Objective To evaluate the effect of fast track surgery nursing on percutaneous lumbar diskectomy. Methods A total of 126 patients were randomly divided into the control group and the experimental group,the control group received traditional nursing plan, the experimental group was given fast track surgery nursing plan. The nursing effect was observed. Results Postoperative anal exhaust time, feeding time, walking time, length of hospital stay ofthe experimental group were (1.61±0.71) days, (2.01±0.71) days, (4.70±2.12) days, (12.72±2.07) days, whichwere significantly shorter than those of the control group, which were (3.37±0.93) days, (2.27±0.63) days, (8.40±3.21) days, (15.81±2.14) days, the difference between two groups were statistically significant (t=4.012-6.068, P<0.05). The incidence of complications was 11.1%(7/63) in the experimental group, which was lowercompared with the control group, 23.8% (15/63), the difference between two groups was statistically significant(χ2=6.639, P < 0.05). Curative effect of the experimental group was 90.4% (57/63), which was significantly higher than that of the control group, 85.7% (54/63), the difference between two groups was not statistically significant (χ2=1.460,P>0.05). The Rdand Morris Questionnaire score of the experimental group was 21.67±3.48, which was higher than that of the control group(14.43 ± 2.01), the difference between two groups was statistically significant(χ2=6.077, P <0.05). Conclusion Fast track surgery nursing can promote the patient's postoperative rehabilitation ,reduce the postoperative complications, shorten the length of hospital stay and improve the quality of life.

Objective:To explore the clinical characteristics and risk factors of influenza virus complicated with gram-positive bacterial infection in children.Methods:The clinical data of children with influenza virus complicated with gram-positive bacterial infection hospitalized at Shenzhen Children′s Hospital affiliated to China Medical University from January 2013 to December 2019 (observation group) were retrospectively studied.During the same period, 110 hospitalized children with influenza virus infection without co-infection were selected as the control group.The clinical data of the children in two groups were analyzed.Logistic regression analysis was used to analyze the risk factors of influenza virus complicated with gram-positive bacterial infection.Results:There were 108 children in the observation group, including 68 boys and 40 girls, with the age of(2.6±1.8)years, and 100(92.6%) children under 5 years old.Incidence month distribution: 61 cases from January to March, 15 cases from April to June, 13 cases from July to September, and 19 cases from October to December.In the observation group, 73 cases were infected with influenza A virus, 35 cases were infected with influenza B virus, 94(87.0%)cases were complicated with Streptococcus pneumoniae infection, 11 cases with Group A Streptococcus infection and 8 cases with Staphylococcus aureus infection.And 15 (13.9%) cases had underlying diseases.None of the patients in the observation group received pneumococcal conjugate vaccine, and two cases received influenza vaccine within one year.There were 110 children in the control group, including 57 boys and 53 girls, with the age of (5.0±2.4)years old.There were 80 cases of influenza A virus infection and 30 cases of influenza B virus infection.Four cases had underlying diseases, six cases received 13-valent pneumococcal conjugate vaccine and 12 cases received influenza vaccine within one year.Compared with the control group, the children in the observation group were younger[(2.6±1.8)years vs.(5.0±2.4) years, χ2=-7.935, P<0.001], had more underlying diseases[13.9%(15/108)vs.3.6%(4/110), χ2=7.200, P=0.007], less proportion of influenza vaccine[1.9%(2/108)vs.10.9%(12/110), χ2=7.439, P=0.006], the hospitalization time was longer[6(5, 7)d vs.4(3, 5)d, Z=-7.278, P<0.001], and mone cases of first use of neuraminidase inhibitors(NAI) for more than 48 hours[75.9%(82/108)vs.14.5%(16/110), χ2=82.971, P<0.001]. In the observation group, there were 97 culture-positive specimens of Streptococcus pneumoniae, including 89 of sputum/bronchoalveolar lavage fluid, five of blood culture and three of cerebrospinal fluid.All Streptococcus pneumoniae were resistant to erythromycin and clindamycin; the resistance rates of non-meningitis Streptococcus pneumoniae to ceftriaxone, cefotaxime and penicillin were 7.7%, 5.5% and 1.1%, respectively, and all the strains were sensitive to vancomycin, linezolid and levofloxacin.All patients in the observation group were treated with NAI and antibiotics, 37 cases were treated with bronchoalveolar lavage, 27 cases were admitted to pediatric intensive care unit, 10 cases were treated by non-invasive continuous positive airway pressure ventilation, and 17 cases received mechanical ventilation; 6 cases died.Logistic regression analysis showed that underlying diseases, unvaccinated with influenza and (or) pneumococcal vaccine, and the first use of NAI>48 hours were risk factors for influenza virus complicated with gram-positive bacterial infection. Conclusion:Influenza virus complicated with gram-positive bacterial infection can aggravate the illness and even death of children.Early identification of gram-positive bacterial infection, timely treatment of NAI and antibiotics, and active control of complications could be helpful to improve the cure rate.Strengthening influenza and pneumococcal vaccine during flu season can help reduce infection.

Objective:To explore the clinical characteristics and risk factors of influenza-related deaths in children and to raise awareness of the disease among clinicians.Methods:Clinical data of 31 influenza-related deaths hospitalized in Pediatric Intensive Care Unit (PICU) of Shenzhen Children′s Hospital from January 2009 to December 2019 (death group) were retrospectively analyzed. A control group enrolled 188 patients with severe influenza who were successfully cured and hospitalized in PICU at the same time. Independent Student′s t test, Mann-Whitney U test and chi square test were used to compare the general conditions, clinical manifestations, laboratory tests and antiviral therapy between two groups. Risk factors of mortality in children with severe influenza were identified by multivariate Logistic regression. Results:In a total of 219 cases with severe influenza, 31 cases progressed to influenza-related deaths, 19 males and 12 females, with age of (4.2±3.3) years; 29 cases had influenza A virus infection and 2 cases had influenza B virus infection. Deaths occurred more in winter and spring (23/31). Eight patients had underlying diseases. In 188 patients who were successfully cured, 138 were males and 50 females, with an average age of (3.4±2.7)years. There were 151 patients with influenza A virus infection, and 37 patients with influenza B virus infection. Twenty patients underlying diseases. None of the patients in the death group has received the influenza vaccine within 1 year before infection. Common symptoms were fever ( n=31), cough ( n=21), and seizures ( n=17) in the death group. The complications were influenza associated encephalopathy (IAE) ( n=17), pneumonia ( n=17), plastic bronchitis ( n=1), air leak syndrome ( n=3), acute respiratory distress syndrome (ARDS) ( n=8), and multiple organ dysfunction syndrome ( n=24). In the death group, 13 patients had secondary infections, of whom 9 cases had gram-positive Cocciinfection. Complete blood count of the patients showed that white blood cells count increased in 15 cases and the lymphocyte count decreased in 13 cases. Meanwhile, high sensitivity C-reactive protein increased in 18 patients. All the 31 patients in the death group were treated with neuraminidase inhibitors for antiviral therapy, of whom 24 cases received the first dose 48 h after fever (late neuraminidase inhibitor (NAI) treatment). The causes of death in 31 patients were further analyzed, including 23 cases died of influenza complications, 4 cases died of underlying diseases and 4 cases died of secondary infections. Compared with the control group, the death group had more underlying diseases (25.8% (8/31) vs.10.6% (20/188), χ2=4.215, P=0.040), higher incidence of secondary infection (41.9% (13/31) vs.20.2% (38/188), χ2=7.029, P=0.008), and more late NAI treatment (77.4% (24/31) vs. 53.7% (101/188), χ2=6.099, P=0.014). Logistic regression analysis showed that secondary infection, late NAI treatment, complicated with ARDS and IAE were risk factors for death of patients with severe influenza (all P<0.05). Conclusions:Influenza can cause multi-system disorder, especially lung infections and IAE. It can improve the success rate of treatment for children with severe influenza, identification and early treatment of secondary infection and complications, and timely administration of NAI treatment.

Objective: To analyze the blood pressure changes of adults aged 18-59 years in rural area of Shanxi province based on a cohort study, and provide reference for the study of the blood pressure level of rural residents and hypertension prevention and control in rural areas in China. Methods: Data were obtained from Shanxi Nutrition and Chronic Disease Family Cohort from 2002 to 2015. Subjects aged <18 years or ≥60 years and individuals with hypertension at baseline survey in 2002, and those who had taken antihypertensive drugs for nearly two weeks during the follow-up survey in 2015 were excluded from the study. A total of 1 629 subjects aged 18-59 years were included in the analyses of the blood pressure level and its change from the baseline survey in 2002 to follow-up survey in 2015. Results: The systolic blood pressure (SBP) of the subjects increased from (122.7±10.4) mmHg in 2002 to (132.8±17.6) mmHg in 2015 and the diastolic pressure (DBP) increased from (72.7±6.9) mmHg in 2002 to (78.8±10.3) mmHg in 2015. The SBP in men and women increased with growth rates of 6.7% and 9.5%. While DBP in men and women increased with growth rates of 9.3% and 7.8%. The SBP levels of those aged 18-, 30-, 40- and 50-59 years increased with growth rates of 5.0%, 6.7%, 9.4% and 11.8%. While the DBP of these age groups increased with growth rates of 12.2%, 8.2%, 8.2% and 6.5%. Conclusions The blood pressure of adults aged 18-59 years old in rural area of Shanxi showed a substantially increasing trend. The mean increase level of SBP in women was higher than that in men, and increased with age. While the mean increase level of DBP in men is higher than that in women, and decreased with age.