Introduction: Little is known about the sero-prevalence of diphtheria anti-toxoid antibody levels among medical students in Malaysia. They too, just like other health care workers (HCWs) are at risk of contracting and transmitting diphtheria. Fortunately, this can be prevented by giving a specific vaccine: the diphtheria, tetanus and pertussis (DTP) vaccine. Nonetheless, data from local or regional surveys are needed before any decision is made by the respective authorities. General objective: We studied the epidemiology of diphtheria anti-toxoid antibody levels and vaccination history amongst medical students and staff in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Specific objectives: We determined the level of diphtheria anti-toxoid antibodies amongst pre-clinical students and staff. Methodology: A total of 152 sera were collected from subjects aged 19 to 63, and diphtheria anti-toxoid levels were measured by an enzyme-linked immunosorbent assay. Results: One hundred and fifty-two (94.4%) blood samples out of 161 participants were successfully withdrawn, which comprised 105 (69.1%) and 47 (30.9%) medical students and staff, respectively. A total of 77.6% and the other 22.4% of the subjects had full and basic protection, respectively. Higher levels were predominant amongst males and they were 1.3 times more protected than females in 20-29 year-old group (85.1% vs 66.2%; odd ratios 1.25 [95% CI 1.03-1.50]; P=0.03). No significant difference in the levels of immunity among subjects for ethnicity and academic position (P>0.05). Recommendations: Level of full protection against diphtheria toxin should be clearly defined by broad population based studies using several comparable detection methods. Medical students and staff with basic protection should be closely monitored or should be given a booster dose for those who are at high risk of acquiring the disease. Thus, a standard degree of coverage should be clearly determined for health workers to prevent a potential outbreak. Conclusion: Students and staff possess immunity towards diptheria toxin however the level of full protective antibody is yet to be determined in future.

AIM To observe the curative effects of Modified Buzhong Yiqi Decoction (Codonopsis Radix,Astragali Radix,Atractylodis macrocephalae Rhizoma,ect.) on perioperative period of intertrochanteric fractures in elderly patients with Qi deficiency and blood stasis type.METHODS One hundred and twenty cases of elderly intertrochanteric fractures were randomly divided into treatment group and control group,60 cases in each group.All patients underwent closed fracture reduction and proximal femoral nail anti-rotation (PFNA) fixation.During the perioperative period,the control group only received conventional treatment,while the treatment group received conventional treatment and Modified Buzhong Yiqi Decoction once a day.The levels of interleukin-6 (IL-6),interleukin-10 (IL-10) and tumor necrosis factor (TNF-α) of both groups in preoperative and in the 1st day,the 7th day,the 14th day of postoperative were observed and compared.The complications and the curative effects according to the Harris score also were observed and compared between the two groups.RESULTS In preoperative,there was no significant difference in levels of IL-6,IL-10 and TNF-α between the two groups (P ＞ 0.05).The levels of IL-6 and TNF-α in the 1 st day of postoperative in the control group were significantly higher than those in the treatment group (P ＜0.05,P ＜0.01).And the levels of IL-10 were similar between the two groups (P ＞0.05).In addition,in the 7th day and the 14th day of postoperative,the levels of IL-6,IL-10 and TNF-α in both groups were all decreased,moreover,the descent degree in treatment group was more significant than those in the control group (P ＜ 0.05,P ＜ 0.01).The treatment group had the lower incidence of complications and the higher curative effects than those in the control group,both differences were statistically significant (P ＜0.05).CONCLUSION Modified Buzhong Yiqi Decoction applying to the perioperative period of femoral intertrochanteric fractures in elderly patients with Qi deficiency and blood stasis,can effectively reduce the perioperative inflammatory response,reduce the incidence of postoperative complications,and improve the curative effects.So it has a positive effect on the rehabilitation for the traumatic patients and is worthy of clinical promotion.

Objective:To study therapeutic effect of levosimendan combined milrinone on severe refractory heart failure (SRHF) and its influence on serum levels of brain natriuretic peptide (BNP) and uric acid (UA).Methods:A total of 156 SRHF patients were enrolled,randomly and equally divided into levosimendan group and milrinone group,both groups re-ceived corresponding medication based on routine treatment for 7d.Heart rate,blood pressure,serum BNP and UA levels,left ventricular end-systolic dimension (LVESd),left ventricular end-diastolic dimension (LVEDd) and left ventricular e-jection fraction (LVEF) before and after treatment,total effective rate and incidence of adverse reactions were observed and compared between two groups.Results:Compared with milrinone group after treatment,there were significant reduc-tions in heart rate [ (73.79 ± 7.61) beats/min vs.(70.39 ± 7.45) beats/min],systolic blood pressure [ (128.84 ± 13.11) mmHg vs.(121.86 ± 12.53) mmHg],scores of lung wet rales [ (2.05 ± 0.33) scores vs.(1.53 ± 0.21) scores],difficulty breathing [ (2.11 ± 0.36) scores vs.(1.60 ± 0.25) scores] and lower extremity edema [ (2.03 ± 0.34) scores vs.(1.50 ± 0.18) scores],serum levels of BNP [ (459.62 ± 46.27) μg/L vs.(248.73 ± 25.91) μg/L] and UA [ (355.97 ± 36.47) μmol/L vs.(282.75 ± 28.61) μmol/L],LVESd [ (41.62 ± 4.52) mm vs.(36.87 ± 3.71) mm] and LVEDd [ (51.89 ± 5.37) mm vs.(47.85 ± 4.83) mm],and significant rise in 24h urine volume [ (3204.59 ± 321.52) ml vs.(3695.78 ± 370.62) ml] and LVEF [ (42.36 ± 4.31)% vs.(47.85 ± 4.86)%] in levosimendan group,P＜0.01 all.Total effective rate of levosimendan group was significantly higher than that of milrinone group (89.74% vs.71.79%),and incidence rate of adverse reactions was significantly lower than that of milrinone group (5.13% vs.28.21%),P＜0.01 both.Conclusion:Levosimendan therapy can significantly reduce serum BNP and UA levels,improve cardiac function in SRHF patients.It possesses significant therapeutic effect,and it＇s safe and reliable,which is better than milrinone.

Objective :To explore plasma expression levels of human maternal expression gene 3 (MEG3) and urotheli-al carcinoma antigen 1 (UCA1) in patients with acute myocardial infarction (AMI) and their clinical significance . Methods : A total of 90 AMI patients treated in our hospital were enrolled as AMI group ,and 50 healthy subjects un-dergoing physical examination in our hospital simultaneously were treated as healthy control group .Plasma expres-sions of MEG3 and UCA1 ,serum levels of creatine kinase isoenzyme MB (CK-MB) and cardiac troponin I (cTnI) were observed and compared between healthy control group and AMI group on 1h ,3h ,6h and 12h after onset . Spearman correlation analysis was used to analyze their correlation .Results : Compared with healthy control group , there was significant rise in plasma MEG3 expression [ (0-002 ± 0-001) vs .0-017 ± 0-003)] ,and significant reduc-tion in UCA1 expression [ (0-027 ± 0-005) vs .(0-017 ± 0-002)] in AMI group on 1h after onset , P＝0-001 both ;after 3h ,there were significant rise in serum levels of CK-MB [ (20-01 ± 3-05) IU／L vs.( (32-10 ± 4-40) IU／L] and cTnI [ (1-01 ± 0-87) ng／L vs.(2-10 ± 0-91) ng／L] in AMI group , P＝0-001 all.Spearman correlation analy-sis indicated that in plasma MEG3 expression was significant positively correlated with serum CK-MB and cTnI levels ( r＝0-351 ,0-368 , P＜0-05 both) ,and plasma UCA1 expression was significant inversely correlated with serum levels of CK-MB and cTnI (r＝ －0-416 ,－0-425 , P＜0-01 both) AMI patients .Conclusion : Plasma MEG3 level significant rises ,and UCA1 level significantly reduces in AMI patients during early onset period .Both are signifi-cantly correlated with CK-MB and cTnI levels ,which may be used as new markers diagnosing early AMI .

INTRODUCTION: Nail psoriasis treatment is challenging due to difficult drug delivery and systemic therapy toxicities. Self-dissolvable microneedle patches embedded with corticosteroids offers a potentially rapid, minimally invasive drug delivery platform with good efficacy and minimal adverse side effects. METHODS: We conducted a 4-month prospective randomised controlled trial. Subjects with psoriatic nails were randomised to receive microneedle device delivered topical steroids on one hand and control treatment (topical Daivobet gel) on the other. Two independent dermatologists blinded to the treatment assignment scored their Nail Psoriasis Severity Index (NAPSI) during visits at baseline, 2 and 4 months. All treatment was discontinued after 2 months. Average NAPSI score on each hand was analysed. RESULTS: A total of 25 participants were recruited, aged 22 to 73 years. Majority were Chinese (72%), followed by Indian and Malay. There was equal randomisation of treatment to the left and right nail. While there was a rapid significant improvement in average NAPSI score for the control arm at 2 months, the treatment arm had a greater, more sustained improvement of the NAPSI score at 4 months. The average NAPSI score improved for both treatment and control group at 4 months compared to baseline. However, only the NAPSI value improvement in the controls at 2 months compared to baseline was statistically significant (P=0.0039). No severe adverse effects were reported. CONCLUSION To the best of our knowledge, this is the first prospective randomised control trial comparing microneedle technology against conventional topical steroids in nail psoriasis treatment. Our findings demonstrate microneedle technology is as efficacious as topical therapy.
Humans ; Nail Diseases/drug therapy* ; Nails ; Prospective Studies ; Psoriasis/drug therapy* ; Triamcinolone

OBJECTIVEUse sagittal reconstruction CT to verify the surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL).

METHODSA retrospective study of 161 patients (106 males and 55 females) who had undergone surgery for OPLL from July 2007 to November 2010 was performed. The mean age at surgery was 54.5 years (range from 26 to 77 years). The mean follow-up period was 28 months (12 - 54 months). There were 40 patients accept anterior approach surgeries (anterior group) which include 14 cases of anterior cervical corpectomy and fusion and 26 cases of anterior cervical discectomy and fusion. There were 120 patients accept posterior approach surgeries (posterior group) which was spinous process-splitting laminoplasty for cervical myelopathy using coralline hydroxyapatite. One patient accepted combined anterior and posterior approach. According to the sagittal reconstruction CT, the main reason for spinal cord compression was cervical disc herniation in anterior group, and OPLL in posterior group. The level of spinal cord compression was 1 to 2 levels in anterior group, and 1 to 5 levels in posterior group with a major of 2 to 4 levels. As the classification of OPLL, segmental type and circumscribed type were major of segmental type in anterior group and all of the four types were in posterior group, the distribution of each type was average. The patients of posterior group were classified into two groups according to the modified K-line classification, and clinical results were compared between the two groups. The modified K-line was defined as a line that connects the midpoints of the spinal canal at C(2) and C(7) on sagittal CT myelography. Compression to the spinal cord did not exceed the K-line in the modified K-line(+) group and did exceed it in the modified K-line(-) group. Clinical data were compared using t-test or χ(2) test. Correlation analysis was used to determine the relationships of C(2)-C(7) angulation between sagittal reconstruction CT and neutral position X-ray.

RESULTSThe patient of anterior group had better recovery rate of the JOA score (72% ± 27%) than the posterior group (59% ± 35%) at the latest follow-up (t = 2.238, P = 0.027). In posterior group, the patients of modified K-line(+) group had better recovery rate of the JOA score (63% ± 37%) than the K-line(-) group (49% ± 30%) at the latest follow up (t = 2.150, P = 0.034). The C(2)-C(7) angulation on sagittal reconstruction CT was 11° ± 9° which has significantly correlated with the C(2)-C(7) angulation on neutral position X-ray which was 10° ± 10° (r = 0.947, P < 0.01).

CONCLUSIONSConsidering the selection of surgical approach, it should be combined with the main clinical diagnosis for spinal cord compression, the level of compression, the classification of OPLL and the kyphotic alignment of the cervical spine. The modified K-line is a simple and practical tool for making decisions regarding the surgical strategy for cervical OPLL patients.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnostic imaging ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo investigate the correlation between different Chinese medicine (CM) syndromes and variations in microcirculation in septic shock patients.

METHODSseventy Septic shock patients were divided into four groups: heat damaging qi-yin group (HDQY, 23 cases); yin exhaustion and yang collapse group (YEYC, 26 cases); excessive heat in Fu organ group (EHFO, 10 cases); and heat damaging nutrient-blood group (HDNB, 11 cases). Sublingual microcirculation parameters were observed by sidestream dark-field (SDF) imaging and scored by Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA), and parameters of microcirculation perfusion variations and prognoses were analyzed.

RESULTSCompared with those with qi-yin heat damage, perfused vessel density (PVD) in other groups decreased dramatically (P<0.05), and APACHE II scores increased significantly (P<0.05). In addition, the recovery time was prolonged substantially (P<0.05), and the mixed venous oxygen saturation (SVO2) decreased (P<0.05). Blood lactic acid increased significantly (P<0.05), and the mixed SVO decreased (P<0.05), in the YEYC group. Compared with the thermal injury camp blood group, sublingual microcirculation parameter variations showed no obvious difference in the YEYC and EHFO groups (P>0.05). There were significant positive correlations between CM syndromes and APACHE II scoring in different groups (r=0.512, P<0.05). There were negative correlations between PVD and APACHE II scoring (r=-0.378, P=0.043), the proportion of perfused vessels (PPV) and APACHE II scoring (r=-0.472, P=0.008), as well as between the microvascular flow index (MFI) and APACHE II scoring (r=-0.424, P=0.023) in different patients.

CONCLUSIONSublingual microcirculation may serve as a clinical diagnostic parameter of the patient condition, as well as being a prognostic indicator.

Aged ; Dopamine ; therapeutic use ; Dose-Response Relationship, Drug ; Female ; Hemodynamics ; Humans ; Male ; Medicine, Chinese Traditional ; Microcirculation ; physiology ; Middle Aged ; Mouth Floor ; blood supply ; physiopathology ; Perfusion ; Shock, Septic ; blood ; drug therapy ; mortality ; physiopathology ; Syndrome

Methods: Patients with congenital scoliosis who underwent SSPPCF using a pedicle screw system were reviewed. We identified the following three surgical indications: (1) hemivertebra or wedge vertebra over the thoracic or thoracolumbar region with structural lumbar curves, (2) hemivertebra or wedge vertebra at the lumbar region with significant pelvic obliquity or sacral slanting, and (3) mixed or complex congenital scoliosis. The demographic, perioperative, and radiographic data of these patients were collected. Results: Thirty-four patients were reviewed. The mean patient age was 14.6±3.4 years. There were 13 hemivertebrae, three wedged vertebrae, two butterfly vertebrae, three hemivertebrae with butterfly vertebra, eight unsegmented bars, and five multiple complex lesions. The average surgical duration was 219.4±68.8 minutes. The average blood loss was 1,208.4±763.5 mL. Seven patients required allogeneic blood transfusion. The mean hospital stay duration was 6.1±2.5 days. The complication rate was 11.8% (4/34): one patient had severe blood loss, one had rod breakage, and two had distal adding-on. The Cobb angle reduced from 65.9°±17.4° to 36.3°±15.3° (p<0.001) with a correction rate (CR) of 44.8%±17.4%. The regional kyphotic angle decreased from 39.9°±20.5° to 27.5°±13.9° (p=0.001) with a CR of 19.3%±49.6%. Radiographic parameters (radiographic shoulder height, clavicle angle, T1 tilt, cervical axis, pelvic obliquity, coronal balance, and apical vertebral translation) showed significant improvement postoperatively. Conclusions SSPPCF was a feasible option for adolescent patients with congenital scoliosis who were skeletally matured.

This paper reviewed the present nursing manager succession planning at home and abroad, covering the succession standard of nursing managers, the content and form of pre-job training, and the evaluation tool of management ability. These efforts aim to provide references for the construction of nursing management talents teams in China.

Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.