Objective:To analyze the influencing factors of perioperative nosocomial infection in elderly patients with hip fracture under the background of enhance recovery after surgery so as to provide guidance for prevention and control of the nosocomial infection.Methods:The clinical data were collected from 1 628 elderly patients with hip fracture who were hospitalized from January 2018 to August 2019,during the implementation of enhance recovery after surgery in Tianjin hospital. Medical records of the patients were reviewed and statistically analyzed through hospital medical record system, the incidence of perioperative nosocomial infection and the influencing factors for the infection were observed.Results:Of the 1 628 hospitalized patients with hip fracture, 102 had nosocomial infection, 125 case-times, with the infection rate 6.27%(102/1 628) and the case-times infection rate 7.68%(125/1 628). Lower respiratory tract, urinary tract and surgical site were the dominant infection sites, accounting for 72.80% (91/125), 11.20% (14/125) and 10.40% (13/125) respectively. Univariate analysis and multivariate logistic regression analysis indicated that bone traction( OR value was 2.152, 95% CI 1.130-4.097), surgery ( OR value was 0.268, 95% CI 0.133-0.537), hospitalization days≥15 d( OR value was 12.123, 95% CI 6.017-24.426), indwelling urinary catheter ( OR value was 7.566, 95% CI 4.093-13.986), cardiac insufficiency( OR value was 2.112, 95% CI 1.192-3.740), electrolyte disturbance( OR value was 2.383, 95% CI 1.396-4.067), lower extremity arteriosclerosis obliterans( OR value was 2.540, 95% CI 1.279-5.045) and senile dementia( OR value was 3.673, 95% CI 1.670-8.082) were the influencing factors for the perioperative nosocomial infection. Conclusions:The main influencing factors of nosocomial infection in elderly patients with hip fracture during the perioperative period were bone traction, operation, length of stay, indwelling urinary catheter and coexisting diseases. The risk of nosocomial infection can be reduced by applying the concept of enhance recovery after surgery in clinical orthopedics, comprehensively optimizing perioperative management and implementing effective prevention and control measures of nosocomial infection.

OBJECTIVETo provide scientific foundations for clinical and acupoints researches on acupuncture for treatment of inflammatory bowel diseases.

METHODSReview the correlated documents of clinical experimental researches issued from 1995 to 2005, and the clinical and experimental documents about remedy of inflammatory bowel diseases by acupuncture and moxibustion were summarized and analyzed.

RESULTSAcupuncture and moxibustion had significant therapeutic effects on inflammatory bowel diseases, and the studies on the mechanisms have achieved some progresses, but the designs and the methods of these studies need to be improved.

CONCLUSIONAfterwards, the specificity of acupoints, and factors of influencing the specificity should be studied via effective diseases treated with acupuncture and moxibustion, so as sum up common regularity, rich and develop the theory about specificity of acupoints to guide clinical treatment of acupuncture and moxibustion.

Acupuncture Points ; Acupuncture Therapy ; Humans ; Inflammatory Bowel Diseases ; prevention & control ; therapy ; Moxibustion

Objective To observe the expressing changes of apolipoprotein M (ApoM),tumor necrosis factor-α(TNF-α) and monocyte chemoattractant protein-1 (MCP-1) in human retinal vascular endothelial cells (HRECs) under the high glucose culture condition and investigate the inhibitory effects of ApoM overepression on the expressions of TNF-α and MCP-1.Methods HRECs were cultured in DMEM containing 10％ fetal bovine serum and 5.5 mmol/L D-glucose and assigned to 6 groups.The cells in the normal control group were cultured in above culture medium;the cells in the high glucose group were treated using the DMEM with 30 mmol/L D-glucose;ApoM was transfected into the cells using lentiviral vector in the ApoM transfected group;lentiviral vector without ApoM sequence was transfected in the empty vector group;the cells transfected by empty vector were cultured in high glucose culture medium in the empty vector+high glucose group;the cells in the ApoM transfection+high glucose group were treated by ApoM sequence transfection and high glucose incubation.The relative expression of ApoM,TNF-α and MCP-1 mRNA was detected using real-time quantitative PCR,and the relative expression of ApoM protein was evaluated using Western blot assay.Results Compared with the normal control group,the mRNA expression levels of ApoM,TNF-α and MCP-1 in the high glucose group were significantly increased (t=5.517,3.295,2.555;all P＜0.05).HRECs grew well after infected with lentivirus.The relative expression level of ApoM mRNA in the ApoM transfected group was 236.400±39.270,which was significantly higher than 1.000±0.153 in the empty vector group (t=5.995,P＜0.01).An enhanced protein band of ApoM was seen in the ApoM transfected group,and the protein band was absent in the empty vector group.The relative expression band in the ApoM transfected group was 1.000± 0.249 and 2.978 ± 0.285 in the cells cultured with normal culture medium or high glucose culture medium,respectively,with a significant difference between them (t =5.056,P＜0.01).The relative expressions of TNF-α and MCP-1 in the mRNA levels were significantly different among the empty vector group,empty vector+high glucose group,ApoM transfected group and ApoM transfection + high glucose group (F =5.966,P =0.026;F =14.410,P =0.002).Compared with the empty vector+high glucose group,the relative expressions of TNF-α and MCP-1 mRNA were considerably reduced in the ApoM transfection+high glucose group (P=0.017,0.004).Conclusions High glucose environment up-regulates the expression of ApoM,MCP-1 and TNF-α in HRECs.Overexpression of ApoM inhibits the up-regulation of MCP-1 and TNF-α expression induced by high glucose.

Objective:To investigate the compliance of statins and influencing factors in population with cardiovascular risks in the community.Methods:One hundred and eighty-six residents with cardiovascular disease risks in a community of Tianjin were recruited from June 2017 to October 2017. The Chinese revised version of the compliance Morisky scale was used to assess the compliance, and the influencing factors were analyzed.Results:Among all subjects 119 were prescribed with statins (64.0%,119/186) , of whom 7.6% (9/119) did not take the drug. According to the risk assessment of arteriosclerotic cardiovascular disease (ASCVD) in the next 10 years, among the 110 subjects taking the medicine, there were 18 subjects with intermediate risk and 92 with high risk. The subjects with good compliance accounted for 30.0% (33/110), and those with poor compliance accounted for 70.0% (77/110). Univariate analysis showed that education level, occupation, and drug types were significantly associated with statin compliance ( P<0.05). Multivariate logistic regression analysis showed that higher education level and fewer total drug users were correlated with better compliance ( OR=3.530 and 0.388, P<0.05) . The reasons for subjects not taking medicine were fearing of adverse reactions ( n=6, 6/9) , and thinking no symptoms and no need to have medication ( n=3, 3/9).The reasons of poor medication adherence were thinking no symptoms and no need to have medication ( n=31, 40.2%), thinking ineffectiveness of medication ( n=28, 36.4%), fearing of adverse reactions ( n=16, 20.8%), and economic pressure ( n=2, 2.6%). Conclusions:The proportion of residents with poor compliance of statins is high in the community. It is suggested that targeted interventions and standardized management for subjects with cardiovascular risks should be conducted based on the related factors found in the study.

OBJECTIVETwo children with hydroa vacciniforme-like lymphoma (HVLL) were reported for a better understanding of this disease.

METHODSThe clinical manifestation, pathological characteristics, therapeutic outcomes of two children with HVLL were analyzed and presented by compared with what described in literatures.

RESULTSTwo children were girls, who treated firstly in the hospital in May 2012, July 2012 and their duration were 1 years, more than 10 years respectively. Their clinical manifestations were both limbs and craniofacial polymorphous rashes. Pathological findings revealed that the dermis and subcutaneous tissue were profiled by atypical lymphocytic infiltration. Immunohistochemistry showed that the infiltration of cells from T/NK cell, and Epstein-Barr virus encoded small RNA (EBER)(+). Case 1 was treated with chemotherapy, but her condition continued to deteriorate. Case 2 just received symptomatic treatment, her skin lesions gradually reduced and rash disappeared completely 2 months later.

CONCLUSIONHVLL is found with special clinical manifestation, its diagnosis mainly depend on skin biopsy and immunohistochemistry, there is no specific treatment method now, and its prognosis still needs further research.

Child ; Child, Preschool ; Female ; Humans ; Hydroa Vacciniforme ; Lymphoma, T-Cell, Cutaneous ; Skin Neoplasms

The purpose of this study was to compare the detection of trisomy 8 in myelodysplastic syndrome (MDS) patients with interphase fluorescence in situ hybridization (FISH) and cytogenetic karyotype analysis. Using Spectrum Green labeled chromosome 8 centromere probe, interphase FISH was established. The trisomy 8 clones were simultaneously detected in 48 MDS cases with FISH and conventional cytogenetic analysis (CCA). Results showed that the CCA revealed no significant difference of constitutional proportion between MDS-RA and MDS-RAEB with karyotypes of whole +8, partial +8 and one +8. With FISH, detectable rates were 66.1% for whole +8. Partial +8 and sole +8 were significantly higher than one +8 and complex +8, respectively. The percentages of trisomy 8 were similar in MDS-RA and MDS-RAEB. Trisomy 8 was detected in 1 of 15 specimens with normal or abnormal karyotype without trisomy 8 by FISH. There was linear correlation between the percentages of partial +8 detected by FISH and CCA. Two patients received CCA and FISH examination at diagnosis and during treatment, the percentage of trisomy 8 was increased with progress of disease. In conclusion, our results showed that FISH is a sensitive and accurate technique to detect trisomy 8 in MDS patients. It can provide contribute to diagnosis, assessment of curative effect and predicting progress of disease in MDS. Clone size of trisomy 8 does not related to classification of MDS, but sole +8 is seems to see in MDS-RA frequently.
Chromosomes, Human, Pair 8 ; genetics ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Myelodysplastic Syndromes ; genetics ; pathology ; Reproducibility of Results ; Sensitivity and Specificity ; Trisomy

OBJECTIVETo probe the mechanism of herbs-partitioned moxibustion for treatment of ulcerative colitis.

METHODSThe rats with ulcerative colitis were randomly divided into 3 groups, normal control group, model group, and herbs-partitioned moxibustion group. The rats in the herbs-partitioned moxibustion group were treated by herbs-partitioned moxibustion at bilateral Tianshu (ST 25). BiostarR-40s gene chip was applied to detect the differentially expressed gene of their colonic tissues and fluorescence quantitative polymerase chain reaction was employed to confirm the results of the microarray analysis with interleukin-1 beta messenger RNA (IL-1beta mRNA) expression.

RESULTSOf 174 differential expression genes identified, 28 genes (including 7 known genes) elevated in rats of ulcerative colitis were down-regulated and 146 genes (including 42 known genes) reduced in the rat of ulcerative colitis were up-regulated after herbs-partitioned moxibustion treatment.

CONCLUSIONMany abnormally expressed genes are involved in occurrence of ulcerative colitis and herbs-partitioned moxibustion can regulate expression of IL-1beta and other genes to exert therapeutic effect.

Animals ; Colitis, Ulcerative ; therapy ; Intestinal Mucosa ; Moxibustion ; Rats ; Rats, Sprague-Dawley

Since the first operational definition of cognitive frailty was proposed by the expert consensus group of the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics in 2013, frailty and neurocognitive assessment has become the standard diagnostic tool.Since then, the reported prevalence in the literature for cognitive frailty in community-dwelling elderly people vary by dozens of times, as a result of different scales and diagnostic cut-off points, seriously affecting health decision-making.This article reviewed the current literature with a focus on the re-recognition of the clinical significance of cognitive frailty, the limitations of existing assessment tools for diagnosis, and possible solutions in the future.

OBJECTIVETo evaluate the surgical technique of "Kou mode of hepatic hilar anastomosis" in the treatment for type III or IV hilar cholangiocarcinoma.

METHODSThe clinical data of 89 patients with type III or IV hilar cholangiocarcinoma surgically treated in our department between Jan. 1990 and Jan. 2008 were retrospectively analyzed. Since January 2000, "Kou mode of hepatic hilar anastomosis" was performed for some patients with advanced hilar cholangiocarcinoma. The patients were divided into two groups: group A treated between 1990 and 1999, group B between 2000 and 2008. The rate of resection, therapeutic efficacy and complications in these two groups were compared, respectively.

RESULTSOf the 37 cases with hilar cholangiocarcinoma in group A, 4 were surgically treated (10.8%), with 1 (2.7%) radical resection and 3 (8.1%) palliative resection. Among the 52 cases with hilar cholangiocarcinoma in the group B, 35 (67.3%) received surgical resection, of them 15 (28.8%) underwent radical resection and 20 (38.5%) had palliative resection. Twenty-eight of these 35 cases underwent the "Kou mode of hepatic hilar anastomosis". The resection rate of advanced hilar cholangiocarcinoma in the group B was significantly higher than that in group A (P < 0.05). The complications in the 89 cases included ascites (3 cases), hemobilia (1 case), heart failure (1 case), and wound infection (2 cases). All the patients who were treated with the "Kou mode of hepatic hilar anastomosis" developed bile leakage to a varying degree and recovered after drainage and symptomatic treatment.

CONCLUSIONThe resection rate of type III or IV advanced hilar cholangiocarcinoma can be remarkably improved by using a novel alternative surgical technique called "Kou mode of hepatic hilar anastomosis". However, the long-term outcome still needs to be determined by close follow-up and further observation.

Aged ; Anastomosis, Surgical ; adverse effects ; methods ; Ascites ; etiology ; Bile Duct Neoplasms ; pathology ; surgery ; Bile Ducts, Intrahepatic ; surgery ; Cholangiocarcinoma ; pathology ; surgery ; Female ; Hemobilia ; etiology ; Hepatectomy ; adverse effects ; methods ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies

Objective To study the relative factors of relapse in children with aplastic anemia (AA) treated with antithymocyte globulin(ATG) combined with cyclosporine.Methods A retrospective analysis of the risk factors of relapse in children with AA after response to immunosuppressive therapy(IST).All patients received IST from Jan.2007 to Dec.2011 in the First Affiliated Hospital of Zhengzhou University.IST:ATG 3 mg/(kg · d) × 5 d,cyclosporine 5-8 mg/(kg · d).Results (1) The basic cure rate was 29.4％ (25/85 cases),remission and obvious progress rate was 47.0％ (40/85 cases),and 20 cases were ineffective,the overall incidence of remission was 76.5％ (65/85 cases),basic cure,remission and obvious progress were considered as effective.The relapse rate was 12.3％ (8/65 cases).(2)Relapse was relative with cyclosporine concentration,infections episodes.And it was not relative with severity of disease,age,sex,duration of AA prior to initial treatment,severity of response.Conclusions A significant proportion of patients subsequently relapsed and required second-line therapy.Early IST,long-time continuation-maintenance of cyclosporine and the reduction of infectious episodes are important to prevent relapse.