[Summary] With the development of diagnosis and treatment levels and the improvement of survival rates of breast cancer , related lymphedema has received increasing attention .In a long term, it is regarded as the primary complication after the breast cancer therapy , which affects the quality of life of patients .Due to lack of consensus in many aspects worldwide , it continues to be a challenge to diagnose and treat the disease .This article aimed to summarize the diagnosis and therapeutics of breast cancer related lymphedema .

Objective To evaluate the performance of VITEK-2 compact,VITEK MS and Bruker MS on the identification of Corynebacterium.Methods This was a methodological evaluation study.The 40 Corynebacterium from bioMerieux were i-dentified with the three methods respectively.16S rDNA gene sequencing was conducted as reference method.Made a de-scriptive analysis of the identification ability,time and cost.Resulets The accuracy of species level of the three methods was 95.0%,88.9% and 97.5%.The mean time was 5~6 h,2~3 min and 2~3 min.The cost of consumable was 50~70 yuan, 15~25 yuan and 10~20 yuan.Conclution Three methods with high accuracy can meet the requirement of clinical diagno-sis,and the identification ability of VITEK MS on Corynebacterium amycolatum need to be further improved.

Accidents, Occupational ; Adolescent ; Adult ; Ammonia ; poisoning ; Female ; Humans ; Male ; Young Adult

OBJECTIVE To understand the distribution or change and drug resistance of the bacteria flora in nosocomial infection,in order to provide laboratory evidence for controlling nosocomial infection and to indicate clinical antimicrobial agents usage.METHODS All isolates were identified by routine procedure and VITEK microbe automatic system and API identified system.Drug susceptibility test was used K-B paper disk diffusion method in accordance with the CLSI/NCCLS standards.RESULTS There were 11 464 strains of bacteria which were obtained from 2002 to 2006.Sputum,secretion and middle urine were the major specimens.The major bacteria floras were Pseudomonas aeruginosa,Escherichia coli,Acinetobacter,Enterococcus,Staphylococcus and Candida albicans,whose isolating rates were 57.02% in 2002,64.46% in 2003,57.83% in 2004,57.49% in 2005,and 60.73% in 2006.E.coli and Klebsiella pneumoniae produced ESBLs rates were from 39.87% to 61.98% that drug resistance rates to cefoperazone/sulbactam and imipenem were 14.06% and 0.64%.The drug resistance rates of nonferment Gram-negtive bacteria to cefoperazone/sulbactam were below 33.22%,Gram-positive cocci to vancomycin was below 0.34%.CONCLUSIONS Now,the important bacteria flora is nonferment Gram-negative bacteria in nosocomial infection.The P.aeruginosa,E.coli,Acinetobacter baumannii,Enterococcus faecalis,C.albicans,and meticillin-resistant staphylococcus(MRS) were prevalent important bacteria in nosocomial infection.The situation of producing ESBLs in Enterobacteriaceae is very severe.Glycopeptides are the best choice to MRS.To zymogenic bacteria and the nonferment Gram-negtive bacteria that cause severe infection,combining-drug treatment can be chosen according to drug susceptibility test results.

Humans ; Infection ; etiology ; therapy ; Pancreatitis ; complications ; therapy

Objective To identify pre-operative demographic and urodynamic (UD) parameters related to overactive bladder (OAB) symptoms of pre-operation and persistence of after pelvic organ prolapse (POP) repair.Methods From Jan 1,2010 to Oct 31,2012,this perspective study examined demographic and UD data of 175 patients undergoing POP surgery.Pre-and post-operative urinary distress inventory 6 (UDI-6) scores for frequency and urge urinary incontinence (UUI) were analyzed,and correlations between scores and pre-operative UD data were also analyzed.Results (1)Surgery resulted in a improvement of frequency (71.0％,71/100) and UUI (69.2％,63/91) at 12-24 months follow-up.(2)Pre-operative UD parameters:first desire of bladder ＜100 ml,6.3％ (11/175); detrusor overactivity,14.9％ (26/175); post-void residual ≥50 ml,11.4％ (20/175); maximal flow rate (Qmax),(16±7) ml/s.(3)Comparison of pre-operative UD datas between patients with OAB symptoms and without,with OAB symptoms group had more patients of type Ⅲ stress urinary incontinence [5％ (5/91) versus 0 (0/84),P=0.022].(4)Qmax was higher in improvement in UUI group than that in persistent UUI after POP repair [(17±7) m]/s versus (13±5) ml/s,P＜0.01].Conclusions POP repair significantly reduces OAB symptoms; however,there had not exact predictor for symptoms of persistent frequency,UUI after POP repair.Persistent UUI symptom may be related to Qmax of pre-operative UD.

Objective To investigate work stress state of nursing home staff and to analyze the influential factors affecting work stress.Methods Stratified random sampling method was adopted to investigate 180 nursing assistants by self-designed questionnaire,Work Stress Scale(WSS),Simplified Coping Style Questionnaire and internal-external locus of control scale investigation.Results Totally 174 valid questionnaires were collected.Variance analysis revealed there were significant differences of age and other factors.Stepwise multiple regression analysis showed five variables entered the equation,including workexpenence education level number of the cared ages work scheduline coping stule and explain 56.7％ of the total variable.Conclusion Nurse managers should pay attention to and improve achievement sense and mental adjustment ability of nursing assistants,to build a well-organized support system to reduce the workload.

Objective To summarize the clinical features,diagnosis and treatment of autologous urologic neoplasms in renal transplant recipients.Methods A retrospective analysis on the clinical data of 25 renal transplant recipients was done in our center.The onset time of new neoplasms was between 29 to 72 months after transplantation,with an average of 48.2 months.Intermittent hematuria was the first symptom in 23 patients,and the rest two cases were diagnosed through routine examination. The pathological diagnoses of thee cases were renal carcinoma,which were treated by transperitoneal laparoscopic radical nephrectomy.Eight cases were diagnosed as having renal pelvic tumor,which was treated by radical resection for the renal pelvic carcinoma.Fourteen cases were diagnosed as having bladder cancer,which was treated by transurethral resection of bladder tumor (13 cases) or radical cystectomy (one case).All patients were subjected to surgical treatment.The dosage of MMF,CSA/Tacrolimus was decreased to 1/2-2/3 of their original dosage. Sirolimus was used in place of calcineurin inhibitors in four patients.Immunosuppressive regimes and adjuvant therapy were given after surgery treatment.Results Twenty-five patients were followed up for 12-84 months.Contralateral renal carcinoma combined with lung and chest multiple metastases occurred in one case after radical nephrectomy,who died after targeted therapy 6 months later.Two patients with lymph node metastasis died 14 months and 20 months after surgery respectively.The rest 22 patients were closely followed up,whose creatinine remained 98-163μmol/L.Conclusion More attention should be paid to patients with hematuria after renal transplantation to screen the autologous urinary neoplasms.Patients should be treated with surgical procedures,and immunosuppressive regimens should be adjusted postoperatively.

Objective To evaluate the application of plasma drug monitoring in pediatric HIV/AIDS patient antiretroviral therapy adherence monitoring.Methods Totally 261 plasma samples and related information were collected from three consecutive follow-up visits of 87 HIV-infected children treated in Shangcai county CDC of Henan province from March to October 2009.The plasma concentrations of antiretroviral drugs were measured by a developed high performance liquid chromatography-mass spectrometry method.Potential adherence influencing factors, such as regimen, age, gender, parent conditions, previous ART exposure and therapy duration, were analyzed by univariate logistic regression.Results Plasma concentration of antiretroviral drugs lower than LLTR (1 000 ng/ml) was the criteria to identify missed dose.The concentrations of 28 plasma samples were lower than LLTR, which meant missing dose.There were 17 patients (19.5%) with their concentrations lower than LLTR at least once in three follow-up visits.Logistic regression analysis of adherence related factors showed that compared with the children whose parents were both alive, the children whose mother and (or) father died were more likely to miss dose.The odds ratio was 4.13(95% credibility interval:1.37-12.46, P values was 0.012).Conclusions HIV-infected children have adherence problems when receiving antiretroviral therapy.Plasma therapeutic drug monitoring can be one of the effective methods to monitor the adherence.

Objective Obesity is one of the risk factors for gout.The aim of the present study was to evaluate clinical characteristics of gout patients with different BMI.Methods A total of 5 104 patients with gout were enrolled and divided into three groups according to the BMI.The clinical information was collected and relevant biochemical indices were detected.SPSS software was applied for the statistical analyses.Results There were significant differences in the ratios of gender,regular exercise,hypertension,tophus,renal insufficiency,hyperlipidemia,impaired glucose metabolism,liver dysfunction among the three groups (all P＜0.01).The onset age in overweight [45(36,55) years] and obese subjects [40(31,50)years] were earlier than that of the normal weight subjects [50 (38,61) years].Moreover,waist circumstances [103(99,108) cm and 94 (90,98) cm vs 87 (82,91) cm],systolic pressure [130 (120,145) mmHg (1 mmHg =0.133 kPa) and 130 (120,140) mmHg vs 128 (115,140) mmHg],diastolic pressure [90 (80,100) mmHg and 85 (80,92) mmHg vs 80 (79,90) mmHg],fasting blood glucose [5.77 (5.30,6.44) mmol/L and 5.65 (5.19,6.26) mmol/L vs 5.55 (5.10,6.15) mmol/L],TG [2.10 (1.46,3.04) mmol/L and1.88 (1.35,2.78) mmol/L vs 1.52 (1.07,2.39) mmol/L],TC [5.20 (4.55,5.93) mmol/L and 5.07 (4.46,5.75) mmol/L vs 4.95 (4.27,5.65) mmol/L],serum uric acid [483(418,552) μmol/L and461(395,524) μmol/L vs440 (368,517) μmol/L],ALT [30 (21,46) U/L and25 (18,36) U/L vs 21 (14,29) U/L],AST [21(17,28) U/L and 20 (17,26) U/L vs 20 (6,25) U/L],the number of joints involved [2 (1,3) joints and 2 (1,2) joints vs 1 (1,2) joints] in the overweight and obese groups were higher than those in the normal weight group (all P ＜ 0.01).There were no statistical differences in family history,involvement of upper limb joints,kidney stones and coronary heart disease among the three groups (all P ＞ 0.05).Conclusions Obesity is associated with an earlier age of gout onset.With the increase of BMI,the blood pressures,glucose,lipid,serum uric acid,liver transaminase levels and the number of involved joints increased gradually.Cautions should be taken in treating patients with different BMI.