Objective To investigate the correlation between dynamic changes in esophageal impedance and dilated intercellular space (DIS) of patients with acid-induced non erosive reflux disease (NERD).Methods From September 2013 to July 2014,a total of 35 patients with NERD and 20 healthy controls were selected and underwent 24 h multichannel intraluminal impedance and pH monitoring (MII-pH monitoring),acid perfusion test and gastroendoscopy examination.One piece of mucosa tissue was taken under gastroendoscope from the anterior and posterior walls at 2 cm above the dentate line of the esophagus.Intercellular space (ICS) of the esophageal epithelia cells was measured by software after hematoxylin and eosin staining.t test and variance analysis were performed for statistical analysis.Pearson correlation analysis was used for correlation analysis.Results Impedance baseline of distal esophagus and impedance recovery rate of patients with NERD were lower than those of healthy control group,which were (2 998±701) Ω vs (3 880±1 054) Ω and (30.1±14.0) Ω/min vs (53.0±14.5) Ω/min,and the differences were statistically significant (t=3.65,5.41;both P＜0.01).Compared with healthy control group,ICS of the esophageal epithelial cells was obviously wider (1.03 ± 0.20) μm vs (0.66±0.14) μm,and the difference was statistically significant (t=-6.57,P＜0.01).Impedance baseline of esophagus and impedance recovery rate of patients with positive acid perfusion test were lower than those of patients with negative acid perfusion test,which were (2 755±680) Ωvs (3 411±536) Ω and (25.4±13.0) Ω minvs (33.4±9.8) Ω /min,and the differences were statistically significant (t =2.99,2.03;both P＜0.05).The correlation between impedance recovery rate and ICS was negative (r=-0.70,P＜0.01).Conclusions Recurrent reflux induced injury and delayed mucosal headline may be the factors of impaired mucosal integrity in patients with NERD.The changes esophageal of impedance baseline to a certain extent reflected the degree of esophageal mucosal integrity impairment.

Objective: To analyze diagnosis rate of chronic kidney disease (CKD) in hospitalized pediatric patients in a single center and understand pediatricians′ awareness of CKD. Methods: This was a cross-sectional study. Children who were admitted to the Division of Pediatric Nephrology, Peking University First Hospital from January 1, 2008 to December 31, 2017 and met the diagnostic criteria of CKD (kidney disease: improving global outcomes 2012 guideline) were recruited. A total of 4 472 cases were enrolled. Original CKD diagnosis was collected from the home page of medical records. Actual CKD diagnosis was validated and corrected by reviewing medical records and recalculating glomerular filtration rate. The diagnosis rate and influencing factors of pediatric CKD, the distribution and etiology of actual CKD were analyzed. The comparison between groups were performed with χ² test. Results: In 4 472 cases, there were 3 470 cases in actual CKD stage 1, among which only 24 cases were in original CKD stage 1. There were 543 cases in actual CKD stage 2-3, among which only 181 cases were in original CKD stage 2-3. Three hundred and one cases were in actual CKD stage 4-5, including 290 cases in original CKD stage 4-5. In addition, there were 43 cases with unknown CKD stage and 115 cases with acute kidney injury. Compared to original CKD diagnosis, the diagnosis rates of CKD stage 1-5 were 0.7% (24/3 470), 16.7% (58/348), 63.1% (123/195), 90.7% (78/86) and 98.6% (212/215), respectively. The proportions of actual CKD stage 1-5 were 80.4% (3 470/4 314), 8.1% (348/4 314), 4.5% (195/4 314), 2.0% (86/4 314) and 5.0% (215/4 314). The etiology of actual CKD included primary glomerular disease (62.2%, 2 686/4 314), secondary glomerular disease (19.7%, 849/4 314), hereditary kidney disease (9.1%, 391/4 314), congenital abnormalities of the kidney and urinary tract (CAKUT) (3.1%, 135/4 314), tubulointerstitial disease (2.2%, 94/4 314) and etiology uncertain (2.1%, 89/4 314). The leading cause of end stage renal disease was etiology uncertain (31.1%, 67/215), followed by hereditary kidney disease (24.2%, 52/215), CAKUT (16.3%, 35/215) and primary glomerular disease (16.3%, 35/215). Conclusions Among actual CKD hospitalized pediatric patients, the diagnosis rate of CKD given by physicians at discharge was relatively low, especially patients in earlier CKD stages, which reflected serious lack of physicians′ awareness of CKD.

Objectives To identify ABO blood type from a child having discrepant results in forward and reverse ABO blood grouping by serological identification and genetic testing.Methods After routine serological detection with ABO blood group,the ABO gene and ABO blood group-A subgroup genotype were tested by PCR-SSP method.Results The Serological results showed that the specimen was positive type A (anti-A:1 +w),the reverse type is O type (Ac:2 +,Bc:4 +);PCRSSP A-subtype typing showed that the genotype of the child was Ax14/O2.Conclusion Difficult blood type identification sometimes need to combine serology and molecular biology methods to confirm.In this case,the phenotype of the child was Ax,and the genotype was Ax14/O2.

Objective? To explore the effects of scenario simulation in the teaching of preventing sharp injuries and to evaluate its advantage compared with the traditional teaching method. Methods? Using convenient sampling method, 120 nursing students who practiced in the Operating Room of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2018 to December 2018 were selected and divided into the observation group (n=67) and control group (n=53) according to their batches of practice. In the control group, sharps injury prevention and occupational protection were taught in the classroom by the instructor in the form of theoretical teaching; in the observation group, sharps injury was taught by the instructor in the mode of scenario simulation training; the internship lasted for 4 weeks. After the internship, the positive rate of attitude towards sharps injury protection, the awareness rate of knowledge about sharps injury protection, the score of sharps injury protection behavior, the score of operation examination and the score of theoretical examination were compared between the two groups. Results? The positive rate of protective attitude towards sharps injury was 100% in both groups. The awareness rate of the common protective measures and disposal methods of sharps injury in the observation group was higher than that in the control group, and the difference was statistically significan(t P＜ 0.05). The scoring of dirt treatment, specialist operation and post-injury disposal dimensions in the observation group were higher than that in the control group, and the total score of sharps injury self-protection behavior was higher than that in the control group, the difference was statistically significan(t P＜ 0.05). The results of operation examination in the observation group were higher than those in the control group, but the results of theoretical examination in the observation group were lower than those in the control group, with statistical significance (P＜ 0.05). Conclusions? Applying scenario simulation in the teaching of preventing sharps injury may improve the nursing students' knowledge about sharps injury prevention, enhance their self-protected behaviors and post-injury management abilities,meanwhile, it can improve their specialized operating skills.

Sunburn is an acute phototoxic reaction caused by excessive exposure of skin to solar ultravilet (UV) or artificial UV light sources. Studies show that sunburn is common in the general population, so that associated financial burden cannot be ignored. Meanwhile, sunburn at any age increases the risk of melanoma. Only by clarifying the influencing factors of sunburn can precise preventive measures be formulated. Although many studies have been conducted on the influencing factors of sunburn worldwide, there are great heterogeneity in reported influencing factors. In this paper, by means of systematic review, factors affecting sunburn were sorted out and summarized from four aspects, including demographic and socioeconomic characteristics, photosensitive phenotypes, UV-related environmental factors, and sun protection knowledge, attitude & behavior. Combined with population characteristics and data availability in China, our review provided reference for subsequent research and development of precise prevention and control strategies.