Background:14 C-urea breath test(14 C-UBT)is widely used for diagnosis of Helicobacter pylori(Hp)infection owing to its noninvasiveness and high sensitivity and specificity. Nevertheless,the presence of false-negative result can influence the diagnostic accuracy. Aims:To investigate the possible causes of false-negative 14 C-UBT for improving the accuracy of diagnosis. Methods:Eight-two cases with confirmed false-negative 14 C-UBT and 813 controls with true-positive 14 C-UBT at the People’s Hospital of Xinjiang Uygur Autonomous Region from Jan. 2014 to Aug. 2014 were enrolled. Patients in both groups were diagnosed as positive for Hp infection by Warthin-Starry silver staining combined with Hp stool antigen test. Univariate and multivariate analysis were performed to screen the factors related with false-negative 14 C-UBT. Results:In univariate analysis,5 variables were significantly different between case group and control group(P ﹤ 0. 05),and were taken into the multivariate analysis. Logistic stepwise regression analysis revealed that bile reflux( OR = 3. 961,P ﹤0. 001),post subtotal gastrectomy(OR = 9. 734,P ﹤ 0. 001),type Ⅱ Hp infection(OR = 1. 892,P = 0. 012)and upper gastrointestinal bleeding( OR = 4. 979,P ﹤ 0. 001 ) were the independent risk factors for false-negative 14 C-UBT. Conclusions:Bile reflux,upper gastrointestinal bleeding,post subtotal gastrectomy and type Ⅱ Hp infection might be the influential factors for false-negative 14 C-UBT. Combined tests for Hp infection should be suggested in patients with negative 14 C-UBT who had undergone subtotal gastrectomy or complicated with bile reflux or upper gastrointestinal bleeding.

ObjectiveTo investigate the risk factors for recurrent ischemic stroke in patients with atrial fibrillation.MethodsThe ischemic stroke patients with atrial fibrillation were enrolled retrospectively.Their demographic and clinical data were collected.The relative risk factors for strokes were compared in the first-ever stroke group and the recurrent stroke group.Multivariate logistic regression analysis was used to determine the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.ResultsA total of 504 ischemic stroke patients with atrial fibrillation were enrolled, including 245 males (48.6%).and 259 females (51.4%).The average age was 76.67±8.26 years.There were 314 patients (62.3%) in the first-ever stroke group and 190 (37.7%) in the recurrent stroke group.The proportions of hypertension (78.9% vs.69.4%;χ2=5.446, P=0.020), diabetes mellitus (38.9% vs.26.8%;χ2=8.181, P=0.004), and age >75 years (68.9% vs.60.2%;χ2=3.915, P=0.048), as well as the baseline systolic blood pressure (153.30±26.02 mmHg vs.148.13±26.40 mmHg, 1 mmHg=0.133 kPa;t=-2.141, P=0.033) in the recurrent stroke were significantly higher than those in the first-ever stroke group.Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 1.734, 95% confidence interval [CI] 1.121-2.682;P=0.013), diabetes (OR 1.757, 95% CI 1.188-2.597;P=0.005), and age >75 years (OR 1.680, 95% CI 1.132-2.494;P=0.010) were the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.ConclusionHypertension, diabetes, and age >75 years were the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.

ObjectiveTo investigate the associations of the Oxfordshire Community Stroke Project (OCSP) subtypes with severity and outcomes of acute ischemic stroke.MethodsThe inpatients with acute ischemic stroke were enrolled prospectively and divided into total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), and lacunar infarction (LACI) according to the OCSP classification.Demographic and baseline clinical data of the patients were recorded.The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity, ≤8 was mild stroke and >8 was moderate to severe stroke.The clinical outcome was assessed at 90 d after onset with the modified Rankin Scale (mRS), and the favorable outcome was defined as mRS score 0-2, and the unfavorable one was defined as mRS score 3-5, death or cardiovascular event.Multivariate logistic regression analysis was used to determine the independent associations of the OCSP subtypes and stroke severity and outcomes.ResultsA total of 765 patients with acute ischemic stroke were enrolled, including 46 (6.0%) with TACI, 281 with PACI (36.7%), 229 (29.9%) with POCI, and 209 (27.3%) with LACI.There were 580 patients (75.8%) with mild stroke, and 185 (24.2%) with moderate to severe stroke;17 were lost to follow-up, 513 (68.6%) had favorable outcomes, and 235 (31.4%) had unfavorable outcomes.There were significant differences between the baseline NIHSS scores and outcomes in each OCSP subtypes (all P<0.05), in which the baseline NIHSS score in TACI was the highest, the outcome was worst, and the proportion of patients with unfavorable outcome was 89.1%;there was significant difference in the baseline NIHSS scores between the PACI and the POCI (P<0.05), however, the proportion of patients with unfavorable outcome was not the case.Multivariate logistic regression analysis showed that TACI was an independent risk factor for moderate to severe stroke (odds ratio 84.881, 95% confidence interval 20.307-354.792;P<0.001) and unfavorable outcome (odds ratio 21.472, 95% confidence interval 8.362-55.136;P<0.001).Conclusion The OCSP subtypes were independently associated with the severity and outcomes of acute ischemic stroke.

Objective To study expression and significance of keratin 17 and 19 in psoriatic lesion.Method The expression of keratin 17 and 19 in 30 psoriatic lesion and 10 normal skin was measured by immunohistochemistry method.Results The expression level of keratin 17 in the psoriatic lesion was higher than that in the normal skin,the expression level of keratin 19 in the psoriatic lesion was lower than that in the normal skin,there were significant differences in the expression of keratin 17 and 19 between them(P ＜0.05).The optical density level of keratin 17 in the psoriatic lesion was obviously raised compared with the normal skin(5.81 ± 1.42 vs.0,P＜ 0.01).The optical density level of keratin 19 in the psoriatic lesion was obviously decreased compared with the normal skin(0.49 ±0.03 vs.2.03± 1.08,P＜0.05).The optical density level of keratin 17 and 19 showed negative correlation in the psoriatic lesion(r =-0.479,P＜ 0.01).Conclusion Keratin 17 and 19 may play a role in the pathogenesis of psoriasis.

Background:The incidence of duodenal Brunner’s gland hyperplasia is low and the etiology and pathogenesis has not yet been clarified. Aims:To investigate the relationship between duodenal Brunner’s gland hyperplasia and Helicobacter pylori( Hp ) infection. Methods:A total of 96 patients with duodenal Brunner ’s gland hyperplasia diagnosed by pathological examination from October 2005 to December 2013 at People’s Hospital of Xinjiang Uygur Autonomous Region were enrolled in this study,and 270 cases without duodenal Brunner’s gland hyperplasia were served as controls. Hp infection was detected by 14 C-urea breath test( 14 C-UBT). The relationship between duodenal Brunner’s gland hyperplasia and Hp infection was analyzed. Results:In the duodenal Brunner ’s gland hyperplasia group,75 patients were Hp positive,the proportion of Hp infection was 3. 57( 75/21 ). In the control group,110 cases were Hp positive,the proportion of Hp infection was 1. 45(160/110). The difference between the two groups was statistically significant(χ2 =10. 97,P=0. 001). Hp infection was a risk factor of the genesis of duodenal Brunner’s gland hyperplasia( OR=2. 46, 95% CI:1. 44-4. 19). Conclusions:Hp infection may be related with the genesis of duodenal Brunner’s gland hyperplasia.

Objective To investigate the status quo and existing problems in 2A or higher level general hospitals in Shandong Province,in order to provide information for establishing and perfecting the head nurse training system of Shandong Province.Methods 666 head nurses from 129 hospitals were investigated by a self-designed questionnaire,namely The questionnaire of status quo of head nurse training in 2A or higher level general hospitals in Shandong Province.Results The head nurses participating in the survey were average (40.1±5.8) years old,66.7％ of whom had intermediate titles,78.8％ with vocational school as basic education,86.8％ with bachelor as the highest degree.The head nurse training contents were mainly level hospital evaluation (73.9％),quality of nursing management training (65.8％) and nursing quality control (64.2％); training forms were mainly seminar (63.7％),conference (51.4％)and short-term training courses (40.5％); cumulative training time was within two weeks; 73.8％ of the teachers derived from clinical nursing specialist.79.3％ of the head nurses did not attend personalized evaluation before training,while 54.7％ received different forms of evaluation after training.57.2％ of the head nurses considered there had been problems in previous training,such as less practical knowledge (64.1％),a single mode of training (50.7％),lack of pertinence (34.6％),training teachers level was uneven (32.2％).Conclusions The systematic,hierarchical,normal,required,flexible-form,effective-evaluation and talents head nurse training system should be established to improve the nursing management level of the head nurse fundamentally.

OBJECTIVETo investigate the clinical applicability and outcomes of the combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap for tongue and lingual root carcinoma.

METHODSThe operation with or without breaking lower lip and mandible was performed respectively in 245 patients (experimental group) and 120 patients (control group).

RESULTSRemoval of tumor and neck dissection were conducted successfully in all patients of two groups with no serious postoperative complication. With the follows-up of 6 to 36 months, in the patients of experimental group there was no recurrence for primary sites but 3 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, there was no damage to appearance, and no osteoradionecrosis occurred in the lymphnode positive cases after radiotherapy; in the patients of experimental group there was no recurrence for primary sites but 4 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, but there was apparent scar in neck and face, and osteoradionecrosis occurred in 11 of lymphnode positive cases.

CONCLUSIONSThe combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap is feasible for tongue and lingual root carcinoma (T2-T3), which reduces the risk for osteoradionecrosis in lymphnode positive cases after radiotherapy and keeps good appearance for patients.

Carcinoma ; surgery ; Free Tissue Flaps ; Humans ; Lingual Nerve ; pathology ; surgery ; Lip ; surgery ; Mandible ; surgery ; Neck Dissection ; Osteoradionecrosis ; Postoperative Complications ; Thigh ; Tongue ; surgery ; Tongue Neoplasms ; pathology ; surgery

Objective To evaluate whether the functional MRI could be used to reflect the change of angiogenesis after drug treat-ment,and obtain the related semi quantitative and quantitative parameters by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Methods The subcutaneous transplantation colorectal cancer were constructed in 20 nude mice,which were treated with Xiaoaifeimi.The transplanted tumor microvascular density,VEGF and PCNA were monitored.The therapeutic effect and MRI monitoring results were evaluated by combining DCE-MRI with the pharmacokinetic model.The semi quantitative and quantitative parameters were obtained for evaluating the effection of medicine.Half of nude mice were sacrificed to obtain the immunohistochem-ical staining.Correlation between pathological findings and parameters were analyzed.Results Compared to the control group,hu-man colon HT-29 cell proliferation rate was significantly decreased (44.87%)(P <0.05),and the apoptosis rate of HT-29 cells was increased 2.45 times (P <0.05)after Uyghur medicine treatment.The correlation between pathological examination and DCE-MRI parameters showed that Ktrans value and Kep were positively correlated with VEGF,MVD and PCNA (P <0.05).Conclusion A good relationship is showed between immunohistochemistry and DCE-MRI quantitative parameters in Uygur drug treating human colon cancer mice.

Objective To regulate nutrition support nursing, facilitate the development of nursing specialty, cultivate nutrition support nurse. Methods Establish nursing specialist team on nutrition support. 30 nurses received theory training, skill training, clinical practice, and completion reporting. Conduct nutrition knowledge management survey. Establish standardized wards of nutrition support nursing and conduct special inspection. Results Nursing specialist team on nutrition support was established, and 29 nutrition support nurses were cultivated. Before training, nurses' knowledge of nutrition and nutrition nursing management score were (3.46 ± 0.47), (0.70 ± 0.24) points, and the score were (4.63±0.14), (0.90±0.27) points after training, results was statistically significant (t=12.848, 2.981, P<0.01). Before and after special inspection of enteral nutrition, enteral nutrition pump and special infusion tube cases were 106,60 and 106, 60, results were statistically significant (χ2=4.747, 4.471, P<0.05). Before and after special inspection of parenteral nutrition, correct infusion and speed cases were 90, 92 and 61, 54, results were statistically significant (χ2=4.642, 7.644, P<0.05 or 0.01). Conclusions The development of nursing specialty of nutrition support was promoted, nurses′ comprehensive ability and self-identity was improved, management quality of nutrition support was.

Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)in pa-tients with hepatobiliary malignant tumor,explore the related risk factors,so as to provide the basis for taking ef-fective prevention and control measures.Methods The occurrence of postoperative HAI in patients with hepatobili-ary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed,risk factors for postoperative HAI were analyzed through reviewing and collecting patients’medical data.Results A total of 302 patients were investigated,42 (13.91 %)developed postoperative HAI,no multiple site infection occurred,the main infection site was deep surgical site (n=10,23.81 %),followed by lower respiratory tract (n=9,21 .43%) and digestive system (n=7,16.67%).Of 42 infection cases,38(90.48%)were sent specimens for pathogenic cul-ture,36 pathogenic strains were isolated,31 (86.11 %)of which were gram-negative bacteria,and 5 (13.89%) were gram-positive bacteria.Multivariate logistic analysis showed that operation duration≥2 hours (OR =1 .48), overweight (or obesity)(OR=1 .40),and preoperative radiotherapy (OR=2.98)were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P <0.05).Conclusion Incidence of postoper-ative HAI is high in patients with hepatobiliary malignant tumor,risk factors are long length of operation,over-weight (or obesity),and preoperative radiotherapy,effective prevention and control measures against risk factors should be taken.