OBJECTIVE To investigate the cognition on hand hygiene and the reasons affecting the hand hygiene performance in hospital.METHODS Medical staff of 358 parsons were randomly selected by questionnaire.RESULTS It was higher cognition among medical staff on hand washing indication learned from Standards of Hand Hygiene among Medical Personnel in Medical Institutions(draft for soliciting opinions) issued by the Ministry of Health.The cognition coincidence of hand sterilization indication was 68.04%,but existed some less cognition or miscognition in this field among them.The main factors affecting the hand hygiene performance were busy at work,to which was the primary cause to affect use of stream water to wash hands.The concept that using stream water wash hand is reliable is the primary cause influence medical staffs to use alcohol scrape hand.CONCLUSIONS The nosocomial infection monitoring,guidance and control should be emphasized in the field of more use of the fast hand antiseptics instead washing hands and supervising the relevance of the amount of hand hygiene product consumpsion to nosocomial infections.

Objective To explore the effects of 4-phenylbutyric acid(PBA) on cognitive dysfunction after chronic cerebral hypoperfusion and underlying mechanisms.Methods 62 male Sprague Dawley rats in clean degree were divided into sham group(n=14),chronic cerebral ischemia group(bilateral carotid arteries occlusion,2VO group,n=24),and chronic cerebral ischemia with PBA treatment(2VO+PBA group,n=24).The chronic cerebral ischemia models were produced by the occlusion of bilateral common caroid artery for 1 month.During the hypoperfusion,the rats were injected intraperitoneally with 11.25 mg · ml-1 PBA(90 mg · kg-1 · d-1) or equal volume of saline once a day for 3 days followed by every other day for 27 days.Learning and memory abilities were tested by Morris water maze and novel object recognition test.The expression and distribution of NR2A in hippocampus were examined by Western blot and immunohistochemistry.Results Morris water maze test showed that the 2VO group had significantly longer latent time than sham group in searching platform (P＜0.01) (from 2nd day to 7th day latency time),and the 2VO+PBA group had dramatically shorter latent time than 2VO group (2nd,5th,6th,7th (P＜0.01),3rd(P＜0.05)).Then the rats' memory test showed that 2VO group spent markedly longer time than sham group to reach the location of the former platform(P＜0.01),but the 2VO+PBA group spent dramatically shorter latent time than 2VO group (P＜0.01).The novel object recognition test showed the exploration ratio and discrimination index of novel object in 2VO group were noticeably smaller than that in sham group (P＜0.01),but the exploration ratio and discrimination index of novel object in 2VO+PBA group were noticeably higher than that in 2VO group (P＜0.01).The Western blot data showed that the level of NR2A in 2VO group was significantly lower than that in sham group (P＜0.01),but the level of NR2A in 2VO+PBA group was significantly higher than that in 2VO group (P＜0.05).The level of NR2B in hippocampus of 2VO group had no significant difference with sham group and 2VO+PBA group (P＞0.05).Immunohistochemistry data was consistent with the data of Western blot for NR2A level and distribution.The ratio of p-CREB/total CREB in 2VO group(0.62±0.04) was remarkably lower than that in sham group(1.00±0.07),but the ratio of p-CREB/total CREB in 2VO+PBA group(0.97±0.07) was remarkably higher than that in 2VO group(P＜0.01).Conclusion NR2A reduction is associated with chronic cerebral hypoperfusion-induced cognitive impairment,which is rescued by the PBA treatment.It suggests that PBA may have a therapeutic effect on preventing chronic cerebral hypoperfusion-induced cognitive impairment.

Professor HONG Guang-xiang is one of the first group of prestigious TCM experts in china.He is a famous expert in internal medicine of TCM and skilfuls at treating pulmonary disease.Reinforcing deficiency and purging excess is the principle of treating chronic obstructive pulmonary disease(COPD).There are different symptom of xu-shi in different period of COPD,the article introduces the thinking and unique experience prescription of HONG Guang-xiang about treating both deficiency and excess basis on the stage of COPD.

Objective:To evaluate the clinical efficacy of shenxiong glucose injection in the treatment of chronic re- nal failure(CRF).Method:78 patients with CRF were divided into a treatment group(n=40)and a controlled gronp(n= 38).The treatment group received shenxiong glucose injection 200ml daily,14 days for one course of treatment.The con- trolled group received ligustrazine injection 80mg with 5% glucose.The changes of serum BUN and SCr were observed.Re- sult:The serum BUN and SCr were significantly decreased in the two groups after the treatment(P

The experiment was conducted at the Basic Laboratory of Integrated Traditional Chinese and Western Medicine, Chengdu University of TCM from March 2005 to March 2006. A total of 40 BALB/C male mice aged 6-8 weeks were selected, and randomly assigned into 4 groups: bcl-2 control group, bcl-2 experimental group, cmy-c control group and cmy-c experimental group with 10 in each group. From the first day of experiment, all the mice were treated with 5 g/L cyclophosphamide solution by intraperitoneal injection for successively 5 days, 6 mL/kg per day. From days 11 to 12, the mice in the bcl-2 experimental group and cmy-c experimental group received Danggui buxue tang by gastric perfusion, 6 mL/kg per day for 10 days. The mice in the control group received saline of the same volume. At day 20, all the mice were killed to obtain bone marrow cells of one side femoral bone of mice. The smear received bcl-2 in situ hybridization immunohistochemical staining after centrifugalization and washing in the bcl-2 control and bcl-2 experimental group. The smear received cmy-c in situ hybridization immunohistochemical staining after centrifugalization and washing in the cmy-c control and cmy-c experimental group. Five fields of each section were red into image analyzer. The sum of positive cell area and the sum of integral absorbance in each field were analyzed. The results showed that the sum of positive cell area was (16.11?3.01)?102 ?m2, and the sum of integral absorbance was (19.9?2.42)?105 in the bcl-2 experimental group. Compared with the bcl-2 control group, there was significant difference (P

Objective To analyze the dynamic changes of perinatal defects in Lishui city from 2005 to 2014.Methods According to hospital-based data,87 294 fetuses and infants aged from 28 weeks of gestation to 7 days after birth were monitored for birth defects in Lishui city from 2005 to 2014.Results Among 87 294 perinatal infants,birth defects were found in 1 914 cases with a incidence of birth defects of 219.3/ten thousand,which was on the rise year by year except 2009.The incidence of birth defects was 235.1/ten thousand (737/31 352) in urban areas,which was significantly higher than that in rural areas (210.4/ten thousand,1 177/55 942) (x2 =5.705,P ＜ 0.05).The incidence of birth defects of boys and girls was 221.1/ten thousand (1 005/45 453) and 212.8/ten thousand (890/41 822),respectively (x2 =0.707,P ＞ 0.05).Among 1 914 cases of defects,657 were detected prenatally and 1 257 case were detected within 7 days after birth.Congenital heart disease was the most common birth defect,followed by polydactyly,cleft lip,microtia and syndactyly.Birth defect accounted for 32.74％ (278/849) of all perinatal deaths and the ratio was on the rise since 2010.Conclusion There is an upward trend in incidence of birth defects in Lishui city in the last decade;the incidence of birth defects in urban areas is significantly higher than that in rural areas;the incidence of congenital heart disease is high,and birth defects are the main cause of perinatal death.

Objective:To study the effect of shear stress on the expression of KLF2 and eNOS in venous endothelial cells under physiological and uremic conditions, and to explore the mechanism leading to dysfunction of venous endothelial cells.Methods:Under physiological conditions and uremia conditions, different shear stresses were simulated in the parallel plate flow cavity, and the shear stresses were applied to the venous endothelial cells of each group for 4, 12, and 24 hours. The expression of KLF2 and eNOS was detected by immunohistochemical fluorescent staining technique and real-time fluorescent quantitative PCR technique.Results:Under physiological conditions, KLF2 is obviously regulated by shear stresses. High-intensity shear stresses and physiological shear stresses will up-regulate the expression of KLF2, while low-intensity shear stresses and oscillating shear stresses will down-regulate the expression of KLF2. As the duration of action increases, the expression of KLF2 will also increase. In the state of uremia, the expression of KLF2 is significantly inhibited. Even if high shear stresses is applied, the level of KLF2 is not high-expressed as the physiological state. And under the action of low shear stresses and oscillating shear stresses, KLF2 expression is more significantly inhibited. KLF2 is mainly expressed in the nucleus. With the action of shear stresses, KLF2 is also expressed in the cytoplasm, while eNOS is mainly expressed in granular form in the cytoplasm and nucleus.Conclusions:After arteriovenous fistula operation, the expression of KLF2 and eNOS is inhibited under the action of multiple factors of uremia environment and oscillating shear stresses, which may be the main cause of the occurrence and development of venous endothelial cell dysfunction, intimal hyperplasia, and AVF failure.

Objective:To systematically evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) in acute kidney injury (AKI).Methods:All studies about the predictive effect of NLR on AKI were searched in the National Medical Library of the United States PubMed Database, the Embase database in the Netherlands, the Chinese Biology Medicine disc (CBMdisc) and the Chinese Evidence Based Medicine Cochrane Centre Database (CEBM/CCD). The data updated by October 2020, and regardless of language, region or whether blind method was used. Two authors independently extracted data and evaluated the quality of the studies. Data extracted from the studies were analyzed with RevMan 5.3 to assess the predictive value of NLR on AKI. A subgroup Meta-analysis was conducted to assess the predictive value of NLR on AKI according to different countries, different disease types (cardiovascular surgery, infectious diseases, other diseases including burns, cirrhosis, and emergency), and different sample sizes (≤ 300 cases and > 300 cases). The publication bias of included studies about the predictive effect of NLR on AKI were assessed by funnel plots.Results:A total of 11 studies were included in this Meta-analysis, including 4 997 patients, 1 308 patients in AKI group, and 3 689 patients in non-AKI group. The Meta-analysis results showed that: increased NLR had predictive value for the occurrence of AKI [mean difference ( MD) = 2.73, 95% confidence interval (95% CI) was 1.78-3.68, P < 0.000 01]. Subgroup analysis showed that increased NLR had predictive value for the occurrence of AKI in patients from Southeast Asia ( MD = 4.04, 95% CI was 1.09-6.99, P = 0.007) and Eurasia ( MD = 2.51, 95% CI was 1.12-3.90, P = 0.000 4). Increased NLR had predictive value for the occurrence of AKI in patients undergoing cardiovascular surgery ( MD = 0.77, 95% CI was 0.34-1.20, P = 0.000 4), infectious diseases ( MD = 4.74, 95% CI was 1.51-7.96, P = 0.004) and other diseases ( MD = 8.53, 95% CI was 6.26-10.80, P<0.000 01). Increased NLR had predictive value for the occurrence of AKI in studies with a sample size of ≤ 300 cases ( MD = 6.02, 95% CI was 4.90-7.14, P <0.000 01) and > 300 cases ( MD = 1.32, 95% CI was 0.61-2.03, P = 0.000 3). There was no significant publication bias in the included studies assessed by funnel plots. Conclusion:NLR is an important predictive tool for AKI.

Objective:To explore the clients' assessment for the ethical behavior of the counselors and psychotherapists.Methods:The main method used in this evaluation was questionnaire,and the self-made questionnaire of the ethical problems in psychotherapy and counseling(for the clients)were used as evaluation tools.Totally 1100 clients,from 12 cities in China,were investigated with 807 questionnaires returned.Results:84.5% of the clients were confident in the treatments,and 89.2% of them gave positive assessment for the ability of their counselors and psychotherapists.15.9% of clients said the counselors and psychotherapists showed impatience or talked to them about their stress sometimes.Besides,59.1% knew about the characters,names and charge of the psychotherapies and counseling,and 53.4% knew the background of the counselors and psychotherapists.91.3% of clients thought the privacy and treatment could be kept secret.7% of clients had intimate relationship with their counselors or psychotherapists,1.5% had sexual relations,and 18.3% made friends in lives.79% of clients could receive timely psychotherapies and counseling.Conclusion:From the assessment of the clients,the vast majorities of the counselors and psychotherapists do well in work ability,confidentiality and time-setting,but not so well in informed-consent and dual relations,which need to be paid attention to and improved.

Objective To evaluate the feasibility of induction with sevoflurane-midaaolam-remifentanil for tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.Methods Twenty-two ASA Ⅰ-Ⅲ patients with huge mediastinal tumor,aged 22-64 yr,weighing 48-76 kg,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midaaolam 0.03 mg/kg and inhalation of 8％ sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 8％,followed by decrement of 2％ every 30 s until 4％.When the eyelash reflex disappeared,remifentani1 2 μ g/kg was injected slowly over I min and sevoflurane inhalation was stopped 30 s later.The patients were mechanically ventilated after tracheal intubation.MAP and HR were recorded before induction and immediately before and 1 min after inlubation.The time of disappearance of eyelash reflex was recorded.The inlubation condition was evaluated using VibyMogensen score.Results The time period from sevoflurane inhalation to disappearance of eyelash reflex was(110 ± 14)s.The success rate of tracheal intubation at the first attempt was 86％.The position of the glottis was higher in 2 patients,and tracheal intubation was successfully performed under the guide of fiberoptic bronchoscope.The satisfactory intubation conditions were found in 86％ of cases.Compared with that before anesthesia induclion,MAP and HR were significantly decreased immediately after intubation and at 1 min after intubation(P ＜ 0.05).SpO2 ＞ 95％ in all patients.BIS was maintained at 45-55 during the period(before intubation until 1 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifenlail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.