Special education teachers should know the related knowledge about assistive technology products selected assistive technology for students. This paper reviewed the content and methods about assistive technology adaptation and assessment for speech therapists, physical therapists, occupational therapists, assistive technology experts and so on.

U.S. Rehabilitation Act is a important law for rehabilitation and employment with disability in USA. The development of the Act was elaborated, the characteristics and how to implement the Rehabilitation Act were analyzed to give some revelation in rehabilitation legislation in China.

External-beam radiotherapy is one of the principle treatment options for localized prostate cancer. Conventionally fractionated radiotherapy is widely used in clinical practice. Studies have shown that prostate cancer is highly sensitive to hypofractionated radiotherapy, also known as stereotactic body radiotherapy (SBRT), and increasing radiotherapy dose can significantly improve the local control rate of tumor. A number of recently completed researches have shown that SBRT is as effective as conventionally fractionated radiotherapy. In terms of radiation toxicity, the short-term toxicity of SBRT is more obvious than that of conventionally fractionated radiotherapy, but there is no significant difference in long-term toxicity. SBRT can provide more convenience for patients, and the medical cost is lower, so it has a great clinical application prospect.

Objective To analyze the distribution and drug resistance characteristics of pathogenic bacteria isolated from blood cultures in the infected patients in our hospital during 2009-2013 to provide the newest evidence for the clinical anti-infection ther-apy.Methods The bacterial identification and drug susceptibility test were performed by applying the VITEK-32 System.The dis-tribution situation and the drug susceptibility test results of pathogens isolated from blood culture specimens in our hospital during this period were analyzed.Results 2 301 strains of positive bacteria were isolated from 14 006 cases of blood culture during these five consecutive years.The positive rate was 16.4%.Among them,1 303 strains were Gram positive bacteria(56.6%),954 strains of Gram negative bacilli(41.5%)and 44 strains of fungi(1.9%).Gram-positive bacteria were mainly Staphylococcus aureus,coagu-lase negative staphylococci(CNS),etc.Gram-negative bacteria were mainly E.coli,Klebsiella pneumoniae,etc.E.coli and Klebsiella pneumoniae were highly sensitive to carbapenem,amikacin,cefoxitin and antibacterial drugs containing enzyme inhibitor.The detec-tion rates of extended-spectrumβ-lactamase(ESBL)-producing Escherichia coli and Klebsiella pneumoniae were 55.8% and 18.4%respectively.Acinetobacter baumannii in blood culture had serious resistance to most of antibacterial drugs.Conclusion The kinds of pathogens isolated from blood culture are complex with different sensitivity to antibacterial drugs.Timely understanding the re-sults of blood culture has the important significance to adjust the treatment scheme in clinic and timely discover drug-resistant strains for serve clinic better.

BACKGROUND:To reducing bone damage in patients with chronic arthritis, anti-tumor necrosis factor alpha treatment has aroused wide concern.
OBJECTIVE:To summarize the action of tumor necrosis factor alpha in the pathogenesis of chronic arthritis and progress in anti-tumor necrosis factor alpha drugs.
METHODS:A computer-based search of NCBI, OVID, EBSCO was performed to col ect articles published from December 1st, 2005 to July 31st, 2013 with the keywords of“infliximab, etanercept, adalimumab, chronic arthritis”in English. There were 162 articles after initial retrieval, and final y 40 articles were included and summarized.
RESULTS AND CONCLUSION:Studies have shown that a number of factors are involved in the activation of osteoclasts, and tumor necrosis factor alpha is only a member resulting in osteoclastogenesis. In addition, there are some media behind tumor necrosis factor alpha and RANK-RANKL system, which may independently induce osteoclastogenesis. Because of this, a separate anti-tumor necrosis factor alpha therapy applied to chronic arthritis cannot achieve the desired therapeutic effects.

Objective:The study was attempted to improve the manipulation and eliminate patient's fear for gastroscopy combined with intravenous injection.Methods:A total of 1350 patients wasrandomized into test group (n=1100 given intraveous protofol and midazolam)and the control (n=250,without anesthetics).Patient's feeling,heart rate,blood oxygen saturation,blood pressure,operative duration and operator' satisfaction were recored and analysed.Results:Data in test group showed less complaints,easier manipulation,high satisfaction and no difference in operative duration and blood oxygen saturation as compared with the control.After intravenous administration of protofol and midazolam,patient's heart rate and blood pressure (systolic and diastolic pressure) significantly decreased.Conclusions:With intravenous use of protofol and midazolam,gastroscopy can be achieved effectively,painlessly and safely.

Objective To investigate the antibiotic resistance of clinical isolates from hospital for the guidance of rational use of antibiotics .Methods Automatic VITEK‐2 system was used to identify bacterial strains and analyze the antimicrobial resistance . WHONET 5 .6 was applied for data analysis according to the breakpoints of Clinical and Laboratory Standards Institute 2013 . Results A total of 3 880 nonduplicate strains were collected in 2013 ,35 .2% (1 366/3 880) of which were gram positive organisms ,64 .8% (2 514/3 880) were gram negative bacteria .The top 6 most frequently isolated microorganisms were E . coli (20 .2% ) , K . pneumoniae (12 .0% ) , P . aeruginosa (11 .1% ) , coagulase negative Staphylococcus (9 .8% ) , A . baumannii (9 .8% ) ,E .f aecalis (8 .1% ) .The bacteria were mainly isolated from respiratory tract (51 .0% ) ,urine (26 .2% ) , and blood (9 .4% ) .The prevalence of both meticillin‐resistant Staphylococcus was higher than 72 .0% .No staphylococcal strainwasfoundresistanttolinezolid,vancomycinortigecycline.Amongthe509Enterococcusisolates,E.faecalisandE. f aecium accounted for 61 .5% and 32 .8% ,respectively .No enterococcal strain was resistant to vancomycin or tigecycline . Enterococcal isolates also showed low resistance (<2 .0% ) to teicoplanin and linezolid .About 67 .4% of the E .coli strains and 32 .0% of the K lebsiella isolates produced extended spectrumbeta‐lactamases.Thestrainsof E.coli,Klebsiella spp.,Enterobacterspp.,and Proteusspp.wererelatively susceptible to beta‐lactam/beta‐lactamase inhibitor combinations such as cefoperazone‐sulbactam and piperacillin‐tazobactam , carbapenems such as meropenem ,imipenem and ertapenem ,and amikacin (< 15 .0% of the strains were resistant) . K . pneumoniae isolates were more resistant than other gram‐negative bacilli .P .aeruginosa was relatively susceptible to amikacin , tobramycin ,cefepime ,gentamicin ,piperacillin‐tazobactam ,but more than 20% of these strains were resistant to meropenem and imipenem .More than 35 .0% of the A . baumannii isolates were resistant to any of the antimicrobial agents tested . Conclusions Antimicrobial resistance is still a serious threat in clinical antimicrobial therapy .It is important to promote the rational use of antimicrobial agents so that resistance is minimized . It is necessary to conduct epidemiological survey and proactively implement effective interventions in the clinical setting with relatively heavy burden of antimicrobial resistance .

Objective To explore the feasibility of excluding oral 75 g glucose tolerance test (OGTT)in pregnant women with fasting plasma glucose (FPG) ＜4.4 mmol/L in middle and late trimester.Methods From February 1,2012 to August 31,2013,18 851 pregnant women without pre-gestational diabetes mellitus who received 75 g OGTT in Maternal and Child Health Hospital of Hubei Province,China,at 24-28 weeks of gestation were enrolled.The criteria for gestational diabetes mellitus (GDM) were FPG ＞5.1 mmol/L and/or 1 h plasma glucose ＞10.0 mmol/L and/or 2 h plasma glucose ＞8.5 mmol/L in OGTT.The values of FPG in predicting GDM were analyzed with receiver operating characteristic (ROC) curve.The differences of detection rates for GDM among women of different ages,women with different FPG levels,and those with or without risk factors of GDM were compared by x2 test and Fisher's exact test.Results The overall detection rate of GDM was 9.11％(1 718/18 851).The detection rate of GDM was lower in women aged ＜ 25 years than women aged 25-,30-and ≥ 35 years [4.77％ (137/2 875) vs 7.76％ (803/10 350),12.43％ (552/4 440)and 19.06％ (226/1 186),respectively,x2=30.53,120.24 and 210.66,all P＜0.01].The sensitivity and specificity were 55％ and 68％,respectively,when the cutoff value of FPG was 4.4 mmol/L,and the Youden index was 0.23 and the area under the ROC curve was 0.61 (95％CI:0.59-0.63,P＜0.01).The sensitivity and specificity were 40％ and 80％,respectively,when the cutoff value was 4.5 mmol/L,and the Youden index was 0.20 and the area under the ROC curve was 0.61 (95％CI:0.59-0.63,P＜0.01).The missed diagnosis rate was lower when the cutoff point of FPG was defined as 4.4 mmol/L.The detection rate for GDM was 3.45％ (384/11 121) in women with FPG ＜4.4 mmol/L,significantly lower than in those with FPG ≥ 4.4 but ＜5.1 mmol/L and ≥ 5.1 mmol/L [8.06％ (561/6 957) and 100.00％ (773/773),x2=183.66 and 7 672.08,all P＜0.01].When FPG was ＜4.4 mmol/L or ≥ 4.4 but ＜5.1 mmol/L,the detection rate for GDM was significantly higher in women with GDM risk factors than in those without [5.09％ (118/2 318) and 10.75％ (184/1 712) vs 3.02％ (266/8 803) and 7.19％ (377/5 245),x2=23.56 and 22.06,P＜0.01].Conclusion OGTT may not be included in GDM screening in the pregnant women with FPG＜4.4 mmol/L and without GDM risk factors in the areas lack of medical resources.

Objective:To compare the differences in distribution and prognosis of cervical cancer patients in the 2009 and 2018 editions of International Federation of Gynecology and Obstetrics (FIGO) staging, and to analyze the prognostic factors of cervical cancer patients.Methods:The clinical data of 524 cervical cancer patients admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2018 were retrospectively analyzed. The cases were staged according to the 2009 and 2018 FIGO staging, and the Kendall τb coefficient was calculated to compare the consistency of the distribution of the two stages. Kaplan-Meier was used for survival analysis, and log-rank test was used to test the difference of prognosis in each stage. Cox-regression was used to analyze the prognostic factors of cervical cancer patients.Results:In the 2009 FIGO edition of staging, 1 case of stage ⅠB1 was reduced to stage ⅠA1 due to the microscopic infiltration depth <5 mm, 51 cases of stage ⅠB1 were raised to stage ⅠB2 due to 2 cm4 cm. A total of 119 cases raised to stage ⅢC1 due to pelvic lymph node metastasis, and 11 cases raised to stage ⅢC2 due to para-aortic lymph node metastasis. The distribution of cases in the two stages was consistent (τb=0.61, P<0.001). There were statistically significant differences in overall survival (OS) ( χ2=107.13, P<0.001; χ2=93.02, P<0.001; χ2=92.74, P<0.001) and progression-free survival (PFS) ( χ2=91.95, P<0.001; χ2=77.69, P<0.001; χ2=73.27, P<0.001) among patients with different stages of FIGO in 2018 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, ⅢC1, ⅢC2, Ⅳ) and 2009 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, Ⅳ) and patients with different T stages (T 1, T 2, T 3, T 4). There were statistically significant differences in OS ( χ2=20.71, P<0.001) and PFS ( χ2=24.25, P<0.001) in 2018 FIGOⅠB and ⅢC stages, and there was a statistically significant difference in OS between stage ⅢC1 and stage ⅠB2 ( χ2=6.18, P=0.013). Multivariate analysis showed that age ( HR=1.88, 95% CI: 1.08-3.28, P=0.026), pathological type ( HR=2.11, 95% CI: 1.04-4.27, P=0.038), lymph node metastasis ( HR=2.18, 95% CI: 1.34-3.56, P=0.002), parametrial spread ( HR=2.56, 95% CI: 1.52-4.29, P<0.001), maximum tumor diameter ( HR=1.98, 95% CI: 1.18-3.30, P=0.009), squamous cell carcinoma antigen (SCCA) positive after treatment ( HR=4.49, 95% CI: 2.09-9.68, P<0.001) and Hemoglobin (HB) level before treatment ( HR=0.58, 95% CI: 0.35-0.96, P=0.035) were independent risk factors for OS in patients with cervical cancer. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅠB1, ⅠB2, ⅠB3 were 100%, 97.1% and 87.9% respectively, with a statistically significant difference ( χ2=7.79, P=0.020), and there was a statistically significant difference between stage ⅠB1 and ⅠB3 ( χ2=5.55, P=0.019). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅠB1 and ⅠB2 were 95.7% and 84.3% respectively, with a statistically significant difference ( χ2=9.08, P=0.003). For patients with 2018 FIGO stage ⅠB, SCCA positive after treatment ( HR=1 172.50, 95% CI: 10.37-132 554.51, P=0.003) was an independent risk factor for OS, and differentiation degree ( HR=0.09, 95% CI: 0.01-0.81, P=0.032), treatment method ( HR=0.17, 95% CI: 0.04-0.71, P=0.015) and SCCA positive after treatment ( HR=190.68, 95% CI: 14.27-2 547.67, P<0.001) were independent risk factors for PFS. For patients with 2018 FIGO stage ⅠB, stage ( HR=9.56, 95% CI: 2.38-38.32, P=0.001), SCCA positive after treatment ( HR=126.32, 95% CI: 12.36-1 290.60, P<0.001) and lymph node metastasis ( HR=20.07, 95% CI: 3.63-111.11, P=0.001) were independent risk factors for OS, and differentiation degree ( HR=0.11, 95% CI: 0.02-0.63, P=0.013), treatment method ( HR=0.22, 95% CI: 0.06-0.75, P=0.015) and SCCA positive after treatment ( HR=43.83, 95% CI: 7.94-241.84, P<0.001) were independent risk factors for PFS. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 95.7% and 75.6% respectively, with a statistically significant difference ( χ2=13.96, P<0.001). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 83.1% and 67.1% respectively, with a statistically significant difference ( χ2=7.61, P=0.006). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 90.9% and 75.0% respectively, with a statistically significant difference ( χ2=8.85, P=0.003). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 75.7% and 66.7% respectively, with a statistically significant difference ( χ2=4.07, P=0.044). For patients with 2018 FIGO stage Ⅱ, pathological type ( HR=20.28, 95% CI: 2.93-140.32, P=0.002) and stage ( HR=4.35, 95% CI: 1.02-18.55, P=0.047) were independent risks factors for OS. For patients with 2009 FIGO stage Ⅱ, pathological type ( HR=5.82, 95% CI: 1.62-20.94, P=0.007) was an independent risk factor for OS, and pathological type ( HR=3.09, 95% CI: 1.22-7.85, P=0.017) and lymph node metastasis ( HR=2.07, 95% CI: 1.22-3.51, P=0.007) were independent risk factors for PFS. For patients with 2018 FIGO stage Ⅲ, maximum tumor diameter ( HR=3.31, 95% CI: 1.45-7.56, P=0.005) and SCCA positive after treatment ( HR=4.67, 95% CI: 1.22-17.86, P=0.024) were independent risk factors for OS, and pathological type ( HR=4.15, 95% CI: 1.47-11.77, P=0.007) and SCCA positive after treatment ( HR=3.96, 95% CI: 1.45-10.86, P=0.007) were independent risk factors for PFS. Conclusion:The 2018 and 2009 FIGO staging have a good distribution consistency in the cervical cancer patients, and the 2018 FIGO stage ⅠB has more advantages in judging the prognosis, but stage ⅢC cannot accurately judge the prognosis. Lymph node metastasis and maximum tumor diameter are more important prognostic factors.

BACKGROUND: Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. METHODS: We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. RESULTS: We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. CONCLUSION Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.
Adolescent ; Child ; Child, Preschool ; China/epidemiology* ; Cities/epidemiology* ; Female ; Hand, Foot and Mouth Disease/virology* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Risk Factors