To evaluate the value of Ranson, acute physiology and chronic health evaluation II (APACHE II), Balthazar CT and pancreatitis outcome prediction (POP) scoring systems in predicting the prognosis of severe acute pancreatitis (SAP).

Objective To analyzed distribution characteristics of gene mutation and gene carrying rate of thalassaemia in Shenzhen.Methods 2 500 cases with adult,neonatal umbilical cord blood of 2 500 cases for alpha thalassaemia,beta thalas-saemia,gene types and carry frequency were analyzed.Results 8 types of alpha thalassemia gene 128 cases,rate of detection was 5.12% (128/2 500),and the main genetic types were-SEA/αα(54 cases,42.19%),-SEA/-α3.7 (32 cases,25%)respec-tively.2 500 cases of adult samples were checked out 7 types of gene mutation 101 cases,and detection rate was 4.04%(101/2 500).Main gene mutation type were CD41-42 (39 cases,38.61%),IVS-2-654 (20,21 cases,79%),CD17 (18 cases, 17.82%)and-28 (13 cases,12.87%)respectively.Conclusion Shenzhen thalassaemia mutation type and frequency had ob-vious regional characteristics and times characteristics,health authorities should strengthen epidemiology study,formulate corresponding prevention and intervention measures.

OBJECTIVE: To study the risk factors for severe acute pancreatitis (SAP) complicated by pancreatic encephalopathy (PE). METHODS: Clinical data from 255 patients with SAP from January 2005 to December 2006 were reviewed. Thirty-one SAP patients had PE, and 224 SAP patients did not. Clinical characteristics of SAP patients in both PE group and non-PE group were analyzed. RESULTS: Ranson scale and the incidence rates of acute respiratory distress syndrome (ARDS), renal failure, hypoproteinemia, hypocalcemia and hyperglycosemia in PE group were higher than those in non-PE group (P<0.05). There were no significant differences in acute physiology and chronic health evaluation II and CT severity index scales, the activities of amylase and lipase, the incidence rate of liver function failure, the infection rate and the operability between the PE group and the non-PE group (P>0.05). Multivariate logistic regression analysis showed that ARDS and hyperglycosemia were high risk factors. Cure rate in PE group was higher than that in non-PE group. CONCLUSION: Nosogenesis of PE is the result of multiple factors. ARDS and hyperglycosemia may be the high risk factors for PE.

Objective To analyze the efficacy and safety of tirofiban treatment combined with percutaneous coronary intervention (PCI) in the elderly with acute ST segment elevation myocardial infarction prospectively. Methods From May 2008 to May 2010, 106 patients who presented with acute STEMI within 12 hours from onset and received successful primary PCI were enrolled into the study. All patients had angiographic evidence of initial total occlusion of infarct-related artery and finally restored toTIMI3 flow after PCI. All patients were divided into tirofiban group (n = 54) and control group (n = 52) according to whether tirofiban was used or not. Assessment of myocardial perfusion included Myocardial Blush Grades (MBG), and the resolution of the sum of ST-segment elevation (sumSTR) at 90 minutes after the procedure. Left ventricular ejection fraction (EF) was measured one week later. Major adverse cardiac events in hospital and bleeding complications were also assessed. Results Baseline clinical and angiographic characteristics of the two groups were similar. Significant higher rates of MBG 3 were observed in the tirofiban group (88. 9% vs57. 7%, P ＜ 0.05). Patients received tirofiban were more likely to achieve higher sumSTR (70. 3% vs 42. 3%, P ＜0. 05). Ejection fraction was also markedly increased in tirofiban group than control group (56. 2 ± 7.6 vs 46. 7 ± 8. 5, P ＜ 0. 05). In-hospital major adverse cardiac events, it was not different between the two groups(P ＞0. 05). There were slightly more minor bleeding complications in tirofiban group compared with control(11.1% vs 6. 0%, P ＞0. 05). No patient had major bleeding or thrombocytopenia.Conclusions Tirofiban can further ameliorate microvascular perfusion and it is safe and feasible for patients with STEMI undergoing primary PCI.

Objective: To explore the effect of mouth muscle training game on salivation cerebral palsy children. Methods: Sixty-eight children with cerebral palsy combined with salivation were randomly divided into experimental group and control group, with 34 cases in each group. The control group received routine rehabilitation treatment, while the experimental group performed oral muscle training game on the basis of the control group. Both the two groups were assessed by teacher salivation grading (TDS) and oral motor function assessment grading standards before and 8 weeks after intervention for salivation and oral motor function of cerebral palsy children. Results: After 8 weeks of intervention, there were 30 children with grade III-V salivation turned to grade I-IV in the experimental group, and 21 children with grade III-V salivation turned to grade I-IV in the control group, with the total effective rate of TDS of 88.2%(30/34) and 61.8%(21/34), respectively, and there was statistically difference (χ²= 5.02, P<0.05). The score of oral transport function in the experimental group was 87.68±12.93, which was higher than that of 76.53±10.92 in the control group, and there was statistically differences (t=3.841, P<0.01). Conclusions Oral muscle training games can stimulate self-exploration and training for oral movement of cerebral palsy children, so as to improve the range, flexibility and strength of the jaw, lip and tongue movement, and promote the self-control of swallowing of saliva, reduce the salivation and improve the quality of life.

Objective:To explore the effect of International Classification of Functioning, Disability and Health, Children and Youth Version (ICF-CY) framed oral motor therapy combined with acupoint massage intervention on children with cerebral palsy swallowing disorder.Methods:From September 2018 to September 2019, 80 children with cerebral palsy accompanied by dysphagia who were diagnosed and treated in the Department of Neurological Rehabilitation of our hospital were selected as the study subjects, and were divided into the experimental group (40 cases) and the control group (40 cases) by random number table method. A total of 76 patients completed the study. On the basis of routine swallowing training and oral movement intervention, the experimental group was comprehensively evaluated from the aspects of body function and structure, activity and participation, and environmental factors with ICF-CY theory as the framework, and was given oral and facial acupoint massage for 12 weeks. The control group was given conventional swallowing training and oral exercise intervention for 12 weeks. The modified water swallow test was used to evaluate the effect of improving swallowing disorder in two groups of children after 12 weeks of intervention. The improvement of oral motor function in two groups of children after 4 and 12 weeks of intervention was evaluated by using the Grading Criteria for Evaluation of Oral Motor Function.Results:After 12 weeks of intervention, the total effective rate of swallowing disorder improvement in the experimental group and the control group were 89.47% (34/38) and 63.16% (24/38), respectively, and the difference between the two groups was statistically significant ( χ2 value was 7.28, P<0.05). After 4 and 12 weeks of intervention, the functional scores of oral motors in the experimental group were (67.13±2.35) and (82.08±2.33) points, respectively, which were higher than those of the control group at the same time (56.16±2.57) and (65.63±2.54) points, and the differences were statistically significant ( t values were -3.320, -4.433 P<0.05). After 4 and 12 weeks of intervention, the children's functional scores of oral motors in each group were higher than those in each group before intervention. Compared with the group before intervention, t values of the experimental group were -5.377 and -5.376; t values of the control group were -10.715 and -17.486; compared to the group with 4-week intervention, t value of the experimental group was -12.732; t value of the control group was -13.281, all the differences were statistically significant (P<0.05). The results of repeated measures analysis of variance showed that the time effect, grouping effect, and the interaction between time effect and grouping effect of functional scores of oral motors were statistically significant ( F values were 426.780, 9.084, 26.538, P < 0.05). Conclusions:Oral motor therapy combined with acupoint massage based on ICF-CY framework can effectively promotes the recovery and reconstruction of mouth perception and motor function in children with cerebral palsy, significantly improves the children's dysphagia and their ability to actively participate in feeding.

Objective:To investigate the prevention effect of nurse-led peer support system on the postpartum posttraumatic stress disorder of primipara.Methods:A total of 74 cases of primipara were randomly divided into experimental group ( n=37) and control group ( n=37). The control group received routine nursing. The experimental group received nurse-led peer support intervention. The postpartum depression and postpartum posttraumatic stress disorder was assessed by using Edinburgh postnatal depression scale (EPDS) and impact of event scale-revised (IES-R) before and after intervention. Results:Before intervention, the socre of EPDS and IES-R was no statistical difference between experimental group and control group ( P>0.05). After intervention, the scores of EPDS and IES-R were significantly decreased in the experiment group [(5.41 ± 0.49) pionts, (16.56 ± 1.36) pionts] compared to the control group [(16.56 ± 1.36) pionts, (19.01 ± 1.98) pionts], the difference was statistically significant ( P<0.05). Conclusion:Nurse-led peer support system can alliviate postpartum depression and posttraumatic stress disorder status and promote the psychological health of primipara.

{L-End}Objective To explore the interaction between social psychology and workload factors on neck work-related musculoskeletal disorders (WMSDs) in manual workers. {L-End}Methods Manual workers in Henan Province and Hubei Province were selected as the research subjects using typical sampling method. The Chinese Musculoskeletal Questionnaire was used to investigate the prevalence of neck WMSDs in the research subjects. A total of 4 327 workers with neck WMSDs were selected as the case group, and 4 327 workers without neck WMSDs were selected as the control group in a 1∶1 pairing. Conditional logistic regression analysis was used to compare the relevant risk factors in the two groups, and the additive interaction model was established to analyze the interactions between the risk factors. {L-End}Results The univariate conditional logistic analysis results showed that dynamic load, static load, power load and psychosocial factors increased the risk of neck WMSDs in manual workers (all P<0.05). In terms of the social psychological factors, insufficient rest time had the greatest impact workers, with the odds ratio (OR) and 95% confidence interval (CI) of 1.799 (1.647-1.965). In terms of dynamic load, static load and power load, repeated similar movements of the head per minute (bending, twisting), forward bending of the neck or maintaining this posture for a long time, and lifting heavy objects>20 kg had the greatest impact, with the OR and 95%CI of 1.599 (1.470-1.739), 1.984 (1.805-2.181) and 1.241 (1.093-1.408), respectively. There was a synergistic interaction between insufficient rest time and forward bending of the neck or maintaining this posture for a long time, and the relative excess risk due to interaction (95%CI) and attributable proportion (95%CI) were 0.420 (0.187-0.652) and 0.171 (0.066-0.276), respectively. There is no interaction between insufficient rest time and repeated similar movements of the head per minute (bending, twisting), and lifting heavy objects >20 kg. {L-End}Conclusion The interaction between insufficient rest time and forward bending of the neck or maintaining this posture for a long time (static load) can increase the risk of neck WMSDs in manual workers, which is an additive synergistic effect.

Objective To investigate the clinical efficacy and safety of high-dose caspofungin (70 mg/d)as initial or salvage treatment for invasive pulmonary aspergillosis.Methods Twenty-one patients with proven or probable invasive pulmonary aspergillosis from June 2014 to October 2017 in Huashan Hospital,Fudan University were retrospectively reviewed.According to the anti-fungal treatment before high-dose caspofungin application,patients were divided into initial treatment group and salvage treatment group.Patients' clinical data and laboratory data were collected.The characteristics,clinical efficacy,adverse reactions,one-year survival rate and the overall effective rate were evaluated.The prognosis of the two groups was compared by Kaplan-Meier analysis.Results Twenty of the 21 patients opportunistic acquired invasive pulmonary aspergillosis during the treatment of underlying diseases.Five patients were initially treated with high-dose caspofungin for 68 (62) days.At week 12,one patient achieved complete response,3 patients achieved partial response,and the overall effective rate was 80％ (4/5).Sixteen patients received caspofungin as salvage therapy for 66.50 (58) days,of which one patient got complete response at week 12,10 had partial response,and the overall effective rate was 68.75％ (11/16).One-year follow-up showed that no patient died in the initial treatment group,and the one-year survival rate was 100％ (5/5).In salvage treatment group,3 patients died of pulmonary bacterial infections and the one-year survival rate was 81.25％ (13/16).During treatment,one patient had elevated total bilirubin,which was possibly associated with high-dose caspofungin.Conclusions High-dose caspofungin regimen has good efficacy and safety,both for initial treatment and salvage therapy in patients with invasive pulmonary aspergillosis.

Objective: To evaluate the efficacy and safety of high-dose fluconazole alone or combined with flucytosine as initial therapy for cryptococcal meningitis (CM) in non-human immunodeficiency virus (HIV)-related patients. Methods: Twenty-five non-HIV-infected patients with CM from June 2015 to September 2018 in Huashan Hospital, Fudan University, who were initially treated with high-dose fluconazole with or without flucytosine for at least seven days were retrospectively reviewed.Clinical features and antifungal (600-800 mg/d) regimens were recorded, clinical responses and drug-related adverse events were evaluated. Mann-Whitney test and Fisher′s exact probabilities test were applied to compare variables between groups. Results: Of the 25 patients enrolled in this study, 15 had predisposing factors. Headache (25 cases), fever (21 cases), vomiting (13 cases) and neck stiffness (13 cases) were common manifestations. Abnormalities of cranial computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were found in 22 cases.Nineteen patients were treated with high-dose fluconazole plus flucytosine for initial therapy, and six patients were treated with high-dose fluconazole alone. The course of initial regimens with high-dose fluconazole was 42 (29, 120) days. At the end of initial therapy, partial response in 20 patients, stable response in three patients and death in two patients were observed, and the overall effective rate was 80%(20/25). In treatment failure group of initial treatment, the proportion of patients with baseline cerebrospinal fluid opening pressure over 300 mmH₂O (1 mmH₂O=0.009 8 kPa) and with altered mental status were both significantly higher compared with those in treatment success group. Fluconazole related adverse drug events were observed including elevated transaminases (one case), gastrointestinal symptoms combined with hypokalemia (two cases), and systemic rash (three cases). Except for three patients with rash reduced the dosage of fluconazole, no other patients were given dosage adjustment. Conclusion High-dose fluconazole alone or combined with flucytosine is effective and safe for the initial therapy of non-HIV-related CM patients.