Objective To investigate the clinical parameters,risk factors,treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective a-nalysis was made for the clinical features,risk factors,treatment and prognoses of the non-HIV infected severe PCP pa-tients hospitalized at Pediatric Intensive Care Unit( PICU) of Children′s Hospital Affiliated to Capital Institute of Pedi-atrics. Results During April of 2010 to April of 2014,there were 10 cases of non-HIV infected severe PCP in PICU of Children′s Hospital Affiliated to Capital Institute of Pediatrics. All of the patients had predisposing diseases,in which 3 cases had connective tissue diseases,2 cases had acute leukemia,3 cases had severe pneumonia and 2 cases had con-genital immunodeficiency. The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea. All patients developed respiratory failure. The median value of Pediatric Critical Illness Score was 79. The median arterial oxygen pressure was 58 mmHg(1 mmHg=0. 133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43. 8 mmHg. The median CD4+T-lympho-cytes counts was 169 ×106/L. Eight patients on admission had mixed infection. Acute respiratory distress syndrome (ARDS) occurred in all of the patients,and 7 cases of them had multiple organ dysfunctions. All of the patients re-quired ventilation support. The median day for invasive mechanical ventilation days was 11 and the median day for non-invasive ventilation days was 6. The pneumothorax occurred in 5 patients. All patients received trimethoprim-Sulfame-thoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients. Six patients had nosoco-mial infection. The median time of PICU stay was 15. 5 days. Six patients survived and the mortality was 40%(4/10 cases) . Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions. Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children.

Objective To observe the formation of the biofilm in endotracheal tubes,the characteris-tics of etiology, drug resistance and relationship between the biofilm and ventilator-associated pneumonia ( VAP) . Methods A total of 60 cases of ventilated children patients whose mechanical ventilation time were≥48 h in the ICU from September 2010 to September 2012,according to the mechanical ventilation time,all cases were divided into 2 to 6 d group,7 to 14 d group and ≥15 d group. The incidence of VAP, biofilm structure under the electron microscope,etiology culture positive rate of the lower airway secretions and bio-film,etiological characteristics and drug resistance were prospectively studied. Results ( 1 ) A total of 19 cases occurred VAP in 60 cases of mechanical ventilation,the incidence of VAP was 31. 7%. (2) Observed by electron microscope,biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation. With prolonged mechanical ventilation,biofilm structure had improved,as well as VAP incidence rate from 9. 1%(2 to 6 d group ) increased to 44. 4%(7 to 14 d group) and 88. 9%(≥15 d group). (3) A large number of pathogenic bacteria colonized in the biofilm. Gram-negative bacilli were dominate and drug resistance was high. (4) With prolonged mechanical ventilation,the cultured pathogens from the lower airway secretions and biofilm converged. Conclusion Biofilm could form in the endotracheal tube with mechanical ventilation patients,and is associated with the occurrence of VAP and refractory infections.

[ ABSTRACT ] AIM: To investigate the expression and clinical significance of bone morphogenetic protein 3 (BMP3) in hilar cholangiocarcinoma tissues.METHODS: Thirty cases of hilar cholangiocarcinoma specimens were col-lected.The expression of BMP3 at mRNA and protein levels in the tumor tissues and paracancerous tissues was detected by real-time PCR and Western blot.The hilar cholangiocarcinoma paraffin-embedded specimens (n=103) were collected. The protein expression of BMP3 was determined by immunohistochemical method, and the relationship of BMP3 protein ex-pression with clinical pathological characteristics was evaluated.RESULTS:In the 30 patients with hilar cholangiocarcino-ma, the expressions of BMP3 protein and mRNA in 22 cases of tumor tissues were significantly decreased compared with the adjacent normal tissues.The results of immunohistochemistry showed that 87 cases were negative and 16 cases were weakly positive in all 103 cases of hilar cholangiocarcinoma.The expression of BMP3 protein was associated with the tumor TNM staging, lymph node metastasis and tumor differentiation (P<0.05).CONCLUSION:BMP3 gene might be inhibited in human hilar cholangiocarcinoma.The down-regulation of BMP3 gene might be associated with the carcinogenesis and devel-opment of hilar cholangiocarcinoma.

Objective To explore the method and effect of thumb and finger reconstruction and repair by emergent primary toes transplantation. Methods Three hundred and fourteen fingers of 282 cases including finger thumb defect and complex injury with hyperthena palm radid soft tissue of forearm were reconstructed and repaired by the second toes, wrap-around flap and the second third toes wrap-around flap combined with distal flap of leg or other complex tissue flap transplantation. Results Three hundred and eight reconstructed fingers survived, the survival rate was 98%. After a follow up to 6 months to 6 years, the reconstructed thumbs and fingers have accepted nip, grasp, opponent function. The result was graded as excellent in 214 fingers, good in 63, fair in 26, poor in 5. The excellent and good rate was 88%according to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. Conclusion Different type of toes and combined toes transplantation can obtain preferable clinical effect on emergent primary thumb and finger defect.

Objective:To explore the research status, hotspots, and directions in traditional Chinese medicine treatment for postoperative gastrointestinal dysfunction both domestically and internationally.Methods:The bibliometric software CiteSpace 5.7.R5 was used to visually analyze literature published on the China National Knowledge Infrastructure and Web of Science core collection from establishment until 2022, and to draw the knowledge graph of authors, research institutions, and keywords.Results:After screening by two researchers, a total of 1 012 Chinese articles and 111 English articles were included. The analysis of annual publication volume showed that this field was showing an upward trend both domestically and internationally. The co-occurrence analysis of authors displayed that Hu Kaiwen and Jingwen Yang had the highest number of publications. Institutional co-occurrence analysis indicated that there were relatively few mature and influential teams formed domestically and internationally, and research institutions had limited cross-regional cooperation. Keyword clustering analysis revealed that the research hotspots mainly focused on integrated traditional Chinese and Western medicine nursing, clinical research, and traditional Chinese medicine external treatment methods.Conclusions:The research on the treatment of postoperative gastrointestinal dysfunction with traditional Chinese medicine is mainly concentrated in China, but there are few closely cooperating and stable research teams. Research in this field is still in its developmental stage both domestically and internationally, close cooperation between multiple institutions and authors is needed to form influential teams to conduct in-depth research on the mechanisms and principles of this field, making significant contributions to its development.

The general practitioners are facing a series of issues in aspect of medical humanities:incomprehensive humanity care,insufficient subjective components in medical records,low service efficiency particularly during heavy work load in outpatient service.To adapt the challenges,a general hospital in Shanxi province had explored a pathway to integrate the medical social work into patient care in general practice since 2017.The medical social workers jointed the general practice team,involved in outpatient service and patient education,generated humanity records to improve the humanistic care,and to promote doctor-patient communication.The general medical services were significantly improved after the program implementation in the hospital.

Objective: To observe the integration frequency of aadA2 resistance cassette at attI site of the integron under different concentration of streptomycin. Methods: Class 1 integron with known gene sequence was cloned into plasmid pACYC184 to produce recombinant plasmid pACIDA, meanwhile the integrase gene was cloned into plasmid pET28a to construct recombinant plasmid pETINT. These two recombinant plasmids were consecutively transformed into E. coli BL(DE3). These transformed bacteria was cultured in the LB medium at 37 ℃ overnight with addition of different concentration of streptomycin. The copy number of total integrons and the copy number of integrated aadA2 at attI site of integrons were determined by using real-time PCR. and the integration frequency is the result of the former divided by the latter. Results: The resulting frequencies were (1.97±0.24)×10^-3, (3.23±1.77)×10^-3, (3.27±0.67)×10^-3, 0.45±0.13 and 1.32±0.11, with respective streptomycin concentrations of 0, 20, 30, 40 and 50 μg/ml. The background frequency of integration without integrase overexpression was less than (1.75±0.33)×10^-7. Conclusion These findings indicate that antibiotic concentration significantly increase recombination frequency of aadA2 resistance cassette at attI site of the integron, catalyzed by integron integrase.(Chin J Lab Med, 2018, 41: 531-535)

Objective To explore the effective nursing method of preventing the deep vein thrombosis according to D-Dimer and lower limb vein B ultrasonic examination.Methods The study investigated 120
patients with femoral neck fracture who were operated hip replacement in Wuxi No.2 People′s Hospital during September 2013 to June 2015. The participants were randomly divided into four groups with 30 cases in each group: basic care group, early path functional training group, SCD group, and early path functional training combined with SCD group. D-Dimer and thrombosis detection rate according to the lower limb vein B ultrasonic examination were observed and compared among the four groups.Results D-Dimer of the four groups had little differences before and after 24 hours of the operation ( P>0.05) , but had differences after 7 days and 14 days of the operation (P<0.05). Moreover, the early path functional training combined with SCD group had lower D-Dimer compared to the basic care group ( P<0.05) . Besides, no thrombosis occurred before and after one day of the operation among the four groups, however, the thrombosis detection rates had significant differences after 7 days and 14 days of the operation (P<0.01). After 7 days of operation, the thrombosis detection rate for the early path functional training combined with SCD group was already lower than the others (P<0.01). After 14 days of operation, the basic care group had the highest thrombosis detection rate while the early path functional training combined with SCD group had the lowest thrombosis detection rate ( P<0. 01 ) . Conclusions The method of SCD combined with early path functional training can effectively prevent the deep vein thrombosis after hip arthroplasty surgery.

Objective To explore the effects of protection motivation theory on fall risk caused by senile osteoporotic spinal fracture, fall incidence and self-efficacy.Methods A total of 94 cases of senile osteoporotic spinal fracture in Wuxi Second People's Hospital from February 2015 to August 2016 were selected and divided into the control group (46 cases) and the observation group (48 cases) according to the random number table. Patients in the control group used routine nursing care, while patients in the observation group received additional protection motivation intervention. The fall risk assessment questionnaire (FRAQ) and osteoporosis self-efficacy scale (OSES) were used to compare the fall risk score, self-efficacy and the incidence of fall of the two groups before and after the intervention.Results At 6 months after the intervention, the incidence of fall was 2.08%(1/48) in the observation group and 13.04%(6/46) in the control group. The difference between two groups was statistically significant (χ2=4.094,P<0.05). The fall risk score in the observation group was (36.46±3.08) %, which was significantly lower than that in the control group; calcium uptake efficiency score (44.98±2.84) and exercise self-efficacy scale score (48.54±2.85) in the observation group were significantly higher than those in the control group (t=3.817, 4.946, 8.186;P<0.05).Conclusions Application of protection motivation theory intervention can effectively reduce the risk and the incidence of fall in patients with osteoporotic vertebral fracture and improve the calcium uptake efficiency and exercise self-efficacy. It is worthy of promotion.

Objective To investigate the diagnosis and treatment experiences for pancreatic trauma. Methods Clinical data of 25 patients with pancreatic trauma admitted to the First Affiliated Hospital of Sun Yat-sen University from August 2003 to July 2014 were retrospectively analyzed. There were 17 males and 8 females, with age ranging from 7 to 54 years and a median age of 26 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. According to the scale of American Association for the Surgery of Trauma (AAST) for pancreatic trauma, 3 cases were classiifed as gradeⅠ, 9 as gradeⅡ, 7 as gradeⅢ, 5 as gradeⅣand 1 as gradeⅤ. The diagnosis, treatment and prognosis of the patients were observed. Results Two patients were observed with consciousness disorders and the other 23 suffered from acute abdominal pain of varying extent. Elevated serum amylase was observed in 63% (15/24) of the cases. Seven cases were observed with increasing amylase via abdominocentesis before operation. Seventeen cases underwent preoperative ultrasound examination and the rate of conifrmed diagnosis was 41%(7/17). Fourteen cases underwent preoperative CT scan and the rate of conifrmed diagnosis was 71%(10/14). Three grade I cases underwent peripancreatic drainage alone. Among the 9 cases of gradeⅡ, 2 received conservative therapy, 6 underwent peripancreatic drainage and 1 received pancreatic rupture repair. Among the 7 cases of gradeⅢ, 4 underwent proximal pancreatic stump closure+distal pancreaticojejunostomy, 2 underwent distal pancreatectomy with splenectomy and 1 underwent distal pancreatectomy alone. Among the 5 cases of gradeⅣ, 4 underwent proximal pancreatic stump closure+distal pancreaticojejunostomy and 1 underwent proximal pancreatic stump closure+distal pancreaticogastrostomy. One case of gradeⅤunderwent pancreatic necrosectomy+duodenorrhaphy+peripancreatic drainage. Of the 25 patients, 2 death case were observed, 6 developed pancreatic ifstula and 5 developed pancreatic pseudocyst after operation. One patient with pancreatic ifstula was cured after receiving pancreatic duct stent drainage by endoscopic retrograde cholangiopancreatography (ERCP). Two patients with pancreatic pseudocyst were cured after undergoing cyst drainage. The other patients with pancreatic ifstula and pseudocyst were cured after undergoing ultrasound-guided puncture drainage. Conclusions Increasing amylase in the serum and lfuid by abdominocentesis before operation can be regarded as indicators of pancreatic trauma. Preoperative CT scan is of certain signiifcance in the diagnosis and classifying the pancreatic trauma. Surgical operation for pancreatic trauma should be selected according to the types, grades of trauma and related complications.