Objective To reduce infection risk in hemodialysis patients through analyzing the causes of over stand-ard colony forming unit(CFU)and conducting bacteriological detection of hemodialysis concentrated B solution. Methods According to microbial monitoring results of hemodialysis concentrate B solution in a hospital between November 2011 and May 2012,disinfection frequency of B solution was changed and dispensing container was covered during the process of using,four groups were divided according to different measures (group A disinfected twice a week,covered dur-ing the process of using;group B twice a week;group C once a week;group D once every two weeks),monthly bacte-riological detection of B solution was conducted,condition before and after disinfection of four groups were com-pared.Results Bacterial count in group A,B ,C and D was(25.41 ±15.08),(28.24±28.04),(68.58 ±22.58), and (75.25±26.63)CFU/mL,respectively (F =79.00,P <0.01 );bacterial count of group A,B,and C after in-tervention were all lower than group D before intervention (all P <0.01),bacterial count of group A and B was the lowest.The qualified rate of group A was 100.00%,the unqualified rate of group B,C,and D was 13.95%, 24.24%,and 35.94% respectively(χ2 =28.70,P <0.01 ),the unqualified rates of group A,B,and C after inter-vention were all lower than group D.Conclusion Hemodialysis concentrated B solution should be used within 24 hours after preparing,disinfected twice a week,and covered during the process of using ,so as to control B solution colony number within the standard level.

Objective To investigate the effect of at-RA in macrophage accumulation in tubulointerstitium of rats with renal tubulointerstitial fibrosis.Methods Unilateral ureteral obstructive(UUO) rat animal models were used for the study.40 SD rats were randomly divided into 5 groups: sham group,UUO group,benazepril group,low-dose at-RA groups and high-dose at-RA groups.The rats were under intragastric administration by benazepril(10mg/(kg?d)) in benazepril group,and by(at-RA)(10mg/(kg?d)) in low-dose at-RA group and 20mg/(kg?d) in high-dose at-RA group and by sodium chloride in tales doses in sham group and UUO group from the day before the operation to 14 day after operation.Immunohistochemistry staining of CD68 and Col Ⅲ was used to define the macrophage accumulation and expression of interstitial Col Ⅲ.The degree of tubulointerstitial damage was scored by HE and Masson staining.Results Tubulointerstitial macrophage infiltration were all significantly reduced by(at-RA) or benazepril treatment.They also improved the histological changes of UUO rats and inhibited interstitial colⅢ deposition.Conclusion Reduction of interstitial macrophage infiltration may be an important event by which(at-RA) or benazepril prevents renal injury caused by UUO.

Objective:To investigate the clinical efficacy of the folding lateral position fixation frame with adjustable angles.Methods:A total of 60 patients from the Department of Intensive Care Unit (ICU) between January and June in 2019 with consciousness disorder or sedation and no ability to change postures on their own were selected and randomized into treatment group ( n=30) and control group ( n=30). Patients in the treatment group were backed by the fixation fame in lateral position of 80 degrees, while those in the control group were backed by sponge triangle pillow in lateral position of 80 degrees. After 2 hours, the angles of the mattress surface and the body of patients in two groups were measured with a SanNiang digital angle ruler. The efficacy rates of maintaining lateral positions of patients in both groups were calculated. The occurrence rates of skin ulcers in both groups were observed as well. Results:The efficacy rate of maintaining a lateral position was 93.3% (28/30) in the treatment group and 33.3% (10/30) in the control group. The differences between two groups were statistically significant ( χ2 value was 23.25, P=0.000). No skin ulcers were observed in patients in the two groups. Conclusion:The folding lateral position fixation frame with adjustable angles helps to maintain the lateral position efficiently, which can smooth sputum drainage, reduce the imbalance between ventilation and blood flow, increase oxygenation and prevent pulmonary infection. Compared with sponge triangle pillow, the frame can bear more weights, which is suitable for patients with varying weights. Beside, the frame is small in size and foldable, which is convenient for storing and sterilizing. It is highly cost effective and can meet different clinical needs.

Purpose: This study aimed to investigate reproductive concerns among breast cancer patients of reproductive age, analyze the influencing factors, explore the relationship between coping styles, fear of progression (FOP), and reproductive concerns, and identify the multiple effects of coping styles on the relationship between FOP and reproductive concerns among Chinese breast cancer patients. Methods: A cross-sectional, descriptive study was conducted among breast cancer patients in four tertiary grade A hospitals in Fujian, China, from January 2022 to September 2022. A total of 210 patients were recruited to complete paper-based questionnaires, which included the general data questionnaires, the Reproductive Concerns After Cancer Scale (RCACS), the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), and the Medical Coping Modes Questionnaire (MCMQ). Structural equation models were utilized to evaluate the multiple effects of coping styles on FOP and reproductive concerns. Results: Reproductive concerns in breast cancer patients had a mean score of 53.02 (SD, 10.69), out of a total score of 90, and coping styles for cancer (confrontation, avoidance) were closely associated with FOP and reproductive concerns. FOP showed a significant positive correlation with reproductive concerns (r = .52, p < .01). At the same time, confrontation was significantly negatively correlated with both FOP (r = −.28, p < .01) and reproductive concerns (r = −.39, p < .01). Avoidance was positively correlated to both FOP (r = .25, p < .01) and reproductive concerns (r = .34, p < .01). The impact of FOP on reproductive concerns is partially mediated by confrontation and avoidance, with effect sizes of .07 and .04, respectively. These mediating factors account for 22.0% of the total effect. Conclusions The FOP directly impacted reproductive concerns, while coping styles could partially mediate the association between FOP and reproductive concerns. This study illustrates the role of confrontation and avoidance in alleviating reproductive concerns, suggesting that it is necessary to focus on the changes in reproductive concerns among reproductive-age breast cancer patients. Healthcare professionals can improve disease awareness and reduce patients' FOP, thereby promoting positive psychological and coping behaviors and ultimately alleviating reproductive concerns.

Objective To explore the efficacy of self-made adjustable tracheal cannula in obese patients with tracheotomy. Methods A corresponding model of tracheal cannula was taken and cut with a length of 16 cm. It is noted that the inflation catheter of the airbag should not be broken. A further trim was done along the longitudinal side of the inflation catheter. The inflation catheter was retained. A rubber cork from a nutrient solution bottle was chosen, and a hole was trimmed with the same length of the diameter of the tracheal cannula, through which the tracheal cannula was put. A disposal oxygen mask was trimmed into two wings like a butterfly, the middle of which was made into a hole with the same length of the diameter of the tracheal cannula. Two rectangular holes were made on the two wings in order to fit the rubber cork. The fixed wings of and rubber cork were put together through sutures. The other end of the tracheal cannula was cut and put on a connector and sterilized with ethylene oxide in the supply room. The intraoperative method was the same as the conventional tracheotomy. After the cannula was inserted, the length of the cannula was adjusted by moving the rubber cork up and down according to the obesity of the patient′s neck. Results Compared with regular tracheal cannula, the self-made adjustable tracheal cannula could be easily inserted into the trachea of patients no matter how obese their necks were. It could be connected to ventilator, keep patient′s airway clear and effectively drain phlegm. No slippage was observed in our practice. It was simple, accessible and lower in cost. Conclusions The application of self-made adjustable tracheal cannula in obese patients with tracheotomy can meet the clinical therapeutic needs, and it also proves to be affordable for patients.

Objective:To analyze the intensity-modulated radiotherapy (IMRT) process based on the TG100 report, aiming to improve the quality control method and guarantee the safety and quality of IMRT.Methods:Based on the TG100 report, a risk analysis team was established. The flow chart of overall and each sub-step of IMRT was constructed. The failure mode and effect analysis method were adopted to determine all potential error modes in the process. The probability of of the error mode, the probability of being checked out and the severity of the effect of the error mode on the clinical bed were evaluated based on the pre-set scoring standard. The priority value of each error mode was calculated and ranked from high to low priority value. The top 20% is defined as the high-risk error mode, which was analyzed by error tree to improve the quality control method.Results:IMRT consisted of 11 main steps and 41 sub-steps, and 180 failure modes were detected. The priority values were ranged from 30 to 178. A total of 36 high-risk failure modes were found. The top 5 high-risk failure modes (RPN) consisted of setup error (178), electronic portal imaging device (EPID) registration (172), contouring error (166), treatment delivery error (160) and prescription dose error (156).Conclusion:TG100 report is practical and convenient to utilize, which can effectively and systematically improve IMRT process and provide safety and quality assurance of IMRT process.

ObjectiveTo analyze the epidemiological features and influencing factors of rabies in Shanxi Province，and to provide evidence to further promote the elimination of rabies in Shanxi Province. MethodsThe incidence data of rabies in Shanxi from 2011 to 2022 were collected and subjected to descriptive analysis. ResultsFrom 2011 to 2022， a total of 348 rabies cases were reported in Shanxi Province， with an average annual incidence of 0.080 3/10⁵. The incidence of rabies showed a downward trend overall. The highest incidence was in August. The cases were mainly farmers， mostly males， and most cases were reported between 50 and 69 years old. The data of cases showed that dogs were the main animals attacking human （93.96%）. The incubation period of most cases was 1‒3 months （37.37%）.The main exposure site was hand（51.33%）. Only 2.66% cases with grade Ⅲ exposure were injected with passive immune agents. ConclusionThe incidence of rabies in Shanxi Province continues to decrease， but there are still loopholes in prevention and control measures. It is necessary to strengthen the management and immunization of dogs，health education， and standardized procedures after exposure to maintain the achievements in the prevention and control of rabies.

【Objective】 To explore the characteristics of esophageal motility and reflux of endoscopic-negative heartburn patients based on the Lyon Consensus Diagnostic Criteria and discuss the differential diagnosis value of the mean nocturnal baseline impedance （MNBI） and the postreflux swallow-induced peristaltic wave （PSPW） index for reflux hypersensitivity （RH） and functional heartburn （FH） patients. 【Methods】 We enrolled 132 patients with heartburn as the main symptom who visited the Gastroenterology Department of our hospital from January 2017 to June 2021， including 24 in the non-erosive reflux disease （NERD） group， 24 in the RH group， and 84 in the FH group. All the patients completed gastroscopy， esophageal high-resolution manometry and 24h-pH impedance monitoring. We analyzed and compared the related indexes of esophageal motility and reflux. The receiver operating characteristic （ROC） curve was used to analyze the esophageal proximal MNBI， distal MNBI， and PSPW indexes for the differential diagnosis of RH and FH. 【Results】 The lower esophageal sphincter （LES） average resting pressure， LES residual pressure and intact relaxation pressure （IRP） in NERD were lower than those in RH and FH （P<0.05）. The number of acid reflux， the upright acid exposure time （AET）， the supine position AET， the total AET， and the DeMeester score were higher in NERD than in RH and FH （P<0.05）. The non-acid reflux， distal MNBI and PSPW indexes were lower in NERD than in RH and FH （P<0.05）. The distal MNBI and PSPW indexes were lower in RH than in FH （P<0.05）. However， there was no significant difference in proximal MNBI among the three groups （P>0.05）. When the proximal MNBI， distal MNBI， and PSPW indexes were used alone respectively to diagnose RH， the area under the ROC curve was 0.480， 0.810， 0.682， respectively， with the sensitivities being 87.5%， 100% and 91.7%， and the specificities being 26.2%， 66.7% and 51.2%， respectively. 【Conclusion】 NERD patients have obvious abnormal esophageal dynamics， mainly manifested as LES relaxation， which further aggravates the pathological acid reflux， while patients with RH and FH are mainly exposed to physiological acid or non-acid reflux. In patients with endoscopic negative heartburn， distal MNBI value can improve the clinical diagnosis rate of RH and help distinguish RH from FH.

Objective: Using three models too estimate excess mortality associated with influenza of Shanxi Province during 2013-2017. Methods: Mortality data and influenza surveillance data of 11 cities of Shanxi Province from the 2013-2014 through 2016-2017 were used to estimate influenza-associated all cause deaths, circulatory and respiratory deaths and respiratory deaths. Three models were used: (i) Serfling regression, (ii)Poisson regression, (iii)General line model. Results: The total reported death cases of all cause were 157 733, annual death cases of all cause were 39 433, among these cases, male cases 93 831 (59.50%), cases above 65 years old 123 931 (78.57%). Annual influenza-associated excess mortality, for all causes, circulatory and respiratory deaths, respiratory deaths were 8.62 deaths per 100 000, 6.33 deaths per 100 000 and 0.68 deaths per 100 000 estimated by Serfling model, respectively; and 21.30 deaths per 100 000, 16.89 deaths per 100 000 and 2.14 deaths per 100 000 estimated by General line model, respectively; and 21.76 deaths per 100 000, 17.03 deaths per 100 000 and 2.05 deaths per 100 000, estimated by Poisson model, respectively. Influenza-related excess mortality was higher in people over 75 years old; influenza-associated excess mortalityfor all causes, circulatory and respiratory deaths, respiratory deaths were 259.67 deaths per 100 000, 229.90 deaths per 100 000 and 32.63 deaths per 100 000, estimated by GLM model, respectively; and 269.49 deaths per 100 000, 233.69 deaths per 100 000 and 31.27 deaths per 100 000, estimated by Poisson model,respectively. Conclusion Excess mortality associated with influenza mainly caused by A (H3N2), Influenza caused the most associated death amongold people.