explore the effect of integrated traditional Chinese medicine ( TCM) and western medicine on prognosis and quality of life of dysphagia in patients with stroke after surgery. Methods A total of 80 patients who underwent surgical treatment for stroke in our hospital were evaluated by GUSS, and 48 patients were found having dysphagia and were randomly divided into the control group and the observation group. Patients in the control group was given routine nursing, while the observation group was given integrated TCM and western medicine nursing combined with routine nursing. The complication rates, SDS and SAS scores were compared between two groups.Results The complication rates in the observation group was 8.3 %, and was 29.2% in the control group (χ2=4.25, P<0.05); the rehabilitation rate was 70.8% in the observation group and was 50.0% in the control group (χ2=4.18, P<0.05). After nursing intervention, scores of SAS and SDS in the observation group were significantly lower than the control group (t=4.45, 5.01;P<0.05). Conclusions Integrative TCM and western medicine nursing can effectively improve patients′ prognosis, decrease complication rates, alleviate negative emotion and improve quality of life.

Objective To investigate the associations of Toll-like receptors (TLRs) mRNA expressions and their downstream signaling pathways in peripheral blood mononuclear cells with clinical outcomes in patients with cerebral infarction.Methods Ninety patients with cerebral infarction of anterior circulation,admitted to our hospital fiom May 2015 to December 2015,were chosen.Quantitative real-time PCR was performed to measure the expressions ofTLR2,TLR4,TLR3,TLR7,TLR8 and TLR9 and downstream signaling molecules Toll-like receptors related molecule (TRAM),interferon regulatory factor 3 (IRF-3),and interferon beta (IFN-β) in peripheral blood mononuclear cells.Good functional outcome was defined as modified Rankin Scale (mRS) scores≤ 2 90 d after onset.National Institutes of Health Stroke Scale (NIHSS) on admission was used to evaluate the severity of stroke,and infarct volume 7-14 d after onset was measured on MR imaging.The baseline characteristics (TLRs,population information,risk factors,stroke types,clinical and imaging data) were compared between patients with good and bad functional outcomes.Multi-factor Logistics regression analysis was performed.Results TLR3 and TLR7 mRNA expressions were correlated with good functional outcome at acute cerebral infarction,and only TLR3 expression was correlated with good functional outcome at sub-acute phase.TLR3 mRNA expression,C-reactive protein (CRP) level,and NIHSS scores on admission were positively correlated with good outcome (OR=4.435,P=0.001;OR=l.12,P=0.033;OR=1.961,P=0.000).The expressions of TLR3 and IRF-3 were both inversely correlated with NIHSS scores and cerebral infarction volume;IFN-β mRNA expression was positively correlated to TLR3 expression (r=0.392,P=0.000);IFN-β expression and IRF level were positively correlated (r=0.347,P=0.01).Conclusion The TLR3 expression is correlated with good functional outcome in peripheral blood mononuclear cells of patients with cerebral infarction,which may play a crucial role in the survival of neurons after ischemia through spuring the extraction of anti-inflammatory factor IFN-β.

Objective To observe the value of intratumoral and peritumoral CT radiomics for evaluating KRAS gene status in patients with colorectal adenocarcinoma.Methods Totally 245 patients with colorectal adenocarcinoma were retrospectively enrolled and divided into mutant group(n=139)and wild group(n=106)according to KRAS gene status,also divided into training set(n=171)and test set(n=74)at a ratio of 7∶3.Clinical data were compared between groups,and clinical factors were screened with logistic regression analysis to establish a clinical model.Based on enhanced venous phase CT images,intratumoral volume of interest(VOI),peritumoral VOI,and intratumoral+peritumoral VOI were delineated,radiomics features were extracted,and radiomics models were constructed.The combination model was constructed based on the best radiomics model combined with clinical factors.The value of each model for evaluating KRAS gene status in patients with colorectal adenocarcinoma was analyzed.Results Significant differences of patients’gender and carcinoembryonic antigen(CEA)were found between mutant group and wild group(both P＜0.05),which were independent impact factors of KRAS gene status in patients with colorectal adenocarcinoma(both P＜0.05).The area under the curve(AUC)of clinical model for evaluating KRAS gene status in patients with colorectal adenocarcinoma in training set and test set was 0.633 and 0.658,respectively.Intratumoral+peritumoral 3 mm model was the best radiomics model,with AUC of 0.921 and 0.894 in training set and test set,respectively.AUC of the combination model in training set and test set was 0.949 and 0.956,respectively.In training set,significant differences of AUC were found between clinical model and intratumoral+peritumoral 3 mm model,also between clinical model and combination model(both P＜0.001),while in test set,significant differences of AUC were found between each two models(all P＜0.05).Conclusion Intratumoral+peritumoral 3 mm radiomics based on enhanced venous phase CT could help to evaluate KRAS gene status in patients with colorectal adenocarcinoma.Combining with patients’gender and CEA could further improve efficacy of this model.

Objective To observe the value of contrast-enhanced CT radiomics combined with clinical and hematology indicators for predicting lymph node(LN)metastasis(LNM)of esophageal squamous cell carcinoma(ESCC).Methods Totally 218 ESCC patients were retrospectively enrolled.Stage pN1 and pN2 were clustering as LNM(n=90),while stage pN0 were taken as non-LNM(n=128).The patients were divided into training set(n=174)and test set(n=44)at the ratio of 8∶2.In training set,clinical and LN imaging features which could be used to independently judge LNM were screened and a clinical-imaging model was constructed.The hematological indicators that might be associated with ESCC LNM were screened,and a hematological model was constructed.Radiomics features in LN ROI and ESCC volume of interest(VOI)were extracted based on venous-phase contrast-enhanced CT images,and those might be associated with LNM were screened,and a radiomics model was constructed.Finally a combined model was constructed based on all the above features.The efficacy of each model for diagnosing LNM was evaluated with the area under the curve(AUC)of receiver operating characteristic curves,and the clinical net benefit was evaluated using decision curve analysis(DCA).Results Body mass index(BMI)and internal necrosis of target LN were both independent judging factors for ESCC LNM(both P＜0.05),and AUC of clinical-imaging model for diagnosing LNM in training and test sets was 0.747 and 0.687,respectively.Seven hematological indicators were included in hematological model,and AUC in training and test sets was 0.623 and 0.583,respectively.Ten LN radiomics features and 15 ESCC radiomics features were included in radiomics model,and AUC in training and test sets was 0.769 and 0.745,respectively.AUC of the combined model for diagnosing LNM in training and test sets was 0.822 and 0.739,respectively,better than other models in training set(all P＜0.05),but no significantly different in test set(all P＞0.05).DCA showed that combined model had higher net gain than the other models in 0.55-0.80 threshold probability interval.Conclusion Combined model based on venous-phase contrast-enhanced CT radiomics and clinical and hematology indicators could relatively effectively evaluate ESCC LNM,which might bring some promotions in clinical benefit.