Objective To conduct a retrospective study about drug-induced hyperthermia (DIH) based on DIH data obtained in medical practice,and elucidate the relationship between DIH incidence and antibacterials overuse.Methods To investigate successively the medical records of inpatients from orthopaedics department in Fudan university affiliated Jinshan hospital at two different periods,and data of DIH cases were extracted to perform a comparative study.The period for 229 effective cases of group Ⅰ was from Feb.1 to Apr.30,2011,before significant improvement on antibacterials use.The period for 342 effective cases of group Ⅱ was from Jul.1 to Sep.30,2012,after the effective enforcements of regulation on antibacterials use.Inclusion criteria for DIH were:①an oral temperature ≥37.6 ℃ since postoperative day 4,②no evidence of infection,③a time relationship between fever and the administration of causative drugs:a fever occurring with drug administration and disappearing after drug cessation within 3 days,④no other causes for the fever,⑤oral temperature ≤ 37.6 ℃ until leaving hospital.Exclusion criteria for DIH were listed below:①possible pathological fever,e.g.,in cancer,②hospitalization within 3 days,③no surgery,④severe trauma,for example,visceral or central nervous system injury.Results All causative drugs were for injection.By comparison,duration of antibacterial administration is significantly shorter in group Ⅱ than in group Ⅰ (1.7 ± 1.7 vs.4.6-± 1.8days,P ＜ 0.01),and total DIH incidence and antibacterials related DIH incidence were significantly lower in group Ⅱ than in group Ⅰ (7.3％ vs.30.1％,1.5％ vs.25.3％,both P ＜0.01).Conclusion DIH incidence is related with drug type especially with antibacterials overuse,and changed with drug program.DIH was more serious for injection of antibacterials than injection of traditional Chinese medicine.Decrease of antibacterials usage is positively associated with the decreased DIH incidence.Safe medication should begin from safe usage of antibacterials.

Objective To investigated the serum level of carcinoma antigen 125 (CA-125) and its clinical significance in patients with Budd-Chiari syndrome.Methods We reviewed medical records and laboratory tests of patients with BCS first diagnosed in our hospital between August 2011 and April 2013.235 patients were included as experiment group,while 120 healthy adult volunteers were randomly selected as control group.The serum level of CA-125 were detected by electrochemilumescence immunization assay in this single-center retrospective control study.Results The average serum level of CA-125 in experiment group is higher than that of control group [(147.9 ±246.6) kU/L vs (16.0 ±7.2) kU/L,P ＜0.001].In experiment group,the relative coefficient for serum CA-125 with ascites,alanine aminotransferase,aspartate aminotransferase,albumin and Rotterdam BCS scores was 0.79,0.45,0.29,-0.393 and 0.71,respec tively,P ＜0.001.As of October 2013,we found that the 68 BCS patients with serum CA-125 level 5-fold higher than the upper limit of normal (＞ 175 kU/L) presented much lower survival rates and asymptomatic survival rates than the rest 167 BCS patients after intervention therapy:(95.6％ and 79.8％) vs (98.8％ and 92.0％),P ＜ 0.05.Conclusions The serum level of CA-125 in BCS patients have positive correlation with ascites volume,liver injury degree and Rotterdam BCS scores.Serum CA-125 evaluation appears to be a valuable examination option in BCS as CA-125 levels negatively correlate with worse prognosis,thus could be applied as an efficient tool for prognostication.

Objective To investigate the protective effects of elctroacupuncture(EA)at Zusanli(ST36) points on intestinal villas damage and mucosal permeability induced by small intestine pro-inflammatory factors in rats with intestinal ischemia/reperfusion(I/R). Methods 30 Sprague-Dawley(SD)rats were randomly divided into three groups(each,n=10):intestinal I/R group(model group),intestinal I/R+EA ST36 group(EA group)and intestinal I/R+sham EA group(SEA group). Rats were subjected to superior mesenteric artery(SMA)clamping at its root part to occlude the vessel for 30 minutes,followed by reperfusion for 60 minutes to form intestinal I/R models. Rats in EA group received EA at the bilateral ST36 points(2-3 mA,2-100 Hz)for 30 minutes immediately after ischemia,those in SEA group received EA at bilateral sham points(the point was located at 0.5 cm away from ST36 point in its lateral side)with the same frequency and intensity of stimulation as EA group for 30 minutes,and those in model group received no treatment. Animals were sacrificed 60 minutes after reperfusion and segments of distal part of ileum were harvested,then the levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in intestinal tissue were measured. Histopathologic changes were viewed and graded via light microscopy. A solution of fluorescein isothiocyanate(FITC)-dextran was injected into the lumen of the segment of intestine 30 minutes after reperfusion,systemic blood was drawn via abdominal aorta puncture at 60 minutes after reperfusion,and then the level of FITC-dextran in blood was measured to determine the changes in intestinal permeability. Results Compared to the model group and SEA group,EA ST36 significantly attenuated intestine TNF-α(pg/mg:3.01±0.50 vs. 8.65±1.02,8.42±1.41,both P<0.05)and IL-6 levels(pg/mg:2.51±0.15 vs. 6.34±0.86,6.13±1.12,both P<0.05),successfully maintained low gut injury scores(1.50±0.33 vs. 3.18±0.39,3.04±0.37,both P<0.05), and significantly reduced permeability of the distal ileum and the content of FITC-dextran(μg/L:282.42±73.92 vs. 856.22±229.47,844.22±239.47,both P<0.05). However,there were no significant differences in all above variables between SEA and model group(all P>0.05). Sections of distal ileum from animals in the model group and SEA group showed no obvious difference histologically,and the pathological manifestations were villous tip necrosis, blunt-shaped and collapse. Compared to the model group and SEA group,the intestinal villous injury in animals of EA group was much milder. Conclusion In rats with intestinal I/R injury,EA ST36 points has protective effect on the gut that is possibly due to the fact it may obviously lower the levels of the pro-inflammatory factors of small intestinal tissue,alleviate mucosal insult of gut and reduce the mucosal permeability.

Based on the conception analysis of the organizational change leadership of the upper-and mid-level nursing manager,this review described connovations of the organizational change leadership and its applications in nursing field at home and abroad,and pointed out the current research status,limitations and the inspirations we got,so as to provide references for promotion and evaluation of the upper-and midlevel nursing manager's organizational change leadership.

A 59?year?old female patient, who received bilateral lower limb amputation 39 years ago, presented with eczematoid changes in both lower limbs for over 20 years, and with chronic granuloma?like lesions complicated by verrucous hyperplasia for more than 10 years. There were large areas of infiltrative and proliferative lesions with exudation and peripheral erythema at the amputation sites in both knee joints. The lesions were hard with tenderness on palpation. Microscopic examination of lesional scales with 10%KOH showed negative results for fungi. However, three times of culture on the Sabouraud dextrose agar(SDA)medium all grew the same kind of fungus, and the front side and reverse side of its filamentous colony were white and orange yellow respectively. Microculture showed that linear hyaline conidiophores came out from lageniform mother cells with conidia ascending alongside. The conidia looked like dark brown eye lens, with an equatorial germ slit. Based on these findings, this fungus was identified as Arthrinium phaeospermum. Periodic acid?Schiff (PAS) staining showed scattered hyphae in the stratum corneum. The internal transcribe spacer(ITS)sequence of the isolated fungus showed 99%consistency with that of Arthrinium phaeospermum. The patient was diagnosed with cutaneous Arthrinium phaeospermum infection, and treated with oral itraconazole capsules 200 mg/d for 16 days. One month later, follow?up showed satisfactory outcomes.

Objective To investigate the diagnosis,surgical therapy of congenital pyloric atresia in neonates.Method Six congenital pyloric atresia neonates in Children's Hospital of Nanjing Medical University were admitted,including 4 cases of complete atresia with pyloric diaphragm,1 case of incomplete atrsia with a foraminula in the pyloric diaphragm and 1 case of pyloric atresia with solid segment.Three cases were associated with epidermolysis bullosa,multiple intestinal atresia and annular pancreas respectively.Results The main presenting symptoms were nonbilious vomiting,and 5 cases of abdominal X-ray plain film showed a large single gastric air-bubble and no gas distally.Ultrasonography and upper gastrointestinal radiography showed complete gastric outlet obstruction,and in 1 case postbulbar obstruction.Neonates with pyloric diaphragm underwent diaphragm excision and pyloroplasty,and that with solid segment did an extended pyloroplasty.The one complicating intestinal atresia was abandened surgery.Five cases were followed up,and doing well with complete recovery.Conclusion Abdominal X-ray plain film,Doppler ultrasonography and upper gastrointestinal radiography help establish the diagnosis of neonatal congenital pyloric atresia.Surgery is the therapy of choice and the prognosis is very good.

Objective To explore the endoplasmic reticulum stress (ERS) apoptosis pathway in unilateral ureteral obstruction (UUO) mechanism of renal interstitial fibrosis in rats.Methods The rats were randomly divided into con-trol group and model group,UUO group line ligation of the left ureter,three days 3,7 and 14 days HE and Masson staining were used to observe the renal pathological changes;Take blood retinal venous plexus,separat and determina-tion of serum blood urea nitrogen and creatinine;Western blot was used to find protein 78 (GRP78) glucose regula-tion,endoplasmic reticulum source sex transcription factor (CHOP) and apoptosis related proteins cysteine aspartic acid proteinase 3(caspase-3) and caspase-12 protein expression. Results Compared with control group,the visible UUO model group 1) expansion of renal tubule and renal interstitial fibrosis degree with the extension of ureteral ob-struction time and progressive increase;2) GRP78,CHOP,caspase-3 and caspase-12 protein expression in postoper-ative 3 d have to rise,as the obstruction prolonged,the protein expression more significantly(P<0.01).Conclusions Endoplasmic reticulum stress related trademark protein in UUO rat renal interstitial fibrosis is the increase in expres-sion may promote the early renal interstitial fibrosis and continuous progress.

Objective To explore the endoplasmic reticulum stress (ERS) apoptosis pathway in unilateral ureteral obstruction (UUO) mechanism of renal interstitial fibrosis in rats.Methods The rats were randomly divided into con-trol group and model group,UUO group line ligation of the left ureter,three days 3,7 and 14 days HE and Masson staining were used to observe the renal pathological changes;Take blood retinal venous plexus,separat and determina-tion of serum blood urea nitrogen and creatinine;Western blot was used to find protein 78 (GRP78) glucose regula-tion,endoplasmic reticulum source sex transcription factor (CHOP) and apoptosis related proteins cysteine aspartic acid proteinase 3(caspase-3) and caspase-12 protein expression. Results Compared with control group,the visible UUO model group 1) expansion of renal tubule and renal interstitial fibrosis degree with the extension of ureteral ob-struction time and progressive increase;2) GRP78,CHOP,caspase-3 and caspase-12 protein expression in postoper-ative 3 d have to rise,as the obstruction prolonged,the protein expression more significantly(P<0.01).Conclusions Endoplasmic reticulum stress related trademark protein in UUO rat renal interstitial fibrosis is the increase in expres-sion may promote the early renal interstitial fibrosis and continuous progress.

Objective To survey the prevalence of stress urinary incontinence(SUI)and related knowledge among postpartum women in Shanghai Melong district.Methods A questionnaire survey on the knowledge of stress urinary incontinence was conducted among 317 postpartum women who were home visited by Meilong Community Health Service Center between March 2017 and June 2017.The self-designed questionnaire included the general situation(age, height, weight, occupation, menstrual history), pregnancy and childbirth, and knowledge of SUI; the International Consultation on Incontinence Questionnaire Short form(ICIQ-SF)was also used.Total 317 questionnaires were distributed and 313 valid ones were retrieved(98.73%).Results The prevalence of SUI in the participants was 26.84%(84/313).Multivariate logistic regression showed that BMI≥24 kg/m2(OR=6.24, 95% CI: 3.41 -11.41), complicated metabolic syndrome(OR=9.84, 95% CI: 2.77 -34.96)and birth weight of previous child ≥4 kg(OR=0.09,95%CI:0.04-0.19)is independent risk factors for the development of SUI.The average SUI knowledge score was(10.39 +8.65)points, only 26.20%(82/313)of the participants knew Kegel training(score 5.99 ±1.60).The SUI knowledge level of postpartum women was associated with educational level(F=12.41),occupation(F=9.06), income(F=4.05), reproductive history(F=10.98)and presence of urinary incontinence symptom(F=22.31)(all P<0.05). Conclusion The knowledge level of maternal stress urinary incontinence in Meilong district is relatively low,and the publicity of SUI and pelvic floor rehabilitation knowledge should be enhanced for the pregnant women.

Objective To analyze the risk factors of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC),and to establish a preoperative prediction model for MVI.Methods The clinical data of 159 patients with HCC from the First Hospital of Jilin University treated from January 2012 to December 2014 were retrospectively analyzed.There were 128 males and 31 females.Univariate and multivariate logistic regression analysis of factors influencing the presence of MVI in HCC patients were carried out.Independent risk factors were scored based on the β values of multivariate analysis.Receiver operating characteristics (ROC) curves were used to evaluate the predictive value of the scores for the risk factor for MVI.Results Univariate and multivariate logistic regression analyses showed that age ≥ 60 years (OR=0.263,95％ CI:0.112 ～ 0.614),tumor diameter ≥5 cm (OR=3.902,95％ CI:1.784 ～ 8.583),neutrophil to lymphocyte ratio (NLR) ≥ 1.83 (OR=2.414,95％ CI:1.065～5.472) and platelet to lymphocyte ratio (PLR) ≥ 72.30 (OR =2.578,95％ CI:1.068～ 6.223) were the influencing factors of MVI in patients with HCC (P＜0.05).The preoperative prediction model of MVI was established using the MVI independent risk factor scores.The area under the ROC curve was 0.793 (95％ CI:0.723～ 0.862).The optimal cutoff value for the presence of MVI was 2.75 points,and the sensitivity was 0.72 and the specificity was 0.78.The MVI positive rates of patients with risk scores of 0 to 1.5,2.0 to 3.5,and 4.0 to 5.0 were 18.6％,42.9％,and 78.3％,respectively.Conclusion Age,tumor diameter,NLR,and PLR were independent factors influencing MVI in patients with HCC.The preoperative model based on the independent risk factor scores can be used to predict the presence of MVI in HCC patients.