Objective To explore the causes of occupational exposure and methods of personal protection from occupational exposure.Methods Twenty seven cases with occupational exposure to HIV hospitalized in our hospital from 2003 to 2008 were analyzed retrospectively.Results Of the 27 cases with occupational exposure to HIV,8 were policemen,4-physicians,12-nurses and 3-laboratory technicians.Of them 4(3 medical workers)were of skin exposure,17(16 medical workers)were injured by sharp devices,and 6(all policemen)were injured by scratch or bite.Post exposure prophylactic interventions were provided for all of them,and no infection was identified after 12 month medical observation.Conclusion Regular training of occupational exposure to HIV for medical workers and judicial staff will be needed.

Objective To evaluate the clinical value of combined detection serum anti-HCG and estradiol and progesterone in infertile women.Methods Serum estradiol(E2) and progesterone(P) in infertile women were detected by ECLIA , Anti-HCG were detected by ELISA.Results the levels of estradiol(E2) and progesterone(P) in anti-HCG positive group were significantly lower than those in anti-HCG negative group.Conclusions The combined detection of anti-HCG and estradiol and progesterone were of important clinical value in diagnosis of infertile women.

[Objective]To study the effects of Caspase-1 specific inhibitor AC-YVAD-CMK on intimal hyperplasia after carotid artery balloon injury in rats and its possible mechanism.[Methods]A total of 33 male adult SD rats were randomly divided into sham group,balloon injury group and balloon injury+AC-YVAD-CMK group. Using the method of balloon injury to establish rat carotid ar?tery intimal hyperplasia animal model,rats were sacrificed and blood vessels were harvested 14 days after operation. Fifteen vascular segments embedded in OCT and the intima to media(I/M)area ratio of neointima was measured by hematoxylin-eosin(HE)staining;18 vascular segments were harvested and the expression of NLRP3 inflammasome,cleaved-Caspase-1,interleukin(IL)-1βand IL-18 were measured by Western blot.[Results]HE staining showed that AC-YVAD-CMK significantly inhibited the degree of intimal hyperplasia compared with the balloon injury group[(0.78 ± 0.13)vs(1.52 ± 0.14);P=0.000]. The expression of NLRP3 inflamma?some was increased in balloon injury group while the AC-YVAD-CMK attenuates the expression of NLRP3(P=0.009);The expres?sion of cleaved-Caspase-1 was in line with the expression of NLRP3(P=0.000). The levels of pro-inflammatory cytokines IL-1βand IL-18 in balloon injury+AC-YVAD-CMK group were significantly lower than those in the balloon injury group(P=0.000).[Conclusion]AC-YVAD-CMK can attenuate intimal hyperplasia after balloon injury of carotid artery in rats,which might be related to its effect on inhibiting the activation of Caspase-1,which could affect the release of pro-inflammatory cytokine of IL-1βand IL-18.

Objective To evaluate the value of endothelial function of brachial artery in predicting coronary artery disease in elderly patients. Methods Flow-mediated vasodilation (FMD)and nitroglycerin mediated dilation (NMD) were measured by high-frequency ultrasound in 98 patients with coronary artery disease and 37 controls. All the subjects were diagnosed by coronary arteriography. They were divided into coronary artery blockages ＜ 50% subgroup, 50%-75%subgroup, ＞75% subgroup or coronary blockages in 0, 1, 2, 3 branch (es) subgroups. The correlations between FMD or NMD and the pathological extent or branches of coronary artery were studied and the predictive value of FMD and NMD were analyzed with ROC curve. Results In coronary artery disease group, FMD and NMD were significantly decreased as compared with the control group. They were closely related with coronary artery disease (r= -0. 54, -0. 52, P＜0.01), and were weakly correlated with severity and range of coronary arterial lesion (P＜0. 01).With ROC curve analysis, FMD and NMD could be used to predict coronary artery disease.Conclusions Endothelial function can be used as an index to predict coronary artery disease.

Objective To describe the feelings,career development needs and the coping styles of stress experience of nurses with master's degree within one year after graduation.Methods The semistructured in-depth interview was conducted in 15 nurses with master's degree individually.The data were analyzed by qualitative content analysis method and the themes were abstractod.Results Three themes were extracted,including feelings,their career development needs and coping styles of stress.The nurses with master's degree reported feelings of heavy work pressure; lack of a sense of accomplishment; strong sense of loss.Their career development needs included improvement of professional knowledge and clinical skills; organizational supports; improvement of professional English and received a doctor' s degree.There were three main coping styles of stress:adjusting attitude and self role orientation; competence improvement; adjusting interpersonal relationship.Conclusions Nursing masters suffer from heavy pressure in clinical practice within one year after graduation.They have some occupation development needs.Nursing managers should explore positive and effective methods to relieve the nurses' stress and ratioually use and actively guide nursing masters,and provide direction and space for achieving their occupation value.

Objective To compare the therapeutic effects of recurrent pterygium treated by with corneal limbal autograft con -junctival transplantation combined with mitomycin C and amniotic membrane transplantation combined with mitomycin C .Methods A total of 153 eyes of 153 cases with recurrent pterygium were divided into 2 groups ,A group :97 eyes who treated with amniotic membrane transplantation combined with mitomycin C ,B group :56 eyes treated with corneal limbal autograft conjunctival trans -plantation combined with mitomycin C ,follow up 12 months after operation .Results 12 eyes had recurrence in A group ,the recur-rent rate was 12 .37% ;5 eyes had recurrence in B group ,the recurrent rate was 8 .93% ,there was no significant different between 2 groups(P> 0 .05) .Conclusion This study indicates amniotic membrane transplantation or corneal limbal autograft conjunctival transplantation combined with mitomycin C can effectively reduce the recurrent rate of recurrent pterygium ,which are safe and ef-fective method .

Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.

Objective To study the effects of different hypertonic saline (4.5%and 7.5%) in fluid resuscitation on hemodynamics in traumatic rabbits with hemorrhagic shock.Methods Thirty-two healthy rabbits ( male or female, 2.0-3.0 kg body weight) were divided into 4 groups randomly:SHAM group, SWT group ( shock without treatment) , 4.5%group (resuscitation with 4.5% hypertonic saline), and 7.5% group ( resuscitation with 7.5% hypertonic saline), 8 rabbits in each group.The rabbit model of uncontrolled hemorrhagic shock was established after anesthesia.The fluid used in the two methods of fluid resuscitation was infused into the rabbits at designed times.The hemodynamic data including the left intraventricular systolic pressure ( LVSP) and maximal change rate of left intraventricular pressure ( ±dp/dtmax) were determined at 0 min, 30 min, 60 min, and 90 min.Results (1) The rabbit models of uncontrolled hemorrhagic shock were generated successfully.At 30 min, data of SWT in the 4.5%and 7.5%groups had no significant difference through pairwise comparison (P>0.05).(2) The hemodynamic parameters changed similarly during the experiment.At 60 min, the values of the 7.5%group ( LVSP=115.00 ±8.37 mmHg, +dp/dtmax=4.29 ±0.50 mmHg/ms, -dp/dtmax=-3.25 ±0.25 mmHg/ms) were significantly higher than those in the 4.5%group ( ( LVSP=104.14 ±7.73 mmHg, +dp/dtmax=3.35 ±0.39 mmHg/ms, -dp/dtmax=-2.27 ±0.12 mmHg/ms) (P<0.05).At 90 min, the data of the 7.5%group were higher, but statistically not significantly different ( P>0.05 ) .Conclusions Fluid resuscitation can improve the hemodynamic function in traumatic rabbits with uncontrolled hemorrhagic shock.Comparing with the 4.5%hypertonic saline, 7.5% hypertonic saline can improve the hemodynamic function more apparently.Our results may provide an experimental support for the treatment of clinical patients with uncontrolled hemorrhagic shock.

OBJECTIVE: To investigate the preservation of the structure and function of the trachea and larynx, the management of laryngotracheal defect when trachea and larynx was involved. METHOD: To review the management and clinical results of 13 cases of thyroid papillary carcinoma with larynx and trachea involvement, the preservation of laryngotracheal structure and relative defect reconstruction of our department from 2007-2014. Those patients being performed total laryngectomy was excluded. 3 males and 10 females, aged from 46 to 67 years old with median age of 53 were included. Among them 8 cases were recurrent. The extent of the tumor foci was estimated with the help of computed tomography and laryngofiberoscope before surgery. Selective neck dissection, total thyroidectomy and related laryngotracheal resection was performed for the first time operation patient, while selective neck dissection, recurrent foci and related larynx and trachea resection was performed for those recurrent patients. Three kinds of modalities were applied to manage the laryngotracheal defect including to reconstruct with pedicled sternocleidomastoid clavicular periosteocutaneous flap, pedicled trapizius muscular flap and to preserve the remaining larynx and trachea and perform a stoma of larynx and trachea which repaired by a second-stage procedure. The patients were followed-up from half an year to 3 years. RESULT: Ten patients out of 13 decannulated while another 3 cases, 2 of which were performed local flap to reduce the stoma, wore tracheal tubes all time. CONCLUSION Either flap transfer or laryngotracheal stoma before second stage repair might preserve partial laryngotacheal anatomy and function in selected cases thus improve the life quality of the patients.
Aged ; Carcinoma ; surgery ; Carcinoma, Papillary ; surgery ; Female ; Humans ; Laryngectomy ; Larynx ; surgery ; Male ; Middle Aged ; Neck Dissection ; Reconstructive Surgical Procedures ; Surgical Flaps ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; Trachea ; surgery

Objective:To observe factors influencing the risk of urinary tract infection (UTI) after cerebral hemorrhage (ICH).Methods:A total of 77 ICH patients undergoing rehabilitation between August 2015 and August 2017 were studied. Among them, 24 were diagnosed with a UTI according to clinical manifestations and urine routine tests and urine culture. They formed the UTI group. The other 53 were the non-UTI group. Complete clinical evaluations were available for all 77, and those data were used to identify risk factors for UTI using univariate and multivariate logistic regression analysis.Results:The univariate analysis showed that age, side of paralysis, consciousness dysfunction, Brunnstrom staging of the lower extremity, tracheotomy, indwelling catheter, lung infection, white blood cell count, neutrophil percentage, serum natrium, uric acid, D-dimer level and fibrinogen were all significant predictors of UTI. The multivariate analysis identified age, right side hemiplegia and D-dimer level as useful predictors.Conclusions:Advanced age and a high D-dimer level are independent risk factors for UTI after ICH, while hemiplegia on the right side is a protective factor.