Purpose:To assess the association between the genetic polymorphisms of N-acetyltransferase1 (NAT 1) and the susceptibility to primary liver cancer (PLC). Methods:The NAT1 genotypes of 96 PLC cases and 173 controls were detected with polymerase chain reaction followed by restriction fragment length polymorphism. And the interactions between NAT1 and environmental risk factors were also analyzed. Results:In PLC cases, the frequencies of NAT1 *3, NAT1 *4, NAT1 *10 and NAT1 *14B were 20.3%, 50.5%, 24.0% and 5.2%, respectively. The frequencies of NAT1 *3/ *3, NAT1 *3/ *4, NAT1 *3/ *10, NAT1 *3/ *14B, NAT1 *4/ *4, NAT1 *4/ *10, NAT1 *4/ *14B, NAT1 *10 / *10 and NAT1 *10/ *14B genotypes were 4.2%, 25.0%, 3.1%, 4.2%, 31.3%, 10.4%, 3.1%, 14.7 and 4.2%, respectively. No statistically significant difference of the frequencies was found between the two groups. In PLC cases, the frequencies of rapid type NAT1 and slow type NAT1 were 32.3% and 67.7% respectively, which had no statistically significant difference compared with the control group. The interaction between NAT1 *10 and occupational exposures was found with an odds ratio of 3.40(95%CI:1.03～11.22). Conclusions:There is no relation between genetic polymorphisms of NAT1 and PLC. NAT1 *10 interacts with occupational exposures.

Objective To investigate the clinical features of osteonecrosis of the knee (ONK) in patients with systemic lupus erythematosus (SLE).Methods A retrospective chart review was conducted to identify patients of SLE with ONK.The clinical characteristics of these patients were analyzed.Results Between 2008 and 2013,eighty-one patients with SLE were analyzed in the 210th Hospital of People's Liberation Army.Eleven of these patients were diagnosed as ONK.All of these ONK patients were female.The age of onset ranged from 19-57 (36±13) years.The disease duration ranged from 4.5-31.0 (13±6) years.The local clinical symptom included knee swelling with pain in 5 cases,only pain with no swelling in 1 patient,no symptoms in 5 patients.All patients were with aseptic necrosis of the femoral head.For laboratory examination,7 patients had elevated triglyceride lipids in blood.Three of 7 patients accompanied with cholesterol level increased.Total cumulative dosage of oral corticosteroids was (66 824±27 328) mg.Conclusion ONK in patients of SLE is common and the majority of them have impaired renal function and elevated blood lipids,as well as long-term glucocortico-steroid therapy.

Objective To evaluate the clinical value of microvascular anastomotic devices in the reconstruction of lower extremity defects by free flap transfer.Methods A retrospective review of 42 consecutive patients who underwent lower extremity microvascular reconstruction performed from May 2013 to November 2013 by microvascular anastomotic devices was performed.Patient charts were reviewed for age,sex,etiology of defect,location of defect,flap type,anastomotic technique,complications and flap survival.Results No patients had an arterial or venous anastomosis revised.The vascular anastomosis patency rates was 100％ and the flap survival rate was 97.6％.Total complication rate (9.5％) was due to 1 partial flap loss,1 partial skin graft loss and 2 hematoma.There were no intraoperative or perioperative complications involving the use of a microvascular anastomotic device itself.Conclusion Microvascular anastomotic devices have effective vessel anastomoses in lower extremity microvascular reconstruction.Thus,it presents an ideal tool for lower extremity microsurgical reconstruction.

Objective To study the apoptosis of human colorectal cancer HT-29 cells induced by Aralia elata Seem leaf total saponin (ETS) and its effects on the expression of relevant proteins. Methods MTT assay was used to detect the proliferation of human colorectal cancer HT-29 cells cultivated with different concentrations (6.25, 12.5, 25, 50, 100, 200 mg/kg) of ETS. Hoechst33258 staining and laser confocal imaging were used to detect the apoptotic cells. Morphological changes were observed. The expressions of Bcl-2 and Bax were detected by immuno-histochemistry. Results ETS could induce apoptosis of HT-29 cells and apoptosis was in a dose-dependent manner in a certain range. ETS could decrease the expression of Bcl-2 and increase the expression of Bax in HT-29 cells (P<0.05, P<0.01), showing a significant dose-effect relationship. Conclusion ETS can induce the apoptosis of HT-29 cells, and the mechanism may be related to reducing the expression of Bcl-2 and increasing the expression of Bax.

Objective To investigate the pathogens distribution in neonatal blood culture and their drug resistance to antibacteri‐al drugs in Dalian City .Methods The routine blood culture ,identification and drug sensitivity test were carried out in the hospital‐ized neonates from August 2014 to August 2015 .And the obtained data were analyzed .Results A total of 186 strains of pathogenic bacteria were detected from 1 570 cases of neonatal blood culture and the positive rate was 11 .8% .Gram positive bacteria accounted for 74 .2% (138/186) and were dominated by Staphylococcus epidermidis .Gram negative bacteria accounted for 25 .3% (47/186) , which were mainly onion burkholderia bacterium .One strain was fungus ,accounting for 0 .5% .The drug sensitivity test results showed that Gram positive bacteria had the higher resistance rate to penicillin and erythromycin (80 .0% -90 .0% ) ,100 .0% sensi‐tivity to vancomycin ,linezolid and teicoplanin ;E .coli and K .pneumoniae had the highest resistance rate to ampicillin (88 .2% -100 .0% ) ,100 .0% sensitivity to imipenem ,amikacin ,low resistance rate to piperacillin/tazobactam ,cefoperazone/sulbactam ,amoxi‐cillin/clavulanic acid ,cefepime and ceftazidime (0% -10 .0% ) .The resistance rate of onion burkholderia bacterium to ticarcillin/clavulanate and meropenem was higher than 80 .0% ,which had 100 .0% sensitivity to cefoperazone /sulbactam ,levofloxacin ,mino‐cycline and compound sulfamethoxazole .Conclusion The neonatal blood culture pathogen in Dalian City is dominated by Gram pos‐itive bacteria ,coagulase negative staphylococcus is the main pathogen .Due to the different regional environmental ,pathogens and drug resistance should be regularly monitored and analyzed to provide objective and accurate basis for clinical rational use of anti‐bacterial drugs .

Patient satisfaction is an important index of hospital quality evaluation and performance evaluation.This study established multi-attribute patient satisfaction index system based on the theory of customer satisfaction index,determined the index weight by combination weighting approach,and graded the hospitals and adjusted the weights by the RSR method.A set of comprehensive evaluation scheme is initially formed,which is suitable for patient satisfaction evaluation and performance evaluation.

Objective To explore optimal suctioning negative pressure in endoscopic nasobiliary drainage (ENBD) after endoscopic retrograde cholangiopan-creatography (ERCP). Methods A total of 131 patients with extrahepatic bile duct stones complicated with infection, who were treated by ENBD after ERCP, were randomly divided into two groups according to intubation dates from September 2013 to December 2014. The patients of two groups were treated with the same medical and nursing care. The pressure of low suctioning negative pressure group (61 cases) was -1--5 kPa and the pressure of high suctioning negative pressure group (70 cases) was -5--8 kPa. The conditions of biliary bleeding, drainage volume, drainage tube obstruction and patient comfort in two groups were compared. Results There were 4 cases of bile occult blood in low suctioning negative pressure group and 9 cases in high suctioning negative pressure group (P>0. 05). The daily biliary drainage volume in low suctioning negative pressure group was (349. 79 ± 108. 26) ml, which was more than that in high suctioning negative pressure group (t=6. 76,P<0. 01). There were 8 cases of drainage tube obstruction in low suctioning negative pressure group, which was less than that of 25 cases in high suctioning negative pressure group (χ2 =8. 83,P<0. 01). There were 2 cases of postoperative vomiting and 4 cases of xiphoid under pain in low suctioning negative pressure group, which were less than those in high suctioning negative pressure group (χ2 =17. 27,3. 89;P<0. 05). Conclusions The optimal suctioning negative pressure in ENBD after ERCP is -1--5 kPa. It can be used in clinical nursing care in order to improve patient comfort and keep the drainage tube unobstructed.

Objectives:To analyze the clinical features of microscopic polyangiitis (MPA), and observe the clinical outcomes of different pathological types.Methods:The clinical data of 61 patients with MPA in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2010 to December 2019 were analyzed retrospectively. According to age, the patients were divided into ≥ 60 years old group (46 cases) and<60 years old group (15 cases). According to the initial serum creatinine, the patients were divided into ≥ 500 μmol/L group (18 cases) and<500 μmol/L group (43 cases). The basic data and laboratory examination results of the patients were recorded, and the disease activity was evaluated by Birmingham systemic vasculitis activity score (BVAS). Twenty-three patients with complete pathological data were pathologically classified and followed up to assess their clinical outcomes. The progression to end-stage renal disease (ESRD) or death was defined as the endpoint.Results:Ferritin in ≥60 years old group was significantly higher than that in<60 years old group: 452 (289, 792) μg/L vs. 210 (119, 451) μg/L, and there was statistical difference ( P<0.05). The fever rate, hemoglobin and platelets in creatinine ≥ 500 μmol/L group were significantly lower than those in creatinine<500 μmol/L group: 3/18 vs. 48.8% (21/43), 77.5 (62.8, 86.0) g/L vs. 85.0 (77.0, 104.0) g/L and 192 (147, 234) × 10 9/L vs. 257 (208, 365) × 10 9/L, the gastrointestinal involvement and BVAS in creatinine ≥ 500 μmol/L group were significantly higher than those in creatinine<500 μmol/L group: 16/18 vs. 25.6% (11/43) and 20.0 (16.0, 23.3) scores vs. 15.0 (12.0, 19.0) scores, and there were statistical differences ( P<0.05 or<0.01). Pearson correlation analysis result showed that BVAS was positively correlated with creatinine ( r = 0.42, P<0.01), negatively correlated with hemoglobin ( r = -0.42, P<0.01), but it had no correlation with erythrocyte sedimentation rate and platelets ( r = 0.05 and 0.04, P>0.05). Among the 23 patients with completed the clinical outcome statistics, endpoint events occurred in 5 of 6 patients with crescent renal pathology, and in 7 of 12 patients with severe renal interstitial injury. Kaplan-Meier survival curve analysis result showed that the average survival time in ESRD MPA patients was significantly shorter than that in non ESRD MPA patients (41.2 months vs. 63.5 months), and there was statistical difference ( χ2 = 0.48, P = 0.028). Conclusions:The clinical manifestations of elderly MPA patients are similar to those of young MPA patients. Creatinine≥500 μmol/L or anemia at initial onset indicate higher vasculitis activity in MPA. The prognosis of MPA patients with pathological manifestations of crescent or severe interstitial injury is poor, and the survival rate of ESRD is lower than that of non ESRD patients.

Objective:To understand the current clinical practice status of evidence on blood glucose management in ICU patients with insulin intravenous infusion, analyze barriers and formulate action strategies, so as to provide reference for the translation of evidence into clinical practice.Methods:Based on the clinical evidence application model of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, clinical nursing problems were identified, literature search, evaluating and summarizing evidence were carried out, and review indicators and methods were developed. From July to August 2023, convenience sampling was used to select 42 nurses and 80 patients with insulin intravenous infusion from the comprehensive ICU of Wuxi Second People's Hospital as participants for baseline review. Barriers were analyzed and change strategies were developed based on baseline review results.Results:A total of 16 pieces of evidence were introduced regarding blood glucose management in ICU patients with insulin intravenous infusion. Nineteen review indicators were formulated, of which 13 had a compliance rate of less than 60%. Analysis identified 18 barriers and 13 facilitators. Sixteen change strategies were developed based on barriers and facilitators.Conclusions:There is still a significant gap between the evidence of ICU insulin intravenous infusion blood glucose management and clinical practice. Evidence-based practice programs should be constructed based on intervention strategies to effectively promote the application of evidence in clinical practice.

The establishment of an intelligent audit system for hospital medical insurance is crucial for standardizing irrational practices and curbing the unwarranted escalation of medical insurance costs. A tertiary hospital has developed comprehensive prescription review rules in terms of indications, nutritional risk assessments, pain score evaluations, drug sensitivity test results, and target patient populations. When using medical insurance funds for settlement, both systematic and manual reviews are conducted, and three-level intervention measures such as " prompt, review, and interception" are implemented based on prescription issues. After the system was put into use, the hospital′s in-process information system supervision mode shifted from the previous focus on prompts to focus on audits. The medical insurance intelligent audit system provided timely prompts and interventions, and the number of unreasonable medical insurance prescriptions and deductions from medical insurance sampling prescriptions significantly decreased ( P<0.001), while the number of medical insurance medication prescription audits increased ( P<0.001). The application of the intelligent medical insurance medication audit system has improved the efficiency of prescription auditing and ensured the rationality of the use of medical insurance funds.