Objective To explore the relationship between the common vascular risk factors and cerebrovascular reserve in the aged patients.Methods 700 patients with sex unlimited were selected from Zhejiang Hospital from July 2007 to July 2010.The clinical data about gender,age,smoking history,drinking history,hypertension,diabetes,dyslipidemia,bilateral carotid artery B ultrasonic examination were collected.The patients were divided into vascular risk factors group(n=400)aged(73.4± 6.8)years and control group(n=300)aged(72.4± 6.9)years.Intracranial vascular reaction was dertermined using transcranial doppler ultrasonography combined with breathholding test to calculate the breath-holding index(BHI)and evaluate cerebrovascular reserve.Results BHI in vascular risk factors group and control group were(0.57±0.18)and(0.97±0.31),respectively,and cerebrovascular reserve in the patients with vascular risk factors was decreased than without risk factors(t =10.87,P ＜ 0.01).Multifactor retrospective analysis showed hypertension,hyperlipidemia,diabetes and smoking were related with cerebrovascular reserve(F=6.51,P =0.000),and the degree to influnce from small to large was followed by diabetes,hypertention,smoking and hyperlipidemia.Conclusions Cerebrovascular reserve is damaged in the aged patients with vascular risk factors.Hypertension,hyperlipidemia,diabetes,smoking may affect cerebrovascular reserves among which the greatest influence is in diabetes.

Objective To evaluate the long-term prognosis and safety of ABO-incompatible (ABO-I) liver transplantation on type-O patients with acute severe liver disease,analyze and compare the effects and main complications between different donor blood types,and investigate corresponding treatment measures.Methods The clinical data of 65 cases of emergency orthotopic liver transplantation (OLT) for type-O patients with acute severe liver disease from January 2014 to January 2017,including 41 cases of ABO-compatible (ABO-C) OLT and 24 cases of ABO-incompatible OLT (7 with type-A donor,9 with type-B donor,and 8 with type-AB donor) were retrospective analyzed.Results The model for end-stage liver disease (MELD) score in the ABO-incompatible group was 32.5±5.5,significantly higher in the ABO-compatible group (23.3±8.9) (P=0.001).The data of the other perioperative factors showed no statistically significant difference between two groups.The cumulative survival rate in the ABO-compatible group was 87.8 % (36/41),not significantly different from that in the ABO-incompatible group [87.5% (21/24),P=0.924].The 57 cases who had survived after perioperative period were followed up for 4-37 months (mean 18 months).Significantly higher incidence of hepatic artery and biliary complications was found in ABO-incompatible group (P=0.005,and P<0.001,respectively).The incidence of hepatic artery complication and biliary complication in ABO-incompatible group was 29.2% (7/24) and 37.5% (9/24),and that in ABO-compatible group was 4.9% (2/41) and 0 (0/41),respectively.The rate of acute rejection in the ABO-incompatible group and ABO-compatible group was 9.8% (4/41) and 4.2% (1/24) (P=0.463).The infection rate in the ABO-compatible group and ABO-incompatible group was 24.3% (10/41) and 29.2%(7/24),respectively (P=0.598).Conclusion The different donor blood types including ABO-compatible and ABO-incompatible liver transplantation program on type-O patients with acute severe liver disease have a favorable outcome.The long-term cumulative survival rate between two groups shows no significant difference.With the help of effective immunosuppression and intensive perioperative management,ABO-incompatible liver transplantation is an acceptable option to cure type-O patients with acute liver failure in emergency.The incidence of hepatic artery and biliary complications was lower in ABO-compatible group than in ABO-incompatible group.For the type-O patients with ABO-incompatible liver transplantation,the use of rituximab and plasma exchange to decrease the antibody titers of recipients is essential to prevent and cure the hepatic artery and biliary complications.

Objective To investigate the clinical and laboratory features of acute promyelocytic leukemia (APL).Methotis 513 APL patients in the last two decades were retrospectively analyzed in this research.We investigated the clinical features including age,sex,abnormality of peripheral hemogram before treatment.therapeutic effect and follow-up and laboratory data such as morphology,immunology,cytogenetics and molecular biology(MICM).Results The median age of the APL patients was 33 years old and the ratio of male and female was 1.21:1.Before treatment,the median level of WBC was 4.3×109/L and the deteetion rate of abnormal promyelocyte on blood film was 85.8%;with immunophenotypie detection,the expression levels of CD117、CD34、HLA-DR、CD7、CD14 and CD19 in APL were found to be lower and the expression 1evels of CD2、CD33 and MPO higher than those in other subtypes of acute myelocytie leukemia(AML)(beth P<0.01).Specific abnormal chromosome t(15;17)was detected in 91.7%of the patients,of whom 75.9%had standard translocation of t(15;17),being the most common one and 15.8% of the patients had t(15;17)with additional abnormal chromosome.There was only 7.5%of the patients with nolnlal karyotype.However,the presence of both simple translocation and complex translocation was seldom seen.With molecular biological detection.PML/RARα fusion gene positive rate was 99.6%.In a relativelv long clinical follow-up,we found that the complete remission(CR)rate in APL patients was 84.7%.incidence of DIC was 13.4%and five-year survival rate was 30.7%.111e median count of WBC in CR group was lower than that non-remission group(P<0.01).There were no significant differences on expressions of CD34 and CD2 and changes of cytogenetics between the two groups(P>0.05).Conclusions Comprehensive evaluation of MICM could be of important significance in the diagnosis and prognosis iudgrnent for APL patients.The CR rate in these patients with high WBC eount was considerable low.

OBJECTIVETo investigate the status of job burnout and its main influential factors in seafarers and to provide a scientific basis for ensuring the physical and psychological health of seafarers and increasing their working performance.

METHODSA total of 1027 seafarers, who underwent physical examination at Fujian International Travel Health Care Center from January to June, 2013, and left and entered China through the Fujian port, were selected. The status of job burnout was investigated using a job burnout scale. A total of 1027 questionnaires were sent out, and 989 valid ones (96.30%) were returned.

RESULTSThe scores of emotional exhaustion and cynicism were the highest in the youngest age group (<30 years), divorced or widowed group, or those with a monthly income per person over 10,000 yuan (P < 0.05). The score of reduced personal accomplishment was the highest in seafarers with a degree of junior high school or less or those with a monthly income per person of 3 000-6 000 yuan (P < 0.05). The highest scores of emotional exhaustion and cynicism were also seen in seafarers with the highest frequency of overtime working, high occupational stress, less than 6 hours' sleep per day, or poor sleep quality (P < 0.05). The highest score of reduced personal accomplishment was also seen in seafarers with the latest sail time lasting for more than six months, low occupational stress, or good sleep quality (P < 0.05). Multivariate analysis showed that poor sleep quality and occupational stress were the main risk factors for job burnout in seafarers, while physical exercise was a protective factor.

CONCLUSIONJob burnout among seafarers is influenced by many factors. Therefore, measures should be taken by relevant administrative departments and seafarers themselves to reduce the incidence of job burnout.

Adolescent ; Adult ; Burnout, Professional ; Female ; Humans ; Job Satisfaction ; Male ; Middle Aged ; Ships ; Surveys and Questionnaires ; Young Adult

Objective To summarize current status of multidrug-resistant organism (MDRO) infection in lung transplant recipients and analyze the risk factors of MDRO infection. Methods Clinical data of 321 lung transplant recipients were retrospectively analyzed. According to the incidence of postoperative MDRO infection, they were divided into the MDRO group (n=122) and non-MDRO infection group (n=199). The incidence of MDRO infection in lung transplant recipients was summarized. The risk factors of MDRO infection in lung transplant recipients were analyzed by logistic regression model. The dose-response relationship between MDRO infection and time of ventilator use was determined by restricted cubic spline model. Results Among 321 lung transplant recipients, 122 cases developed MDRO infection, with an infection rate of 38.0%. Two hundred and twenty-nine strains of pathogenic bacteria were detected in the MDRO infection group, mainly Gram-negative bacteria (92.6%), and the top three strains were carbapenem-resistant acinetobacter baumannii (46.3%), carbapenem-resistant pseudomonas aeruginosa (22.3%) and carbapenem-resistant klebsiella pneumoniae (14.8%), respectively. MDRO infection mainly consisted of lower respiratory tract infection (61.5%), followed by ventilator-associated pneumonia (26.2%). Univariate analysis showed that the risk factors of MDRO infection in lung transplant recipients were single-lung transplantation, long-time postoperative use of extracorporeal membrane oxygenation (ECMO), long operation time, long-time urinary catheterization, long-time central venous catheterization and long-time ventilator use (all P < 0.05). Multivariate logistic regression analysis indicated that single-lung transplantation and long-time ventilator use were the independent risk factors for MDRO infection in lung transplant recipients (both P < 0.05). Results of restricted cubic spline model analysis showed that the risk of infection continued to increase with the prolongation of ventilator use time within 20 d. After 20 d, prolonging the time of ventilator use failed to increase the risk of infection, showing a plateau effect. Conclusions The MDRO infection rate tends to decline in lung transplant recipients year by year. Single-lung transplantation and long-time ventilator use are the independent risk factors for MDRO infection in lung transplant recipients.

Objective:To investigate epidemiological and clinical characteristics of botulism, and the adverse events among those received botulinum antitoxin treatment.Methods:Patients with discharge diagnosis as botulism in the Second Affiliated Hospital of Xinjiang Medical University were enrolled between 2017 and 2021. The epidemiological and clinical characteristics were evaluated. Infection and mechanical ventilation as in-hospital outcomes according to baseline characteristics were analyzed. Patients with and without the interested outcomes were compared. The adverse outcomes among those received botulinum antitoxin treatment were investigated. Those with and without the adverse outcomes were also compared.Results:Sixty-seven cases of botulism were enrolled, and most cases got sick between January and March (32/67, 47.8%); among them 62 cases were Han ethnicity (92.5%); prevalence was highest in Aksu region (15/67, 22.4%); commonly seen symptoms and signs included fatigue (58/67, 86.6%), dysphagia (48/67, 71.6%), dizziness (42/67, 62.7%), ptosis (42/67, 62.7%), blurred vision (41/67, 61.2%), and limb weakness (35/67, 52.2%). Compared with patients without in-hospital infection ( n=52), patients with in-hospital infection ( n=15) were more likely to have severe botulism (0/52 vs 5/15, χ 2=19.79, P<0.001), diplopia (16/52, 30.8% vs 11/15, χ 2=8.77, P=0.003), dysarthria (17/52, 32.7% vs 11/15, χ 2=7.91, P=0.005), consciousness disorder (1/52, 1.9% vs 4/15, χ 2=10.32, P=0.008). Compared with patients without mechanical ventilation (62/67, 92.5%), patients with mechanical ventilation (5/67, 7.5%) were more likely to have severe botulism (5/5 vs 0/62, χ 2=41.17, P<0.001), and consciousness disorder (4/5 vs 1/62, 1.6%, χ 2=29.58, P<0.001). Among 67 cases of botulism, 19 cases (28.4%) had adverse events after receiving antitoxin treatment, with an average of 6.5 days from the antitoxin treatment beginning to the adverse event onset; among the 19 cases, 18 cases (94.7%) had rash. Age, sex, and severity did not differ between the groups with ( n=19) and without adverse events ( n=48) after receiving antitoxin treatment. Conclusions:Fatigue, dysphagia, dizziness, ptosis were the most frequent symptoms and signs in the botulism in Xinjiang Uygur Autonomous Region, China. Infection was a commonly seen complication of botulism, and proactive prevention and close monitoring were needed. Adverse events after receiving antitoxin were prevalent, and might not be associated with age, sex, and severity of botulism.

Objective:To investigate the efficacy of modified encephalo-duro-arterio-synangiosis (EDAS) combined with superficial temporal fascia attachment-dural reversal surgery in treatment of ischemic cerebrovascular diseases.Methods:Twenty-four patients with ischemic cerebrovascular diseases, admitted to our hospital from December 2018 to June 2020, were selected. Their clinical data were retrospectively analyzed. All patients were treated by modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery. CT cerebral perfusion (CTP) was re-examined 3 months after surgery to detect intracranial cerebral blood flow perfusion. Cephalic DSA was re-examined 6 months after surgery to observe the collateral circulation. Modified Rankin scale (mRS) was used to evaluate the good prognosis rate 6 months after surgery (mRS scores≤2 was defined as good prognosis).Results:Preoperative cerebral blood flow (CBF), time to peak of regional blood flow (rTTP), and regional mean transit time (rMTT) of 24 patients were (26.91±8.77) mL/(100 g·min), 17.57 (15.30, 19.55) s and 7.89 (6.39, 11.45) s; 3 months after surgery, the CBF, rTTP and rMTT were (33.74±11.23) mL/(100 g·min), 16.22 (13.84, 18.44) s, 6.16 (5.20, 10.38) s; significant differences were noted between the preoperative indexes and indexes 3 months after surgery ( P<0.05). Re-examination of the cranial DSA 6 months after surgery showed successful establishment of intracranial collateral circulation in all patients, and the good prognosis rate 6 months after surgery was87.5%. Conclusion:Modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery is an effective method for ischemic cerebrovascular diseases, which can significantly increase the establishment of collateral circulation in the surgical area and prognosis of ischemic cerebrovascular diseases.

Objective To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. Methods Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. Results The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (P<0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (P<0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (P<0.001). Conclusions MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application.