Objective To explore the effects of health education combined with WeChat′s public platform in the management of risk factors in patients with coronary heart disease. Methods A total of 100 coronary heart disease patients were randomly divided into intervention group and control group and there were 50 cases in each group by the random number table. The intervention group received health education about risk factors combined with WeChat′s public platform for 6 months. The control group received routine health education. Evaluate the control rate of blood pressure, blood glucose and blood lipid and the score of coronary heart disease self-management scale of the two groups before and after the intervention. Results At the 6th month after intervention, the control rate of blood pressure of the intervention group was 88.0％(44/50) and it of the case group was 70.0％(35/50).The difference between the 2 groups was statistically significant (χ2=4.882, P < 0.05). The score of coronary heart disease self-management scale of the intervention group was (102.44±8.22) points and it of the case group was (89.82±8.01) points . The difference between the 2 groups was statistically significant(t=7.776, P < 0.05). Conclusions The health education combined with WeChat′ s public platform contributed to help coronary heart disease patients to establish good self-management behavior and it can be widely used in the management of coronary heart disease risk factors.

ObjectiveTo study the effect of angiotensin Ⅱ type 1 receptor antagonist (ARB) losartan on reducing the incidence of stroke in patients which suffer from hypertension and atrial fibrillation(AF).MethodsProspective randomized analysis was used to divide one hundred and eighty hypertemion patients with atrial fibrillation into two groups.ARB treatment group was treated with losartan (n =90) and beta-blockers treatment group was treated with metoprolol ( n =90),all patients were treated for three years and followed up.Blood pressure,pulse pressure,incidence of stroke and myocardial infarction and mortality of cardiovascular events were evaluated.ResultsAfter antihypertensive treatment,blood pressure was reduced in two groups,the pulse pressure in losartan group was reduced obviously( all P ＜0.01 ).The incidence of stroke and myocardial infarction and mortality of cardiovascular events in losartan group were 22.2％,10.0％ and 13.3％,respectively,lower than that in metoprolol group 70.0％,40.0％ and 44.4％ ( all P ＜0.01 ).ConclusionLosartan reduced the incidence of stroke in the hypertension patients with AF.

Objective To explore the effect of insulin subcutaneous pump combined with psychological intervention on gestational diabetes mellitus.Methods A total of 118 patients were enrolled in this study from November 2015 to October 2016 in Lishui central hospital.The patients were randomly divided into the experimental group and the control group according to the time of hospitalization.The experimental group was given insulin subcutaneous pump combined with psychological intervention.The control group was given insulin subcutaneous pump.Results After intervention, the degree of complete compliance in the experimental group was 86.44% and 28.81% before intervention, the difference was statistically significant(P<0.05).Compared with before treatment, blood glucose and glycosylated hemoglobin were decreased after treatment(P<0.05).The incidence of complications in the two groups include: pregnant women with excessive amniotic, neonatal hypoglycemia, pregnancy induced hypertension syndrome and so on.The difference of complication rate between the two groups was statistically significant(P<0.05).Conclusion The timely and accurate psychological guidance of pregnant women with diabetes mellitus can control the blood glucose in the normal range, reduce the occurrence and development of maternal and child complications, and ensure the safe and healthy mother and child health.

Objective To investigate the prevalence of plasmid-mediated quinolone resistance ( PMQR ) determinants [ qnr,aac ( 6' ) -Ib-cr and qepA ]and mutations in quinolone resistance-determining regions (QRDRs) of gyrA and parC and their association with fluoroquinolone susceptibility in clinical isolates of Serratia marcescens in Anhui.Methods The minimum inhibition concentration ( MIC ) of 104 strains of S.rnarcescens collected from various clinical specimens from 34 hospitals during 2005 to 2010 were determined by agar dilution method.The qnr,aac (6')-Ib,qepA,gyrA and parC genes were screened by polymerase chain reaction (PCR) in 31 strains resistant to ciprofloxacin,and positive results were subsequently confirmed by sequencing.The conjugation experiments were performed for qnr and aac(6')-Ib-cr positive strains.The MIC of S.marcescens isolates,recipient strains and conjugants were tested by agar dilution method for quinolones and other antimicrobial agents.Results Six strains of the 31 S.marcescens isolates harboured qnr and/or aac(6')-Ib-cr genes.Among those 6 strains,2 strains harboured a qnrB6 gene,1 harboured a qnrS2 gene,and 4 harboured aac( 6' ) -Ib-cr,whereas no qnrA-,qnrC- or qnrD-positive isolate was detected.None of the 31 isolates carried the qepA gene.Mutations in the QRDR of gyrA and parC genes were detected in 9 and 7 isolates,respectively.The conjugation experiments were successfully carried out in 5 isolates of 6 PMQR determinants-postive strains.The MIC of conjugants for quinolones were increased evidently compared to recipient strains.Conclusions Chromosome and plasmid-mediated resistance determinants play an important role in quinolone resistance in clinical isolates of S.marcescens.And more important is that the PMQR determinants can be horizontal transmitted.It is necessary to continuously survey and watch for the spread of PMQR in S.marcescens in public health control program.

Objective To investigate the nutritional risks in hospitalized patients with liver diseases and work out nursing countermeasures.Methods Forty patients with liver cirrhosis, 40 patients with primary liver cancer and another 40 revisiting after liver transplantation involved in the investigation with a self-designed general information questionnaire and the nutritional risk screening 2002. The three groups were compared in terms of nutritional risks.Results Among the total 120 patients,38.3%(46/120)of them took the nutritional risk and even 12.5%(15/120)had the risk of undernourishment.The risk in the patients with liver cirrhosis was higher than that in the other two groups(χ2=9.899 and 11.4299 and P=0.002 and 0.001,respectively).Conclusions The nursing staffs should pay attention to the nutritional status of patients with liver diseases, especially the patients with liver cirrhosis.It is necessary to take effective measures in order to improve the nutritional status of the patients to reduce the nutritional risks.

Objective To analyze whether routine prophyrlactic antibiotic administration is necessary for the patients undergoing coronary stent implantation. Methods The clinical data of 156 patients from January 2010 to December 2010 (prophylactic antibiotic therapy),and 466 patients from January 2014 to December 2014(no-prophylactic antibiotic therapy), who underwent coronary stent implantation, were retrospectively analyzed. The prophylactic antibiotics and the infection rates in two groups were compared. Results The rate of infections related to coronary stent implantation in no-prophylactic antibiotic therapy group and prophylactic antibiotic therapy group, such as surgical site infection (0.2% vs 1.3%,P>0.05) and catheter-related infection(0.6% vs 1.9%,P>0.05), was not significant different(P>0.05). Similarly, the unrelated to coronary stent implantation was not significant different, too ( P > 0. 05). Conclusion Routine prophylactic antibiotic administration is unnecessary for the patients undergoing coronary stent implantation.

ObjectiveTo investigate the variations and distributions of the plasmid-mediated quinolone resistance genes in clinical isolates of Shigella and their resistance to antimicrobial agents. Methodsqnr, aac(6')-Ib-cr and qepA genes were identified by polymerase chain reaction (PCR) in 137 clinical isolates of Shigella.DNA sequencing of gene-positive strains were analyzed and the conjugation experiment was performed. The minimal inhibitory concentrations (MIC) of Shigella isolates, recipient strains and transconjugants were tested by agar dilution method for quinolones and other antimicrobial agents. The genotype of transconjugants were determined by PCR and sequencing. ResultsFour (2.9％) strains of the 137 Shigella isolates were qnr gene positive, including 3 qnrS2 positive and 1 qnrB4 positive (GenBank accession numbers of the complete sequence were JF261185 and HQ917003, respectively).Furthermore,five (3.6％) aac ( 6')-Ib-cr gene-positive strains (GenBank accession number JF261186 ) and one (0.7％) qepA gene-positive strain were identified in all isolates. The conjugation experiments were successfully carried out in six out of ten PCR-positive isolates. The MIC of transconjugants against quinolones and other antimicrobial agents increased differently compared to recipient strains. Conclusions The plasmid-mediated quinolone resistance genes are lowly prevalent in clinical isolates of Shigella. However, these resistance genes have the characteristic of horizontal transfer, which indicates that more attention should be paid to this phenomenon.

ObjectiveTo analyze the clinical distribution and antimicrobial resistance profile of Serratia marcescens(S. marcescens), and to provide the scientific evidence supporting clinical diagnosis and treatment.MethodsThe antimicrobial susceptibility test was performed in 104 strains of S. marcescens by agar dilution method. The results were judged according to the criteria recommended by Clinical and Laboratory Standards Institute (CLSI) 2010.The data were analyzed by chi square test. Results The majority of S. marcescens were isolated from sputum specimens,accounting for 59.6％ (62/104). The bacteria were most frequently isolated from department of respiratory (33.7％,35/104),followed by intensive care unit (23.1％,24/104),department of gerontology (16.3％, 17/104). The results of antimicrobial susceptibility test showed that the resistance rates of S.marcescens against ampicillin,gentamicin and cephazolin were high,which were 90.4％,86.5％ and 79.8％,respectively; those against the 3rd generation of cephalosporins were 24.0％-43.3％. No imipenem and meropenem resistant strains were identified. Compared with cefoxitin-resistant strains,the resistance rates of non-cefoxitin resistant strains against piperacillin (82.9％ vs 28.6％),ceftazidime (63.4％ vs 9.5％),aztreonam (68.3％ vs 9.5％),amikacin (68.3％ vs 20.6％),ciprofloxacin (48.8％ vs 19.1％) and chloramphenicol (90.3％ vs 58.7％) were all lower (all P ＜ 0.05 ). Conclusions S. marcescens is one of the most common conditional pathogenic bacteria leading to nosocomial infections,which is resistant to many kinds of antimicrobial agents.The surveillance of antimicrobial resistance in S. marcescens should be strengthened for purpose of preventing the transmission of multidrug resistant strains.

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

Objective To explore the effects of different time spans for off-bed activities on postoperative rehabiliatioin of patients with liver transplantation. Methods The clinical data of 42 patients having undergone allogeneic liver transplantation during Jan. 2014 to Oct. 2015 were assigned as the observation group. Another 44 patitents during the same period , matched to those in the observation group in terms of general data , were assigned as the control group . The clinical data of two groupos were reviewed to make comparisons in terms of the time for anus exhaust , the time spans for gastric tube and urinary catheter indwelling , abdominal cavity effusion and hemorrhage and pulmonary infection 3 days after operation. Result The time for anus exhaust and the time spans for gastric tube and urinary catheter indwelling in the observation group were all significantly shorter than the control gorup (P<0.05), but there were insignifiant differences between the groups in abdominal cavity effusion and hemorrhage and pulmonary infection. Conclusion Off-bed activities 3 days after operation is safe and feasible for the patients having undergone allogeneic liver transplantation. It can promote their process of rehabilitation.