Objective We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal di-alysis ( PD) . Methods In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 ( control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place.Per-itonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. Results In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy.After implementation of the CQI initiative, the peritonitis rate de-clined to 1 episode in 77.3 patient-months from 1 episode in 22.6 patient-months.In the CQI group, the complicance of blood pressure was more significantly improved than the control group ( 67.8% vs 47.4%,P<0.05).During the 3 years of follow-up,cardiothoracic ratio and IVST were significantly increased in the control group [0.55 ± 0.08 vs 0.51 ±0.05,P<0.05,11.07 ±1.66 mm vs 10.25 ±1.38 mm, P<0.05〗.The difference of LVID between the two groups was signifi-cant at the 2nd and 3rd year of follow-up(P<0.05).Patient survival at 1, 2, and 3 years was significantly higher in the CQI group (97.3%, 96.3%, and 96.3%respectively) than in the control group (92.6%, 82.4%, and 67.3%respectively, P<0.001).Imple-mentation of the CQI initiative also appeared to significantly improve technique survival rates:95.6%, 92.6%, and 92.6%in the CQI group compared with 89.6%, 79.2%, and 76.8%in the control group (P<0.001) after 1, 2, and 3 years respectively. Conclusion Integration of a CQI process into a PD program can significantly improve the quality of therapy and its outcomes.

Background: Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery. Methods: We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery. Results: Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation. Conclusions Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.

Background: Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery. Methods: We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery. Results: Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation. Conclusions Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.

Objective:To evaluate the status and influencing factors of psychiatric comorbidities of patients with epilepsy (PWEs) in Hubei province during the outbreak of COVID-19.Methods:From February 23, 2020 to March 5, 2020, a network questionnaire survey (including demographic characteristics, seizures, Generalized Anxiety Disorder Scale-7 score, Patient Health Questionnaire-9 score, Insomnia Severity Index score) was conducted among 570 PWEs who visited the Epilepsy Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology during April 1, 2019 and January 20, 2020. SPSS 22.0 software was used for correlation analysis of sociodemographic characteristics, epilepsy related factors, perceived threat to the COVID-19 and psychiatric comorbidity (depression, anxiety and insomnia) of PWEs during the COVID-19 epidemic.Results:A total of 362 valid questionnaires were included for analysis (the response rate was 63.51%,362/570). Thirty-four (9.4%), forty-seven (13.0%) and seventy-one (19.6%) patients suffered from anxiety, depression and insomnia, respectively. Patients with seizure frequency ≥2 times/month before the epidemic ( OR=3.395,95% CI 1.561-7.384, P=0.002), poor subjective quality of life during the epidemic ( OR=10.753,95% CI 1.938-59.654, P=0.024), and moderate to severe worry about bad impact of the epidemic on epilepsy ( OR=3.077, 95% CI 1.382-6.853, P=0.006) were more likely to be anxious. Patients with poor subjective quality of life during the epidemic ( OR=6.188, 95% CI 1.317-29.079, P=0.021) were more likely to be depressed. Patients with COVID-19 related symptoms ( OR=3.609, 95% CI 1.674-7.778, P=0.001), children ( OR=3.090, 95% CI 1.759-5.431, P<0.001), seizure frequency ≥2 times/month before the epidemic ( OR=1.907, 95% CI 1.017-3.575, P=0.044), and moderate to severe worry about unanticipated seizures ( OR=2.555, 95% CI 1.370-4.764, P=0.003) were more likely to suffer from insomnia. Conclusions:During the COVID-19 epidemic, parts of PWEs suffered from anxiety, depression and insomnia. PWEs with poor subjective quality of life, high frequency of epileptic seizures before the epidemic, excessive worry about bad impact of the epidemic on epilepsy and excessive worry about unanticipated seizures were prone to anxiety, depression and insomnia.

Objective To study the expression of metallothioneiu (MT)and Fas ligand (FasL) in rectal carcinoma and their association with metastasis to lymph node and liver. Methods Immunohistochemistry method and quantitative RT-PCR technique were used to assay the expression of MT and FasL at protein and mRNA levels in 85 cases of rectal carcinoma. The data of each group were compared and analysed by statis-tics. Results The rates of MT expression in primary foci, normal rectal mucosa, lymph node metastasis and hepatic metastasis were 57.3% ,29.6% ,79.5% and 61.8% respectively. And the rates of FasL expression were 45.8%, 17.8% ,63.5% and 90.3%, respectively. The positive rates of MT and FasL in primary foci, hepatic and lymph node metastasis were higher than that in normal mucosa (X~2 =33. 1322,56. 7142,P < 0.01). Among clinical stages, the positive rates of MT and FasL in C and D were higher than that in A and B (X~2 = 18. 8372,21. 5823 ,P <0.01). And higher rates of MT and FasL expression were detected in low differentiation adenocarcinoma and mucus adenocarcinoma than in middle-high differentiation adenocarcino-ma(X~2 = 11.2146,9.3136,P < 0. 05). High MT mRNA level was found in lymph node metastasis and high FasL mRNA level in hepatic metastasis. Conclusions The detection of MT and FasL expression was useful in clinic to predict lymph node metastasis and early diagnosis of liver metastasis of rectal carcinoma respec-tively. Assay of MT and FasL expression has prognostic values for rectal carcinoma patients.

Objective To evaluate the effects of the two different operations, such as open total extraperitoneal herniorrhaphy or traditional anterior approachs on tension-free repair of inguinal hernia. Methods In a prospective randomized controlled study, 165 cases with inguinal hernia were allocated randomly to either the anterior approach group (82 cases)or open total extraperitoneal herniorrhaphy group( 83 cases ).The index including the operation time, hospital stay, mean expense, time for returning to normal activity,and the recent or long-term operative complications and recurrence rate, were observed to evaluate the curative effect of open total extraperitoneal herniorrhaphy approach. Results The follow-up rate were 98.79% ,after (20.52 ± 1.54) months in average follow-up in the anterior approach group and (21.63 ± 1.76) months in the TEP group, and no significant differences were recorded between the two groups in the operation time, hospital stay, time for returning to normal activity, recurrence rate(3.66% vs 1.22% ) and urinary retention ( P > 0. 05 ), but operative complications in TEP group were significantly less than that in anterior approach group (P< 0.05). Conclusions The operative complications or postoperative unwell decrease significantly through the open total extraperitoneal herniorrhaphy approach in repairing inguinal hernias. Its curative effect was confirmed and deserves to be clinically popularized.

Objective This study aimed to explore the clinical value of human papilloma virus ( HPV) E6/E7 mRNA tests in identifying precancerous lesions of the uterine cervix-cervical intraepithelial neoplasia 2 or more CIN2+( CINⅡand CINⅢ).Methods This study is a cross-sectional survey design , between December 2011 to December 2013.The specimens were collected from the First People′s Hospital of Huizhou and the Third People′s Hospital of Huizhou in Department of Obstetrics and Gynecology outpatient and inpatient of cervical disease suspected patients , with thin-prep cytologic test ( TCT ) and histopathological results as reference , detected 345 patients of exfoliated cervical epithelial cells by using the branched DNA (b-DNA) technology to evaluate the application value of high risk HPV E 6 /E7mRNA in the clinical diagnosis of CIN.Using spss 19.0 software for data analysis.Results (1)Compared with TCT, the positive rate of E6/E7 mRNA in 325 samples were grading by cytology as follows: no intraepithelial lesion cells (NILM) 21.1%(40/190), atypical squamous cells (ASC) 38.5%(15/39 ), low-grade squamous intraepithelial lesions ( LSIL ) 76.9% ( 30/39 ) , atypical squamous cells can not exclude high-grade intraepithelial lesions (ASC-H) (8/10), high-grade squamous intraepithelial lesions (HSIL) 72.3%(34/47), TCT grades and HPV E6/E7 mRNA positive rate showed linear association (χ2 =67.654,P<0.01;r=0.497, P<0.01 ); and with HPV E6/E7 mRNA copy number was also relevant ( r =0.511, P <0.01).(2) Compared with pathological results , the positive rate of E6/E7 mRNA in 164 women samples were grading by pathology as follows:with NILM was 27.8%(10/36), with CIN Ⅰwas 65.9%(29/44), with CINⅡwas 80.6%(54/67), and with CINⅢwas 82.4%(14/17), pathological grades and HPV E6/E7 mRNA positive rate showed a linear correlation (χ2 =26.426, P<0.01; r=0.438, P<0.01); and the number of copies correlated with the increase of pathological grades too (r=0.543, P<0.01).(3) Screening effectiveness analysis results showed , the sensitivity of HPV E6 /E7mRNA was 84.6% while TCT was 47.7%.The sensitivity and specificity were 40.0% and 91.1% respectively when HPV E6/E7 mRNA and TCT processed as sequential detection test.The CIN2 +( CINⅡand CIN Ⅲ) best diagnostic critical point of 890.26 copies/ml,was established using receiver operating characteristic ( ROC) curve.The sensitivity and specificity were 58.5% and 93.7%, respectively.Conclusions The sensitivity of HPV E6/E7 mRNA test is better than TCT, the specificity is high in HPV E6/E7 mRNA and TCT processed as sequential detection test.Using the optimal cut-off value of ROC curve to detect CIN 2+has high sensitivity and specificity, so the detection of HPV E6/E7 mRNA may have some clinical value in screening and risk assessment of precancerous lesions of the uterine cervix.

Objective To do research on Multi-points EGFR gene mutation and heterogeneity in lung adenocarcinoma and its influence on the prognosis,to analyze EGFR gene mutation and its heterogeneity influence on patients'overall prognosis.Methods The clinical features of patients with lung adenocarcinoma at stage Ⅲa from January 2006 to January 2007 at our institution were retrospectively reviewed.The primary lung tumors and corresponding metastatic lymph nodes tissue specimens were obtained by surgery.The adenocarcinoma primary nodes and corresponding metastatic lymph nodes EGFR mutation were detected by amplification refractory mutation system (ARMS).Univariate analysis and multivariate analysis by Cox proportional-hazard model were used to analyze the impact of EGFR mutation and its heterogeneity as influential factor on patients 'prognosis.Results 76 patients with the adenocarcinoma primary nodes and corresponding metastatic lymph nodes were detected by epidermal growth factor receptor (EGFR) mutation.40 patients with EGFR mutation were detected (40/76,52.63％).There were 9 specimens out of 40 who had lung primary nodes and corresponding metastatic lymph nodes EGFR gene heterogeneity (9/40,22.5％).Log-Rank univariate analysis showed that there was no significant difference in overall survival period between EGFR mutation patients and wild-type patients(x2 =0.382,P =0.537),but there was significant difference in illnessfree progression period(x2 =4.147,P =0.042).Gene heterogeneity factor does not affect on the overall survival period and illness-free progression period of the patients with EGFR gene mutation (x2 =1.774,P =0.183 ;x2 =1.249,P =0.264).Multivariate analysis by Cox proportional-hazard model showed that EGFR gene mutation is not the independent risk factor that has 赵 impact on the prognosis of patients with lung adenocarcinoma.Conclusion Assessment of EGFR gene mutations in a single-point specimen can not reflect the whole EGFR gene mutation status,which may probably cause difference between targeted drugs'predicted effect and its actual usage effect.

Objective: To study the correlation of occupation musculoskeletal disease (OMD) and safety behavior in assembly line workers. Methods: Selected assembly line workers of 3 manufacturing factory in Pacity as the objects of this study by judgement sampling. Questionnaires were used for messages collection including the general sociodemographic characteristic, OMD condition, occupational safety behaviors. Results: This study shows that, 826 OMD workers were found that the annual prevalence was 38.03%. The scores of work posture, handling habits, health habit in OMD group was lower than non-OMD group (P<0.01) but personal protection behavior was higher than non-OMD group (P<0.01) . Test of binary logistic regression revealed that age, workage, work posture, handling habits were the factors of OMD (P<0.01) . Conclusion Safety behaviors were the potent factors of OMD that work posture and handling habits should be broadcast.

OBJECTIVETo evaluate the association between occupational stress, social support, and occupational unintentional injuries.

METHODSA 1:1 matched case-control study was conducted in 151 cases of occupational unintentional injuries who were admitted to 6 occupational injury-admitted hospitals in Zhongshan City from October 2013 to December 2013 and 151 matched controls without unintentional injuries in the last year who had matched age, sex, and occupation. Their demographic characteristics, occupational stress (by the effort-reward imbalance questionnaire), and social support were investigated with a structured questionnaire.

RESULTSAnalysis of the data showed that there were significant differences in the score of each dimension of occupational stress, the ratio of effort to reward, and the score of superior support between the case group and the control group (P < 0.05). The Cox regression analysis results showed that more extrinsic efforts (OR = 1.47, 95%CI = 1.20∼1.80) and over commitment (OR = 1.30, 95%CI = 1.08∼1.55) were the risk factors for occupational unintentional injuries, while more superior supports (OR = 0.64, 95%CI = 0.48∼0.84) and higher earnings (>3 000 yuan each month) (OR = 0.67, 95%CI = 0.54∼0.84) were protective factors.

CONCLUSIONOccupational stress and social support have an influence on the occurrence of occupational injuries.

Accidents, Occupational ; Case-Control Studies ; China ; Humans ; Occupational Diseases ; epidemiology ; Occupational Injuries ; epidemiology ; Reward ; Risk Factors ; Social Support ; Stress, Psychological ; epidemiology ; Surveys and Questionnaires