Objective:To investigate the clinical efficacy of amoxicillin combined with metronidazole in the treatment of peri-implantitis and its effect on serum matrix metalloproteinase-8 (MMP-8), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels.Methods:Sixty-four patients with peri-implantitis who received treatment from January 2017 to December 2019 in Xiasha Hospital, SiR Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this study. They were randomly assigned to receive treatment with metronidazole (control group, n = 32) or amoxicillin combined with metronidazole (observation group, n = 32). Clinical efficacy, periodontal pocket depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI), plaque index (PLI), matrix metalloproteinase-8 (MMP-8), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) levels and the incidence of adverse reactions were compared between the control and observation groups. PD, CAL, SBI and PLI were correlated with MMP-8, TNF-α and IL-1β levels. Results:The clinical efficacy in the observation group was significantly higher than that in the control group [93.75% (30/32) vs. 75.00% (24/32), χ2 = 4.267, P < 0.05]. After treatment, PD [(3.02 ± 0.24) mm], CAL [(1.70 ± 0.14) mm], SBI [(11.54 ± 3.26)%], PLI (0.87 ± 0.11) in the observation group were significantly lower than those in the control group [(4.47 ± 1.37) mm, (3.77 ± 1.06) mm, (18.84 ± 5.11)%, (1.12 ± 0.15), t = 5.897, 10.952, 6.813, 7.603, all P < 0.01]. After treatment, serum MMP-8 [(0.78 ± 0.23) μg/L], TNF-α [(71.24 ± 10.33) μg/L], IL-1β [(1.20 ± 0.14) μg/L] levels in the observation group were significantly lower compared with the control group [(1.12 ± 0.35) μg/L, (113.28 ± 15.73) μg/L, (2.55 ± 1.02) μg/L, t = 4.592, 12.637, 7.417, all P < 0.01]. Spearman correlation coefficient analysis showed that PD, CAL, SBI and PLI were positively correlated with serum MMP-8, TNF-α and IL-1β levels (all P < 0.01). Conclusion:Amoxicillin combined with metronidazole is highly effective in the treatment of peri-implantitis because it can promote plaque regression, reduce inflammatory reaction, and has a certain clinical promotion value.

Objective To approach the effect of protective mechanical ventilation on acute lung injury after orthotopic liver transplantation, by observing changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia, 42 males and 18 females, aged 21-62 years, weighing 43-80 kg, ASA physical status Ⅱ-Ⅳ, were randomly divided into 2 groups: protective mechanical ventilation group (group P) and unprotective mechanical ventilation group (group U).Pulmonary artery blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points: before operation (T1), 3 hours after mechanical ventilation (T2), 2 hours (T3) and 4 hours in neohepatic stage (T4).These mediators included clara cell secretory protein (CC16), surfactant proteins (SP-D), soluble receptor for advanced glycation end-products (sRAGE), TNF-α, IL-6 and IL-8.Moreover, blood gas results were recorded at these 7 time points: T1-T4, 2 hours after operation (T5), before tracheal extubation (T6) and 2 days after operation (T7).The postoperative awakening time, tracheal extubation time, ICU stay time and the incidence of ALI were recorded.Results Compared with T1, plasma level of CC16 in the two groups increased at T2 and T3 (P<0.05 or P<0.01), however, plasma level of SP-D, sRAGE, TNF-α, IL-6 and IL-8 did not increase until T3 (P<0.01).Moreover, plasma level of sRAGE, TNF-α, IL-6 and IL-8 at T4 were higher than those at T1 (P<0.05 or P<0.01).Compared with T1, OIs in the two groups increased at T2, T5 and T6 (P<0.05 or P<0.01), while decreased at T4 in group P (P<0.01) and at T3 and T4 in group U (P<0.01).In group P, patients showed a lower plasma level of CC16 at T2 and T3 (P<0.05 or P<0.01), a higher OI at T3 (P<0.05) and an earlier tracheal extubation after operation [(8.9±3.2) h vs (9.3±2.8) h, P<0.05] compared with group U.There was no significant difference of acute lung injury incidence between the two groups after operation, which was 5(16.6%) and 7 (23.3%), respectively.Conclusion Protective mechanical ventilation may promote oxygenation index, and shorten tracheal extubation time, thus protect lung function of patients in liver transplantation to some extend.

Objective To evaluate the effects of lung-protective ventilation on acute lung injury after liver transplantation.Methods Sixty patients of both sexes,aged 21-64 yr,with body mass index of 18-28 kg/m2,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,scheduled for elective orthotopic liver transplantation,were divided into 2 groups (n =30 each) using a random number table:conventional mechanical ventilation group (group CMV) and lung-protective ventilation group (group LPV).In group LPV,the patients were mechanically ventilated (tidal volume 6-8 ml/kg,respiratory rate 10-15 breaths/min,positive end-expiratory pressure 3-10 cmH2 O),and lung recruitment mnaneuver was pertormed every 2 h.Before skin incision (T1),at 3 h of preanhepatic phase (T2),at 30 min of anhepatic phase (T3) and at 2 and 4 h of neohepatic phase (T4.5),bronchoalveolar lavage fluid (BALF) was collected and blood samples from the radial artery were simultaneously collected for determination of tumor necrosis factor-alpha and interleukin-8 concentrations in BALF and serum by enzyme-linked immunosorbent assay.At 2 h after operation (T6),before tracheal extubation (T7) and at 2 days after operation (T8),blood samples from the radial artery were collected for blood gas analysis,and oxygenation index was calculated.The concentrations of serum Clara cell secretory protein 16,surfactant protein D and soluble receptor for advanced glycation end-products were determined at T1-T8 using enzyme-linked immunosorbent assay.The postoperative emergence time,extubation time,duration of intensive care unit stay and development of acute lung injury were recorded.Results Compared with group CMV,the cxtubation time was significantly shortened,serum concentrations of Clara cell secretory protein 16 at T2,T3,T6 and T7,serum surfactant protein D concentrations at T5 and serum concentrations of soluable receptor for advanced glycation endproducts at T5 and T6 were decreased (P＜0.05),and no significant change was found in tunor necrosis factor-alpha and interleukin-8 concentrations in serum and BALF at each time point or postoperative incidence of acute lung injury,oxygenation index,emergence time and duration of intensive care unit stay in group LPV (P＞0.05).Conclusion Although lung-protective ventilation dose not decrease the development of acute lung injury after liver transplantation,it attenuates lung tissue injury to some extent.

Objective To investigate the status of professional self-concept of nurses and its influencing factors of Clinical registered nursing major in Guangdong. In order to provide the basic theory of improving the level of professional self-concept of nurses. Methods A total of 280 nurses were investigated from different levels and deployment of hospitals by convenient sampling method and with Nursing Professional Self-concept Scale (PSCNI).With variance analysis, two-sample t test and multiple stepwise regression analysis to analyze the influence of professional self-concept of nurses by demographic questions. Results The score of professional self-concept of nurses was (85.79±9.23) points, the project average score was (2.86 ± 0.31) points which were positive. Dimension score of flexibility was the highest which was (3.23±0.44) points. Dimension score of communication skills was the lowest which was (2.62± 0.38)points. Age、years of work, marital status, job title, whether hold executive duties、the choice of career, job satisfaction (t/F=1.29, 1.53, -3.13, 1.88, 3.68, 3.59, 1.68, P<0.01)all had a significant impact on professional self-concept of nurses. And age, the choice of career and job satisfaction (t=4.385,-2.889,-2.268, P=0.000, 0.004, 0.024)were three main related factors of the score of professional self-concept. Conclusions The professional self-concept of nurses was positive, but it is also unbalanced. Nursing managers should be concentrate on increasing the level of professional self-concept of young and involuntary nurses, and also according to the characteristics of hospitals and departments to improve the job satisfaction of nurses to achieve the purpose of improving the professional self-concept of nurses themselves.

ObjectiveTo compare the efficacy and safety of sequential intravenous moxifloxacin treatment against cefoperazone/sulbactam in patients with acute biliary tract infection. MethodsA prospective, randomized, non-blind, multi-centric study was performed to compare the efficacy and safety of moxifloxacin 400 mg Ⅳ once daily to cefoperazone-sulbactam (2 g q12 hours) and metronidazole 250 ml once daily to treat patients, from March- December 2009 in 13 hospitals, with acute biliary tract infection.The primary efficacy variable was clinical cure rate after the end of a 5 - 14 day treatment period,bacteriologic outcomes and adverse reaction effects were also determined.ResultsA total of 319 subjects were enrolled, 282 of whom were eligible for protocol efficacy analyses ( 138 moxifloxacin, 144 comparator).Demographic and baseline medical characteristics were similar between the 2 groups. Clinical success rates were 86.2％ for moxifloxacin and 84. 7％ for the comparator(P =0. 7192). Pathogens (55 moxifloxacin, 61 comparator) were isolated from bile or blood cultures and the predominant strains were E. coli, Klebsiella species and Enterococcus species. Bacterial eradication rates were 85.4％ ( 37 of 55 ) with moxifloxacin versus 82. 0％ (50 of 61 ) in the comparator group ( x2 = 0. 2568, P = 0. 6123 ). Both treatments were safe and well tolerated. ConclusionsE. coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with acute biliary tract infection. Moxifloxacin monotherapy has high clinical and bacteriological efficacies and safety for the treatment of acute biliary tract infection.

Objective To evaluate the storage performance of storage bags for apheresis platelets produced by Shandong Weigao Group Medical Polymer Co .,Ltd ( experimental bags ) with Trima set platelet storage bags produced by the U .S. Gambro BCT as the control .Method One unit of apheresis platelets was divided into two equal parts , added to control blood bags and experimental blood bags respectively .All samples were stored at ( 22 ±2 )℃ with consecutive oscillation . The platelets′count, mean volume, aggregate activity (ADP, THR), pH, glucose, lactate concentration, lactate dehydro-genase concentration , hypotonic shock reaction , expression of CD62P and phosphatidyl serine on surface of cell membrane were detected at 0,3,5 and 7 d respectively.Results There was no significant difference in platelet quality after five days of storage between the experimental group and the control group (t-test, P>0.05).Conclusion Two types of platelet stor-age blood bags have similar storage performance for apheresis platelets .

Objective:To preliminarily explore the effects of tumor treating fields (TTF) arrays on the dose distribution in the treatment of Glioblastoma (GBM) using combined radiotherapy and concurrent TTF.Methods:EDR2 and MatriXX plate ionization chamber were employed to measure the absorbed doses of tissues at different depths (< 1 mm, 3 mm, 5 mm, 1 cm, 1.5 cm, 3 cm, 5 cm, 10 cm, and 15 cm) in the case that TTF arrays and latex-free foam were attached and not attached on the surface. Then the absorbed doses were calculated, compared, and analyzed. For the volumetric arc therapy (VMAT) of 10 GBM patients, deep dose verification was performed using the Sun Nuclear ArcCheck 3D dose verification system and the D99%, Dmean, and D1% of tumors and OARs were assessed. Results:The surface dose increased by 173% in the case that TTF arrays and latex-free foam were attached to the surface compared with the case of the surface with nothing attached. The surface dose increased by 61.7% due to the attachment of low-density latex-free foam. The dose deviation gradually decreased with an increase in the depth and stabilized (about 4%) at a depth of greater than 1.5 cm. As indicated by the VMAT verification result, the D99%, Dmean, and D1% of PTV and CTV decreased by 1.1%-1.2% and the Dmean and D1% of OARs (i.e., brainstem, pituitary gland, optic chiasma, optic nerve, eyeball, and eye crystal) decreased by 0.7%-1.5% in the case that TTF array and latex-free foam were attached on the surface compared with the case the surface with nothing attached. Conclusions:The combined radiotherapy and concurrent TTF in the GBM treatment will lead to a slight reduction of the absorbed doses of targets and OARs but a significant increase in the absorbed doses of the scalp. Therefore, it is recommended that the scalp doses should be reduced as far as possible in the design of the radiation treatment plan to reduce the adverse reactions on the scalp of GBM patients.

Objective To analyze the characteristics of elderly frequent clinic attenders in a Shanghai community health service center.Methods The medical records of patients over 60 year who visited Shanghai Weifang Community Health Center clinic from October 2014 to October 2017 were obtained from the hospital outpatient management system.The persistent frequent attenders were defined as whose visiting times were among the top 10％ of attendance in the three consecutive years.The general condition and disease characteristics of persistent frequent attenders were analyzed and compared with those of non-frequent attenders and transient frequent attenders.Results There were total 19 240 patients paying 1 171 thousand clinic visits in the center for three years,the persistent frequent attenders accounted for 5.3％ (1 029) of total patients and had 21.4％ of total visits (251 thousand);those figures for transient frequent attenders were 10.2％(1 965) and 23.9％ (280 thousand);for non-frequent attenders were 84.5％ (16 246) and 54.7％(640 thousand),respectively.The average annual visits of three groups were (81.4 ± 27.5),(47.5 ± 21.4) and (13.1± 11.1) times,respectively.The reasons for encounter in persistent frequent attenders were:coronary heart disease (11.2％,48 thousand),cerebral insufficiency (3.5％,15 thousand),joint pain (2.5％,11 thousand),osteoporosis (2.9％,13 thousand) and sequelae of stroke (2.1％,9 thousand).Age above 70(OR=2.163,95％CI:1.872-2.498),age above 80 (OR=2.243,95％CI 1.895-2.655),female sex (OR=1.426,95％CI:1.249-1.627) and contracting general practitioners (OR=5.665,95％CI 4.217-7.611) were associated with persistent frequent attendance (P＜0.05).Conclusion Elderly frequent attenders occupy large outpatient resources of community health center,and age,gender and contracting status could affect their attending frequency.

Objective To compare the efficacy of early and delayed removal of debridement implant for infection after internal fixation of tibial fracture.Methods A retrospective case control study was conducted on the clinical data of 27 patients with tibial fractures who received plate or screw internal fixation admitted to the East Hospital Affiliated to Tongji University from March 2005 to September 2016.There were 21 males and six females,aged 18-81 years [(41.6 ± 14.3)years].According to the treatment methods,the patients were divided into the delayed implant removal group (Group A,10 patients) and the early implant removal group (Group B,17 patients).Group A was given debridement and anti infection treatment followed by continuous dressing change,and the implant was removed after the fractures were healed.Group B was given debridement and implant removal after one month of anti infection treatment and continuous dressing change when the infection was not clearly controlled.Patients with stable fracture ends were given only negative pressure closed drainage (VSD),and those with instable fracture ends were given external fixation and VSD.The time from infection to implant removal,the time of infection control,the fracture nonunion rate,the chronic bone infection rate,the knee joint function score of the American Hospital for Special Surgery (HSS),and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale were compared between the two groups.Results All patients were followed up for 13-47 months,with the average of 28.4 months.There were significant differences between Group A and Group B in terms of the time from infection to implant removal [(49.9 17.1) weeks ∶ (19.3 ± 9.2) weeks],the time of infection control [(85.3 ±78.3)days∶ (6.3 ±2.8)days],fracture nonunion rate (30％ ∶ 0),and the chronic osteomyelitis incidence (30％ ∶ 0) (all P ＜0.05).No significant differences were found in HSS knee joint function score and AOFAS ankle hindfoot scale between the two groups (both P ＞ 0.05).Conclusion For patients with postoperative infection after internal fixation for tibial fracture,early thorough debridement and implant removal can quickly control the infection and reduce the incidence of nonunion and osteomyelitis.