Objective To investigate the relationship between the detection of serological antibodies of Helicobacter pylori(HP) infection and the pathological features of gastric ulcer.Methods 228 cases of patients with gastric ulcer diagnosed by endoscopic biopsy(180 cases of benign ulcer and 48 cases of malignant ulcer) were enrolled in this study from January 2015 to October 2016.All subjects were given 14C-urea breath test.The positive rates of cytotoxin associated gene A(CagA),urease A(UreA),urease B(UreB),vacuolating toxin A(VacA) and flagellin antibodies in serum were determined by immunoblotting.The relationship between serum antibody level of Hp infection and pathologic features of gastric ulcer patients were analyzed.Results HP positive rate and type Ⅰ HP positive rate in malignant gastric ulcer group were significantly higher than those in benign gastric ulcer group(P<0.05).The positive rates of CagA,UreA,UreB,VacA and flagellin antibodies were significantly higher in patients with malignant gastric ulcer than those in benign gastric ulcer group(P<0.05).The positive rates of UreA,UreB,VacA and flagellin antibodies in patients with gastric ulcer area>2.0 cm2,severe mucosal inflammatory reaction and severe inflammatory reaction activity were higher(P<0.05).Conclusion The occurrence of gastric ulcer and progression of the disease could be related to the interaction of HP virulence factors.HP serological antibodies detection could help to classify patients with HP-positive gastric ulcer and formulate targeted prevention and treatment plan.

Objective To investigate the feasibility and safety of transcatheter closure of coronary artery fistula (CAF)with Amplatzer vascular PlugⅡ(AVPⅡ)in pediatric patients.Methods Between June 2012 and October 2015,5 children aged 0.9 to 7.0 years old and weighted 10 to 21 kg with CAF were admitted to the Department of Pediatric Cardiology in Shandong Provincial Hospital Affiliated to Shandong University.Aortic root angiography was used first to confirm the origin,shape,branches,drainage and the diameter of the orifice of CAF by deploying the pigtail catheter.The AVPⅡwas retrogradely deployed into targeted artery through guiding catheter and aortic angiography was performed before releasing the plug.Results All the 5 children underwent transcatheter closure by AVPⅡsuccessful-ly.Two cases were involved with right coronary -right ventricular fistula,1 case of left anterior descending coronary -right ventricular fistula (residual fistula after surgical repair),and 1 case of left circumflex coronary -left atrial fistula. Four children had a single fistula,and 1 case had double fistulas.The diameter of the orifice ranged from 2.00 to 5.96 mm,and the selected occluders from 8 to 14 mm.The ratio of diameter of occluder to fistula orifice ranged from 2.3 to 3.4.All the patients were followed up for 4 to 44 months.Two patients developed instant minor and modera-te aortic re-gurgitation.No other complications such as thrombosis,embolization,residual shunt,arrhythmia,coronary dissection or perforation occurred.Conclusions Transcatheter closure of CAF by AVPⅡin pediatric patients is feasible and safe. Aortic regurgitation should be noted,especially during the procedure.

Objective To evaluate the effect of dexmedetomidine administered at different time points on the quality of anesthesia recovery and inflammatory response in children undergoing craniotomy.Methods According to the randomized double-blind method,200 pediatric patients who underwent craniotomy in Beijing Fengtai Hospital from August 2017 to August 2022 were divided into 4 groups,with 50 cases in each group.In preoperative group,0.5μg/(kg?h)dexmedetomidine was intravenously pumped 30min before anesthesia induction,and the drug was stopped before the start of surgery.In intraoperative group,0.5μg/(kg?h)dexmedetomidine was infused intravenously after the beginning of the operation,and the drug was stopped 30min before the end of the operation.In postoperative group,0.5μg/(kg?h)dexmedetomidine was infused intravenously after the main steps of the operation,and the drug was discontinued at the end of the operation.In control group,the same volume of normal saline was injected intravenously 30min before anesthesia induction.The recovery quality,hemodynamics,inflammatory response,and adverse reactions were compared among the four groups.Results The extubation time of postoperative group[(43.84±5.12)min]was significantly longer than that of preoperative group[(16.73±3.28)min],intraoperative group[(18.05±3.47)min],and control group[(25.63±4.64)min],the difference was statistically significant(P<0.05).Ramsay sedation scores,mean arterial pressure(MAP),heart rate(HR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 were compared between preoperative group and intraoperative group before anesthesia induction in a quiet state(T0),immediately after extubation(T1)and 5min after extubation(T2).The difference was not statistically significant(P>0.05).Ramsay sedation scores and levels of CRP,TNF-α and IL-6 at T1 and T2 in postoperative group were significantly higher than those in preoperative group,intraoperative group and control group,and MAP and HR were significantly lower than those in preoperative group,intraoperative group and control group,with statistically significant differences(P<0.05).There was no significant difference in the overall incidence of adverse reactions among the four groups(P>0.05).Conclusion Intravenous infusion of dexmedetomidine at different time points in children undergoing craniotomy has no obvious adverse reactions,but intravenous infusion of dexmedetomidine before and during operation has little effect on hemodynamics and inflammatory response during anesthesia recovery period,and the quality of recovery and sedation is better.Intravenous infusion of dexmedetomidine after operation will prolong extubation time.

Objective: To compare the efficacy between three-layer suture and Allgöwer-Donati suture on wound healing. Methods: From September 2016 to June 2018, patients with Sanders type III calcaneal fracture were randomly divided into two groups: three-layer close suture group (26 cases, 18 males and 8 females, aged 19-48 years, with an average age of 33.69±8.84 years) and Allgöwer-Donati group (26 cases, 19 males and 7 females, aged 19-49 years, with an average age of 32.38±8.45 years). The traditional L-shaped incision was used in all patients. The inflammatory reaction area of incision, skin temperature change at the corner of L-shaped incision line and the healing grade of incision were compared between the two groups. Results: 52 pa-tients were followed up for 6 months. At 2 weeks after operation, the inflammatory reaction area of incision skin in the three-layer close skin suture group (26.46±9.37 mm²) was smaller than that in Allgöwer-Donati suture group (33.16±9.33 mm²). There was a significant difference between the two groups (t=2.584, P=0.013). There was no difference in skin temperature at the corner of L-shaped incision between the two groups before and on the first day after operation. However, the incision skin temperature of the three-layer close suture group on the 2nd and 3rd day after operation[ (36.47±0.33) ℃ and (36.54±0.22) ℃]was higher than that of Allgöwer-Donati group[ (36.20±0.42) ℃ and (36.22±0.43) ℃]. The difference was statistically significant (t=2.61, P=0.01; t= 3.48, P=0.001). There were 25 cases of Class A healing and 1 case of Class B healing in three-layer close suture group, with Class A healing rate of 96.15% (25/26). In Allgöwer-Donati group, there were 22 cases of Class A healing, 1 case of Class B healing, and 3 cases of Class C healing, with Class A healing rate of 84.62% (22/26). Among all grade B healing incisions, 1 case had a small amount of local hemorrhagic exudation in the three-layer close suture group, while 1 case had a black necrosis at the edge of the in-cision, 3 cases had a purulent incision and exposed steel plate in the Allgöwer-Donati group. Conclusion In the treatment of L-shaped incision of calcaneal fracture, three-layer close suture is a better method than Allgöwer-Donati suture because of smaller in-flammatory reaction area of incision, higher skin temperature change at the corner of L-shaped incision on the 2nd and 3rd day af-ter operation, higher rate of first-degree healing of incision and slighter incision complications.

Objective To investigate the nursing care burden,medical assurance and comorbidities of patients with hereditary epidermolysis bullosa (EB) in China.Methods From September to December in 2018,a cross-sectional telephone/internet-based questionnaire survey was conducted in EB patients registered at DebRA China between January 2013 and September 2018.Results Totally,377 participants (EB patients or their parents) were enrolled into this survey,and a total of 367 valid questionnaires were collected.Of the 367 registered patients with EB,275 (74.9％) were minors,and 319 (92％) reported wound care costs per month less than 3 000 RMB Yuan,and 211 (57.5％) reported that medical expenses were mainly paid by themselves.These patients were distributed in 30 provinces,autonomous regions or municipalities directly under the central government of China,and no patient was from Tibet.The largest number of registered patients was from Jiangsu province (49/367),followed by Henan (35/367),Guangdong (27/367),Hebei (23/367) and Shandong (20/367) provinces.Of the 367 patients,168 received genetic testing.The most common comorbidities of EB patients were nail peeling and itching,with the prevalence rate being 66.2％ and 55.3％ respectively.Disabilities occurred in 122 (33.2％) patients,102 (27.8％) of which had physical disabilities.Conclusion Most of EB patients cannot obtain appropriate diagnosis,nursing care and medical assurance,comorbidities and disabilities are common,and their quality of life is very low.

OBJECTIVE: To carry out combined genetic analysis on two patients suspected for Burkitt lymphoma to facilitate their diagnosis and treatment. METHODS: G banded karyotyping and interphase and metaphase fluorescence in situ hybridization (FISH) were used to detect the specific sites of chromosomes by using separate and fusion probes. RESULTS: The separate probe showed no presence of MYC gene abnormality, while fusion probe confirmed the IGH::MYC translocation in the samples. Combined with the clinical features and pathological characteristics, the two patients were finally diagnosed with Burkitt lymphoma, which was confirmed by targeted capture next generation sequencing. CONCLUSION The separate probe for the MYC gene has some shortcomings and should be used together with dual fusion probe to improve the accuracy of diagnosis.
Humans ; Burkitt Lymphoma/pathology* ; In Situ Hybridization, Fluorescence ; Genes, myc ; Translocation, Genetic ; Karyotyping

Objective To learn the current doctor-patient trust in contracted service of family physicians in suburban Beijing, and analyze its influencing factors from residents′ perspectives to propose countermeasures. Methods A total of 197 contracted residents were sampled from 12 community health service centers in 4 out of 10 suburb districts of Beijing, for a questionnaire survey using stratified random sampling method. Items of the questionnaire cover residents′knowledge of the family physicians′ contracted service, their trust of family physicians′ competence, and their trust level of the ethics and the influencing factors. Measurement data were calculated form the mean value, while the count data were subject to proportion analysis, frequency description and rank ordering. Results 175(88.8% )and 156(79.2% )of the contracted residents trust the ethics and competence of their family physicians. Whether the ethics trust exists between doctors and patients was decided by if residents′respect, care, and interests considerations taken into account by the physicians; the factors influencing the competence trust of the residents were the age, education of the residents, and whether the physicians display respect, care. Conclusions Upgrading the medical competence and ethical conduct is conducive to the establishment of doctor-patient trust. In the establishment of the family physicians contracted service, it is necessary to improve acceptance of the contracted residents. At the same time, medical ethics issues such as respect for care, privacy protection, and maximum interests of the residents in the process of medical treatment deserve further attention.

Based on management ethics,this paper explored the related ethical problems in the development of family doctor'netting services,and put forward the ethical principles that should be obeyed.In addition,this paper pointed out the corresponding countermeasures and suggestions from the perspective of management ethics.In view of nation,society,and individual,it analyzed the countermeasures in order to make this service develop more standardly and thus to better service for people's health and building a healthy medical environment for doctor-patient harmony,mutual trust and win-win situation.

Objective:To explore the pathogenic genes, clinical characteristics and treatment follow-up of children with congenital long QT syndrome (LQTS).Methods:Clinical data of 20 cases diagnosed with congenital LQTS and underwent gene testing from April 15, 2011 to April 15, 2021 in Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University were retrospectively collected and analyzed using independent sample t-test and Fisher′ s exact probability method. Results:LQTS-related gene mutations were detected in all the 20 cases, and pathogenic or suspected pathogenic mutations were identified in 18 cases (90.0%). Five LQTS mutation genes were discovered, including KCNQ1, KCNH2, SCN5A, CACNA1C and AKAP9.Eighteen cases (90.0%) had positive symptoms, and 13 cases (65.0%) had definite inducements.The inducement of symptoms in children with LQTS type 1(LQT1) was related to exercise, the causes of syncope in LQT1 and Jervell-Lange-Nielsen syndrome type 1 (JLNS1) with complex heterozygous mutations were exercise or emotional agitation; the causes of syncope in LQTS type 2 (LQT2) were unrelated to exercise; severe exercise in LQTS type 3 (LQT3) resulted in symptoms; and seizure in LQTS type 8 (LQT8) was non-induced.The corrected QT(QTc) interval of 20 cases was (553.1±66.6) ms, with a range of 460-707 ms, among which 17 cases showed QTc≥480 ms.The electrocardiogram(ECG) manifestations of children with various types of LQTS were different.There was no significant difference in QTc between different genders, or between children with syncope and those without syncope (all P>0.05). The follow-up time was (3.4±2.3) years, ranging from 0 to 8.3 years.Seventeen children received treatment[beta blockers and implantable cardiovertor-defibrillator(ICD)] and 3 cases did not.By the end of the follow-up, 1 child died, 19 cases survived, and 2 cases of the surviving children lost consciousness. Conclusions:There is a high consistency between genetic diagnosis and clinical diagnosis of congenital LQTS.The positive rate of gene detection is 90.0%.The clinical manifestations and ECG characteristics vary with genotypes.Beta blockers are protective.ICD therapy can prevent sudden cardiac death when oral medication does not respond.

Objective To evaluate the safety and efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV)in the treatment of the children with pulmonary stenosis (PS),and to observe the long - term prognosis and analyze the influencing factors. Methods The total of 230 children were collected,who had been diagnosed with pul-monary valve stenosis and had undergone percutaneous balloon pulmonary valvuloplasty between November 1987 and November 2015 in Shandong Provincial Hospital Affiliated to Shandong University. Their ages ranged from 4 months to 17 years,and the follow - up duration lasted from 1 month to 29 years. The data included clinical data and long - term follow - up data of hospitalized children,and the echocardiography data from the healthy peers in the same period. Then the data were analyzed statistically. Results In this study,228 cases of children were successfully performed PBPV, and the success rate was 99％(228 / 230 cases). The pulmonary transvalvular gradient (△P)of preoperation,24 hours postoperatively,half a year postoperatively,2 years postoperatively,5 years postoperatively,and 10 years postope-ratively was (63. 5 ± 23. 8)mmHg (1 mmHg = 0. 133 kPa),(26. 2 ± 11. 1)mmHg,(24. 8 ± 9. 8)mmHg,(20. 9 ± 8. 9)mmHg,(18. 1 ± 8. 7)mmHg,(15. 3 ± 7. 3)mmHg and (15. 3 ± 7. 3)mmHg,respectively. The immediate post-operative △P was significantly lower than that of preoperation (P < 0. 01),and the △P of the most children decreased in the long - term follow - up. The results of Logistic regression analysis showed that valve dysplasia with right ventricu-lar outflow tract stenosis and the immediate postoperative residual transvalvular gradient degree were the risk factors for long term curative effect of PBPV in children who could not reach the best standard. The restenosis rate was 4. 6％(3 /65 cases)with children followed up for more than 10 years. The incidence of long - term follow - up pulmonary valve regurgitation (83％)was significantly higher than that before operation (58％)and short term (68％)after operation, and the degree of regurgitation also increased (P < 0. 05),while the degree of regurgitation of the tricuspid regurgitation decreased gradually during the follow - up (P < 0. 05);the right ventricular diastolic diameter of the patients at 10 years or more after the operation was measured as (19. 27 ± 3. 03)mm,which was significantly higher than that (15. 24 ± 2. 89)mm of the healthy children of at the same term healthy age (P < 0. 05). Conclusions The PBPV has a high success rate in the treatment of children with PS,and it has good medium - long - term curative effect,less com-plications and lower restenosis rate. Therefore,PBPV can be used as the first choice for PS. However,the incidence and degree of pulmonary regurgitation has an increasing trend after PBPV and the right ventricular diastolic diameter is still larger than that of the healthy children. Therefore,the long - term follow - up is necessary out of the hospital.